What? Me Worry?
Written by Rebecca Unger, MD
Karen Pierce, MD, a clinical associate professor of psychiatry at Northwestern University, joined us at our Brown Bag Chat to talk about strategies and tools to help parents and families identify and manage anxiety. Here is some information from our discussion with Dr Pierce. The concepts Dr Pierce discussed relate both to parents and children.
Why do we worry?
We worry because it is our mammalian instinct to try to protect ourselves and our families from fear and harm. It is a yellow light of caution. Usually it is not a green or red light but rather a coping strategy that helps us pay attention. In most circumstance it does not stop us from doing our regular activities. It becomes a red light when we are not able to do those regular activities.
What is normal?
Worry is normal. Worry and anxiety can be good even though they can cause physical symptoms such as stomach ache and headache. Exposure to anxiety helps you learn that you are ok and you can learn from how you deal with your situations. Worry and anxiety are not normal when you cannot do your regular activities such as eat, sleep and go to school.
What can we do?
Do not reassure your child that there is nothing to worry about. Acknowledge fears and help your child learn how to handle the fears to build resiliency. It is ok to say that anxiety and worry are scary.
Let go of anxiety. Worry and fear are natural reactions. Help your child realize he has choices and he can be in charge of how he thinks and feels.
Talk about how worry is ok. It can motivate us to do our best.
Bring worry to life. Consider role playing to help your child understand what tools she has to deal with her anxiety.
Be a “thought detective.” Ask and talk about “nutty thinking” which may escalate thoughts and conversation. Help your child calm down, help yourself calm down, and then work on problem solving.
Breathe. Teach your child how to breathe deeply to help learn to pause, and then process. Learning mindfulness is good medicine.
Let kids worry. Your child has more information than you do about his anxiety. By guiding your child to solve his own problem, he will learn a lot. This is the beginning of learning about empathy.
“Avoid avoiding” things that make your child nervous.
Be compassionate and respectful of each person’s understanding of their own anxiety. Do not be judgmental.
When do you need more help?
These above tools teach mindfulness, resilience, and problem solving techniques that can be part of everyday life. They can be helpful for the entire family. However when your child avoids certain activities or events because of anxiety and fear about what can go wrong, it is time for more help. Therapists often use cognitive behavior therapy (CBT) to treat anxiety. This therapy provides both short and long term benefits to help children (and adults) learn skills to manage anxiety and the physical symptoms that go along with anxiety.
The three related points of the CBT triangle include: 1) Thoughts 2) Behaviors and 3) Feelings. Under most circumstances, these can all be controlled. Children can learn to understand their fears so they can tackle the least fearful things before they have to face the most fearful things. Whether these tools can be taught within the family at home or whether there is a need for outside support depends on the individual situation. Your child and family may benefit from talking to your doctor, seeing a counselor or therapist, and/or collaborating with other families and parents.
The pediatrician’s perspective
As pediatricians, we screen for health concerns at each visit from our first prenatal or newborn visit through the early college years. We also provide information to families about what to expect from one visit to the next.
Similar to screening and counseling about nutrition, sleep, development, dental health, and bike helmets, addressing concerns about a child’s worries and anxieties should be part of each well child visit. By paying attention to these concerns early on, it can be easier to help your child develop tools in her mental health toolbox.
Suggested books:
What Does It Mean To Be Present by Rana DiOrio
A Boy And A Bear: A Relaxation Story by Lori Lite
KidStress by Georgia Witkin
Freeing Yourself From Anxiety by Tamar Chansky
Freeing Your Child From Anxiety by Tamar Chansky