My teenager is missing out due to anxiety

Q. My 14-year-old daughter has always been an anxious child . For a lot of her childhood she was afraid of the dark, going places alone and we would have to reassure her a lot (and often let her sleep in the bed with us). For a few years she was acutely afraid of dogs and then this lessened. I had hoped she was growing out of her fears but she continues to be a big “worrier” and I notice that she often avoids doing things she might like because of her fears. For example, she dropped out of a school play due to performance anxiety and also didn’t go on an overnight stay with a couple of friends a week ago, which I know was due to her being fearful about sleeping in a new place. It is very hard to reason with her about her worries and sometimes we have these long conversations which can end with both of us upset. What can we do to help her? I don’t want her to go through life missing out on things because of her anxiety.

A. Anxiety and worrying excessively are among the most common mental health problems for children and adults, and many people have an inclination to worry and ruminate from time to time. How much of it is a problem depends on how much the worrying impacts on a person’s life and stops them getting on with everyday things. Like your daughter, many children get into a pattern of avoiding the feared situation in order to stop feeling anxious. However, this causes them to not only miss out on important life experiences, but it stops them learning how to handle their anxiety which may be more intense the next time a similar situation comes round. The good news is that you can do a lot to help children and teenagers manage their anxiety and to stop it interfering in their lives.

Listen and support your child
First, it is important to understand and be supportive when your child is worried. It is very helpful for a child to express their worries and for someone to understand their feelings without dismissing or judging them. Acknowledging and normalising anxious feelings is very important and helps a child realise that these feelings are normal and that they can be overcome and managed.

Don’t get caught up in the worry
However, it is also important not to get hooked into your child’s worries nor to “collude with them” nor spend too much time discussing them. It is very easy to get caught into a long discussion with a child trying to “argue” them out of their worry, exploring long sequences of “what ifs”, and so on. The danger of such long conversations is that they can increase a child’s ruminations and this may end in frustration. One of the most important strategies I use with parents and anxious children is to keep discussions about worries limited to specific times and durations. For younger children this time can be a 15-minute “worry time” or with teenagers it can be simply your “chat before bed”. Such an approach takes the worries seriously but helps them be contained.

Keep your own anxiety and frustration contained
Many children who are anxious have anxious parents. A child’s fears can spark similar in their parents who can become anxious and worried in response. Alternatively, it is easy to get frustrated listening to a child’s worries – you might start out by listening and being reassuring and then eventually end up being frustrated and angry as they continue to ruminate. The important thing is to try to contain your own feelings – the more calm and supportive you can be the better. In addition, take a break before you get frustrated – “let’s step away from this for while and talk again after dinner”, for example.

Help your child address the problem situation
Some of your daughter’s worries can be solved or the situation can be changed to make it more manageable. You can brainstorm with her how you can negotiate the sleepover to make it easier or explore with her how she can successfully approach the performance at the school play. Frequently, anxious children have good problem-solving abilities and imaginations, but often these strengths are employed against them visualising all the things that can go wrong. You want to help her redirect these strengths to overcome the problem, whether this is imagining a school performance going well, or identifying what they need to do to prepare and/or strategising about the best approach to a social situation.

Help your child manage their anxiety
It is also important to help your child learn to manage their anxious feelings so that they don’t feel overwhelmed by them. There are many different strategies that can be learnt to achieve this such as becoming “mindful” of the anxious feelings in your body or using your breath to relax your body. Alternatively, you can help your daughter learn to distract herself from worries, for example, by focusing on the task in hand or by visualising a positive outcome or by building a picture in her mind of a safe place or by repeating positive coping statements such as “this is fine, I am getting through this” before going into an anxious situation.

In addition, certain creative rituals can help, such as writing worries out on a page (rather than ruminating about them at night) and placing them in a “worry box” to be dealt with in the morning. There are lots of good books and resources online that deal with strategies to overcome worries. You could read these books and learn these strategies with your daughter or alternatively seek out relaxation, or yoga classes that you could do together. Working together as a team to overcome anxiety could also be great for your relationship with your daughter.

The key to overcoming anxiety is to accept and understand your anxious feelings, to use them as a call to take action and to break the pattern of avoidance. As popularised in many books, you want to help your daughter to learn “to feel the fear and do it anyway”. If it continues to be a problem, seek help from an adolescent mental health or counselling service.

Dr. John Sharry, Irish Times Newspaper, March 2013. John writes in The Irish Times Health+ every Tuesday.