In recent months I happened to work with a number of elementary-age children who had developed anxiety symptoms such as resistance to separation, excessive worrying, nightmares, restricted activity, and “meltdowns.” They were all very bright, creative children who engaged in a lot of fantasy play and were described by their parents as very sensitive. While excessive anxiety is not limited to this cohort of personality factors, I do believe that they represent a majority of the children who, in fact, get immobilized by their fears.
The good news is that those same characteristics can be used to help them change from feeling powerless and overwhelmed into children who feel capable of solving their problems. In other words, these children learn to be more resilient. When I ask parents in my workshops what qualities or strengths they most want for their children, I usually hear a list that includes happiness, health, kindness, sociability, and achievement. What I focus on, however, is resilience. This concept, expertly evolved in a series of books written by Drs. Robert Brooks and Sam Goldstein, refers to developing a sense of being able to solve the problems that life inevitably poses to all of us.
In the discussion that follows, I will describe some of the issues these children presented (details are changed to protect confidentiality) and the strategies used to empower these children to learn how to manage their fears.
Micah, an 11-year-old boy, who was described as very sensitive and caring, had developed a significant problem around separating from his parents. It had reached a point where it impacted their ability to go out without him as well as his ability to go on field trips or to stay over at a friend’s house. He had developed chronic complaints of stomachaches (nothing found by his physician). We refer to developing physical symptoms as somatization. It is very common in children (keeps school nurses very busy) but is also common in adults.
Typically one of the first stages in my work with these children is a psychoeducational piece. With Micah, I explained what happens in the body when we get anxious (nervous, worried). The brain sets off an alarm and the body, like a fire department, swings into action. This is about the “flight or fight” mechanism. The body produces adrenalin which in turn causes our heart to speed up, pumping more oxygen to give the body more energy. Our muscles tighten, ready to spring into action. Our pupils dilate, the better to spot problems. Now, this can be helpful if there is really a threat that we need to deal with. But what if there isn’t? I use one of the many ideas I’ve learned from a colleague, Dr. Susan Davidson, a behavioral psychologist, who specializes in the treatment of anxiety disorders. “Micah, does the smoke alarm ever go off in your house but there isn’t a fire?” He laughs. “Sure sometimes when mom’s cooking!” Please note the value of humor in helping children understand and deal with problems. (Actually it’s also very helpful with adults.) So we begin to use the concept of “false alarms.” Do we want those firemen racing to his house when there’s no fire to put out? Of course not.
Micah and I worked on the problem in a few ways. I taught him how to relax his body. Open your palms, hands pointed down (an inviting rather than rejecting position that is part of yoga), taking a deep breath, and then drop your belly! Kids usually laugh when I say this. But they catch on quick as I demonstrate it and can immediately feel their body relax. I explain how their body can’t be anxious and relaxed at same time. Micah started to feel he could control at least part of what was happening to him.
We also talked about how stress causes “aches” and he was able to list stomach, back, and head as common aches we all experience from stress but he had never thought of it in that way. Another helpful piece of information.
Then we began to make lists of past worries and checking off which had actually come to life. Sometimes there may be a couple. Often there are none. Either way, it is immediately clear that most of the worrying is for naught. Then we make a list of worries about what bad things might happen in the coming week. At our next appointment we review the list and rarely has any of the worries come true. I focus on the concept of the brain sending false alarms (not Micah having unnecessary worries – better to blame the brain) and that he can now begin to tell the brain when there really isn’t a fire. “Aw, it’s just mom burning dinner again!”
Given a way to understand what has been happening inside his body and a few strategies to better control what is going on, Micah quickly has a couple of positive experiences and quickly improves. I find that these bright children are able to take the ball and run to daylight almost immediately. They start to feel more confident, more resilient, and often are quickly telling me they don’t really need these appointments any more. Thank you very much, but I’d rather be playing with my friends!
Allison, an 8-year-old, brought another aspect of these issues into the office – temperament. She was described by her parents as “slow to warm up.” These children, and their close “cousins,” shy, have an exaggerated self-consciousness that makes them more prone to worry. Allison demonstrated a common aspect of worriers – “catastrophizing.” This refers to taking a small problem and turning it into a potential catastrophe. Often the child doesn’t see that she is doing this but Allison did. However, she said she couldn’t stop it and had no idea why she was doing it.