Helping Children Deal with Anxiety: The Worry-Eater
Posted by FamilyFirst Psychological Services
Childhood anxiety is all too common in today’s world. Parents often ask me for concrete, practical ideas to help school-age children deal with worries. One of the tools I sometimes use in therapy with children is to create a “Worry-Eater.” To try it at home, tell your child that you have a great idea that will help take the power away from his worries.
Let him know that although the worries seem very powerful and difficult to get rid of, it is possible to gain control over the worries. Since children often doubt their own ability to manage the worries at first, ask your child to think of what kind of animal/monster/creature would be able to help him gain control over his worries. Ask your child to think about what his Worry-Eater would look like, what its name would be, and what kind of powers it might have. Once he has thought about the kind of Worry-Eater that could help him get rid of the worries, ask him to draw it. Be sure to have him add detail to the drawing and to really flesh out and describe the Worry-Eater’s powers.
Once the Worry-Eater is created, attach a big envelope or folder (anything that can hold pieces of paper) to the back of the drawing. Your child and you will then write down one of your child’s worries. For instance, your child might write, “I am worried I might get sick”, “I am worried about my test tomorrow”, or “I am nervous about this weekend’s sleepover.” Once the worry is written down, ask your child to “feed” his worry to the Worry-Eater (i.e., put it in the envelope/folder). Then help your child think about what the Worry-Eater will do to get rid of the worry.
In addition to “eating it up”, this might include using coping skills such as coming up with positive, encouraging thoughts, challenging the worry, and/or distracting oneself with pleasurable activities. This active and creative process of creating and using a Worry-Eater helps children feel more in control of their worries and builds important coping skills. Moving forward, your child can write down and have the Worry-Eater eat his worries on a daily basis (or as needed).
Praise your child when he gives worries to the Worry-Eater and if he brings up thos worries again later, gently remind him that the worry is gone because the Worry-Eater has already eaten it. With practice, your child will soon learn that he does not have to be bothered by worries any longer.
If your child has significant anxiety that is not responsive to your attempts to help him control it, it may be helpful to seek a short-term course of individual therapy with a professional who has expertise in childhood anxiety.
Kelly H. Theis, Ph.D.
Licensed Clinical Psychologist
Enjoying the Season by Focusing on the Present
Posted by FamilyFirst Psychological Services
As the holiday season approaches, many of us begin to feel stressed, overwhelmed and exhausted. In the face of shopping lists to work through, travel itineraries to plan, and seemingly endless school functions to attend, we often lose sight of the potential for joy, celebration and re-connection with loved ones that this season is supposed to bring. Thus, the holiday season is an especially good time of year to practice “living in the moment”. Although this advice often sounds trite and worn out, in fact it is based on very sound psychological principles that can help reduce stress, boost your mood and improve your outlook on life.
First, consider the alternatives to “living in the moment”. One alternative is to focus on the past. While there can be some value in reflecting on the past and taking stock (how else would we make New Year’s resolutions?!), too much dwelling on the past can foster feelings of regret and sadness that can in turn promote depression. If you find yourself constantly thinking thoughts that begin with “if only I had…” or “I wish that I could have…” it may be time to try focusing on the present. A second alternative to living in the moment is focusing on the future. Again, there is some value in anticipating what challenges may be ahead of us and planning accordingly. However, a singular focus on the future tends to promote feelings of anxiety and distress, and can lead to feeling overwhelmed and helpless. If you are often playing various possible scenarios over and over (“what if this happens…” “what if that happens….”), consider working more on focusing on the moment that you are in.
This holiday season, try to actively savor something that you might otherwise hurry through. Take a break from your “to do” list and focus on what your senses are telling you about where you are and what is going on around you. Be an objective observer of your environment, and stop to notice what you see, hear, smell, taste and feel. If you are baking treats for a child’s school function, take a few minutes to luxuriate in that smell of fresh-baked holiday goodies. If you are wrapping a gift for your work gift-swap, take time to notice the way that the wrapping paper sparkles and how the ribbons curl just so. Appreciate the warmth of your sweater, the sparkling lights on your neighbor’s porch, and the sweet smell of pine as you pass the display of wreathes outside of the grocery store. If you find yourself becoming overwhelmed with tasks, stop, close your eyes, and breathe. Focus on the fact of your breathing, being sure to breathe deeply into the bottom part of your lungs, engaging your diaphragm. Counting as you breathe will help you to breathe more deeply, and also help you to focus on what you are doing as opposed to what you have to do.
