Friday, September 1, 2017

Anxiety in Kids - Part 1: Empathy and Calming

This is the first installment of a three part series about kids growing up with an anxiety disorder. It covers the physical changes in an anxious person’s body, how to achieve understanding through empathy, and how to apply your understanding to your child’s daily struggles.


The hot days are giving way to the cool crispness of my favorite season. The trees put on their warmest colors, and the nights are brisk for cozy sleeping during the extended night. Reflecting on our summer, I see my children, slippery with sunscreen, splashing and jumping in the water. Their smiles sparkle like the sunlit water as they squeal with their special brand of joy. The one thing marring this vision is the cumbersome life vests wrapping their torsos.

My girls haven’t yet learned to swim, so I think: swim lessons. I bask in these visions as I call my six-year-old daughter over and propose the idea. Instead of excitement and anticipation—she loves water!—her eyes widen with fear, and her chest rapidly rises and falls with shallow breaths.

“Will you be there!?”

“Sure, I can watch, but you’d be in the pool with an instructor and other kids.”

She flops on the floor, her voice is grating with distress, “No. No. NOOO! I don’t want lessons!!”

“What!? Why not?”

With her eyes squeezed shut, she unleashed a hurricane of questions that blew away the pleasant scent of wet rocks and damp hair; clouds darkened the sunny picture in my mind.

“But I can’t swim! What if the other kids splash me in the eyes? What if everyone is better than me? What if I sink? Can you save me if I sink? Can I wear a life jacket? Will the pool be deep? Is the water cold? Where will I change? What if the big drain at the bottom opens up and sucks me into the abyss and the purple monkey runs away with my sparkles?! No! I don’t WANT swim lessons!”

OK, the purple monkey thing was mine, but that’s how it all sounds to me.

I make the same mistake I've made countless times and try to reassure her, “You’ll be fine. They would never let a student drown.” But her panic only deepens. That’s because I have an anxious child. She gets this way whenever we are fording to new territory. If this sounds familiar to you, you may have one too. We’re in good company, the American Academy of Pediatrics estimates that close to 10 percent of children and adolescents struggle with one of the many forms of anxiety. The good news is that there are effective ways to coach your children to learn skills for managing their anxiety, whether it is General Anxiety, Separation Anxiety, Social Anxiety, or one of the other flavors.

What’s Going On?

The culprit is a part of our brain called the amygdala. In response to alarming stimuli, the amygdala triggers the fight or flight response, charging the body with adrenaline. This releases sugar into the bloodstream, which speeds up the heart and breathing, and opens airways to fuel the muscles and the brain with oxygen.

The amygdala acts automatically, without checking with the logic centers of the brain. For our primal ancestors, that threat might have looked like a prowling lion; whereas my daughter’s lion is a pool of water, an instructor, and five other six-year-olds waiting their turn to practice forward strokes and long legs.

For people with an anxiety disorder, the amygdala is overactive, firing life or death responses when facing daily challenges, new situations, or sometimes for no overt reason. It is similar to the way the immune system of a person with a peanut allergy responds to contact with a peanut. It is an inappropriate and automatic response by one of the body's protective systems.

I'm not giving you a hard time.
I'm HAVING a hard time!
All of us experience anxious moments, but it becomes a disorder when the anxiety controls the person's decision making and/or the constant strain of daily anxiety affects their physical health.

The amygdala may not check with logic centers, but our logic centers can check our amygdala. First, my daughter must recognize what’s happening in her body, use her calming techniques, then, usually later, work through the issue that caused the anxiety. It is a difficult skill set, but it gets easier with practice. Lately, I’ve noticed she doesn’t have to work so hard to control her anxiety, and fewer situations (or suggestions) trigger the flight or fight response. This confidence is powerful; more powerful than the imaginary beasties that lurk in the shadows of her mind.

How is this done?

The first task was to understand how she’s feeling.

I am afraid of snakes. When they surprise me, I have a strong fear response. However, I don’t have anxiety so I can quickly regain control. When she started getting scared about something that seemed silly to me, I would imagine a room with several loose snakes hiding out in the furniture, and someone pressuring me to go in there.

OK, I get it.

This exercise brought to light several points about how to work with her when she’s anxious.

Point 1: Don’t shame me for my fear, I can’t help it.

Point 2: Change is hard.
Sure, some form of snake fear therapy could help, but I don’t want to. Facing a fear is uncomfortable and difficult.

Point 3: I need control of the process.
If I needed to seek snake-fear therapy, it would need to be on my terms. If you tried to decide for me and pushed me into a room of snakes (even cute little harmless ones) and closed the door, I would hate you for ever. Period.

Point 4: I want to be equipped before I face my snake.
I would want to learn and be prepared with calming techniques beforehand and know that I could go at a pace that felt safe, even if it took years.

Point 5: This is for my benefit, not yours.
My fear response to snakes might seem silly or exasperating to you, but I would need to confront this issue for me. The worry of disappointing someone else would make the pressure unbearable and almost ensure failure.

How to apply these points to a child:

Resist the urge to reassure. A crucial part of this process is to abandon attempts to reassure your child. His body is readying him for a fight to the death, telling him to calm down, that it’s just a friendly little snake (or imaginary) doesn’t help. Instead, describe what you see with genuine concern, “You’re breathing really fast and your eyes are wide. You must be really worried.” Then reflect his fear back to him, so he knows that you know there’s a snake there—you know? This practice also creates awareness of his physical responses to anxiety, so he can eventually recognize it and head off the process on his own.

Inducing physical calm. Practice belly breathing through the nose, clenching and releasing muscles, prayer, and/or meditation. These techniques can help a child to shut off the flight or fight response. Following up with a physical activity is a great way to discharge the remaining adrenaline to prevent it from causing the typical anxious child tummy ache or headache.

Distraction. Before his mind can return to what caused the anxiety, coach him to engage in a mental distraction, e.g. reading, or playing a mental game like trying to remember the alphabet backward, or counting by threes, until he feels in control.

Make a list.
Once your child has refined a process that works, suggest making a list for her to keep in her pocket or backpack. It’s difficult to think clearly when under duress, and a familiar list of things to do can help be confident that she can regain control.

Recognize her effort.
If you see her belly breathing or mumbling numbers in order to induce calm, once she's regained control, notice her efforts in the same way you would with a great report card or a three-point shot.  

That’s it for now. Let that soak in then come back for the next segment in which we will explore coaching techniques to help our children work through difficult situations.

I'd love for you to add your experiences and advice in the comments.  

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