Sarah Stearns, of Deer Creek Psychological Associates, has been in practice for 17 years, and specializes in treating anxiety disorders (phobias, separation anxiety, post-traumatic stress disorder, generalized anxiety and social anxiety). She was previously employed at Dartmouth-Hitchcock Medical Center, where she ran an anxiety group for children ages 8-12. She recently spoke with Valley Parents about anxiety disorders in children. The interview has been edited for length and clarity.
Question: What role does trauma play in anxiety?
Answer: Children who experience trauma can develop a particular kind of anxiety known as post-traumatic stress disorder, but not all children who experience trauma necessarily develop this level of anxiety. All kinds of things can lead to a traumatic reaction: an event they witnessed or heard about, particularly if there are violent or gruesome details. It’s usually an event where there is a threat of serious bodily harm or injury or death.
Q: Could an event like the Las Vegas shootings cause trauma, even for those who weren’t there?
A: For sure. When there is something like that — seeing it repeatedly on TV, on 24-hour news, the sounds of ongoing shooting, scenes of people being distraught — little brains aren’t able to process that, to understand that it’s over, that it’s not continuing to happen, and sometimes it’s hard for us to provide reassurance. With a natural disaster like the fires in California, particularly for very small children, they don’t understand where Santa Rosa, Calif., is and that it’s not close.
One coping strategy for families is to look for the helpers. Fred Rogers (of Mister Rogers’ Neighborhood fame) used to say to look around and see how many helpers there are: all the firefighters, policeman, teachers — there are lots of adults who care about you. Who are the helpers in our neighborhood? Who are the people we know who we can go to if we needed help? That can be very reassuring to children.
Q: What are some physical symptoms of anxiety in children?
A: When children have anxiety, their heart tends to race, they may get sweaty, they may get dizzy, they may have a tingling sensation, and they may feel faint. They might feel sick, like they have the flu, or they can’t catch their breath.
Q: How do you broach the idea of seeking professional help with your child without making them feel more anxious?
A: I typically refer to myself as a “feelings doctor.” So I tell kids if you have a sore throat or chicken pox you go see your pediatrician; and if you have a sore tooth, you go see your dentist. If you have sad feelings or behavior that’s getting in the way of life, you go see a feelings doctor.
Try to reassure children that they are not in trouble. We’re kind of like detectives trying to figure out a mystery or solve a problem, and they are a big part of the team trying to figure that mystery out. If we look at it more as a problem-solving model than blaming, kids tend to buy into that more.
Q: Does it help for kids to know they are not alone in experiencing anxiety?
A: One of the things I loved about running the groups at DHMC was that kids could see that they were not the only ones, and that they might be good at something that someone else is afraid of. For instance, I’ve always had a tough time going to the dentist, but there were kids in my group who could say, “I can go to the dentist, I just can’t give an oral report.”
Q: What does treatment involve?
A: First, we want to understand the problem. What are the triggers for anxiety and what are the behaviors that get in the way of typical functioning? Next, we would typically coach children in relaxation strategies and get them to practice this at home until it’s easy for them to do.
Sometimes, we teach the child to conceptualize and externalize the anxiety, and give it a name; so that “Mr. Worry” can’t bully you and he certainly can’t bully your parents. He can’t boss you around.
Anxiety treatment is very much dependent on a child’s ability to practice the strategies and to tolerate being a little bit uncomfortable.
Most kids, when they are anxious, try to avoid the situation that makes them anxious. To treat them we have to teach coping strategies, but also to expose them to situations that they are not entirely comfortable in, so they can learn that those situations are not dangerous.
This is where it’s helpful for parents to have their own support, either through their own mental health services or a friend who has been through something similar, because oftentimes what we are asking the parents to do is hard. We are asking the parents to allow their child to be uncomfortable, and for most parents that’s really difficult. We’re helping the parents to reframe their thoughts about it: Is your child in danger? The discomfort that the child is in temporarily while they are working on these strategies is not harmful, it’s helpful.
Q: Aside from treatment, what are some things parents can do to support their children to feel less anxious?
A: Learning how to relax is one of the most important skills that kids can have. A lot of schools are starting to teach yoga and meditation. So finding out what the language is that the schools are teaching and being consistent with that is helpful. Also, going on YouTube and finding some child-friendly recordings, and there are a variety of free apps available that help you do short relaxation modules.
Learning how to use abdominal or “belly” breathing: in through your nose, out through your mouth, very slowly. It’s not an instant fix; it may take several minutes, but it’s a very practical thing a parent can do with the child. The other thing is, in terms of the pressures kids are under, focusing on the process of learning as opposed to the end result of a grade. Focus on the behaviors that go toward mastery of a subject or skill.