In short, the best way to get more enjoyment out of your holiday season is to focus a bit more on the present moment – and perhaps a bit less on the present(s) on your list.
Kathleen Boykin McElhaney, Ph.D.
What To Do When You Can’t Do Anything About It
Posted by FamilyFirst Psychological Services
Wishing something would happen but it never does. Wanting someone to do something different, but she never does. Worrying about what someone else thinks of us, getting angry when the rain spoils our cookout, and stressing about what the traffic will be like when we leave work tonight. These are all things we have no control over. And yet, these are the types of situations that we often spend many hours of our day fretting about, causing our lives to be more stressed than they need to be.
Often, when we are stressed, anxious, or feeling down, we are focusing on what we can’t control and, unfortunately, not taking charge of what we actually can control. When we focus on what we cannot control, our anxiety, as well as our feelings of hopelessness and sadness, increase because we are, in fact, creating an impossible situation for ourselves. No matter how talented or intelligent we are, we have no control over the weather, what someone else thinks of us, or what someone else does or says. And when we shine the spotlight on that which we cannot control, we leave all that we can control hiding out in the dark. For example, we can take control by developing a contingency plan or alternate date for our cookout, and by making the best possible behavioral choices for ourselves when interacting with others. Once we have taken control of what we can, it then helps to remind ourselves that this is all we can do, and we will have to let the rest go. If we are successful, we tend to feel more at peace and less stressed and anxious.
Differentiating what we can and can’t control, problem solving when we do have control over a situation or parts of a situation, and letting go when we do not, are vital steps for maintaining a mentally healthy life. Once we have determined which parts of a situation we can and can’t control, we can go through 4 basic problem solving steps to manage what we can control and we can learn strategies for letting go of what we cannot.
When we approach a problem or a dilemma, we first want to define the problem, then think of ALL possible solutions, thirdly, think of the consequences or ramifications for each possible solution, and finally, make the best choice, given our options and the consequences for each option. We can practice slow deep breathing, mindful meditation, yoga, and visual imagery techniques to learn to let go of that which we cannot control. Distracting ourselves with enjoyable activities such as reading, exercise, listening to music, talking to a friend, or snuggling with our loved ones, also works well when we need to let go of what we cannot control.
When feeling especially stressed, ask yourself if you are shining the spotlight on what you can’t control and try to light up what you can control. Often the stressful feeling itself can be a clue that you are focusing on things you have no control over. Learning to differentiate what we can and can’t control, problem solve what we can control, and let go of what we can’t, will help us find a sense of peace, reduce stress and anxiety, and leave us with a greater sense of empowerment in our daily lives.
Marcia Kaufman, Ph.D.
Licensed Clinical Psychologist
How Many Sessions?
Posted by FamilyFirst Psychological Services
One question I am regularly asked is, “how long should I expect therapy to last?” Unfortunately, the answer to this question can vary greatly from person to person, as well as from presenting problem to presenting problem. For example, though two people may seek therapy services from a clinical psychologist aimed at decreasing symptoms of anxiety, the time it takes for each person to make improvements may be completely different depending upon a variety of factors such as their motivation to make changes, their support system (i.e. family, friends, etc.), personal insight, and even their comfort level with the therapy process. Additional factors may include the severity of each individual’s symptoms, the type of anxiety being addressed, or other confounding difficulties (i.e. attention difficulties, interpersonal problems, etc.) that may exacerbate the situation.
