COURSE SLIDES
The slides for the first night of the course are available to view here.
The slides for the second night are available to view here.
The slides for the third night are available to view here.
The slides are intended for your personal use only and should not be copied or distributed.
Relaxation Links
List of 50 visualisation videos for children
www.onemomentmeditation.com/
Progressive muscular relaxation
ANXIETY Q&As
There are many of John’s previous answers to parents questions, (including more than sixty on managing anxiety) on the website. On night 2 of the course some of you were asking questions about dealing with perfectionist, worries about death, OCD and separation anxiety. These are answers related to these subjects on website – You can search by topic here.
CURRENT IRISH TIMES 6-PART ARTICLE SERIES
Published every second Tuesday in The Irish Times , John writes on how you can support your child to manage and overcome their anxiety.
Below are the articles in the series covered so far.
Part 1
The strength of worrying
Excessive worrying and anxiety is the most common mental health problem for children and teenagers and many parents struggle in finding the best way to respond. There are many different types of anxiety-related problems such as separation anxiety, when children find it hard to be away from their parents, or phobias, when children develop a specific debilitating fear, or generalised anxiety, when children develop a habit of worrying and ruminating about just about everything. Most common of all, is social anxiety, when children become excessively shy or avoid certain social situations altogether due to anxiety.
Despite being a common problem, many anxious children do not receive the support they need. Frequently, these children can be well behaved and don’t draw attention to themselves, which can mean they suffer in silence ( unlike other children who might have behaviour problems who can become the centre of attention).
In my clinical work, I see many children who excessively stressed and worried about school, yet the teacher is not aware of this as the child is well behaved in the classroom. The tragedy of this lack of attention is that anxious children usually respond very positively to a small amount of attention and support. With a little bit of help anxious children can be taught skills to manage their anxiety that they can use throughout their lives.
Over the course of this series of articles in The Irish Times, I will outline six practical principles you can use as parent to help children and teenagers who might be anxious, starting the first principle today, which focuses on taking time to understand the strengths that underpin your child’s worrying.
How anxiety can help
It is important to remember that some anxiety is not necessarily a bad thing. A little bit of anxiety helps children prepare and can motivate them to act well. For example, if you feel a little anxious about an exam it can motivate you to study or if you are nervous about a social situation it makes you think through and prepare well.
Anxiety only becomes a problem when it is excessive and stops children from functioning or makes them avoid important events (eg avoiding school or refusing to go an important social events). In helping children, the goal is to help them manage their anxiety, so it helps rather than prevents them from being successful.
While excessive anxiety can of course cause lots of problems for children, the presence of anxiety also indicates a number of possible strengths that these children possess. Anxious children usually have vivid imaginations, though these are unfortunately working against them, visualising in full colour and in great detail what might go wrong. The tendency to ruminate, rehearse and replay negative events indicates the potential to be good thinkers, planners and organisers.
Socially anxious children are usually very sensitive to their own feelings and those of others in social situations which gives them great skills in understanding people. Overall, anxious children are usually reflective people who have a great facility to think things through. The goal is to help children access these potential strengths so they are working for and not against them.
Using their strengths
Usually children who are anxious are self-critical and beat themselves up about being anxious. The feel they are a burden to their families who are may be equally debilitated by the anxiety (eg whole families not going out due to a child’s anxiety). When I meet them for the first time I try and start with their strengths to show that they have many abilities.
For example, I might say to a socially anxious child
– “It sounds like you are very sensitive to everyone’s feelings – you work hard to understand people’s feelings.”
– “It sounds like you take your time to consider things before you decide what to do, that is a good skill.”
By appreciating children’s strengths you counteract the belief that there is something “wrong with them” and you empower them to think they have the ability to sort their problems out for themselves
– “You have an amazing imagination, just that you are only imagining the worst that can happen. Supposing you were to imagine the best that could happen, what would that be like?”
