Helping Children Tame Anxiety

Mary Bolger, Ph.D.

Anxiety is An important signal “Caution” “Be Alert” A source of motivation to take on challengesNeurobehavioral

Physical make-up of our brain Maintained through reinforcement

Typical Early Childhood Worries

Separation AnxietyNew and unfamiliar situationsReal and imagined dangers (dog bites, spiders,

monsters, the dark, basements)

Typical Worries of School Aged Children

• Real world dangers (fire drills, burglars, illness)• Social acceptance• Academic and athletic performance• Risk and safety

Typical Adolescent Worries

Social acceptanceConcerns about the larger worldMoral issuesFuture success

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 temporaryWorry functions not as a signal but a way of life

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

What Unhealthy Anxiety Looks Like in Children

Headaches, stomachaches, nausea, vomitingSleeplessness, difficulty falling asleep, frequent

nightmares, unable to sleep aloneRefusal to go to school, outside the home, places in

the home or unable to be without parent for appropriate time period

Poor concentrationUnrealistic, catastrophic, pessimistic thinking patternsSeeks excessive reassurance, “what if” questions

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 learnedBest time to intervene is early because left

alone the interference from anxiety becomes more disabling

Overcoming anxiety builds competence!

Cognitive-Behavioral Therapy

Active, skilled focused intervention that is the treatment of choice

Magic Circle Thought

s

FeelingsBehaviors

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

CBT for ChildrenEducation About Worry

Worry begins in the Worry Center of the BrainWorry Center is sending mistake messagesGet in Charge! Take Control of the Worry Center!

CBT for Children

Externalization

Anxiety can be thought of as a entity separate from the child, “The Worry Bully”

Point out the child’s competenciesName and characterize the worry

CBT for ChildrenCognitive RestructuringUse self-talk (inner voice) to talk back to the worry bully

The bad feeling will go away

soon.

The worry bully is

sending a false alarm. I don’t need to

listen.

CBT for ChildrenStep by Step ExposureCompeting demands, the ART of DISTRACTIONCharting Progress

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

Interventions for AnxietyHealthy

Goal: promote mastery 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

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

10 Best Parenting Practices for Fighting

Anxiety1. Empower your child to fight back! Fight the worry not your child!2. Make a plan with your child3. Enlist the support of important people in your child’s life (teachers, school

psychologist, nurse)4. Target erroneous thoughts, select a new skill to practice, and monitor change5. Practice containment of anxiety6. Role Play7. Always go forward, no matter how small the step8. Recognize each small step as a victory over the Worry Bully9. Be a role model for problem solving worries10. Remember to make home a safe haven

How to Collaborate with Your Child’s School

Be proactive so your child is not misunderstoodFind your support contact at school Schedule a time to talkSet regular check-insKnow ThyselfEncourage therapist and teacher connection

Connecting Your Child’s Pillars of Support

Email regular updates that include parent, school, and therapist

Include outside therapists at school meetingsLook for the positive contribution of each pillarLook for therapists who will work with the school and

are flexible about how classroom plans are developedFeedback between therapist, school and home helps

guide intervention to support change for childRemember the child is part of the team!

Classroom EnvironmentPotential 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

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 behaviorCreate a classroom atmosphere that looks for the

positive