Is Loneliness Contagious?

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Humans live in an interconnected, interdependent world. This is true for all social species. These facts have led researchers to study the effects of social isolation for many different types of animals. What they have found is that, for instance, isolation decreases the lifespan of the fruit fly, and leads to type II diabetes and obesity in mice. They have also found that, in rhesus monkeys, isolation negatively effects their psychological and sexual development. The effects of isolation can be even more profound in humans perhaps because our kids have the longest period of dependency of any species. Researchers have also discovered that it is not the objective number of social contacts that predicts loneliness, but rather our perceived feelings of social isolation.

Recently, researchers have been looking at how loneliness spreads within communities. In a 2009 edition of the Journal of Personality and Social Psychology researchers John Cacioppo, Nicholas Christakis and James Fowler looked at this question more closely. The researchers looked at data from a famous medical study that tracked people from a small town over a close to 40-year period. Cacioppo and his colleagues were looking for patterns of connection, loneliness and isolation.

The researchers were able to rule out two different hypotheses. First, that lonely people attract other lonely people. Second, that the environment that lonely people were in was creating their sense of loneliness. For instance, that going away to college or getting divorced led to persistent or increased loneliness. Instead, what they found was that loneliness acts rather like a contagion, and that it spreads through face-to-face discussions and disclosures. In effect, they found that lonely people tend to make non-lonely people, lonely. Furthermore, they found that this phenomenon is evident to three degrees.  That is, that lonely people make friends of friends, of friends, lonelier. They also found that this contagion spreads more quickly amongst women than men perhaps because the methods of transmission – face-to-face discussions and disclosures – are more practiced in women. Their findings have led them to wonder about how the spread of this contagion is kept in check. Cacioppo and his colleagues speculate that, in order to protect their social networks and cohesion, non-lonely people push lonely people out of their social circles. This phenomenon has been observed in rhesus monkeys.

Has being around lonely people led to your feeling lonely? How have you dealt with loneliness? Leave us a comment. Let us know.

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Anatomy of Three Things (Episode 94)

Three ThingsDoctors Brian and Giuseppe talk about recent research in psychology, including:

  1. How overweight college students react to spam e-mails
  2. How loneliness spreads between friends
  3. Does month of birth affect IQ?

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Website of the WeekWebsite of the Week: Scientific American Psychology

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Winter Blues, Part 3: How friendship and self-esteem affect SAD

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Seasonal Affective Disorder (SAD), sometimes called seasonal , is a major concern, with some statistics suggesting that it affects anywhere between 3 and 12% of the population – that’s over 9 million people in the U.S. alone. Dr. G wrote yesterday about some of the differences between SAD and non-seasonal . Certain symptoms are considered to be “hallmarks” of SAD: physical symptoms such as increased appetite, increased need for , and fatigue. But even if SAD is biological, is it possible that social factors or negative beliefs affect its course? Researchers at the University of Manchester investigated whether social support and low self-esteem influenced the experience of in people suffering from SAD in a study published in a 2002 issue of the journal, Psychological Medicine.

Everyone included in the study had previously experienced seasonal ; anxiety and depressive symptoms were measured every two weeks from the beginning of September until the end of March. They found that increased through the fall; on average, a mild could have been diagnosed at about 6.5 weeks. It was most severe from mid-January to mid-February. As expected, the physical symptoms tended to occur earlier than the cognitive ones (which included self-dislike, feelings of worthlessness, and self-criticism).

Self-esteem and social support affected the onset of . People who reported low self-esteem or limited social support experienced a faster onset of . The researchers thought that increases in appetite and sleepiness might draw attention to negative beliefs about themselves, making the worse. This might set up a negative cycle, in which physical symptoms lead to negative thoughts, which increase sad feelings, making the physical symptoms worse and possibly leading to avoidance and withdrawal.

The researchers also surmised that people with limited social support would have fewer opportunities for their negative beliefs to be challenged through social interactions. On the other hand, positive relationships might delay by reducing withdrawal and disconfirming feelings of worthlessness. Overall, the results suggest that people with chronic low self-esteem and few friendships become more depressed at a faster rate than those with more friends and a positive self-image.

So what can you do if you suffer from SAD? Talking your doctor is always an option. Also, if increasing social support can have a positive impact on symptoms, then planning ahead in the summer becomes essential! People who anticipate depressive symptoms in the winter might benefit becoming involved in activities that encourage social connections – this will probably be hard to do once the depressive symptoms begin, but might be easier in the summer. The expansion of the social network might provide more opportunities for negative beliefs to be disconfirmed, and might also reduce opportunities to withdrawal socially when the winter blues come along.

You can find the Psychological Medicine study here.

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Free child looking out a window with reflection by Pink Sherbet Photography

Winter Blues, Part 2: How Seasonal Depression Differs From Depression

and Seasonal Affective Disorder have many symptoms in common. Both can involve a loss of interest in activities, poor concentration, disturbance in appetite and , and suicidal thinking. However, there are several distinctions. The most obvious is that S.A.D. comes and goes with the changing of the seasons. While S.A.D. has been known to occur during the summer months, patients typically experience it in the winter months and find relief in the summer. In addition, the quality of the symptoms is S.A.D. often differ from a depressive disorder. For instance, people with S.A.D. tend to eat and more than usual. This contrasts with where people are just as likely to eat or less than they normally would.

Researchers have noted for many years that one of the associated features of is the “overgenerality effect”. Psychologists and clinicians have been using the concept of overgeneralization for decades. Psychotherapists often focus on this cognitive distortion with their depressed patients. Overgeneralizing involves taking an isolated event and then, with little evidence, drawing a general conclusion about yourself that spans many contexts and circumstances. For instance, one disrespectful experience with a sales clerk leads you to believe that no one respects you and that you are not worthy of respect.  When you overgeneralize, aspects of the situation, for instance, that the sales clerks boss had just finished disciplining him or her, are not properly assessed. It is easy to see how this kind of cognitive distortion can lead to depressive feelings.

Researchers have studied the overgeneralizability effect within the context of autobiographical memory. What they have found is that, in response to positive and negative word cues (e.g., happy, jealous), people who are depressed tend to remember their past experiences in general, decontextualized terms. For instance, someone who is depressed may say, “I’m happy from time to time”, whereas someone who is not depressed is more likely to say, “I remember going on my honeymoon with my wife. It was her birthday during the same time and we went out for a wonderful diner.” Research over the years has pointed to the fact that people experiencing fail to recall the contextual details that would confirm or provide evidence against their distorted thinking.

