How to discuss coronavirus (COVID-19) with my children?

The key steps to discuss difficult topics with children are: Ask, Listen, Reflect and Clarify.

First, ask children about their understanding of the situation. For older children, use open-ended questions, such as “What do you hear about coronavirus?” For younger children, use yes-no questions, such as “Do you hear about the new sickness that’s going around?” Then, follow up with more questions to explore their understanding. For younger kids, it is helpful to discuss those topics in play or during other hand-on activities. Listen to their concerns, questions, and thoughts about coronavirus.

In the process of the communication, reflect children’s feelings of confusion, fear, or concerns. Simply, validate their feelings by reflecting that it is normal to feel this way and reassure their safety. Sometimes, when appropriate, discuss your own feelings to normalize the situation.

When you hear some misleading facts or irrational fears, clarify calmly with the facts. Do not over-share the emotional content from the news or social media. Instead, focus on the objective facts, and things you can do together.

It is very important to discuss coronavirus in a developmentally-appropriate way.

For Adolescents, their minds are able to understand abstract concept and start to question right from wrong. The requirement of social distancing is most difficult for adolescents as they seek peer approval and long for socialization. Sometimes, the rules due to the pandemic add on more strain on the relationship when their needs are not met. They can become more irritable, or even oppositional. Do not take it personal. Discuss openly about the coronavirus and its impact on house rules and everyone. Allow adolescents to hold their view about COVID-19 independently as long as they can maintain safety behaviors within certain boundaries.

For School-age children, the understanding of coronavirus may be more limited, especially those in lower elementary school. Visual learning of virus and germs can help them understand the importance of hand-washing and masks. Generalize the importance of the personal hygiene to more than just to coronavirus. Parents’ reaction can impact children’s perception of a threat. Allow children to ask questions. Answer their questions honestly and calmly. No more, no less.

For Kindergarteners, Preschoolers, and Toddlers, they are present at the moments. Help them understand what others are talking about could relieve the fear of uncertainty. Attune to their feelings and curiosity. Ask them about COVID-19 and their understanding of it. Respond to their questions and correct misinformation if any. Very likely, they forget about it quickly when they are playing at home again.

Take the steps and respond to children according to their needs. Keep the conversation going when they have questions. Do not avoid discussion or constantly talking about it all the time. The middle path is the way through any difficult situation or conversation.

How to challenge loneliness in pandemic?

Loneliness is a subjective feeling regardless you are surrounded by a crowd or in isolation. During pandemic, the sense of loneliness becomes more and more overwhelming and eventually swallows the joy of life. The emptiness and darkness infiltrates every day-to-day moments and prevents any possibility to connect or enjoy. This may be one of the first signs of depression. Later, sleep and appetite disturbsnces may follow. Eventually, social withdrawn predominates and paradoxically the last thing lonely people want to do is to reach out.

Lonileness is a dark cage inside that trapped the beautiful minds.

When you notice your family or your friends start to cancel social gathering or stay in bed excessively, it is very important to remind them the beautiful things in life and reach out to them even when they reject it. Your accompany and listening means a lot for a lonely person. Do not underestimate the power of a kind word, a warm hug and a gentle smile. Even in the darkest room, just a spark of light can brighten and warm up the whole room.

If you feel lonely, please reach out to family and friends despite your body is tired and you do not feel like doing so. You can send them a message, call them on the phone, or go for a visit. If you cannot reach anyone at the moment, try something which you used to enjoy, go for walk, or immerse yourself in the nature. The nature is aways the best place to reset and energize lonely mind.

Nature calms people down. It allows you to reflect and feel connected again.

After you’ve tried everything and nothing seemed to work, please consider supportive counseling with counselors. If you ever experience any thoughts to end your life, you are not alone. Please call the 24-hour suicide prevention hotline at 1-800-273-8255. Your moment of loneliness will pass even when you cannot see it.

What to do if my child has OCD?

