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First Aid for Panic

27 Aug

From Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

First Aid for Panic

A child in the grip of panic, or perhaps even terror, is not a sight that a parent easily forgets. The circumstances can range from a trip to the dentist, the prospect of a thunderstorm  observing  something frightening, or just getting out of the car to go to school. But there is your child hyperventilating, and either huddled in a ball or pacing back and forth and feeling desperate.  And what can you do? Well, actually the first aid advice tends to be very similar, even when it comes from professionals who have every different orientations. The basic elements in bringing a panic attack under control involve the following:

  1. The hyperventilating needs to be replaced by slow, deep “belly breathing.”
  2. The disorientation and dizziness produced by the panic need  to be counteracted by having the child “ground” herself by feeling her feet on the ground.
  3. The child needs help to get “out of their heads” by orienting to the immediate physical environment.
  4. Challenging the self-talk that sustains the panic, as in, “I can’t handle this.”

The trick with children who are in a panic state is to translate those ideas into a format or language that helps them grab hold of the lifeline you are offering.  It may be that the best medicine you can offer at first is to be a calm, reassuring presence while you are waiting for this wave of anxiety to subside.  You don’t resolve the problem by being reactive, and in fact by being calm you create a sense of safety.  But of course we want to do more than just wait the panic attack out, we want to teach your child some skills to deal with these intense feelings.   Children of course depend upon their parents to help them regulate and manage their emotions  because their nervous systems are still under construction.  So the parent’s job is to help the child build a bridge to the basic first aid strategies for panic.  There are several elements in this bridge building:

  1. The parent is actively modeling belly breathing, grounding techniques and orienting to the external world.
  2. When possible, using pleasing imagery that will capture the child’s imagination. I like the image of breathing like a frog, but there are many possibilities: blowing up a balloon, blowing out birthday candles, or smelling a beautiful flower.
  3. The immediate relief provided by avoiding the panic-inducing situation is powerful, which can lead to children avoiding participating in school or other activities. So the parent has to find a way to set some limits to help the child learn how to manage these feelings. Sometimes, “just do it” is appropriate to the situation. But that requires some judgment and sensitivity, not just getting tough, so the child is not just overwhelmed but can learn to deal with the problematic situation. A studied balance between being very firm and very flexible is optimal, and this rests on having a sense of how overwhelmed the child is.
  4. The first aid is going to work better if the parent and child have practiced those techniques outside of the panic moments. In  the heat of the moment it is almost impossible to learn anything new.

The Importance of Breathing in Dealing with Anxiety

6 Aug

From Your Anxious Child: Emails to Parents by Edward H. Plimpton

 

The Importance of Breathing in Dealing with Anxiety

 

Got a panic stricken, hyperventilating youngster in front of you? One basic first aid  measure will involve convincing the child to take calm, deep relaxing breaths.  Perhaps you will ask them to blow into a paper bag and fill it up, or just look into your eyes and copy-cat your breathing or just imagine that they are blowing bubbles. This calm, deep belly breathing in which you can see the belly or diaphragm move, helps counteract the overactive alarm system that characterizes many anxious children. It also helps to get them physically active to burn off all that anxious energy.

 

But the benefits of practicing this type of belly breathing go beyond temporary first aid. When we breathe, there is a difference in our heart rate between inhaling and exhaling. Our heart rates increase when we breathe in and slow down when we breathe out. This is known as heart rate variability and it correlates with anxiety. About 10-15% of children are biologically more on the shy and anxious side, and as psychologist Jerome Kagan discovered, these children have lower heart rate variability than their less anxious peers. Fortunately, practicing calm breathing can do wonders. In one study, on the power of breathing, adults were given artificial blister wounds on their arms, one group was taught breathing skills and the control group was left alone. The group that was taught breathing skills found that their blister wounds healed much more quickly than those of  the control group. In other words, breathing helps support the body’s natural capacity to heal itself. We know that the emergency response system, the sympathetic nervous system, the part involved in the fight or flight responses, gets a “regular exercise” from all the anxious things your child does. However, the calming and repairing system has been typically sitting on the sidelines and does not have a chance to get into the ball game. Engaging in calm breathing actually helps build up the muscles in the calming and repairing system, or the parasympathetic system. As a result, the child has some calm down “muscles” that can help tame the overactive alarm “muscles” or help set the foundation so that the child can access his/her smart brain.