In 2001, researcher Tim Dalgleish and his colleagues conducted a study to determine if this overgeneralization effect was evident amongst people with seasonal affective disorder. As in previous research, they followed a group of patients experiencing S.A.D. What they found was that the overgeneralization effect was not evident in the experience of S.A.D. That is, people with S.A.D. were not overgeneralizing from their experience in the same way depressed patients would. The results provided evidence for the notion that S.A.D. is a biologically driven mood disorder caused by a lack of sunlight over the winter months and not caused by cognitive distortions such as overgeneralization. The results have implications for . Some believe that the study provides evidence that medically based treatments, as opposed to psychotherapy, are indicated for this disorder. Medically based treatments for S.A.D. can include light therapy, medication, or even supplements of the hormone melatonin.

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FA Retro: Anatomy of the Winter Blues

Winter Street Scene: Park Ave, Paterson NJ by Tony the Misfit

http://www.flickr.com/photos/tonythemisfit/ / CC BY 2.0

Doctors Brian, Giuseppe, and Richard talk about the winter blues, Seasonal Affective Disorder (SAD) and how to overcome seasonal .

Why do people become depressed in the winter?

What can you do if you experience seasonal sadness?

And no, Family Anatomy was not voted “the #1 family website of reference,” but we’re currently the #1 Kids & Family podcast at Podcast Alley. Thanks for the votes!

Find out in this week’s episode!

Listen here:

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You can also get your free podcast subscription in iTunes. If you use iTunes, you can leave a review!

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When dreams go bad: 5 Tips for Parents

Voldemort should see a dentist by kevindooley

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“I had a bad dream!”

These words, often delivered between sobs, can become the bane of a parent’s nighttime existence. You and your child are both losing , and that doesn’t make the next day any easier. Bad dreams are a normal part of development, but they can be extremely distressing for kids and their parents. In a few cases, they can even be indicators of significant problems. What can parents do to help their kids to cope?

Valerie Simard and her colleagues at the Centre d’étude du sommeil ( Study Centre) in Montréal investigated risk and protective factors for chronic nightmares in preschool kids; their study can be found in a 2008 issue of the journal . The good news about their work is that very few of the children in their study had frequent nightmares. However, for those that did, it was a chronic condition that persisted for years, and other studies have shown that frequent nightmares may be far more common for children between the ages of 6 and 10.

The researchers found that kids who had difficult temperaments at the age of 5 months were more likely to have frequent nightmares at the age of 2.5 years. Children with difficult temperaments tend to be more reactive to stress and frustration, which might be a contributing factor to bad dreams; this temperament can also be stressful for parents, contributing to a reduction in responsive parenting that might also have an impact on their kids stress level.

If frequent bad dreams are a stable phenomenon that can be predicted from infant personality traits, what can parents do? Luckily, Simard and her colleagues examined parenting practices to see what might be helpful. Here are a couple of things that parents did for their 2.5 year-olds that reduced nightmare frequency when it was measured years later:

1. Taking the child out of bed to provide comfort.

  • Hugging or rocking your preschool child after a bad dream is OK.
  • Kids Health recommends that parents label the source of the child’s fear, telling them, “You had a bad dream, but it’s over now.”
  • Listening to the child’s description of the dream and the feelings it evoked is also appropriate.
  • It’s not a bad idea for parents to talk to their kids about the tricks that they use to feel better when they’re afraid.

2. Allowing the child to in the parents’ bed.

  • Co-sleeping was helpful for the children in this study, which should come as no surprise to those who believe in “attachment parenting.”
  • Arguments against co-sleeping tend to revolve around the notion that the child won’t develop self-soothing skills; although this may be true for older kids, the children in Simard’s study were 6 and under.
  • Parents who comforted their kids but left them in their bed, probably to help them develop coping skills, had kids who were at greater risk for chronic nightmares at age 6.

A combination of providing comfort, building skills, and co-sleeping might provide an optimal variety of support for pre-schoolers with chronic nightmares. Although Simard and her fellow researchers didn’t investigate preventative strategies, here are a few that might be helpful:

  1. Establish a consistent bedtime routine. Change is stressful for many kids, and a predictable routine can be comforting. Going to bed at the same time every night can also make it easier to fall asleep.
  2. Look for patterns. At my house, certain bedtime snacks were linked to bad dreams for one of my boys. Particular television shows might also increase anxiety and contribute to a nightmare. It might help to  keep a journal of bedtime routines to see if there is a link between something that happens before bed and a nightmare.
  3. Get help! If your child is bothered by frequent bad dreams, it might indicate that he or she is experiencing some kind of difficulty during the day; some studies have linked chronic nightmares to daytime anxiety symptoms. Check with your family doctor or talk to a therapist if you’re worried that this may be the case, or if other strategies don’t help!

You can find the study here.

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Note: Posts on Family Anatomy are for education only. If you need to talk to someone about family or mental health issues, you can get a referral from your family doctor.

When dreams go bad: Tips for parents

“I had a bad dream!”

These words, often delivered between sobs, can become the bane of a parent’s nighttime existence. You and your child are both losing , and that doesn’t make the next day any easier. Bad dreams are a normal part of development, but they can be extremely distressing for kids and their parents. In a few cases, they can even be indicators of significant problems. What can parents do to help their kids to cope?

Valerie Simard and her colleagues at the Centre d’étude du sommeil ( Study Centre) in Montréal investigated risk and protective factors for chronic nightmares in preschool kids; their study can be found in a 2008 issue of the journal . The good news about their work is that very few of the children in their study had frequent nightmares. However, for those that did, it was a chronic condition that persisted for years, and other studies have shown that frequent nightmares may be far more common for children between the ages of 6 and 10.

The researchers found that kids who had difficult temperaments at the age of 5 months were more likely to have frequent nightmares at the age of 2.5 years. Children with difficult temperaments tend to be more reactive to stress and frustration, which might be a contributing factor to bad dreams; this temperament can also be stressful for parents, contributing to a reduction in responsive parenting that might also have an impact on their kids stress level.

If frequent bad dreams are a stable phenomenon that can be predicted from infant personality traits, what can parents do? Luckily, Simard and her colleagues examined parenting practices to see what might be helpful. Here are a couple of things that parents did for their 2.5 year-olds that reduced nightmare frequency when it was measured years later:

  1. Taking the child out of bed to provide comfort.

· Hugging or rocking your preschool child after a bad dream is OK.

