Anxiety Coach by Mayo Clinic child psychologist Stephen P. Whiteside, Ph.D, L.P, offers families a self help method for using exposure therapy to understand, situate and reduce mild, moderate or severe anxiety that is holding a child or teen back from living a full, healthy everyday existence. The book sets out criteria for anxiety disorders, obsessive compulsive disorder and phobias, surveys all the ways a parent can seek professional help and a timeline for such, and then offers a simple, comprehensive guide to using the tools of exposure therapy in a child’s everyday life, to reduce distress, worry and symptoms.
The following excerpts from Anxiety Coach look first at every parent’s initial pressing question when their child or teen starts showing too many signs of being anxious: how do you know the difference between organic, life protecting anxiety and a debilitating anxiety disorder? The second excerpt touches on what exposure therapy is and uses a tangible, everyday example to show how a family may employ the easy to follow direction of Anxiety Coach to help their child or teen get on top of an anxiety disorder that has been preventing them from going about their daily lives.
Is my child showing signs of healthy anxiety or symptoms of an anxiety disorder?
Feeling anxious encapsulates two separate but related feelings: being scared and being worried. Being scared, or afraid, is an immediate experience, in which we think that something bad is about to happen right here, right now. This is how we might feel when we stand up to give a presentation. Worry, on the other hand, is anxiety about something that might happen in the future or possibly happened in the past. This might include your kid worrying they will fail an upcoming test or that they said something wrong at school yesterday and everyone is talking about them.
There are important differences between immediate fear and future worry. What combines them is that they both involve feeling nervous that something bad will happen. Being afraid, worried, or nervous is normal and an important part of being human. If you never felt afraid, worried, or nervous, that would be a problem because these feelings help keep us safe.
Does that mean anxiety can actually be good for us?
In short, yes.
Anxiety, fear, nervousness, and worry are essential and serve as safety tools and, in the face of potential danger, alarm bells. We need these feelings to survive. They help us stay safe and do things now to prepare for the future. Anxiety reminds us to look both ways when we cross the street. It helps us leave situations where we can potentially be hurt. Worrying about not doing well at school motivates your child to study hard, check their answers, and turn their homework in on time. Worrying that your child is going to have a bad day if they don’t get enough sleep or have a good breakfast helps you as a parent make the decision to get the kids to bed on time or run to the grocery store because the granola’s run out, even if it would be more fun to stay up and hang out with them a little bit more.
Anxiety motivates us to take action by activating our sympathetic nervous system, which revs up the body to protect us by making our heartbeat and breathing faster and releasing adrenaline that can result in making us hyperalert and full of energy. This is called the fight or flight response, and it’s a valuable mechanism if you are actually in danger. If you go on a family camping trip and wake in the night to hear a noise in the woods that may be the sound of a wild animal, your attention needs to be sharply focused for any sign of movement, and your body needs to be ready to physically protect your family. Another response to danger is freezing, in which we stay perfectly still in the hope that if there is something out there in the woods, it won’t see us and will move on.
An anxiety disorder, however, involves a child being more nervous in a situation than most other kids would be. If 99 kids find making a presentation to their class unpleasant but they know they can do it, and one kid can’t sleep for a week before the presentation, begs to get out of it, and stays home from school the day of the presentation with a stomachache, that one kid likely has an anxiety disorder.
Let’s take the example of a 10 year old boy called Michael. His neighbor has a German shepherd who loves people, and almost everybody in the neighborhood knows and loves this dog. However, this dog gets excited and barks a lot if she feels she is not getting enough attention. If Michael is afraid of that dog when every other kid on the street likes her and thinks she’s cute, then he may have an anxiety disorder; he is afraid of something that is generally, by social consensus, considered safe, and that other kids in the neighborhood are not afraid of. On the other hand, let’s say there’s another neighbor with a dog, and this dog is poorly trained, generally mean, and everyone on the street knows that it once bit the mail carrier. They feel that, given that background, it really ought to be kept behind the fence. Most people who live on this street make sure to stay away from this dog and feel nervous passing by when it aggressively barks at them from the front yard. If Michael is afraid of this dog but not of the German shepherd, his fear is not a sign of an anxiety disorder. Instead, he’s reacting to a stressful situation. He still feels nervous, worried, or scared, but so do other adults and kids who live on the street when they encounter this dog.
