Writer: Rachel Busman, PsyD, ABPP

Clinical Expert: Rachel Busman, PsyD, ABPP

Question

My daughter who is graduating high school this year is having trouble with anxiety issues. She worries over graduating, college, and future events in her life, which seems normal to me, but lately she says she can't sleep and her heart races sometimes while she is just sitting in her room. What could be causing this? Is this really a panic attack, or is she imagining this?

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

It’s so great that you’re reaching out with this question. You’re absolutely correct that young adults can worry about transitioning to college, the future and being an adult. Having those worries can be very normal. However, it sounds like your daughter’s sleep might be being impacted and she might be having some bodily sensations related to anxiety, which could be cause for concern.

A panic attack is a surge of physical sensations and/or intense fears that come seemingly out of the blue and last for a discreet period of time. A racing heart is one of the symptoms, but not being able to fall asleep isn’t. For your daughter to be having a panic attack she would need to be experiencing at least three more of the following panic attack symptoms:

- Palpitations, pounding heart, or accelerated heart rate

- Sweating

- Trembling or shaking

- Shortness of breath

- Feelings of choking

- Chest pain or discomfort

- Nausea or abdominal distress

- Feeling dizzy, unsteady, light-headed, or faint

- Chills or heat sensations

- Numbness or tingling sensations

- Derealization (feelings of unreality) or depersonalization (being detached from oneself)

- Fear of losing control or “going crazy”

- Fear of dying

Even if your daughter isn’t having panic attacks, you are still picking up on some feelings of distress that are outside of the norm for your daughter, so it is good that you are asking questions. It may well be that her impending graduation is causing some situational stress. She may find it very helpful to talk to a mental health professional about some of the stress that she’s having. A mental health professional could also help determine if her sleep disturbances and other symptoms are transient in nature or more chronic, or if she is also struggling with other things like a depressed mood. Either way, talking to someone may help her with managing the stress that’s coming in the next couple months with her graduation and transition to college. https://standingabovethecrowd.com/?p=16152

James Donaldson on Mental Health - Agoraphobia in Children

When kids avoid certain locations because of a fear of something bad happening

Writer: Rachel Ehmke

Clinical Expert: Jamie Howard, PhD

What You'll Learn

- What is agoraphobia?
- What does agoraphobia look like in children?
- What are agoraphobia treatments for kids?
- Quick Read
- Full Article
- Feeling panic
- Diagnosing agoraphobia in kids
- Agoraphobia treatment
- Inducing physical symptoms
- Agoraphobia medication
https://www.youtube.com/watch?v=97QAcRZ75tY

Agoraphobia is a kind of anxiety that is triggered by specific situations. Common fears in agoraphobia include being in crowds, enclosed spaces like elevators, open space like bridges or parking lots, and public transportation. People with agoraphobia are afraid that something bad will happen in one of those situations and they won’t be able to escape or get help. Often, they are afraid of having a panic attack and they may avoid situations where they have previously had one.

Children with agoraphobia might not be able to explain why they feel afraid. The first sign might be confusing behavior, like insisting that they can’t travel over bridges. When they’re in a situation that scares them, kids with agoraphobia may show signs of panic like a racing heartbeat or sweating. They often beg to go home. They may also start to avoid places where they have had a panic attack before.

Because kids with agoraphobia may refuse to leave home, it’s easy to confuse it with other kinds of anxiety, like social anxiety or separation anxiety. That’s why it’s important to get an evaluation from a mental health professional if you think your child might have agoraphobia. Some kids with agoraphobia also have another anxiety disorder.

In treatment for agoraphobia, a therapist slowly exposes the child to the situation they’re afraid of. With the therapist’s help, the child can get used to the scary situation in a safe, controlled way. Therapists can also teach kids who have panic attacks ways to relax, such as deep breathing exercises or visualization. Medication can also be helpful for kids with more severe agoraphobia.

The stereotype most of us have of agoraphobia is someone who is afraid of stepping outside the home. In its most severe form, agoraphobia can become this limiting. But for most people it starts with anxiety triggered by a specific situation.

Some people develop a fear of open spaces, while others fear enclosed ones. The situations that most commonly cause fear with agoraphobia are:

- Public transportation (like buses, trains and planes)
- Open spaces (like bridges and parking lots)
- Enclosed places (like shops, movie theaters and elevators)
- In line or in a crowd
- Outside of home alone

What inspires dread in these situations is the potential for something upsetting to happen. Jamie Howard, PhD, a child psychologist at the Child Mind Institute, explains, “People with agoraphobia worry that something bad will happen and then they’ll be out in the world, unsafe, unable to escape, and there will be no one who can help them.”