· Kids Health recommends that parents label the source of the child’s fear, telling them, “You had a bad dream, but it’s over now.”

· Listening to the child’s description of the dream and the feelings it evoked is also appropriate.

· It’s not a bad idea for parents to talk to their kids about the tricks that they use to feel better when they’re afraid.

  1. Allowing the child to in the parents’ bed.

· Co-sleeping was helpful for the children in this study, which should come as no surprise to those who believe in “attachment parenting.”

· Arguments against co-sleeping tend to revolve around the notion that the child won’t develop self-soothing skills; although this may be true for older kids, the children in Simard’s study were 6 and under.

· Parents who comforted their kids but left them in their bed, probably to help them develop coping skills, had kids who were at greater risk for chronic nightmares at age 6.

A combination of providing comfort, building skills, and co-sleeping might provide an optimal variety of support for pre-schoolers with chronic nightmares. Although Simard and her fellow researchers didn’t investigate preventative strategies, here are a few that might be helpful:

· Establish a consistent bedtime routine. Change is stressful for many kids, and a predictable routine can be comforting. Going to bed at the same time every night can also make it easier to fall asleep.

· Look for patterns. At my house, certain bedtime snacks were linked to bad dreams for one of my boys. Particular television shows might also increase anxiety and contribute to a nightmare. It might help to keep a journal of bedtime routines to see if there is a link between something that happens before bed and a nightmare.

· Get help! If your child is bothered by frequent bad dreams, it might indicate that he or she is experiencing some kind of difficulty during the day; some studies have linked chronic nightmares to daytime anxiety symptoms. Check with your family doctor or talk to a therapist if you’re worried that this may be the case, or if other strategies don’t help!

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Dreams, Part 2: What Do Dreams Mean?

Asleep in Battery Park on hot day (Library of Congress)

While dreams have been of interest to people throughout the centuries, it was Austrian psychiatrist Sigmund Freud who first made the “scientific” study of dreams popular after the publication of his book “The Interpretation of Dreams” in 1899. In this book, Freud discussed his theory that all dreams were wish fulfilments. He felt that our primal urges and impulses had to be suppressed in waking life and that dreams allowed these impulses to be expressed. At the same time, he believed that, even in dreams, these urges could be too disturbing and they would often appear in disguised symbolic form. So for instance, according to Freud, stairwells, mine shafts, and small narrow recesses in buildings had symbolic repressed sexual undertones.

For the better part of the 20th century, Freud’s theory of dreams, or some version of it, dominated the field of psychology. However in the later part of the century, advances in brain imaging technology led to theories that made fewer inferential leaps and stuck to the “facts” that were being discovered through functional MRI’s. In other words, neuroscientists began to track areas of the brain that were active during , and with their knowledge of the typical uses of these brain areas, were able to surmise a more functional rational for dreams. What these studies showed is that during , motor areas of the brain are “turned off” thereby keeping us from physically acting out our dreams. At the same time, the visual areas of our brains, the parts of our brains that interpret visual information, and the emotional brain centers, all remain active. So according to these researchers, the brain is simply trying to make sense of random simulation coming from the parts of our brain that remain active during .

So what do dreams mean? The theories of Freud and the more modern day neuroscientists reflect two ends of a continuum. There are psychologists who continue to see significant symbolism in dreams and use dream material to help their patients come to understand their emotional functioning and relationships. There are also psychologists that consider dream interpretation of little use as they subscribe to the idea that dreams simply reflect random brain activity. However, like most people, most psychologists fall somewhere between these two extremes.

In the end, dreams mean what you want them to mean. Generally, people who find life to be meaningful will also want to find meaning in their dreams. Similarly, people who see life as random and lacking in meaning will tend to see their dreams in the same light.

For those who are so inclined, dreams can be another source of information about life that compliments or contradicts what you know about yourself in waking life. Making sense of your dreams can be an integrating experience. While on the surface, dreams are often bizarre and obscure; the emotional content is often very understandable and revealing.

Tell us about your dreams and what dreams mean to you.

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Anatomy of Dreams (Episode 93)

Dream on a train by Katiya~

http://www.flickr.com/photos/katiyarhode/ / CC BY 2.0

Doctors Brian and Giuseppe talk about dreams and nightmares.

Do dreams have hidden meanings?

Is it normal for kids to have nightmares?

How can parents help their kids to deal with bad dreams?

Find out in this week’s episode!

Listen here:

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You can also get your free podcast subscription in iTunes. If you use iTunes, you can leave a review!

Website of the WeekWebsite of the Week: Kids Health – Nightmares

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Compassion, Part 3: Are kids with ADHD less compassionate?

Payground 4 by kkiserAs parents, we want our kids to be compassionate – to be concerned about the suffering of others. On this week’s episode of the Family Anatomy Podcast, we talked about some possible ways that parents can encourage the development of empathy and compassion in their kids. Empathy is important in relationships, and it has been linked to prosocial behaviour and reductions in aggression – both of which are likely to have a positive impact on peer relationships! However, there is a large group of children who tend to experience social behaviour problems that interfere with their friendships – research has consistently shown that kids with Attention Deficit/Hyperactivity Disorder () are more likely to have trouble in these areas. However, it isn’t clear why. Some have proposed that the impulsive behaviour of kids with gets them into trouble at school, leading to peer rejection. Others have suggested that distractibility interferes with social interactions. Researchers at University of Toronto and Dalhousie University investigated whether is linked to reduced empathy or difficulties in social perspective-taking that might affect kids’ relationships with their classmates.

The study, published in a recent issue of the Journal of Abnormal Child Psychology, included nearly 100 8 to 12 year-old students, about half of whom had been diagnosed with . Parents also provided information. Although the kids with rated themselves as being equally empathic as those without the disorder, parents’ ratings were lower for the kids with the diagnosis. There’s a lot of research suggesting that people with tend to underestimate their problems, so this finding may not be surprising. Upon further examination, though, it turns out that was not actually the reason for the lower empathy scores – in fact, kids with conduct problems (e.g., aggression, bullying, lying, cheating, etc.) were actually the ones who received lower ratings. And conduct problems happen to be more common among kids with . So attention problems aren’t necessarily linked with lower empathy, unless conduct problems are present.

