Managing Strong Feelings

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Why Reassurance Doesn’t Work…and What to Do, Instead

Wednesday, June 16th, 2010

“You’ll be fine!” How many times have you said that to your child? One hundred times? One thousand? I promise I’ll be there to get you. You’re not going to throw up. It isn’t going to rain. There won’t be any dogs. Just call me if you need me…

But here’s the thing – no matter how many times you’ve reassured your anxious child, it isn’t enough. She needs to hear you say it one more time. To promise. Pinky swear. And still, it will never be enough.

Anxiety is characterized by the inability to tolerate uncertainty. Those dreaded “what if’s” – What if I don’t feel well? What if you aren’t there? What if I don’t like it…I miss you…I get bitten…we lose power…something goes very, very wrong? You can tell your child that none of those things will happen, and still her anxiety comes back with…what if they do?

There are 3 classic thinking mistakes inherent in anxiety:

1. Overestimating probability (the bad thing that might happen WILL happen)

2. Overestimating magnitude (the bad thing that might happen will be CATASTROPHIC)

3. Underestimating ability to cope (I totally cannot handle the bad thing that is going to happen)

Helping children recognize and correct these thinking mistakes is far more powerful than providing repeated reassurance. I use a method called The 3 Questions. Here’s how it works:

When a child is anxious (fretting, asking for reassurance), help her think through:

1. What is the worry saying? Kids often feel anxious without knowing why. They’ll say they don’t feel well, or that something is ‘boring,’ or they just don’t want to do it. Help your child pin down what the worry is actually about.

2. How likely is that? Help your child estimate probability. You don’t have to get fancy – likely/unlikely is fine.

3a. (if whatever she is worrying about it unlikely) What’s more likely, instead?

3b. (if whatever she is worrying about it likely) What can she do to help herself?

Pose each of these questions, in turn. Or better yet, have your child write them on an index card so she can refer to the questions, herself. This sort of logical, sequential thinking makes it easier for kids to evaluate their worries, recognizing and correcting the classic thinking mistakes. Over time, it gets easier for kids to remember that the things they worry about rarely happen.

Your role is to stop reassuring and, instead, prompt your child to use The 3 Questions. Say, “That sounds like a worry-question; let’s think about those 3 questions.” Encourage your child to answer the questions herself (rather than having you provide the answers) – your aim is to help your child internalize the sequence of questions and, importantly, to learn how to answer them herself. Then, and only then, will she be able to recognize, “That’s the worry talking to me; the worry doesn’t know what it’s talking about; I don’t have to listen.” Won’t that feel good?!

Posted in Managing Strong Feelings, Moving Away From Reassurance | 1 Response »

Picturing Success: See It, Do It

Wednesday, March 31st, 2010

‘What if’ is the rallying cry of anxious children everywhere. What if you aren’t there after school? What if that noise was a bad guy? What if I miss you? What if I strike out? Feel scared? Get sick? Terrible outcomes cascade through the minds of anxious children, some so awful, so utterly catastrophic that the mere suggestion of going to school, going upstairs, going to a friend’s house causes panic.

Parents spend a great deal of time reassuing their anxious children (which, as you’ve probably noticed, doesn’t help – more on that another time), while anxious children spend a great deal of time avoiding whatever has the slightest chance of causing harm. It’s a viscious cycle. One that will not end on its own. If you child isn’t reassured the first or second time you tell him that going near the blanket his sister threw up on last week (which of course you’ve thoroughly sanitized) isn’t going to make him sick, he isn’t going to be reassured the 20th time you tell him, either. And if your child is afraid of bees, continuing to avoid them isn’t going to make it any easier to go outside.

There are lots of things kids (and parents) can do to break free from anxiety. Previous and future posts cover an array of strategies. Here’s another: picturing success.

Picturing success is a visualization technique combining exposure (known to reduce anxiety) and relaxation (ditto). Your child will need some help with it, especially at the start. Let’s say your child is going to the orthodontist, where a mold of her mouth will be made. She has sensitive gag reflex and is terrified of the procedure, sure that she will gag and throw up ~ her worst nightmare. Every time you mention the appointment, your child tears up. So you stop mentioning it, hoping for the best while bracing yourself for the major scene you know will unfold at the doctor’s office (assuming you are able to manhandle her into the car to get there). Your child is only too happy to wipe the appointment out of her mind, too – except it keeps popping back up, reducing her to tears.

