The three fundamentals of supporting young people with anxiety

In our clinics, the most COMMON area of challenge for the children /teens we see is managing anxiety.  This is a reflection of a wider trend - anxiety is the most common psychological symptom experienced by kids and teens in Australia.

Often in my writing, I drill down to the specifics of the work we can do as professionals, teachers and counsellors in helping young people cope with anxiety.  Today, I'd like to take a step back and think about the five broad goals we are trying to achieve when we work with children and young people who are anxious..

Here's what I think they are:

1. We want to help young people feel heard and cared for.

We know that one of the most important predictors of educational and therapeutic outomces is the relationship we have the child/teen we are working with.  I think it's so important to remind ourselves of this.  We get so caught up in "strategies" that we forget this underlying principle.  We need to make sure the young person in front of us knows we hear their struggle and we care about it.

I use short statements like “I’m sorry to hear that”, “That sounds really hard to cope with”, “What a tough experience” or “I’m sorry you are feeling like that”.  I try to remember to say these things without adding “BUT….….” and without finishing the sentence with a little lesson, instruction to look on the bright side or reassurance (e.g “I’m sorry to her that BUT cheer up, it’s no big deal” or “That is a bummer BUT if you had done this in the first place it wouldn’t be happening” or “that sounds hard BUT you should just do…….”). 

When we try to reassure, teach or suggest things to worried and sad kids/teens before we have truly empathised with them, it often backfires.  Young people feel like we have not heard them and they are not in any state to learn or listen.  In my view, we must start with caring before anything else.

2. We want to help young people reduce their physiological arousal

Stressed kids and teens have brains which think they are in a war to the death with a wild animal.  They are breathing hard, tense and have rapid heart rates.  We want to help them calm their bodies so they can learn and think.  We might do this is by focussing on something outside themselves for a minute (mindfulness).  We might help them slow their breathing.  We might help them to relax their muscles.  However we do it, we need to help children physically reduce their arousal and tension levels - which then helps them think, communicate, problem solve and listen.

3. We want to young people have reassuring and calm statements they can say to themselves

As adults we reassure ourselves with words.  Children and teens aren't as good at doing this - they need our help.  I gently ask kids and teens to come up with sentences like “I can cope because...”, “This is not terrible because...” and “I’m okay because...”.  

Taking five minutes with a young person to write out (or draw pictures of) lists like “five reasons why I can cope when someone says something mean”, “5 reasons why it is not terrible if I don’t understand my homework” or “5 reasons why I will be okay going into school by myself” can be helpful.

4. We want to help worried children and teens to solve problems and make plans themselves.  

As professionals we get so caught up in advice giving.  We start thinking it's our most important job.  Advice giving isn't bad.  But unfortunately when we lots of advice or suggestions to kids and teens it means they don’t have the opportunity to solve problems themselves.   Sometimes they get more and more hooked on advice and reassurance from others.  

Our more important job instead of giving advice, is to try to build problem solving skills in young people.  This actually isn't too hard - it can start simply by us asking them the right question. Instead of giving advice, when children or teens tell us they are worried or sad about something, one of our first responses should be to ask a question which helps them think.  Helpful questions might be:  “what do you think might work?”, “what might make this a little better?”, “what do you think your options are”, “what do you think would help?” and so on. 

Children and teens will often not have the answers the first time we ask them these questions, but with coaching (“do you think THIS or THIS might be better?”) and practise they will improve, and learn important skills.

5. Help children/young people act in brave ways

Finally, one of tasks is to help young people to act in brave ways - even when they are feeling scared.   As psychologists we call this exposure hierachies - and it's anxiety management 101.  Unfortunately we forget to do it sometimes - or feel like the young person won't respond.  The evidence is pretty good for this approach though, so as "unsexy" as it might be - we need to return to it.  We can't neglect it.  The more young people avoid things they find scary, the more scared they get.  If children and young people we are working with avoid going into the classroom on their own, going to friends’ houses, talking to adults, playing sport – or other things they find nerve wracking – we know they will usually become more scared of these things over time. 

One of the more complex tasks in this is to identify the exact brave behaviour it's important for children and teens to do.   When I'm working with young people I ask myself questions like this:  "What would this young person be doing if they were not at all worried?", "What would they be doing? What would I see?  What would they be saying?  What would they NOT be doing.  And then I figure out if I can coach, encourage, reward and enforce these behaviours - tiny step, by tiny step. 

Behaviour is key.  The more often young people act in brave ways, the less their worry will dominate their life.

I think those would be my top five.  What about yours?

Kirrilie

For supervision in supporting worried or sad kids or teens, click here;

For support for professionals working with 5 to 11 year olds, click here