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Summary: Does your child have trouble coping with stress? Does he or she exhibit serious concern about academic, athletic, or social competence? Do you see an exceptional need for reassurance, frequent aches and pains, acute sensitivity to the comments of others, fatigue, difficulty concentrating, irritability, or sleep disturbance? Does your child quickly give up attempts at self-control or fail to recognize his or her success at such attempts? These are some of the signs of ...show more excessive anxiety, a debilitating condition that afflicts millions of children, causing deep frustration and often leading to lifelong unhealthy patterns of behavior. Although medications can be helpful, studies have shown that nearly 90 percent of all anxious children can significantly benefit by learning coping skills. Your Anxious Child empowers you to teach your child these essential skills in engaging, creative ways. Through dozens of activities you can start using right now, your child will learn how to alleviate stress, build courage and trust, and become an innovative problem solver. Your Anxious Child is based on the acclaimed "COPE" program, which has been used successfully with children throughout the United States for the past 15 years. The program offers physical, mental, and spiritual strategies for Calming the nervous system; activities designed to help your child Originate a creative plan to relieve anxiety; approaches to help your child Persist in the face of obstacles and failures; and effective ways for you and your child to Evaluate and refine your plan. Each step includes field-tested activities that are easy and fun to do, suit a range of ages, and can be individually tailored. Activities include games, puzzles, checklists, biofeedback techniques, breathing and sensory awareness exercises, yoga, prayer, journaling, playacting, storytelling, and lots more. With this supportive guide, you can offer your child tremendous tools and strategies to alleviate anxiety.
An Empowering Guide for Relieving Your Child's Anxiety
Katie freezes when she's asked to perform. José is a clinger. Damian is terrified of animals. Felicia always worries that she's going to make a mistake. It's hard being the parent of an anxious child, watching your son's frustration grow, or seeing how your daughter tries to cope with her fears but gives up so quickly. Filled with solid information, a proven four-step program, dozens of engaging activities, and insightful personal vignettes, Your Anxious Child gives you easy, fun, and highly effective tools to help your child become a creative problem solver. Parents and teachers alike will find excellent strategies in this essential guide. ...show less
Dacey, John S. : Boston College
John S. Dacey, Ph.D., is professor at Boston College in the Department of Counseling, Developmental Psychology, and Research Methods. An expert in child development, he is also the author of many books and articles on parenting, creativity, adolescent psychology, and human development.
Fiore, Lisa B. : Boston College / Curry College
Lisa B. Fiore, Ph.D., teaches courses in developmental and educational psychology at Boston College and Curry College. Her background as an early childhood educator has fostered her research in Head Start centers and her work in counseling parents of young children.
What Anxiety Is and
How It Can Be Alleviated
''My Katie is a little chatterbox, but when you ask her to perform, even for the family, she gets so nervous that she freezes up. I wish I could help her relax more.''
''Almost since he was a baby, Jose has been a 'clinger.' He hated starting kindergarten, and even now in the third grade, he misses me and can't wait to get home. I can't travel anywhere without him. We thought up a plan to help him be less frightened, but it just didn't work out.''
''Our Damian is terrified of animals. He hates to walk down the street by himself. He thinks a squirrel is going to jump out at him! We took him to a psychologist, who helped him think about his fears differently, and for while he was a lot better. Then a dog barked at him, and he just gave up.''
''I wouldn't say Felicia is a frightened child. She does most of the things the other kids do-it's just that she worries about doing everything. She's very capable, but she's always afraid she's going to screw up. She works hard to get over her fears, and we tell her that she is doing better. She just can't see it, though. She just doesn't realize the improvements she's made.''
These four parents' statements reflect the four central problems that all anxious children face:
It's hard to be the parent of an anxious child. Often you don't know what is causing her1 anxiety, and sometimes you're not even aware that she is feeling frightened. Anxiety has been called the silent affliction, because most people are able to hide their upset from others. What can you as a parent do?
The good news is that studies have shown that about 90 percent of all anxious children can be greatly helped by learning coping skills. The goal of our book is straightforward: we want to empower you and your child with the coping skills that can help relieve her feelings of anxiety. In the chapters that follow, we will provide strategies and activities that you can use with your child to help her understand and contend in new ways with being anxious. The strategies form the basis of our four-step COPE program, which has undergone fifteen years of successful field testing in schools and with individual children in various parts of the country. Each of the strategies that make up this program is accompanied by a set of activities. These activities will help you deal effectively with the four problems (listed earlier) that all anxious children face. COPE, which will be more fully described throughout this book, has been designed to ensure that all children are given opportunities to gain control over their anxiety problems, through the help of those who know and love them best: their parents.