If empathy isn’t lower for distractible, impulsive children, why do they have more social problems than other kids? It may come back to another prerequisite for compassion – perspective-taking, or being able to put oneself in another’s shoes. The researchers examined the impact of IQ and language abilities as well as on social perspective-taking. They found that slower learners and those with language difficulties had more trouble with perspective-taking. Kids with had particular difficulty, though. They had trouble considering multiple perspectives when solving social problems; this was concerning for the researchers, since previous studies have found that understanding the thoughts and feelings of others facilitates sympathy, sharing, comforting, and helping - if these behaviours sound familiar, it’s because they’re also elements of compassion! Children with difficulties in perspective-taking have trouble forming and maintaining friendships, and are rated as being less popular than their peers. It seems plausible that the limited ability of kids with in perspective-taking could contribute to their peer difficulties.

What are the implications? Parents of kids who have conduct problems might be wise to seek help sooner rather than later, since these behaviours might interfere with their relationships. More generally, kids with attention problems might require explicit teaching to learn to recognize the thoughts and feelings of others. In fact, previous research has shown that impulsive, disruptive kids who learned to take into account the thoughts and feelings of others have greater improvements in behaviour than those who participate in a traditional social skills training program.

You can find the Journal of Abnormal Child Psychology study here.

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Compassion, Part 2: How Compassion for Yourself Changes Your Life Experience

Give yourself a big hug by quinn.anya

http://www.flickr.com/photos/quinnanya/ / CC BY-SA 2.0

When we think of compassion it is often assumed to be towards others. And rightly so. We are naturally more aware of our own suffering than the trials and tribulations of others because we feel our own experiences directly and not, so to speak, second hand. Therefore, it is compassion toward others that is our general challenge in life both for their well-being and for our ability to create, maintain and deepen our experiences with the people around us. However, as humans we are uniquely endowed with the ability to self-reflect, and in so doing, are capable of being the subject of our own experience. We regularly think about how we treat others, whether we are kind or mean-spirited towards them, and whether we have treated them harshly or with tenderness and care. We are less likely to direct this inquiry inward perhaps because we forget that we have a hand in how we are treated not just by others, but by ourselves.

Research into this area, that is, into “self-compassion”, has been growing in recent years. Dr. Kristin Neff, associate professor at the University of Texas at Austin has been one of the lead researchers in this field over the past decade. She defines self-compassion as “being open to and moved by one’s own suffering, experiencing feelings of caring and kindness toward oneself, taking an understanding, non-judgmental attitude toward one’s inadequacies and failures, and recognizing that one’s experience is a part of the common human experience”. Her research has shown that high levels of self-compassion act as a buffer for stress the same way having a kind friend or family member consoling you would. In effect, self-compassion is thought to be a self-protective factor that promotes resilience in the face of life’s difficult or painful experiences.

Why is this line of research seen as important? In a series of studies conducted by researchers from Duke University, Louisiana State University and Wake Forest University, Dr. Mark Leary and his colleagues found that self-compassion affects peoples’ experience in significant  and surprising ways.

In one study, they validated the idea of self-compassion by showing that participants that score high on a measure of self-compassion reported trying to be kind to themselves more often than those low in self-compassion. The researchers noted this is significant given that previous research carried out by Dr. Neff has shown that higher self-compassion was related to lower levels of anxiety and .

In another in their series of studies, the researchers had participants videotaped for three minutes while they talked about themselves. They were then provided with either positive or neutral feedback from people who had observed their video. Interestingly, participants with high self-compassion reacted more similarly to positive and neutral feedback, whereas those low in self-compassion were more likely to evaluate themselves higher when given positive feedback and lower when given neutral feedback. These results suggest that people with high self-compassion tend to take both positive and negative feedback (neutral feedback was seen as relatively more negative by both groups) in stride.

Another experiment using videotape had participants make up a children’s story while being viewed by third party observers. Participants also viewed their own performance and as expected those with low levels of self-compassion were more likely to diminish their performance on video as compared to people with higher levels of self-compassion. Interestingly, the neutral third party observers showed no preference for the performance of either group. That is, even though people with low self-compassion thought they did more poorly, objectively speaking, this was not so! Being kind to yourself is not about self-deceit or having to exaggerate your true worth or competencies.

Self-compassionate people are more likely to see their role in negative life events and absorb the ramifications without seeing themselves as “bad or worthless”. It is about seeing yourself as others see you, with all your strengths and flaws, and accepting yourself for who you are.

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The Effects of Stress During Pregnancy: First of a Series

PregnancyA significant amount of research over the years has been conducted in an effort to determine the effects of stress during pregnancy. While it would be helpful to have a straight forward answer to this question, conflicting results, weaknesses in research methodologies, and the intricate nature of the relationship between pregnancy and stress, make easy answers difficult.

The general hypothesis of those who believe that stress can negatively affect pregnancy is that difficult life events produce increased levels of the stress hormone cortisol. Since studies have shown that persistently high levels of cortisol in adults have been linked to negative health effects such as increased blood pressure and heart disease, the exposure of the fetus to high levels of cortisol must also have a detrimental effect. The belief is that too much cortisol in amniotic fluid affects the developing brains of foetuses. There are certainly studies that have shown that increased stress leads to premature birth and lowered birth weight. Other studies have also shown that increased stress during pregnancy is related to , learning problems and even schizophrenia later in life. One study even linked severe stress in the six months prior to conception to preterm birth. Given all this research and the headlines they generate, one begins to wonder whether the stress related to exposure to this research is having a negative effect!

However, as stated above, there are several things to consider when deciding how much to worry about the effects of worry. First, not all studies have demonstrated negative effects. In fact, an American study from 2006 found that moderate levels of stress were linked to more advanced mental ability in children by the age of two. There is certainly a competing hypothesis here related to the fact that cortisol, in an evolutionary sense, is critical to health and well-being. Its release in the brain is related to the fight or flight response which protects us from dangerous threats in the environment. Cortisol helps us focus our energies thereby leading to engagement, and perhaps improved competence, in the face of challenges. Psychologists have known for some time that there are optimal levels of “good” stress that can increase performance, while too little or too much stress have the opposite effect.

Second, critics also point to methodological problems with many of these studies. For instance, studies are often done retrospectively. That is, women are asked after their children have been born to rate their stress during pregnancy. The problem here is that women who have had a worrying low birth weight or premature birth experience are more likely to recall stressful life events during the pregnancy. Some have called into question the subjective nature of these studies. Other critics question the robustness of the results since the studies typically involved relatively small groups of women. Still others note that if the stress event is, for instance wife abuse during pregnancy, how can one rule out the detrimental role of the continued abuse in the months or even years following birth?

