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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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.