– “You spend a lot of time thinking about things . . . it strikes me that you have a very good mind – lets now use that thinking to critically analyse the anxiety that is affecting you.”
In helping anxious children we want to employ their strengths to tackle their problems, redirect their nervous energy to problem solving rather than simply worrying, use their good imagination and planning to envision positive things they want rather than just worries they are seeking to avoid.
In practical terms you can use their strengths to try out creative exercises that can help them cope and manage. For example, anxious children are often great at doing imaginative exercises such as talking to worry dolls to sort out problems or imagining putting their worries in a box each evening so they don’t bother them at night or visualising a happy place as they listen to music as a means to help them relax.
1) Thinking of your children, make a list of the things you admire about them. Make a plan to tell them these things over the coming week.
2) Considering their particular anxiety, make a list of the underlying strengths, this anxiety might indicate.
3) When you listen to them next week talking about a worry, remember to point out some of these strengths. For example
– “You are good at imagining things, you are just imagining how things might go wrong, lets think of how things could go well.”
– “You are sensitive to people’s feelings, lets think how how they might be really feeling in that situation.”
John Sharry, The Irish Times, 8th January 2017
www.solutiontalk.ie
Part 2
In the first article of the series two weeks ago, we spoke of the many strengths that anxious children can possess such as sensitivity, good imaginations and planning abilities which can be harnessed to help them manage their worries and overcome their problems.
In this article we describe how anxiety can be maintained by the response of other people particularly parents in the case of children. Being a “worrier” tends to run in families – anxious children tend to have anxious parents. While anxious parents can share the strengths of their children, they can also share the tendency to over-worry which can aggravate their own children’s anxiety.
Two problematic responses
When reacting as a parent to an anxious child or teenager there are two problematic responses that can make matters worse.
The first is to over engage and attend to the worries by taking them on and immediately becoming anxious yourself. This can cause the child to worry more, to believe their worry is uncontainable and for their anxiety to escalate.
The second problematic response is to not listen or dismiss the child’s worry sometimes in an exasperated manner. The parent becomes frustrated with the child’s anxiety and tells them to “snap out of it”. This response can make the child feel bad about their anxiety and to worry that they will never be able to change. It can even cause them to think there is something “wrong” with them and as a result their anxiety increases.
These problematic responses can often be employed one after the other and sometimes in the same morning! For example, if a child is worried about going to school, a parent might initially listen and “worry with them” before getting exasperated and angry, trying to force the child out the door which leads to a “meltdown”. These negative cycles leave everyone feeling bad and are damaging if repeated daily.
Pausing in the face of anxiety
So how do you break the pattern of reacting unhelpfully to your child’s anxiety? The most important thing to do is to “pause” when your child becomes anxious. Don’t react to their anxiety and instead try to remain calm. While your child might get aggravated or into a tizzy or even have a meltdown, you commit to being calm and still.
You become a relaxed counterbalance to your child’s heightened anxiety. You can visualize yourself as a still point even though your child might be in whirlwind. Responding in this way can be enormously helpful and in itself can help your child calm their emotions.
Responding warmly and empathetically
The second principle is to respond warmly and empathetically to your child. Try to understand and acknowledge what is the source of their worry. For example, you might say “Many people find their worries get on top of them just before they go to sleep” or “I know you are anxious about going to meet your friends, lots of people feel this way initially”.
The goal is to accurately name what your child might be feeling in an understanding way that does not make them feel “bad” about their feelings. Sometimes this can be very hard to do, as it may not be clear about what your child is worrying about and they might find it hard to talk.
In these situations, you might have to do a bit of detective work or spend time encouraging your child to express what is on their mind. In future articles I will describe the importance of having a daily listening time with your children when you give them space to talk and get things off their chest. The key is to respond in an empathetic understanding way.
Choosing an effective response
Once you have acknowledged the anxiety the next step is to take action and to positively respond. Taking action does not mean you give into the child’s worry and let them avoid the situation that causes the worry. For example, if your child gets anxious going out the door to school, you might acknowledge their upset and still insist they go to school (in future articles we will talk about how you can address the underlying issues that might cause the anxiety).