 

There are many child friendly ways to teach calm breathing and here are some to get you started.

  1. “Make Lemonade”. Get some newspaper and crumple it up. Put one newspaper ball in your hand. Now pretend the ball is a lemon, and squeeze out as much lemon juice as possible. Do one hand at a time, squeeze as hard as possible, and then relax.
  2. Pretend you are blowing out birthday candles
  3. In more tense situations, ask the child to look into your eyes and copy-cat your breathing.
  4.   http://youtu.be/OaVB7j4BJn    This Ytube video also contains some nice suggestions for children.
  5. Consider also the following books: Lori Lite A Boy and a Bear: The Children’s Relaxation Book, Michael Chissick and Sarah Peacock Frog’s Breathtaking Speech: How Children (and Frogs) Can Use the Breath to Deal with Anxiety, Anger and Tension.

 

Anxious children often want instant results and can be quick to dismiss suggestions. Parental modeling of calm breathing helps as well as  incorporating it into the bedtime routine or other transitional moments. It is a skill that needs to be practiced in nonanxious moments for it to have a chance to be helpful in more high intensity situations.

 

copyright@Edward H. Plimpton 2014

The Deer in the Headlights: Understanding the Anxious Freeze

15 Apr

Your Anxious Child: Emails to Parents. Edward H. Plimpton, PhD

The Deer in the Headlights: Understanding the Anxious Freeze

Perhaps your child will not go to school, or take swim lessons or get that needed shot at the doctor’s office. So you have created a reasonable plan to help her. It involves a series of incremental steps, baby steps or exposures to the source of the fear. But this step by step plan isn’t working. Your child just freezes up and will not budge. What is going on here? The show stopper may be that your child is not engaged in the standard fight or flight response to anxiety but rather a more defensive freeze or immobility response. The importance of the freeze or immobility response has slowly received increasing recognition in the therapy world and it definitely has implications about how you respond to your child.

The freeze or immobility response comes into play when the organism, be it a child, corporate lawyer or zebra, is overwhelmed. But for simplicity’s sake, let’s take the zebra. The lion has caught it, and has the zebra by its throat. Under the circumstances, the poor zebra can’t run away or fight, so it tries to play dead and hopes that this will basically gross the lion out so it will leave her alone. While the circumstance may not be as dramatic, children also can get overwhelmed for all sorts of reasons, and they end up freezing up. So they may stop talking, stop engaging in any eye contact, and become more rigid in their posture. Adults can often get irritated at this lack of responsiveness, and at our worst we assume the child is being manipulative. And that might be part of the picture, but it can also be that the child just feels overwhelmed. And as adults we often discount or minimize events that may be overwhelming to a child because we don’t experience them as such.

So what to do? First, a child in freeze is a child not engaged with people. And we know when someone is highly anxious, their rational or smart brain goes into hiding, so reasons or rational explanations are of little use. Engagement is the thing. You can start with nonverbal engagement when possible, such as tossing a ball or taking the dog for a walk or blowing bubbles, and sometimes simple touch can be effective as well. The child’s body is all revved up and needs some form of physical discharge. The physical activity, in turn, helps the child get out of the freeze response, and then he or she is more available to be engaged with others, such as teachers or parents. Indications that a child is coming out of freeze are smiling, laughter and spontaneous talking.

The freeze or immobility response does not respond to reason and hence requires some special consideration. Failure to recognize freeze responses will lead to a standoff where everyone is just digging in their heels. Think about engaging your child in a more physical manner to help him/her get out of this frozen state.
copyright@edward plimpton

The Lessons of Goodnight Moon

30 Dec

From Your Anxious Child: Emails to Parents by Edward Plimpton, PhD

                                      

When you have a baby, and you live in the United States or some other developed nation, then chances are you have a copy of Goodnight Moon by Margaret Wise Brown. If that book escaped your notice, then  rest assured that it is easily obtained-sometimes even in large grocery stores.   Worries, fear and anxiety have a favorite time of day to make an appearance, which is, of course, bedtime. Hence, the numerous books written about bedtime for young children. In Goodnight Moon, a mother rabbit is helping her bunny to sleep and the dialogue consists of saying goodnight to all of the objects in the room. It begins with:

