• Learning to Manage Anxiety

     

    Executive Skills Needed:  1. Emotional Control, and 2. Flexibility.

    Steps to Take:  

    1. Together with your child, make a list of the things that happen that cause your child to feel anxious. See if there’s a pattern and whether different situations can be grouped into one larger category (for example, a child who gets nervous on the soccer field, when giving an oral report in school, and playing in a piano recital may have performance anxiety—that is, he/she gets nervous when he/she has to perform in front of others).
    2. Talk with your child about what anxiety feels like so he/she can recognize it in the early stages. This is often a physical feeling—“butterflies” in the stomach, sweaty hands, faster heartbeat.
    3. Now make a list of things your child can do instead of thinking about the worry (called replacement behaviors). These could be three or four different things your child can do that either are calming or divert attention from the worries.
    4. Put these on a “Worry Board” (an example follows).
    5. Say to your child, “Let’s pretend you’re getting nervous because you have a baseball tryout and you’re worried you won’t make the team. Which strategy do you want to use?” (See the more detailed practice guidelines that follow.)
    6. After practicing for a couple of weeks, start using the process “for real” but initially use if for only minor worries.
    7. After using it successfully with minor worries, move on to bigger anxieties.
    8. Connect the process to a reward. For best results, use two levels of rewards: a “big reward” for never getting to the point where the Worry Board needs to be used and a “small reward” for successfully using a strategy on the Worry Board to deal with the trigger situation.

    Practice the Procedure:

    1. Use real-life examples. These should include a variety representing the different categories of triggers.
    2. Make the practice sessions “quick and dirty.” For example, if a coping strategy is to practice “thought stopping,” have the child practice the following self-talk strategy: Tell him/her to say, loudly and forcefully (but to herself), “STOP!” This momentarily interrupts any thought. As soon the child has done this, have him/her think of a pleasant image or scene. Practice this a few times daily. When the problem or anxiety-provoking thought occurs, use this strategy and continue repeating it until the thought stops.
    3. Have your child practice each of the strategies listed on the Worry Board.
    4. Have brief practice sessions daily or several times a week for a couple of weeks before putting it into effect.

    Modifications / Adjustments:

    1. Possible coping strategies for managing anxiety might include deep or slow breathing, counting to 20, using other relaxation strategies, thought stopping or talking back to your worries, drawing a picture of the worry, folding it up, and putting it in a box with a lid. Listening to music (and maybe dancing to it), challenging the logic of the worry. For further explanation of these, type “relaxation for kids” into a search engine and check out the web sites that come up. Another helpful resource is a book written for children and parents to read together: What to Do When You Worry Too Much, by Dawn Huebner, PhD.
    2. Helping children manage anxiety generally involves a procedure sometimes called desensitization in which the degree of anxiety to which the child is exposed is low enough so that with some support he/she can get through it successfully. For example, if a child is afraid of dogs, you might begin by asking him to look at a picture of a dog and model what he might say to himself (“I’m looking at this picture, and it’s a little scary when I think of there being a real dog, but I’m managing okay, I’m not getting too scared. I can look at the picture okay.”) The next step might be to have the child be inside a house with a dog outside and talk about what that’s like. Very gradually, bring the dog closer to the child. A similar approach can be used with other fears and phobias. The exposure has to be very gradual; you don’t move to the next step until the child feels comfortable with the current step. The critical elements in guided mastery are physical distance and time—in the beginning, the child is far removed from the anxiety-provoking object and the exposure is for a very short time. The distance is reduced and the time increased gradually. It’s also helpful to have a script (something the child is to say in the situation: and a tactic he can use (such as thought stopping or something he/she can do to divert his attention).
    3. The kinds of worries or anxieties that this approach will work with are: (1) separation anxiety (being unhappy or worried when separated from a loved one, usually a parent), (2) handling novel or unfamiliar situations, and (3) obsessive or catastrophic things (worrying about something bad happening). This approach should work on all three, although the coping strategies for each may vary.

     

    SAMPLE  WORRY  BOARD

    I Get Worried When…

    1.       I have a test at school

     

    2.       I have to kick a soccer ball in a game

     

    3.       I have to talk in front of a group

    When I Get Nervous My Body ….

    1.       My heart beats too fast

     

    2.       My stomach feels queasy

     

    3.       I have trouble thinking clearly

    When I’m feeling Worried or Nervous, I Can …

    1.       Draw a picture of my worry and then tear it up

     

    2.       Use a relaxation technique—deep breathing, listen to music, or positive imagery

     

    3.       Talk back to my worries

     

    MY  WORRY  BOARD

    I Get Worried When…

    1.        

     

    2.        

     

    3.        

    When I Get Nervous My Body ….

    1.        

     

    2.        

     

    3.        

    When I’m feeling Worried or Nervous, I Can …

    1.        

     

    2.        

     

    3.        

     

    From Smart but Scattered by Peg Dawson and Richard Guare.  Copyright 2009 by The Guilford Press. P. 177