“Children are really the canaries in the mineshaft of human society. They are the individuals within our cultures that are the most sensitive to the difficulties – and stresses – that societies experience,” Tom Boyce tells me. Professor of pediatrics and psychiatry at the University of California, he specialises in the treatment of three- to eight-year-olds. Major stressors in this age group include marital conflict, violence in the home, violence in the community, problems with parental mental health – a mum or dad who is depressed – maltreatment and disciplinary behaviours that become punitive.
On top of all that, as Dominique Thompson, a former student health GP who treated clients aged 11 and up, points out: “School is a source of huge anxiety.” SATS ensure that academic pressure is felt even in primary school. “Children are naturally very wary of letting people down,” Thompson adds. Friendships, social media, and social situations are additional triggers, while teens especially struggle with identity. “The whole point of adolescence is to separate from their parents”, she says. “They are creating their new image, who they want to be, what they want to be known for. That in itself is a stressful process.”
“Some kids can say what is bothering them,” says Boyce, whose new book, The Orchid and the Dandelion, explores why some children struggle to survive while others thrive easily. More often, he says, parental detective work is required. There may be nightmares, night-waking, bed-wetting. Children may seek to avoid activities they would normally take pleasure in. Some may display obsessive behaviours, overuse social media, or become withdrawn.
For children who want to talk repeatedly about worries, set aside 15 minutes’ daily “worry time”. Establish that worries may be thoroughly discussed in worry time but not outside of it; say, “let’s talk about that in worry time”. Thompson recommends Headspace’s kids app, which she uses with her nine-year-old. “He has two minutes’ mindfulness before bed,” she says.
Deciding when to push a child and when to accede to their refusals is difficult, and can only “be based on intuition of your own infinite knowledge of your child”, Boyce says. Creativity helps. He mentions one mother of a young child who refused to get ready for school. She stuck fuzzy felt-type pieces for brushing teeth, putting on shoes, eating breakfast etc on a board and let her son choose which order to arrange these events in each day.
Boyce’s key recommendations for children are: stick to routines and rituals. Engage in play. Show compassion, communicate that your love is unconditional. Honour the differences between children. All of this takes time but Boyce is fond of telling parents that there is no such thing as “quality time”. Just provide enough time of any kind together. Closeness and frank conversations can emerge out of this swathe of time, at unplanned moments such as during a journey to a football match or while doing another activity.
For children who become avoidant, Thompson suggests this approach, influenced by cognitive behavioural therapy (CBT): “Don’t ridicule. Don’t catastrophise. Say, ‘What are you worried might happen? … And what would happen then?… OK, we can deal with that. We’ve got plasters, a first aid kit …’” When stress and anxiety “interfere with normal life”, she says, that’s the time to see your GP.
“Developmental tasks from late teens into early adulthood are about moving away from your family,” says Alex Fowke, a clinical psychologist. With independence comes the fear of rejection and humiliation. Relationships, or lack of them, cause immense stress, not least because these are busy years in terms of shaping identity. Greater fluidity around identity can bring its own challenges. Fowke mentions a former client who was fluid in gender and sexuality. “As much as they found themselves attracted to everyone, by fitting everywhere, you don’t fit anywhere,” he says. All this at a time when you might find yourself, as a student or in a first job, living away from home with strangers.
Financial worries are common, although according to Thompson, who is a member of the Student Minds clinical advisory group, students tend to cite these less often than relationship and academic pressures. At exam time and during university, the atmosphere can foster a tendency towards perfectionism – the setting of impossible targets, often accompanied by self-beration, prevarication, and impostor syndrome.
Social media exerts its own particular pressures and a habit of incessantly comparing with others — what Fowke describes as “compare and despair”. In addition, family stressors – divorcing parents, for instance – are common. Thompson advises parents robustly to resist the temptation to look to their older children for support.
At this age, stress can sometimes disguise itself in strong emotions. Thompson says that lots of young women present with tearfulness, and men with irritability and anger – punching walls or picking fights. Others may find that they are compulsively seeking reassurance. There can be a non-specific sense of dread in the back of the mind. Some may use alcohol or drugs or smart drugs to manage worries, especially those who are living away from home or in reach of a cheap student bar. “Focusing and attention become difficult,” Fowke adds, “and can result in what might look like a memory problem.” Many will choose to avoid any kind of social scenario. Some will lurk on social media in order to compare themselves with others.
