Seeing your child anxious can be one of the hardest things as a parent. It is hard because none of us like to see our children in pain, and we often don’t know the best way to respond or help. In our last blog post, we discussed ways to teach your child to talk back to anxiety. If you didn’t have a chance to read the blog, check it out here.
Now, we are going to be diving deeper into arguably one of the best ways to help your child minimize anxiety, which is something we call exposure. Exposure simply means taking steps to intentionally do the things your child fears. Remember what we learned in the last blog — Anxiety grows bigger through avoidance. Thus, the primary way for your child to learn that their fears don’t come true is by putting themselves in the feared situation, so they can learn through experience. No more avoidance! And in that process, sometimes your child’s fears do actually come true. However, what children often learn is that it wasn’t as bad as they thought, and they were able to cope with the challenge.
In the last blog, I also talked with you about a little boy with an extreme fear of separating from his mother. He was terrified that his mother would leave him and never come back. I am going to share with you how we helped him face his fears through exposure, and how you can do the same.
Use A Worry Thermometer
To learn more about the little boy’s fears of separation, I used a worry thermometer. On a scale of 0 (totally calm, no worry) to 10 (the worst anxiety he could imagine), he said he was at an 8 when his mother was in the waiting room, and he could not see her.
We used this same worry thermometer to identify his fear in a number of other situations. For instance, some steps were:
- Mom standing across the room from him but he can still see her (Worry = 3)
- Mom going into the room next to him for 1 minute, but he can’t see her (Worry = 5)
- Mom sitting on the floor while he went to sleep (she normally slept in his bed) (Worry = 3)
- Mom going into the room next to him for 5 minutes but he can’t see her (Worry = 6)
- Mom sitting outside his bedroom door while he went to sleep (Worry = 6)
- Mom sitting on the living room couch while he went to sleep (Worry = 8)
- Mom sitting in the kitchen while he went to sleep (Worry = 9)
- Mom goes around the house and he doesn’t know where she is at or when she will return (Worry = 10)
This gave us a starting place of what situations were hard or easy for him. You can be creative in this process. Think of numerous situations and how to make them easier or harder for your child.
Create a Worry Ladder
We then created a worry ladder and put the easiest situations on the bottom and the hardest ones at the top. Based on that information, we all planned to create a series of exposures or “worry challenges” throughout the week. We would do exposures at the office, and he and his mother would practice exposures at their home throughout the week. When we planned times of separating the boy from his mother, we also made sure that the boy had some fun activities to do during the separation. In addition, he had breathing and relaxation exercises to use. It is important to stick to exposures that are not more than a 5 or a 6 on the worry thermometer. If you start in a situation that is more than that, you will likely start to see refusal and resistance from your child.
Start Taking Baby Steps Up the Worry Ladder
Have you ever seen the movie, “What About Bob?” If you haven’t seen the movie, I highly recommend it. It is hilarious and one of my all-time favorites. In the movie, the main character Bob sees a psychiatrist, Dr. Leo Marvin, due to having severe anxiety and phobias. Dr. Marvin has just written a book, “Baby Steps,” and recommends it to Bob. The idea of taking baby steps (i.e., small, reasonable goals) is what I want you to think when helping your child work their way up the worry ladder.
When I first talked with the boy about talking back to anxiety through exposures, what do you think his response was? It was a big, old “NO!” He wanted nothing to do with it. Expect this of your kids when you first introduce the idea. Facing fears, especially if your child has been avoiding them for a long time, can be overwhelming and scary. However, after we talked through how anxiety grows and how to make it go away, he was willing to take some small steps that he felt were manageable. Once he started seeing that his anxiety was getting better when taking those steps, he started to gain confidence and wanted to continue.
When having your child take small steps and do challenges, the goal should be to stay in those challenges until your child’s anxiety goes back down (e.g., starting worry = 5 to ending worry = 1 or 2). If your child does the challenge and then leaves right away, your child will only remember that heightened feeling of anxiety. When doing an exposure, remember that anxiety spikes quickly, but it always goes back down. In most cases, the anxiety should start to lessen over the course of several minutes as your child adjusts to the situation and realizes that their fears do not come true and they can cope with the situation.