Dr. Howard worked with a teenager with agoraphobia who was afraid of being in long lines, riding the subway, standing in Times Square, and being in the middle of an aisle at a movie theater. “She had a full-onpanic attack when she went to see Wicked, which was something she was so looking forward to,” said Dr. Howard. “She said to me, ‘It’s the fear that I can’t escape. That’s what I don’t think other people understand.’”

Feeling panic

What makes it a little confusing is that the thing people are often afraid of is having a panic attack. A person who is having a panic attack experiences an abrupt surge of disturbing physical sensations, such as a racing heart, sweating, shaking, dizziness, shortness of breath and nausea. Accompanying those sensations are intense fears that they are having a heart attack, dying, or “going crazy,” and a desperate need to escape.

Although the person having the panic attack isn’t actually experiencing a medical crisis, they feel like they are, which makes panic attacks very frightening. People may start avoiding locations where they previously had panic attacks in order to avoid experiencing another one. This can lead to agoraphobia.

While panic attacks are closely identified with agoraphobia for this reason, not everyone with agoraphobia experiences panic attacks. Others may fear a variety of incapacitating or embarrassing things that they won’t be able to escape from or get help for, such as falling or vomiting. Younger kids tend to fear being outside the home alone, without a caregiver, or becoming disoriented and lost.

Diagnosing agoraphobia in kids

Agoraphobia can develop out of nowhere and children may or may not be aware of what is happening. They know that their anxiety feels bad, but if they are able to avoid the thing that  triggers their agoraphobia, they feel okay — at least temporarily. The problem may be more noticeable to their parents. “Kids don’t usually say, ‘Help me, I don’t want to go outside,’” says Dr. Howard. “It’s more like it’s annoying because it causes a functional impairment within the family. Parents will say, ‘What do you mean we have to take an alternate route because you can’t go over a bridge?’”

When children have agoraphobia it can sometimes be mistaken for a different mental health issue, so it is important to have an evaluation to determine what is behind a child’s avoidance.

In younger kids, agoraphobia can often look like school refusal or separation anxiety, because the child may be pleading to stay home or go home or be with their mother. But while a child with separation anxiety will be fine if a caretaker agrees to stay with them on a playdate or during soccer practice, a child with agoraphobia may still be anxious.

Likewise, a child with social anxiety might avoid things like parties or talking with sales clerks, which could look like agoraphobia, but their fear is focused on embarrassing himself socially. However, Dr. Howard notes, it isn’t uncommon for a child to have agoraphobia and another anxiety disorder as well. “Social anxiety is a worry that you’ll humiliate yourself doing everyday things. For a child who has social anxiety and agoraphobia, it would be, “I’ll humiliate myself and then I won’t be able to get away.”

For children with a history of panic attacks, it is common to be diagnosed with panic disorder as well as agoraphobia.

Agoraphobia treatment

Treatment for children with agoraphobia is a form ofcognitive behavior therapy calledexposure therapy. It’s based on the idea that while it’s our instinct to avoid the things that trigger anxiety, avoiding those things actually makes it stronger. Facing these triggers in a controlled setting makes anxiety diminish over time.

At the start of exposure therapy, the clinician will explain how facing anxiety actually helps it to gradually fade away. Then, the clinician and the patient will work together to face anxiety triggers in a gradual and carefully controlled way.

In the case of agoraphobia, that means visiting places the child has been avoiding. “We break the association that these places are unsafe somehow,” says Dr. Howard. “The more data they have that it’s actually fine, the less strong that association is.” So for example Dr. Howard walked to Times Square with her patient who was afraid of it, and also helped them practice standing in long lines and riding the subway, which were other big anxiety triggers.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Inducing physical symptoms

If a child has panic attacks along with agoraphobia, then they will also need treatment specifically to help them cope with panic attacks themselves. This is called interoceptive exposure, which is a kind of exposure therapy that induces the physical symptoms associated with panic attacks, to gradually defuse the anxiety they cause.

As with any exposure therapy, the clinician starts by explaining the theory behind the treatment. In the case of interoceptive exposure, this includes explaining how panic attacks work, and how they may feel very dangerous, but actually aren’t. Then the clinician and patient start to induce individual panic attack symptoms on purpose.

“I’ll put a person in front of a space heater,” Dr. Howard says, “and we’ll have them run up and down the stairs — because a lot of times is a really fast-beating heart and sweatiness and feeling hot and flushed that make them panic. For other people it’s nausea, so I’ll have them spin around in a chair.”

Then, once the person starts feeling panicked, their clinician will help them practice deep breathing techniques designed to calm their physical symptoms down and help them feel more in control of their symptoms.

Agoraphobia medication

For people with more severe agoraphobia, medication may be necessary to help them deal with their anxiety. Antidepressants called selective serotoninreuptake inhibitors (SSRIs) can be very helpful in reducing worry and enabling people to participate in therapy.

