The Eight Part Covid Survival Kit

Ways to Make Your Life Predictable, Moderate, and Controllable (Covid PMC)

 

Part I - Structure

 
 
 
In an April 01 2020 edition of Psychology Today Veronika Tait PhD interviewed Bruce Perry MD and together they shared a COVID 19 Pandemic Toolkit for Parents:
 
Although this tool kit is designated for parents and is focused on children
we will use this Tool Kit as a guide to review over the fall and winter months to some essential tools to help us deal with stress of COVID 19 pandemic. These tools apply to those of all ages, children, adolescents, young adults, adults, and elders.
Each month we will highlight Tools to help manage this crisis and identify for you web videos, articles, discussions, and resources we have found helpful.
 
We value your input. Please let us know what you find helpful in this presentation. If you had an experience, questions or found something worth sharing please contact us at info@namicapecod.org
 
This month our focus will be on the fundamentally important Tool of Structure.
In Bruce Perry‘s model, the Stress Response System evolves in complexity and flexibility over our development. The Stress response System is built from the bottom up as the child’s brain develops in his family and community and as she acquires increasingly complex tools of self-regulation through resilient experiences.
He emphasizes that the PATTERN OF STRESS is a key factor that determines the healthy development of the Stress Response System.
Stresses that are Predictable, Moderate and Controllable build Resilience.
Stresses that are Unpredictable, Severe and Uncontrollable are destructive and hinder development.
 
COVID-19 is a once in a lifetime event for all of us. It is not yet in our control, it has been severe in its consequences, and destructive to our social fabric.
Trying to create a safe passage through these difficult and challenging times is hard work. A primary strength in dealing with such tough times is to share the load and do it together. Bruce emphasizes the need to recognize how difficult this can be and it is essential to be kind to one another if we, our families and community are to become Resilient.
 
Creating Structure is Bruce’s first identified Tool. Creating Structure is a work in progress not a fixed Destination. Developmentally tuned Structure provides safety, predictability, and trust for us to explore, experiment, adapt and create.
We thrive, particularly in adverse times, with structure and routine; these are comforting, and they give us a sense of control and predictability. This is particularly important when the COVID-19 crisis has led to such significant disruption and uncertainty in our lives. We cannot predict the many turns this virus will take, nor understand precisely the challenges to our own well-being, we can incorporate a level of fidelity to our routines. Rituals, like mealtimes, exercise, planned breaks, regular meetings, etc. are grounding and comforting. 
So, what are structures and routines? Simply put, a structured environment is one that is organized and predictable. When we have day-to-day routines and a schedule to follow, this creates structure in our lives.
 
How to Create Structure for Children
  • Identify important daily activities and decide the order they should happen.
  • Identify key times of the day when the activities should occur and make a routine.
  • Example: Bedtime Routine
  • 7:15 begin with washing face and hands, next, brush teeth, after that, put on pajamas
  • Read Aloud from a book of the child’s choice
  •  Last, tuck-in and kiss good night
  •  Lights out
 
How to Create Structure for Pre-Teens and Teens
  • Identify important daily activities and structures. Decide which ones are not optional and therefore, predictable.
  • Example:
o  Attend school regularly
o  Attend family meals at least 3 times a week
o  Do schoolwork nightly
o  No screens 30 minutes before bedtime
o  Set a sleep routine to get 8 to 10 hours each night
o  Be in bed/home by ____________
o  Let them know you will always be there for them no matter what
 
How Young Adults Can Create Structure
·    Add structure to your life to focus on what is most important to you.
o  Wake up and go to bed at the same time as often as possible
o  Set a strict sleep schedule to get 7 to 9 hours sleep each night
o  Build in reminders so you don’t forget or get sidetracked.
o  Learn to budget your time:
·    Time for studying, for working on assignments,
·    to keep in contact with friends and family
·    to clean your room/apartment, do laundry
o  Take 10-minute breaks (step away) from a task, 2 to 3 times a day
o  Schedule in mealtime; for at least one full meal a day
 
Creating Structure and Routines for Adults: Example Morning Routines
Planning routines help you know what to do next, even if things go wrong. When routines break down, things go awry. Focus on the here and now not the hypothetical and you will decrease stress and anxiety.
o  Plan your morning at night. Set your goals. What do you wish to accomplish? Create a block for important tasks.
o  Put your clothes out for work. Make your lunch.
o  Wake up at the same time. Set an alarm you can live with.
o  Eat a healthy breakfast
o  Exercise for at least 15 minutes
o  Meditate, take some time for yourself
o  Try not to anticipate problems, address only the ones you have control over
o  Get dressed, play music to help you get your day started
o  Gather up your things, keys, wallet/purse, lunch, etc.
o  Get out the door!
 
Senior Citizens Need Social Routines/Structures to Stay Connected
o  Daily exercise in any form is beneficial, especially with a companion
o  Each day connect with a family member, friends or someone in your
community
o  Take time to stay emotionally connected whether it be a person, pet or spiritual being
o  On a weekly basis reach out to others, participate in church activities, volunteer for Hospice, or for other community services
o  On a weekly basis participate in Senior Center or community activities
Not all of us have the same starting point or resources to deal with stressors. For those with limited resources and unpredictable futures these are very difficult times.
Bruce Perry’s YOU TUBE COVID 19 talk about Stress may be a good place to begin.
Some find the presentation a bit philosophical others terrific.
 
Babette Rothschild, a clinician I admire, has a Scandinavian quote “at tigge pa“. It means “chew on it “. If it does not taste good, you should spit it out immediately.
However, if it tastes OK then just swallow a little and see how it goes just before swallowing the whole thing.
 
