By Caraline McDonnell and Cal Chertavian
If you notice that your child is often nervous or worried, has a hard time separating from caregivers, acts differently around peers, or can’t speak in school or in public, it might be time to seek out some support from mental health professionals. Identifying what makes your child anxious, and understanding how this anxiety impacts them, is the first step to diagnosing anxiety. An assessment with a mental health professional can provide some clarity on whether your child qualifies for an anxiety disorder diagnosis, and if so, what exactly makes them anxious. Following an assessment, your clinician will help to identify a treatment plan that will work best for your individual child and family.
Evidence-Based Anxiety Interventions
Regardless of the type of anxiety disorder your child may have, proven treatments often look the same. Cognitive behavioral therapy (CBT) is often the first treatment recommendation for children with anxiety, and it is consistently an effective approach. CBT incorporates the knowledge that both how we think and act impact how we feel. CBT approaches will help your child learn how to challenge negative thoughts and identify “false alarms” of anxiety. Treatment will also include psychoeducation about what anxiety is, and how children can recognize it. For younger children, focusing on the behavioral component of CBT (e.g., facing fears through bravery) will be the most impactful approach.
When a child is feeling anxious, their initial response will be to avoid the feared situation. However, avoidance of these fears only makes them more powerful. For example, going to the nurse instead of taking a math test will help a child reduce their anxiety in the moment because they don’t have to take the test. Unfortunately, the more a child avoids the things that they are afraid of, the more likely they are to avoid that same thing in the future. The anxiety they feel anticipating the feared scenario will remain high over time. The goal of CBT is to teach a child how to approach their fears rather than avoid them. To achieve this, your clinician may use a practice called exposure and response prevention (ERP). In this strategy, kids will be encouraged to face their fears in small steps and in a safe environment. As they slowly work their way up, getting closer and closer to facing the situation they fear the most, the anxiety will fade and have less control over their bodies. By facing their fears, they learn that the situation isn’t as bad as they thought it would be, and they have the power to take control of their lives.
For example, a child who has a specific phobia of bees might engage with exposure and response prevention to reduce their anxiety. First, they would listen to audio of a bee buzzing, then watch a video of bees flying around, then go on a walk near some flowers, then hold a dead bee in a cup, and eventually, walk near a live bee's nest in a park! This final activity would sound impossible at the start of treatment, but by the time they get to it, the anxiety isn’t so bad anymore. This strategy can be applied to almost any fear a child might have and is most safely done with the guidance of a mental health professional. The key to successful exposure and response prevention is practice, both inside and outside of the session.
These same practices can also be applied in group treatment settings. For kids with social anxiety, having a group treatment approach can naturally incorporate exposure practice into the therapy experience. In group anxiety treatments, children will be encouraged to face their fears by engaging socially with their peers in small increments. Sometimes it is easier to encourage others’ brave behavior than oneself, but seeing others face their fears can also be motivating. It can also help externalize the worry, thereby reducing the fear’s power.
Anxious children often come with caregivers who face their own experiences of anxiety. Even if a child has anxious behaviors that don’t resonate with their family members, support from caregivers and loved ones is crucial to successful anxiety treatment. In fact, there are parent-based anxiety interventions, such as SPACE (Supportive Parenting for Anxious Childhood Emotions), that work solely with the caregiver to help a child face their fears while reducing accommodations to anxious behaviors. For instance, a child whose caregiver drives them to school every morning because they are afraid to take the school bus. This is a reasonable accommodation at first, but can often lead to a child stalling, refusing to go to school, and the parent being late to work. An intervention like SPACE would teach a caregiver to get the child back on the bus, praising brave behavior, removing attention from behavioral outbursts and pleading, and rewarding independent bus taking and getting to school on time. Even if a child is engaged in individual CBT for anxiety, it is crucial that caregivers understand the rationale for ERP, cheerlead brave behavior at home, and encourage ongoing practice on a regular basis.
Children who have more severe symptoms and experiences of anxiety might require some additional care. If the symptoms are inhibiting the functioning of daily life to the point where CBT alone isn’t effective, medication for anxiety may be recommended. Guidance from an assessment and a mental health professional is the best way to determine if your child would benefit from medication.
Skills and Strategies to Support Your Anxious Kid at Home
Raising an anxious kid can be challenging. When a child’s anxiety is impairing, it can often impact the functioning of family life. Getting your kid to school or to a birthday party might be a battle if they’re fearful of social situations. If your kid is afraid of shots, annual doctor’s appointments might feel like a nightmare!
Often, our natural reaction to an anxious child is to give them reassurance that everything will be okay. We’ll give them a hug and a kiss, and maybe even let them stay home from school, the party, or the doctor’s office. While it feels good to remove the burden from their little shoulders, we’re inadvertently reinforcing avoidant behaviors. Instead, we should be using skills and strategies that will encourage kids to face their fears and will grow their sense of confidence.
Here are some helpful tips to encourage brave behaviors:
- Use approach strategies at home. Instead of accommodating your child’s anxiety and reinforcing avoidant behaviors, try to emphasize the importance of facing your fears. We like to call this “Bravery Practice.” If your child is anxious about speaking in public, you can encourage them to be brave and order their own dinner at a restaurant instead of speaking for them.
- When doing “Bravery Practice,” start small! Identify the things your child is worried about and find lower intensity versions of them to tackle first. If your child is afraid of dogs, you can take them to a pet store and watch the dogs together through the window.
- Use labeled praises to increase the likelihood of your child engaging with brave behaviors in the future! If your child is nervous about interacting with peers, but joins in a game at a birthday party, you can praise them by saying, “Nice job joining in a game of Twister today, that was so brave!”
- You can also use rewards to encourage brave behavior. Even something as small as a sticker can reinforce facing fears!
By using these skills with your child, you are encouraging them to learn how to address their anxieties head on, instead of deferring their nervousness to a later time. Utilizing these skills may feel uncomfortable, but with enough practice both you and your child will become better at dealing with their anxieties.
While these at-home tools can work for some children, others may need a higher level of support.
Want to learn more?
- Attend our FREE webinar on March 21
- Read What is Anxiety, and How Does It Work?
- Contact us