Third, the number of different variables involved in the stress and pregnancy equation is much larger than it may at first appear. Consider the following questions. If stress is harmful to the developing fetus, does it matter if the stress occurs during the first, second or third trimester? Is is only severe stress that leads to negative consequences, while more moderate stress has no effect, or as mentioned above, a positive effect? Is the social support one receives during pregnancy, or lack of it,  a more powerful predictor of post-natal outcomes than stress levels? In addition, is it the stressful life event itself that leads to negative consequences or the interpretation given to that event by the particular person involved, that is related to positive versus more problematic outcomes? How about the effects of acute versus chronic stress? As can be seen, the relationship between stress, pregnancy and outcome is quite complex.

What has your experience taught you? What conclusions have you reached? Let us know what you think.

Visit us tomorrow for the second part of our series on Stress and Pregnancy.

You can read more here and here and here and here and here.

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The Effects of Stress During Pregnancy: Second of a Series

HeartYesterday, we reviewed the research on the effects of stress on pregnancy. As was mentioned, the results can leave one feeling confused and more stressed! Despite this, there is a general trend in the research that does allow for a some relatively straightforward truths.

The main question is, does stress negatively effect pregnancy? The answer is, yes, if the stress is unusually intense. That is, intensely stressful experiences like the death of a loved one, abuse, or trauma, tend to be associated with premature birth or low birth weight. These outcomes have, in turn, been linked to difficulties later in life for some children (e.g., learning disabilities). However, it is also true that these types of experiences are difficult to avoid. Given this fact, it begs the question, what benefit is gained from knowing that intense stress can negatively effect your pregnancy? While we cannot control traumatic events in our life, we can turn to resources both internal and external in response to these stressors. Stress reduction techniques are within our control and have been proven to be effective.

The answer to our question also leads us to another common wisdom gleaned from the research. If you are pregnant and are under low or moderate levels of stress,  there is no need to worry – it will only make you more stressed! Pregnancy, by its very nature, typically brings with it low to moderate levels of stress. And rightly so. For the majority of us who live in a modern urban atmosphere where we feel as though life is within our control, watching nature take over our body to produce life can be anxiety provoking. Miscarriages, morning sickness, birth complications, childbirth, and birth defects, are just some of the fears expecting parents have to deal with. If these very common stressors were the cause of significant pregnancy complications then nearly everyone could expect negative consequences. Fortunately, this is not the case. While the average stress that accompanies pregnancy need not, in and of itself, be a source of worry, dealing with this stress will make for a more pleasant and rewarding pregnancy. Therefore, here again, stress reduction techniques are recommended.

Although intensely stressful experiences are typically outside of our control, there are situations where the knowledge of negative consequences for the developing baby can help spur people to a health promoting action or reaction. For example, a woman being abused by her spouse has the option of leaving either before becoming pregnant, while she is pregnant, or after giving birth. Obviously the earlier  an abused woman leaves the better it is for both her and her baby. However, the obstacles to leaving an abusive relationship are many (e.g, financial, social, familial). Women need to reach out to find the support and resources that will help them facilitate a change. Self-respect and self-protection should be enough motivation for women to leave abusive relationships. The research on the effects of intense stress on pregnancy simply provides another reason.

Visit us tomorrow for the third and last part of our series on Stress and Pregnancy when we’ll take a closer look at stress reduction techniques.

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The Effects of Stress During Pregnancy: Third of a Series

Relaxed PregnancyOur first article on the effects of stress during pregnancy focused on the complexity and confusion surrounding research in this area. Yesterday, the focus was on a couple of “truths” gleaned from the research. More specifically, the research suggests that intensely stressful events can have a negative impact on pregnancy, while mild to moderate stress is normal, and as such, should not be an extra source of worry. Of course, this current wisdom could change as new studies emerge. Today, we’ll focus on stress reduction, as it can be useful regardless of the particular circumstances you find yourself in, or the stress levels you are experiencing.

Eight Tips to Help Reduce Stress During Pregnancy.

1. Cognitive restructuring. This is the term psychologists use to describe the effects that thought can have on emotions. Peoples’ interpretation of events can vary widely. A mildly stressful event can be turned into a very stressful experience depending on your interpretation of that event. If, for example, your pediatrician has said something that has caused you to worry, don’t mind-read. Talk to the physician about your fears and ensure you have gained the proper interpretation of what was said.

2. Deep Breathing, Meditation, Massage. Your body can carry your cognitive and emotional stress. It deserves some attention. Get a professional massage or simply ask your spouse for one. Deep breathing and relaxation exercises help place the body into a relaxed state. Get some assistance so that you are doing it right. Breathing too shallow or quickly can increase your stress.

3. Reduce Exposure to Stressful People and Events. Perhaps prior to becoming pregnant you had plenty of energy along with the ability to absorb the stresses of day to day life. You might put up with a friend or family member that upsets you, or go to events that you were not very happy about attending in order to meet someone’s needs. Now is the time to reduce stress by saying no to some of the people or places that have brought you stress, and saying yes to your own needs.

4. Be Open to Learning. Learn about the practical things that will help you deal with the challenges of a new baby, through books, videos and people. Books can be very helpful, although you’ll want to stay away from ones that detail all the things that are unlikely to go wrong. Professionals are an important source of unbiased information.  Friends and family who have children can also be helpful, particularly with respect to validating the experiences you’ll be going through and helping you feel like you’re normal and not alone. However, be careful not to get lured into the idea that there is only one right way to raise a child. Everyone has different needs and ways of doing things. The most important thing you can do for your child is provide a safe and loving atmosphere. This includes setting proper limits for their behaviour.

5; Seek Social Support. This cannot be underestimated. Regardless of the level of stress you are under, support from others can be a powerful buffer and source of healing. You may also want to plan ahead to see if your spouse can take a leave from work. Having two people in the first few weeks or months after the baby’s arrival can make a world of difference. For financial reasons, this is not always possible. However, when your spouse is home don’t feel that you have to do everything yourself. If this is your first baby, there is no reason why your spouse cannot be learning along with you by taking equal responsibility. Friends and family can also help. Some may offer to babysit. Take time to get to the point where you’ll feel comfortable having them stay with the baby for a few hours while you take care of your needs.