Between 8 and 10 percent of American children and adolescents are seriously troubled by anxiety. Over three million children suffer from one (or more) of eight anxiety disorders; anxiety is currently the most prevalent psychiatric diagnosis in those sixteen and younger. Anxious children are two to four times more likely to develop depression, and as teenagers they are much more likely to become involved with substance abuse. Why? Are they victims of some trauma that has left them perpetually on guard? Were they just born that way? Are other factors involved?
As adults, most of us can look back on the worries of childhood and laugh at how insubstantial they appear. What once seemed like an iceberg now looks more like an ice cube. As grown-ups, we've all had life experiences that have given us the broader lens through which we can examine everyday worries and keep them in perspective. Unlike adults, children do not have those mental capabilities or that experience.
As parents, you are often faced with such questions from your child as ''What if I'm not picked for the soccer team?'' ''What if I can't tie a square knot when it's my turn?'' or ''What if nobody gives me a valentine?'' It is difficult to know whether your child's worries are a harmless case of the ''what ifs'' or whether she has a serious anxiety problem. For such a child, everyday tasks and events can become extremely challenging, with seemingly insurmountable obstacles. She simply can't imagine personal success when she first imagines failure or harm. We're Never Going to Make It!
It was a cold, sunny day as my father and I set out on our drive to the San Bernardino Mountains for my Indian Princesses retreat. This was a father-daughter group, similar to Cub Scouts or Girl Scouts, but based on Native American stories, crafts, and values. We were going camping with the other members of our group. We would be staying in real wood cabins, sleeping in cozy sleeping bags, and cooking food over a campfire. I had been looking forward to this trip for weeks, imagining ghost stories and marshmallows and looking up at a million stars in the night sky.
The drive was long, over two hours, and my father and I chatted about school, family, and life in general while we listened to the radio. Once we started the drive up the mountain, my attention was drawn away from conversation to the scenery outside my window. Sometimes the road curved sharply in hairpin turns, and I began to think that the two lanes seemed awfully narrow for two cars. On some stretches of roadway, there were only thin metal barriers on the edges of the cliffs, and on other parts of the road there were no barriers at all to prevent cars from falling thousands of feet to the ground below.
I began holding my breath when we drove around the sharp turns that were along the side of the cliffs, and felt great relief when we got back to the part of the road where my side was next to the mountain. Finally we turned off the main highway onto the local road that would take us to the campsite. There was no asphalt, only gravel, dirt, and ruts, which caused the car to bounce and bob as we drove slowly along, looking for the sign for our site.
''Do we have enough gas?'' I asked my father. He assured me that we did, and kept driving. I tried to peek at the gas gauge to see where the needle was pointing, but I couldn't see it. I hoisted my seven-year-old body up higher, placing all of my weight on my wrists and elbows, and I could barely see the gauge. The needle didn't look right to me.
''Are you sure we've got enough gas?'' I asked.
My father was beginning to get annoyed with me. ''Yes, I said. We've got plenty of gas. Lisa, what are you doing? Sit down ... and put your seat belt on,'' my father cautioned.
''It is on,'' I told him, and I continued to look at the gas gauge. I couldn't stop trying to see where the needle was, and I began holding my breath again. I imagined us being stuck in the middle of nowhere, and I would never see my mother or my brother again. We would die in the wilderness, and everyone would miss me.
''Finally,'' my father sighed. ''Here we are!'' We turned into the parking area of the campsite, and I recognized a few of my girlfriends from Indian Princesses. I felt the blood pumping through my heart as an enormous sense of relief flooded through me. ''We made it!'' I thought to myself. ''Hooray!''
THE NATURE OF ANXIETY
Young Lisa certainly experienced some highly anxious moments on her trip with her father. From her father's view, she was never in any danger, but she imagined that she was. Do these feelings indicate that Lisa had a serious problem? Before we can try to answer this question, we need to further explain the nature of anxiety.
