parasympathetic nervous system

Coping Strategies for Anxiety and Panic

By | NESCA Notes 2022

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Do you, your child or your loved one deal with frequent anxiety? Stress? Panic? Sometimes it may feel like you are spinning out of control. With so much going on in the world, in our own lives, and in our own head, it can feel like an impossible task to quiet the mind and calm the body. However, there are things we can do to regulate the nervous system, thereby relaxing the body and reducing the effects of anxiety. Below is a list of these strategies, but they are not one-size-fits all. Try each of them and see what works best for you or your loved one.

  • 5, 4, 3, 2, 1 Grounding Technique: This technique is helpful to ground yourself in the present moment. Often, we can get stuck in our own head, and our worries and fears spiral out of control. This strategy is helpful to pull yourself out of those thoughts and into the present moment. The procedure is as follows:
    • Identify five things you can see. Feel free to describe them. What color are they? What are their shapes?
    • Identify four things you can touch. Get up and actually touch them! How do they feel? Are they soft? Hard? Squishy? Wet?
    • Identify three things you can hear. Is there a car driving by? Are the noises loud or soft?
    • Name two things you can smell. Are the smells pleasant? Neutral? Familiar?
    • Finally, name one thing you can taste. Can you taste the remnants of dinner on your tongue? Perhaps you have a piece of candy nearby you want to put in your mouth and describe.

Hopefully, completing this technique helps break the anxiety spiral. Feel free to repeat it as many times as you need. You can try to identify new items and sensations each time.

    • Weighted blanket or deep pressure: Deep pressure activates the parasympathetic nervous system, which is responsible for relaxing your body. Therefore, if you are feeling anxious, try sitting with a weighted blanket. Alternatively, if you have a pet, put them on your lap. Both the pressure of their body and the act of petting them is great for relaxing. You could also try giving yourself a hand massage or tight hug.
    • Box breathing: This is a breathing technique that also activates the parasympathetic nervous system and relaxes the body. The steps of this technique are as follows:
      • Take a slow breath in through your nose (if possible) for four seconds
      • Hold that breath for four seconds
      • Slowly breathe out for four seconds
      • Hold your breath again for four seconds
      • Repeat this cycle three or four times
    • Funny videos: Sometimes it can be helpful to distract the mind with a funny video. Animal videos can be great! Or perhaps you have a favorite comedian that will always make you laugh.
  • Progressive Muscle Relaxation: This technique involves tightening different muscle groups and then letting them go. It helps to relax the body and reduce tension. You can find a guided YouTube video to walk you through the process, or you can also try it on your own by moving from head to toe, tightening different muscle groups. You may start by tightening all of the muscles in your face for 5-to-10 seconds as you inhale and relaxing the face muscles as you exhale. Give yourself 10-to-20 seconds to relax before moving on to the next muscle group.


About the Author

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.


To book coaching and transition services at NESCA, complete NESCA’s online intake form

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Let’s Stop Trash-talking Stress and Anxiety-Part 1

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.

Coordinator of Therapy Services; Trauma-informed Therapist

Stress and anxiety have gotten a really bad name in our society. Just ask kids – it is a question we sometimes pose to our clients during testing, and the answers we get usually run along the lines of, “Are you kidding? There’s nothing good about stress!”. So, let’s talk about the purpose of stress, how it functions, and what we can do to manage it.

From a scientific viewpoint, stress is a challenge or stimulus to DO SOMETHING when certain circumstances arise – specifically, when danger is detected. Let’s make this easy – what would your body need to do if a tiger showed up? Let’s start with upping your heart rate and breathing faster to get oxygen into your blood so that you are able to move quickly, and then let’s send some fuel (glucose) to your muscles for strength. This is the process that happens when some kind of danger is sensed – the brain sends down orders to the body that diverts resources to the systems that help us escape from the tiger (fight, flight or freeze) while diverting resources from systems that are less important at that time (rest, digest and think). When the danger is over, the focus changes; our fear response is dampened, our heart rate and breathing slow down and those other systems come back online to get our bodies back to normal.

The feedback between these two systems of getting us prepared for danger (activation of the sympathetic nervous system) and calming down after the event has passed (activation of the parasympathetic nervous system) remain important, even when tigers are no longer a concern. Remember that stress is a stimulus to do something in the face of fear or danger. A little stress in our daily lives helps us get things done, like studying for that big test. It is also adaptive to be anxious at a time like now, when our whole world is under the threat of the COVID-19 virus. There’s lots to be worried about, and this stress can help us remember to take precautions like staying home and keeping physical distance. We’ll get back to this.

But what happens if the threat is more immediate, the danger sensor is too sensitive and/or the body never gets a chance to calm down? In this situation, the person remains activated, looking for danger and ready to respond, even when it is not appropriate or even against their best interests. Remember, during these times of perceived danger, the child does not have access to higher-level cognitive processes, like thinking flexibly, problem solving or even access to language. At these times of high stress, they are not available for learning. Asking a child to “talk about it” or even tell you what the problem is can be beyond their capacity at the time and will only add to their stress. This is the situation in school encountered by many children with learning issues, emotional concerns, autism or other neurodevelopmental disorders. They may find the academic, organizational and social demands of school to be so threatening that their danger alert is set off and only gets the chance to reset when school is finished.