If identity or legacy issues are causing stress, Fowke recommends doing some work on your values: ask yourself what you would like people to say about you at your leaving party. Retirement is a very long way off, but according to Fowke, legacy worries commonly present at this age, perhaps because the choices young people are asked to make can feel like committing to an entire career. Thinking about the bigger picture helps to adjust expectations. “Sometimes our task as individuals is to reconcile the stuff we do for fun with the stuff that just needs to be done,” he says.
For those about to embark on university life, Student Minds has free, downloadable resources. Student unions are a good starting point, while universities offer counselling and courses to tackle perfectionism, exam pressure, prevarication, and other mental health challenges; ask if yours has signed up to a closed trial of Fika, an app designed to foster self-acceptance and coping skills. The website Kooth offers free online counselling, and a place to monitor your emotional wellbeing.
“Mindfulness-based treatment helps to shift the focus away from catastrophic thought spirals,” Fowke advises. Social anxiety can be confronted with gradual exposure – go for coffee and listen to the types of conversations other people have, Fowke says. “Sometimes [confronting anxiety] needs more formal training,” adds Thompson. In those cases, GPs can offer referrals for CBT. “And a few people need medication, which is no problem because it works really well.”
This is a time of huge life transition. “There is this pressure to make lifelong decisions at a really young age,” Fowke says. Social media permits endless comparisons, with others who have made the same or different decisions. “When we do social comparisons,” Fowke adds, “we typically come off worse.” Many in this age group will focus on how to have the perfect marriage and children while still making an impact at work. They might compare their lives to those of their parents at the same age. There may be a pressure to start a family. “One of the stressors tends to be: ‘I should have these things by now. I see my friends settling down. I’m not even dating anyone.’ There’s sometimes an unrealistic expectation that everything is possible,” Fowke says. For women in particular, children impact on career progression, which brings new worries.
Those entering employment for the first time face a major adjustment; perfectionists can suffer. “They find themselves in a situation where they are deskilled or incompetent, and it unsettles their sense of self,” explains Sally Brown, a coach and counsellor who says she sees many young, driven, outwardly successful people aged 18 to 30 who are struggling with debilitating levels of anxiety.
“Anxiety will leak out in whichever way that your individual vulnerability will allow it,” says Brown. “I saw somebody recently who became very anxious about whether she had hit someone while driving. That is a form of OCD.” She also cites the compulsive overthinking of social situations. “Post-event analysis: coming home, rerunning conversations, feeling judged.”
Some people find they lose the will to do tasks they were previously happy to do, from getting on the underground to speaking in meetings. They might become avoidant, while others exist in a “hypervigilant state, where you feel that something awful might happen. This sense of fear lurks around the edges. There can be a constant narrative of ‘Am I having a breakdown, will I be able to cope, will I have another panic attack?’” Brown adds.
Self-criticism is “massive in this age group. Many clients “have installed an inner bully in their head, that berates them 24/7. We would not tolerate that kind of person in our life following us around saying that to us, but we do it to ourselves.”
Brown advocates self-compassion. “It is not about letting yourself off the hook, it’s about self-acceptance.” To those who self-berate, she suggests an experiment. “For one week, treat yourself with the same kindness and acceptance that you would treat a good friend whom you love. That in itself can be transformative.” Sometimes it helps to label the self-berating voice. Brown talks about “putting the troll back in the box”.
Listen carefully to your anxiety. Panic attacks are often “a sign that the brain needs to have opportunities throughout the day to come down to a state of calm,” Browns says. She recommends “a personal daily prescription for mental wellbeing”. Take five minutes with a cup of tea; resist scrolling through your phone. “Check in with yourself,” she says. Ask yourself, “How do I feel, where’s my thinking going?” If your shoulders are up by your ears, let go of tension. Try 7/11 breathing – breathe in for a count of seven and out for 11: a longer out-breath regulates the level of carbon dioxide in the blood.
