February 07, 2024
By Dr Kathy Weston
So here we are, it is Children’s Mental Health Week in the UK. I could write about so many different aspects of this theme, but I have chosen to write about anxiety. Why? Well, it is the largest mental health disorder affecting children and young people and it is also often misunderstood. Is it really the enemy per se?
It is important to acknowledge that anxiety is something that regularly features in our daily lives. We all have experience of it affecting our bodies, our health, our thoughts and our actions. Ever felt butterflies in your tummy, sweaty hands before a big event, a dry throat at the thought of giving a speech, sleep or eating issues whilst waiting for exam or test results? We can also all likely relate to our thoughts being out of control and negative self-talk taking over. Have you ever catastrophised and imagined only the worst outcomes? Felt riddled with self-doubt and excessive worry? Some of us may have also experienced panic attacks (mine lasted for a few months at university) where anxiety feels acute and, during these episodes, one can even experience a feeling of disassociation from one’s own body.
Anxiety can have a big impact, which is why we need to understand how it affects us as individuals and which strategies we can use to reduce it to manageable levels. Most importantly, particularly this week, it is useful to consider any legacy of anxiety that we might be inadvertently passing on to our children.
We know that anxiety can run in families so it is important as a very first step to think about our own levels of anxiety; what we fear and how we might express that. What are we modelling? It is not that we aren’t entitled to feel afraid or anxious, quite the opposite, but it is good to be conscious of our own wobbles and worries, so we can be sure to model effective coping.
An additional motivating factor for writing this week’s Wednesday Wisdom on the theme of anxiety is that I have had the good fortune to attend a lecture on childhood anxiety by Professor Cathy Creswell, a national expert who is based at Oxford University.
What did I learn that I could share with you? What tips have I picked up to help parents supporting anxious children? Professor Creswell made it clear that a key part of anxiety literacy is carefully differentiating between appropriate (normal) anxiety and problematic anxiety. For example, it is normal to worry about those monsters under the bed at age six, bees and wasps stinging us, big dogs when we are little, and to be frightened about stepping into a cave. Anxiety serves a purpose in alerting us to a threat. However, here is the litmus test. If the fear is out of proportion to the threat, and if the anxiety is stopping your child doing what they love or enjoy, then it becomes problematic.
An anxiety problem, as Professor Creswell noted, is when the anxiety that the child experiences is out of proportion to the environment they are in. She applied a wonderful visual metaphor in explaining how an anxious child or adult might respond; like an overly sensitive smoke alarm that goes off in the absence of actual smoke. Whilst normal anxiety might ebb and flow, an anxiety problem might be persistent. It might stop your child seeing friends, eating, sleeping well or attending school. 28% of people will have anxiety disorder at some point in their life (over a quarter of us!), and for half of these people, anxiety started before the age of 12, so really thinking about how we identify early anxiety problems is important.
It can be tricky to work out why a child is anxious (indeed, they may not have any clue themselves), but this is where we need to adopt the stance of the researcher; staying curious, noticing patterns, paying attention to context and basically committing to puzzling it out together, whilst not doing anything that might inadvertently make the anxiety worse. We know that a problem-solving approach can often be optimal when supporting anxious children. Through occupying the role of the caring, curious coach rather than ‘chief reassurer’, we are optimally placed to help them work out what is going on, what potential triggers might be, and how we might establish appropriate goals to face some of those fears.
Clearly, it is optimal for children to be receiving clinical support if their anxiety feels like it is obstructing their daily lives. Professor Creswell mentioned how CBT (cognitive behavioural therapy) can work well in helping young people to consider those vicious cycles that ‘keep anxiety going’ and how we might disrupt that. It was disturbing to hear that sadly only about 2% of children (as of 2019) have been able to access this treatment! What can we do in the absence of immediate help?
Professor Creswell’s work and her brilliant book, ‘Helping Your Child with Fears and Worries’ models an approach to supporting children that we can learn to apply. I will summarise some key points and takeaways that parents of anxious children might benefit from.
When leaning in and talking to our children about what they are worried about, she recommends questions such as: What are you feeling worried about, what is frightening you? What do you think will happen if you did [a particular thing]? What is it about this situation that feels scary or that is making you feel worried? We might not get conclusive answers, but we are showing a commitment to puzzling it out together, collaboratively.
We also need to carefully validate how they are feeling, avoid minimising or dismissing their worries, and try not to be too reassuring (the latter can inadvertently exacerbate anxiety!). Validating how they are feeling involves saying things such as: ‘I can see why you are feeling worried about going upstairs on your own if you think something will happen to you. That must be scary’. It involves taking time to empathise and to normalise their feelings.
Parental reflection ahead of setting small goals with our children can be beneficial. Professor Creswell recommends parents ask themselves: What would I like my child to do differently, if the anxiety wasn’t present or around? What changes would I notice if the anxiety wasn’t in control? What changes would I notice if my child no longer had anxiety difficulties? What is anxiety getting in the way of them doing? This helps us articulate a vision for what we want for our children and motivates us to think about supporting them to set and teach appropriate goals. These goals might be things like: I want my child to be able to sleep independently in their own bed for a week, or I want my child to play in the garden when another child is present.
Next, we want to model a curiosity about what our children need to do to overcome their anxiety. Which tools might help? And is that child motivated to move towards those little goals? Professor Creswell recommends focusing on one little goal at a time. Once that is achieved, a child’s confidence will grow as a result, and their learning can then be generalised to other aspects of their life.
Remember, avoidance keeps anxiety going. Supporting them to dip their toes in the water with small exposure to things considered to be scary requires calm consideration and a strong heart on the part of a parent (ideally done with the support and guidance of a clinician), but ultimately the path to empowerment lies in experience. It is not about putting children in adverse situations, but rather giving them opportunities to try things and then catching their courage and effort on the other side.
By asking, “Wow, you were nervous before you did that, how did you manage that?”, we encourage our children to delve deep and to consider the tools, strategies or self-talk that carried them through each moment. This learning can be applied time and time again and provides a springboard for further goal-setting, and gently building their self-esteem and confidence along the way.
Are you a Tooled Up member?
Anxiety is something that we are commonly asked about at Tooled Up and we have a whole section of resources devoted to the subject. The first place to start is our Quick Guide to Anxiety, which extracts the most important things that you need to know from current research, focuses on practical things you can do to help children navigate anxiety generally and lets you know where you can find more advice and information in the Tooled Up library.
If you'd like to hear directly from Professor Creswell, then tune in to our podcast interview on childhood anxiety. You might also be interested in our webinars on separation anxiety with expert Chloe Chessell, performance anxiety with Dr Anna Colton and fire anxiety with Joanna Foster. We also have podcast interviews on maths anxiety and eco-anxiety!
For practical evidence-based activities that can help your child to better control feelings of anxiety, we suggest that you take a look at our 'wobble' resources. One of the best ways to overcome anxieties is to take gradual steps towards having a go at the thing that worries us. Our Wobble Ladder is a useful tool for setting out small, step by step goals and rewarding progress. It can be used in conjunction with our other ‘wobble’ activitites, designed to help children identify and work through exactly what is causing them anxiety, nudging them to become ‘thought scientists’. You might also like to nudge them to consider what things they can control and what things they can't using our simple template.
Should your child's anxiety cause them to struggle with school attendance, we have a range of resources on 'emotionally-based school avoidance'.