Would you like to help your child and teen clients manage anxiety? This post will share some of the inspiring guidance Lynn Lyons, LICSW, provided in her “Anxious Kids, Anxious Parents” workshop at the 2017 Psychotherapy Networker Symposium.
We all experience stress and worry. Sometimes emotional stress can cause pain or other symptoms such as headaches, repetitive stress syndrome, stomach upset and more. Both the emotion and the ways in which it manifests itself in our body are uncomfortable.
The way we typically address anxiety is by focusing on what we’re anxious about and trying to get rid of the unpleasant symptoms and feelings. In light of uncertainty being an inevitable condition of life, Lyons advocates for preventative steps in which you focus on the worry process itself, build skills and embrace the unknown.
She recommends providing psycho-education to your patients (and their parents) about what anxiety is and how it impacts the body and thoughts, as well as six key strategies. These appear below in both text and graphic form.
One qualification to her approach is that it is not applicable for individuals in the midst of trauma.
Kid-Friendly Approach to Explaining Worry Cycle
Lyons suggests using your very first session with the child and parents (ideally two hours long) to say something like:
Anxiety looks overwhelming. It may lead to diarrhea, vomiting, screaming, temper tantrums, hives, migraine headaches, biting and kicking.
Once you move away from all of anxiety’s drama, it is simple. It does the same thing over and over again.
Anxiety in a nutshell is “blah blah blah” and you can’t handle it. ” Blah blah blah” refers to all the different worries that you may experience.
In front of me is this awesome [fill in the blank] who has [fill in the blank] going for him and [fill in the blank] going for him. And then worry shows up and worry is like: “you can’t handle it, you can’t handle it.”
Worry wants to convince you that you can’t step forward, that avoidance, safety and certainty are your best options. This is why worry and I don’t get along because I see your strengths and creativity.
I’m pulling you out of worry’s game. Worry is looking for certainty and comfort. Anxiety wants to know everything ahead of time and it wants to feel comfortable.
Also, Lyons recommends providing some psycho-education on the physiological piece (please see worry cycle in image below).
6 Key Strategies
- Expect to worry
- Talk to your worry
- Be unsure/uncomfortable on purpose
- Bridge back to your successes
- Take action
1.Expect to Worry
Of course, you’re going to worry. Things going wrong are a normal part of growing and living. Worry will appear whenever you try something new. It will also appear when you’ve managed to get through an awful or traumatic experience, and you’re triggered because what’s happening now reminds you of what happened in the past.
The goal is not to get rid of the natural process of worry, but rather to change how you or your patient will respond to it. Roll the eyes at worry! Demote it to normal based upon the circumstances, or the process of growing.
2. Talk to Your Worry
Lyons advises both parents and their children to create a relationship with their worry part by giving it a name. Also, give permission for the child to tell the parent when the parent’s worry part is in charge: “Hey, Mom â€“ [worry name] is in charge.” This approach enables you to interrupt the parental worry pattern impacting the child.
Focus on how the worry works (as illustrated in the Kid-Friendly Approach to Explaining Worry Cycle section above) and avoid giving reassurance that whatever your client fears won’t happen. This reassurance only strengthens the worry.
When worry emerges, recommend that the parent and child talk back to the worry and say: “That sounds like worry to me.” Review talking back plan and provide parents with coaching in this area.
3. Be Unsure/Uncomfortable on Purpose
Embrace uncertainty. Encourage your clients to purposely step into uncertain and uncomfortable situations and handle them so as to retrain their brains.
Guide both the children and their parents to perceive and mange their physical symptoms through a different lens. If they stop telling their alarm center that there’s danger, it will learn on its own not to push the danger button. They keep on entering uncomfortable situations not to prevent worry from showing up, but rather to become comfortable facing worry.
Empower yourself with statements such as:
- I’m willing to feel uncomfortable (or unsure/uncertain)
- I’m willing to be brave and do what needs to be done
Teach kids simple breathing exercises to reboot their brains (getting their prefrontal cortex, the thinking part of the brain, back online). Relaxation exercises help with understanding the connection between the mind and body. They also help the children develop mastery and flexibility with the inevitable ups and downs of life. That said, just breathing for individuals with Obsessive Compulsive Disorder or strong somatic symptoms is insufficient; they will likely require hypnosis.
With young kids, it is helpful to offer small rewards. For example, they may earn a point for each anxious situation they face and after a certain number of points are earned, they get something, regardless of how long it takes. (Requiring a changed behavior seven days in a row would be too much pressure.) It is recommended that the rewards be very concrete and small such as an extra story with a caregiver, one candy or a piece of bubble gum.
On the parents’ side, they need to be able to tolerate the uncertainty from doing this work. Guide them to practice relaxation exercises and being calm when their child escalates. This advice will help them be a warm, supportive and loving presence.
5. Bridge Back to Your Successes
Anxious kids and parents will tend to forget their successes. For example, an anxious kid was able to get on the bus yesterday for school but the following day(s), the child claims an inability to do so.
Help your patients understand the common learning pattern we all share. Our brain learns from experiences. When something is new, we start out not knowing and feeling uncomfortable. It feels awful and we make mistakes and slowly we become masterful.
Connect your clients with some past challenges or uncertain situations that they handled. You can give an example of your own and ask them:
- What past challenge(s) or uncertain things have you handled? or
- What can you do now that you couldn’t a few months (or years) ago?
6. Take Action
Lastly, create a written plan and provide homework assignments for both the parents and child (things for them to do as a family in between sessions). It is important for the kids and their parents to be on the same team when the worry shows up.
Lyons recommends emphasizing problem-solving, focusing on the worry process vs. the content, and embracing uncertainty, to help your anxious children and parents succeed. Provide support and hope. Also consider sharing stories about what other kids are worrying about and how they are handling it to engage your young clients. Success builds rapport!
What strategies have you found successful in helping children address their anxiety?
Lyons, L. (2017, March 21). Anxious Kids, Anxious Parents. 2017 Psychotherapy Networker Symposium Session# 7170-218.
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