Brown likes the 5-4-3-2-1 exercise as a way to ground yourself in the present: think of five things you can see, four things you can hear, three things you can feel, two you can smell and one you can taste. Try to resist the urge to check social media first thing in the morning. One early refusal can make a big difference to the day.
Know your thinking patterns: catch yourself in the act of catastrophising or being a perfectionist, or inflexible, and name the behaviour to yourself. This helps to take anxiety out of the driving seat.
“There’s real mental and physical load at this age,” says Louise Tyler, a counsellor based in Altrincham who works with many high-achieving professionals on building resilience. Financial concerns, ageing, a sense of mortality are all factors, along with what Tyler calls “an existential search for purpose. People start to become aware that life doesn’t go on for ever.” There are questions such as “Have I put enough money aside? How will I face retirement?” And all the while there’s “a need to feel constantly productive and efficient”, she says. Commonly known as the sandwich generation, many in this age group will care for both teenage children and ageing parents. Relationship breakdown, divorce and loneliness can be further triggers, along with the emergence of health issues.
For others, Fowke says, anxiety may be triggered by grief at not having had children. The perimenopause and menopause both cause stress, including both physical and emotional symptoms. For men, there is thought to be a similar life change called the andropause, associated with a gradual drop in testosterone. Men may develop depression, loss of sex drive and other symptoms.
As Jonathan Rauch, author of The Happiness Curve: Why Life Gets Better after 50, points out, in this age group “it’s perfectly natural to go through an emotional reboot”. (Consider this a rebranding of the midlife crisis.)
Waking at night, often with the mind whirring. “If you have cortisol racing through the body in the day, it will not switch off at night, Tyler warns. “Your body will ping awake.” Stress hormones can bring palpitations and nausea, a lack of energy and restlessness. Tyler finds some people develop irrational phobias that they’ve not had before – becoming fearful, for instance, of driving on the motorway. Rauch cites “unaccountable frustration and disappointment”. Anger and arguments with partners can increase.
Tyler says that women in the sandwich generation tend to “take on more of the emotional laundry” and arrive at her door “burnt out”. She encourages these clients to give themselves permission to switch off and suggests including regular “stop points” – ideally three times a day. What you do in this time doesn’t matter; it’s the stopping that counts. Meditate, read the paper, put on music during the commute home. It’s important to “make that switch from seeing downtime as selfish”, she says. Exercise also helps by burning off adrenaline. Tyler thinks it may help to stop thinking of exercise as something you “should” do, and to see it as “a useful strategy” you choose to deploy. Counselling works for some.
Rauch, an author and journalist, found coaching beneficial when he experienced a slump in his forties. For those who are feeling discontented, he points in his book to research that shows that after the age of 50 stress levels begin to drop. It helps, he says, to know “that what you are going through is normal and healthy, and [is part of] a transition to positivity and contentment”. Change is best made in small, manageable steps. “The urge to escape is misleading and won’t help in most cases. Normalise. Understand. Reach out to others. Not doing that is the mistake that I made,” he says. “Social isolation makes it worse. Stay focused in the present. Midlife is a time trap. You are disappointed about your life in the past and pessimistic about it in the future.” But, he says, this is just the start of a period of shifting values.
“Death, to be blunt,” says Martin Pollecoff, 69, a psychotherapist and chair of the United Kingdom Counsel for Psychotherapy. Friendship groups at this age may be decimated by ill health and death. As in any time of transition, the strain on relationships is immense. “It’s quite common that one partner is much better at amusing themselves,” says Celia Dodd, author of Not Fade Away: How to Thrive in Retirement. “If one partner is retired and one isn’t, the one who isn’t is very likely to say, ‘What have you been doing all day?’” This can exacerbate the sense of purposelessness. There may be conflict with grownup children, distance from grandchildren.
For those who have associated stress with a busy working life, it can be hard to recognise listlessness as a sign of anxiety, while those who are new to retirement might be running on adrenaline, with nowhere to spend it, no sense of purpose.
For some, Dodd observes “a kind of competitive retirement” in which there is “a new pressure on people to have a great time.” Regrets can loom large. And underlying all this is deep uncertainty about what lies ahead.
Procrastination, along with enlarging health worries. Many people feel reluctant to leave the house. Some feel frustration at not achieving anything in the day, or ruminate on past disappointments. “Wine o’clock starts earlier and earlier,” Dodd says. “And then just feeling uninterested in life, thinking, What’s the point in anything?”