Differentiating between whether a child has an anxiety disorder or is responding to a stressful situation is one of the main things that needs to be established before beginning treatment with exposure therapy. If a child has an anxiety disorder, we have to help them face their fears using exposure therapy so they learn through their own experience that the thing they’re afraid of is not actually dangerous.
If instead the child is experiencing anxiety due to a stressful situation, then we need to help fix the cause of the stress or avoid the situation altogether, like all residents on the street joining forces to petition the neighbor with the mean dog to keep the dog leashed, fenced, or supervised when it’s on the front lawn and visible to passersby.
How can exposure therapy help my child’s anxiety get better?
Treating anxiety disorders with exposure therapy, an action focused form of therapy, involves a child or teen facing their fears and learning through lived experience that what they are afraid of is unlikely to happen and that they can in fact handle feeling anxious. The rationale for using exposure therapy arises from how we understand anxiety disorders and how your kid’s fears fit into the avoidance cycle. With an anxiety disorder kids are more nervous, worried, or afraid of a situation than we would expect them to be because they expect something bad will happen that they cannot handle. By avoiding the situation or doing rituals to cope, they never get the chance to learn that the situation they fear isn’t as bad as they thought it would be and that they can in fact manage it. Avoidance provides relief in the moment but keeps kids trapped in a cycle of fear and avoidance. Exposure therapy breaks this cycle.
To illustrate what we mean, let’s revisit 10-year old Michael and his fear of dogs. Michael is playing in the front yard when suddenly his neighbor’s German shepherd barrels out the front door. As he has taught himself to believe, Michael immediately thinks the dog is going to bite him and becomes afraid. Rather than running inside like he usually does, Michael decides to face his fear. He stays outside in his yard and watches as the dog runs across the neighbor’s lawn to inspect a tree, turns around, and starts barking at him. After about ten seconds of barking, the dog quiets down, stretches out, and lies down on the grass. All this time Michael stands still, his heart pounding. Slowly the pounding in his chest settles and his anxiety eases. He realizes the dog is not going to bite him and isn’t even all that interested in him. By remaining in the yard and facing his fears, Michael took an initial step toward breaking the cycle of avoidance that had, until now, prevented him from enjoying playing outside like other kids.
This scenario illustrates a fundamental principle of exposure therapy—Michael took action despite his anxiety. He stayed outside and changed his usual pattern of behavior and only after that began to feel better. It would be infinitely easier if kids could stop worrying and feeling scared first and then face their fears. But unfortunately, it doesn’t work that way, because we can’t control our thoughts and feelings. We can, with dedicated effort, control our actions. And if we take action and face our fears, our feelings and beliefs can change based on these new experiences.
This is only Michael’s first step toward overcoming his fear of dogs. Exposure therapy and all its carefully planned treatment steps, involve a lot of repetition. Michael can’t simply stay in the yard one day and then announce that he has triumphed over his anxiety. To overcome his fear, Michael needs to stay out in the yard on multiple occasions when the neighbor’s dog is outside. And then the next time the neighbor is outside Michael actually enters their yard and pets the dog. Eventually he may feed the dog a treat or help walk the dog around the block. And then, to fully master his fear of dogs, he will need to pet many different dogs in many different situations until he learns from his own experience that he can handle most dogs most of the time. To get there, he will need to practice, repeat, and practice some more. Exposure therapy, through this process of exposing a child or teen to their fear in a controlled, graded strategic way, can often achieve a decrease in anxiety within three months, bringing a rapid solution to a family.
Relevant reading
Back and Neck Health
Back and neck pain are common complaints. When you think of all of the work that your back and neck do each day — constantly moving, bending and twisting as you go about your day-to-day activities — it’s not surprising that problems develop. But just as doing too much can…
Want more children’s health and parenting information? Sign up for free to our email list.
Subscribe Open parent optin subscribe modal