“In the great green room
there was a telephone
And a red balloon
And a picture of the cow jumping over the moon.
And there were three little bears sitting on chairs…”

So at time when anxiety might be increasing, what does the mommy do? She helps the little bunny get out his/her potentially anxious thoughts by bringing attention to the concrete aspects of their surroundings. What is in the room?  A telephone. What are on the walls? A picture of the cow jumping over the moon. She is helping the little bunny get out of his/her head and focus on reality of where they are. Any thought of monsters under the bed are interrupted by reminders that they are in a very familiar bedroom. So this focus on what is in the room helps keep the little bunny grounded rather than drifting off into an anxious sea of bad thoughts.

But the mother bunny is also doing something else. She is remaining very calm. We know that anxiety is very contagious. An infant or young child has an immature nervous system and consequently relies on adults to help them regulate it. Children are consequently checking in with their parents to see how they appraise what is going on-technically this is referred to as social referencing. And the mommy is indicating to her little bunny that she views the situation as totally safe. In a similar manner, you will help your anxious child by conveying a calm and confident manner that the situation is safe and you will take care of any problem that might develop.

This classic bedtime story illustrates the importance of orienting to the external environment in dealing with anxiety and demonstrates how parents can help children manage their anxiety by providing a calm presence. A similar point is made in another essay on this blog, “Helping Your Anxious Child Get Out of His Head and Out of Worry.”

copyright@Edward H. Plimpton, PhD

Movie Worries

30 Dec

Maybe you needed some down time, or maybe the children needed to be occupied so that you could get some other things done, so you allowed them to watch a movie. Let’s say you chose Walt Disney’s Snow White, because it is so well-known and you remember it from your own childhood. The kids watch the movie, you have some time to attend to your business, and everything seems fine. But when bedtime rolls around, there is a problem. The image of the old hag who gives Snow White the poisoned apple is stuck in your child’s head, and it will not go away.

What is going on here? This is just a cartoon, after all, and it was made for children. Nevertheless, it is undeniable that movies can overwhelm some children by presenting them with frightening images from which the motion picture rating system provides only imperfect protection. For some children, the possibility presented in the movie — that people can seem one way but turn out to be another — is a very compelling idea. In addition, movies in which a character actually morphs into something else — movies such as Freaky Friday, Spirited Away, Big, and The Incredible Hulk — can produce intense anxiety. Children are often misled by appearances, and believe exactly what they see, even if it is presented in a cartoon format.

Logic cannot help anxious children reason away their fears. Long ago, the Swiss psychologist Jean Piaget did an experiment in which he presented young children with two glasses filled with equal amounts of water. Preschoolers were easily able to see that the two glasses looked the same. However, when he took one of the glasses and, in front of the children, poured its contents into a shorter but wider glass, the children invariably said that the taller glass had more water and the shorter glass had less. Although they had seen the same amount of water poured into a different shaped glass, they still reasoned on the basis of appearance. In other words, it is easy to fool young children into believing that appearances are real, even if you tell them that something is “imaginary,” or created with special effects. So it is wise to use caution in what you allow your children to see, especially those children who are more than ordinarily anxious.

The potential of movies to leave children with anxious preoccupations, of course, isn’t confined to very young children still in the grip of very magical thinking. Older children, teens and adults can be similarly affected. And with regard to some excessively explicit movies our culture produces, it may be reasonable to ask, “Who wouldn’t be freaked out?” At the same time, there are a group of children whose excessive reactivity to movies that their peers can tolerate and enjoy is a reflection of limitations in their own anxiety management capacity. While just saying “No” to movies that are too much is one perfectly acceptable approach, for some children it may result in them missing out in group activities with their peers. For the latter children, learning to build their “Movie Muscles” may be helpful and also build their capacity to tolerate tension and suspense in other areas of their life. A simple way to build “Movie Muscles” is to start with a movie such as Finding Nemo and with the remote control handy, stop the movie whenever your child is showing any fear or signs of physical tension. Ask your child whether he can notice what is happening in his body and then wait for his body to calm down. Then repeat the scene that was just played until the child is less reactive before proceeding with the rest of the movie. This exercise will help build capacity to tolerate the tension and suspense of movies.