While practicing facing anxiety is essential to treatment, clinicians are careful not to push people beyond what they can handle. According to Dr. Howard, “If the child is afraid to leave their house, we’d have to go to their house. And at first it might just be that we take a step out on the porch. We look out the window.” But with the right treatment and practice, their world will get bigger.

Frequently Asked Questions

What is agoraphobia?

What causes agoraphobia?

Agoraphobia often develops from a combination of factors, including previous experiences with anxiety or panic attacks. In many cases, it can be linked to a fear of having a panic attack in a situation where escape might be challenging or help is not easily accessible. For children, the causes may not be as clear, but it’s often connected to the anxiety they feel in specific situations.

What is the fear of leaving the house called?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-agoraphobia-in-children/

When kids avoid certain locations because of a fear of something bad happening

Writer: Rachel Ehmke

Clinical Expert: Jamie Howard, PhD

What You'll Learn

- What is agoraphobia?

- What does agoraphobia look like in children?

- What are agoraphobia treatments for kids?

- Quick Read

- Full Article

- Feeling panic

- Diagnosing agoraphobia in kids

- Agoraphobia treatment

- Inducing physical symptoms

- Agoraphobia medication

https://www.youtube.com/watch?v=97QAcRZ75tY

Agoraphobia is a kind of anxiety that is triggered by specific situations. Common fears in agoraphobia include being in crowds, enclosed spaces like elevators, open space like bridges or parking lots, and public transportation. People with agoraphobia are afraid that something bad will happen in one of those situations and they won’t be able to escape or get help. Often, they are afraid of having a panic attack and they may avoid situations where they have previously had one.

Children with agoraphobia might not be able to explain why they feel afraid. The first sign might be confusing behavior, like insisting that they can’t travel over bridges. When they’re in a situation that scares them, kids with agoraphobia may show signs of panic like a racing heartbeat or sweating. They often beg to go home. They may also start to avoid places where they have had a panic attack before.

Because kids with agoraphobia may refuse to leave home, it’s easy to confuse it with other kinds of anxiety, like social anxiety or separation anxiety. That’s why it’s important to get an evaluation from a mental health professional if you think your child might have agoraphobia. Some kids with agoraphobia also have another anxiety disorder.

In treatment for agoraphobia, a therapist slowly exposes the child to the situation they’re afraid of. With the therapist’s help, the child can get used to the scary situation in a safe, controlled way. Therapists can also teach kids who have panic attacks ways to relax, such as deep breathing exercises or visualization. Medication can also be helpful for kids with more severe agoraphobia.

The stereotype most of us have of agoraphobia is someone who is afraid of stepping outside the home. In its most severe form, agoraphobia can become this limiting. But for most people it starts with anxiety triggered by a specific situation.

Some people develop a fear of open spaces, while others fear enclosed ones. The situations that most commonly cause fear with agoraphobia are:

- Public transportation (like buses, trains and planes)

- Open spaces (like bridges and parking lots)

- Enclosed places (like shops, movie theaters and elevators)

- In line or in a crowd

- Outside of home alone

What inspires dread in these situations is the potential for something upsetting to happen. Jamie Howard, PhD, a child psychologist at the Child Mind Institute, explains, “People with agoraphobia worry that something bad will happen and then they’ll be out in the world, unsafe, unable to escape, and there will be no one who can help them.”

Dr. Howard worked with a teenager with agoraphobia who was afraid of being in long lines, riding the subway, standing in Times Square, and being in the middle of an aisle at a movie theater. “She had a full-onpanic attack when she went to see Wicked, which was something she was so looking forward to,” said Dr. Howard. “She said to me, ‘It’s the fear that I can’t escape. That’s what I don’t think other people understand.’”

Feeling panic

What makes it a little confusing is that the thing people are often afraid of is having a panic attack. A person who is having a panic attack experiences an abrupt surge of disturbing physical sensations, such as a racing heart, sweating, shaking, dizziness, shortness of breath and nausea. Accompanying those sensations are intense fears that they are having a heart attack, dying, or “going crazy,” and a desperate need to escape.

Although the person having the panic attack isn’t actually experiencing a medical crisis, they feel like they are, which makes panic attacks very frightening. People may start avoiding locations where they previously had panic attacks in order to avoid experiencing another one. This can lead to agoraphobia.

While panic attacks are closely identified with agoraphobia for this reason, not everyone with agoraphobia experiences panic attacks. Others may fear a variety of incapacitating or embarrassing things that they won’t be able to escape from or get help for, such as falling or vomiting. Younger kids tend to fear being outside the home alone, without a caregiver, or becoming disoriented and lost.

Diagnosing agoraphobia in kids

Agoraphobia can develop out of nowhere and children may or may not be aware of what is happening. They know that their anxiety feels bad, but if they are able to avoid the thing that  triggers their agoraphobia, they feel okay — at least temporarily. The problem may be more noticeable to their parents. “Kids don’t usually say, ‘Help me, I don’t want to go outside,’” says Dr. Howard. “It’s more like it’s annoying because it causes a functional impairment within the family. Parents will say, ‘What do you mean we have to take an alternate route because you can’t go over a bridge?’”