6. Set Limits at Work. Being pregnant can take a physical and emotional toll. Co-workers and employers may not be aware of your increased stress levels and can continue to expect too much from you. While prior to becoming pregnant you may have been taking work home with you and not been too concerned with how it was eating into your personal time, this is not likely to be the case now or in the first year or two following the baby’s birth.

7. Be Prepared to Adjust to the New. Being pregnant means your body is changing, your identity is changing, your relationship with your spouse may change and even your connections with friends may change. Be prepared to be flexible. You may not be able to engage in the same activities that used to take up so much of your time. However, unlike a grief experience, your loss will not leave you with a void. The baby will likely displace something or someone. For most people, the rewards of a child will outweigh anything you may have lost.

8. Take Time for Yourself. Go to a movie or a concert, go shopping, listen to music, do whatever makes you happy even if is for a shorter time than you are used to. You may even find that you appreciate some of these activities more now that you are not taking them for granted.

We hope this information is helpful. At the same time, we realize that this is not an exhaustive list. Perhaps there are tips you would like to share that have worked for you and are not mentioned above. Share your experience. Leave us a comment!

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Stress and Pregnancy: What about post-partum?

Post Partum DepressionThis week, Dr. G has written about the lack of clarity in the pregnancy/stress research, the findings that are more consistent, and he gave some hints about how mothers can reduce stress. But, even though many parents are relieved after the birth of their healthy child, the stress doesn’t disappear in the post-partum period. Probably everyone reading this has heard of post-partum (or perinatal) (PPD). Although some research has estimated the rates of PPD at 10-20% of women post-delivery, a closer look at the statistics indicates that there is a high degree of variability between and within countries. Lee & Chung in 2007 estimated that rates varied between 0.5% to over 60% depending on the population.

Mothers with PPD may experience a number of symptoms, many of which overlap with Major Depressive Disorder:

  • Sad mood, crying, and tearfulness
  • Lack of enjoyment
  • Low energy
  • Insomnia or hypersomnia
  • Change in appetite
  • Concentration problems
  • Feelings of helplessness and/or inadequacy

For some mothers, PPD interferes with the development of their bond with their infant; they may feel emotionally detached from their baby or from other family members. Mothers may also lose their temper with the baby, and in some cases, they may wish to harm their infant. This anger and irritability sometimes surprises new moms, who may have expected to feel sad rather than irritable and short-tempered. An article on the Baby Ready blog described one mother’s experience that was later identified as PPD:

Do I feel depressed? Not exactly. Do I sit and weep inconsolably? Who has time? So, how do I feel? Angry. Ridiculously, illogically, uncontrollably angry. I am irritable, impatient, and resentful. Then I feel guilty, which makes me feel angry all over again.

Researchers have examined possible treatments to prevent PPD, but the complex biological, psychological, social and cultural factors that contribute to the make it difficult to develop an effective plan in the prenatal period. It might be helpful for mothers to be aware that the biggest predictor of PPD is a previous experience of .

Even though it’s difficult to prevent the development of PPD, research suggests that it’s important to address it as early as possible when it occurs. Lognitudinal studies suggest that PPD is associated with an impairment of parenting skills; maternal withdrawal might be of particular concern. However, the actual effects of these difficulties on the baby’s development appears to be quite small. At any rate, therapeutic intervention, similar to that is used for other kinds of depressive episodes, has been found to be effective in addressing PPD as well. Mothers should talk to their partners and other family members, and should try to be willing to accept support. It doesn’t necessarily require a therapist to reduce these symptoms, and friends or family members can be valuable resources.

Although moms are typically the focus of research and when it comes to PPD, fathers also experience considerable stressors in the weeks and months after the birth of the baby. Lee and Chung cite research suggesting that 5 to 24% of fathers suffer from depressive symptoms in the early postnatal period; there is a 40 to 50% chance that partners of mothers who suffer from PPD will also experience . One study found that paternal can interfere with the mother’s recovery from PPD!

What should parents remember about PPD? Here are a few important tidbits from the research:

  • Mothers’ experience of PPD may vary – they don’t necessarily need to be crying all the time to be depressed.
  • PPD can interfere with a mother’s parenting skills and with the developing bond with the baby, but the impact of this on the child seems to be small.
  • Fathers also experience an increased risk for depressive symptoms in the weeks after the baby is born.
  • The support of family and friends is important, but when the symptoms are severe, professional help may be warranted!

You can find Lee and Chung’s study here (that issue has a few articles about PPD). The study about paternal support is here.

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FA058 – Anatomy of Pregnancy Stress

Pregnancy and StressDoctors Brian and Giuseppe talk about the impact of stress during pregnancy, along with post-partum , and what to do about it.

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Childhood Anxiety, Part 1: Definitions and Parent Concerns

All people feel anxiety. It is an important and ancient defensive feature of the human body. Without anxiety how else would we be alerted to imminent danger? Our “fight or flight” response to threat has helped to protect us and keep us safe as a species. When our minds become aware of a threat, our nervous system kicks into gear. Powerful hormones begin to race through our bodies and activate our heart and lungs for increased blood flow  and oxygen. In addition, there is a slight increase in blood to our arms and legs in preparation for this fight or flight response. Confronting the things that threaten us, or running away from them, keeps us safe.  Thus, although anxiety may at first appear to be an annoying, unpleasant and even painful experience, this is not part of its intended function. In fact, anxiety is critical to optimal performance. For instance, imagine a public speaker who has little or no adrenaline coursing through their bodies. Chances are their speech will not be very inspired.

A child’s experience of anxiety is very similar to that of their parents or other adults. All six of the anxiety disorders detailed for adults in the diagnostic manual of mental disorders also apply to children. The six disorders are panic disorder, specific phobias, obsessive compulsive disorder, generalized anxiety, social phobia and post traumatic stress disorder. What these disorders all have in common is an unusually intense fear that significantly interferes with a person’s daily functioning. This kind of anxiety is no longer improving performance or keeping you safe. It has gone beyond these positive effects and is now restricting you or your child’s life. While the underlying feelings of threat and physiological reactions are similar in kids and adults, what we see may be different. In fact, a seventh anxiety disorder is seen only in children  and is called separation anxiety disorder.

What are you likely to see in your child and when should you become concerned? Look for the following signs:

Avoidance of school, social or other activities.

Frequent complaints of tummy aches and headaches.

Intense insistence on sameness in routine.

Excessive clinginess to mom and dad even after age 6.

Frequent nightmares with themes of kidnapping or death, involving family members or themselves.

