Understanding and Helping The Worried Child

1. Understanding and Helping The Worried Child April 9, 2013 7:00 PM Sporting Hill Elementary School Dr. Michel Harris, Mrs. Cheryl Peterman, & Mrs. Jennifer Sanborn-Miller

2. Workshop Objectives: • To identify the differences between fear, worry, and anxiety. • To know how and when to refer children for professional help. • To explore strategies that may work for children experiencing fear, worry, or anxiety. • To learn ways to build resilience in children with the hope of preventing anxiety.

3. Quiz Time!!(Don’t worry…it’s not too hard!)

4. Is it fear, worry, or anxiety?? • Susan screams when she hears thunder. • Mark cries when he thinks about swimming lessons that begin next week. • Annie freezes in her steps when a big dog runs toward her. • Jonathan says he doesn’t want to go to the bowling party because he thinks the other kids will make fun of him since he has never done it before. • Abigail won’t go to school because she thinks something bad may happen to her mother while she is gone.

5. Common Childhood Fears

6. Definitions: • Fear - a response to something that can harm; usually results in physical symptoms like changes in heart rate, change in blood pressure, and release of hormones (adrenaline, cortisol).

7. 10 Most Common Fears Reported in Children Include: • being struck by a car • not being able to breathe • a bombing attack • being burned in a fire • falling from a high place • a burglar breaking into a home • natural disasters • death • poor grades • snakes Goldstein, S., Hagar, K., and Brooks, R (2002). Seven Steps to Help Your Child Worry Less. Specialty Press, Inc., p 12.

8. What really is worry?

10. Easy…right???

11. Wrong!!!

13. More Definitions: • Worry – an uncertainty or uneasiness about something that could or might happen in the future

14. When should I be “worried about the worry?”

15. Worry is Often a Good Thing! • Most worry is normal and a formative part of childhood. • If a child worries “well” the result can be a child who has developed a sense of safety and comfort that they will be OK when things don’t go as planned. • Worrying well gives a child permission to fail and not feel like a failure. Hallowell, E.M. (2002). Worry. Ballantine Books.

16. When does fear and worry develop into anxiety? • Worry and fear are common human experiences. They are useful and keep danger in perspective. Not worrying can actually be dangerous or a form of denial. Hallowell, E.M. (2002). Worry. Ballantine Books.

17. More Definitions: • Anxiety – develops when worry persists and grows • Physical symptoms emerge (queasiness, muscle tension, heart pounding, rapid breathing). • Behavior changes to avoid the fear producer, and when reassurance no longer helps.

18. Causes of Anxiety • Some anxiety is rooted in a faulty cognitive process – thoughts that are not based on fact and lead to worry. • Some anxiety is neurologically and chemically based. • Consult with professionals who can help determine the cause of anxiety in children.

19. Categories To Be Concerned About: • Worries related to problems with connectedness. Children need connectedness to feel safe and secure. Can slow emotional and intellectual growth. Connectedness allows one to have normal worry with another. • Worries that are imposed upon children by parents and others. Unreasonably high expectations, heavy discipline, and too much information are examples. • Diagnosable, brain-based, emotional problems involving worry (less common).

20. Types of Anxiety: • Phobias – when fears are out of control • Separation Anxiety – fear of being away from family grown-ups • Generalized Anxiety Disorder – constantly worrying for months at a time • Panic Attacks – fear that stops you in your tracks • Obsessive-Compulsive Disorder – thoughts and actions you just can’t stop • Post-Traumatic Stress Disorder – stress and fear from a terrible memory Crist, J.J. (2004). What to Do When You’re Scared & Worried. Free Spirit Publishing.

21. When should I seek outside professional help?

22. Seek outside professional help when …. • Persistent symptoms that are not helped with a shift in focus • Change in school performance • Worry becomes severe and interferes with regular activities • Frequent physical complaints • Threatening or harmful behavior when worried American Academy of Child and Adolescent Psychiatry. (2011). Facts for Families: When to Seek Help For Your Child. www.aacap.org

23. Questions to ask a professional • How long before I can get an appointment? • How often will you see my child? • What certifications/licensure do you hold? • What approach do you use in working with anxiety? • What age ranges do you work with? • What insurance do you accept? • Do you provide a sliding fee? • What is your procedure for a crisis? • How is the parent/family involved?

24. What will professionals do with my child? • Gather information and listen to all perspectives • Psychological tests or rating scales • Families may receive treatment “homework” to assist the child in making changes • Collaborate with other professionals working with the child

25. What type of professional is most appropriate? • Counselor/Therapist • Creative Expressive Therapy: Music, Art • Play Therapy • Cognitive-Behavioral Therapy • Psychologist • Psychotherapy, Research, Psychological tests to diagnose. • Psychiatrist • Medical professional who can diagnose and prescribe medication

26. Cognitive-Behavioral Therapy Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety. Behavior therapy examines how you behave and react in situations that trigger anxiety. This treatment assumes a strong relationship between thoughts, emotions and behaviors.

27. Cognitive-Behavioral Therapy • Studies have shown CBT as an effective therapy for children with anxiety • Kendall (1993) support for using muscle relaxation, deep breathing, cognitive imagery to reduce anxiety • Study in 1992 found cognitive strategies resulted in 71% effectiveness rate in ending panic attacks. Kendall, P. (1993). Cognitive-behavioral therapies with you: Guiding theory, current status, and emerging developments. Journal of Consulting and Clinical Psychology, 61, 235-247. Beck, A., Sokol, L., Clark, D., Berchick, R., & Wright, F. (1992) A crossover study of focused cognitive therapy for panic disorder. American Journal of Psychiatry, 149 778-783. Thompson, C.L. & Henderson, D.A. (2007) Counseling Children (7th ed.). Belmont, CA: Thompson Brooks/Cole

28. What strategies will someone with a CBT lens recommend? • Become aware of self-talk (thoughts) • Start a new internal dialogue (a new way of thinking) • Learn new skills • Coping skills will be practiced in real-life situations Corey, G. (2001). Theory and practice of counseling and psychotherapy (6th ed.) Belmont, CA: Wadsworth/Thomson Learning.

