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:
- Separation Anxiety
- Social Anxiety
- Obsessive-compulsive disorder (OCD)
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.
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.
This blog was written by Leigh Adley, Hypnotherapist/Psychotherapist at Set Your Mind Free, based in the UK.