It is natural that children experience fear when they perceive a threat that may be real or imaginary. In fact, a moderate amount of fear can motivate them to learn new things. Whether the perceived threat takes the form of a dentist, a witch, or a snake, all children encounter stressful situations, and these circumstances change as the child matures into adolescence. For example, preschoolers may feel afraid of the dark, being alone, or monsters; older children may worry about rejection by peers or incompetence in school activities. Children and adolescents inevitably come to learn about potentially fearful, even dangerous, events. The ways they respond to anxiety depend on their individual personalities.
The terms fear, worry, and anxiety are often used interchangeably. In fact, there are subtle differences that are worth mentioning here. Psychologists use the word fear to describe frightened feelings toward a clear danger or threat. Fear is a reaction to an environmental threat that is focused on a specific object, individual, or circumstance. Worry is similar to fear, in that it refers to less intense reactions to specific dangers or foreboding about specific future events.
In contrast, anxiety is a general, frightened response to a source that is not readily identifiable. It could be the perception of a threat of what might have happened in the past or might happen in the future. An anxious child or adolescent may feel agitated and unsettled about some event over which she has no control. When a child is unable to think of a solution to the problem, feelings of helplessness often arise, resulting in a personal crisis. In summary, anxiety is a more generalized response to people or events that pose no immediate threat, although to the individual, they seem threatening.
WHEN ANXIETY BECOMES A PROBLEM
In the simplest sense, anxiety is the feeling that one's safety or well-being is threatened. Under some circumstances, a potential threat is readily resolved, such as the first time a child musters the courage to blow bubbles in the swimming pool. When she hears applause for joining the ranks of the ''minnows,'' the threatened feeling is replaced by a feeling of success.
Some children, however, find it more difficult to experience success in everyday situations. They find themselves plagued by anxiety that is more pervasive than a simple fear. Most of the time, this feeling is the result of two types of mistaken thinking: (1) faulty perception of the facts and (2) misunderstanding of the meaning of the facts. (The child may experience one or both.) Let's look at some examples of mistaken thinking.
Fact: ''My heart is beating faster than usual now.''
Faulty perception of the fact: ''My heart is racing; it feels like it may burst!''
Misunderstanding of the meaning of the fact: ''If my heart rate doesn't slow down soon, I will surely have a heart attack and die!''
Other typical faulty perceptions of facts: ''This distressing situation is really always going to be this way.'' ''No one understands me.'' ''I am a totally weak person.''
Other typical misunderstandings of the meaning of facts: ''Because I am having tense and fearful feelings, I am unlucky. Maybe I deserve this stress. Others don't have it. I must be getting punished for something I've done.'' ''I'm so often scared, there must be something wrong with me. I have some sickness [devil, syndrome, demon, mental illness] in me that won't let me rest.'' ''I can see no real danger, but still I feel fearful; obviously I am missing some threat to my safety.''
For your child's anxiety to be reduced or eliminated, these errors in thinking must be rectified. The goal of all the strategies and activities in this book is to help your child achieve this end. However, this book should not replace psychotherapy and medical treatment for the more serious cases. The only safe way you can determine the seriousness of your child's problem is through the professional methods used by qualified therapists and psychiatrists. Nevertheless, it is our contention that you, the parent, are most often in the best position to help, especially when you are armed with the knowledge available in this book.
MAJOR CAUSES OF ANXIETY
Social scientists used to try to explain human traits, including anxiety, from the standpoint of two causes: nature and nurture-that is, genes and environment. In recent years, social scientists have carried out numerous studies of the causes of anxiety. They have made much headway. Perhaps the most important conclusion they have reached is that anxiety always results from a combination of three factors: biological, psychological, and social. These researchers use what is referred to as the biopsychosocial model to explain the influence and interrelationships of the three factors. Understanding this model will help you take a more comprehensive approach to coping with your child's problems. Let's look at each of these factors more closely. Although we describe them separately, please remember that in reality they are always interacting and affecting each other.
From the moment your child was conceived, she was subject to biological influences that affected her level of anxiety. Some of the indicators of a genetic tendency toward anxiety are obvious, such as a tense, irritable temperament or erratic sleep patterns. Other biological factors are less obvious but are equally influential, such as hormonal imbalances and abnormal brain activity. Whenever these biological abnormalities are present, they increase adrenaline in the bloodstream. As a result, a child will likely exhibit some physiological symptoms: shallow breathing, increased heart rate, sweaty palms, and tense muscles, for example. These symptoms are also typical when a child or adolescent is under stress and experiences the alarm reaction. The alarm reaction involves twenty-two physiological responses that usually result from heightened adrenaline levels (see the list that follows). Not all of these responses need to occur simultaneously for the alarm reaction to be present. Ironically, many people come to fear the uncomfortable and disabling symptoms of the alarm reaction more than the cause of the anxiety itself.
