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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

 

 

 

How to Panic

14 Jul

How to Panic

 

Did you know that you can induce an anxiety state? Your child can do it too. And sometimes it helps to know that you can control this process — if you can make anxiety happen, perhaps you can understand it better and help it go away.

 

Here are some instructions for improving your chances of having a genuine panic attack:

 

1.)    Breathe in a shallow and rapid manner. In other words, hyperventilate.

2.)    Scan your body for anything that doesn’t feel quite right. It’s especially useful if you can notice some tightness in your chest, but other body parts can do the job quite well. For instance, perhaps your stomach doesn’t feel well, or the back of your throat feels funny. Remember, if you have a strange feeling, or any feeling at all, there is a reason—and it’s probably not a good reason, either.

3.)    Now, take those feelings and use your imagination. Think of the worst thing that could happen. Consider that you might die, have a heart attack or throw up in school. Be sure to think hard about these possibilities and how frightening they are.

4.)    If you have ever had these feelings before, try to forget that they eventually went away. Try to imagine these feelings as being worse than anything that has happened before.

5.)    Hope for a quick fix.

 

For more straightforward reading on this topic, I would recommend Reid Wilson’s book Panic for adults, and Tamar Chansky’s Freeing Your Child From Anxiety for dealing with children.

Reassurance Questions

14 Jul

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

 

Reassurance Questions

Consider these questions: “Will everything be OK?” “Am I going to throw up?” “Are you sure this food is safe to eat?” These are more than just questions. They are simple requests for reassurance, something we all need from time to time. As a parent, providing comfort to a distressed child is one of the things we do best, and with infants we are biologically wired so it happens automatically. But when no amount of reassurance seems to calm your child and you have the feeling that you are dealing with a bottomless pit, different measures are called for.

It is not just information that is needed, because you have provided that and your child is still an anxious mess. In fact, when you are at your wit’s end, it can feel like your child doesn’t think you are a credible source of information. Much of dealing with anxiety involves learning to tolerate uneasiness and recognizing that our prior attempts to feel better don’t work and in fact actually make the situation worse. Without intending it, your repeated efforts to reassure your child have acted like an addictive drug, providing quick relief, but leaving her craving more. What we need to help your child learn is to teach her that when an anxious worry pops into her head, if she leaves it alone, it will go away by itself, but if she gives it serious consideration, it hangs around.

So what to do? Your response needs to be informed by how anxious you gauge your child to be. For the highly anxious child who is near panic, utilize the  breathing techniques to bring down his anxiety, and the two-part sentences discussed in a previous chapter, which involves  empathizing with the feeling, but reminding him  of the facts. These are more management strategies for intense moments when there isn’t too much rational thinking going on. However, it will be more helpful if we can make “anxiety” wait and not respond to it right away. So you might say, “That sounds like a worry monster question, I would like you to wait five minutes and see if you still need to ask this question.” If the child gets busy doing something and forgets about the question, then mission accomplished.  If the child still has the question after waiting the requisite amount of time, then answer the question. The child at the very least has learned to tolerate some discomfort for a short time. With practice, she will be better able to tolerate not having these questions answered automatically — and for most children, the anxiety will diminish. The amount of time you ask your child to “make worry wait” needs to be also gauged to what you think he can tolerate, but the goal is have him tolerate increasingly longer periods of time so that the thoughts truly have a chance of floating away.

She is not worried with me

14 Jul

 

 

“She is Not Worried with Me!”

 The expression of worry by a child isn’t necessarily the same in the various places he/she goes during the day. This discrepancy in how the child is perceived is found in scientific studies comparing  ratings of anxiety between school and home in which  these studies  typically do not find much aggreement. Disagreements between parents can occur, which may be magnified if they are divorced. One parent may take the position that the child is being overly indulged and the other perceives the child as quite sensitive and vulnerable. The difference occurs both ways in regard to home and school. For children with selective mutism , they can be chatterboxes at home and yet say not a word in school . Alternatively, there is the child who complains bitterly about going to school, and yet 10 minutes after being left in the classroom is fully engaged. This is a fairly commonplace observation is the reason parents are typically discouraged from prolonging the goodbyes when leaving a child at school. Likewise, there can be a split between the parents in how they understand the child. While both parents may be fully engaged as parents, for typically practical reasons, they don’t spend the same amount of time with the child. As a result, the child may not share his/her concerns equally with both parents. And of course, a child is more likely to share a worry if he/she will not be judged or made fun of for being worried.

What is to be done when observations are not uniform?  First, is to recognize that this is not unusual when it comes to the expression of anxiety, in fact it is quite common. Some worries are only expressed in certain situations. Observations do not have to be uniform to validate that the child is struggling with anxiety. Second, the answer to what to do can be devilishly simple or complex. It can be as simple as following the teacher’s advice and not prolonging the goodbye at school. But there are plenty of children for whom a more nuanced approach is needed and a greater understanding of what the worries mean is absolutely needed.

One step at a time-thinking incrementally

14 Jul

The Incremental Mindset

 

I share with you the desire to help your child overcome the anxiety that is so much interfering with his or her life. It is hard to be patient when you can see your child in the grip of something that really does not make sense. Understandably, most parents respond to their child’s discomfort with reassurance. It is a natural parental response. Unfortunately, when you are in the “land of anxiety,” no amount of reassurance seems to work, and your child seems like a bottomless pit. So we need some different medicine, and this takes the form of finding a way to face the fear.

 

There is a delicate balance between pushing your child to confront her fears versus letting her do things at her own pace. Because avoidance behaviors are so reinforcing—they really do provide some short-term relief–chances are that things will get worse, not better, if a child is consistently allowed to avoid anxiety. Avoidance, in fact, actually makes people more afraid in the long run, and becomes a sort of addiction.