Rather than trying to avoid thinking about the appointment, help your child imagine it in as much detail as possible. That’s right: picture it. Imagine the beginning, the middle, the end. In detail. Even the scary parts. AND the parts that show your child coping. Create a story to review with your child every day (children ages 6 and over can participate in creating and telling the story). Your story might sound something like this:

“It’s the day of your appointment and you wake up feeling a little sick but then you remember you are getting your braces off, and that part’s really great. You have some breakfast, only a little, but it’s raisin toast with cream cheese and it tastes good going down. I tell you it’s time to go and you really don’t want to because you keep thinking about that mold and it seems so scary. But then you remember what the orthodontist said, that it only takes a few seconds to get the mold in place, and you know you can put up with a few seconds, even if you do gag. You remember that you’ve gagged lots of times and it was unpleasant but it ended pretty quickly and you were okay. So we get in the car and crank up the music, singing along to keep ourselves busy. We pull up at the office and they call you in right away and your stomach starts to feel sick but you tell yourself, I can do this, and you follow the nurse in…(more details)…and then it’s time to open your mouth, and even though you feel scared, you do it. And you remind yourself to keep breathing, nice and slow, just in and out through your nose, and you take yourself on a mental vacation to Grammy’s cottage. You are sitting in the orthodontist’s chair, tilted back, and your mouth is wide open and you are breathing, breathing, and you are picturing yourself at Grammy’s the way it looks first thing in the morning when you and Grammy go out looking for blueberries. And you feel like you might gag but you relax your throat and you’re okay. You just need to breathe and think about Grammy’s house and then, all of a sudden, the mold is in place and you’re doing it! You’re mouth is open and that mold is back there and it feels weird but you are okay. And you breathe and see Grammy’s house and you can smell the lake, that earthy, watery smell, a little like fish only better. You’re still in the chair and the nurse tells you to open just a little wider and you don’t see how you can, but you do, and she takes out the mold and you’re done. You did it!”

Clearly, your child’s story will reflect her own experience. Make it detailed enough for her to picture. Include the hard parts, and the parts that show how she copes. Underline that coping, again and again. Tell the story (some version of it) every day in the days leading up to The Event. Coach your child to imagine the scene in her mind, breathing slowly and deeply while she listens to (or tells) the story. Repeating this exercise over and over provides a model for coping while easing your child’s anticipatory anxiety. When it comes time for the actual experience, she’s practiced it (in her mind) and desensitized herself to the scarier parts. Picturing success enables success.

Have you tried this with your child? How did it work?

Posted in Managing Strong Feelings, Picturing Success, Relaxation | No Responses »

Keeping Socks On…And Other Sensory Challenges

Wednesday, March 10th, 2010

Do you have one of those kids who rip off their socks, turn them inside out, and rip them off again? Who react to any hint of a label, and cannot wear jeans? Some kids have sensory sensitivities. Things in the environment bother these kids. A lot.

There are a number of excellent books explaining sensory challenges and pointing parents toward solutions (for example The Out of Sync Child and Sensational Kids). If you have a sensory-sensitive child, you might want to pick one of them up. In the meantime, here are two strategies to make clothing battles a thing of the past – one is for you and one is to teach to your child:

(For you) Get rid of the blue jeans. As much as you might love the way he looks in blue jeans, button-down shirts, corduroys, clothing with fancy stitching – some makes/fabrics/styles are simply more difficult for kids with sensory sensitivities to wear. Go through your child’s drawers and clear out the items you know are really tough. The clothes made of stiff fabric, with lumpy seams or tight necklines. Think soft, non-constricting, tag-less (what a great invention, those stamped-on clothing labels!). If your child likes a certain style of sweatpants, get 3 or 4 pairs. Ditto for socks, shirts, underwear. Put all the clothing your child is never going to wear (the worst offenders, the things you can sort-of understand him reacting to) into a bag and bring it to Goodwill. Or give it to the neighbor who just had a baby. Get this clothing out of your house – its continued presence is only going to frustrate you (and your child).

Once you’ve pared down to (or stocked up on) the things that should work for your child, teach him to habituate. Here’s how:

(Many thanks to Tamar Chansky, PhD, in whose wonderful book, Freeing Your Child From Anxiety, I first discovered this metaphor)

Talk to your child about jumping into a swimming pool. Have him imagine what the water feels like – Brrrrrrr! It’s cold. Ask your child what he would do next. Most kids say something along the lines of “start moving around.” Yes, you start swimming or playing, diving deep beneath the surface or paddling from one end of the pool to the other and after a while, what do you notice? Most kids can tell you, “It warms up.” Ahhh. But is it the pool that’s warmed up? Has the water temperature actually changed? “No,” any self-respecting 6-year can tell you, “You get used to it!” Exactly.

Our bodies are designed to get used to things, even uncomfortable things – like cold water. We just need to hang in there, and pretty soon, we don’t notice the cold any more. It happens even faster if we’re doing something fun, liking racing to the end of the pool or diving for treasure. But you have to stay in the pool.

It’s like that with socks (or underwear, or shirts, or pants), too. We can put them on (that’s like jumping into the pool) and keep them on (that’s like staying in, even though - ICK – they don’t feel right) and go get busy with something else (playing with the dog or eating breakfast or watching TV) and pretty soon…you’ve gotten used to it and your body doesn’t notice the seam/cuff/fabric any more.