Physiological Responses of the Alarm Reaction
Physiological factors such as sleep, stimulation, and food affect the anxiety response to a degree and on an individual basis. For example, your child may be getting too much stimulation from her environment or not enough. Any child will be more easily agitated if she has not had enough sleep or has ingested too many candy bars or sugary, caffeinated soft drinks. Exercising judgment and control over a child's sleeping and eating habits is easier with young children than with adolescents, who make more decisions on their own. Nevertheless, by modeling desired eating habits and sleeping routines in the home, you can beneficially influence your child both directly and indirectly.
Psychological causes of anxiety result from an interaction between biological forces and disturbing experiences. An example would be what happens when a child takes a tumble off a tricycle. For most children it is upsetting, but they soon forget it. For a child who has a ''high-wired'' nervous system, however, such an accident can cause tricycles to become feared objects. Psychological factors affect the way your child perceives and thinks about the world.
Children who are anxious also become hypervigilant, which is a heightened state of sensitivity to the possibility of danger or threat. If your child's mind is in a constant state of alert, you may have discovered that she finds it difficult to relax. If your child views the world hypervigilantly, she is likely to spend most of her time in a state of discomfort, which in turn distorts her view of reality.
Social factors typically involve your child's interactions with her family and friends and others in her life. These people may contribute to her anxiety in various ways, and their influences change as she matures. Parents, siblings, and other playmates can be constant sources of anxiety if she perceives them as a threat. For example, her big brother may be only kidding, but your child may think he is really going to hurt her. The intentions of these persons may be good, but if your child is predisposed toward feelings of anxiety, then everyday conflicts may seem especially threatening to her.
The patterns of behavior that parents use in raising their children are referred to as parenting style. Several such styles have been identified, and each contributes, positively or negatively, to children's development. Some parents, for example, demand perfection from their children. Such children may come to believe that their efforts can never be good enough. These circumstances can foster serious problems, such as eating disorders. Having an anxious parent or sibling often contributes to a child's level of anxiety, particularly if the parent or sibling shares his own anxieties with the child. When the child sees her role model in a state of anxiety, she may come to internalize these feelings herself.
We do not wish to convey the idea that if a child is anxious, it is the parents' fault. Parents can, of course, contribute to the problem, but many studies show that children are influenced by many aspects of their environment, and parents are only one of them. We will explore the ways that parenting style can encourage freedom from anxiety in Chapter Seven.
As you will see in the section that follows, different cultures can also produce a myriad of unique influences. A good example of the importance of social context may be seen in the children of the Caribbean islands. Consider the views of two therapists who practice on one of these islands, St. Maarten, which is about one hundred miles east of Puerto Rico. Dr. Karen Philips was born in Holland and has worked on St. Maarten as a clinical psychologist for the last sixteen years. Dr. Judith Arndell was born on St. Maarten and has spent most of her life there.
Anxiety Among Caribbean Children
Dr. Philips observes that after hurricane Luis, which brought about major destruction on St. Maarten in September 1995, the number of posttraumatic stress cases increased. She sees the source of her clients' anxiety as their anticipation of their surroundings, as well as the way they talk silently to themselves about their perceptions. Focusing on changing this ''inner talk'' toward more positive statements and anticipations is the core of her plan for treating these anxieties. If clients realize they can actively change their own perceptions and thoughts, then a sense of control develops that can result in reducing anxiety. The choice is whether to concentrate on and emphasize what could go wrong or what could go right. Dr. Philips finds that if her clients can focus more positively and constructively on developing healthier inner talk instead of fighting anxiety, they can make good progress.
Dr. Arndell states that more than half of her clients suffer from anxiety problems. She finds that in Caribbean children and teens, stormy weather is certainly a problem. However, she believes their primary problem is the insecurity caused by their parents telling them they will be punished by spiritual beings (bogeymen, devils, their dead relatives) for their bad behavior. The youngsters come to believe that these hobgoblins hide in various places, waiting to punish them.
