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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.

Floor Time

14 Jul


Floor Time


A recent Nielsen Company survey reports that the average American is spending an average of 4 hours 49 minutes watching TV a day — and that is those ages 2 years on up. Yikes. But then again, your TV time is probably after the children are in bed, unless your anxious child just won’t bite the pillow. TV is a problem inasmuch as it is a regular source of scary images for children that will keep them up at night and you from your late-night show. It is a lean, efficient anxiety-producing electronic machine. But also there is the issue of whether it is being used too much as a substitute babysitter and keeping you and your child from more productive activities.


It sometimes can take some time to figure out why your child is anxious or having a hard time in school. Does your child have a short attention span because he/she is anxious or because of attention deficit disorder or both? Or, does your child have some learning disabilities that need to be clearly identified? Whatever the reason, you know that you have a stressed-out child on your hands and the answers to these questions may take some time. When all else fails, consider going back to the basics. A lot of undesirable behavior in children is inappropriate attention-seeking. Children crave attention. The most basic mental health intervention you can give your child is 20 minutes of undivided attention everyday. In a way, it may not sound like much, but actually it can really do a lot to take the edge off things. The activity can take many forms, but please try something more interactive than video games. Sometimes you have to try out a few ideas to find ones that are a good match between you and your child. It will probably be more fun if you engage your child in an activity that you find interesting than one for which you have no aptitude. But then again, being a parent is a way to expand your horizons and develop some new interests.


Time spent with your child is important because children often do not respond promptly and efficiently to such well-meaning inquiries as, “How was your day at school?” The response often suggests that you don’t have security clearance to have access to such information. However, given some time, often children will spontaneously blurt out a concern or share an experience. The time you spend with your child also communicates to her that you consider her important and worthy of your time and that of, course, will help her feel that she is worthwhile. It is one instance where quantity of time is as important as the quality of time.

What Happened? The Follow-Up Question

14 Jul


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



What Happened? The Follow-up Question


In the heat of the anxious moment, it is hard for children to have any perspective. Furthermore, they may not feel very receptive to the best-intentioned efforts of their parents. All they know is that they feel lousy, and when the anxious moment passes, children often act on the “out-of-sight, out-of-mind” principle. However, the mastery of anxiety involves recognizing that the feelings are “false alarms” and that they will go away on their own. By asking some simple questions, parents can help children begin to realize that their initial anxieties were not good predictors of what actually happened in real life.

Say, for instance, that the child has a big test in school and complains about feeling cold and asks, “Do you think that I have a fever?” You feel his forehead and it is as cool a cucumber, and you tell your child that he does not have a fever. The follow-up involves a simple question when the child returns from school, such as, “Whatever happened to that cold feeling you had this morning?” And hopefully the child will respond with something like, “Oh that feeling went away as soon as I entered the school building.” Such questions and comments slowly help children make the difficult connection that their initial reactions are not always good indications of what will actually happen. Since children, especially in the early and mid-adolescent years, are very sensitive to any adult suggesting that they know how they feel, it is probably prudent to take on the role of the curious bystander, rather than the “know-it-all adult.” But over time, the child will be quietly building a bank of accumulated experiences, so that he or she will be more accepting when a parent says, “Do you remember how you felt when you (…went to your last birthday party, sleepover, started last semester)?”

Two part sentences

14 Jul

Two-part Sentences



In the heat of the moment, the anxious child typically needs “containment statements.” These statements do not provide any magical relief, but do help far more than some less productive things desperate parents might say in moments of frustration. These are two-part sentences in which the first part is empathic toward the child, and the second part reminds her of the reality of the situation. Both parts are needed. If you just remind your child that the fears don’t make sense, you are likely to get back a statement such as, “You just don’t understand,” or “I’m so stupid I might as well be dead.” Even if you don’t hear this type of negative response, you may inadvertently be providing the child with the type of reassurance that actually increases anxiety over the long term.


What not to say


  1. “What?      You are saying makes no sense.
  2.  “Don’t be silly”
  3. “Of      course there are no sharks in the bathtub.”
  4. “That      is just the worry monster”
  5. “No,      you don’t have a bleeding ulcer.”