Pediatric OCD is diagnosed in school-age children between age 7 to 12. The diagnosis of OCD in kids and teens is often overlooked and under-diagnosed. If your child struggles with the following symptoms, your child may struggle with OCD:

These obsessions are the most common among kids and teens:

  • Fear of dirt or germs
  • Fear of contamination
  • A need for symmetry, order, and precision
  • Religious obsessions
  • Preoccupation with body wastes
  • Lucky and unlucky numbers
  • Sexual or aggressive thoughts
  • Fear of illness or harm coming to oneself or relatives
  • Preoccupation with household items
  • Inrusive sounds or words

These compulsions are the most common among kids and teens:

  • Grooming rituals, including hand washing, showering, and teeth brushing
  • Repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or rereading, erasing, and rewriting
  • Checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework
  • Rituals to undo contact with a “contaminated” person or object
  • Touching rituals
  • Rituals to prevent harming self or others
  • Ordering or arranging objects
  • Counting rituals
  • Hoarding and collecting things of no apparent value
  • Cleaning rituals related to the house or other items

OCD is like the hiccups of the brain. It makes your child get stuck and cannot stop doing the compulsions. When you attempt to interrupt OCD, your child can have a melt down. The cause of OCD is believed to reside in the deep brain circutry that involves prefrontal cortex (orbitofrontal and anterior cingulate cortexes), basal ganglia, and thalamus. Very rarely, certain autoimmune process after streptococcus infection can trigger OCD and it is called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections).

When you suspect your child struggles with OCD, it is very important to work with professionals who specialize in cognitive behavioral therapy (CBT). Your involvement in treatment process is also very important to the treatment outcomes. Sometimes, medications can facilitate the therapeutic process of CBT for severe cases of OCD. Other alternative treatment for refractory OCD include transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS).

Please check out the following website for resources if your child struggles with OCD.

How COVID-19 impact OCD?

It really depends. COVID-19 has brought uncertainty and fear to everyone. In general, people who struggle with OCD are more susceptible to the stress during pandemic. However, the wax-and-wane nature of OCD can take on its own course without any clear triggers or factors. Some stable OCD patients even feel more “normal” to justify their rituals in this pandemic.

For those who struggle with worsening OCD symptoms during pandemic, most of them are not directly interfered by the fear of COVID-19, at least no more than usual. The irrational and creative mind of OCD always surprises people with different content to obsess about. The uncertainty, social isolation, boredom, and disrupted routine invites OCD to fill in the blank with various thoughts.

Please be gentle and compassionate to the situation we are in and focus on what we can control to make a difference. COVID-19 is one of many life challenges we face in life and do not forget to take care of yourself. The peace inside you are not the feather in the wind; it can be as still when your mind is calm and quiet.

Please see the following resources if you are interested in reading more:



McLean Hospital:

How does COVID-19 impact mental health?

At beginning of COVID-19, people were in shock and fear. Many decided to hide at home in response to uncertainty. Six months into pandemic, the emergence of anxiety, depression, OCD and eating disorder is evident in the clinic. The severity and prevalence is unusual, though expected.

Several factors have contributed to the increased needs for mental health, including direct threats from an unknown disease, social isolation, and change of daily routines. While social distancing stops the spread of COVID-19, it also leads to sense of loneliness, social isolation and disconnection from others. The effects of social distancing will continue to carry through this winter with expected worsening depression and anxiety during holiday seasons. It is very important to focus on a structured routine. Despite we cannot change the nature course of COVID-19, maintaining a healthy daily routine is very critical for resilience, such as good quality of sleep, balanced diet and regular exercise. Yoga, walk, and meditation can also be very helpful tools to cope with stress in the pandemic.

Where can I find support group for OCD?

OCD Support Group – Worcester, MA
Location: UMass Medical School
    55 Lake Avenue North
    Worcester, MA 01655
When: Every 2nd Thursday of the month
Time: 7-8:30 PM
Open to: Older teens and adults with OCD

OCD Support Group – Cambridge, MA
Where: Cambridge Friends Meeting House
              5 Longfellow Park
              Cambridge, MA 02138
When: Every first and third Monday of the month
Time: 7-8:30 PM
Open to: Adults with OCD
Fee: $8.00 per group
Contact: Joel Light,

OCD Support Group – Belmont, MA
Where: McLean Hospital
             DeMarneffe Cafeteria, Room 132
            Belmont, MA 02478
When: Every first Tuesday of the month
Time: 8 -9 PM
Open to: Teens and adults with OCD

OCD Support Group – Northampton, MA
Where: Smith College  – McConnell Auditorium
            7 College Lane
            Northampton, MA 01062
When: Every third Tuesday of the month
Time: 8-9 PM
Open to: Older teens and adults with OCD

Family Support Group – Belmont, MA
Where: McLean Hospital
             DeMarneffe Cafeteria, Room 132
            Belmont, MA 02478
When: Every first Tuesday of the month
Time: 6-7 PM
Open to: Family and loved ones

Where can I find resources about OCD?