''As a result,'' Dr. Arndell says, ''the children frequently develop fears of going into certain rooms, especially bathrooms and bedrooms. Many of them become obsessed with these concerns. Such obsessions often lead to separation anxiety, performance anxiety, and a variety of social phobias. They can be quite difficult to overcome. In fact, comparing my ten years' experience in the United States and the rest of my career here, I would say that although the causes of the problems of Caribbean children and American children are often different, the ways they manifest their anxiety are really quite similar.
''I see my job as helping kids to stop thinking about all those negative things in their lives, whether real or imaginary. I teach them not to entertain those thoughts. I show them how to substitute more wholesome ideas. Most of my younger clients need to practice having thoughts about safety and security. That's what I tell their parents, too: 'If you can make them feel that their home is secure, that's the most important contribution you can make to relieving their anxiety.'
''The other thing I emphasize is living in the present. Most of these kids have their minds fixed firmly on what is going to happen. I try to help them quiet their fears about what the future will bring and instead to concentrate on the present moment. When I can get them to do that, they're on their way to getting better.''
In the Caribbean, virtually all children have experienced hurricanes and have been threatened by the idea of bogeymen. Most do not suffer from anxiety problems, however. Those who do usually are also afflicted with highly sensitive temperaments, have experienced early psychological distress, and lack effective social supports such as belonging to a close circle of friends. No matter what the behavior, it is always the result of the complex interaction of these three factors. This combination of biological, psychological, and social elements is a good example of what we mean by the biopsychosocial model.
ANXIETY AT DIFFERENT AGES AND STAGES
As you may well have noticed, age affects your child's anxiety patterns. For example, infants' fears revolve around sensory experiences, such as loud noises, falls, and their parents' absence. Toddlers will likely experience fear of strangers or distress upon their caregivers' departure (known as separation anxiety). Childhood brings with it fears of animals, the dark, and imaginary beasts and creatures. As children's circles of exploration and experience widen, the likelihood of exposure to anxiety-provoking stress increases. Children in middle childhood are often concerned with performance, and adolescents are more concerned with social and interpersonal anxieties as they begin to form intimate relationships. The list that follows shows the typical fears that child experts find at several age levels.
Typical Causes of Anxiety of Children at Several Age Levels
Ages 6 to 7
Strange, loud, or abrupt noises (for example, animal noises, telephone and alarm ringing, wind and thunder sounds)
Ghosts, witches, and other ''supernatural'' beings
Separation from parents and being lost
Being alone at night (and having nightmares or visitations from ''evil'' creatures)
Going to school (so-called school phobia)
Physical harm from, or rejection by, specific individuals at school
7 to 8
The dark and dark places (such as closets, attics, and basements)
Real-life catastrophes suggested by television, the movies, and books (for example, kidnaping, floods, fires, nuclear attack)
Not being liked
Being late for school or left out of school or family events
Physical harm from or rejection by specific individuals at school
8 to 9
Personal humiliation Failure in school or play
Being caught in a lie or misdeed
Being the victim of physical violence (either from known people or from strangers; either deliberately or randomly motivated)
Parents fighting, separating, or being hurt
9 to 11
Failure in school or sports Becoming sick
Specific animals (especially animals larger than humans or those known to attack humans)
Heights and sensation of ''vertigo'' (for example, dizziness)
Sinister people (for examples, killers and molesters)
11 to 13
Failure in school, sports, or social popularity Looking and acting ''strange''
Death or life-threatening illness or disease
Sex (attracting others, repelling others, being attacked)
Being fooled or ''brainwashed''
Losing possessions, being robbed
The famed child expert Jean Piaget proposed that children's thinking proceeds from vague to specific awareness of their surroundings. Then, in early adolescence, the child's thinking progresses from concrete to abstract ideas. As a child's mental abilities evolve, her capacity for anticipating the future improves. This enables her to meet the increasingly complex demands of the tasks she encounters. Unfortunately, a downside to this growth is the improved ability to clearly visualize the possibility of unpleasant events. Normal fears become associated with exaggerated expectations. Thus some youngsters become progressively more anxious as they move toward adolescence.