In the long term, overcoming anxiety is not about avoiding the situation that causes the worry but instead learning to face it and to overcome it. In a nutshell, you want to help your child “feel the fear and do it anyway”.
Anxious while sleeping – an example
Choosing an effective response means that you “pause” in order to break a pattern that is not working. For example, if your young son is anxious about falling asleep alone, and you have got into the habit of lying with him until he falls asleep ( which is exhausting for you and does not teach him how to manage his anxiety), you can break this pattern gradually as follows. Instead, of lying with him as he falls asleep you agree a system of periodically checking on him. You suggest he lies and relaxes on the bed and agree that you will return in five minutes to check on him.
If he gets agitated or leaves the bed, you say to him “when you are lying on your bed and calmly relaxing, then I will come back”– this way he only the gets the reward of your comfort once he has put some effort in to managing his anxiety himself. Over time you can increase the length of time between “check ins” so he gradually learns to manage the anxiety by himself and to fall asleep alone (in future articles we will look at ways you can teach children relaxation skills).
Tips for going forward
Take time to reflect about how you respond when your child becomes anxious or starts to worry about something. Do you find yourself ever getting anxious or frustrated in return? Have you got into a pattern of reacting that makes things worse?
The next time it happens, make sure to to pause, tune in and choose a more helpful response
1. Take a pause – Try to remain calm and to manage your own feelings
2. Respond warmly – Try to empathise and understand your child’s anxiety, acknowledge their feelings
3. Choose your response – A calm, sympathetic though sometimes firm response works best.
John Sharry, The Irish Times, 23rd January 2017
www.solutiontalk.ie
Part 3
A key feature of anxiety is worry and rumination. Anxious children and teenagers are often engaged in constant and frenetic mental activity of either worrying about “bad” things that might happen or ruminating about “bad” things that did happen.
These worries and ruminations are usually cyclical, negative and self-defeating. A child might repeatedly worry that they said the “wrong thing” in a social situation and then beat themselves up about this. Or a child might constantly visualise a negative outcome for future events, which will cause them to become debilitated by fear and then to avoid the event altogether.
This constant worrying can take over family life, with parents finding themselves engaged in daily conversations trying to reassure worrying children who make no progress.
In helping anxious children, the goal is to break their cycles of worry and rumination. In particular, you want to help them move on from spending all their time “in their head” and instead to take constructive action to address the sources of their worries. Taking action is the antidote to worry and rumination.
Setting up a daily ‘worry time’
One of the most useful tactics to tackling constant worry is to put a boundary around worry to keep it to defined times. When working with parents and children who are constantly talking about worries and problems, my suggestion is to set up a specific daily “worry time” for 15-30 minutes (sometimes positively named a “daily chat” or “problem-solving” time) when the parents will be available and totally present to listen and problem solve with their children.
However, at other times the parents will not engage in worry conversations and will gently redirect the children – “let’s talk about that after dinner for our daily chat as we agreed”.
If your child finds it hard to postpone the discussion – you can try to distract them or coach them in how to relax (we will cover some of these techniques in the next article). By keeping the worry conversation to an agreed daily time, you begin to limit its negative effects and it also gives you a specific time when you can put some real effort into problem-solving.
Becoming a solution detective
During the daily chat, the goal is to help the child move from emotional worrying to objective thinking and problem-solving. A metaphor I find very useful with children is to invite them to become a “detective” – you want them to take on the persona of a detective who is searching for clues to uncover a solution to their problems.
Becoming a detective is usually a good metaphor to start problem-solving: a good detective is usually unemotional and objective – they ask good questions and look at at the evidence before they decide what to do.
You want your child to engage the analytical-thinking part of their brain and to keep their emotions in check. When working with children in a playful way, I sometimes find it useful to give them a detective notebook and even suggest they put on a detective hat to signify they are now problem-solving and looking for solutions (rather than worrying).
