Changing the Path of Anxiety
Lesley Solomon, LPC
Anxiety in childhood can lead to serious disturbances. It can pervade family life and every day functioning. Anxiety can also undermine a child's selfesteem and level of confidence. Anxiety can lead to early alcohol use, smoking, drug use and depression.
At the Tarnow Center, we are aware of the increasing evidence for the importance of early intervention in order to prevent serious adolescent and adult problems.
What happens to the body and brain when we are worried or anxious?
fMRI data show that anxiety causes changes in the brain. These changes involve a dysfunction in the brain circuit involving the amygdala and various prefrontal cortical regions. The reactivity of the amygdala in patients with anxiety is heightened so that these patients are more sensitive to perceived stressors. This anxiety response is instinctual and requires no prior learning. This continual anxiety response can become an over learned pathway.
Our children face different kinds of stressors, bombarded with constant day-to-day events such as:
- A new environment like divorce or a move
- Perceived rejection by peers at school
- Yelling or a harsh tone of voice of an adult
- An unexpected change in routine
Because these stressors are constant and never go away, they demand more of the nervous system than it can handle effectively. While we are quite well adapted to threats that require immediate action, our stress responses are less effective against the chronic, daily stressors. These perceived threats might be physical, psychological, or social, real or imagined, and still elicit the anxiety – or "fight-or-flight" response. Being constantly tense and easily aroused can cause restlessness, inattentiveness, and distractibility.
Everybody worries from time to time. This is perfectly normal, even healthy.
Anxiety is a natural response to anticipated future problems. After all, we are like animals that have an instinct to survive in the jungle. Anxiety can be a valuable friend and increase our productivity and excitement about life. Some anxiety can motivate or mobilize us to change and accomplish goals. But when worry becomes a full-time preoccupation, it can lead to anxiety or stress-related disorders. Children with anxiety are more predisposed to:
- Migraine and tension headaches
- Irritable bowel syndrome
- Insomnia
- Obsessive Compulsive Disorder
- Phobias
- Panic attacks
- Post-traumatic Stress Disorder
The Fight / Flight or Freeze Response
Just as the word "anxiety" has many different meanings to different people, anxiety can be expressed in different ways. The "fight-or-flight" response is the most active defense. This fight or flight can be expressed as "acting out", for example, some children become oppositional and aggressive.
Stressed elementary students tend to show emotional stress behaviors such as crying, throwing tantrums, wetting themselves, and vomiting. Older children, such as those in middle school, are more likely to exhibit "rebellious" responses such as refusal to participate, cutting class, avoiding studying, appearing lazy, and deliberately undermining a test by answering incorrectly. In high school, anxiety can be seen as refusal, defiance, anger, aggression, drug and/or alcohol use. These behaviors might be a way for these children to actively avoid their uncomfortable feelings of anxiety.
Expressions of anger and frustration are examples of the "fight" response, whereas the instinct to run away or avoid is an example of the "flight" response.
When fighting or fleeing are no longer physically possible, there is a freeze response and a person becomes immobile. This frozen state is just like an animal playing dead in the wilds – the predator might leave him for dead.
This freeze response is an instinctual and reptilian response that completes the escape response.
What happens to the body in this "freeze state"
- Heart rate decreases
- Blood pressure drops
- Muscle tension decreases
- The focused and alert mind become numb and dissociated • Cognitive functioning is compromised
- Memory access and storage are impaired
When children freeze, they display passive aggressive behavior, "not doing" or forgetting homework. In a test situation, these children feel trapped and shut down, like "deer caught in the headlights." What is in fact happening, fighting or fleeing are no longer physically possible, the child feels helpless and is not able to run away/flee from the classroom. The only way the child can escape the situation, is to play dead, and like the caveman or an animal in the wilds, the child freezes. This has become a very effective yet dysfunctional escape response.
What does a child look like in the freeze response?
- Lazy
- Avoidant
- Spacey
- Inattentive
- Distractible
- Not listening
What happens to anxious children when they grow up?
Children who experience anxiety at a young age are at greater risk for developing depression in adolescence. Depression can be an extreme freeze response. Children with anxiety and depression are more prone to engage in destructive behaviors to soothe these uncomfortable feelings of anxiety and depression. These coping skills can include:
- Drugs
- Alcohol
- Self mutilation
- Risk taking
- Aggression
- Isolation
- Eating disorders
- Suicide
How can we change the path of anxiety?
