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treatment for anxiety Urmila Pai, M.D. and Kimberly Williams, Psy.D. composed Feel the Fear: A Treatment for Anxiety in collaboration.

Child Therapist:

“Carly, it seems you were very anxious. How did your body feel?”

Child:

“I don’t know…maybe it felt like, running away!”

When assessing and treating children with anxiety, clinicians agree it can be challenging to help youngsters understand and give detailed account of their feelings, especially in the moment of heightened fear. Often, children are unable to classify their physiological feelings as anxiety.

A study conducted by Dr. Kai MacDonald at UC San Diego, explores concepts in understanding how “gut feelings” or body based sensations, to help point out emerging anxiety.  Within this research framed for adults, there are promising implications for helping children understand their own body to help abate anxiety.  Guided by a child clinician, anxious children can learn the biology of their emotions and how to recognize the physical cues of feeling afraid, cues that are not always overly obvious.

Help Children Understand the Mind-Body Connection – A Treatment for Anxiety

To help children understand this concept, it must be explained that anxiety is linked to the brain’s fear system, which is able to detect impending dangers or threats.  The body then provides an appropriate response—which manifests as anxiety.

To better understand these mechanisms, children are taught about the cortical and subcortical brain regions. These include areas involved in recognizing anxiety provoking cues, signals that cause behavioral and physiological responses, and areas within the prefrontal cortex that provide more direct access into the conscious awareness and appropriate regulation of emotion.

Learn Interoceptive Cues – Treatment for Anxiety

Two primary components of the brain involved in the fear response are the amygdala and the insula.

The amygdala is the integrative center for emotions, behaviors, and motivations. It processes external and internal stimuli and then signals other areas of the brain if there is a potential threat.

The insula is a portion of the cerebral cortex that is involved in the learning and processing of emotions and interoception, or more aptly referred to as Interoceptive Cues (IC).

Simply stated, IC’s are the physical symptoms or manifestations a child may feel in the moment of their anxiety.  Typically, a child’s anxiety is conscious and they recognize that their fear is escalating.

However, there are also times where the anxiety is unconscious and children will engage in reflexive behaviors (i.e. avoidance or meltdowns) that seem to come out of nowhere. During these times, a child may experience pounding in their head, pains in their stomach or sweaty palms. Yet, it’s difficult for kids to notice, acknowledge or describe the unique sensory aspects of their anxiety.  Helping a child learn their IC’s is the beginning of treatment for anxiety.

Exposure-Based Intervention – Treatment for Anxiety

Exploring interoceptive cues turns anxiety into a tangible and real phenomenon within the mind-body dynamics. There must be a balance between the physical and emotional distress.

Additionally, encouraging a child to experience an IC brings these feelings to conscious awareness. As a child consciously or mindfully tolerates the physical symptoms and removes it from hiding, it becomes an exposure–based intervention, which can ultimately abate anxiety.

A clinician can train a child to direct his or her attention to their physical responses in a head-to-toe approach by asking the child to sequentially describe how each body part is feeling in that moment. This will allow a child to be more aware or mindful of their anxiety rather than just saying, “I just feel sick” or “stressed out”.

Steps to Help Children Use Interoceptive Cues (IC) – Treatment for Anxiety

1. First discuss with children how their fear is connected to their brain and body.

2. Then actively explore the physical discomfort of the anxious feelings.

3. Encourage the child to describe a specific stressful or avoided situation in detail. While the child describes their physiological markers of anxiety, such as strained breathing, or rapid heart rate, use body directed questions to help the child remember and recall the sensory experiences in their mind. It’s important for the child to have a mental picture of what’s happening to their body.

4. Assess whether these symptoms are normal, recurrent, or disabling. An age appropriate scale may be used.

It is well studied and known that when an individual shares details about their anxiety and the coinciding experiences, the overall fears and anxiety will decrease. With the appropriate psycho-education into IC, exploration makes anxiety a real physical event and removes the stigma of discussing one’s fears. It also reduces defensiveness in children who feel or have been told that anxiety signals defective character and weakness or their symptoms are not real.

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Dr. Kimberly Williams is a clinical psychologist and neuropsychologist who specializes in the assessment and treatment of children and adults with psychological disorders including anxiety, depression, and disruptive behaviors, as well as learning disorders, developmental delays, executive functioning issues and social deficits. When Dr. Williams isn't in her Great Neck and Brooklyn, NY offices helping kids get ahead in their academic and social development, she is consulting and providing workshops and training in issues related to Autism, Asperger’s Disorder, Nonverbal Learning Disability, Special Education and Parent Advocacy. Visit her site at Dr. Kimberly Williams.