We present the fifth in a series of interviews that were conducted by Tom Sykesas part of the research for his upcoming book The Years of Travelling Anxiously, available now from Icon Books. In today’s instalment, Lucy Sykes of Mind discusses the ways in which new experiences can trigger anxiety and what can be done to remedy it.
Tom Sykes (TS): Can you describe what your job involves and the people you work with and for?
Lucy Sykes (LS): I work for Mind, the national mental health charity. All over the country there are local Minds. Within the organisation we have the Children and Young People Service, for whom I work. And then within that we have the Mental Health Crisis Drop-in Service, which young people can come into when they need support. We don’t take referrals, we don’t have waiting lists. We’re funded by the NHS to fill gaps outside of the hours that people could normally get help from their school or college.
To get any immediate CAMHS (Children and Adolescent Mental Health Services) support, young people need to be self-harming or considering taking their own life. Lower-risk cases tend to be assigned to Mind.
I suppose we do things differently to CAMHS. We’re not as prescriptive. I lead a safe haven, a particular drop in service, which is based in Havant, Hampshire, and we primarily assist young people within the borough. It’s a deprived area and there isn’t much support. I’ve been working for that service since it started in 2019 but I started as a wellbeing practitioner and then I moved into the senior position where I lead and supervise the team.
We give one-to-one support to young people who will come in feeling very anxious. They might have had a day where they’ve been thinking of suicide or self-harming. We will help them with safety planning, de-escalation techniques and emotional regulation methods. A practitioner will safeguard them and work with them to develop some healthy coping skills. We also have a group room support area for the lower-risk young people.
We teach mental health topics including anxiety. We pass on skills, the young people give their input – we make it as interactive as possible. We lay on craft activities and play card games with the younger ones. These are nice distractions for them if they’ve had a bad day. It can also be a way of starting to form therapeutic relationships with them.
It’s a unique service in that we’re not super-prescriptive, we’re not super-clinical, but we are all trained mental health professionals. Quite a few of our practitioners work privately as counsellors in the day and then work for us in the evenings. Many colleagues have worked in mental health in education. As wellbeing practitioners, we can be creative with our toolbox about how we support the young people. There are no psychiatric nurses or doctors on site.
TS: When a young person comes to you with anxiety, do the triggers they mention come from doing something different, something new, like travel or going out into the world?
LS: We see a lot of quite usual teenage anxieties like transitioning to new schools and exam stress. With young people there are a lot of changes going on in their bodies hormonally and this is an added cause. Going up to senior school is a huge contributing factor to anxiety and they’ll talk to us a lot about that. We have one young person at the moment who is really worried about their future and they don’t want to go to university, but they’re feeling really anxious about what the other options are, and the pressures around that. Others will talk about changes to their friendship groups. Fear of the unknown comes up quite a lot, but then we see more complex circumstances such as historic abuse and bereavement.
TS: How do craft activities and games help to alleviate anxiety?
LS: Sometimes young people get caught in a cycle of anxiety where they have dark thoughts and then act accordingly. They might be anxious about something, so they try to avoid or escape it, and all that does is feed back into longer-term anxiety. They get into a routine of not finding anything positive or new to do in their lives. All that’s left for them is to hyper-focus on all those worries and anxiety triggers.
Naturally, our brains are looking out for things that might be a threat to us. We can get into unhelpful thinking styles like that. It’s really important for young people, or anyone, to find things that they enjoy in their life that can bring some distraction, some joy. We talk a lot about self care with young people, which includes sleep, exercise and diet. A huge part of it is doing things that are meaningful to you and that you are fulfilled by, because it’s so easy with anxiety to get into that rut of just worrying about what’s going to happen in the future and about what happened in the past.
I will always say to a young person, ‘If you’re doing something that you’re going to find scary that day, like an exam or an interview or a presentation, think about what you’re going to do when you get home, what you’re going to reward yourself with.’ Often it’s the simple things like playing a card game with their family or expressing themselves by doing a therapeutic art activity.
TS: When you were talking about these activities I wondered if being sociable helps young people. Do some of these anxiety problems stem from people spending too much time on their own? There’s a lot of disturbing research into the link between using social media and mental health issues. Is that something that you’ve encountered in your role?
LS: Yeah, I’ve realised that it’s a problem from both working in this service and being a parent. On a very personal level, the effect social media is having on young people’s mental health and anxiety is almost too much to bear. People might feel that they are being sociable online but it’s actually very isolating. In the days before the internet you could come home from school and, if it had been a difficult day, you could leave all that socialising behind. But now with phones and social media you can still be targeted at home by bullies or nasty people, but you’re not getting any of the benefits you would have if you were hanging out with your friends. It’s a really complex issue.
I tend to see the negatives of social media more with young people in our service. Having a group room available to our young people with serious social anxiety really helps with making those human connections at a time when you’re feeling really vulnerable. Sometimes the young person coming into the group room and making that step into that unknown social situation is a really positive thing for them.