When children have agoraphobia it can sometimes be mistaken for a different mental health issue, so it is important to have an evaluation to determine what is behind a child’s avoidance.

In younger kids, agoraphobia can often look like school refusal or separation anxiety, because the child may be pleading to stay home or go home or be with their mother. But while a child with separation anxiety will be fine if a caretaker agrees to stay with them on a playdate or during soccer practice, a child with agoraphobia may still be anxious.

Likewise, a child with social anxiety might avoid things like parties or talking with sales clerks, which could look like agoraphobia, but their fear is focused on embarrassing himself socially. However, Dr. Howard notes, it isn’t uncommon for a child to have agoraphobia and another anxiety disorder as well. “Social anxiety is a worry that you’ll humiliate yourself doing everyday things. For a child who has social anxiety and agoraphobia, it would be, “I’ll humiliate myself and then I won’t be able to get away.”

For children with a history of panic attacks, it is common to be diagnosed with panic disorder as well as agoraphobia.

Agoraphobia treatment

Treatment for children with agoraphobia is a form ofcognitive behavior therapy calledexposure therapy. It’s based on the idea that while it’s our instinct to avoid the things that trigger anxiety, avoiding those things actually makes it stronger. Facing these triggers in a controlled setting makes anxiety diminish over time.

At the start of exposure therapy, the clinician will explain how facing anxiety actually helps it to gradually fade away. Then, the clinician and the patient will work together to face anxiety triggers in a gradual and carefully controlled way.

In the case of agoraphobia, that means visiting places the child has been avoiding. “We break the association that these places are unsafe somehow,” says Dr. Howard. “The more data they have that it’s actually fine, the less strong that association is.” So for example Dr. Howard walked to Times Square with her patient who was afraid of it, and also helped them practice standing in long lines and riding the subway, which were other big anxiety triggers.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Inducing physical symptoms

If a child has panic attacks along with agoraphobia, then they will also need treatment specifically to help them cope with panic attacks themselves. This is called interoceptive exposure, which is a kind of exposure therapy that induces the physical symptoms associated with panic attacks, to gradually defuse the anxiety they cause.

As with any exposure therapy, the clinician starts by explaining the theory behind the treatment. In the case of interoceptive exposure, this includes explaining how panic attacks work, and how they may feel very dangerous, but actually aren’t. Then the clinician and patient start to induce individual panic attack symptoms on purpose.

“I’ll put a person in front of a space heater,” Dr. Howard says, “and we’ll have them run up and down the stairs — because a lot of times is a really fast-beating heart and sweatiness and feeling hot and flushed that make them panic. For other people it’s nausea, so I’ll have them spin around in a chair.”

Then, once the person starts feeling panicked, their clinician will help them practice deep breathing techniques designed to calm their physical symptoms down and help them feel more in control of their symptoms.

Agoraphobia medication

For people with more severe agoraphobia, medication may be necessary to help them deal with their anxiety. Antidepressants called selective serotoninreuptake inhibitors (SSRIs) can be very helpful in reducing worry and enabling people to participate in therapy.

While practicing facing anxiety is essential to treatment, clinicians are careful not to push people beyond what they can handle. According to Dr. Howard, “If the child is afraid to leave their house, we’d have to go to their house. And at first it might just be that we take a step out on the porch. We look out the window.” But with the right treatment and practice, their world will get bigger.

Frequently Asked Questions

What is agoraphobia?

What causes agoraphobia?

Agoraphobia often develops from a combination of factors, including previous experiences with anxiety or panic attacks. In many cases, it can be linked to a fear of having a panic attack in a situation where escape might be challenging or help is not easily accessible. For children, the causes may not be as clear, but it’s often connected to the anxiety they feel in specific situations.

What is the fear of leaving the house called? https://standingabovethecrowd.com/?p=16150

By Issy Ronald, Stephanie Halasz, Sharon Braithwaite

Alice Kessler and Ellen Kessler

EDITOR’S NOTE:  If you or someone you know is struggling with mental health, help is available. Dial or text 988 or visit 988lifeline.org for free and confidential support.

Alice and Ellen Kessler, the German twins who rose to fame in the 1950s as a variety entertainment duo, have died at the age of 89 by joint assisted suicide, advocacy organization the German Society for Humane Dying (DGHS) said on Tuesday.

Local police confirmed to CNN on Tuesday that “there was a deployment yesterday lunchtime in Gruenwald” – the leafy suburb of Munich where the twins lived – but did not say the reason for that deployment.

The twins contacted the DGHS, which provides access to lawyers and doctors, more than a year ago and became members, the organization told CNN on Tuesday.

