Most children who worry about death and tragedy can usually be appropriately reassured. However, when children repeatedly fret about such things as colliding with a car in which they believe the outcome will be fatal; that they and their parents will come to harm in a house-fire; or that sudden death might occur on the spot, a more concrete approach might be needed to address these death and tragedy obsessions.
Jessica says: “I get scared when I have to leave for school because I can’t stop thinking that I’ll get knocked down by a car.”
Sarah expresses: “I get horrible thoughts crossing my mind about a house-fire starting, especially at bedtime.”
Sam adds: “I get really panicky because I think at any moment I’m going to die… just die, right there on the spot, you know, while I’m doing something like watching a movie, playing with friends, or when I’m in bed.”
Discuss Low Probability
Talking to a child about probability can be helpful. For example, explain to them that while accidents do happen, and that sudden death has been known to occur, the likelihood is close to zero. Following this, help them to understand that they have a choice to either live with this uncertainty; or worry forever about something that might never happen.
Be prepared for doubts in the form of ‘what-ifs?’
Jessica says: “But what if a car drives through a stop light as I’m crossing? “
Sarah adds: “My thoughts seem so real! What if this means they’ll come true?”
Along with Jessica and Sarah, Sam points out: “I lose my breath with fear when I get the death thought. What if losing my breath means death is actually happening?”
A need for certainty is often linked to thinking errors such as catastrophizing. Children who worry too much often have an over-developed sense of responsibility for keeping oneself and others safe. To help a child reduce their over-exaggerated ideas try the following two strategies.
Develop For and Against Statements
Make two columns on a large piece of paper with coloured pencils and write down the child’s ‘what-ifs?’ in the first column titled ‘For Statements’ and in the second column note down your ‘Against Statements’.
For example, when Sam says, “What if losing my breath means death is actually happening?” your against statement might be, “Your experiences are showing you otherwise, and you are coping better.”
His next ‘what-if?’ might be, “But there’s always the chance that losing my breath will make it happen,” to which you could follow with, “The risk of this happening is very small; mostly the chances are that you will faint.”
He might follow with, “But what if I don’t wake up from fainting?” You might say, “Because there is no evidence to prove that people don’t wake up from fainting.”
Sam might write down in his column, “Okay, but what if you’re wrong?” to which you could write: “There are no reported cases. These are simply worrying thoughts and fears, and nothing else.”
Keep this up until the child becomes dog-tired with their ‘what-ifs?’ The outcome is that they not only learn to live with probability, they also learn to accept and trust realistic beliefs.
It might be worth pointing out that using this method at first seems like a compulsion, because it appears similar to giving into reassurance-seeking. However, the idea is that the child eventually fathoms out that only proof can be found in facts, not irrational concepts. For fostering self-efficacy and encouraging positive reinforcement, keep the filled-in sheet so that the child can reflect independently whenever they need.
As a further measure, the recognition that a child’s worries are over-exaggerated can be explained by using a decatastrophizing technique. Doing this exercise further helps to decrease reassurance-seeking and instead encourages realistic self-statements. You can help address these thinking errors by asking open questions.
For example: “Realistically, what is the worst that could happen?” and “How would you cope if the worst did happen?”
The child is asked to write down their realistic statements and memorise them.
Jessica’s more rational response might be: “The likelihood of getting run over by a car is small. I am learning to live with that small risk, and on the off-chance that a car appears to be speeding, I will cope by waiting by the lights until I am sure I can cross safely.”
A more toned down response from Sarah might be: “A house-fire cannot start just because I thought about it because that’s magical thinking; but in real life if the worst did happen, it would probably be where it could be handled before a fire could get out of hand. This is because we have fire-alarms fitted which are regularly checked. Living with uncertainty is hard, but worrying constantly is too.”
Sam’s less exaggerated response might be: “So far I’m still alive. I guess my worried thoughts are all in my head. Fearing death doesn’t mean it will happen just because the thought popped into my head, this is nonsensical I guess. The worst that could happen is that I’ll faint, but I can live with that because my ‘what-if?’ exercise proved that you can’t die from fainting.”
Exhausting what-if questions and decatastrophizing helps to eliminate reassurance-seeking. As such, realistic self-statements are encouraged in which the child learns to live with uncertainty in favour of worrying constantly about their fear. These exercises also help the child to accept that bad things do happen in real life but that these don’t usually turn out as bad as they imagined. Decatrastrophizing also offers them the chance to have a plan of action in place should the likelihood of a particular scenario occur. This reinforces their ability to cope.
For example: “If a car speeds as I wait to cross the road, I’ll likely be fine because I’m careful to only cross when the road is clear.”
Or: “If a fire starts, and the alarm goes off, I’ll stay calm and follow the fire rules.” In addition: “If I think I’m going to faint during one of my death-related fears, I will tell myself I will survive it.”
For more on ‘what ifs’ and decatastrophizing exercises please refer to my earlier blog, Compulsive Checking – Two Games to Help a Child Think Differently.