The other advantage of doing those enjoyable activities in the group room is that we can teach the young people how to focus on what’s going on in the here and now. Our one-to-one sessions use mindfulness in this way to combat anxiety or low mood. Much of what we get anxious about is thinking about past events and how things could have been different, and worrying about what’s going to happen in the future. Mindfulness is an amazing tool that brings us back to the present. It’s important to do that proactively on a regular basis. So much research shows that this can reduce anxiety.
We also teach grounding techniques, which are easier to do for young people than meditation. You can do a craft activity or play a game in a group situation without having to sit around in silence for forty minutes.
TS: Meditation has helped me over the years, but I find it hard to do nowadays. You have to not think of anything but that just seems to leave your brain open to all kinds of thoughts. I start thinking about what I’m going to have for dinner tonight or worries about work, health, whatever, and it all floods in. But if you’re doing an activity that requires your concentration on something else, like winning a game of cards or being creative in some way, that’s more effective for younger people?
LS: Definitely. There’s a crossover with my autism training and my mindfulness training, and it’s called the flow. You can maintain the flow if you’re doing a task which is challenging enough to be interesting and to hold your focus, but not so challenging that you want to give it up. That’s a way of being in the here and now, being in the moment. That’s not to say that we have to live our whole lives only focusing on the present moment – that’s not how mindfulness works.
When your anxiety is getting too much, you have to learn how to bring yourself back to the moment. The research has shown that if you practice this on a regular basis – or what we would call proactively – then your anxiety will remain at a lower level. But like you say, not everybody can sit and meditate.
I was trained by someone who in turn was trained by Danny Penman and Mark Williams, who wrote the book Mindfulness: Finding Peace in a Frantic World. They talk about practical ways of learning mindfulness in a cognitive therapeutic way. There are brain experiments that can challenge anxiety and low mood, different ways that you can be mindful throughout your day. You can mindfully have a shower. You can mindfully make a cup of tea. Doing boring tasks in a mindful way makes them a lot more interesting. You could easily apply that to travelling, to cope with long train journeys or delayed flights.
TS: Presumably, you’ve been in a situation where a young person’s anxiety is unmanageable – a panic attack, for example. What would you do in that situation to help them?
LS: We have grounding techniques that are almost like games. In a crisis, it’s important to be grounded so we would get them to use their senses to ground them. The 54321 Technique involves asking the young person to take some deep breaths first because they might not be able to talk. By taking those breaths we’re slowing everything down, slowing our heart rate down, and tricking ourselves into thinking that we’re calmer than we are. The adrenaline stops pumping so fast.
We would then ask the young person to look around the room and list five things that they can see or hear or could touch and so on. We go through the five senses. Soon they’re not panicking about what’s going on or what’s going to happen to them. They’re distracted from worrying. Part of what increases our anxiety is not understanding what’s going on in our bodies. We feel like we’re dying sometimes and we have all these physical symptoms that are telling us there’s something really wrong.
When we talk to a young person about all this, we tell them that everybody feels anxious and that a little bit of anxiety is useful. You don’t go into an exam without feeling a bit anxious because you’re not going to concentrate. Your memory is not going to work properly. You’re not going to care about doing well in the exam.
We also tell them that anxiety is a response to threat. It would have kept humans alive in the jungle. When the heart’s beating fast it makes the adrenaline rush around the body which would have helped you run away from that sabre tooth tiger or whatever threat. We call it the fight, flight, freeze response.
Many of our young people complain of feeling sick. They think there must be something terribly wrong with their tummy, that they’re going to puke everywhere. We tell them that, when we’re anxious, our digestive system reorganises itself as the body gets ready to run.
Self awareness is also at the crux of this. We all need to know what happens to us individually when we get anxious. We should know the early warning signs that our anxiety is getting past the normal threshold and getting to a point where it is unmanageable. The Fizz Scale is an emotional scale that’s based on the idea that our bodies are like bottles of fizzy drink. It’s pitched at children. Our Fizz Scale can go up or down depending on who we’re talking to and there are different contributing factors. Like a bottle that’s shaken up, our bodies will explode emotionally if we don’t do anything about it. That explosion will be a state of panic attack or an episode of self harming or an attempt to take your own life.
We ask the young people to think about what bodily sensations they have when they stop being calm, when they start to feel just a bit anxious. Do they notice that their tummy feels funny? Do their legs feel weak? We apply the scale to that and we ask what it feels like at stage three. Or at five. Each stage is on a journey of anxiety, relating to what we’re feeling in our bodies at that time. That opens up conversations about what we can do at this or that stage. We teach people to check in with themselves regularly.
For example, this morning I was rushing around trying to get the kids out of the house and anxiety is creeping up because I’m thinking about all the things I have to do at home and work. I have to consider if I’m at stage 6 or 7 and what I can do in this moment while I’m boiling the kettle to bring myself down to feeling okay. I might do the 54321 Technique in my head while I stand in the kitchen. Maybe I’ll do some breathing for 30 seconds before I leave the house. This way, once I’m in the car I know that I’m not going to have a panic attack or react in a way that’s unhealthy.
It would be great if we could teach children from a young age to check in with themselves and have a toolbox of techniques with which to deal with anxiety before it gets out of control. Hopefully it’ll become a lifetime habit.
