What’s in Your Toolbox?

In the past few weeks there have been more anxious children and adolescents in my office than usual.  This is probably just the randomness of the universe.  Anxiety is often a feature with children who have ADD, learning disabilities and Asperger Syndrome. The situation has caused me to reflect on how treatable anxiety is.

Deep Breathing

I like this work because I can teach skills to a client so that they have a “toolbox” to draw on when they get home and the anxiety returns.  I usually start by teaching people (children and adults) to practice deep breathing.  In deep breathing, you inhale to the point of fullness, hold it briefly, and then exhale slowly and completely.  I tell people that they should feel like a limp balloon at the end.  You can also inhale on two counts and exhale on four counts.  As you exhale, you can be thinking “Relax” or “Letting go.”  Most often people find that this exercise is relaxing.  I tell my clients to practice deep breathing for at least five minutes a day so that they learn the feeling of their body relaxing.  Then the deep breathing becomes a tool to use in times of anxiety.

Happy Place

The second tool involves imagery.   I ask a client to imagine a place where he or she feels most relaxed and safe.  It can be a real or imagined place.  For children I often call this a “happy” place.  Once we have an image, I ask many questions to help fill out the details and all the sensory experience of this place, including aromas, temperature and sounds.  We do some exercises in the office to help intensify the experience of the place, and then I again assign homework.  Put yourself in your happy place at least once a day, whether you need it or not.

Talk Back to Anxiety

The third tool involves flash cards that we make in the office. Together we consider the anxious thoughts that the child has when feeling especially uncomfortable.  These could be, “What if I fail the test?” or “I have no friends,” or “What if I get sick in the night?”  We talk about the thoughts and we consider whether these are realistic concerns or worries.  Then I help the child develop alternative thoughts or answers to the worries.  We write them down on 3×5 cards.  The cards might say, “I studied as well as I can.”  “I’ve never failed a test before.”  “If I do fail, I’ll find out why and do better next time.”

With younger children I involve parents so that they know what is in the toolbox.  (Often parents can benefit from the same strategies.)  Then when a child becomes very anxious, a parent can cue him or her to use the tools.

In very difficult cases medication is helpful for adolescents to decrease the anxiety  enough for them to work with it.  But often it is not needed.

This is just a quick overview of some tools for working with anxiety. For children with learning disabilities, ADHD, or Asperger Syndrome, anxiety is often a difficult part of life because their school and social experiences have included many situations that leave them feeling anxious and discouraged.   It’s bad enough to realize that there are things it is hard for you to do, but it’s worse to feel overwhelmed by anxiety when faced with it.  Having the toolbox really helps these children feel more competent in the world.

Photo credit:  Brittany 0177 on Flickr

 

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Comments

8 Responses to “What’s in Your Toolbox?”
  1. These are all great basic tips, Carolyn. I especially like the reminder to breathe – even though I encourage clients to use this technique all the time, I often forget in the midst of an anxious time. One cleansing breath can make a huge difference for me.

  2. dr.cstone says:

    Hi Rachelle,
    Thanks for your comment. I agree about the breathing–we can all use that reminder. So simple.
    Best,
    Carolyn

  3. Hi Carolyn,
    I also give clients breathing exercises. Since our deep breathing activates the parasympathetic nervous system, we really can’t be stressed out while breathing deeply. I also teach yoga and I forget to stop and take a few good breaths when I get stressed out! I really should put it on my calendar to just stop and breathe every couple of hours.

  4. dr.cstone says:

    Hi Lynda,
    I like the idea of a reminder to breathe. Maybe a buzz from my iphone!
    It’s one thing to give the advice, another to take it!
    Thanks for the comment.
    Carolyn

  5. JoAnn Jordan says:

    Totally agree with all the comments on breathing. I like the idea of flashcards to practice potential anxiety producers and options for appropriate responses.

  6. dr.cstone says:

    Hi JoAnn,
    Thanks for your comment. I find the flashcards are useful for people to have in their purse, at their bedside, or in their desk. They are helpful reminders of tools to use in the moment. Also kind of a transitional object to the therapist.
    Best,
    Carolyn

  7. Arlene Johnson says:

    Carolyn,
    I agree with the previous comments. The flash cards are a great tool.

  8. dr.cstone says:

    Hi Arlene,
    Thanks for the support!
    Carolyn