“When anxious, uneasy and bad thoughts come, I go to the sea, and the sea drowns them out with its great wide sounds, cleanses me with its noise, and imposes a rhythm upon everything in me that is bewildered and confused.” Rilke
Everyone has good days and difficult days. Every life has good intervals and difficult intervals. Most agree that 2020 and 2021 have been a “very difficult to breathe interval”, as reported by a 14 year old.
The secret to success for many lies in prevention and planning.
We will spend the next year to provide practical information for children. Professionals often use the same techniques with good outcomes.
During psycho-education or various psychotherapies children are advised to create and maintain a contingency plan for difficult days or times. It is important to create and practise the plan during good days or good times. Difficult times are not ideal for making plans and testing plans, however, it is not impossible.
Some children prefer a cupboard drawer or box they keep for this purpose. Some keep favourite items, music, movies, photos, mementos, books or poetry in this drawer or box. Children are advised to think about what they would buy for or take to their friend at the hospital to cheer them up perhaps, and create the same for themselves, for when they need it.
Many children prefer to have an activity, routine or rhythm for difficult times, or prefer a combination of both a box or drawer as well as a routine. Examples that many children prefer include spending time walking the dog, engaging with animals, spending time in nature, spending time next to water or on water, spending time listening to music or dancing or watching favourite movies. Many also prefer sports from swimming, surfing and canoeing to hiking and horse riding. We often recommend that children keep a picture or a list of these activities in their cupboard, so that they don’t forget what their ‘go to’ plan is in difficult times (often when “one’s mind goes blank”, as reported by an 11 year old).
This plan must have a ‘reliable’ element – it cannot be dependent on the weather or someone providing transport – it must be relatively easy to achieve success with this plan in the context of ‘a difficult time’.
This practice, having a contingency plan, is associated with and inspires emotional independence – to take care of one’s own emotional needs.
Children are however always advised to speak to responsible peers and responsible adults about difficult days. The same advice is given to adults. “Going it alone” is not recommended for difficult days or times – it is important to talk to people about worries and to spend time together not talking or thinking about worries. Balance is essential for general health and mental health; balance includes for instance normative activities (we have written much about this due to the significant effect on prognosis), enjoyment, excitement and calm moments or rest.
This practice also instills a ‘plan, practise and peace’ approach – preparedness. Putting in effort at the beginning often means you can relax and enjoy yourself, knowing you have a plan B and C in place for challenges. You can also apply this approach to practical activities, for example long road trips. What might you need?
It is important to keep a ‘sharp mind, soft hands’ approach. This practice should not increase anxiety, it should decrease anxiety in the short and longer term. Ask for help if you find this stressful.
Two contingency plans are usually advised; one for low grade difficult days, as above, which are not emergencies, and which requires trial runs and one for emergencies, which usually does not require trial runs, as professionals or authorities are usually or always involved from an early stage.
Emergency plans should always include talking to your doctor (GP or the doctor at Accident and Emergency) without any delay. Emergency plans can vary significantly from child to child depending on whether the likely potential emergency;
A- medical (biological) such as hypoglycaemia in the context of Diabetes Mellitus or a serious side effect to medication, or
B – psychological such as anxiety (not due to medical causes) or
C – social such as physical safety issues, aggression or violence.
We recommend that children compile emergency plans with their carers and families, as well as with professionals. It is important that everyone is aware and happy with the plan.
The important message is that simple measures can prevent crisis or can reduce risk and harm in a crisis.
Difficult moments, days or intervals are often not entirely predictable, and these measures do not guarantee smooth sailing, because challenge, loss and trauma can be tricky (we will talk about what affects outcome in later posts), and how people respond is not always entirely predictable, however, these simple measures often help to avoid a crisis or ensure risk, along with harm, is markedly reduced.
These measures aim to inspire thinking, planning, education, focusing on prevention, and it should inspire calm, a feeling of empowerment and be enjoyable.
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