 

As I said, the cure for the anxiety is going to involve finding a way to face the fear, rather than avoid it. However, this needs to be approached carefully. We want your child to master his fears, not be overwhelmed by the interventions that are designed to help him. In most cases, what we need to do is to start with very modest projects and build from there. A very common mistake is to forget to start small. Thinking in incremental steps sounds simple but “impatience” and “frustration” gets in the way potentially for both parent and child. That is in the eagerness to resolve the problem we can get impatient and ask the child to do more than he is ready for or the child may similarily gets impatient . There is also a tendency to devalue the importance of incremental steps by either adults or the child with a comment along the lines of “…but he (I) still can’t…” But that is obviously a mistake for it takes the spotlight away the small successes that can provide hope and encouragement.

 

At this point, we need to clearly identify the building blocks that each child needs in order to be able to confront fear. Typically it is helpful to make a hierarchical list of the steps it will take to confront a fear or a “fear ladder”. A fear of dogs might begin with looking at pictures or movies of dogs, then observing them outside at a distance and then gradually move closer.  In addition, having a  “feeling thermeter” is important tool in adjusting the pace.   It takes some thought and patience to break a problem down into manageable incremental steps. It is bit like the game of pick-up sticks where you are looking for next stick to take that won’t rattle the pile.  The range of possibilities can vary dramatically from child to child. For some children, just having a clear rationale of what we are doing and why is sufficient. But if we can clearly outline the steps to take, then the journey becomes more tolerable and we can focus on the child’s small victories along the way.

Anxiety is allergic to humor

14 Jul

Use of humor

When I was growing up, I didn’t know about anyone who had a peanut allergy, but now if you ask most children they can tell you about someone who has one kind of allergy or another. For reasons that are not completely understood, allergies seem to have become more prevalent. Well, it turns out, as Michael White, a therapist who really developed the idea of personifying worries and other problems, has stated, anxiety has allergies too. Anxiety is allergic to humor. It wants everything to be taken very seriously. So in dealing with anxiety, we can take a cue from Harry Potter and Prisoner of Azkaban

where in their class on the defense against the dark arts, Professor Lupin instructs the class on dealing with boggarts.

 

“ ‘So, the first question we must ask ourselves is, what is a boggart?’

    Hermione put up her hand.

  ‘It’s a shape-shifter,’ she said. ‘It can take the shape of whatever it thinks will frighten us most.’”

Professor Lupin goes on to explain:

“‘The charm that repels a boggart is simple, yet it requires force of mind. You see, the thing that really finishes a boggart is laughter. What you need to do is force it to assume a shape that you find amusing’” (p 133-134 Harry Potter and the Prisoner of Azkaban by J.K. Rowling).

 

A similar point about the power of laughter in dealing with worries came up in the movie Monsters, Inc. where the monsters power their city by capturing children’s nighttime screams. However, a little girl becomes friends with a good monster and toward the end of the movie when a bad monster tries to scare her, she laughs at him, and in an instant all of his power is taken away.

 

Of course we never want to laugh or belittle the child for his fears, for that would truly make matters worse. However, we do want to engage your child in trying to transform the worry into something less dangerous, and hopefully disarm it. So we might want your child to draw the worry and change it or turn into something silly, perhaps giving it a diaper or a pink tutu. If we can get your child laughing, we are on our way to taming this worry.
Copyright@Edward H. Plimpton

Anxiety is about getting junk mail

14 Jul

http://www.youtube.com/watch?v=hbDtEv8-o2oFrom Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

Junk Mail

Let’s say your child has lots of anxious questions of the type that don’t have a close connection to anything that has really happened in her life, as in “Am I going to throw up today?” but the last time she threw up was two years ago. You have tried reassuring her but she usually comes back to double- and sometimes triple-check your answer. “Are you really sure?”

What is going on here? If the brain has some similarities to a computer, then we could say that the anxious brain is not good at sorting out “junk mail” from regular mail. Junk mail in this case are those worries about the future that are theoretically possible, but rather unlikely to occur. As we know, junk mail can come in all shapes and sizes and can look very convincing because there is always a possibility that this proposed worst-case scenario could take place. This type of anxious thinking is junk mail.

Asleep or awake, we are always having thoughts and images passing through our minds.  It is actually nonstop traffic, although the intensity and clarity of it does vary. For someone with a more anxious nature, this natural buzz of activity can be a significant source of distress. It turns out that there is not much difference between the anxious brain and the non-anxious brain in terms of the thoughts that occur, but there is a difference in terms of how these thoughts are dealt with, and their frequency and intensity. The anxious brain tends to treat all thoughts as potentially significant, and then follows this with a question along the lines of, “What does this say about me that I am having a thought like this?” Perhaps this thought is an indication of who I am truly am. In contrast, the nonanxious brain does not have to grab hold of every passing thought and can let the junk mail float by.

A large part of dealing with anxiety is changing your child’s relationship to it. In another e-mail, I discuss giving anxiety a name, whether it is the Worry Monster or something of the child’s invention. Then a next step is labeling what the “Worry Monster” says as junk mail. Sometimes it looks important, but the Monster is really trying to trick your child into buying something you don’t need. You might want to have your child watch you sort through the mail at home and see that there is some mail that goes straight into the trash can or shredder without even being opened. We might almost say that anxiety is trying to sell you an expensive insurance policy for something that is quite unlikely to occur. But in labeling the anxious thought as “junk mail,” we can begin to respond to it differently and consequently lessen the effects of these intrusive thoughts and images.

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