“The decisive factor is likely to have been the desire to die together on a specific date,” DGHS spokesperson Wega Wetzel told CNN, adding that she wasn’t aware of the precise reasons given by each woman.

“Their desire to die was well-considered, long-standing, and free from any psychiatric crisis,” Wetzel said.

During an interview with Italian newspaper Corriere della Sera last year, the twins said they wanted “to go away together on the same day.” “The idea that one of us might get it first is very hard to bear,” they added.

They wished to have their ashes interred in the same urn too, alongside their mother Elsa and dog Yello, Ellen Kessler told German tabloid Bild last year.

Assisted dying, under certain circumstances, is legal in Germany after the country’s top court ruled in 2020 that an individual has the right to end their life and to seek help from a third party if they aren’t subject to external influences.

How to get help

- Help is available if you or someone you know is struggling with suicidal thoughts or mental health matters.

- In the US: Call or text 988, the Suicide & Crisis Lifeline.

- Globally: The International Association for Suicide Prevention and Befrienders Worldwide have contact information for crisis centers around the world.

-

With their blonde, coiffed hair, long legs and talent for both singing and dancing, the Kessler twins embodied the aesthetic of the 1950s and 60s showgirl.

As children, they attended classical ballet school before fleeing East Germany in 1952 to pursue dance. Shortly after, the twins began their careers at the Lido in Paris, a venue known for its cabaret performances, but they quickly transcended that world.

Alice and Ellen Kessler reached the height of their fame in the 1950s and 1960s. 

They represented Germany at the 1959 Eurovision Song Contest, appeared several times on “The Ed Sullivan Show,” once featured on the cover of Life magazine, and moved in circles populated by the biggest stars of that era like Fred Astaire, Frank Sinatra, Elvis Presley and Rock Hudson.

“The Ed Sullivan Show” posted a tribute to the Kessler twins on social media, remembering them as “dazzling stars, true legends, and sisters whose grace, charm, and magic will shine forever.”

Fame in Italy

The sisters soon became stars in Italy too. They made history as the first showgirls to appear on Italian television and the first female stars to show their legs on screen, according to Eurovision. However, they had to wear opaque tights due to the strict Christian conservative values of the time, state broadcaster RAI said. Nevertheless, their legs were dubbed “the legs of the country.”

And when they posed naked for the Italian edition of Playboy in 1976, it sold out in three hours, according to Eurovision’s website.

They appeared in Italian movies and in theater, achieving such widespread fame there that state broadcaster RAI released a detailed plan on Tuesday of the ways in which it would cover their deaths, both on the news and by rerunning old television shows starring them.

The sisters’ entertainment careers continued long after the era of the showgirl had waned. As well as making guest appearances on German television, they starred in a musical that played in Berlin, Munich and Vienna from 2015 to 2016.

Their lives were intertwined beyond just their shared career. They lived in “two mirrored, connecting apartments,” the sisters told Corriere della Sera last year, and would meet every day at noon for lunch.

The twins were born in a village that today belongs to Grimma, a town in Saxony.

Tino Kießig, the mayor of Grimma, said in a statement Monday that the town “mourns the loss of these two world-renowned personalities.” https://standingabovethecrowd.com/?p=16173

James Donaldson on Mental Health - Behavioral Treatment for Kids With Anxiety

Kids learn to handle the bully in the brain

Photo by samer daboul on Pexels.com

Writer: Jerry Bubrick, PhD

Clinical Expert: Jerry Bubrick, PhD

What You'll Learn

- What is cognitive behavioral therapy (CBT)?
- How does CBT help kids with anxiety?
- What is intensive treatment for kids with anxiety?
- Quick Read
- Full Article
- What is cognitive behavioral therapy?
- The bully in the brain
- How does exposure therapy work?
- Intensive treatment

While medication can help anxious kids, it isn’t the treatment experts recommend most for children with mild or moderate anxiety. A kind of therapy called cognitive behavioral therapy (CBT) is the first choice. And for kids with severe anxiety, the recommendation is CBT combined with medication.  

CBT is based on the idea that how we think and act both affect how we feel. By changing our thinking or behavior, we can change our emotions.  

In order to understand how CBT works, it helps to understand how anxiety works. When kids are anxious, they learn to avoid the things that make them worry. At first this makes them feel better. But as the child keeps avoiding their fears, the fears only grow more powerful. CBT helps kids stop avoiding their fears.  

The basic idea is that kids are exposed to the things that trigger their anxiety in small steps and in a safe setting. As they get used to each trigger, the anxiety fades, and they are ready to take on another trigger. This is called “exposure therapy” or “exposure and response prevention.” The child and the therapist will work together to come up with a list of the child’s anxiety triggers. Then they will rank the fears on a scale of 1 to 10. Next, the child is exposed to their fear in its mildest possible form. The therapist supports the child until their anxiety fades. As their anxiety lessens, children feel more in control.   

