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Supporting children and young people with stress and anxiety

Stress is caused by an existing stress-causing factor or stressor. Stress can be ‘routine’, related to everyday activities or ‘sudden’, brought about by a change or transition, or ‘traumatic’, in relation to an overwhelming event.

During stressful events our adrenal glands release adrenaline, a hormone which activates the sympathetic nervous system, our body’s defence mechanism which causes our heart to pound, blood pressure to rise, muscles to tense, and the pupils of our eyes to dilate. Historically, this prepared us to respond to attackers with one of three responses – fight, flight or freeze.

This stress response can still be helpful to us today. It provides a burst of energy which can help us to stay safe when suddenly facing a speeding car, for example. Or, it might help us meet deadlines and goals through increased efficiency and focus. Our stress response ceases to be helpful if it is activated too easily or at a level which is too intense or if it goes on for too long, preventing us from returning to a relaxed state.

Anxiety is stress that continues after that stressor is gone. When we are anxious, fear can take over whenever there is worry and apprehension. This can lead to irritability, low mood, social withdrawal, lack of motivation, poor concentration and nervousness, as well as physical symptoms like chest pains, disruption to eating routines, dizziness, shortness of breath, fatigue and panic attacks.

There are multiple triggers for stress and anxiety in young people today. Those most commonly reported include school, exams and future prospects; social difficulties including peer pressure, social media issues and bullying; family concerns such as conflict or financial problems; and major world events. For some, these factors can become overwhelming.

A good place to start when helping children and young people with stress and anxiety is to be aware of what we are thinking, feeling and doing ourselves. This will help us to tune in to kids and look after ourselves so that we can stay calm, alert and responsive. There are many routes to self-care – the 5 Ways to Wellbeing is one of them – How are you doing right now? What steps might help you to build your own self awareness and take care of your own support needs?

Secondly, psychotherapeutic work is naturally based on a belief that by talking and thinking about difficulties we create space for creative exploration, digestion/ processing, increased understanding and new perspectives/ opportunities. It can be helpful to take a moment to consider where you stand yourself with regards to talking about feelings.

And do you think your child/ teenager believes it is okay to have feelings? Whether the answer is yes or no, how might he/she have picked up this message? What do we think is likely to help give a message that it is okay to feel feelings and to talk about them?

We can begin by making time to notice how young people are doing, listen to their concerns without judgement and then take them seriously. In ‘How To Talk So Teens Will Listen’ and ‘Listen So Teens Will Talk’, Faber and Mazlish (2006) advocate: “Identifying thoughts and feelings . . . Acknowledging feelings with a word or sound . . . Giving in fantasy what you can’t give in reality . . . and . . . Accepting feelings as you redirect behaviour.” (p31).

To make the above possible, it helps if we can stay calm and avoid becoming either frustrated or overwhelmed with our own worries about the child’s worry. We also want to steer clear of trying to fix things too quickly as this can seem like we’re not really interested in a child’s felt experience.

Being listened to can start to give shape to what might often feel like a formless mass of uncontrolled emotion. Feeling understood can, in itself, help to bring anxiety under control. It then becomes more possible to actively build self-awareness through tools like a stress-graph or diary, which maps stress intensity across a day, week or year. Other visual systems using scales and colours can be helpful too. A 0-5 scale, for example, can enable children to identify the difference between a slight glitch, a small/ medium/ large problem, and a situation which feels quite huge or even like an emergency. Other systems like the ‘Zones of Regulation’ or the similar ‘Just Right State Program’ (widely used in Brighton and Hove schools) help young people to notice their emotional/arousal state at any given time and to learn what helps them either to up-regulate or down-regulate in those moments in order that they can relate and learn effectively.

Specific calming approaches can be taught such as deep belly-breathing or simple, unobtrusive techniques for the classroom like hand-breathing or square breathing. Positive self-statements can also help – in place of an ‘all or nothing’ catastrophic approach (“I’ve messed up this essay, I may as well give up”) the young person might say to herself, “I’ve done it before, I can do it again” or “this feeling will pass”. Others may benefit from being helped to express thoughts and feelings through writing or drawing. Others might need to move around, take sensory breaks, do Yoga, make a mess with clay, cook a meal together, make a special den, imagine a calm place, complete a puzzle, make a list or listen to a favourite story or a book about anxiety, like ‘The Huge Bag of Worries’ by Virginia Ironside. Lots of helpful ideas for activities can be found in Karen Triesman’s ‘Treasure Deck of Grounding, Soothing, Coping and Regulating cards’.

