Helping Children Cope with Anxiety in and Uncertain World, by Andrew Eisen

The Power of Cognitive Therapy

How can we help children who are struggling with anxiety? At the CADC, trained doctoral students in FDU’s clinical psychology PhD program administer cognitive-behavioral therapy (CBT) to youths 6 to 16 years of age experiencing a wide range of anxiety problems, including phobias (e.g., animals, environmental dangers, blood-injection-injury and public transportation), chronic worry, social anxiety, panic attacks, obsessive-compulsive disorder (OCD), and school refusal behavior. Treatment typically lasts 10 to 15 sessions. Families may be self-referred, or referrals may be made through pediatricians, schools or mental-health professionals.

Children are first taught relaxation techniques to help manage physical complaints, generalized anxiety and stress. Relaxation empowers children with a greater ability to “self calm” and to feel “more in control.” The first step is breathing exercises. Deep breathing is one of the easiest and most effective ways of helping children calm down under stress. The CADC teaches a three-step sequence of breathing in through the nose slowly and deeply, breathing out through the mouth slowly and gently, and practicing this technique until the child can relax on cue.

Next, we teach children deep muscle relaxation. Deep muscle relaxation involves first tensing different muscle groups, then relaxing them. The idea is that when children tense then relax their muscles, they will release anxiety and frustration. Some of the exercises include squeezing fists, stretching arms and tensing shoulders. The ultimate goal is to have children use both deep breathing and muscle relaxation to replace fearful and inappropriate behavior such as crying or tantrums, when faced with anxiety-provoking situations.

Once children develop the ability to calm themselves down under stress, they are ready to learn cognitive therapy and problem-solving strategies. With these strategies, children can identify and challenge irrational anxiety-provoking thoughts. This can be accomplished by asking children a series of questions that are based on commonly used cognitive-therapy techniques. Telling children not to worry doesn’t help. If anything, it invalidates their feelings. Rather, the goal is to help children recognize that their fearful thoughts have minimal if no chance of occurring. The following dialogue between a child with intruder fears (Visitor) and her mother illustrates the point:

Child: What if someone breaks into the house tonight?
Mother: Has that ever happened before?
Child: Never [sighs]. But it could.
Mother: What are the chances that someone will break into our house tonight?
Child: Not very much.
Mother: What’s the best thing that will happen tonight?
Child: No one will break in. I’ll stay in my room.
Mother: That sounds good.

But the most important component of the treatment program is exposure. The only way to overcome anxiety is to experience anxiety. We have to show children that nothing bad will happen when they confront feared situations.


Accepting Anxiety

The final step and perhaps the hardest one, involves accepting anxiety. Being afraid to feel uncomfortable, a “fear of fear,” is what triggers panic attacks. In order to minimize panic, children are taught to accept uncomfortable feelings as a form of feedback, i.e., our bodies and minds telling us that we’re stressed (rather than to assume catastrophic outcomes). We ask children to repeatedly say to themselves, “I don’t like it when I feel nervous or scared, but it is OK.”

The same is true with insomnia. We cannot force ourselves to fall asleep. When we accept that it is okay to have restless nights periodically, and use this time productively or consider it much needed “quiet time,” we fall asleep a great deal sooner.

Everyone experiences anxiety. At the CADC, we explain to children that anxiety is a good thing. It simply means you’re challenging yourself. You’re doing something that is unfamiliar or does not come naturally. We help children understand the three A’s:

Anticipate uncomfortable feelings,
Accept uncomfortable feelings rather than be afraid, and
Appreciate the lack of connection between uncomfortable feelings and actual events.

Our research shows that, while we may not be able to completely eliminate anxiety, it can be well managed. In addition, later adjustment problems in adolescence and young adulthood can be short-circuited by early intervention.

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Opening Page | When It's More Than Anxiety
When to Seek Professional Help | About the Author

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