Helping Children Tame Anxiety

1. Helping Children Tame Anxiety Mary Bolger, Ph.D.

2. Anxiety is • An important signal “Caution” “Be Alert” • A source of motivation to take on challenges • Neurobehavioral • Physical make-up of our brain • Maintained through reinforcement

3. Typical Early Childhood Worries • Separation Anxiety • New and unfamiliar situations • Real and imagined dangers (dog bites, spiders, monsters, the dark, basements)

4. Typical Worries of School Aged Children • Real world dangers (fire drills, burglars, illness) • Social acceptance • Academic and athletic performance • Risk and safety

5. Typical Adolescent Worries • Social acceptance • Concerns about the larger world • Moral issues • Future success

6. When Anxiety is No Longer Protective • Your child worries immensely over insignificant situations • Your child’s automatic response is worry and avoidance • Worry response is not temporary • Worry functions not as a signal but a way of life

7. What Unhealthy Anxiety Looks Like in Children • Behavioral reaction is excessive and disproportionate to the situation • Age inappropriate clinginess, tantrums, irritability, or crying jags • Withdrawal from family, friends, peers • Excessive time spent consoling child about distress of ordinary situations, or excessive coaxing to do normal activities like homework, hygiene, meals, play dates • Avoidance or giving up are primary response to challenges • Not happy, not moving forward • Coaxing, reassurances, logical plans don’t help

8. What Unhealthy Anxiety Looks Like in Children • Headaches, stomachaches, nausea, vomiting • Sleeplessness, difficulty falling asleep, frequent nightmares, unable to sleep alone • Refusal to go to school, outside the home, places in the home or unable to be without parent for appropriate time period • Poor concentration • Unrealistic, catastrophic, pessimistic thinking patterns • Seeks excessive reassurance, “what if” questions

9. Reasons Not to Fear Anxiety • Interventions for anxiety work! • The brain’s capacity for “survival of the busiest” • Handling worry is a skill that can be learned • Best time to intervene is early because left alone the interference from anxiety becomes more disabling • Overcoming anxiety builds competence!

10. Cognitive-Behavioral Therapy • Active, skilled focused intervention that is the treatment of choice • Magic Circle

11. Components of Cognitive-Behavioral Treatment Magic Circle What you think the inner voice inside your head How you feel our thoughts result in many different feelings What you DO when feelings become very strong they start to have an affect on what you do and these actions REINFORCE thoughts and feelings

12. CBT for Children Education About Worry • Worry begins in the Worry Center of the Brain • Worry Center is sending mistake messages • Get in Charge! Take Control of the Worry Center!

13. CBT for Children Externalization Anxiety can be thought of as a entity separate from the child, “The Worry Bully” Point out the child’s competencies Name and characterize the worry

14. CBT for Children • Cognitive Restructuring Use self-talk (inner voice) to talk back to the worry bully The worry bully is sending a false alarm. I don’t need to listen. The bad feeling will go away soon.

15. CBT for Children • Step by Step Exposure • Competing demands, the ART of DISTRACTION • Charting Progress

16. Desensitization Gradual exposure helps defeat worries -builds a sense of competence -creates new patterns of learning in brain Avoidance reinforces worry behaviors -give up, stop doing things -avoid situations that might be difficult -reluctant to try new things

17. Interventions for Anxiety Healthy Goal: promote mastery Unhealthy Goal: temporary relief Avoid Repeat answers over and over Reassure, coax, accommodate to minimize distress Push, scold, let child know the behaviors aren’t normal and are annoying • Face the fear step by step • Answer anxious questions only once or twice • Learn to tolerate the discomfort • Make home a safe haven • Parent uses techniques to manage own anxiety

18. 10 Best Parenting Practices for Fighting Anxiety • Empower your child to fight back! Fight the worry not your child! • Make a plan with your child • Enlist the support of important people in your child’s life (teachers, school psychologist, nurse) • Target erroneous thoughts, select a new skill to practice, and monitor change • Practice containment of anxiety • Role Play • Always go forward, no matter how small the step • Recognize each small step as a victory over the Worry Bully • Be a role model for problem solving worries • Remember to make home a safe haven

19. How to Collaborate with Your Child’s School • Be proactive so your child is not misunderstood • Find your support contact at school • Schedule a time to talk • Set regular check-ins • Know Thyself • Encourage therapist and teacher connection

20. Connecting Your Child’s Pillars of Support • Email regular updates that include parent, school, and therapist • Include outside therapists at school meetings • Look for the positive contribution of each pillar • Look for therapists who will work with the school and are flexible about how classroom plans are developed • Feedback between therapist, school and home helps guide intervention to support change for child • Remember the child is part of the team!

21. Classroom Environment Potential targets that can be manipulated to help anxious children: • Classroom Seating • Following Directions • Classroom Management • Testing Conditions • Unstructured Times • Returns from long absences • Fire and Safety Drills • Curriculum Content

22. Teacher Awareness About Anxiety • More than 10 percent of the kids in class are anxious and have difficulty processing risk accurately • I am here for you and will do everything I can to help you • Emphasize handling emotions versus winning or being right • Firm but understanding limits on behavior • Create a classroom atmosphere that looks for the positive