The pool analogy makes keeping the item of clothing on (to habituate to it) more palatable to kids. Most have had the experience of getting used to cold water. They know the basics – you have to stay in; you have to start moving around, turn your attention to something else. Talk to your child about this, then sweeten the pot by offering a reward: each day your child puts on his [whatever item of clothing causes trouble] and keeps it on, puts it on and immediately leaves the room to get busy with something else for at least 20 minutes (ample time for most kids to acclimate), he earns a point. Once he has 10 points, he can trade them in for a trip to the bookstore, one-on-one time with Dad, a family-wide Monopoly night, something meaningful/rewarding to your child.

The idea is to take into account the reality of your child’s sensitivity AND to teach him a useable skill. Has anyone tried this with their sensory-challenged kids? How did it work?

Posted in Keeping Socks On, Managing Sensory Challenges, Managing Strong Feelings | 3 Responses »

Why Breathing Doesn’t Work…and How to Tweak It So It Does

Tuesday, March 2nd, 2010

We all do it. When faced with a panicky child, our most common piece of advice is, “Take a breath.” And then one of two things happen:

Compliant child: Opens mouth to sob in more air, only to find her chest is too constricted so not much goes in, which is so scary, escalating the panic as she wails – I CAN’T BREATHE!

Less compliant child: THAT DOESN’T HELP (and she’s right)

It doesn’t help to simply tell our kids to take a breath. When they are already hyperventilating (or close to it), they can’t breathe effectively, which only serves to escalate their fear. And when it’s the first thing we say, it feels (to a frantic 5-year old, 7-year old, 9-year old) hopelessly inadequate.

Think about the last time you were really worked up. How would you have responded if someone met your sobbing (ranting, panicking, clenching) by telling you to breathe? “I am breathing, damn it!” It doesn’t really help.

And yet, it does. Not telling someone to breathe, but the act of breathing. When we are worked up (frightened, angry, tense) our breathing changes. It becomes more shallow, less restorative. We begin to starve ourselves of air, throwing off the balance of oxygen and CO₂, making it harder to remain calm, to think, to figure out how to help ourselves. We need to breathe to restore our inner stasis, and kids do, too. Here’s how to help them do it:

Start with an out-breath. When chest muscles are tight (which happens as our feelings escalate), it is hard to breathe in. Not being able to breathe in is scary, triggering a danger alarm deep within the brain, adding to that sense of panic already spiraling out of control. Coach your child to breathe out, first. Purse your lips a little and do it with her, blowing the air out like you would blow to extinguish a candle.
Do it with your child. Even before you start speaking, blow out some air. That’s a cue for your child, a nonverbal reminder to exhale. Keep your breathing nice and slow. Focus initially on the out-breaths, making them long, with shorter intakes through your nose in between. Gradually lengthen your own in-breaths, so you are breathing in deeply (through your nose) and breathing out long and steady (through your mouth). People have a natural inclination to match the pace and emotional pitch of their companions. You are consciously bringing yours down, to help your child begin to de-escalate, too.
After your first out-breath, say something empathic. Reflect what you are seeing, or put your child’s feelings into words in a calm, steady voice. Something like, “Wow, that seemed scary” or “You are really mad right now.” Keep all judgment out of your tone. You are letting your child know that you get it. You see what your child is feeling and whatever it is, it’s okay.
After that first, supportive comment, say something along the lines of “blow it out” or “let’s work on making your body feel okay so we can figure out what to do.” Breathe as directed above, setting the pace, modeling for your child, letting your calm presence soothe her.
Resist the temptation to jump in with lots of words. Questions, admonishments, threats – all of these are disorganizing to kids when they are already in a heightened state. Practice what Dr. Teresa Bolick has described as “Low and Slow” (from Aspergers Disorder and Young Children), bringing the pace, tone, volume, and complexity of your speech down a few notches.
All of this will work substantially better if you practice breathing with your child ahead of time. Start with a simple explanation: You know, when we get worked up it’s hard to think clearly. We need to calm down before we can figure out what to do. Making sure we’re breathing nice and slow can help us calm down. Let’s practice so the next time we’re super-mad or really scared (or whatever feeling your child tends to have trouble with), we know just what to do. Then aim for two or three brief practice sessions a day (we’re talking minutes here – in the car, before bed, etc.). Simply prompt with, “Let’s do a few of those breaths.” And you do it, too.
Some kids respond better when there is a visual component. Have them imagine a smell to breathe in – brownies, sun tan lotion, horses. They can picture the object and sniff in the scent, pulling it into their nostrils.

Have you found a way to coach your child to breathe? A visualization or relaxation exercise that works? Feel free to share it here.

Posted in Breathing, Managing Sensory Challenges, Managing Strong Feelings, Relaxation | 1 Response »