International OCD Foundation is a dedicated platform for OCD patients, clinicians, and family. Please visit IOCDF website to learn more about OCD ( In addition to psychoeducation about OCD, IOCDF has a therapist list where OCD patients can identify local therapists, treatment centers, and organizations. It also engages in advocacy activities, such as conferences in June and an awareness week in October. Destigmatizing OCD is a critical mission for the future.

Locally, OCD Massachusetts ( hosts free series zoom meetings and lectures. Please check on the website from time to time for more information.

What is the difference between anxiety and stress?

The differentiation between anxiety and stress is a very critical part of treatment. Stress is from environment and most people feel overwhelmed in a stressful situation, such as taking exam, getting fired, or social isolation during pandemic. However, when the severity of the anxiety or the presence of the anxiety is out -of-proportion to the situation, it is considered anxiety disorder.

Anxiety symptoms are not enemies. Instead, anxiety is functions as a survival signal. Flight-or-flight response is ingrained in our emotional brain and body to react to dangerous situation. Therefore, emotional brain often overrides the rational brain when it comes to survival. Human brains learn efficiently with a cost to misinterpret safe situations as threats. Sometimes, those irrational fear can limit a person’s ability to function.

In cognitive-behavioral therapy (CBT), therapists first help clients to practice to identify thoughts and feelings in a non-judgmental present way. This process help differentiating stress and anxiety. CBT offers skill set to cope with stress, such as mindfulness, deep breathing exercise, progressive muscle relaxation and many other tools. When anxiety is out-of-tune with reality, recalliberation of the feelings is important in the session. CBT for anxiety is in general exposure-based. Through the therapeutic process, clients learn how to conquer anxiety.

What is obsessive compulsive disorder (OCD)?

Obsessive compulsive disorder (OCD) is defined as recurrent intrusive thoughts/images or repetitive behaviors due to urges or anxiety. It affects 1-3% of the US population, in both children and adults. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) described the criteria as followed:


Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action.


Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

The common symptom dimensions in OCD can be categorized into:

  1. symmetry, arranging, ordering
  2. aggressive obsessions (harm to self or others)
  3. contamination, cleaning
  4. forbidden thoughts
  5. religious obsessions, morality, scrupulosity
  6. checking
  7. hoarding, collecting
  8. magical thinking
  9. tapping, sensory phenomenon
  10. health and somatic obsessions

A thorough list of OCD symptoms are described in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), a common scale used to quantify the severity of OCD.

What is cognitive-behavioral therapy (CBT)?

Cognitive-behavioral therapy (CBT) is a group of evidence-based psychotherapies developed from experiments in behavioral laboratories. The most well-known experiment is the Parvolov dog to illustrate classical conditioning. The scientists rang the bell every time before feeding the dog. Over a period time, it was observed that the dog salivated by just hearing the bell ring. The phenomenon of salivation in response to the bell, not just food, described the concept of classical conditional. Later, the behavioral and cognitive researches bloomed over decades, including operant conditioning, and relational frame theories (RFT).

Parvlov’s dog

The application of behavioral or cognitive researches was extended to therapy rooms over the past decades. Different schools of psychologists eventually combined into cognitive-behavioral therapy (CBT). In order to study CBTs, the treatment protocols are usually manualized with 16-20 sessions to target symptom reduction. Exposure and response prevention (ERP) is one of the CBT protocol specifically developed for obsessive-compulsive disorder (OCD). Most recently, acceptance and commitment therapy (ACT) was developed based on relational frame theories (RFT).

Compared to other psychotherapies, cognitive-behavioral therapy (CBT) is goal-orientated, well-defined, and structured. CBT analyzes feelings and thoughts in certain context and fosters change of behaviors. In the collaborative therapeutic process, clients engage in value-guided committed actions despite those difficult thoughts and feelings. At the end of the treatment, CBT therapists and the clients go through this new and adventurous experiment to acheive goals of a more fulfilled life.

Case conceptualization of CBT

CBT is also a present-focused skill-based psychotherapy. Clients learn the nature of cognition and emotions from structured handout and experiential moment in the session. Other useful tools of CBT include skills to manage stress, to communicate effecitively with others, to regulate emotions, and to disengage with diffocult thoughts. CBT therapists tailor individual treatment plans with different emphasis of interventional components.

To date, CBT has been the most evident and effective form of psychotherapy for children and adults with anxiety, including panic attacks, phobias, slective mutism, social anxiety and obsessive-compulsive spectrum disorder. For further information, please contact Remede Therapy.