Due to the number of variables that come into play with respect to the reasons why individuals seek therapy services, I typically discuss the possible avenues available to clients with respect to the duration and frequency of treatment when the question is raised about how long one should expect to participate in therapy. Some examples of potential therapeutic avenues include a one-time consultation with a clinical psychologist, brief therapy with a clear focus of treatment (typically around 8 sessions), or longer term services that can last from several months to several years. Those seeking a one-time consultation might need education about a particular topic, want to explore their specific symptoms or situation with a psychologist to determine if further intervention is warranted, or simply need to be heard and validated on a particular topic. Individuals seeking brief therapy services usually have a specific goal in mind that can be adequately concentrated on within the specified time period. For example, specific phobias can often be treated over the course of a specified number of sessions as it lends itself to step by step therapeutic intervention. However, it is important to realize that it is not uncommon for individuals to begin treatment for one particular area only to discover that they could benefit from services that are more comprehensive and long-term. Of course, the decision to continue services is left to the client. Finally, those seeking longer term therapy services often come in with the understanding that therapy is a process and that improvements can wax and wane over time. It is important to recognize that those who choose longer term therapy services do not necessarily have more severe psychological distress or interpersonal difficulties, though this type of treatment is what I would likely recommend for individuals experiencing a great deal of internal distress.
My recommendation for those seeking psychological services is to discuss the possible avenues available to you with respect to your particular situation and presenting concerns during your first session. One of the essential aspects of the therapy process is open, honest communication between therapist and client; therefore, I encourage you to discuss your thoughts and feelings about the length and frequency of therapy. For example, it is not uncommon for individuals to begin visiting with a psychologist on a weekly basis and then move to every other week sessions once the relationship is established and clinical progress is regularly being made. It is hoped that by knowing that the logistics of the therapy process are up for discussion each client who comes through our doors feels in control of their treatment and educated about the process.
Mary Kathleen Hill, Ph.D.
Licensed Clinical Psychologist
The Types of Childhood Anxiety and Their Symptoms
Posted by FamilyFirst Psychological Services
When you have a child that has anxiety, it is important to identify what type of anxiety is present. Doing so will help guide his/her treatment. Because not all anxiety is the same, treatments may vary depending on the symptoms and presentation of the worry or worries. A brief description and symptoms of the various kinds of anxiety disorders is listed below.
Generalized Anxiety Disorder (GAD)
Children with GAD are best described as “worry warts” because they experience uncontrollable worry about a number of things. Their brain holds a laundry list of worries. Main symptoms of GAD include excessive worry about ordinary situations (e.g., grades, tests, friends, etc.), worry is uncontrollable, physical symptoms of anxiety (e.g., irritability, sleep disturbance, etc.), and worry present most of the time for at least 6 months.
Separation Anxiety Disorder (SAD)
Children with SAD have difficulty separating from caregivers or home. While uneasiness about separating may occasionally occur in all children, those with SAD have this problem for at least 4 weeks and it interferes significantly with daily life (e.g., going to friends’ houses, bed, or school). Parents too often have limited mobility as a result of the child’s worries. Other symptoms of SAD include excessive worry about harm befalling the parent or caregiver, nightmares involving separation themes, reluctance to go to sleep or engage in activities in fear of being separated from caregiver, and crying/clinging behavior upon separation that is not developmentally appropriate.
Panic Disorder
Panic Disorder consists of recurrent, unexpected Panic Attacks. These attacks are characterized by a number of symptoms (e.g., racing heart, shaking, nausea, trembling, etc.) that are abrupt and reach a peak in 10 minutes. The child also has feelings of losing control, going crazy, or dying, and begins to avoid situations for fear of having a panic attack. When children experience panic they seek their safety zone, which is usually home.
Specific Phobias
A phobia is an intense fear of a specific situation/object that poses no real danger. The child avoids the feared situation. When faced with the feared situation, the child displays extreme distress such as crying, freezing, clinging, tantrum etc. Children with phobias are typically worry-free when they avoid the situation. A phobia typically forms when a child overestimates the danger of a situation/object while underestimating the ability to cope with it. Common childhood phobias include airplanes, bees, bugs, dogs, and injections. While most children may not like bees etc., the child with a phobia restricts their activities in an effort to avoid encountering the feared situation. Social phobia is a subtype included in this category. This describes a condition where a child is consistently and extremely shy or uncomfortable around people or situations where performance is the focus (e.g., raising hand in class) and feels significant discomfort about being embarrassed.
