Overcoming Anxiety in Children & Teens E-Book

Jed Baker

• Herausgeber: Future Horizons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 130

Veröffentlichungsjahr: 2016

Beschreibung

The key to this book is that it outlines both the science and art of anxiety therapy. The science of overcoming anxiety is using the well researched approach called gradual exposure therapy which involves helping individuals gradually face their fears. The art of therapy is figuring out how to actually convince someone to face their fears. Jed describes motivational techniques, cognitive behavioral strategies, exercises, relaxation and mindfulness guides to lower anxiety to the point where individuals can begin to confront their fears . The book covers: simple phobias, social phobia, selective mutism, separation anxiety and school refusal, panic disorder, obsessive compulsive disorder, somatic symptom disorder and/or illness anxiety disorder, generalized anxiety disorder, perfectionism, and other common fears.

Leseprobe

Overcoming Anxiety

in Children and Teens

Jed Baker,Ph.D.

Arlington, Texas

All marketing and publishing rightsguaranteed to and reserved by

721 W. Abram St

Arlington, TX 76013

Toll-free: 800-489-0727

Phone: [phone]

Fax: [phone]

Website: www.FHautism.com

E-mail: [email protected]

All rights reserved.

©2015

Printed in U.S.A.

Cover design: Maddie Coe

Interior design: David E. Brown

No part of this publication may be reproduced by any means without the express written permission of Future Horizons, Inc.

Children and teens depicted in photographs are models, not clients.. Photographs and graphics used under license. iPad photograph in chapter 6 by Michael Coté licensed under Creative Commons license 2.0. See https://creativecommons.org/licenses/by/2.0/legalcode. Photograph modifi ed by the publisher…

ISBN 13: 978-1-941765-14-2

Contents

Introduction: Why This Book?

Who should read this book?

How to use this book

1    Some People Are More Anxious than Others

Genetics and early temperamental differences

Effects of a sensitive alarm system on thinking style

Environmental stress

Parenting style

2    Research Versus Practice: The Science and Art of Treatment

The Science of Cognitive Behavioral Treatment (CBT)

The science of neurobiological treatments

Reducing environmental stressors

The art of treatment in real practice

3    Getting Ready for Treatment: Motivating Change

Step 1: Increase positive self–awareness

Step 2: Learning about anxiety and FALSE ALARMS

Step 3: Accept the presence of anxiety, but learn not to be controlled by it

4    Identifying Fears: Creating a Fear Ladder

Step 1: Identify the type of feared situations

Step 2: Create a “fear ladder”

Step 3: Give the client control of moving up the ladder

Step 4: Create a way to rate one’s own level of anxiety

Step 5: Reward facing fears

5    Developing Tools to Lower Anxiety and Face Fears

Calming your worrisome thoughts (CBT strategies)

Calming your mind and body through exercise

Meditation, mindfulness–based stress reduction, relaxation

Putting it all together: Calming and facing fears.

6    Adapting Treatment for Less Verbal Children with Autism

Identifying their fears

Deciding whether to do exposure–based treatment or to simply change the environment

Environmental supports for problems waiting, stopping something fun, or dealing with a change

Modifying sensory challenges

Modifying difficult demands

Set up a fear ladder when it is not sensible to avoid a situation

Explore tools to promote a relaxed state

7    Simple Phobia

8    Social Anxiety

9    Selective Mutism

10    Separation Anxiety and School Refusal

Jonathon

Mandy

11    Panic Disorder

12    Obsessive Compulsive Disorder

13    Somatic Symptom Disorder, and/or Illness Anxiety Disorder

14    Generalized Anxiety Disorder

A Case of Perfectionism and College Admissions Anxiety

15    Other Common Fears

Fear of others’ aggression

Fear of unexpected changes in schedule or routine

16    Summary of Key Points

Treatment starts with motivation

Identify specific fears and create a fear ladder

Develop tools to help cope with and face fears

Consider the big picture!

The ultimate goal

References

Illustrations

Introduction: Why This Book?

There are many good books on helping children and young adults with anxiety. Numerous works spell out the key treatment components of programs proven to be effective in helping individuals face their fears and overcome debilitating anxiety. What they all have in common is the well–researched treatment protocol known as “gradual exposure.” Study after study has shown that if you can get anxious individuals to gradually face their fears, their anxiety will decrease, and they will no longer be controlled by their fear. That is the science of treatment, to gradually face fears. That being said, how do you get someone with overwhelming anxiety to do just that? The art of treatment is figuring out what to do or say to persuade someone to gradually face his or her most dreaded fears.

