Anxiety is a physical experience. Uncomfortable sensations such as difficulty breathing, chest tightness, a racing heart or an upset stomach are some common manifestations, no matter what your age, but there are plenty more. It can also present as worry, often about some “What if…” possibility in the future. It is often the uncomfortable physical sensations that get children and adults thinking about worst case scenarios. And of course, one important part of anxiety treatment is helping your child evaluate these anxious thoughts and feelings differently, as junk mail, or a false alarm.
But we are not going to get very far in helping anyone with anxiety if we ignore the physical sensations that are part of the experience. Interestingly, anxiety seems to create a lopsided situation, where certain sensory experiences seem to predominate over others. In OCD, someone might continue to check whether the stove is off, all the time disregarding what their eyes are telling them. Even though a child hasn’t vomited in several years, he or she may interpret any sign of stomach discomfort as a sure sign that they will throw up. In anxiety, certain sensory experiences seem to take front and center, pushing information from other sensory systems off to the side.
There are three ways in which attending to sensations can help with anxiety. The first involves what are commonly referred to as grounding techniques. In high intensity moments, you can help children manage their feelings by directing their attention to the sensory system that gathers information from the outside world. This is what you do on a long car trip, which can be agony for child, when you suggest playing some license plate game. The child’s attention shifts from focusing exclusively on their internal sensations of discomfort to what they can see outside the car window. A different type of grounding technique is to ask the child to notice three thing that they see, and so on. It is what the classic children’s book, Goodnight Moon by Margret Wise Brown, is about. The young bunny settles down to sleep by focusing on all the familiar objects in her room rather than any scary thoughts she might have. This shift in focus from distressing internal sensation to the outside senses helps manage high intensity moments.
The second means of attending to sensations is learning to notice and label internal sensations, or in other words, to develop interoceptive awareness. Interoception is one of three hidden senses, the other two being proprioception and the vestibular system. Interoception refers to the signals we receive about how our body is feeling, such as whether we are hungry, need to use the bathroom or are cold. Developing awareness of these signals is basically what is referred to as mindfulness. If you are hoping to change anything, you have to develop some awareness of what you are responding to so that you are not always ambushed by your feelings.
Finally, anxiety makes all sorts of predictions about what will happen, generally convincing a child that he will not be able to handle whatever it is. To challenge this worst-case scenario, it is important to notice physical sensations and follow or track them to see where they lead. Do they lead to the worst case as imagined? Or do they diminish and transform into something else? In the intensity of the moment, we tend to lose a sense of time and forget that everything changes. This of course is especially hard for children. This is essentially what we are doing when facing our fears or doing therapeutic exposure activities. We are seeing what happens over time and opening up the possibility that things can change.
copywrite Edward H Plimpton, PhD
Your anxious child 
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