Obsessive-Compulsive Disorder (OCD)
Children who suffer from OCD display recurrent obsessions or compulsions that are severe enough to be time consuming and interfere with their daily living. An obsession is an intrusive, unwanted thought or image that is involuntary, irrational, and occurs whether the child wants to think about it or not. A compulsion is a repetitive action (e.g., ordering, checking, counting etc.) performed to suppress or reduce the obsession (intrusive thoughts) the child is having. A child with OCD is in a sense trapped in a vicious cycle of unwanted thoughts and/or behaviors that causes significant anxiety and suffering. A child with OCD believes that unless he/she does something in a certain way, something bad will happen.
There are highly effective treatments for childhood anxiety. Early intervention is important in helping your child get better. If you feel that your child fits a description of one of these anxiety disorders, seek the professional opinion of a child psychologist.
Maria Kanakos, Psy.D.
Licensed Clinical Psychologist
Battling the Wintertime Blues
Posted by FamilyFirst Psychological Services
Many people start feeling blue as the air turns chilly and the days get shorter. However, for some this seasonal change in mood is more serious and may require treatment. Seasonal Affective Disorder (also called SAD) is a type of depression that occurs at the same time every year, usually beginning in the fall and lasting until the spring. SAD is a cyclic, seasonal condition. This means that signs and symptoms come back and go away at the same time every year. Symptoms of winter-onset SAD include:
• Depressed mood that starts in the fall or winter (with remission in the spring and summer)
• Hopelessness
• Anxiety or irritability
• Loss of energy, especially in the afternoon
• Slow, sluggish, lethargic movement
• Social withdrawal
• Oversleeping, including excessive daytime sleepiness
• Loss of interest in activities you once enjoyed
• Appetite changes, especially a craving for foods high in carbohydrates
• Weight gain
• Difficulty concentrating and processing information
The specific cause of Seasonal Affective Disorder is unknown. As with many mental health conditions, it is likely that genetics, age, and your body’s natural chemical makeup all play a role in developing the condition. A few specific factors that may come into play include:
• Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may disrupt your body’s internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
• Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.
• Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in Seasonal Affective Disorder. Reduced sunlight can cause a drop in serotonin, perhaps leading to depression.
Treatment for SAD may include psychotherapy, antidepressant medication, and/or light therapy. In light therapy, also called phototherapy, you sit a few feet from a specialized light therapy box so that you’re exposed to bright light. Light therapy mimics outdoor light and appears to cause a change in brain chemicals linked to mood. This treatment is easy to use and seems to have few side effects. Before you purchase a light therapy box or consider light therapy, talk to your doctor or mental health provider to make sure it’s a good idea and to make sure you’re getting a high-quality light therapy box.
Psychotherapy is another option to treat Seasonal Affective Disorder. Although SAD is thought to be related to biochemical processes, your thoughts, feelings, and behavior also can impact symptoms. Psychotherapy can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthy ways to cope with seasonal affective disorder and manage stress.
Additionally, there are several things you can do on your own to improve your mood if the winter blahs are upon you:
• Make your environment sunnier and brighter. Open blinds, add skylights and trim tree branches that block sunlight. Sit closer to bright windows while at home or in the office.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
• Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
• Socialize. When you’re feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around.
• Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter-onset SAD.
• Try mind-body therapies. These can include acupuncture, Yoga, meditation, or massage therapy.
Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own — you may have Seasonal Affective Disorder. If the wintertime blues have become more serious and you are having difficulty going about your day-to-day activities because you are feeling too down, you may need to talk with your doctor or mental health professional about the issue. Addressing the problem can help you keep your mood and motivation steady throughout the year.
Melissa K. Hunt, Ph.D.
