The question, “What does successful child anxiety treatment look like?” is one that that I made up based on different versions I’ve heard from people who are coming to me to ask about my program or to ask why treatment they’ve sought before didn’t work.
First I want to talk a bit about expectations because I think this gets in the way of successful treatment.
Many parents who talk to me tell me that their child went through counseling and they’re still anxious and so they say counseling didn’t work.
But anxiety isn’t something you just cure like a rash. Treatment isn’t like a course of antibiotics. It’s never going to clear up like that. That’s because anxious brains are shaped to be anxious and anxiety isn’t necessarily going to go away. For one, it’s part of us and it’s an important part of us.
Anxiety does a lot of good things. It makes us look both ways before we cross the street. It makes us make sure our nice work outfit is clean the night before a big interview. We need anxiety; some of us are just more sensitive to it than others and That’s fine as long as we’re still running the show.
The problems start when our anxiety gets out of control. That can look like seeing danger everywhere even where there is no danger. That can look like having such strong somatic symptoms such as stomachaches or headaches that we feel incapacitated. Sometimes that can be feeling frozen because our standards for performance are too high. Sometimes unmanaged anxiety can result in depression as we become increasingly discouraged or get down on ourselves for not being able to move forward.
So what does managed anxiety look like. It looks like seeing danger and being able to say to ourselves, “Oh that feels dangerous but it’s not dangerous.” That can look like having somatic symptoms and recognizing them as anxiety and knowing how to calm those symptoms down. That can look like recognizing our perfectionism as anxiety and knowing how to realistically lower our standards. And it can also look like being kind to ourselves when we’re feeling sad or incapable or discouraged so that we can muddle through anyway.
Successful treatment is going to give us three things:
- It’s going to give us an understanding of our anxious experience, understanding how it feels in our body — where it shows up — and how it tries to trick us. So we’ll understand how it can warp our point of view and how we see things.
- It’s going to give us coping tools that work for us, so we’ll need to try different things at different times to help us with the inevitable dread of anxiety, of the fear of stress response, and for coming down after we’ve faced it when we might feel more fragile.
- And it’s going to give us a sense of ourselves as successful, as people who can face our anxiety and get through it rather than avoid it.
What that treatment is not necessarily going to do is not make us anxious. I mean, it can. Especially for specific phobias or fears. You can overcome a fear of dogs or bridges or public speaking. Absolutely yes, you can do this. But if we have specific phobias or fears, we may just be a bit more prone to other worries, too, and again, that’s part of our make up.
Child anxiety is trickier to treat than adult anxiety for a couple of reasons. The first is that there is the developmental component. We need to shape our education and intervention to the child’s age and, importantly, we will need to revisit the learning as they grow older. Kids need to learn things over and over and over again because they are changing and their understanding of the world changes, too. Knowing how to manage sad feelings when you’re three or five is very different than knowing how to manage the sad feeling that come with a first break up or a major disappointment like not getting into our number one school. Right? So emotional regulation, identifying emotions — that’s ongoing for all of us. We learn over and over again.
And the second reason that anxiety is harder to treat in kids is attached to that, which is that someone needs to teach that to the child again and again. And the ideal people to do that, is their parents. The way that we teach our children how to manage their anxiety is both direct — in talking to them, sharing the information and observation, learning about the technicalities of anxiety and anxious cognitions so that we can pass that on. But also indirect by setting an example for them by using those tools, recognizing our own cognitive distortions and facing our own anxiety particularly our worries about their worry.
And of course we teach them not to avoid by not helping them avoid, which is the crux of the Child Anxiety Support program.
Successful treatment doesn’t mean our kids won’t struggle or that we won’t struggle with them. Successful treatment is going to mean that you both know more or less how to do it.
My goals for people who go through my program is that they are realistic with themselves and their kids about what anti anxiety work looks like. That they learn what’s unique about their child so they understand that child’s particular challenges and can shape their support to fit that child. And that they understand what the goals are. They know how to walk themselves through the problem solving of child anxiety and are able to pass those skills — identifying the avoidance, making the plan, celebrating progress — to their child so that when that child is grown up and wanting to avoid, that child is able to take themselves in hand and push through and cope.
That’s successful anxiety treatment.
There are still going to be sleepless nights and new challenges. There will be setbacks and frustrations. That’s ok. Life is like that. It’s a journey, right?
I mean, think of it this way. Think of something you know how to do that’s not easy. Maybe it’s satisfying, maybe you enjoy it, but it’s not easy. Whether that’s running or knitting or gardening. Even if you’re great at those things, sometimes it’s hard. It’s just built into the doing of the thing that sometimes it’s hard. Anxiety life is like that, too. Sometimes it’s just hard but that doesn’t mean you’ve failed. You have to rely on those tools you’ve learned.
So I guess I’d say the only time counseling or a program like mine doesn’t work is if it failed to teach you and to teach your child how to cope. And I’d say that if that’s the case, it’s time tot ry another therapist or another program. Because there are lots of resources out there and it’s important that you find the one that makes sense to you. That makes this information and those tools accessible to you.