Bruce Perry’s YOU TUBE COVID 19 talk as a background FOR dealing with Stressors approx.16 minutes
 
Links to other resources you may find helpful
 
The COVID 19 Workbook Practical tips for your family during this time of quarantine.
Laura Domer-Shank, ED.D approx. 27 minutes
 
How To: Dealing with Changes (COVID 19) contains Comic Strip Conversations
Approx.15 minutes
 
Helping Seniors Manage Loneliness and Anxiety During COVID 19
 
On Our Sleeves The Movement to Transform Children’s Mental Health
 
 
Psychology today.com
References
 
NFI VT COVIS-19 Wellbeing Ideas, Melnick
 
Creating Impeccable Structure for Your Life: Leo Babauta
 
Dr. Bruce Perry’s COVID19 Series; neurosequential.com
 
The You tube about Stress and Resilience https:/youtu.be/02h6V4
 
 
 
 
The Eight Part COVID-19 Survival Kit
Ways to Make Your Life Predictable, Moderate, and Controllable (COVID-19 PMC)
 
Part II – Kinship (Core Group)
 
 
IPart I of our COVID-19 Survival Kit, we highlighted the human need for Structure in creating PredictableModerate, and Controllable environments within our lives to help us mitigate the stresses of this time of a world- wide pandemic. This need for structure is not chosen but is wired into our brains. When our physical and social expectations are not met, we become stressed, setting off our Stress Response System (SRS). Depending upon the degree of the stress, our brains alter our responses to the world and how we perceive it with either positive or negative results.
 
The second tool in Dr. Perry’s COVID-19 Survival Kit that is essential in helping us navigate our lives in these difficult times is maintaining Kinship with our Core Group, a basic need for us as a social species to connect with and to belong to which, is wired into our DNA. Perry states, “We are dependent creatures-unavoidably interdependent of one another.” In his work, Perry, addresses the importance of human connections in the management of stress. Not having predictable and safe social connections with one’s core group whether it be family or very close friends, can make our Stress Response System (SRS) respond as if we were under a mortal threat. However, recognizing the cause of this stressed state and our response are under our control. Just like other parts of our brain set off an alarm when we are hungry and need food, our Stress Response System (SRS) lets us know we need social connection when we are lonely. Loneliness calls out for the safety of connection. What sooths and lessens social pain and deactivates the Stress Response System (SRS) is the warmth of the human touch and connection. Belonging is essential to our survival.
 
However, it is important to make clear that the feeling the “loneliness alarm” sets off is different from just being alone. The ability to enjoy being alone and comfortable with one’s self in SOLITUDE, is a resilient strength based on the experience of a felt sense of safety and the ability to explore and reflect on our own. Developing resiliency when facing stressful situations like those brought about by life in the COVID-19 era is a positive outcome. But failure to respond to the stress of loneliness in a positive and realistic way can lead to increased anxiety and depression.
Loneliness is a social pain as real as physical pain and can affect one’s physical health.
 
When you perceive your social world to be unpredictable and socially unsafe, it wears you out and makes you more susceptible to illness. During a pandemic when we are being asked to isolate, socially distant, and quarantine, we need to be thoughtful and creative in order to alleviate the stress caused by loneliness.
We hope that you might respond to this series by email to www.namicapecod.org or call us at 508-778-4277 if you have questions or comments or have personal experiences to share. We would welcome hosting a Zoom discussion group on any one of the eight topics. Below are interesting and informative links and as well as ideas and activity suggestions for people of all ages as we go through these socially distancing times and the 2020 holidays.
 
Activities
 
Children:
 The Counseling Teacher: 6 Engaging Anxiety Management Activities for Kids https://thecounselingteacher.com/2019/12/6-engaging-anxiety-management-activities-for-kids.html
Children worry about how the coronavirus has changed their lives and what is next. The activities in this website also apply to children at home during the pandemic.
·      Belly Breath
·      Worry Box
·      Draw/Write Away Worries
·      Tear It Up Today
·      Worry Escape Room Activities
·      Marathon Kids
 
Helping Kids Cope with Loneliness During COVID-19
 
Loneliness due to the pandemic is particularly tough on children. Compared with adults, kids tend to have a harder time communicating their feelings.
 
 
Families:
Indoor activities for the whole family that maintain a sense of connectedness.
Fun easy games using household items are explained. For example: Hide and Seek with Objects, Q-Tip Blow Dart game, Cereal Puzzles, Milk Jug Catch and Cotton Ball Races.
·      Play games indoors! Games for younger children include Simon Says, Duck, Duck Goose, or Follow the Leader.
·      Older children can play “I Spy,” Charades, indoor bowling, or make up new games.
·      Try a new recipe or make dinner as a family; find recipes and tips for cooking with children safely on the Cooking with Kids webpage.
·      Read a chapter book together and discuss the characters and plot and ask questions to encourage critical thinking.
 
What to Do at Home with Your Kids During COVID-19
 
Tips for Families: Coronavirus
Young children are highly affected by the quarantine and the anxiety of their parents and other adults. This article discusses five things parents can do to help their child.
 
Teens:
 
Helping Your Child or Teen Stay Socially Connective and Safe During COVID-19
·      Don’t take away your teen’s phone, rather schedule times to put it away like mealtime and bedtime
·      Communicate – teach them advocacy
·      You may need to designate certain times when they can be alone and others when they are expected to interact with family.
·      Allow limited computer or video game time. Coordinating time with a friend so they can skype and compete will help keep your teen connected to their peers.
·      Remind your teen you or another family member they are close to are available to support them during this difficult time.
 
Supporting Teens during COVID
65 minutes long
Panel discussion with 6 professionals.
 
Staying Home During Covid-19: Help Teens Cope, Nilu Rahman, M.S., C.C.L.S.
 
“Teens cut off from their normal activities and stuck at home want to feel like they have purpose and meaning,” Rahman. The article discusses ways to help teens respond to loneliness and decrease anxiety and depression.
 