Licensed Clinical Psychologist
December 13, 2010
Helpful Ways of Dealing with Anxiety in Children
Posted by FamilyFirst Psychological Services
Anxiety is the most common type of psychological problem found in children and adolescents. Problems with anxiety can negatively affect a child’s life. For example, anxious children tend to have fewer friends than other children their age because they may be shy or fear meeting or being with new people. Anxiety can also interfere with a child’s academic achievement. For example, children who worry a great deal are likely to struggle with homework completion as well as learning lessons in the classroom because they are pre-occupied with their worry and thus cannot focus adequately. The amount of anxiety will vary from child to child and may also change depending on the situation. Regardless, anxiety is uncomfortable and if not adequately addressed can be a significant hindrance in life.
Being a parent of an anxious child can be really challenging, and no doubt there will be moments when you feel that you just don’t know what to do in response to your child’s anxiety. There are numerous ways of handling a child’s anxiety. Some of the more common strategies follow:
Reward brave, non-anxious child behavior. As a parent look for and catch your child doing “brave” behaviors and reward them. Bravery in these cases specifically means when a child is doing something he or she normally resists doing due to fear or anxiety.
Ignore behaviors that you don’t want repeated. This tip involves removing your attention from your child’s anxious behavior and waiting until it has stopped before attending. Of course your child should be made aware of the purpose for this response so that he/she understands what needs to happen to regain your attention. This strategy is particularly useful for children who repeatedly seek reassurance or ask the same worry-related questions over and over again.
Help prevent avoidance. If you allow your child to avoid a feared situation or thing, his or her anxiety will only continue and worsen. Avoidance behaviors do not allow children to learn to cope with their anxiety. My personal preference for younger children is slow and gradual exposure to the feared situation with parental support along the way.
Communicate empathy. When your child expresses his worries and fears, it is very important that he or she feels listened to, understood, supported, and encouraged to overcome it. A common mistake parents make is to say invalidating things such as “There is nothing to be worried about” or “Stop worrying.” These statements do not offer comfort and encouragement to the anxious child. Instead, use validating and empathic statements such as “I understand this makes you worried and we will get through it.”
Model non-anxious behavior. Children learn to behave by watching others around them. If parents or caretakers are anxious themselves, then their behaviors may be inadvertently maintaining a child’s anxiety. It is important that parental reactions to a child’s distress are calming and reassuring, rather than reactive and alarming.
Maria Kanakos, Psy.D.
Licensed Clinical Psychologist
Tools For Teaching Children To Calm Down
Posted by FamilyFirst Psychological Services
Summer time is here! For some families the summer season is full of activities and adventures. While children enjoy this time of year, reducing stimulation over the course of the day is paramount. Over stimulation can contribute to irritability, hyperactivity, and melt-downs in some children. Take the opportunity this summer to help your child develop and use effective self-calming skills that he/she can also use during the school year. Below you will find several self-soothing activities to use for your child that come from various sensory inputs (e.g., touch, sound, etc.).
Calming activities involving the sense of touch include having your child take a warm bath, hold a soothing object such as a soft blanket or stuffed animal, snuggle with a parent, pat a pet, get a massage, or play with something like play-doh or sand.
Calming activities involving sound include having your child listen to a relaxation tape, a story on tape, and use a white sound machine. Sometimes children need noises screened out. In these cases, providing your child with ear phones or ear plugs can be effective.
Calming activities using vision include reading a storybook to your child, providing dim lighting (e.g., night light or glow in the dark stars), and for some children watching a familiar show (although not recommended before bed time) helps soothe them.
Calming activities involving movement include swinging or any other back-and-forth motions such as rocking in a rocking chair, shooting baskets, bouncing on a bouncy ball, and talking a walk.
Calming activities involving relaxation tactics include yoga, blow toys (like blowing bubbles) that encourage deep and slow breathes, and having your child lay down and imagine a peaceful place while taking doing relaxations breathing in through the nose and out through the mouth.
In closing, it is important for all parents to keep in mind the importance of avoiding over-scheduling children. Often children have so many planned things to do that they lose sight of the simple pleasures that make them happy. I encourage parents to try to maintain an equal balance of stimulation and down time in your child’s daily schedule.
Maria Kanakos, Psy.D.
Licensed Clinical Psychologist
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