Excessive ordering or hoarding of objects.

Excessive worries in anticipation of the day ahead and a persistent need for reassurance.

Again, all people, including children, experience anxiety. So you may be asking yourself, at what point should I get worried? What qualifies as “excessive” or “intense”? You’re own intuition will likely guide you in this respect. In addition to your intuition, you can ask yourself – to what extent is anxiety interfering with my child’s day to day functioning? Can he or she live with it? Is it leading to a pattern of increasing avoidance of life in general? Would my child’s experience be significantly improved without this degree of anxiety?

Tell us about your experience. Did you experience anxiety as a child? Have you seen dysfunctional levels of anxiety in your children? Leave us your comments and tell us your story.

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Childhood Anxiety, Part 2: What can parents do?

http://www.sxc.hu/profile/RotorheadAlthough some kinds of anxiety, such as a fear of strangers or separation, are normal parts of development, sometimes specific fears or a general sense of worry becomes so chronic or severe that it interferes with daily life. That’s one way to tell if your child has a problem (and Dr. G posted some other warning signs in Part 1), but you don’t necessarily need to wait that long to try and support your child through their fear and worry. Professional help may be required to address severe anxiety, but parents are on the front lines, so to speak, and you might be able to help. In fact, parents can use some of the same strategies as psychologists to help their kids learn to cope!

One form of psychological therapy that has proven to be effective in addressing anxiety for kids and adults is cognitive behavioural therapy, or CBT. Put simply, this is aimed at changing underlying beliefs that lead to anxiety in some situations, along with encouraging behaviour to reduce anxious thoughts and feelings.

The good news is that this kind of has been proven again and again in research to be effective in reducing anxiety symptoms in children, adolescents and adults. The first step is education about feelings, which begins with a discussion about anxiety. With kids, though, it’s sometimes hard for them to express their feelings in words – they may not fully understand their feelings yet. I ask kids to think about a thermometer – often we draw one together, and add numbers from 1 to 5. The number 5 is the MOST anxious they’ve ever felt, and the 1 is how they feel when they aren’t anxious at all. Once we’ve talked about what the different numbers feel like for that particular child, we have a shared language to discuss their anxiety. So instead of using words like “nervous,” “slightly fearful,” or “terrified,” we can use the numbers on the thermometer to begin our discussions. Some kids are willing to use the numbers at home with their parents, giving the whole family an easy way to talk about their feelings that most kids can understand.

Psychologists who use CBT believe that feelings are made up of three elements: thoughts, physical reactions, and behaviour. These elements are inter-dependent, and a change in one or two of these areas can really affect how you feel! When I work with kids, we often talk  about how people react differently to the same situations. Parents can do the same, allowing kids to begin to think about their feelings in a new way – one that will hopefully give them a sense of control. You and your child can begin to think about thoughts, physical reactions, and behaviours that make your child feel more or less anxious. You might give the categories names, like “helpful” or “harmful” thoughts.

Tomorrow, Dr. G will write about anxious thoughts and beliefs in more detail, and on Thursday I’ll be back with a post about how parents can help their kids to deal with the physical element of anxiety. Remember, if you’re concerned about your child’s anxiety or fearfulness, it’s a good idea to consult with a professional – your family doctor can probably provide a referral.

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Childhood Anxiety, Part 3: How Beliefs Affect Behaviour

http://www.sxc.hu/profile/RotorheadYesterday, Dr. Brian discussed an overall framework that many psychologists use to help kids and adults deal with anxiety. Cognitive Behaviour Therapy or CBT for short, involves examining your thoughts, challenging your thinking patterns and noticing the changes this can make in how you feel.

I often explain how beliefs can affect behaviour by giving the following example. You’re a student at a bus stop and your bus races by you without stopping. How do you feel? People answer this question differently depending on what they are thinking. If you’re thinking about how inconsiderate the bus driver is, you’ll be angry.   If you’re thinking of being late and your principal’s punitive reaction, you’ll be scared. If you’re thinking of how little your parents care about you being late, you’ll be happy to have an excuse to be late as it affords you more time with your friends. If you’re thinking of how this would not have happened if your parents had bought you a car like Billy’s parent did, you’ll feel envious.

So given the premise that thoughts affect our feelings, psychologists go about trying to get people to become more aware of their thinking patterns. Thoughts have two common traits. First, they often run through our heads without our conscious awareness. Although we are not typically aware of it, our brains’ rarely stop thinking. If we were aware of each and every thought that popped into our minds, we would be easily distracted and terribly annoyed in short order. However, when emotional states, such as anxiety, cause us great suffering, it is important to take a closer look at thoughts that may be exacerbating some of the difficult experiences we endure in life. Second, our thoughts can also be automatic in nature. That is, when presented with similar situations we tend to develop re-occuring thought patterns. These “thought habits” can compromise our mental and emotional well-being. Being aware of and challenging our automatic negative thought habits is an important aspect of CBT .

When I work with teens, I like to have them become more aware of their automatic thinking by unearthing the thoughts they are having when they are anxious. I typically  have them write these thoughts down and then systematically examine the evidence for and against the validity of these thoughts. This examination typically results in the realization that their thought processes are distorted. For example, catastrophic thinking patterns (e.g, “My heart is racing, that means I will have a heart attack and die”), and over-estimating the probability of a stressful event (e.g, “When I give that speech in front of the class tomorrow, all the kids will stand up and openly ridicule me”) are the two most common thought patterns leading to excessive anxiety in kids. Challenging these automatic thought distortions can significantly reduce children’s anxiety.

Treating anxiety is a multi-step process. Tomorow, Dr. Brian will be talking about addressing the physiological reactions related to anxiety and how parents can help deal with them.

Read Childhood Anxiety Part 1 and Part 2.

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Childhood Anxiety, Part 4: Controlling reactions to stress

http://www.sxc.hu/profile/RotorheadWhen I’m worried about something, it’s more than a feeling – it’s a physical sensation, and it isn’t pleasant. My clenched jaw and the tightness between my shoulders always come along when I’m feeling stressed. Other people might feel their heart race or their hands become sweaty. Sometimes these physical reactions lead people to feel more anxious. Someone who is having a panic attack might interpret their racing heart as a signal that they’re going to die! Many of us learn to recognize how our bodies react to stressful situations, and hopefully we’ve learned to manage both the stress and the effect it has on us physically. That learning takes time, though, and anxious kids are often unaware of their body’s stress signals.