CURRENT THERAPEUTIC PERSPECTIVES ON ANXIETY
The science of psychology has taught us a great deal about the nature of anxiety. Unfortunately, but not surprisingly, there is still some disagreement about the best way to reduce it. There are several schools of thought that influence diagnosis and treatment of anxiety in children and adolescents: psychoanalytic, behaviorist, family systems, and cognitive. We think it is important to briefly describe these current psychotherapeutic viewpoints so that you can clearly see the orientation of this book. Many of the activities you will do later in the book are built on these perspectives, especially the behaviorist, family systems, and cognitive viewpoints. Also, knowing this information is helpful when you are choosing a therapist, should that be necessary.
The Psychoanalytic Perspective
Although Sigmund Freud was the father of psychoanalysis, his work has been largely superseded by the theory of Erik Erikson, another famous psychoanalyst. In his much-discussed book Childhood and Society, Erikson outlined eight universal stages of development. He stated that progressing from one stage to the next depends on the child's resolving the conflict present in each stage. At each stage, two personality traits conflict with each other. For example, at stage two the conflict is between whether the child develops a sense of autonomy or becomes filled with a sense of shame. For healthy development, the child needs to resolve the crisis in favor of the first trait in each pair. From the standpoint of the anxious child, the most relevant stage is stage four: industry versus inferiority. During this stage, which occurs at approximately five to eleven years of age, children are concerned with performance in school and at home. The anxious child may be overly concerned with ''making the grade'' both academically and socially. ''Will I pass the test?'' ''Will I make new friends?'' ''Are people making fun of me behind my back?''
For these children, anxiety exceeds the routine self-doubts that others experience. An anxious child is often hindered because her anxiety is so great that she has difficulty functioning with her peers. When this happens, she experiences a sense of inferiority, and her ability to achieve success declines.
Psychoanalysis tries to help children primarily through encouraging them to express their anxious feelings and then analyzing the origins of these feelings. A major emphasis of this perspective is the relationship between the parents and the child. Through a process called transference, a therapist attempts to act as a surrogate parent and to help the child restructure her feelings about herself by being a kind and understanding parent-substitute.
The Behaviorist Perspective
Anxious children naturally wish to avoid situations that scare them, even more than other children do. When your child avoids such situations, her behavior is reinforced because her frightened feelings are temporarily reduced. This only perpetuates the anxiety, according to behaviorist theorists, such as B. F. Skinner. Some parents feel that giving in to the child's reluctance is appropriate and caring, but doing so enables the child to avoid fearful situations, and she thus fails to deal with the problem.
Another aspect of the behaviorist approach is seen in the work of Albert Bandura, who has done considerable research on the concept of modeling. Stating that children learn primarily through imitation and modeling, Bandura espouses the use of these processes to promote confident behaviors in children. In modeling situations, parents or other influential individuals behave calmly and competently in real or make-believe scary scenarios, which shows the child alternative reactions to anxious situations. According to this perspective, you instruct your child to imitate what you do, then give her positive feedback as she succeeds in doing so. Over time, she learns to adopt these modeled behaviors as her own and gradually becomes less anxious.
The Family Systems Perspective
Family systems therapists, such as Virginia Satir, regard the anxiety symptoms of an individual as a family problem, and thus they find it necessary to treat the whole family rather than just the child or adolescent. There are many varieties of family treatments, which may be combined in different ways and with other types of therapy. Perhaps the most important feature of this perspective is the idea of bringing the whole family together for therapeutic sessions, as families are seen as self-sustaining systems that influence each member in a myriad of ways. The child is the ''identified patient'' whose symptoms bring the family to therapy. Once the family's rituals, rules, and routines have been determined, the therapist attempts to alter the patterns that affect the child. These changes then reverberate throughout the family system. For example, a family therapist will try to influence the interactions between a husband and wife in order to help the child. The personal story that follows illustrates how a mother's anxieties about separation from her husband can affect her children.
The Attack of the River Rats
Our house had a small front yard, surrounded by a low hedge. On the side of the hedge facing away from our house was a huge open field sloping down to the railroad tracks and the bank of the Delaware River. There was a narrow break in the hedge that opened onto a path, and that path led across the field to a train station about a quarter-mile away. It was exactly the kind of place that kids would want to explore and that any parent would declare off-limits.