 
Young Adults:
Toolkit for People 18-24
 
This website offers a wealth of information for several topics including Structure and Isolation such as...
 
  • Web Resources
  • FAQs
  • Posters
  • Fact Sheets
  • Social Media
  • Videos
 
 
Adults:
 
The lethality of loneliness: John Cacioppo
Loneliness is a stigmatized. It is the psychological equivalent to being a loser in life or a weak person. Stigmatisms lead to denial. Loneliness can be dangerous. When something happens negative in the social environment, that brain is focused on self-preservation, not a concern of the other person.
What to do about the dangers of loneliness.
1.    Recognize what the signal is and don’t deny it.
2.    Understand what it does to your brain and to your behavior.
3.    Respond: the quality of a few relationships is better than quantity, share good times
 
Your Brain on Social Distancing: Loneliness & Isolation During COVID-19 Coronavirus
(about4 minutes)
 
Animated characters give 7 tips to manage isolation and loneliness.
 
Elders:
For the elderly population socialization is essential. Research supports that socialization plays a significant role in their overall health. Also, planned activities can provide structure and purpose that helps to keep the elderly rooted to their community and makes them feel more connected to themselves. The following excerpt is a true story of how an 82-year-old woman found the right place to restore her connectedness and purpose.
When it became obvious my mom was likely presenting behaviors indicative of dementia - paranoia, fear, and expressions of loneliness, her actions became most worrisome for me as her daughter. She had always been very active and social. Slowly her activity and social interactions began to wane. When it became clear it was no longer safe for her to live alone, we found a Senior Living Community she liked. She moved into the Assisted Living section. This allowed her to come and go from the building at will. Although this new lifestyle provided for plenty of socialization, she continued to tell me she was lonely. Nine months after moving into Assisted Living, it became obvious to my family and the staff that it was time for her to move into the Memory Care section of the building.
I was bracing myself for her to become angry and resentful of this new living situation that would "take away her freedom” and make her a "prisoner". To my amazement the opposite has happened. She tells me she doesn't feel lonely. She seems to have fallen back on her nurturing qualities and the skills she developed while volunteering for the Council On Aging in the past. I am told she will walk into a staff meeting and participate with very good ideas, she supports others who live there when they are feeling sad, and she helps staff with setting up activities. She has found purpose, satisfaction in helping others, and seems to be thriving in ways I never would have thought possible!
 
 
Activities for the elderly in lockdown and isolation that help build a sense of safety and strengthen resiliency.
·      Coloring
·      Drawing
·      Sorting objects
·      Crosswords, word searches, hidden words
·      Sensory boxes
·      Grow indoor plants
·      Learn to Skype someone
·      Play digital games like Sudoku, Solitaire and Scrabble
 
Establish a routine for exercise indoors
·       Walk, march or jump in place
·       Lift 2-3 lb. object while exercising muscles and body parts
·       Dance
·       Yoga: stretch and extend muscles
 
 
Additional Links
 
Ideas for Activities at Home During COVID-19 Pandemic
Activities for deaf-blind children as well as visionally impaired
 
Tag #M25challenge!
Excellent learning activity for days-of-the-week, each with a task to performed, followed by a challenge and a new word definition and ways to pray. Really pulls a family together.
 
Making 'Social' a Superpower in the Classroom - Matthew Lieberman
“Social Pain” is more than a metaphor. A broken heart is real.
 
John Cacioppo on How to Cope with Loneliness | Big Think
Cacioppo tells us to concentrate on 1 or 2 meaningful relationships. Expect the best but don’t expect it to be perfect.
 
Tool Kit for People 15 – 21
 
How Seniors Can Cope During COVID-19
 
The Eight Part COVID -19 Survival Kit
 
Ways to Make Your Life Predictable, Moderate, and Controllable (COVID-19 PMC)
 
Part III – Socialization
 
 
In Part I and Part II of the COVID-19 Survival Series, we have discussed the importance of Structure and Kinship (Core Group) as outlined by Dr. Bruce Perry and their relevance in establishing PredictableModerate, and Controllable environments for learning and developing resilience. We have also recognized the core concept that we are social in our nature. In Part III of our series, we are addressing Socialization, a challenge in our present world where self-isolating is the suggested norm, and its effects on the individual and on the community as a whole.
 
Babette Rothschild, a clinician who works with people and communities who have undergone trauma, describes this social nature as “our relations are woven in, around, and through the fabric of our beings and entwined in everything that we do.”
 
Hopefully the discussion of the first two tools in our tool kit have taught the following about relationships:
 
1.    Learning happens in the context of relationships and that within the context of social bonds, we develop the motives and the values that guide our lives.
2.    What we learn in the context of those relationships impacts outcomes. Our individual community and national responses to the COVID-19 crisis has made this very clear.
3.    Building positive, trustworthy, and safe relationships in our family, our clan, and our community is essential for the growth, creativity, and resilience of each of these domains.
4.    When you are connected, you feel protected and capable of new learning, discovery, and exploration. When you experience physical or social threats, new learning is not possible.
 
The sense of care and connection figures predominately in our well-being. Positive social relationships are better predictors of well- being than economical or biological factors and serve as buffers to life’s trials. Perceiving others as social threats undermines feelings of social connection, activates our Stress Response System, impairs our ability to learn, cooperate, face, and adapt together to stresses and can create a negative bias looking out into the world.
 
When under stressors that are UNPREDICTABLE, EXTREME, and UNCONTROLABLE, it is easy for the road to hell to be paved with good intentions. Many of the neural networks involved in experiences of physical threat and safety are also attuned to social threat. Social support reduces both physical and social pain. Rejection, exclusion, and dismissal in our social networks over time are painful and limiting to the individual and to the community.
 
