By Emily Hanlon
If you've read any of my blogs on anxiety, you'll already be familiar with the different presentations of anxiety. To briefly recap: anxiety is the most common mental health condition that affects an individual’s ability to concentrate, sleep, and carry out basic daily tasks. Anxiety affects 1 in 10 children and is the most common type of mental health condition in both children and adults.
When I work with adults, the first step I take in helping them manage their anxiety, is to give them as much psychoeducation as possible. A thorough understanding of anxiety is so important, as without understanding a problem fully, how are we able to make it better? Think of it like you would a medical problem. You have tummy pains and you go to your local doctor. However, your doctor is unable to help you properly until he/she knows exactly what is causing the tummy pain and why. It is the exact same with anxiety. I feel like this step is often missed with children, and it is so important!! When it comes to my first few sessions of anxiety management therapy with children, I tend to follow the same basic structure:
1. A full session of rapport building. A child is not going to open up to me about anything unless they actually know me. Sometimes, it can take 3-5 sessions for a child to feel completely comfortable and that is ok. This is often tricky for parents to understand at times, as they feel like money is being wasted on me simply ‘playing’ with their child. That is why it is important to be forthcoming with parents about what to expect in the very first session.
2. Psychoeducation on anxiety. This can go for 1-3 sessions, and typically follows this pattern:
- Some form of anxiety-related story. For younger children, I may read them the When I’m Feeling Scared book by author Tracey Moroney (link to this book series can be found later in the newsletter under ‘useful links.’) For older children, I might use a relevant movie character or use a comic book, depending on the child’s interests.
- I’ll then try and bring awareness to the worries with children, by saying something like ‘When I am feeling worried, I can feel my heart rate increase, my face go hot, and my breathing get fast. Can you think of any ways that your body starts to let you know you that it is feeling worried?’ If I’m doing this in a group, or with a younger child, I may even trace their body on a big piece of paper (or the tinted window in my office…shhhhh don’t tell my boss!), and ask them to draw/circle where they feel their worries. This isn’t necessary, it just makes it a little more interesting and interactive.
- I will then share, what I like to call the Alarm Bell Metaphor of anxiety (this can be used for anger and sadness also). The script roughly goes something like this: ‘Have you ever heard an alarm go off? Maybe a car alarm, house alarm, or fire alarm? They’re pretty loud right!! The reason they are so loud, is to let us know that there is a problem that we need to respond to. In our last activity, you showed me all the places in your body that you feel worry. I want you to think of these signals as small alarm bells going off in your body to let you know that you are feeling worried. Together, you and I are going to come up with some cool and fun strategies to help turn this worry alarm off whenever your body switches it on, does that sound ok?’ I really like this metaphor because it is a simple way for children to visualise exactly what goes on in their body and how we are going to help manage it.
- The last step of my ‘psychoeducation’ phase of anxiety is to explore emotional identification and awareness. I do this in a number of ways, using Bear Cards (linked under useful resources), that are these adorable cards with bears who have different feelings. I might also read a book with a child and pause intermittently to ask how they think the character is feeling and why they feel that way. The last way I do this, and the biggest crowd pleaser, is to choose an age appropriate video on Youtube. I pause the video where appropriate, and ask the child how they think the character is feeling and why they feel that way.
- It is only after this, that I will explore a therapeutic avenue and coping strategies, typically using either a CBT (cognitive behavioural therapy) or mindfulness approach.
Summary
Anxiety disorders can be treated in a variety of ways. However, without laying the foundation of a solid understanding of anxiety, it becomes quite difficult for children to make therapeutic gains.
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