So, what does the overly stressed child look like and how can we help? This is going to be the challenging part, because you are going to be asked to look at common behaviors in a different way. Let’s go back to the Fight-Flight-Freeze responses. Most of us tend to prefer one of these, though we will use all three depending on the situation.

Fight – This version of the response involves active resistance to the threat, but in the classroom or the dinner table, it more likely takes the shape of being argumentative, noncompliant and defiant (“You can’t make me!”).

Flight – This version is characterized by avoidance or getting away from the threat. This could mean needing to go the bathroom, see the school nurse or suddenly remembering that very important pen in their cubby that they absolutely have to have at that moment. However, it could also mean leaving mentally (“spacing out”).

Freeze – This version involves immobilization strategies, like wild animals who “freeze” so as not to attract the attention of a predator. In children, these behaviors are more subtle; they manifest as problems with getting started, switching from one thing to another and/or stopping. Oftentimes these kids are described as “shutting down,” but it is more accurate to describe them as “stuck.”

How do we help our kids get out of this stress response?

Remember, stress is a response to the perception of danger, and anxiety is the feeling of being helpless and out of control.

What “turns off” the threat alert and allows us to feel more capable and ready to try? The perception of being safe. When children feel safe, they can focus and concentrate on the task at hand. They can think and problem solve. And, they are more aware of others and what they are saying and doing.

How do we help our children feel safe and capable of tackling a challenge? Say a child doesn’t like math and does everything to avoid doing their homework. Which of these three approaches would make them feel more safe and ready to give it a try?

  • “Stop acting like a baby and just get that math done. It’s only 10 problems! Don’t even think of playing any video games tonight.”
  • “You poor thing. I know you are bad at math and it’s mean that your teacher is making     you work so hard. I’m going to write to her and tell her you can’t do that much.”
  • “Wow, you really don’t like to do your math homework, do you? That’s hard! Tell you what, I’ll help you with the first two and when you are done with the rest, we’ll play a game together!”

Notice that in the last example, the parent started with validating the child’s feelings, or just recognizing what the child’s emotional experience is like at the moment – not the same as agreeing with him or her. The second thing s/he did was to offer some help, and the third was to offer a fun activity to help the child feel calmer and more connected.

What if the child is really upset and can’t switch gears to start working? Just change the order of the events. Validate feelings, offer a calming and connecting activity and offer some help to get back to work. The calming/connecting activity doesn’t have to be a game – it just needs to be something they makes the child feel cared for and gives them something else to think about, like a cup of tea or a special cookie.

But what if the stress and anxiety is related to something that is bigger than math homework and can’t be easily fixed with a cup of tea and some extra help with those fractions? What if it is something that is out of the parent’s control, like the COVID pandemic? Again, the way to “turn off” the threat alert in our children’s brains is to help them feel safe and to have some control over what is happening to them. How do we do that? Validate their feelings makes them feel heard. Answering their questions (but sticking to their concerns) will tell you what they are really worried about and allow you to correct misperceptions and reassure them. Calming and connecting activities are still really important. Finally, helping them feel more in control by being able to do something to help. Utilize a child’s skills and interests in finding ways for them to help. If your child likes to draw, have them make pictures for family, friends and neighbors. Do you have a budding computer whiz? Help them make a zoom video of their classmates saying hi to their teacher. Is your child someone who loves people and isn’t shy? Have them call grandparents and older neighbors who may not be able to leave their houses. Equally importantly, remind them that they can help others by following the guidelines of washing their hands, keeping physical distance and, as hard as it is, staying home.

In a follow-on blog, we’ll discuss how to build resilience in children.


About the Author:

Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. She specializes in the neuropsychological and psychological assessment of children and adolescents with complex learning and emotional issues and enjoys consulting to schools on these issues. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing therapeutic services, providing therapy and psychoeducational counseling and, in the time of the COVID-19 crisis, providing teletherapy to parents and teens.

In her early career as an adolescent and family therapist, Dr. Monaghan-Blout became very interested in the needs of those contending with traumatic experiences. She brought that interest to her work as a pediatric neuropsychologist and continues to be passionate about treating this population. She has developed an expertise in working with adoptive children and others who have experienced early trauma. She is a longtime member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic and presents nationally and regionally on assessment and treatment of children with complex/developmental trauma.

Dr. Monaghan-Blout graduated from Bowdoin College and received a Master’s Degree in Counselor Education from Boston University. She obtained her Doctorate in Clinical Psychology from Antioch New England Graduate School with a dissertation entitled, “A Different Kind of Parent; Resisting the Intergenerational Legacy of Maltreatment.” She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York, and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital.

She joined Dr. Ann Helmus at Children’s Evaluation Center in 2003, and again at NESCA in 2007. A member of the Massachusetts Neuropsychological Society Board of Directors from 2010 – 2013 and from 2014-2017, Dr. Monaghan-Blout served in many capacities, including as President. Dr. Monaghan-Blout is the mother and stepmother of four children and the grandmother of six. She is also an avid ice hockey player, cook, gardener and devotee of urban fantasy.


To book therapy services with Dr. Monaghan-Blout or an evaluation with one of our many expert neuropsychologists and transition specialists, complete NESCA’s online intake form.


Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.