Cognitive behavioral treatments offer some strategies to help children and teens face their fears. The primary method is to challenge anxious thoughts that serve to maintain fears and then provide rewards for gradually facing fears. For example, if a girl worries that a robber will come get her at night and refuses to be alone in her room, treatment would include reviewing the actual probability of such events to help her see that logically this is not likely to happen. The child would then be rewarded for gradually spending more and more time alone in her room. Treatment might also include strategies to help the body be calmer, including relaxation and physical exercises. All of these are tools to help an individual face fears.

The general idea of challenging anxious thoughts, using rewards and relaxation strategies to face fears is clear. What is not as clear is the exact words and strategies used to persuade a client to participate in treatment. In this book, I describe how to “win over” children and teens to partner with us in facing their debilitating fears. I try to give real life examples of the actual words and strategies used to motivate individuals to face a variety of common anxiety situations. Specifically, I describe what to do for simple phobias (e.g., fear of very specific things like dogs or bees); social anxiety; selective mutism; separation anxiety and school refusal panic disorder; obsessive compulsive disorder; somatic symptom disorder or illness anxiety disorder; generalized anxiety disorder; fear of others’ aggression; anxiety due to unexpected changes; and fear of mistakes (perfectionism).

Who should read this book?

If you are a parent, teacher, or therapist with a child or teen whose anxiety interferes with the ability to function, then this book can help. Children with anxiety may not simply present with anxiety issues alone; they may have social or learning challenges that can lead to anxiety. They may have difficulty controlling impulses and their attention, which can lead to school and social difficulties that, in turn, lead to anxieties. A child may have an autism spectrum disorder that can contribute to difficulties with change, sensory challenges, and social and learning challenges. These can all contribute to heightened anxiety.

Many of the treatment strategies described in this book are appropriate for use with verbal children. You can use words to help them understand their anxiety and manage it. Exposure therapy (gradually facing one’s fears) is the core component of anxiety treatment. For this, a facility with language is not needed. Chapter 6 shows how to adapt treatment to help children with more language challenges face their fears and lower their anxiety.

How to use this book

Those working with anxious children and teens, should learn about the general components of treatment described in chapters 1–5. For those working with children with severe autism, or children with less language comprehension, chapter 6 covers how to adapt treatment strategies with limited language.

After readers learn about the general components of treatment, they can look through chapters 7–15 to find case examples showing how treatment can be applied for specific types of fears.

In many ways, the strategies described in this book are not meant to be one–time strategies to “fix” an anxiety issue. These are tools one uses for life to help manage anxiety. This is not unlike the dieting world. Anyone can get on a diet to lose weight, but learning to eat better and exercise more are lifestyle changes that create lasting health. Those who struggle with anxiety issues, as described in chapter 1, may have a more sensitive system prone to anxiety reactions. Learning lifelong skills to manage these reactions is better than a quick, temporary fix.

The goal is to learn ways to manage anxiety so that the anxiety does not manage the individual. We all feel anxiety from time to time, yet we do not want it to lead to a pattern of avoidance and limit what we can do in our lives.

1

Some People Are More Anxious than Others

All of us have an alarm system to help us survive in the face of perceived danger. When a significant threat is detected, we are wired to react automatically with an intense emotional response to fight, flee, or freeze as if our lives depended on it. Daniel Goleman, in his book Emotional Intelligence, refers to these moments as a state of being “hijacked by emotions” (Goleman, 1995). It is as if the emotion center has taken over the rest of the brain so that we don’t have easy access to our reasoning ability.

Some people refer to this as the “crocodile” or “reptilian” brain taking over. The human brain has both the remnants of the old reptilian brain (particularly the limbic system), which controls this “fight–or–flight response,” and the newer, human part of the brain, called the neocortex, which is associated with planning and reasoning ability. When threatened, our reptilian brain may cause us to flee, fight, or freeze without the cerebral cortex intervening (i.e., without our ability to reason or think about what we are doing). This quick, non–thinking response certainly has survival value. In a truly dangerous situation, we may not have time to contemplate our actions. We swiftly move away from the danger, hide out, or fight back.

For example, when walking down the street, if a car suddenly veers off the road onto the sidewalk into your direction, this is not a time to reflect. You must move quickly to a safer place. This is a TRUE ALARM. Yet in a world where perceived threats may not always be life threatening, the fight, flight, or freeze response can lead to FALSE ALARMS, causing us to become emotionally reactive when no actual danger is present.

Why would some people have a more sensitive alarm system that may lead to more false alarms?

Genetics and early temperamental differences

Although anyone can feel threatened and become emotionally reactive, some of us may be born with a more sensitive alarm system than others. Genetic studies show that anxiety disorders do run in families, and if an individual has an anxiety issue, there is a greater likelihood that some family members also have had anxiety issues.