On Tuesday, I wrote about Cognitive Behavioural Therapy, or CBT, and how many therapists teach their clients to pay attention to their thoughts, their physical reactions, and their behaviour when they feel anxious. Changes in one or more of these areas is thought to help people to feel better. Yesterday, Dr. G posted some ideas about anxious thought patterns, but how can kids manage their body’s response to stress?

As I said above, many kids are unaware of their response to anxiety. It can be helpful to talk about it. In Part 2 of this series, we wrote about how parents can discuss with their children the variations in the severity of their worry – they can include the physical responses as well. If Billy is so afraid of being stung by a bee that he refuses to go outside, he might be able to explain what it’s like for him to think about going out. Maybe his breathing changes, or his heart races in response to his extreme fear. But what if he’s only a little bit nervous around other bugs? These reactions to lesser stress can help you and your child learn to recognize signs of anxiety before the fear becomes extreme. Once your child is aware of their body’s signals, he or she has an opportunity to control them.

I think slow, deep breathing is important when people are feeling anxious. When you’re stressed, breathing often becomes rapid and shallow, resulting in an increased heart rate that the brain might interpret as a further increase in anxiety. If kids can learn an exercise to manage their breathing before they become panicked, they might be able to keep their heart rate down and feel more control over the situation. Daily practice of deep breathing exercises can make it easier for children to notice changes in their breathing when they start to feel worried, allowing them to use the techniques in times of stress. As we wrote last year, at least one psychologist believes that blowing bubbles can be a helpful breathing exercise when people are stressed; the slow, controlled breathing required to make a bubble is exactly the kind of breathing recommended in CBT!

One exercise that kids sometimes enjoy involves a combination of breathing and visualization. The child has to think about their favourite colour, and their favourite Jello flavour. Then they imagine a balloon in their belly (their favourite colour balloon) and a spoonful of Jello in front of their mouth. They have to breathe in slowly to fill up the balloon, and then they breathe out slowly so the Jello doesn’t wiggle off the spoon! I often ask kids to think about how they feel before their deep breath, and again afterwards. This encourages them to notice the physical changes that accompany a relaxed feeling, and increased awareness can help kids to gain control over their physical reactions more easily. There are many similar breathing techniques and other relaxation exercises in The Relaxation & Stress Reduction Workbook for Kids.

A word of caution is in order, though, for parents who want to teach their kids breathing or relaxation exercises. People who are prone to panic attacks may be extremely alert to their body’s signals, and changes in breathing or heart rate might precipitate a panic. Consult a physician or a therapist before beginning a relaxation program.

Tommorow, I’ll be writing about behaviours that are linked to anxiety, and how to help kids engage in effective coping behaviours.

Read Childhood Anxiety Part 1, Part 2, and Part 3.

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Childhood Anxiety, Part 5: Taking action to control fear

IAN HOOTON / SCIENCE PHOTO LIBRARYWhat’s your first reaction when approaching an anxiety-provoking situation? As adults, many of us can take a deep breath, grit our teeth, and face our fear – if we couldn’t, there would be a sharp decline in the number of presentations at staff meetings. When kids feel afraid, though, many parents’ first reaction is often to protect them – to remove them from the source of their fear so they can feel better! But how can parents help their kids learn to control their anxiety instead so they can overcome fear? This week, we’ve written about how kids can monitor and manage anxious thoughts and physical reactions to stress, but avoidance of fearful situations may be one of the biggest obstacles to coping with anxiety for both children and adults.

Avoiding feared situations occurs because it works. Kids might immediately feel better if they cross the street to avoid getting too close to a dog. The problem with avoidance is that it can interfere with day-to-day functioning – the relief you feel when you’ve avoided fear can make the situation even more anxiety-provoking the next time around!

Facing feared situations can be risky, however. You hope that exposure to the frightening situation will help your child to realize it wasn’t as scary as they expected, and it will be easier to face their fear next time. Parents who drop their kids off on the first day of school may be familiar with this. Many kids are nervous about going to school for the first time, but teachers work hard to make it a positive experience, and children gradually learn that school is not a scary place. On the other hand, if your child who is afraid of dogs gets bitten the first time he tries to pet one, his fear might increase! This is why we presented strategies to manage thoughts and physical reactions before talking about exposure – these techniques are meant to prevent fear from becoming overwhelming. When kids feel overwhelmed, it can interfere with decision-making and increase the likelihood that the situation will not be a positive one. It is this risk that makes it important to work with a therapist to ensure the best possible outcome if your child is coping with significant anxiety.

In cognitive behavioural therapy, or CBT, psychologists often recommend gradual exposure when treating anxiety. Some start with visualizing the situation, or looking at pictures, and giving their clients an opportunity to practice relaxation strategies and to challenge anxiety-provoking thoughts. After practicing in this way, they might gradually approach the feared situation with the knowledge that they have some control over their reaction. This is particularly effective when treating specific phobias, such as a fear of flying or a fear of riding in an elevator.

Once your child has learned some anxiety-reducing techniques, such as positive self-statements and breathing exercises, they may be more willing to face the feared situation. If you can set up a situation that is somewhat controlled, you may be able to increase the likelihood of a positive experience. For example, if your child is afraid of going to school, you might be able to set up a visit after school hours, when there are few people in the building. You can set up a visit to the classroom so they’ll know where it is, reducing their fear of getting lost. If the teacher is made aware of your child’s difficulties, he or she may be able to remind them of their coping strategies, or allow them to take a break if their stress level rises. Parents and psychologists often brainstorm for solutions to make the exposure a beneficial one.

Here’s an example. One of my kids was nervous about entering swimming pools when he was younger – although it’s good to be aware of the dangers of being careless while in the water, his fear was preventing him from going swimming at all. With his life preserver and a parent nearby, the situation was as safe as it could be. He eventually entered the water and had a great time, but on a later visit, his face went under the water briefly and he panicked. We took him out of the pool, talked to him and calmed him down. Although he was reluctant, I worked really hard to convince him to come back in the water with me before we went home. It was important to me that he leave the pool with a positive memory, rather than a negative one. I was worried that if he avoided going back in, he would once more be fearful of swimming. He went in the water, we had fun for a little while, and he was willing to swim again next time. Now, he not only loves the water, but always works hard to face his fears! He even encourages his younger brother to try (appropriately safe) things when he’s nervous.

Read Childhood Anxiety Part 1, Part 2, Part 3, and Part 4.

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