Three steps to problem-solving
When talking to children about the problems, there are a few important steps that are best followed in sequence:
1. Listen first: it is important to always first listen to your child’s worries and concerns before you begin to problem solve. It is really important that they have time to express what is on their mind, to get their worries off their chest and to be listened to.
Frequently, this is the hardest step, as often your child might be too young to tell you what is on their mind or an older child might be closed down and not able to express what is worrying them (such as in the situation of bullying or something they might feel embarrassed about).
In those situations you have to be very patient to help them talk. This might mean changing the time you talk such as picking a time when they are more relaxed, or how you talk such as going for a walk together or even by reading a relevant story book together. For lots of young children, this might mean guessing how they feel and responding in an understanding way – “Lots of children feel nervous, going somewhere new . . . that is okay”
2. Explore solutions: the next step to problem-solving is to explore potential solutions with your children. While with preschoolers you might have to do much of the work of problem-solving yourself, children from the age of four or even three, can begin to reflect on their own responses. It is always best if you encourage children to think out things for themselves.
Gentle questions are an effective way to do this such as “What could you do when feel nervous in school?” “Who could support you when this happens?” “What could you say/do if someone said something nasty to you?”
Exploring past solutions when they have managed before can work particularly well. For example, “How did you manage on Tuesday when things went well? How did you cope then?”
3. Agree a plan: once you have come up with potential solutions, the goal then is to make a plan as what ones will be put into action. Good questions are, “What solution is the best one?” “Which one would leave you feeling the best?” “What can you try next week?” “What would you like me to do to help?”
While there are of course situations where you have to take action yourself to help (such as talking to a teacher), it is generally best if you talk options through first with children.
Whatever you agree, make sure to talk again at the next daily chat see how they got on and to support them further.
Three tips for going forward
Set aside a regular time to problem solve and coach your child next week about the problems that might underpin their anxiety. Remember to:
Listen: get them to express how they think and feel first and be warm and understanding in response.
Encourage: them to come up with solutions themselves.
Agree a plan: together set a course of action and talk again.
For preschool children who are too young to talk problems through with you, set aside your own problem-solving time with a partner or by yourself when you think about what is happening for your child and make your own action plan.
John Sharry, The Irish Times, 23rd January 2017
www.solutiontalk.ie
Part 4
In previous articles in the series I emphasized the importance of responding in a calm way to your child’s anxiety. In this article we look at how you can teach children to relax themselves when they experience worry and anxiety.
Getting in touch with the body
Though anxiety might start out as a negative thought or worry it is always experienced in the body as a feeling. People who are over anxious have agitated bodies – their hearts are beating faster, they are breathing is quicker and they might experience symptoms such as sweaty palms or pains in their stomachs. As well as tackling the thinking that causes anxiety ( which we cover in Article 5), an important way to overcome anxiety is to learn to manage the feelings of anxiety and in particular learning to relax the body.
Generally, a key feature of problematic anxiety is that the child is out of touch with their body. They are often living too much in their heads ( which are full of anxiety laden thoughts, ruminations and worries). Frequently, the goal is to help them ‘get out of their heads’ and live more in their bodies – you want them to stop over thinking and to start living.
Sometimes, anxiety is caused by the mind misunderstanding the bodies basic signals as in the case of a panic attack – for example, an anxious teen might notice their heart breathing faster, causing them to worry that they are having a heart attack, which in turn causes their heart to beat even faster and so the anxiety escalates.
Learning to relax in the face of anxiety
A key step in overcoming anxiety is becoming aware of how it impacts your body and then learning ways to discharge those feelings in order to relax your agitated body ( which in turn relaxes your mind).
In my clinical experience, different techniques work for different children ( and adults). For example, some children can readily use introverted activities such as becoming aware and slowing their breathing and others find extroverted activities easier such as using physical exercise to discharge their anxiety.