The ability to learn and develop social and cognitive skills requires practice, hard but rewarding work and pro social attitudes. Wellbeing for ourselves and our community is hard and meaningful work and requires team work.
 
We, at NAMI CC&I, are very fortunate to have so many individual and community connections and alliances with whom to work in our efforts to foster well-being in the Cape and island communities.
 
Reaching out and socially connecting for individual benefit or for the benefit of the community is a challenge during this period of pandemic. The following resources offer ways for people of all ages to continue to socialize during COVID-19 restrictions, both for the good of their own mental wellness and for the health of the community as a whole.
 
Dr. James McGuire, NAMI CC&I Board of Directors
 
( Parts I and II of the COVID-19 Survival Kit can be found on our web site-www.namicapecod.org) 
 
PART III Helpful Links
 
Children
Generosity and kindness can be taught
Respect -- and nurture -- your child's natural inclinations to do good
Children help because it feels good
Giving kids prizes and toys for helping isn't such a good idea.
 
Kid’s President 25 Reasons to Be Thankful
Life is tough. It’s important to remember the things that are awesome.
 
Activities to Help Your Autistic Child (or any child) with Social Skills
Eye contact
Help with idioms
Interpreting emotions
Stay on topic
 
Children: Giving Back
  • Promotes positive self-esteem and a sense of purpose
  • Improves a person’s ability to manage stress
  • Increases self-confidence and promotes positive behaviors
  • Helps introduce children to positive role models who may provide positive encouragement and support
 
Ways to Give Back
donate toys, send a kindness card to healthcare workers or community services people, etc.
perform a service: yard work or dispose trash for an elderly neighbor, offer to babysit or do childcare
 
Families
Family Connect-Being Thoughtful in COVID (spiritual message)
Provides thought provoking questions that help you look for the joyful even when things are hard.
Families are encouraged to try activities they have not done together before COVID e.g. keep a COVID journal, write something you did as a family everyday and take a picture. Keep it as a record for your children.
 
Keep Connected with Your Neighborhood from Your Sidewalk, Front Door or Driveway
Play bingo using a megaphone
Say hello at night by switching your lights on and off
Lead each other into singing familiar songs
Turn up some music, dance like no one is watching
Exchange jokes with each other
 
Donate your time outside the home:
Blood Bank Centers, Food Banks, Homeless Shelters and Meals on Wheel
Run errands for elderly
When out and about, smile at people
Donate Your Time From Home
Virtual babysit depending on child’s age, offer divergent activities so parents can get work done
Go to Points of Light Volunteers to find out what you can do
Use Facebook/social media to create a help line
 
Teens
10 Proven Ways to Stay Connected During the Pandemic
Humorous approach to not feeling isolated
1.    Don’t panic
2.    Take pleasure in your own hands
3.    Say hello—don’t ignore each other
4.    Make a list—who are you connected with? Start with who you are most connected with and end with who you are connected with the least, then contact that person
5.    Dance like nobody’s watching
6.    Break bread together—cook with someone in your house
7.    Connect with nature—go outside, notice what’s near you
8.    Feel it with music
9.    Always play everywhere—do something silly in a place you normally would not
10. Reach out to your tribe/community—we are all social creatures, it’s natural
 
COVID-19 Wellbeing Tips for Teens with Dr. Watson Clinical Psychologist
This video provides teens with strategies they can use to stay calm, focused, and motivated while everything around them is changing and uncertain. You will learn tools for soothing feelings like fear, confusion, and boredom; staying focused and hopeful; and choosing actions that support wellbeing in both the short and long term.
 
Young Adults
How Young People Can Cope
Researchers argue that one-way young people can combat mental health struggles is to try to deliberately savor ordinary, everyday experiences by using the five senses to amplify positive emotions and promote a sense of calm. This is pretty much the opposite of what some of us are doing when we spend hours a day consuming COVID-19 news, which can hurt our mental health. Researchers also highlight the crucial role of human connection and social support. Finding ways to stay connected and give and receive support can help combat the traumatic experiences many are facing due to this global pandemic.
 
 
5 Things You Can Do to Help Young Adults Cope with Social Distancing
·       give emotional space
·       have grateful moments
·       encourage a schedule
·       make regular connections
·       promote sleep & physical activity
 
10 Ways Young People are Leading the Way Against COVID-19
Women Deliver Young Leaders perform vital work on the frontlines of the pandemic response
 
Adults
 
Staying Connected
Does your neighborhood have a Face Book Group or a group email? Ask to join and see what fun activities you can share. 
One neighborhood put shamrocks in their windows for kids to find while walking.
Another neighborhood promoted themed sidewalk drawing competitions for different age groups or families.
Use a video chat app to make a game night, dinner party or coffee date
Make a good old fashion phone call
Snail mail, write a note or send a card
Create and follow a daily routine, try to include regular daily activities such as walk the dog or pick-up the kids
Check in on your loved ones often
 
8 Ways You Can Help Your Community Amid the COVID-19 Crisis
 
Give Five Wave Five
Give $5.00 to a local food bank when food shopping
Transition to Donati(on)
Use the money you’re saving on gas to buy gift certificates for local restaurants
Conversations With Dogs
Nod your head, say hello when you walk by people.
Wholesale Order Up!
Order from local wholefood sellers who are losing some or all of their business
Masks for All
Collect and donate unused N95 masks
Dine inside
Making sure we can do either curbside pickup or contactless delivery
The start of something new
 
Elderly
Staying Connected/Giving Back
 
·      Call 10 people a week you know are alone (get a list from your church or senior center if necessary)
·      Stick to a routine: exercise, reach out, read, mediate, do a word search or puzzle, eat a regular meal
·      Get a new hobby: buy a bird feeder and book about birds, genealogy, photography or another new hobby.
·      Sit at your front door or window and wave hi to your neighbors
·      Call your grandchild or neighbor’s child and read a story over the phone
·      Call a friend and watch a movie together or have a cup of tea
·      Have a curbside social hour bring your chair to the driveway and have a fun visit
·      Buy and/or deliver groceries to other seniors that are homebound
·      Volunteer opportunities, the Smithsonian Institute, help transcribe important documents, and StoriiTime connects senior readers with children via video call in the US, Canada & UK. (https://www.storiitime.com/)
 
Pen Pal or Phone Friend
Connect to patients in assistant living centers who have been in lock downs to stop the spread of COVID.
 
