Again I use a psychoeducational piece. This time I make a fist, tucking the thumb under my curled fingers, and talk about the different parts of the brain. The thumb represents the place where emotional messages come from, the fingers are the front of the brain that manages things (executive function), and the wrist is the lower brain, oldest or reptilian portion, that carries the action messages down the spine (the forearm). The child can see that emotional messages beat managing messages to the parts of the body that will be responding. Thus, if we can learn to delay our reaction for just a second, the thinking part will have a chance to solve the problem, avoiding “bad reactions” including meltdowns. Being able to “see” this is helpful. Then we practice those relaxation strategies to gain the time needed for more effective responses. This can simply be taking a few deep breaths. I explain hyperventilation to children, the subtle, often undetected, taking of short, quick breaths that can make us feel anxious and light-headed. Just a couple of slow, deep breaths provides some relief and, again, buys time for a better response.

I use lists for catastrophizers just as I do for worriers. I try to provide some information that a child can relate to that puts the low probability of her fears into perspective, e.g., you are more likely to be hit by lightning than to be kidnapped. Transitions are especially hard for these self-conscious children. Common symptoms include difficulty trying something new and difficulty returning to school after a vacation, but especially after missing a couple of days of school due to illness. The latter usually responds well to my incredulous response, “Are you telling me that the best solution to missing a few days is to miss some more days?!” Then I’ll ask (these are usually good students) if they have ever not caught up after missing some school? “No.”

I also explain the inborn nature of their self-consciousness and how walking into a new group or their old class after being out makes them feel like everyone is looking at them. Doesn’t she look at the new child or the friend who has been out a few days? “Yes.” “How long do you keep looking?” “Not long.” “Okay. Remember that when you are the one walking in.” Also add the deep breath that helps to calm and the child is often able to begin to take control in a situation where she has previously felt a lack of control and not understanding what was happening. (You can see certain themes repeating themselves here – knowledge and strategies that work leading to a sense of empowerment.)

Some of these children are capable of using visual relaxation techniques. Picture yourself in a safe place doing something that is very relaxing. Floating in a swimming pool. Lying on ground and looking up at the clouds or stars. One child described sitting on the floor and drawing pictures. The point is that children can learn to use these relaxing images to manage anxiety or to clear their minds at night if they are having trouble falling asleep. Again, it is important that the child comes up with what works for her. It is all part of developing the sense of being able to solve her own problems.

Jonathon, 10 years old, presented me with a long list of daily worries. They appeared to become exacerbated following a medical procedure that left him worried about his health, even though everything was now fine. Jon had a tendency to worry even before this happened but it was manageable then. Not now. He was not only intensely preoccupied with his worries but also was having nightmares, a common symptom for this group of children. Since he loved to draw, I had him draw a picture of his body part that had required some repair. His image reflected a distorted sense of a still damaged organ. Input from his doctor allowed me to help him create a correct drawing and enabled him to quickly begin to “feel” healthy because he didn’t feel defective.

We addressed the avalanche of worries in a few ways. Little annoying worries were zapped with weed killer spray (we had identified these minor worries as weeds growing in his lawn and drew a picture of that image). A large number of medium strength worries were identified as “spam.” He, like so many young children today, was very computer literate and knew about spam and spam filters. So he “installed” his own mental spam filter and “delete spam” became a way to clear his mind! We used a scale of 0-10; zero being no worries and 10 being overwhelmed with worries. He started out at 8 and within weeks the number was steadily dropping until it actually got to one, to which I complained that now he was worrying less than I was! Could he please help me get to one?

We worked on the nightmares with my usual strategies. Nightmares are the child’s own thoughts. “They are your nightmares and you can control what happens in them.” We work on coming up with assistance from a superhero or adding superpowers. The former can be a real superhero or one created by the child, e.g., a pet dog or a favorite stuffed animal or a character from a favorite book. The latter can be a plastic ring or elastic wristband worn to bed (have extras in case the original gets lost). The child then learns to call upon the superhero or the superpowers in the dream and vanquish the threat. It requires children to recognize they are having a dream but it is amazing how most children can do this. Sometimes, when the problem is proving to be a bit more stubborn, we’ll use drawings of the dream and change the process in the drawings which the child is often able to carry into their nightmare after some practice.

All these children showed the rapid recovery I mentioned earlier. It’s a reminder how most children have a natural resilience that we just need to tap and unleash with strategies that give them helpful information and some techniques to allow the emergence of a sense of being able to solve their own problems. This not only helps resolve an immediate concern but it provides them with a foundation for managing the future challenges that life will inevitably present.