One of the issues I have been hearing a lot about from camp professionals around the country has to do with camper anxiety. I have gotten more anxiety-related questions from camp directors in the past year than any other topic besides accommodating transgender campers. At a meeting of Maine Summer Camps in January of this year we spent an entire morning on the topic of anxiety in campers and staff. I want to share with you some of the skills and tools that I think can be helpful in dealing with these issues in campers.

Skillset One: Connect Before You Redirect

Before I talk about helping a camper with a setback, which can cause stress and lead to anxiety, or about camper anxiety in other forms, I want to revisit a basic habit that is critical for success in working with campers in general. I call it "connect before you redirect."

Counselors and other adults often make suggestions, give advice, or try to intervene in a situation (called "redirecting") before they make a connection with the camper (or staff member) they are trying to help. Let us take for example a camper who at mail call laments not having gotten any letters that day. His or her well-meaning counselor responds by saying, "Well, maybe if you wrote a few letters yourself you might get more in return." While possibly true, the camper hears this as a judgment or a put-down and doesn't take the message seriously. The counselor is redirecting without first making a more empathic connection to the camper. If the counselor had simply said, "I know what you mean! I feel disappointed when I don't get any mail too," that counselor would have been making an empathic connection to the child. At that point the counselor could add, "Hey, let's think of a few people you could write to who might be more likely to write you back." By joining with the camper first the counselor is making it more likely that the camper will take his or her suggestion (especially if the counselor agrees to help).

There are several ways to "connect" with campers by acknowledging:

• What a camper is feeling (sad, disappointed, frustrated, etc.)
• The challenging or demanding situation or experience the camper is having ("Hey, this is the first time you've ever tried going down a zip line! It can be kind of scary. Don't be so hard on yourself.")
• The camper's effort or bravery or persistence ("I am really impressed at how hard you are trying to get this right.").
• The camper's positive intention ("I know you were only trying to help. I don't think you knew that your cabin mate wouldn't take it the way you meant it.")

Skillset Two: Three Steps to Addressing a Setback

We often attempt to make campers feel better when they have had a setback instead of connecting with them and giving them ways to make themselves feel better. Very often children feel like we are trying to talk them out of their feelings when we try to make them feel better, which can backfire. Try the following three-step process instead:

1. Connect by acknowledging the feeling: "I can see how frustrated, upset, angry, disappointed, sad, hurt you are."
   1. Connect more deeply if you can by acknowledging the situation: "No wonder you're frustrated. You've never tried this before." Or by acknowledging their effort: "I am so impressed with how hard you are working at this."
2. Normalize the feeling or response: "Lots of kids have felt that way. Everybody struggles when it comes to . . . ."
   1. Normalize more deeply if you can by sharing your own experience: "Even I've felt that way. One time . . . ." (Keep it short and relevant.)
3. Redirect: "Let's see what we can do to help you get on top of this." "It's not that you can't do this; you just can't do this yet." "You're new at this and maybe you're being a little unfair to yourself. You'll get it eventually."

For example, at basketball you notice a camper trying to make a key shot in a game of scrimmage with another team. He or she misses the shot and, in a fit of frustration and embarrassment, runs off the court and into the adjacent woods or field. Instead of immediately chasing after that camper (chasing kids makes them run away more), take your time and slowly follow him or her. (Obviously, you need to make sure there is another staff member who stays back with the other kids.) As you approach the upset camper you might say, "Wow! I know how that must stink. I can see how upset and frustrated you are." As you move slowly, remember that your job is not to talk that kid out of what he or she is feeling, but to verbalize it. This make take a few minutes. Your objective is to simply be present with the camper in their upset until they are somewhat calmer so you can redirect: "Sometimes if we take a short break and try again later it helps. Let's try heading back and we'll help you take a deep breath."

Skillset Three: Addressing Performance Anxiety

Very often campers, like the rest of us, will get anxious before a new physical or social challenge (e.g., a zip line or a dance), tryout (e.g., for the swim team or the play), or performance. One of the things we know about anxiety is that the way we think about anxiety has a lot to do with whether it stresses us out or just helps us "get up" for the coming challenge. Like many adults, children often get anxious about being anxious, so if we can give them some reassurance about what they are feeling, it can help immensely.

Try the following formula:

1. Connect by acknowledging the affect or situation: "Are you feeling a little nervous about the game this afternoon?"
2. Normalize if you can, especially if you can share your own experience.
3. Reframe by saying, "This is your brain's way of getting you ready. We all get nervous when we are faced with something new or challenging. Your brain's job is to keep you from being surprised. It's getting you ready to be at your best. That's all that's happening right now."
4. Redirect by saying, "Let's think about all the ways you can beat this. Let's think about how strong/ capable you are." Help the child focus on past success or on a personal strength he or she can't see in this moment.

Note: We have found that trying to get them to forget their fears doesn't work. Focus instead on the reframing I mentioned.

Skillset Four: Responding to a Panic Attack

A panic attack is a kind of tantrum-like fear reaction where the child feels a flood of anxiety that overwhelms him or her. Panic attacks can show up with a variety of symptoms, like rapid breathing (hyperventilating), dizziness, nausea, stomach pain, trembling or shaking, crying, or a combination of these symptoms. One of the dynamics of a panic attack is that the child actually senses the fear response in his or her body because of the release of stress hormones. This causes the child additional worry, as if something is physically wrong, adding to his or her anxiety (this is known as the "worry loop").

When dealing with a panic attack, take the following steps:

1. Remain calm yourself. This may be challenging as children in a panic state are extremely intense about projecting their fear and discomfort. Practice shifting from empathy to compassion. If you mirror the panicked emotions of the child, it will only escalate the situation.
2. Join with the child by speaking firmly but calmly and in a positive way using the pronoun "we." "We are going to help calm you down." "We are going to help you feel better!" Another joining technique is to say, "I need your help." (This is usually a good way to introduce the breathing technique in Step 4.)
3. Get the child away from loud noise or high activity. Have the camper sit on the ground, if possible, and put his or her hands on the ground or on his or her knees.
4. One of the most important techniques is getting the child to breathe. Have the camper breathe in through the nose, hold it if he or she can for a second or two and blow out slowly through the mouth. This may take a few tries and the child's technique will improve as he or she makes more attempts.
5. Acknowledge that the camper is having very strong feelings and as strong as they are, he or she will be okay.
6. A child often worries that the adult doesn't realize the severity of the situation, so you may need to acknowledge that fear: "You're having very strong feelings right now and you are going to be okay. It will pass as soon as we can help you breathe. I know how frightening it must be for you."

Children Prone to Panic

It helps to educate children (and their parents) about anxiety when they are calm (that is, not in the "point of struggle"). One way to do this is to explain that when we know what "triggers" us, we can make a plan to avoid that trigger or cope with it when we know it is coming.

Another point is to let a child know that anxiety is normal in smaller amounts and is the mind and body's way of getting us ready to do our best when faced with a challenge.

One of the things I tell kids is that it is their brain's job to protect them from being taken by surprise or getting blindsided, so our brains "alarm us" to make sure we are ready for the challenge. One of the problems is that we aren't always in the danger our brains think we are in. It is as if our brains are operating on old news, like when something happened that scared us when we were younger and couldn't defend ourselves as well as we can now (when we are bolder or can ask for help). Once the "brain alarm" does sound, it just takes a while to calm that alarm down. That's when our friends or a caring counselor can help. 

Bob Ditter is a licensed clinical social worker specializing in child, adolescent, and family therapy.