All of these statements emphasize the facts, but don’t empathize with the feeling. When you don’t acknowledge the feeling, you might get an angry, “But you just don’t understand”. So what we want to do is create two-part sentences that empathize with the feeling, but also remind the child of the facts


What to say


  1. That is a scary thought, but sharks needs lots of water and need to live in the ocean.
  2. I am sorry your stomach doesn’t feel quite right, but I have noticed you often have complaints like this on Sunday night.
  3. I am sorry your stomach doesn’t feel quite right-what else could it be besides an ulcer?
  4. I am sorry your stomach doesn’t feel quite right-what makes you think it is something that serious?


Admittedly, there may be a cumbersome quality to such comments. In general, they tend to work better when they are formulated ahead of time, rather than trying to invent them on the spot. While these statements won’t do anything miraculous, they will provide a respectful acknowledgment of the child’s feeling and a gentle reminder of the facts

Wait, wait, don’t tell me

14 Jul

Wait, Wait, Don’t Tell Me”


So your child is anxious, perhaps saying some things that are freaking you out a bit, and upon honest reflection you know that you are a little anxious yourself. It has that feeling of the apple not falling far from the tree. We’ll acknowledge this point, but let’s not get into a blame game here, because there is a more important point to be made with regard to how you can help your child. It can be unpleasant to watch your child struggle and equally hard not immediately correct some of the anxious statements and questions that they have. But wait, restrain yourself a bit and give your child the opportunity to do some thinking. Your help may be more to relieve your own anxiety than what your child needs.

So let’s say you and child have seen a program about Lou Gehrig, and he/she plays baseball, and the next day he comes tired after a long day and asks, “Do you think I have Lou Gehrig’s disease?” Now understandably, you might reply “Don’t be ridiculous,” and after a fashion that would be accurate. If your child is not too freaked out at this moment, I would suggest holding back a little and trying to promote your child’s thinking on this topic with some requests for clarification.

“What makes you think you have Lou Gehrig’s disease?”

“Well, I am really tired”

“How long did you play baseball today?”

“I was at baseball camp all day, you know that, and then I play soccer”

“Is there something after the way you feel tired today, after being very active, that is unusual or different? Most kids would feel a little tired after a day like that.”

So the dialog may seem a little artificial, but the point is to try to give your child a chance to do some thinking rather than jumping in right away to solve the problem. In doing so you are helping build some anti-anxiety coping skills. This needs to be done with compassion and genuine curiosity about how the child looks at the situation. Otherwise, your child may feel you are discounting the very significant distress he is feeling.


There is more on this topic in the next letter on two-part sentences.

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.

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.

Child meeting therapist for first time-or actually doing anything new

14 Jul

First Session

I am looking forward to meeting your child next week, but don’t be surprised if the reaction you get from your child is, “No way, I am not going!” As I said in our meeting, I think it is important to remember that for any anxious child, any new situation can be especially challenging and that include seeing a doctor who specializes in worries. I think it is helpful to view their brains as having an overactive alarm system that just sends out a lot of false alarms. So I do not think we should be surprised if he does not want to speak, appears to be velcroed to your side and puts his mouth on your ear to whisper. Going anywhere new and meeting anyone new can be scary. The older child may simply hide behind impossibly vague statements or feign a vaguely coma-like state, or get irritable and ask when he is going home. These are simply the ways in which the child shows the new situations get the alarms bells ringing or more technically activate the sympathetic nervous system. However, an informal rule of thumb is that anxiety waves typically last 15-20 minutes. So I do not have expectations that your child will participate in the session for the first 15-20 minutes, but if she does, that is great. I will direct a lot of questions to you (remember I am not going to meet alone with your child at first) and I might do something like toss a ball around, or give you and your child some pipe cleaners, or some other way of discharging some physical tension.


A problem with anxiety is that your body gets all revved up thinking that there is some wicked danger nearby like a sabre-tooth tiger, but it has no place to go, so all that tension gets translated into something like an upset stomach, headache or feeling that you are going to faint. It really helpful to have some way of getting rid of that anxious tension. So that is why you may find me tossing a ball around, giving you pipe cleaners or excitedly showing you how my remote control spider works (as long this isn’t one of the worries). Please don’t ask say to your child “Would you like to tell Dr. Ted about …. (your soccer game or whatever)?” Have you noticed that this never works? If we give your child some time, she will start talking in her own way.