copyright@Edward H. Plimpton, PhD

Get out of your head

14 Jul

 

From Your Anxious Child: Emails to Parents Edward H. Plimpton, PhD

Helping Your Anxious Child Get Out of His Head and Out of Worry

 

When an anxious thought or image takes hold in your child, it hijacks his attention. In children’s intense preoccupation, a narrowly focused tunnel vision takes hold in which the worry is the only thing in sight. This narrowing of vision makes sense if there were a realistic danger that had to be dealt with. Hitting the reset button involves helping the child get out of her head and refocused onto the world around her. For example, one girl struggled watching movies with her friends because she was much more easily frightened by what she saw compared with her friends. On her own, she came up with the idea that when she was frightened by something she saw, she would look around the room and start naming what things. She would say to herself, “There is the lamp, there is the cat, there is my popcorn…” and this listing would help her reorient and gain some distance from the frightening image.

A slightly different example is provided by a 10-year-old boy who had been anxious about going to school for a long time. There were frequent trips to the school nurse and guidance counselor with complaints about stomach pains. Merely talking about his feelings and providing reassurance didn’t help with his anxiety. Partly in desperation, the guidance counselor started having the child write down his schedule in her office as soon as he got into school. By the time he was finished writing down his schedule for the day in great detail, his anxiety had diminished to the degree that he was able to go to his class without difficulty. This simple exercise did a couple of things. First, the act of writing his schedule down moved him away from his anxious thoughts because he had to think about his schedule, which was not the same every day.  Second, since he was filled with nervous anticipation about what was going to happen during the day, writing his schedule moved him away from the anxious anticipation to visualizing what would really happen during the day. This focus on the external reality of the day seemed to help calm him down. Third, the anxious child is usually operating at high speed, but writing something down can really slow things down so he can challenge some of his anxious thoughts or they can just dissipate on their own.

So helping your child focus on the environment outside of his head can often be an important step in helping him deal with anxious thoughts.

Effort versus Performance

14 Jul

Effort Versus Performance

 

Whether it is an upcoming swim meet or a spelling bee on Friday, children can often suffer from performance anxiety, some of which is perfectly normal and appropriate. However, when the anxiety clearly begins interfering with the child’s participation in the event, then the issue of performance anxiety needs to be considered. Some children who are rather perfectionistic by nature can put a lot of pressure on themselves.

 

Adults, however, provide added pressure depending upon whether they focus on the child’s effort or performance. It turns out that how we praise children can have a big effect on how they perform depending upon whether you focus on their effort or intelligence.  This insight comes from research by Carol Dweck, who discovered an interesting effect on children’s school performance depending upon whether parents comment on the children’s effort and hard work, or their intelligence and talent. She proposes that we tend to understand success as either the result of innate ability and talent, or the result of hard work and effort.

 

However well-intentioned, telling your child that he/she is smart and brilliant can inadvertently put pressure on him as when he encounters a problem in his homework that he has difficulty solving. This child may feel that because he could not solve the problem easily, this is an indication that he is not as smart as he thought he was because it required effort. So he gives up. Anything that requires effort is to be avoided and challenges are not welcome.

 

In contrast, comments that focus on the child’s effort tend to promote greater persistence and a more positive attitude. This has been confirmed in studies on children’s performance on math tests where the feedback in one classroom was on how smart they were and in the other classroom, the feedback focused on their persistence and effort. When given achievement test, the “persistence” group did substantially better.

This point was recognized a long time ago in the book How to Talk So Children Will Listen and Listen So Children Will Talk, by Adele Faber and Elaine Mazlish, who recommended simply describing what you see rather than lavishing praise on your child. Rather than saying to your kindergarten child’s quickly drawn picture, “Oh that is so beautiful,” instead comment, “Wow, there are so many colors in this picture and the house has four windows.” The latter does communicate that the child’s effort was worthy of detailed attention and it brings her attention to what she did that helped make the picture interesting.

 

So when it comes to providing encouragement for your child, try to focus more on describing the way in which you see him displaying effort and persistence rather than praising him for being talented or smart.

copyright@Edward H Pllimpton, PhD