How can we help children who are struggling with anxiety? At the CADC, trained doctoral students in FDU’s clinical psychology PhD program administer cognitive-behavioral therapy (CBT) to youths 6 to 16 years of age experiencing a wide range of anxiety problems, including phobias (e.g., animals, environmental dangers, blood-injection-injury and public transportation), chronic worry, social anxiety, panic attacks, obsessive-compulsive disorder (OCD), and school refusal behavior. Treatment typically lasts 10 to 15 sessions. Families may be self-referred, or referrals may be made through pediatricians, schools or mental-health professionals.
Children are first taught relaxation techniques to help manage physical complaints, generalized anxiety and stress. Relaxation empowers children with a greater ability to “self calm” and to feel “more in control.” The first step is breathing exercises. Deep breathing is one of the easiest and most effective ways of helping children calm down under stress. The CADC teaches a three-step sequence of breathing in through the nose slowly and deeply, breathing out through the mouth slowly and gently, and practicing this technique until the child can relax on cue.
Next, we teach children deep muscle relaxation. Deep muscle relaxation involves first tensing different muscle groups, then relaxing them. The idea is that when children tense then relax their muscles, they will release anxiety and frustration. Some of the exercises include squeezing fists, stretching arms and tensing shoulders. The ultimate goal is to have children use both deep breathing and muscle relaxation to replace fearful and inappropriate behavior such as crying or tantrums, when faced with anxiety-provoking situations.
Once children develop the ability to calm themselves down under stress, they are ready to learn cognitive therapy and problem-solving strategies. With these strategies, children can identify and challenge irrational anxiety-provoking thoughts. This can be accomplished by asking children a series of questions that are based on commonly used cognitive-therapy techniques. Telling children not to worry doesn’t help. If anything, it invalidates their feelings. Rather, the goal is to help children recognize that their fearful thoughts have minimal if no chance of occurring. The following dialogue between a child with intruder fears (Visitor) and her mother illustrates the point:
Child: What if someone breaks into the house tonight?
Mother: Has that ever happened before?
Child: Never [sighs]. But it could.
Mother: What are the chances that someone will break into our house tonight?
Child: Not very much.
Mother: What’s the best thing that will happen tonight?
Child: No one will break in. I’ll stay in my room.
Mother: That sounds good.
But the most important component of the treatment program is exposure. The only way to overcome anxiety is to experience anxiety. We have to show children that nothing bad will happen when they confront feared situations.