Treatment for moderate anxiety usually takes 8 to 12 sessions. Some kids make more progress if they are also taking medication to reduce their anxiety at the same time. 

Medication is often prescribed for children with anxiety, as it is for adults. And medication — antidepressants are usually our first choice — often helps reduce anxiety. But what many people don’t know is that cognitive behavioral therapy (CBT) can be very effective for kids who are anxious. In fact, for children with mild to moderate anxiety, the recommended treatment is CBT. For children with severe anxiety, experts recommend CBT plus medication. And unlike taking medication alone, therapy gives children the tools to manage the anxiety themselves, now and in the future.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is based on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and behavior that is dysfunctional, we can change our emotions. With younger children, focusing first on the behavioral part of CBT can be most effective.

To understand how CBT works, first it helps to understand how anxiety works. Serious untreated anxiety tends to get worse over time, not better, because the child learns that avoidance works in reducing the anxiety, at least in the short run. But as the child — and, indeed, the whole family — work to avoid triggering those fears, they only grow more powerful. The goal in CBT is, essentially, to unlearn avoidant behavior.

One of the most important techniques in CBT for children with anxiety is called exposure and response prevention. The basic idea is that kids are exposed to the things that trigger their anxiety in structured, incremental steps, and in a safe setting. As they become accustomed to each of the triggers in turn, the anxiety fades, and they are ready to take on increasingly powerful ones.

Exposure therapy is very different from traditional talk therapy, in which the patient and a therapist might explore the roots of the anxiety, in hopes of changing their behavior. In exposure therapy we try to change the behavior to get rid of the fear.

Exposure therapy is effective on many different kinds of anxiety, including separation anxiety, phobias, obsessive-compulsive disorder (OCD), and social anxiety.

The bully in the brain

For children with anxiety disorders, the process begins by helping them, and their parents, get some distance from the anxiety and start thinking of it as a thing that is separate from who they are. One way I do this is by having them conceptualize it as a “bully in the brain,” and I encourage kids to give the bully a name and talk back to him. Kids I’ve worked with have called him the Witch, Mr. Bossy, Chucky, the Joker, and, in the case of some teenagers, names I cannot repeat here.

We explain that we are going to teach skills to handle the bully, giving children the idea that they can control their anxiety rather than it controlling them.

It’s also important to help kids really understand how their anxiety is affecting their lives. I may actually map out things a child can’t do because of their fears — like sleeping in their own bed, or going to a friend’s house, or sharing meals with their own family — and how that makes them feel. Getting kids to understand how their anxiety works and gaining their trust is important because the next step — facing down their fears — depends on them trusting me.

Adopting Robert Frost’s observation that “the only way around is through,” exposure therapy slowly and systematically helps a child face their fears, so they can learn to tolerate their anxiety until it subsides rather than reacting by seeking reassurance, escaping, avoidance or engaging in ritualistic behaviors such as hand washing.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How does exposure therapy work?

The first step is identifying triggers. We design a “hierarchy of fears” — a series of incremental challenges, each of which is tolerable, and which together build to significant progress. Instead of thinking in black and white terms — I can’t touch a dog or I can’t cross a bridge — kids are asked to consider degrees of difficulty. We might ask a child with contamination fears, for example, “On a scale of 1 to 10, how difficult would it be to touch the door handle with one finger? To touch and open the door?”

For a child with a fear of vomiting, we might ask: “How difficult would it be to write the word vomit?” If that is a 3, saying “I will vomit today” might be a 5. To see a cartoon of someone vomiting might rate a 7. To watch a real video of someone vomiting might be a 9. At the top of the hierarchy would likely be eating something the child thinks will make them vomit. By rating these different fears, kids come to see that some are less extreme, and more manageable, than they had thought.

Next, we expose the child to the trigger in its mildest possible form, and support them until the anxiety subsides. Fear, like any sensation, diminishes over time, and children gain a sense of mastery as they feel the anxiety wane.

Intensive treatment

With a child who is severely anxious — who can, for instance, barely leave their room for fear that their parents will die, or must wash their hands dozens of times a day to avoid contamination — I may work with them several times a week, for several hours at a time. We do exposures in the office and then, when a child is comfortable enough, do them outside.

For someone with social anxiety, for instance, we might go out wearing silly hats, or walk a banana on a leash. For someone afraid of contamination, we might ride the bus together, or shake hands with strangers, then eat chips without washing.

Once we have worked through some exposures and they are feeling more confident, I assign homework to practice what we did in the sessions. We want kids to really master their exposures before moving up the ladder. And parents are taught to help kids progress by encouraging them to tolerate anxious feelings, rather than jumping in to protect them from their anxiety.