My mother could not help worrying about it all the time; she was a ''worry wart.'' Her training as a nurse contributed to this trait, I think. She was perpetually concerned that the colds my brothers and I were always catching would turn into pneumonia and that our bumps on the head had caused concussions. She felt sure that one day one of us would wander through the hedge, cross the field, and get hit by a train. To prevent this, she told us a vivid story about the ''river rat'':
''You kids must never go through that hedge unless Daddy or I am with you. A family of river rats lives down by the river, and there are always a few of them hiding near the opening of the hedge. They have a cave in the riverbank, and they might take you there. If you become their pet, they won't let you come home again. So if you know what's good for you, you'd better stay away from that hedge!''
Her story was effective, particularly because there really were immense rats in that area. I still have a most graphic memory of the few that occasionally made their way into our house. And so we children were duly terrified by the thought of crossing through that hedge. But I don't recall my siblings becoming hypervigilant as I did-on the lookout for danger everywhere. Therefore, my mother didn't cause me to be a highly anxious child. I believe I had inherited an inclination toward an anxious personality. Early experiences, such as this rat situation, interacted with my genetic proclivity to produce a ''nervous'' child-me.
One morning when I came downstairs for breakfast, I found my mother entering the front door, wearing her light coat and a hat with one of those veils made so popular during the war years by Ingrid Bergman and the other mysterious Hollywood femmes fatales. I couldn't see her face, so at first I didn't realize that she was sobbing. When I did, I asked her what was wrong.
''Oh, nothing. I just walked Daddy to catch a train, and I'm just very sad that he's gone.'' I later learned that she hated it when my father traveled.
It was unusual that my father should take a train trip, but he had done so before. Nevertheless, she had said the word gone, and the first thought that occurred to my four-year-old mind was that the rats had gotten him. I pictured hundreds of rats jumping on my father from their hiding places in the hedge. They knocked him to the ground and, with pieces of his clothing clenched in their teeth, dragged him back to their disgusting cave. I started crying too, and it took her a while to discover my fear. Eventually, she helped me calm down, but this was one more reinforcement for me that life is a very dangerous undertaking. It was years before I began to question that attitude.
The Cognitive Perspective
The cognitive perspective on anxiety focuses on the thoughts of the child. This view is the opposite of the psychoanalytic approach, which identifies repressed feelings as the culprits. Cognitivists, such as Aaron Beck, believe it is distorted thinking that causes disruptive feelings rather than the other way around. In the cognitive view, feelings are analogous to the level of the mercury in the thermometer when you have a fever. The heightened mercury in the thermometer is not itself important. It simply indicates that the body's internal temperature is above average, which is a sign of an invasion of germs. So it is with anxious feelings: they usually reflect thought patterns that have gone awry. Fix the thoughts, and the anxious feelings will subside.
Your child plays an active part in controlling her life through the way she thinks about things. For example, confronting unfamiliar situations is probably quite anxiety provoking for her. For some children, novel situations are not bothersome, but for anxious children, novelty can fuel an already anxious temperament. For them, if it's new, it's dangerous.
One way to make your child less likely to perceive situations as threatening is through ''cognitive restructuring.'' This treatment involves working with her to
The Perspective We Espouse
In our work with children and adolescents, we have employed each of these four perspectives. Although there are cases that respond well to the psychoanalytic, behaviorist, and family systems perspectives, in our experience most anxiety problems can best be helped by the cognitive orientation. Anxious children tend to be brighter than average and therefore are more likely to understand the mental skills the cognitive approach is trying to foster. In addition, as we argued earlier in this chapter, anxiety itself is most often a result of faulty perceptions and, even more important, faulty interpretations of the facts. Cognitive therapy is specifically designed to discover and correct mental misapprehensions. Therefore, the COPE program consists mainly of activities that were inspired by this orientation.
THE COPE METHOD
For the past fifteen years, John Dacey has been experimenting with techniques for helping children and adolescents increase their self-control over their study habits and their ability to avoid using drugs. In recent years he has adapted this method specifically to help children with anxiety problems. The method that has resulted from all this research is called COPE. The letters in this acronym stand for the four steps that make up the method:
What we have discovered through our teaching and our therapeutic and research studies is that most people, children and adults, have similar problems when they deal with situations that are anxiety provoking. These four problems (the same ones that are reflected in the four quotations with which we opened this chapter) fall into categories that are the focus of the four steps of COPE.