29. Strategies for Coping with Fears and Worries

30. Faulty Thinking • All or nothing thinking: • Seeing things in black and white categories; • Unless something is perfect, it’s a complete failure • Overgeneralization: • Seeing a single negative event as a never-ending pattern of defeat ; • e.g. using words like “always” and “never” • Jumping to Conclusions: • Interpreting things negatively when there are no facts to support the conclusion. • ie: Mind-reading: without checking it out, the child arbitrarily concludes that someone is reacting negatively to him/her • ie: Fortune-telling: Predicting that things will turn out badly

31. Help Children Identify Feelings

32. Clear vs. Muddy Messages Event: You’re going to camp for the first time. Muddy Message: I’ll never make the whole week. Clear Message: I’ll have to be brave. Things will work out. Frank, K.T. (2011). The Handbook for Helping Kids With Anxiety & Stress. YouthLight: Chapin, SC

33. The Three R’s • Recognizing • What, if any, negative thoughts do I have? • Examples: “It’s awful, I can’t stand it, It’s hopeless, etc” • Reality Checking • What proof is there to believe this? • Example: “There is no proof that the situation can’t be handled. It’s not the end of the world, but rather it’s a big challenge.” • Reframing Thoughts • What is the best way to think about this? • Example: “No one said it would be easy but I can work through this. I will give it my best shot.” Frank, K.T. (2011). The Handbook for Helping Kids With Anxiety & Stress. YouthLight: Chapin, SC

34. Reason for Using Activities and Art “When a child draws, or imagines, or creates, they have control over the situation; they become more powerful than their fear. When a child draws, or imagines or creates, they get the fear outside of themselves where they can see it more clearly. When a child shares the drawings and creativity with an adult, the fear almost always diminishes.” Johnson, Joy. (2003). Beautiful Dragons and Other Fears. A Workbook for Children. Centering Corporation: Omaha, NE

35. Magic Button 1. Think of a specific feeling you want to have. 2. Make a list of good experiences you’ve had or would like to have that would help bring about the feeling you want. 3. Choose a magic button. Make sure your magic button touch or movement is the same each time. 4. Picture in your mind the good experiences you’ve listed. When your pleasant feeling is strong, push your magic button. 5. Practice step four regularly. The magic button connection to the feeling you want, will become automatic. 6. Use your magic button during periods of time when you are having unpleasant feelings. This will wash them away and replace them with the pleasant feeling you want. Frank, K.T. (2011). The Handbook for Helping Kids With Anxiety & Stress. YouthLight: Chapin, SC

36. ANT Squash • Automatic………..instant • Negative…………….bad • Thoughts…………..ideas Ant Hill • It’s just awful. • It’s just too scary. • I can’t handle it. • If only things were different, I’d feel better. • It’s impossible • Life is always bad • It just figures this would happen Frank, K.T. (2011). The Handbook for Helping Kids With Anxiety & Stress. YouthLight: Chapin, SC

37. Worry Time - Worry Box

38. Draw It • Draw a picture of what you are most afraid of- this can be an object such as the classroom pet, people in costumes, or a situation such as speaking in class • Draw a second picture. This time draw the worst possible thing you can imagine happening as it relates to your fear. Example: Classroom pet biting you • Finally, draw a picture of you handling your fear successfully. Make it as positive as possible. Example: Show yourself holding the classroom pet.

39. Relaxation • Breathing techniques: You can use books like “A Boy and a Bear” • I Can Relax! A relaxation CD for children

40. Exercise • Adrenaline kicks in when we are scared or worried. • Exercise helps to trick the brain by using up the adrenaline and releasing chemicals that calm you down. • Frank, K.T. (2011). The Handbook for Helping Kids With Anxiety & Stress. YouthLight: Chapin, SC

41. Acknowledge thoughts/feelings • Help children identify feelings • Help get the thoughts/feelings outside of themselves • Challenge unhelpful thoughts/ faulty thinking • Model and Encourage Brave Behavior • Relaxation • Exercise

42. Anxiety Prevention: • Remember that children are children. Always speak to and around children using language that is appropriate to their age. • When in doubt, use your child as a barometer. They will show you what they can handle. • Don’t burden children with adult worries. Try to maintain a protective barrier around children…preserve childhood.

43. Use reasonable and age appropriate discipline and maintain reasonable expectations. • Allow children to fail and problem solve. Provide a safe place to do it. • Help your child keep things in perspective and keep a hopeful outlook. • Don’t overbook your child. They need “down-time” to relax. • Never let children worry alone.

44. Building Resilience in Children • Resilience – having the ability to cope and feel competent • Resilient children have a connection – a safe and nurturing place in which to problem solve. • Resilient children are aware of their weaknesses and know how and when to ask for help. • Resilient children have developed the ability to problem solve and make decisions based on their mistakes. • Without experiencing challenges and having the opportunity to respond successfully, children don’t build skills to cope with their world.

45. So……. allow your children to experience the joy of successful problem solving so they can feel confident in and competent to handle life’s situations and stressors.

46. Our Favorite Books