Thursday, July 3, 2014

Part 2 Children and Anxiety: Cognitive Behavior Therapy

In my last post, Escorting Children Through Anxiety, I mentioned the importance of educating ourselves about anxiety disorders in children. Today I'd like to discuss Cognitive Behavior Therapy, which is the go-to therapy for anxiety disorders. Traditional talk therapy will only worsen anxiety, so we want to make sure we are choosing therapists who are experienced with CBT, or Cognitive Behavior Therapy.

I need to explain three principles to you: containment, externalization, and competing demands

Today we will have time for the first two only.

We want to contain anxiety, much like we contain anything--ketchup in the ketchup container, for example. We cannot let children talk or think about their worries all day long. Neither can we constantly assure them when they bring up their worries. This only makes things worse, giving the worries too much power.

The book What To Do When You Worry Too Much by Dawn Huebner uses the analogy that if you keep tending your garden and pulling the weeds and watering it faithfully, you'll yield a huge crop of tomatoes. Anxiety is the same. If you keep tending and feeding it, it just grows bigger, until you've got more yield than you know what to do with.

Containment, so things won't overgrow. We set aside a time each day, say for 15 minutes, and call it worry time. Children pretend all day to put their anxieties in a worry box, only to be taken out at worry time. Mom and Dad, when approached for the usual assurance during the day, can only say..."Sounds like that should go in the worry box." No matter how much your child wants your assurance right now, try hard to only remind her about the "worry time".

Worry Time: Choose a 15-minute time segment during the day when she is not exhibiting bodily signs of anxiety, and when there are no other distractions (not from siblings, TV, computers, etc.). After she unloads everything she's worried about, help her learn to use logic. She must stop the worst-case scenario self-talk. Discuss the improbability of the worst thing happening, and leave it at that. Logic is also knowing that even if something bad does happen, she can get through it. Don't argue these thoughts with her, just present them, and tell her she must learn to use logic on her own with time.

The anxious child needs to learn that he is not his anxiety. The anxiety is an outside entity that your child is hosting, and in order to exert control over it, he needs to externalize it.

Teach the following ideas when your child is calm.

~ The worry is a BULLY. Have your child use his imagination to picture what the worry bully looks like, perched on your child's shoulder all day. Have him draw a picture of what his worry bully looks like.

~ Right now, the worry bully is stronger than the child, but that will change and the child will learn to boss the worry bully and gain the upper hand. Teach these truths about the worry bully: Worries lie. They trick you. They exaggerate.

~ Teach your child to talk back to the worry bully whenever it bothers her during the day, especially when it refuses to go in the worry box for later.

"I don't believe you!"
"That's a bunch of GARBAGE!"
"Leave me alone!"
"Get lost."

Next time we will talk about competing demands, which are forms of distraction, some targeted toward reversing the bodily signs of stress, once they've already started.

1 comment:

Beth said...

I like the idea of 15 minute of worry time. Maybe that would work for my father-in-law who worries about everything.