As a result, you have to be patient to find out what works for your child. Below are some of the techniques that I have found most useful working clinically with children – all of which need to be practiced regularly if they are to work.
Encouraging Body awareness
The first step is to help children become aware of exactly where and how they experience anxiety in their body. For example, a child anxious going to school might experience tummy pains (and interpret this as being sick and a reason to avoid school).
It can be helpful to invite them to notice this as being caused by anxiety – ‘sometimes, worries can cause us to feel a tummy pain’. I find it useful to do up a body map with children, where you draw out or colour in the different parts of the body where they experience anxiety symptoms. This helps them tune into their body and not to be overwhelmed by the anxiety.
Physical exercise and relaxation
Doing something physical and then relaxing afterwards is an excellent method of dealing with anxiety. This might be as simple as going for a walk when you feel anxious, taking ten minutes on the trampoline or doing ten press ups. More formally this could mean practicing the evidence-based technique of progressive muscular relaxation (PMR) whereby you practice systemically tensing and then relaxing each part of your body.
PMR is usually learnt by listening to a audio guide ( many of which are available on youtube) that you could use with your child as part of their bedtime routine. In using physical exercise techniques, a key aspect is to get your child to focus on their body as they exercise and then to take time to relax afterwards.
Breathing and relaxation
A second major set of techniques that you can use to help children to relax, is encouraging them to become aware of their breathing. There are many different breathing techniques that you can use (Yoga has hundreds!) but simple ones such as counting slowly as you breathe can work well.
For example you can invite your child to ‘breathe in… 1 2 3 4 5, relax … 1 2 3 4 5 and then breathe out … 1 2 3 4 5’. The goal is to help children slow their breath ( which reduces anxiety) and to attend to their body ( which stops them attending to worrying thoughts).
Mindfulness and Meditation
The practice of Mindfulness and Meditation provide many different tactics that you can teach children as means of managing their anxiety. In simple terms, these techniques focus on helping children simply notice and accept what is happening in their bodies and environment without trying to change anything. Given the current popularity of mindfulness there are literally hundreds of guides on how to teach children. Have a search online.
Positive Visualisation
As anxious children often have great imaginations ( unfortunately focused on negative things) a good technique can be to teach them to use positive visualisation as a means of relaxing. For example, as a ritual during the bedtime routine you can listen to an audio clip with relaxing music that encourages a child to identify a happy memory or a safe relaxed place which they can practice recalling when anxious or as a means of aiding sleep. Learning the discipline of distracting your mind from negative and fruitless worries is a key tactic in managing anxiety.
Tips for going forward
· Take time to think of what relaxation techniques might work for your children.
· Remember all techniques are best practiced as a daily habit, so they can be drawn upon in crisis or peak of anxiety.
· There are lots of classes that teach children relaxation skills either directly such as yoga or indirectly such as sports training. Make sure your child is involved in some of these.
· Many of these relaxation skills are now is integrated into teaching in schools (e.g. teaching mindfulness or relaxing to music). Check with your children’s school what might be available.
John Sharry, The Irish Times, to be published February 2017
www.solutiontalk.ie
Part 5 Challenging worry
In Article 3, we looked at the importance of helping children to problem solve and to take action to address the issues that cause them to be anxious. In this article we discuss how you can get them to scrutinize and examine the anxiety itself. The goal is to get them to to question the utility of their worry and to challenge the circular thoughts that make up their anxiety.
Learning what anxiety is
It is important to take time to help children understand what anxiety is and how it affects them. As discussed in Article 3, when having these conversations with children you want to engage their problem solving and thinking abilities. While a little bit of anxiety is a good thing ( getting children motivated and concerned), too much is overwhelming and causes the rational part of their brain to be taken over.
There are lots of good child-centred pictorial explanations about this that can help children understand. My favourite is the notion when overwhelmed by anxiety the ‘lizard’ part of the brain (ie. the primitive emotional centre) has taken over the ‘wizard’ part ( i.e. the thinking rationale part). The goal is ‘tame the lizard’ and to ‘activate the wizard’ to solve the problems that are really there.
