How CBT helps Children deal with Anxiety: Guest blog by Leigh Adley, therapist at Set Your Mind Free

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(image: Pinterest)

As we know, children are also vulnerable to anxiety. Unfortunately, many parents believe that this type of mental health problem will only be temporary in nature. For example, they may think that their child’s shyness will disappear as they grow older. However, if this shyness is increasingly interfering with the child’s life as well as their family’s, then obtaining help is of paramount importance. If left untreated, a child’s severe anxiety will in all likelihood deteriorate as they will choose to avoid situations that make them anxious.   

People suffering from anxiety, including children, are often treated with medication, particularly antidepressants. However, there are alternatives available, such as cognitive behavioral therapy (CBT), which can help children deal with stress.  

Two decades of research has shown that CBT has been successful in reducing the symptoms of severe anxiety. This therapy also provides children with the tools to identify situations that trigger their anxiety. It also helps them manage the symptoms themselves.

What is CBT?

Cognitive behavioural therapy is used to help people manage their way of thinking and feeling. For example, it can help change distorted thoughts and dysfunctional behavior in order to alter an individual’s emotions. For children, therapists will often focus on getting them to unlearn their undesirable behaviour.     

 

Exposure and response prevention

This is the technique most therapists use for children with anxiety. It is a basic idea whereby a child is exposed to the situations that make them anxious. However, this exposure is structured and incremental and takes place in a safe environment. The goal is to make them accustomed to the triggers so their anxiety response is reduced. 

Exposure therapy has little in common with traditional talking therapy. CBT sessions generally involve talking to the patient to explore the root causes of their anxiety, and they then use this knowledge to alter their behaviour. Once they modify or change their response, the fear also disappears.

Exposure therapy is used for various types of anxiety, such as:

 

Treating anxiety as a person

It is helpful to go to a cognitive behavioral therapist as they will enable a child and their parents to think of the anxiety as an entity that is separate from their identity. The child may consider his or her anxiety to be a bully. To treat the anxiety as a person, the patient may give this bully a name, such as ‘Bossy’. Once the anxiety has been given a form, the CBT therapist can then teach the child how to control this ‘bully’. 

Children are also taught to recognize that anxiety can negatively affect their lives. By letting their fears control them, they miss important events such as:    

  • Sleeping in their own bed
  • Visiting their friends’ homes or going to a restaurant
  • Sharing meals with family or friends

It is also essential that the therapist gains the child’s trust so they can encourage them to face their fears.

 

Steps involved in exposure therapy 

The CBT therapist will firstly identify the triggers. The child will then confront a “pyramid of fears”, namely a sequence of incremental challenges. Every test that the child successfully accomplishes will help build their tolerance to the anxiety.

Before taking the challenges, the child will be asked to consider the degree of difficulty when encountering an uncomfortable situation. For example, a child who is afraid of touching dirt will be asked how difficult it would be (on a scale of 1–10) to write the word ‘dirt’. If they say ‘3’, then saying ‘I will touch dirt today’ could be a ‘5’, seeing a cartoon where a character picks up dirt may merit a ‘7’ and seeing an actual person touch dirt may go up to a ‘9’ on their difficulty scale.

By letting the child rate the scale of difficulty for their various fears, they can distinguish between the easy and extreme levels.

The first exposure trigger should come in its mildest form until the child’s anxiousness subsides. Fear is similar to any sensation; it decreases over time and the child will soon gain some control as the anxiety they feel goes away.

Depending on the severity of the child’s anxiety, a CBT session can take place several times a week, lasting several hours. The exposure often takes place in the CBT office, and then once the child feels comfortable, in an outside environment. For example, children with social anxiety may go outside wearing a funny hat. If they are afraid of germs, the exposure may involve:

  • Riding a bus or train
  • Shaking hands with strangers
  • Eating food without washing their hands

Once they have undergone several vulnerable situations and are feeling more confident, they can try some of the exposure sessions on their own. Parents have a vital role to play in this process. They should encourage their child to tolerate their anxious feelings rather than shielding them.

 

Duration of CBT sessions

It can take 8 to 12 sessions for a child to handle mild to moderate levels of anxiety. In addition, medication can help them reduce their stress while enabling them to engage in the CBT sessions.

 

Conclusion

CBT is a good way of helping children deal with their anxiety. CBT utilises various methods to overcome anxiety, and the exposure and response prevention techniques are particularly suitable for children. The child will confront their fears in increments until they can handle the stress on their own.

However, both the child and their parents need to understand that exposure therapy can be difficult. Nevertheless, once their fears diminish, the family can participate in activities that they previously found difficult.  

 

Author’s bio:

This blog was written by Leigh Adley, Hypnotherapist/Psychotherapist at Set Your Mind Free, based in the UK.

Mental health and the juggling act: New Job, My book and Wedding. by Eleanor

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(image: Trigger Publishing)

Nearly a month ago, I started my new job at a big Jewish charity here in London. I work in a small but lovely team in PR and Communications- helping run social media, write and distribute press releases and copywriting. I am enjoying it but its totally different from my other work and I am far less immersed in the mental health world than I was a few months ago. It is a juggling act. Trying to keep up with changes and all that’s occurring though. Hopefully soon I will find time to write articles again for my friends at Metro.co.uk and Happiful.

