How Parents Can Help Their Children With Managing Anxiety Disorders?

By Isha Malik

WHEN a child does not outgrow the fears and worries that are typical in young age, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Different types of anxiety disorders include separation anxiety, social phobia, specific phobia, generalized anxiety, panic disorder, obsessive compulsive disorder etc.

The following are different tips on how parents can help their child to overcome anxiety:

• Encourage regular sleep routine, healthy eating and regular exercising.

• Try not to become overprotective or anxious yourself. Model  healthy ways of coping with anxiety. as children learn the most via observational learning.

• Sit with them and offer physical reassurance/support. Feeling you nearby, holding your hand or having a cuddle can make them feel calm and secure.

• Reassure them that the anxiety will pass, and they will be okay soon. Spend quality time with your child as a family. This will help divert their attention from all their worries.

• Discuss about your child’s worries and scary thoughts and how to deal with them. Ask them how it feels inside their mind and body. It is very important to empathize with their experience, accept and validate their feelings.

• Help your child learn about signs of anxiety so that they can recognize when they are feeling anxious. This way they will know when to ask for help or help themselves. Knowing this beforehand can make the experience less overwhelming/ frightening.

• You can explain about anxiety to your child through story telling- example: The Story of the Caveman

• This story is useful to help your children understand where anxiety comes from and it can be adapted depending on the age of the child. Back in the distant past, when we were still cavemen walking around in furs, we came across many dangers, like dinosaurs and sabre tooth tigers. Our bodies (naturally wanting to protect us from danger) designed a special alarm inside us that was set to go off whenever danger was present. This alarm gave us the ability to fight the danger, or run away by increasing our heart rate, and supplies of blood to our muscles- making us breathe faster. It also made us think more quickly, and be on the alert for dangerous situations. It worked brilliantly! However, as we don’t have dinosaurs or sabre tooth tigers on the planet anymore, we don’t need the special alarm as much. Unfortunately we can’t turn it off, and some peoples’ alarm system gets stuck in ‘on’ mode, which causes them to feel ready for danger at all times. This is what anxiety is.

• Teach easy relaxation techniques such as deep breathing, rainbow breathing. Breathe slowly and deeply together. Ask them to think of a safe/relaxing place. It could be their grandfather’s bedroom, their last holiday destination, a nearby park. Sometimes holding a memento (e.g., shell, pebble etc.), souvenir, or photograph of a relaxing place can help. Making them draw and name their safe place is also helpful.

• Rainbow breathing: 

Have your child gently close her eyes and imagine that she is lying under a rainbow. Tell her that you are going to practice breathing the colours in out while thinking certain thoughts. Encourage her to allow her/his body to relax and let go of any tension in her/his body.

You can give your child instructions.

Breathe in the colour green and think, “I am feeling fresh”

Breathe out the colour yellow and think, “I am feeling happy”

Breathe in the colour blue and think, “I am feeling calm”

Breathe out the colour orange and think, “I am creative”

Breathe in the colour purple and think, “I am wise”

Breathe out the colour red and think, “I am safe”

Repeat this several times. As he/she is lying there breathing, imagining the colours gently flowing in and out, you can speak these thoughts out loud as he/she practices breathing.

• 5-4-3-2-1 Grounding technique Try using all five senses together. Connecting with what they can see, touch, hear, smell and taste can bring them closer to the present moment and reduce the intensity of their anxiety symptoms. You can together identify five things they can see, four things they can touch, three things they can hear, two things they can smell and one thing they can taste.

• Encourage your child to do any activity they enjoy and which makes them feel happy. For e.g., gardening, sketching, painting, watching favourite animated movies or reading a short story.

• Make a Worry Box with your child:

A worry box basically helps symbolise the idea that feelings of anxiety are simply thoughts that we can distance ourselves from. It’s a great way for young kids to start understanding and identifying their emotions, and dealing with them in a purposeful and productive way. Create and decorate a small box, such as a tissue box or a small cardboard box. Then, perhaps each night before bed, write down the child’s worries onto a piece of paper. or if your child can write then it’s better to make the child write down or draw his/her worries.

Have them fold the piece of paper and put it in the box. The next day – take the notes out of the box and ask your child if they still have those worries. If they do, place them back in the box; if they don’t, have them rip up the paper and throw it in the dustbin.” The worry box serves the important purpose of ‘externalising’ your child’s anxieties. It’s more helpful for them to have something age appropriate they can actively do to process their anxieties. So instead of reassuring our children about their anxieties, we should rather be helping them to process them in age-appropriate ways. The worry box is particularly beneficial for young children, because it helps them to understand their thoughts and feelings, and give them control over them. The symbolic nature of the worry box helps to show kids that their thoughts are just – thoughts – and negative ones won’t have an impact on their future. The act of decorating and creating the box shows the child that they can have ownership and control over their thoughts and feelings.

The ritual of writing the worries down helps them to acknowledge and address those feelings. And the disposing of the worries helps to symbolise their release of those problematic emotions. The worry box is an easy and helpful solution for trying at home.

More suggestions for parents on how to help their children deal with specific kinds of anxiety disorders:

SPECIFIC PHOBIAS (in other words, fear of certain situations, places or things)

• Practice graded exposure at home- Exposure/ fear ladders. For example, if the child is extremely fearful of dogs, one can follow the steps explained below.