RESOURCES
RESILIENCY AND THE COVID-19 PANDEMIC: The Hidden Strengths of Those with Lived Tip Sheet Experience of Mental Health Conditions
6 Ways to Improve Your Child’s Social Skills
 
Steps parents can take:
·       Follow their interest
·       Learn to ask questions
·       Practice role-playing
·       Teach empathy
·       Know your child’s limits
·       Be a good role model
 
Here are 17 research-inspired social skills activities for kids, organized loosely according to age-group. It begins with games suitable for the youngest children, and ends with social skills activities appropriate for older kids and teens.
How Can I Stay Connected with Others During COVID-19 While Distancing Myself Physically?
 
Validate it’s a challenge to stay connected. Try to talk to someone outside your home every day.
It’s a sign of stress, if you’re finding you do not have energy to respond to people that are checking on you each day. That may be the time to reach out to a friend or therapist.
 
References
 [d1]
The Eight Part COVID-19 Survival Kit
 Ways to Make Your Life Predictable, Moderate, and Controllable (COVID-19 PMC)
 
Part IV – Screen Time
 
In this day and age, screen time is a blessing and a curse. The past year, as we have struggled with adjusting our lives to living during a pandemic and we have come to rely on our screens as lifesavers as we communicate on-line instead of in person. We have Zoom meetings, we work from home, our children Zoom into their classes. Zoom cocktail hours, Zoom fundraisers, and facetime with children and grandchildren have become the norm. We have seen screens become our way of life. We can be thankful for this technology that has kept things happening during this crisis.
 
On the other hand, screens can be our enemy when they are allowed to dominate our physical and emotional lives. Sitting in front of a screen all day and into the evening is not healthy when we are not exercising, not eating healthy meals, and overdosing on sensation, often frightening news stories. We need to moderate and control our screen time. We need to be mindful of who is in charge – the screen or us!
 
Jackie Lane, ED
NAMI CC&I
 
 We are fortunate to have Dr. James McGuire, a practicing Cape Cod psychiatrist, as a valued partner in producing this series. Here are his thoughts on screen time during the pandemic, followed by resources and actionable steps for people of all ages when dealing with screen time:
 
Happy New Year now seems like an incongruous greeting! This month, January, has been an exhausting, uncertain, and dangerous time to experience.
 
The videos and descriptions of the insurrection in our nation’s capital, the death toll of the coronavirus climbing to over 400,000, the uncertainty of the distribution of the vaccines and to whom they will be administered, the presence of new and more contagious strains of the coronavirus, and the secular/ religious wars in politics have been discombobulating and overwhelming for me.
 
In the last three NAMI newsletters, we have been sharing items in our COVID-19 tool kit patterned after the recommendations advised by Bruce Perry, MD, PhD of the Child Trauma Academy.
We have shared information about our brain’s development that occurs in a social context and the importance of providing a shared safely structured, Predictable, Moderate, and Controllable environment within our family, kinship, and community.
 
Dr. Perry warns us that as we navigate our way through the pandemic, our Stress Response System (SRS), will be chronically activated and we will become physically and emotionally exhausted by the felt sense of threat to ourselves and our community. He reminds us that dysregulated defensive negative emotions that emerge are contagious like the virus, and can quickly spread within the community with disastrous consequences, which we have all just witnessed. The importance of Predictable, Moderate, and Controllable social contexts that allow us to self-regulate and operate in a more reasonable and constructive manner becomes obvious.
 
Over the past month I have been re-watching several of Dr. Perry’s webinars. They have been helpful to me, so I am again recommending a review of some of them.
 
(I am also aware of the president’s recent advice to his aides whose advice was too academic. He suggested that the aides might call their mothers, share their ideas with them and if they understand, proceed!)
 
So, with caution, I recommend the following Bruce Perry’s presentations:
 
State-dependent Brain Functioning: “Neurosequential Network Stress & Trauma Series” https://youtube.com/playlistlist=PLyhWK71WKiZK_7P4lE5nLDIQcHcS96Ei7 time: 21:57
 
Emotional Contagion: “Neurosequential Network Stress & Trauma Series”https://youtube.com/playlist?list=PLyhWK71WKiZK_7P4lE5nLDIQcHcS96Ei7 time: 17:53
 
Regulate, Relate, Reason (Sequence of Engagement): “Neurosequential Network Stress & Trauma Series”
 
 Our topic for this month’s Nami newsletter is Screen Time. I am broadening this umbrella and including social and digital media.
 
For me, my use of digital media comprises of using it as a tool to research topics of interest on Google Scholar and YouTube, watching movies, checking out the news in the evening and during the day on my phone, and playing dominoes.
 
We at NAMI have collated articles, YouTube, Vimeo presentations and webinars, about navigating the Default Digital Age we are living in and have highlighted those we have seen as most helpful to us.
 