Treatment for mild to moderate levels of severity usually takes eight to 12 sessions, and some kids make more progress if they are also taking medication to reduce their anxiety, which can make them more able to engage in therapy.

It’s important to understand that exposure therapy is hard work, both for kids and their parents. But as fear diminishes, kids get back to doing things they like to do, and the family gets back a child they feared they had lost — and that’s a great reward.

Frequently Asked Questions

How do you treat anxiety in children?

You treat anxiety in children with exposure and response prevention therapy (ERP). ERP involves exposing kids to the things that trigger their anxiety in structured, incremental steps, and in a safe setting. The idea is that the anxiety will fade over time and kids will learn to take on increasingly powerful triggers.

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-behavioral-treatment-for-kids-with-anxiety-2/

Kids learn to handle the bully in the brain

Photo by samer daboul on Pexels.com

Writer: Jerry Bubrick, PhD

Clinical Expert: Jerry Bubrick, PhD

What You'll Learn

- What is cognitive behavioral therapy (CBT)?

- How does CBT help kids with anxiety?

- What is intensive treatment for kids with anxiety?

- Quick Read

- Full Article

- What is cognitive behavioral therapy?

- The bully in the brain

- How does exposure therapy work?

- Intensive treatment

While medication can help anxious kids, it isn’t the treatment experts recommend most for children with mild or moderate anxiety. A kind of therapy called cognitive behavioral therapy (CBT) is the first choice. And for kids with severe anxiety, the recommendation is CBT combined with medication.  

CBT is based on the idea that how we think and act both affect how we feel. By changing our thinking or behavior, we can change our emotions.  

In order to understand how CBT works, it helps to understand how anxiety works. When kids are anxious, they learn to avoid the things that make them worry. At first this makes them feel better. But as the child keeps avoiding their fears, the fears only grow more powerful. CBT helps kids stop avoiding their fears.  

The basic idea is that kids are exposed to the things that trigger their anxiety in small steps and in a safe setting. As they get used to each trigger, the anxiety fades, and they are ready to take on another trigger. This is called “exposure therapy” or “exposure and response prevention.” The child and the therapist will work together to come up with a list of the child’s anxiety triggers. Then they will rank the fears on a scale of 1 to 10. Next, the child is exposed to their fear in its mildest possible form. The therapist supports the child until their anxiety fades. As their anxiety lessens, children feel more in control.   

Treatment for moderate anxiety usually takes 8 to 12 sessions. Some kids make more progress if they are also taking medication to reduce their anxiety at the same time. 

Medication is often prescribed for children with anxiety, as it is for adults. And medication — antidepressants are usually our first choice — often helps reduce anxiety. But what many people don’t know is that cognitive behavioral therapy (CBT) can be very effective for kids who are anxious. In fact, for children with mild to moderate anxiety, the recommended treatment is CBT. For children with severe anxiety, experts recommend CBT plus medication. And unlike taking medication alone, therapy gives children the tools to manage the anxiety themselves, now and in the future.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is based on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and behavior that is dysfunctional, we can change our emotions. With younger children, focusing first on the behavioral part of CBT can be most effective.

To understand how CBT works, first it helps to understand how anxiety works. Serious untreated anxiety tends to get worse over time, not better, because the child learns that avoidance works in reducing the anxiety, at least in the short run. But as the child — and, indeed, the whole family — work to avoid triggering those fears, they only grow more powerful. The goal in CBT is, essentially, to unlearn avoidant behavior.

One of the most important techniques in CBT for children with anxiety is called exposure and response prevention. The basic idea is that kids are exposed to the things that trigger their anxiety in structured, incremental steps, and in a safe setting. As they become accustomed to each of the triggers in turn, the anxiety fades, and they are ready to take on increasingly powerful ones.

Exposure therapy is very different from traditional talk therapy, in which the patient and a therapist might explore the roots of the anxiety, in hopes of changing their behavior. In exposure therapy we try to change the behavior to get rid of the fear.

Exposure therapy is effective on many different kinds of anxiety, including separation anxiety, phobias, obsessive-compulsive disorder (OCD), and social anxiety.

The bully in the brain

For children with anxiety disorders, the process begins by helping them, and their parents, get some distance from the anxiety and start thinking of it as a thing that is separate from who they are. One way I do this is by having them conceptualize it as a “bully in the brain,” and I encourage kids to give the bully a name and talk back to him. Kids I’ve worked with have called him the Witch, Mr. Bossy, Chucky, the Joker, and, in the case of some teenagers, names I cannot repeat here.

We explain that we are going to teach skills to handle the bully, giving children the idea that they can control their anxiety rather than it controlling them.

It’s also important to help kids really understand how their anxiety is affecting their lives. I may actually map out things a child can’t do because of their fears — like sleeping in their own bed, or going to a friend’s house, or sharing meals with their own family — and how that makes them feel. Getting kids to understand how their anxiety works and gaining their trust is important because the next step — facing down their fears — depends on them trusting me.

