Category: Anxiety

Anxiety Disorders in Children: A Family Affair

Written by Regine Galanti

When a child has anxiety, it often becomes a family rather than individual problem. While an adult with anxiety might suffer alone with racing thoughts of danger, or avoidance of anxiety provoking situations, children with anxiety are best viewed from a perspective that incorporates the whole family. This family-perspective is often true of adults with anxiety and OCD, but in the case of anxious children, it is the norm rather than the exception.

Take the case of Emma, an 11 year old who begins to have panic attacks. When she had her first panic attack, she was alone in her room, and felt her heart pounding, her breathing quickened, and her body began to shake. She was sure she was having a heart attack, and felt terrified, helpless and alone. When she felt better, she was determined to avoid those feelings of being alone and helpless forever. In order to feel safe, she refused to stay alone in her house, despite the fact that she used to do so easily. She demanded that her parents drive her to and from school, despite having taken the bus for years. Her father had to rearrange his work schedule to go in late every day, and her mother had to leave work early to pick her up. She was also incredibly fearful of being the last one awake in the house, and would constantly check on her parents to make sure they weren’t sleeping before she did. Her parents took to sitting in the living room to “prove” to Emma that they were awake, despite previously reading in bed, and sometimes going to sleep before their pre-teen daughter. She also asked her parents an endless string of health related questions, which she demanded the answers to, even though she challenged every answer. Emma’s mother and father were distressed by the effects of her anxiety on her own life, but recognized it was taking over their lives as well.

The term family accommodation is used to describe the ways in which family members of individuals with anxiety disorders adapt or modify their own behaviors to reduce their child’s anxiety. Accommodation in families most frequently involves parents – over 90% of parents of anxious children report that they change their own behavior to reduce their child’s anxiety in some way — but sometimes incorporate siblings as well. On its face, this may seem like a positive, as the family members are changing their behavior in order to reduce anxiety to help a child function better. Higher degrees of accommodation, however, are related to many negative factors in childhood anxiety, including a higher level of impairment in anxious children, and more severe symptoms. Accommodation sends the message to a child that their anxiety actually IS dangerous. In the case of Emma, her parents modifying their behavior to reduce her anxiety tells her that if she does stay home alone, something bad might actually happen, and that would be dangerous. Her parents are protecting her from something that isn’t actually dangerous, thereby sending her the message that she needs protecting. Instead, our goal when helping families with anxious children is to help parents support their anxious children – teaching parents how to tell their children that anxiety is a normal emotional experience, and that the best way to handle it is to face those fears even though it’s difficult rather than avoid them. The important factor to keep in mind here is that, though the child might be the one in treatment, often parents can play a role in reducing anxiety as well – though not in the way that you might think. By stripping away the layers of accommodation, parents can teach children how to face their fears in a healthy, adaptive way, and improve their long term functioning.

Decisions, Decisions…

Written by Thanos Nioplias

Making decisions is a complex process that has been examined from various fields including cognitive psychology, neuroscience, and philosophy. Decision making is also very relevant to psychotherapy, since difficult dilemmas are a known source of anxiety, frustration, and feelings of helplessness for many people. Choosing between two career paths, between two romantic partners, or the right mental health treatment can lead one to stay up at night, procrastinate, and constantly seek reassurance from friends and family by asking questions such as “Is this the right choice?” “What would you do if you were me?” “But are you sure?!”

From a therapeutic perspective, feeling anxious and helpless when having to make hard choices is related to intolerance towards uncertainty – reacting negatively to uncertain situations and events. When anxious individuals face a dilemma, they tend to tell themselves that they wouldn’t be this anxious if only they knew how their life would turn out with each of their two options, while they also make draining efforts to achieve an absolute sense of certainty that their decision is the right one. The reality, however, is that uncertainty is part and parcel of life – achieving 100% certainty about anything is impossible.

How can we be more efficient when facing stressful decisions? First, it can be helpful to refocus on one’s values and goals in life. Instead of calculating possibilities and probabilities, reflecting on one’s internal values and objectives that they want to guide them in decision making can help restore equilibrium and calmness. For example, ask yourself questions like: “What am I aiming for in making this decision, and how does it fit into my overarching life goals (e.g., building relationships with family, establishing financial security, growing spiritually)?” “What are the characteristics I want to embody in this process” and “When I look back on this problem one year from today, what are the values that I would like to have influenced my choice and therefore my life?”

Second, it is important to acknowledge that we live in a world that is filled with uncertainty, and that we have much less control of future possibilities than we believe that we do. Instead of trying to eliminate any risks when making decisions, one can accept and even embrace the idea that risk is inherent in every hard choice! Even though acknowledging your limited capacity to control and predict future risks is frightening, it can also be surprisingly liberating. In other words, the only variable that you may be held liable for when making a decision is not about the risk you did not foresee, but about acting in a way that was incongruent with your values and the person you wanted to be!

Third, accepting uncertainty is not an easy process and therefore it takes practice for one to master. For instance, when ambivalent about smaller decisions – such as which restaurant to go to or what to order from the menu – you can practice making a quick decision and accepting the risk that the decision they are making is actually the wrong one! In other words, learn how to make decisions while accepting all potential outcomes instead of reaching a sense of certainty prior to making a choice.

Good luck and over time you will learn to choose wisely!

Staying Present in the Face of Anxiety

Written by Tonya Swartzendruber

Most of us are familiar with the feeling of trying to escape from or avoid anxiety – we think that if we avoid a particular place/person/conversation our uncomfortable feeling will go away and never come back. But over time, those who pay attention also recognize the futility of escape, since anxiety always comes back and often grows even stronger when we try to avoid. As well, our attempts to escape or avoid anxiety makes our lives get smaller and smaller as the list of things that provoke anxiety grows and grows.

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