  1. The Family Digital Wellness Guidehttps://cmch.tv/familydigitalwellness/ which is downloadable. Here you will find the science-based guidance for raising happy healthy children from toddlers to teenagers in today’s digital environment. Built on a bedrock of research the Family Digital Wellness Guide will give you a quick overview of your child stage of development and how it relates to the media they use. You can explore the guide through its interactive webpages. The guide addresses the effects of screen time on the developing brain in childhood and adolescence with practical suggestions for entering a discussion. **
  2. “The Effects of Screen Time On The Developing Brain,” https://www.nyas.org/ebriefings/2020/the-effects-of-screen-time-on-the-developing-brain/ a Vimeo webinar of the New York Academy of Sciences. This is a roundtable discussion of digital media that is a thoughtful and informative discussion of the realities, risks, and benefits of screen time.
  3. “Education Now: Screen Time Sanity,” https://www.youtube.com/watch?v=QBWTbiMDIOA(time 38:56 minutes)
  4. Parenting for a Digital Future. This is a book by Sonia Livingstone and Alicia Blum–Ross that broadly reviews Digital Media and its impact both positive and negative in our lives. ***
My sense after reading and viewing the information is to:
 
·      Make screen time a developmentally appropriate activity used in moderation and a part of a healthy balanced lifestyle.
 
·      Discuss Screen Time with children and teens and in-betweens as a part of a forum for sharing and collaborative problem solving between parents and children.
 
·      Use digital media to foster cohesion in the family and include Important discussions about living through COVID-19 and digital health.
 
·      Model the behaviors you would like others to follow.
 
·      Understand a new world with COVID-19 with thoughtfulness and patience.
 
·      Make an effort to let your children and teenagers help you learn digital media.
 
·      Accept that screen time for teenagers is the critical social environment for them with all its pluses and inherent problems.
 
·      Stick to the general rules of making the digital world as Predictable, Moderate, and Controllable as possible, understanding the critical importance of different social contexts require different solutions.
 
·      Make screen time value laden with your values and an active collaborative decision-making process within your family or community when possible.
 
·      Spend time together using screen time as an opportunity to discuss how the world we share can be experienced differently.
 
 
Part IV - Resources 
Children
Both adults and children are experiencing an increase in screen time, but experts are saying it’s going to be OK. In fact, there’s actually very little evidence directly connecting screen time to harm in kids. The bigger problem lies in screens replacing positive activities like exercise, socializing, and sleep. Here are three simple things to keep in mind.
 
One media-free meal per day.
·      Don’t even have the TV on in the background
 
Two screen-free hours before bed. 
·      “Blue lights” can disrupt natural sleep patterns and wake-up time
·      Keep phones out of preteens and teens bedrooms at night
 
Three ways to measure screen use:
1.    The amount of time spent using a screen 
2.    The quality of the content
3.    Being there to help your child process what’s on the screen
 
Other suggestions from Canada’s Healthy Relationships Hub:
·      Set time limits but be flexible and gentle with yourself: it’s fine to allow more screen time than usual, as long as it’s age appropriate.
·      Allow children to play and interact with friends: it is important for children to maintain relationships with peers. Under appropriate supervision, kids
FaceTime their friends, play online games, or send silly videos.
·      Watch TV and movies together with children: Experts suggests that parents and caregivers watch media with children when possible and talk through it. Co-viewing can support early comprehension and literacy skills and boost empathy.
 
Teens
 
“Is All Screen Time Harmful to Teen Mental Health?”
 
 
Teens speak openly and frankly about internet use, content and language may not be suitable for children
 
Young Adults
Author Jennifer Nelson (2021) advises:
§ viewers that blue light from devices signal our brain to wake-up.
§ Setting night filters on your devices to reduce blue light will help with sleeplessness.
§ Turning off screens an hour before bedtime is a must for a good night’s sleep.
§ Be aware of the emotional cost of staying informed and connected. Give yourself a break. Set limits on time spent scrolling negative content and set an alarm to enforce them.
§ Practice being “unavailable” sometimes. Try leaving your phone behind for short periods of time. Limit or delete any endless scrolling through content on Netflix, Instagram or elsewhere.
§ Connect with people on social media that share your values, interests, and pursuits. Find ways to use your screen time to contribute, create or pursue goals.
§ Mute notifications that constantly alert. Limit screen time while participating in other activities so you won’t miss moments that create contentment and happiness.
 
Adults
*Put your alerts on hold.
*Limit your screen time after sunset.
*Daily email detox.
*Get your work done without distractions!
*Intermittent social fasting.
*Avoid social media during working hours. With increased focus, you’ll lower your chances of having to work late.
 
Dr. Vivek H. Murthy, author, Togetherness, suggests four recommendations addressing the social strains we’re experiencing:
 
1.    Spend more time with those you love—at least 15 minutes.
2.    Focus on each other and give one another your undivided attention.
3.    Embrace solitude. Connecting with yourself is a prerequisite for connecting with others.
4.    Help and be helped.
 
Elderly
Screen time is higher for the elderly than younger people, new data reports.
 
Five best uses of screen time for older adults
1.    Talk live to the people you care most about on FaceTime, Skype, Zoom or other video conferencing platforms. Or text them to share your appreciation and gratitude.
2.    Watch a TED Talk every day. The nonprofit organization claims more than 3,300 talks to “stir your curiosity."
3.    Watch a nature video. You may not be able to escape to the great outdoors, but you might meditate to that video of a babbling brook.
4.    Record a video of stories from your life to share with your kids and grandkids.
5.    Visit the places online that help you nurture your most passionate creative pastimes.
 
Other Resources
 
Family Digital Wellness Guide: “What Parents Need to Know About Media and Their Children,”
Boston Children’s Hospital 2020 Version download at https://cmch.tv/familydititalwellness
This guide provides a wealth of information for parents of children ages infants to teens in an easy to read and comprehend format.
 
