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When Anxiety Keeps Knocking

When Anxiety Keeps Knocking

Published: 04/15/2014 by Kim Eckert

» Health & Wellness
» Student Psychology

If you surveyed a hundred different parents you would ehar a simialr message about what they wish for, more than anything, is a happy child. When a parent sees this dream slipping away it can be overwhelming. No parent want their child living in the grip of fear panic and worry. 

In this article, I will share some of the terminology ised by professionals surrounding anxiety and then introduce one family who worked together to loosen the grip of anciety in their child "Sara'*


Collecting Information

When a child is referred to a psychologist because of anxiety, parents and the child may be asked to complete one or more checklists. These checklists include a broad number of symptoms of behaviors that present themselves when a child experiences anxiety.


This information helps the psychologist to develop an intervention plan for the child, determine the impact of the child’s symptoms on daily functioning, provide information about how long the anxiety has been present and provide a way to track how therapeutic interventions are working.



Sometimes, after interviewing parents and reviewing the checklists completed, it may be decided to formally provide a diagnostic label for the cluster of symptoms presented by the child. Psychologists (and other health professionals) utilize the DSM-5 manual that sets the guidelines for

diagnostic categories and criteria.


In the DSM-5, anxiety disorders include: Separation Anxiety, Selective Mutism, Specific Phobia, Social Anxiety (Social Phobia), Panic Disorder, Generalized Anxiety Disorder, Obsessive- Compulsive Disorder and Post-Tramatic Stress Disorder. 



Symptoms of anxiety are a normal response to uncertainty. Many times parents have brought their child in for support because of a difficult life event or because they have seen a shift in how much fear their

child is experiencing. In these cases, we get busy on supporting the child and family and no further assessment is warranted.


Case Study

Sara, a delightful 6 year old, and her mother came to see me because Sara had several fears. She reported that Sara was afraid to go to school, became distressed parting from her at school and

that she was experiencing frequent sleep disruption because of nightmares. For this family checklists were completed to guide therapy, but a DSM-5 assessment was not completed, as setting

goals for what needed to be addressed was more important than diagnosing the fear.

Sara arrived in my office with her blonde hair in braids and her arms wrapped tightly against her body. She kept her eyes focused on the marbles she was playing with but every so often she would take a peek at my face. With the loving support of her mom, I invited them to come together to explore our play room. Within this space I could see Sara take a bigger breath, as if to tell me that being in a room filled with stuffies, action figures and a sand tray felt familiar and safe.




Whenever I start to work with a child or youth, my primary goal is always to build trust. It is only through a trusting relationship that I will be invited to give her just the right amount of help she needs to explore her feelings of fear. Children will build this trust relationship at their own pace. This may take a few or many sessions, but can never be rushed. Sara's mother and I communicated often and determined when Sara was showing  us she was ready to take the next step. 



Emotional Literacy 

In this phase of support, I introduced Sara to her brain. Sara and I spent several sessions mapping out the job of each side of her brain. Her right brain gives her an idea about what she is feeling. While her left brain uses words and stories to go with those feelings and sensations. I explained to Sara that our goal is to use both sides of our brain. 


We then moved into a game of emotion charades. Sara, her mom and I took turns acting out a feeling and seeing if the others could name that emotion. Sara loved this game and it became clear she had a good grasp of what feelings looked like on our face and bodies and could recognize them in others. 


Feelings Come and Go 

Researchers have determined that on average, most emotions last for about 90 seconds (Raising Happiness Newsletter, December 2013). Sara was rightfully unsure if she believed this. She did, however, love the idea that fear was an important protective emotion. If she could notice and name this feeling, help soothe and comfort herself, she could see that her brain was alerting her to a real or anticipated problem to be solved. 


Sara and I spent time exploring different ways she could “chill” so she could learn what her fear was telling her. These strategies included: 1) Taking a movement break e.g., jumping on the trampoline or dancing to a favorite song; 2) Going to her “happy place” in her imagination, 3) Creating a worry box/container in our imagination where fears could be stored until she had time to give them attention. 

Sara was now ready to review situations where she felt afraid, practice noticing where she felt her fear in her body and how she could listen to this emotion long enough to make a plan to handle the situation. 


Parental Support 

This is where parents play an important role. Children need the support of a caring adult to organize their big feelings so that they can start to learn how to do this on their own. 


I spent a few sessions with Sara’s mom and we explored the science behind how and why we need to learn how to handle big emotions within a caring adult-child relationship. Sara’s mom spoke openly about how she struggled with talking about Sara’s fears and often tried to distract her or help her look at the “bright side of life”. She shared how on the one hand she felt responsible for Sara’s fears but on the other hand she sometimes felt stumped and annoyed when Sara was afraid and she didn’t understand the cause. 

Sara's mom felt releif in knowing that supporting Sara wasn't going to make the fear worse. She supported Sara by naming her emotion of fear and practicing Sara's self- 
soothing strategies alongside her. 


Sara’s fear did come and then go, and after using a self-soothing strategy, Sara was able to join her mom in developing plans to help her explore the world around her again, including transition plans when heading to school. 


Sara also began to demonstrate a willingness to try new places and met new people. Before these events, Sara and her mom would talk through ideas that would help Sara with her nervous feelings. Over time, Sara gained greater independence in noticing her nervous feelings, determining if it was alerting her to danger or was alerting her to solve a problem. 



Within six months, Sara was flourishing. Fear still came to visit (but not as often), and when it did, it was no longer an unwelcomed guest. Sara gained the skills and understanding that her emotion of fear was just as valuable to her as joy or curiosity. Our work together was done. Sara gained the necessary awareness of 1) what she felt in her body when anxiety came knocking, 2) how to determine if real danger existed or not, 3) how best to sooth herself to get her brain ready for problem-solving; and 4) how to make a plan to help her go out into the world and explore! 


In closing, fear is protective in nature, but if the threat is over and your child’s brain and body cannot release the fear and reset to a state of feeling calm and safe, help is available. Working together with a trained therapist, the grip of fear, panic, and worry can be released so your child can get back to the business of childhood - playing, learning, and exploring their world! 

*Names have been changed 



D. Siegel and T. Payne Bryson. (2011). The whole brain child.

Katie O’Shea & Sandra Paulsen. (2009). 
When there are no words.


Christopher McCurry. (2009). Parenting your anxious child with mindfulness and acceptance: A powerful new approach to overcoming fear, panic, and worry using acceptance and commitment therapy