Tag Archives: anxious children

Physical Sensations and Anxiety

30 Aug

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

The Kid Figures It Out

24 Sep

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

The Kid Figures it Out

Amid the despair and discouragement concerning whether your anxious child will actually get better, there is the potential for something amazing to be overlooked. At all levels of our body we have the capacity and tendency to self-heal. A Band-Aid after all only supports the body healing from a cut or scrape; the immune system does the job. And well-known artists such as Steven Spielberg have said that their art is a way that they master the fear they had as a child. But guess what? If we are not watching we can miss a child inventing their own cure for anxiety all on their own.

A three-year-old boy enters a daycare full of enthusiasm only to discover that one of  the popular books in the classroom is Going on a Bear Hunt. This is a rhyming, interactive book in which a family goes on a “bear hunt” only to run away quickly at the first hint of the bear.  He had overheard his older sister’s enjoyment of this book at home, but at his two-plus years it was just too scary for him. But there was that dreaded  book again, and the problem was that all of the other children were enjoying it and he didn’t want to be left out. Over the next several months, in small steps, he gradually got over his fear without any direct help from adults.  At first, whenever the book was being read, he would leave the room in a hurry. This lasted for several weeks. Then he began peeking around the corner and listening until the family got close to the bear. Another month or two. Then he began he nuzzle up to the adult who was reading the book and then exit when it got to the scary part. Another month or so. Then he requested a blanket so he could hear about the bear hiding in his cave. Then he pretended to be the bear and chased the other children in the classroom at the end of the book. And his pleasure at mastering his fear was evident, a process that unfolded gently and gradually over several months, guided by his own internal psychological “immune” system. A therapist could not have devised a better plan.

Related to the value of taking incremental steps in dealing with anxiety is developing the capacity to tolerate tension. A high school girl had struggled with separation anxiety all of her life, and it had interfered with her having adventures during the summer as well getting together with her friends. But she explained that she has begun to really enjoy the tension and suspense of Alfred Hitchcock movies. She made it clear that she did not like the  horror movies or gory movies  that some of her peers are drawn to, but the Hitchock films involved her in the feeling of suspense.  On her own, she has devised a program to increase her capacity to tolerate tension and anxiety. This improvised movie therapy exposed her to emotional tension and anxiety in a way which she could manage and feel empowered by. She was learning to face her fear.

An eighth grader who was voracious reader explained that she had seen a Disney movie when she was in second grade and it gave her nightmares. But she found as her parents were reading to her at night, her interest in the story made the anxiety disappear. She quickly became an avid reader. Now her top ten  favorite books would easily match that of any adult. She had found a way, again on her own, to focus her attention in an extremely productive manner.

These children invented a cure for their anxiety. They did need a safe and supportive environment for this natural capacity to emerge. But given some minimal support, a natural healing process took place. Perhaps, you can catch your child inventing his/her own solutions to mastering those worries.

copyright@Edward H. Plimpton, PhD

Obsessive-Compulsive Disorder

27 Aug

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

                                              Obsessive-Compulsive Disorder

The condition commonly called OCD is not the same as being “obsessed” with football, gardening or “Dancing with the Stars”. To have a strong, consuming interest is not the same as having OCD. In OCD there is an intense preoccupation, which causes considerable distress, and which the individual seeks to get rid of through a series of actions which are known as rituals.  Because of the excessive and often time consuming nature of these rituals, or compulsions, and the emotional distress involved, they begin to interfere with everyday life. Perhaps the most well-known OCD ritual is hand washing, which can be carried out to such an extreme that the hands become red and chafed. But rituals can also take on the form of questions which are repetitive such as, “Are you sure you know the way home?” or, “Are you sure I don’t have cancer?” in which no amount of reassurance seems to put the matter to rest. And with some rituals there is a clear superstitious or magical element, as when a child might tap his foot a certain number of times.  Some rituals do not involve an overt behavior but rather consist of having to have a “good thought”  in order to undo a” bad thought.”  There are several sources for the distress that this condition causes. First, the awareness that the rituals do not make sense and that other people don’t share their concerns. Second, with intrusive thoughts, the child might feel, “If  I am having these bad thoughts I must be a bad person.” Third, the intense discomfort that occurs from the obsessions and consequently the difficulty in not acting on them. The rituals really do provide some momentary relief and consequently become quite compelling. The unfortunate problem is that the rituals begin to act like an addiction so that the more you do them the more you have to do them.

There are a number of good books for parents on this topic: Tamar Chansky  Freeing Your Child From Obsessive-Compulsive Disorder, John March with Christine Benton Talking Back to OCD, and Dawn Huebner What To Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD,  to name just a few.  And don’t get discouraged if your child appears to be dealing with OCD. It is actually one of the more treatable anxiety disorders providing the therapist is trained in cognitive behavior therapy using exposure and response prevention.  There is some emerging evidence that children who receive treatment for OCD may not necessarily retain their symptoms into adulthood, or at least the severity will be greatly diminished.  The reason to take action is simple: we don’t want the child to accumulate the hours of practicing the OCD habits that will then create an entrenched way of doing business, and early intervention can interrupt the development of this habit.  Additionally, don’t be surprised to discover that some of your best intentioned efforts to help your child, while they may have provided short term relief, actually made the problem worse over time. Our default reaction as parents is to provide comfort and reassurance when there is distress, but in the landscape of OCD such reassurance is not helpful. This is not to say that you should stop being empathic and caring with your child, but rather that there are skills that need to be learned. It is not straight forward, but then again neither is OCD.