“COVID-19: Screen Time and the Developing Brain,” presented by; The New York Academy of Sciences Reported by Barbara Knappmeyer Posted July 30, 2020
 
“Staying Emotionally Close In The Time of COVID-19,” Bruce Perry, MD, PhD
 
 
New report on teens and mental health: How screen time impacts kids
“Digital by Default: The New Normal of Family Lives Under COVID-19.” This is a blog by Sonja Livingstone Dr Phil. It takes 5 minutes to read and a week to digest and is child and family centered. **
“Digital Advertising To Children.” An article in the July 2020 journal Pediatrics by Judy Radesky, MD that gives an overview of the use, methods, and intent of advertising in gaming and social media.
 
References
Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). “The Novel Coronavirus (COVID-2019) Outbreak: Amplification of Public Health Consequences by Media Exposure.” Health Psychology.
Nelson, Jennifer Digital Detox, “Are We Too Attached to Our Digital Devices?”
bp magazine Winter 2021
 
“How to Handle Screen Time During the COVID-19 Pandemic,” Dr. Michael Rich, Director, Center on Media and Child Health, Boston Children’s Hospital
 
“How to Manage Your Screen Time While Staying Home,” March 25, 2020/General
 
Dastagir Alla E., January 7, 2021 “What To Do About That Pit In Your Stomach In This Terrifying American Moment” USA Today
 
The Eight Part COVID-19 Survival Kit
 
Part V
Ways to Make Your Life Predictable, Moderate, and Controllable (COVID-19 PMC)
 
 
From Dr. James McGuire:
 
We are now going to learn about the 5th tool in our COVID-19 toolbox.
First an informercial!
If I were to ask you whether you would consider this tool, you would likely want to know more about it, its uses, its benefits, and its costs. If I told you that his tool is free and has been used by humanity for millennia in a variety of ways and that using this tool could add years to your life, but even more important improve the quality of your life and your sense of wellbeing, would you be interested in learning more about this tool?
If, in addition, I told you that using this tool will improve your immune system, protect you from stress, relieve anxiety and depression, improve your moods in general, allow you to be more successful and productive at work, play, and life and also decrease your chances for developing chronic illnesses such as cancer, heart disease, diabetes, and dementia, would you be interested in learning more?
And finally, would you consider adding this cost free tool, which can be added at any time in your life with the benefits noted above, and can be used in conjunction with all the other tools we have previously discussed, if the only requirement is creating the time and commitment to allow it to happen?
If so, read on!
I will be 80 at the end of this year and importance of making exercise an essential part of my physical and mental wellbeing has never been clearer. One of the reasons that I am so interested in exercise is because I know it has been a good companion in my life’s journey. Exercise is important in any age group, and certainly in the over 65 group whose numbers have tripled in the past hundred years, becoming 13% of the population. Cognitive decline is part of aging and we are a nation that is getting older. It is projected that by the year 2050, there will be 14,000,000 people suffering from Alzheimer’s in this country. Protecting ourselves from this uncurable disease includes physical exercise. In fact, exercise is an essential ingredient to quality of life and wellbeing form birth to senescence.
 
When we talk about adding exercise to your life, we are not talking about becoming Olympic athletes. We are talking about engaging in physical activity in a myriad of forms available to all. When we talk about exercise at a baseline, we are talking about engaging in a physical exercise that increases your heart rate and may leave you a little out of breath. It creates the brain fertilizer that maintains your brain, your physical health, and your well- being.
In our discussion of tools with which to cope with COVID-19, we have paid attention to the importance of STRUCTURE, SOCIAL CONNECTIONS, and PREDICTABLE, MODERATE, CONTROLLABLE LEARNING environments.
 
John Ratey MD, is a psychiatrist who over the past decade has highlighted the importance of EXERCISE for our brain’s development, our health, and our well-being. He reminds us that 10,000 years ago, humans were hunters and gatherers emerging out of Africa following the last Ice Age whose survival depended upon working together using predictable, coordinated, rhythmic, shared physical and social skills independently and as a group. He reminds us that human beings have always been on the move, moving separately or as a member of a clan. Moving is a part of our essential nature, part of the rhythm of our lives. All our talents and intelligences are grounded in experience that is complex, patterned, rhythmic, physical, and social. Our physically embodied exploration of the world is grounded in EXERCISE.

Below we have again collated annotated articles, You Tube, and Web presentations about exercise and its wellbeing across the life cycle.
 
The following research and information is submitted by Debbie Bratcher, staff member at NAMI Cape Cod. It is meant to compliment Dr. McGuire’s presentation.
 
In our previous Tool Kits, we have discussed that Predictable, Moderate and Controlled environments can help us self-regulate and develop resilience. Exercise: when scheduled regularly, is mindful, creative and works for our body allows us to operate in a more sensible and positive manner.
 
Bruce Perry, MD, Ph.D. states: The only way to move these super-high anxiety states, to calmer more cognitive states is rhythm. Patterned, repetitively rhythmic activity: walking, dancing, singing, repetitive meditative breathing--you use brain stem-related somatosensory networks which make your brain accessible to relational reward and cortical thinking. 
The list of repetitive, rhythmic regulations used for trauma by Dr. Perry, Dr. Bessel van der Kolk, Dr. Pat Ogden and others is remarkable. It includes singing, dancing, drumming, and most musical activities. It also relies on mediation, yoga, Tia Chi, and Qi Gong, along with theater groups, walking, running, swinging, trampoline work, massage, equine grooming and other animal-assisted therapy…even skateboarding.
 
The following links are meant for your viewing pleasure. They are examples of people enjoying music and or rhythm and exercise.
 
Children
 
Twin Toddlers Escape From Their Cribs To Have Overnight Party
 
 
Rhythm is fun. However, this concept has a much deeper meaning in the role of childhood regulation and the development of resilience. Rhythm is really about predictability. What is it about predictability that is so good for children? American psychiatrist and author Bruce Perry, MD, PhD, suggests that the only way children can move from a state of high anxiety and activation to a calmer state is through rhythm. 