Adopting Robert Frost’s observation that “the only way around is through,” exposure therapy slowly and systematically helps a child face their fears, so they can learn to tolerate their anxiety until it subsides rather than reacting by seeking reassurance, escaping, avoidance or engaging in ritualistic behaviors such as hand washing.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How does exposure therapy work?

The first step is identifying triggers. We design a “hierarchy of fears” — a series of incremental challenges, each of which is tolerable, and which together build to significant progress. Instead of thinking in black and white terms — I can’t touch a dog or I can’t cross a bridge — kids are asked to consider degrees of difficulty. We might ask a child with contamination fears, for example, “On a scale of 1 to 10, how difficult would it be to touch the door handle with one finger? To touch and open the door?”

For a child with a fear of vomiting, we might ask: “How difficult would it be to write the word vomit?” If that is a 3, saying “I will vomit today” might be a 5. To see a cartoon of someone vomiting might rate a 7. To watch a real video of someone vomiting might be a 9. At the top of the hierarchy would likely be eating something the child thinks will make them vomit. By rating these different fears, kids come to see that some are less extreme, and more manageable, than they had thought.

Next, we expose the child to the trigger in its mildest possible form, and support them until the anxiety subsides. Fear, like any sensation, diminishes over time, and children gain a sense of mastery as they feel the anxiety wane.

Intensive treatment

With a child who is severely anxious — who can, for instance, barely leave their room for fear that their parents will die, or must wash their hands dozens of times a day to avoid contamination — I may work with them several times a week, for several hours at a time. We do exposures in the office and then, when a child is comfortable enough, do them outside.

For someone with social anxiety, for instance, we might go out wearing silly hats, or walk a banana on a leash. For someone afraid of contamination, we might ride the bus together, or shake hands with strangers, then eat chips without washing.

Once we have worked through some exposures and they are feeling more confident, I assign homework to practice what we did in the sessions. We want kids to really master their exposures before moving up the ladder. And parents are taught to help kids progress by encouraging them to tolerate anxious feelings, rather than jumping in to protect them from their anxiety.

Treatment for mild to moderate levels of severity usually takes eight to 12 sessions, and some kids make more progress if they are also taking medication to reduce their anxiety, which can make them more able to engage in therapy.

It’s important to understand that exposure therapy is hard work, both for kids and their parents. But as fear diminishes, kids get back to doing things they like to do, and the family gets back a child they feared they had lost — and that’s a great reward.

Frequently Asked Questions

How do you treat anxiety in children?

You treat anxiety in children with exposure and response prevention therapy (ERP). ERP involves exposing kids to the things that trigger their anxiety in structured, incremental steps, and in a safe setting. The idea is that the anxiety will fade over time and kids will learn to take on increasingly powerful triggers.

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/?p=16146

By Nicole Nielsen

The death of Cowboys player Marshawn Kneeland by suicide is a tragedy and a reminder that mental health struggles do not discriminate.

Even for athletes or celebrities, suicide continues to claim lives, regardless of fame or success.

Mental illness doesn't spare anyone

"It doesn't matter how rich, or famous, or talented you are," said Dr. Jaya Mathew, psychologist and founder of Wellness 360 in Dallas. "Mental illness kills."

In the wake of Kneeland's death, Mathew said she hopes the heartbreaking news encourages people to have an honest conversation about suicide, which is something many still avoid.

"We avoid it like the plague," she said. "We think almost by saying the word suicide that we're going to cause harm, but we're not. We have to ask the question."

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Suicide statistics show alarming trend

According to the CDC, nearly 49,000 people died by suicide in 2023 — one person every 11 minutes. When a public figure dies by suicide, it can often serve as a turning point for others struggling in silence, particularly men, Mathew said.

"Research does show that more men die by suicide," she said. "High pressure, high stakes, high demand."

NFL has expanded mental health care

While the NFL has taken steps in recent years to expand mental health resources for players, including on-site clinicians, Mathew said loved ones still play a vital role in recognizing the warning signs, such as hopelessness, giving away possessions or sudden isolation. A family member can also offer a sympathetic ear and try to connect them with help.

"It gives them a moment to say someone is paying attention," she said. "If you know someone with lethal drugs or guns, please put them away safely and securely, at a distance."

A call to check on others

Mathew said she hopes Kneeland's death becomes a catalyst for awareness and prevention.

"Let this be a call to action," she said. "As we sit in this sort of collective grief that a young life was lost, let's make a commitment to checking in on one another and asking these questions about mental illness and mental health."

If you or someone you know is struggling, call or text 988 to reach the Suicide and Crisis Lifeline for free help. https://standingabovethecrowd.com/?p=16137