Calming the Nervous System
The first problem most of us confront when we enter a stressful situation is the stimulation of the fight-or-flight response, a physiological reaction to assault that is ''hard-wired'' into the human body. In prehistoric times this response, which prepares the body either to attack the antagonist or to run away, was most functional; life-or-death situations demanded immediate, unthinking action. In those days, if you were out hunting alone and saw an enemy tribe running toward you, pausing to consider your alternatives could mean disaster. Today, however, children in most scary situations cannot resolve their problems by simply attacking or running away. For example, as your child walks into a room full of children at a birthday party, she may feel angry with the people staring at her, or she may want to run and hide. However, what she needs to do is quell this neurological response to stress so that she can think clearly about what she wants to say and how she wants to say it. A calm nervous system, then, not a highly aroused one, is what she needs when dealing with most modern stressors.
In this book we will cover different strategies for calming the nervous system. Some of them are physical, some mental, some a combination of the two, and some involve spiritual approaches. We will provide numerous activities that your child may use to achieve tranquility.
Originating an Imaginative Plan
The second problem that anxious people often face is that, even when calm, they often have faulty understandings of their feelings and why they have them. Further, because they are under such pressure, they may be unable to think of really imaginative plans for dealing with their quandaries. Anxious children are less likely than others to have imaginative ideas about the best way to problem-solve, even though, with their vibrant imaginations, they often have greater creative potential. However, if they have calmed down their nervous systems, they can use the techniques that we teach to originate better insights about themselves and design an imaginative plan for dealing with their problem.
In recent years, research has identified a number of thinking strategies and styles that are much more likely to produce creative problem solving. We will offer numerous activities that are aimed at helping you and your child become better problem solvers. As you and she learn these techniques, you both will improve your ability to design a plan that will really combat her anxiety.
Persisting in the Face of Obstacles and Failure
We have found that many plans for dealing with anxiety start out well, but then the child loses faith. The temptation to quit blossoms, and soon the child gives up on her plan. A number of scholars have shown that those people who believe in God or some other higher power or supernatural force such as the Great Spirit are more likely to persevere when the going gets tough. Anxious children are especially prone to the problem of ''throwing in the towel.'' We will offer a variety of paths your child can take to help her have faith in herself, her plan, and her ''higher power.'' Among these paths is a new one about which we are very excited: techniques for designing your own family rituals, which, when faithfully attended to, are proving to be powerful anxiety fighters.
Evaluating and Adjusting the Plan
Having faith in her plan is important, but what is critical to your child's success is making sure the plan really works. We recommend evaluation techniques to use both while the plan is in operation and after the plan has been carried out, so that you and your child can construct improvements. We suggest a number of ways your child can get objective feedback on the efficacy of her plan.
We have devoted a chapter to each of these four strategies. In these chapters, we offer activities that will help you and your child practice the strategy and see precisely how to carry it out. Some of these activities are for five- to ten-year-olds, some are for ten- to seventeen-year-olds, and some are useful for this whole age range. Why have we chosen these ages? We start with five-year-olds because we believe that our cognitive approach is too difficult for children younger than that. Many of our activities would be helpful for persons older than seventeen, but we assume that most of them will no longer be under parental guidance in their efforts to quell their anxiety problems.
"With today's kids confronting an increasingly stressful world, Your Anxious Child is a book that every parent, teacher, and therapist needs to read and put into practice."
--Alex J. Packer, author, Parenting One Day at a Time
"Your Anxious Child will help parents (and teachers) to help children grow and develop. I gladly recommand this delightful and persuasive book."
--Timothy Dugan, M.D., director of training in child and adolescent psychiatry, Cambridge City Hospital; psychiatry instructor, Harvard Medical School
"Well thought-out strategies by experienced therapists." —Susan Shnidman, psychotherapist and psychology instructor,
--Harvard Medical School
"Filled with hands-on advice and activities that can tell parents, teachers, therapists, and relatives what to do to relieve anxiety."
--Neal Klein, psychotherapist and associate professor, Lesley College
Submitted by Publisher, January. 2002
1. What Anxiety Is and How It Can Be Alleviated
2. Eight Types of Anxiety Disorders in Children and Adolescents
3. COPE Step One: Calming the Nervous System
4. COPE Step Two: Originating an Imaginative Plan
5. COPE Step Three: Persisting in the Face of Obstacles and Failure
6. COPE Step Four: Evaluating and Adjusting the Plan
7. How Your Parenting Style Can Help Ease Your Child's Anxiety
AppAndix A: Summary of Activities and Their Goals
AppAndix B: Solutions to Activity Problems
About the Authors
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