Although anxiety is a natural part of life, it must be managed effectively for our healthy well being. Early awareness of anxiety is key in understanding and treating anxiety. Developmentally, it is common for anxiety to occur before depression. Anxiety disorders are the most common form of mental disorder in early to middle childhood, and depression shows a dramatic increase around middle adolescence. Early awareness is key to timely interventions. Timely interventions promote lasting, positive results.
Children learn in two important ways:
- directly through observing, experimenting, experiencing, imitating (a child putting a hand on a hot plate)
- through adults who present information from the outside world and direct children's responses (a parent pointing to the hot plate, saying "Hot" and blowing on their hand)
Children can be born with an inherited predisposition to anxiety. Anxiety in children can be sustained in a cyclical way. The child, for example, might exhibit difficulty in separating from parent(s) and the parents might respond in an overprotective or controlling manner in response to their own anxiety. In this case the parents provide an environment which could shape not only the child's behavior, but also the way the brain develops. Parents can model an anxious response to a child. Conversely, parents can learn to model a more relaxed response.
Because parents are important role models for their children's learning, early intervention and prevention of anxiety can be accomplished by parents.
At The Tarnow Center, we teach parents skills to help their child overcome stress and anxiety, and reduce the risk of depression in adolescence and adulthood. We offer a series of 4 sessions, each 50 minutes long. Both parents are strongly encouraged to attend in order to achieve success.
Session 1: Explanation of anxiety and how the anxiety is interfering with their child's current behavior.
Session 2: Demonstration and practice of biofeedback-assisted relaxation skills.
Session 3: Learning about exposure hierarchies and systematic desensitization: The application of relaxation skills to overcome the fear in each step of the hierarchy.
Biofeedback Therapy:
Biofeedback therapy teaches skills that help produce a state of relaxation.
We learn to reduce our state of anxiety and learn that we do have control over how our body responds to a stressful event. Biofeedback-assisted relaxation training is more than seeing a movie to take our mind off things, or taking a long quiet walk to unwind.
Biofeedback training most often includes a combination of deep breathing, progressive muscle relaxation, and visualization skills. Through biofeedback training sessions, we will discover that our racing thoughts will start to slow down, and our feelings of fear and anxiety will ease. We learn how to interrupt panic and how to use self-regulation skills to overcome phobias. In fact, when our body is completely relaxed, it is not possible to feel fear and anxiety. Relaxation and anxiety are physiological opposites.
Cognitive Behavioral Therapy
What goes hand-in-hand with the biofeedback training, is to address the way we think of, or interpret an event. Thoughts can cause feelings and emotions. How we feel, determines how we will behave or function. In fact, most of our behaviors are driven by our unconscious thoughts. These thoughts are so over-learned over our lifetimes, that we are typically not aware of them anymore (like learning to drive that car – we don't have to think about it at all – we drive from our unconscious knowledge that results from doing it over and over for most of our lives). Simply put, when we change the thought, we change the feeling. Cognitive retraining teaches you how to recognize, challenge, and then change the thought.
Medication Management
This is the biological part of the biopsychosocial human. Some children need medicine, especially in the beginning, so they can learn the psychological and social parts of the therapy. It is important to frequently consult with the psychiatrist because in many cases, as the child learns healthy ways to manage his/her anxiety, or depression, a medication adjustment is needed.
The psychiatrist is the physician who is most up-to-date with these medicines. At the Tarnow Center, our psychiatrists are available to consult with the treating therapist so that both mental health professionals can treat the child collaboratively, as a team.
In summary, healthy modeling by parents can potentially alter the path of anxiety in their children. Healthy modeling can help teach anxious children to self-regulate. Children who have learned effective ways to manage the discomfort of anxiety are less likely to choose destructive coping behaviors and less prone to depression and other anxiety-related disorders. Because anxiety is a learned response, effective parental behavioral and cognitive-behavioral modeling can be accomplished using these interventions of biofeedback and cognitive retraining. These practical and concrete approaches focus on specific problems and help to teach emotional self-management skills. These self-management skills promote good health.