1.Self-Regulation as Rhythm
As caregivers, we have a role in helping children organize their feelings and understand their own particular rhythms regarding sleep, hunger, moods, and energy levels. When children listen to their body rhythms they learn that they can trust their bodies to let them know what they need and that they can trust themselves to get their needs met. Through listening to their body, they will develop a sense of personal responsibility and agency.
 
2. Rhythm Through Structure
When we provide routine and predictable structure in the home and in children’s other environments, children benefit in a lot of ways. Predictability fosters trust (“But mom, you always scratch my back before bed!”) and allows children to anticipate their day and their expectations. The key, however, is to find a balance between predictability and rigidity.
 
3. Rhythm Through Activity
There are countless benefits to children engaging in movement, arts, music, and reading. Why is it that children love rhyming stories, dance, swimming, play, drama, and games? One of the reasons is that these activities facilitate regulated nervous systems. One of the best ways we can help children develop calm and regulated nervous systems is through activities that expose them to an alternation between settled and aroused states. 
There are numerous ways that we, as caregivers and helpers, can create predictable rhythm in children’s lives. As children are naturally drawn to rhythm, we can effectively cultivate relationships, environments, and activities that will facilitate regulated brains and promote resilience.
 
Teens
 
Teen Loses 60 lbs. Jumping Rope
This is a story about a teen who improves his health and self-esteem.
 
Rhythmic movements are important to teens. These kinds of movements such as walking, running, swinging, swimming, swaying help develop the process sensory information and access the cortex. Access to the cortex is the basis for many skills such as focusing, control of impulses, managing the emotions, abstract thinking, learning, planning, making decisions and using foresight. According to the U.S. Department of Health and Human Services, teenagers should get at least 60 minutes of exercise per day. They should focus the majority of this time on moderate or vigorous exercise and include some strength training three times per week.
 
 
 
Young Adults
 
Dancing Bhangra for Joy, Exercise and Positivity | Yukon, Canada
 
The benefits of exercise as a young adult are life lasting. According to a recent study, presented by the Association of Academic Physiatrists, data collected from the exercise habits of 413 people aged 25 to 65 in Taiwan found that if you were active as a teenager, you are more likely to have those habits stick with you for life. The result was that those who had consistent exercise habits as teens performed much better on the strength, endurance, and function tests compared to those who didn’t exercise much in adolescence. They also, found that those who had consistent exercise habits as teens performed much better on the strength, endurance, and function tests compared to those who didn’t exercise much in adolescence.
 
 
Adults
 
 
An 11-Minute Body-Weight Workout with Proven Fitness
 
One of the hallmarks of these programs is that you perform the exercises consecutively but not continuously; that is, you complete multiple repetitions of one exercise, pause and recover, then move on to the next.
 
Elders
 
Lively 30 Minute Senior Zumba
 
The immobility of the seniors increases their vulnerability making them suffer from stiffness, aches, and pains like the tinman with no oil. Health experts believe that physical health decline occurs if the person doesn’t have enough physical activity. Therefore, one should not forget about the benefits of sport and fitness activities for the elderly.
 
1.     5 Best Exercises for Seniors
Simple armchair exercises, directions are easy to follow
 
2.     10 Minute indoor Walking Workout for Seniors
 
3.     Silver Sneakers At Home Workout (free)
 
 
Any Age
 
Tai Chi 5 Minutes a Day Module 01 - easy for beginners
 
 
In a 2018 study from Trinity College Institute of Neuroscience and the Global Brain Health Institute at Trinity, it was shown that there is a neurological link between respiration and focus. Studies show that breathing exercises can actually improve cognitive function, encourage positive thought processes, and reduce symptoms of anxiety.
Deep breathing exercises can have a profound effect on your state of mind, as well as improve the quality of your meditation practice. While allowing the breath to flow naturally throughout meditation is
encouraged, intentionally taking a couple of deep breaths initially can help ground the mind and create space for growth.
 
How to begin your breathing exercise, FREE audio/video clips to help you relax and sleep.
 
 
Resources
 
A Safer Online Experience for Kids
YouTube Kids
 
“Exercise is the Best Medicine for our Brain” by Dr. John Ratey
 
Expert Exercise Tips for Kids
 
Group exercise improves quality of life, reduces stress far more than individual work outs
https://www.sciencedaily.com/releases/2017/10/171030092917.htm
 
Inside the Effects of Exercise: From Cellular to Psychological Benefits
 
 
Kids’ Brainpower Tied to Exercise, Sleep and Limited Screen Time
 
Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S.
 
National Library of Medicine
Physical activity in European adolescents and associations with anxiety, depression, and well-being
 
Noisy Learning: Loud but Fun Music Education Activities
Great k-12 lesson plans/activities
 
Story, Sonia, “What is Rhythmic Movement Training? “move*play*thrive Brain and Sensory Foundation
 
10 Benefits Of Exercise On The Brain And Body - Why You Need Exercise
 
 
 
References
 
American Psychological Association. (2013) Exercise: A healthy stress reliever. www.apa.org/news [Web page]. Retrieved from https://www.aps.org/news/press/releases/stress/2013/exercise#
 
Chekroud et al. (2018). Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: A cross-sectional study. [Web page]. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349619/
 
Klassen, Tricia (MSW, RSW) Trainer, Crisis & Trauma Resource Institute [Web page].Retrieved from https://ca.ctrinstitute.com/blog/childhood-resilience-rythym/
 
Millard, Elizabeth
 
 
Reynolds, Gretchen. 11 Minute Body Weight Workout with Proven Fitness Benefits [Web page]. Retrieved from https://www.nytimes.com/2021/01/13/well/move/an-11-minute-body-weight-workout-with-proven-fitness-benefits.html
 
Sujain Thomas, “7 Benefits of Sport and Fitness Activities for the Elderly”