Identify Safety Behaviors and Get Rid of Them!
Children have significant safety needs. For the boy in our example, his mother was his primary safety need. If she went into another room without him, he had to call her name to check and make sure she had not left. We had to address this safety need when doing exposures. For instance, if we planned a 5-minute separation and the boy called his mother’s name to check, his mother had to be consistent and not respond. This type of behavior will help to maintain and grow your child’s anxiety. Sometimes, you will find that exposures do not seem to help your child. If this is the case, your child might have safety behaviors they are using during the exposures that are still maintaining the anxiety.
Sometimes there are other sneaky safety behaviors, safety objects, or safety people that our kids might have that can sabotage overcoming their fears. Ask your child if there are things they do or need to make themselves feel safe in a situation. You might also just observe your child in feared situations to see what they might be doing in an effort to minimize or avoid their anxiety (e.g, asking questions, holding an object, avoid talking, etc.). For children, safety behaviors often involve parents. Children might ask parents to wash their hands prior to playing with their toys, request that parents tell them the expiration dates of the food they eat, or repeatedly ask parents if they look sick or feel feverish. All of these behaviors can be safety behaviors. Remember, your response as a parent might provide initial reassurance to your child’s fears, but in the long run the reassurance helps maintain and grow your child’s anxiety.
As a parent, it can be so hard to see our children suffering with anxiety. You can help your child by not engaging in their requests for reassurance. Stay strong and hang in there!
Be Empathetic and Plan on Setbacks
We always try to tell parents that therapy is not a linear process. Yes, you should see improvement, but expect setbacks along the way. For the young boy and his mother, he started to see progress quite quickly with frequent practices separating from his mother during the day. However, nighttime separation proved to be a much harder process. We included rewards for staying in bed and had his mother provide check-ins after certain time periods. Some nights were successful and some were not. After several weeks though, he was able to make good progress in falling asleep unassisted and with his mother in another room.
Some days those steps up the worry ladder feel very daunting and overwhelming for your child and some days they are more manageable. If your child decides that an exposure is too hard for them one day, that is ok. Work together to think of one that they can do or minimize the challenge for them. Anxiety is mean, loud, and an annoying bully. Your child has to deal with this mean bully all day, every day. Try to be understanding and show compassion as much as possible.
Praise and Reward
It is very hard for children to engage in exposures. It is so important that you make a plan with your child to reward them for making this amazing effort. Using tangible rewards, such as stickers, special time with family, or even toys can be useful in the teaching process. Always remember to pair these rewards with specific praise about your child’s effort and courage in this process. Make a plan with your child before you take the steps up the worry ladder to identify things your child would like to earn in the process. For more information, check out our post on positive reinforcement.
Through the process of exposures and providing rewards for his courage, the young boy I worked with learned that his mother did not leave him when she was out of sight. After several weeks of daily practice, he and I could meet together alone while his mother went to Starbucks and treated herself to her favorite drink.
Remember, doing exposures and helping your child with anxiety is best done with a trained clinician who can help you tailor this process to your child’s needs. And if you haven’t done so already, make sure to download our Free Relaxation Guide to get started on teaching your child skills to use as they work their way up their worry ladder. As always, let us know if you have any questions.
Have an amazing week mama!
Lori
[…] Remember how anxiety grows bigger through avoidance? That means the way your child will overcome school refusal is by doing the thing that they fear – going to school. It is important for your child to create a worry ladder. If your child has been out of school for a long time, you will start small. For instance, your child might only be going to school and sitting in the parking lot. And then maybe going to school and sitting in the front office. To learn more about how to create a fear ladder, check out this blog post. […]
[…] It is important to remember that long-term accommodations to anxiety can become a barrier to treatment and overcoming the anxiety. The goal should be to provide initial accommodations as the child is in therapy. As they begin to make goals to face their fears, then some accommodations should be changed to chall…. […]