This has brought its own challenges as I havn’t been blogging here as much either, due to writing my book. My book  ‘Bring me to Light’  will be released in the UK on November 5th and the USA shortly after, with Trigger Publishing. The title references going from darkness to light, as I have done with my bipolar and anxiety since I was 16. I have written most of it (50,000 words!) but my very kind editor has extended the deadline for it so I can write everything I need too, whilst also doing my day job and wedding planning (!). I am really excited to see a printed copy and to promote it later this year- the hard work will be worth it I hope. I also hope you enjoy reading it and thank you all for your ongoing support.

So, wedding planning, we are 5 weeks away now until I marry Rob, my fiance. It has come round so fast especially as we have had a year and few month’s engagement, I am counting down the days until I am under the Chuppah (Jewish marriage canopy) and we are officially married in presence of those we love! This week I had my final dress fitting and it was super emotional. I still can’t believe its happening. Rob’s dad is recovering slowly at home but his condition is still serious as he has cancer.

Naturally, you will be wondering- how am I staying sane with my bipolar with everything going on and with Robs dad not being well? Firstly, as we know, stressors can make bipolar worse and trigger episodes. At the moment, my main mood stabiliser Lithium keeps me very grounded and stable. Despite the stress, I am not dipping down into  deep depression as I would have done in the past. Yes-  there are times when I might feel stressed, overwhelmed, exhausted or tired and just want to sit in my pyjamas watching Made in Chelsea or First Dates. There are also times when I am too tired to cook or do laundry and need support with those. I am lucky to have a very supportive family who look out for me too.

My work colleagues have been super supportive when I have been overwhelmed or anxious and I am finding the flexibility of my work helpful too.  I am having less anxious days now I am working too due to exposure therapy and going out a little more (taking the bus and cabs and talking to new people).

For me, I really need self care time, time to switch off and unplug. As we go into Shabbat  now is the perfect time to read and be quiet, come off my phone and computer and just be. I really promote looking after you and taking time to sleep and rest for optimum mental health and to feel better again. Sometimes it can help to let others know how you’re feeling too.

I have two weeks to give in my first book manuscript and five til my wedding day. These are dreams I have had for years and I can’t quite believe they’re happening. Staying sane while planning a wedding without a planner can be hard but we have worked as a team. Having a good cry has really helped also at times, when things get too much! But generally happy, wonderful things so not to complain. Everything at once can get a lot for anyone. Life at the moment is hectic but I am pacing myself as much as possible.

If you would like to preorder my book, you can do so on Amazon or the Trigger website and I would love to know if you do :).

Thanks for being there for me and for supporting my work too. I hope we end the stigma against mental health by talking, sharing and explaining.

Love,

Eleanor xxx

Therapy Tales Part One.

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My therapy journey began at just 15 years old- when I went to see the school counsellor for talking therapy due to suffering my first anxious and depressive episode (before I was diagnosed as bipolar).

Since then- 13 years later, I have tried many different kinds of therapies to help heal me from my anxiety disorder and help manage my bipolar disorder. Therapy still has a stigma, which is wrong,- but it is vital to the healing and recovery of mental illness and general healing from stressful life events eg deaths, divorce, moving house, illness.

I have done many forms of therapy, starting off with talking therapies- where you talk to your therapist about whats going on in your life (and sometimes they psychoanalyse in order to help you). I then did 3 lots of Cognitive Behavioural therapy (CBT). This is where you unpack your negative thoughts and assumptions that cause your illness in thought records, where you learn to challenge thoughts and change behaviour. However, for me, CBT was frustrating. I felt like I couldn’t fully apply it and it didn’t click with my brain.

I felt that the anxiety and panic I was dealing with was very much in the subconscious- and so the CBT could not eradicate the emotional, deep response that had formed within me to certain situations. It was then I began to realise the power of exposure therapy- which is essentially, exposing yourself to your feared situation slowly, with support. The more I went out, the more people I saw and the more I did, the anxiety began to lessen. It boosted my self esteem too to know I could overcome my fears. It is something that has to be practised and you have to be kind to yourself too and in the right head space for it to work,.

Of course, therapy works in conjunction with medications and it is also vital to make sure you like your therapist and have a good relationship with them. If you dread seeing them and you aren’t getting much from it, they are likely to be the wrong therapist for you.

I have done many other therapies: art therapy (which I loved and recommend hugely if you enjoy it), meditation and deep breathing (which I still do and which really helps my anxiety) and of course the unique therapy that friends and family bring. There are more therapies out there including ACT and its always worth googling therapies.

Ultimately, don’t be too scared about sharing with a therapist. They are trained professionals, have seen it before and they are there to support you. It is also very much trial and error. Even though CBT wasn’t for me, I found other therapies which have worked.

Just be aware that NHS therapy waiting lists are months long, so if you have the money to get private care, do.

I have worked with both psychologists, psychotherapists, occupational therapists (during a period of group therapy) and of course psychiatrists in order to keep well. It is very much a collaborative effort and now I am much better, I can deal with it with my support network (with my psychiatrist in the background)

I hope you find the right course of therapy for you and know you can heal from whatever stresses you are dealing with.