Externalising worry
Frequently, children over identify with their anxiety which makes them defensive about talking about it and blamed when their parents try to question them. A useful strategy is to ‘externalise’ the worry whereby you talk about the anxiety as something that is separate and external to them.
For example, if your child is having tummy pains because of anxiety, you might say – ‘that Anxiety is bothering you again in your tummy’. Or if your teen is reluctant to go to party because of social anxiety you might say ‘the Anxiety is trying to stop you from doing something you love, that is a pain’.
A first step in externalising anxiety is to ask the children to name it and to even give it a personality. The can be simply the name ‘Worry’ or ‘The Anxiety’ or more colourfully ‘The Tyrant’. Having a name allows you to poke fun at the anxiety and to develop strategies to contain and overcome it. For example, you can first explore with children the impact of the anxiety such as
- What is ‘The Worry’ making you do?
- What is The Worry saying to you?
Then you can explore what they can do in response –
- What do you want to say back to the Worry when it bothers you like that?
- How can you keep the Worry at bay?’ What normally works well for you?
Externalising anxiety like this is a very useful strategy for parents, because instead of fighting your children over their anxiety and meltdowns you can join with them in fighting the common enemy of their Anxiety – you can become allies working together rather than opponents.
In addition, the strategy can add a much needed lighter note to dealing with serious problems. The Externalising Strategy is also a well respected therapeutic device for working with children and teens affected by clinical problems – see the interestingly titled book ‘How I ran OCD off my land’ by John March.
Identifying worrying thoughts
It is important to help children to identify their worrying thoughts and to pinpoint the beliefs that underpin them. For example, some children might have social anxiety because they have a belief ‘that everyone does not like me’ or other children might be over perfectionistic because they have a belief ‘I can’t ever make a mistake or no one will respect me’. Help your children uncover and pinpoint and ideally these beliefs so you can encourage them to evaluate them.
When working with children, I often get them to write out these ‘worrying’ beliefs in thought bubbles or to draw pictures of them if they are more artistically inclined. Once they are identified then you can get the children to challenge them by asking questions such as
- Is that really true? What is the likelihood of that happening?
- What is a more likely explanation?
- How does thinking this way affect you?
- Is it the most helpful way to think ?
Creating more realistic thinking
Once their negative anxious thoughts are identified and challenged the next step is to invite your child to think differently and in more helpful ways. Once again asking good questions is the best way to do this. For example, you can ask the child
- What is a more realistic explanation?
- What is the most helpful way to think about that situation?
The goal is the help your child create more helpful thinking about situations. For example, when a child has fallen out with a friend instead of assuming ‘everyone hates me’, you invite the child to think in a more balanced way – ‘Ok I had a row with J, but I can make up with him again’ or ‘There are lots of other children I could be friends with, I just have not got to know them yet’.
Or when your child has failed at something, instead of them concluding ‘I am useless at this’, you invite them to think ‘Each time I try, I can learn something new’ or ‘I’m going to do my best’ or ‘It is not my best subject – there are things I do/ enjoy better’.
It can be helpful to do up a set of coping cards with children, that contain positive affirmations that they can refer to when their anxious thoughts affect them ( such as ‘I will always do my best’ or ‘I always feel better once I get started’). As well as remembering these coping thoughts, they can take these cards out and read them anytime they need to during the day.
Dr John Sharry is a social worker and psychotherapist and co-developer of the Parents Plus Programmes. He will delivering a talk on Promoting Positive Self-Esteem in children in Kilkenny on Monday 20th March and in Dublin on Wednesday 10th May and a workshop on Parenting Young Children in Cork on Saturday 1st April. See www.solutiontalk.ie for details
The last article in the six part series will be on 21st March, and will look at how parents can help children put together step by step plans to overcome anxiety based problems.