First teach the child any easy relaxation technique and explain to them that they will jointly work on getting rid of his fear of dogs. Any time during the process if the child gets emotionally overwhelmed then he/she should be instructed to use the relaxation technique.

• Start with showing the child a drawing of a dog.
• Then make him/her look at the picture of dogs in magazines/books.
• Watch funny dog movies (animated)
• Watch videos of people petting dogs.
• Go to a pet store to watch puppies/dogs from a distance.
• Visit a friend/relative who has a pet dog and watch them playing.
• Pet your friend’s dog and make your child do the same for some seconds.

Each step should be decided in agreement with the child and the parent, and plenty of praise / rewards should be used as the child or young person moves through the ladder. If the child or young person becomes distressed or does not feel they can manage the next step, then make the step smaller. It may take a considerable length of time for them to get to their goal, and everyone is different so patience, time and support are required in bucketloads from the family (and school if appropriate). You can assess when a child or young person’s anxiety drops by getting them to rate it on a scale of 1-10. When that number drops below 2 in the situation, you will be ready to move on to the next step.

Social Phobias (in other words, being afraid of social situations or being watched by others)

• At home, do role plays and practice how to interact with others.
• Practice situations such as asking questions in class, ordering food in a restaurant, buying a pack of chips from the departmental store, answering a phone call, talking to a friend/neighbor, etc.
• Arrange frequent, short play dates for young children. For older children, ask them to carry out at least two social activities. Example- calling a friend, visiting a nearby neighbor, reviewing homework with a friend.
• Practice assertiveness skills. These include: speaking up for oneself, asking others for help, saying no to something they are not comfortable with, expressing one’s opinions.

Separation Anxiety (in other words, severe distress about being away from home or apart from people who are important to them)

• Make sure that the child sleeps in his/her own bed. Use rewards and praises to reinforce this desirable behavior.

• Make the child often spend a short duration of time away from parents. For example, a mother can go for an evening walk everyday while the child stays at home with his grandparents.

Gradually increase the length of time they are apart and use different situations.

• Help a child to cope with stress in uncomfortable situations like school, camps, staying overnight at a friend’s place or at some relative’s house.

Panic Disorder (in other words, severe and unexpected attacks of fear that also cause physical symptoms) 

Panic disorder can cause physical symptoms like increased heart rate, feeling dizzy and stomach aches, breathlessness etc.

• Parents can make sure that a child understands that panic attacks are safe, painless, and private (nobody else can see them), and they only last a few minutes.
• Different relaxation/ mindfulness/ grounding techniques need to be practised.

Generalised Anxiety Disorder (in other words, frequent, intense worry about many things, such as school, the safety of their family, or world events)

• Explain to the child or teen that worry is not useful. What works better is to try to solve the problem. For example, ask what he or she could do to make sure that the scary situation doesn’t happen.  Remember not to encourage their reassurance seeking repeatedly. Encourage your child to ask you fewer questions like ‘What’s going to happen?’ If you’ve already answered the question, encourage your child to think about the situation, come up with the answers, and rely on her own judgment.

• Becoming comfortable with some uncertainty

Because children with GAD feel anxious whenever things are uncertain, a good way to fight back worries is to help your child become more comfortable with uncertainty.  Do this by deliberately taking action when they are not sure what will happen. Like any tool that involves facing a fear, it is important to start small. The following are some exercises your child can do:

• Completing homework without asking family whether it was done correctly (or only asking once).
• Calling a friend spontaneously and asking him or her to come over to play without making plans in advance.
• Deliberately making a small mistake on homework so that it isn’t perfect (crossing something out; making it a little messy).
• Coming to school a few minutes late.
• Talking to someone in school without planning the conversation.
• Saying “I don’t know” when the teacher asks a question.
• Looking out the window for a few seconds when the teacher is talking.

Obsessive Compulsive Disorder (OCD): (in other words, thoughts, images, ideas or impulses that are not welcome and that interfere with their lives.)

• Children with OCD usually need the help of a trained therapist.

However, parents can support the treatment in a number of ways:

• Help the child or teen deal with the worries or obsessions that they fear by rating the levels of distress associated with each fear. Examples of worries are : contamination by dirt or germs and anxiety about whether something is turned off.
• Once the worries are organized they can be put into ‘fear ladders’ that arrange the worries from those that are feared the least to those that are feared the most.
• Coach the child through exposure to the feared situations or events. When you do this, make sure the child or teen cannot reduce the anxiety this causes by using OCD behaviours such as rituals of washing, checking or ‘fixing’. If this behaviour is allowed it will undo any gains that have been made. Parents should make sure not to involve in their child’s compulsive rituals.
• Exposure should happen every day and should be practiced. Start with low-level exposure and gradually build up.
• Give rewards to help motivate the child or to progress.
• Reassure the child  that they are not “freaks/abnormal/crazy”. Tell them that one out of every 50 kids in their school has OCD. To get a concrete number, ask them about how many kids are in their school and then work out how many may have OCD. This will help normalize the experience.

Views expressed in the article are the author’s responsibility and are not a substitute for medical advice. These are for educational purposes only 

• The author is a clinical psychologist

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