What to Do if Your Child Suffers From Significant Anxiety

Cognitive behavioral therapy is the single most effective treatment mode for all the anxiety disorders experienced by children, adolescents, and adults. Yes, everyone. Insight-oriented, psychodynamic, psychoanalytic, and play therapies are not known to be effective in treating anxiety and related problems. In the United States, most clinicians are trained in these other modalities, not CBT. It’s a big problem!

Breaking the cycle of anxiety

Before you can break the cycle of anxiety, you need to understand how it is created.
First, being in a particular situation triggers your child’s worry and fear, which results in high levels of distress.

Then your child responds with behaviors (mental and/or overt) to reduce or eliminate this distress. We call these safety and avoidance behaviors. In OCD, we call them rituals or compulsions. Parental accommodation is also a safety or avoidance behavior.

All of these behaviors are somewhat effective in reducing the distress in the short run but feed and maintain your child’s anxiety in the long run.

When your child engages in a behavior that gives relief, their brain experiences a reward, or reinforcer, because it temporarily takes away or diminishes the discomfort and distress they feel.

When a behavior is reinforced, it leads to more of that behavior. Avoidance or other actions to reduce distress quickly become habits. Every time your child avoids or engages in other similar behaviors, their brain’s association between fear and the situation is strengthened and their anxiety grows and spreads to similar situations.

Through such attempts at gaining relief and a sense of safety with such behaviors, your child and you unintentionally make their anxiety flourish and grow.

How CBT treats anxiety

Many people have heard about CBT and the great track record it has in treating various psychological problems, but few truly understand what it is and how it breaks the cycle of anxiety.

CBT integrates cognitive therapy and behavioral therapy. In the 1960s, cognitive therapy was created by Aaron Beck, MD, who trained as a psychoanalyst and conducted clinical trials of Freud’s theories, hoping to find scientific evidence of its efficacy. He was unable to find data to do that, which led him to develop cognitive therapy. He observed that anxious individuals had negative, fearful thoughts that did not line up with what was happening and popped up frequently and spontaneously. He termed them automatic thoughts.

Beck understood that our thoughts drive how we feel in any given moment. A mind predisposed to anxiety creates thoughts that make situations seem dangerous—even in neutral situations that shouldn’t set off alarm bells. He also noted the many extreme behaviors that individuals of all ages resort to quell their fears, or make the feared outcomes seem less likely to occur.

Behavior therapy, developed by B. F. Skinner in the 1950s focuses on how individuals acquire new learning and how we extinguish old learning based on our behavioral responses to various situations.

The basic process of CBT treatment for anxiety disorders involves identifying distorted thinking, correcting those thinking errors, and adjusting specific behaviors.

Exposures are the single most important element of successful CBT. The basic technique of exposures is to gradually face a situation that triggers anxiety, while at the same time not engaging in any safety, avoidance, or accommodation behaviors or rituals.

The goal of exposures is to provide opportunities for your child to learn something new in these trigger situations: that the feared consequences don’t happen, that they can tolerate some anxiety, and that it wasn’t as bad as they had predicted. Reliance on safety, avoidance, or accommodation behaviors or rituals blocks this important kind of learning.

The old, fear-based associations that were strengthened by safety, avoidance, or accommodation behaviors do not go away, but your child’s brain is loaded with new “safe” associations by doing exposures. Many repetitions are needed to achieve new learning, which is our goal.

When a person has a stroke, their brain needs to establish new and different connections and make new associations. Similarly, exposures give your child’s brain the opportunity to rewire, to learn different beliefs and behaviors.