Acceptance. “Accept the things you have done, the things you will never be able to do,” Pollecoff advises. “You have to face up to the paths you didn’t take,” Dodd adds. “Think about them. Then try to think of the good things that you did instead.”
Rauch, 58, is finding this age “a great period for relaunch. Our values change. We put less emphasis on ambition and more on relationships, other people, which is very rewarding.” Finding new routines helps. “Work fills up this big space in our life, and it is a question of finding new things that have value,” Dodd says. “They are really to do with people. Connecting with other people.”
For those who find it hard to get out of the house, Dodd suggests making small changes. Listen to a different radio station. Go to a cafe for breakfast. Walk a different way to a familiar destination. Find a new activity that challenges you. “Comfort zone is a horrible phrase,” Dodd says, “but you’ve got to keep stretching and be prepared to be a bit uncomfortable sometimes. Then you get this fantastic sense of achievement.”
Volunteering is one way to do this, although the challenge could also be planning a holiday, with a subsidiary goal of learning a language, say, or a physical challenge such as running a 5K. Try your hand at something new. And remember, “It’s OK to be crap at things,” says Pollecoff. “One of the great things about old age is that you can fail and it’s not going to destroy you.”
Use newly available time to prioritise health. “Become your own doctor,” Pollecoff says. “Diet. Exercise. Put health first.” Finally, Dodd and Pollecoff both agree that “following your curiosity” is key.
Over 70 years
Each decade over 70 brings subtly different challenges, but throughout this period you may be facing the loss of a partner, or of friends, and a perceived loss of place in society. For some there is the prospect of a move into a care home, or the fear of it. For those with early stages of dementia with some insight into their condition, there may be the sense that “the locus of control is moving away from you”, explains Duncan Forsyth, a consultant geriatrician.
According to Alex Bailey, a doctor in the old age faculty at the Royal College of Psychiatrists, fear of death is not a big problem. “I’m 40 and I’m terrified of death,” he says. “But you don’t tend to see that in older people so much. People who have had a long life experience have generally come to terms with that.” Or built resilience against it. Ill health, on the other hand, does lead to anxiety, especially if the illness is a threat to independence.
There may be financial worries, particularly about the cost of care. “You may not be confident in the ability of your family to steer your life. How much do you trust your kids, for example?” asks Bailey. “There can be a fear of being seen as a burden, as well as the fear of physical and mental incapacity, and of being left alone, while others may have the stress of contributing to the care of young grandchildren. Loneliness is rife. On top of that, “The messages that older people get from society are that life is less meaningful than it was.”
Somatising – expressing distress in physical symptoms – is common. Loss of weight and appetite are often interpreted as the result of an altered lifestyle: “Well, I don’t move around as much, so I don’t need to eat as much.” But they may be caused by stress or anxiety – a leg pain might be the result of anxiety around walking, for example.
The key, Bailey says, is to keep your social network as active as possible. “We’re social creatures. Keep at it.” Communities are full of opportunities to socialise: seek them out. Even small daily moments of interaction help, such as chatting to postmen or shopkeepers.
This is a great time to take up a new hobby or physical activity – especially one that involves meeting others.
Try to focus on what is causing the stress and try to set the worry to one side. “What is it that you are thinking about that stops you going to sleep. Why can’t you switch your brain off? Have you always been a worrier, a person who cogitates too much in the dark hours when you should be putting into neutral?” Forsyth asks. Try altering your breathing to slow the heart rate (by breathing out for one second more than you breathe in, for instance). “Anxiety is a pathological state. It can be helped,” Bailey says. If you have or fear early stage dementia, the National Dementia Helpline offers free advice. CBT is another option. More sessions may be needed in this age group, Bailey says.
And while friends and family members may judge your decisions, it is not for them to change or make them: “If you want to make a crazy decision, that’s your right,” Bailey advises. This applies to relatives who may be trying to influence your care provision to your choice of holiday.
Psychotherapy can also be beneficial in this age group. Ask your GP if the NHS’s Adult Improving Access to Psychological Therapies (IAPT) scheme is available to older people in your area.