Long–term studies (from infancy through childhood) show that most individuals are born with a recognizable and persistent temperament. Some folks are easy going, others quite slow to warm up, and others more likely to show greater negative emotional reactions to new situations. Thomas and Chess (1977), in their now–famous studies of newborns, examined nine key dimensions of behavior:

1.  Activity level

2.  Rhythmicity (e.g., schedule of feeding, sleep, and elimination)

3.  Approach/withdrawal patterns

4.  Adaptability

5.  Threshold of responsiveness

6.  Intensity of reaction

7.  Quality of mood

8.  Distractibility

9.  Attention span and persistence

Based on these nine dimensions, Thomas and Chess were able to characterize about 60% of children into one of three categories and show that these patterns of behavior were often quite stable over time. The first category is the “easy child” who can accept frustration with less fussiness, maintain a more positive mood, and easily adapt to change.

The second is the difficult child. He shows a more negative response to new situations and has more intense crying and tantrums when frustrated. The last is the “slow–to–warm–up child.” He initially shows a mild negative reaction to new situations, but gradually adapts with more exposure to those situations. Both the “difficult child” and “slow–to–warm–up child” are more likely to be prone to anxiety and emotional reactivity. Although these patterns seem to be stable characteristics, parental response can alter a child’s temperament. For example, work by Kagan (1994) shows that timid youngsters who are gently encouraged to be more outgoing by their parents—and thus are gradually exposed to new situations—become less fearful.

Although having a difficult or slow–to–warm–up temperament does not mean one has a “behavior disorder,” certain disorders are associated with greater levels of emotional reactivity. Children with anxiety disorders, attention deficit hyperactivity disorder (ADHD), and some mood disorders (such as bipolar disorder) may have greater difficulty controlling their emotional reactions. In addition, those with autism spectrum disorders and sensory processing disorders may have greater challenges in handling new situations and prefer repetitive routines.

Effects of a sensitive alarm system on thinking style

Those who are more emotionally reactive to potential dangers will often develop hypervigilance to such threatening situations. In other words, they may tend to focus much more on the potential for harm and anger. Their thoughts tend to be dominated by anxious worry because they frequently anticipate their own reactivity. Studies show that anxious individuals are much more likely to develop an anxiety–prone cognitive style that overinflates the probability and severity of anticipated negative events (Uhlenhuth et al, 2002; Rapee et al, 2008).

The good news is that treatment can potentially reverse these negative thinking styles. Exposure therapy can help individuals realize that dreaded expected events do not happen with the probability or severity anticipated.

Environmental stress

In addition to inborn temperament and thinking style, certain environmental factors can contribute to heightened sensitivity to threats and fear. Traumatic stressful events can lead to a variety of negative outcomes, including heightened anxiety, depression, and subsequent drug use.

Not all stressful events lead to trauma. Research suggests that prolonged inescapable stress leads to worse outcomes. For example, getting robbed once could certainly be traumatic, yet living in a war zone or in certain crime–ridden environments exposed to constant stressors with no way to escape is likely to have a more traumatizing effect. Chronic family conflicts, abuse, or ne–glect are examples of prolonged stressors that can raise the risk of anxiety disorders.

Parenting style

Protecting children from REAL DANGERS is crucial. However, when families enable their children to avoid non–dangerous, yet feared, situations, they create a higher risk of developing problematic anxiety. For example, allowing kids to avoid going to a supportive school or interacting with kind peers can lead to worsening anxiety.

If parents have their own high levels of anxiety, this can influence how much they allow their child to face his or her fears. It may be more difficult for parents with high levels of anxiety to tolerate seeing their child feeling the same way. The tendency may be to protect the child from this discomfort. With education, parents can learn when a situation is a true danger, and when it would be better to encourage their children to face a feared situation.

2

Research Versus Practice: The Science and Art of Treatment

Researchers and therapists often have different goals, yet both inform each other. Researchers often seek to evaluate a treatment approach; therapists seek to help a particular client. When doing research, certain clients may be ruled out if they do not fit the criteria for the study. As a clinician or a parent, the client or kid you see is the one you treat. As researchers design and evaluate treatment protocols, therapists and parents have to modify those protocols to fit the needs of their clients or kids. Thus, there is the science generated from the research, and the art of practice where such treatments are used in real life settings.

The Science of Cognitive Behavioral Treatment (CBT)

Much research (see Barlow, 2004) has demonstrated that a key component of effective anxiety reduction is gradual exposure to the feared situation until an individual learns that nothing bad happens. When a person has a false alarm, the only way to learn that it is a false alarm is to confront the situation long enough to discover it is safe. Therefore part of the science of anxiety reduction is a behavioral treatment called “gradual exposure therapy.”