Young people who are feeling sufficiently safe and regulated might also be able to consider the bigger picture of how their thoughts, feelings, body sensations and behaviour all inter-relate and where they might be able to make one small change which could then have a beneficial knock-on effect. Read more on these approaches in books like ‘Starving the Anxiety Gremlin’ (Kate Collins-Donnelly) and ‘Overcoming your child’s fears and worries’ (Cathy Cresswell).

For young people who are specifically stressed about exams, the following links may be helpful:

– The #NoStressSuccess series of video clips on Youtube about a wide range of opportunities for education and training post-16, made by Brighton Met College students.
– The ASAP Science Youtube clips: 9 Best Scientific Study Tips and 7 Tips to Beat Exam Anxiety.

As supporters of children and young people, one challenge we have is to be regulated in the way that we offer help and ideas. If we overload with strategies and things to ‘do’ to make the stress go away, we can be in danger of increasing pressure rather than decreasing it. If we can remember to be accepting of our children and if we model self-acceptance ourselves, we might go a long way towards helping them effectively manage stress in their lives. Dan Millman has said: “Resistance creates suffering. Stress happens when your mind resists what is. The only problem in your life is your mind’s resistance to life as it unfolds.” And in a similar vein, the following Chinese Proverb tells
us that: “Tension is who you think you should be. Relaxation is who you are.”

 

Michael Reeves is a Psychotherapist working with children and young people aged 4-18 and/or their parents/carers. He is available as a clinical supervisor for training or practising therapists and counsellors, whose work is primarily focused on children/ families/ parents. He is available at our Lewes Practice.

 

Further reading by Michael Reeves –

Educational Psychotherapy (2) – developing empathy, mind-mindedness and self-discovery

Educational Psychotherapy (1): supporting social-emotional development and learning

Curiosity: how can children’s behaviour help us understand what they need from us?

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The Benefits of Yoga Breathing for Children with a History of Trauma

When children feel helpless, angry, or scared for long periods of time, it can be remembered in their bodies. This is particularly so in the case of trauma, whereby specific (trauma-implicated) body parts may start to feel somewhat disconnected to the rest of the body (e.g. headaches, neck pain, stomach aches, back spasms, etc.). Body tension is also common in children who were very young at the time of their trauma and, therefore, may have no conscious or verbal memory of it. This phenomenon can be hard for parents (and professionals!) to make sense of and can often lead to them seeking assessment and treatment for many things before considering the long-lasting impact of historical stress or trauma on child. An important task of a psychologist, therefore, is to help chronically stressed or traumatized children to tolerate physical sensations without being afraid of then. This includes teaching them how to regulate their own internal arousal.

The brain-body system that we target in this kind of work is known as the Autonomic Nervous System (ANS) – also known as our ‘survival system’. At its most basic level, the ANS is comprised of two discrete branches called the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS is associated with the release of chemicals such as adrenaline, which spur the brain and body into action. The PNS on the other hand, is associated with the release of chemicals such as acetylcholine, which enables us to be calm and to regulate important bodily systems such as our digestion and sleep. In a healthy child, the SNS and PNS work closely together to enable a child to have an optimum awareness of both themselves and their environment, so that they can respond to each appropriately. For some children, however, historical stress and trauma can cause the SNS too become too powerful, leaving the child vulnerable to quickly dysregulating in response to misunderstood internal sensations or external stressors.

One biological marker that has been identified as a strong indicator of how well the ANS is working is ‘heart rate variability’ (HRV). In healthy children, the very act of breathing leads to steady, rhythmical fluctuations in their heart rate, which in turn is a measure of their wellbeing. This is because inhalation activates the SNS (and therefore raises their heart rate), whereas exhalation activates the PNS (and therefore slows heart rate down). Good HRV – and therefore, good balance between the SNS and PNS, enables children to execute a reasonable degree of self-regulation, including being able to calmly appraise upsetting situations without dysregulating, such as disappointment or peer rejection. Poor modulation between the two systems, however, negatively affects how their body and brain responds to stress. Research indicates that people with posttraumatic stress disorder (PTSD) often have poor HRV (Hopper, et al., 2006).

One way to improve HRV, has been shown to be through focused breathing techniques. Indeed, simply changing the way one breathes, has been associated with a wide range of positive physical and psychological outcomes, including marked improvement in mood disorders, asthma, and back pain (e.g. Pilkington, et al., 2005; Sherman, et al., 2005; Streeter, et al., 2010). Focused breathing techniques for children can be found in many forms, but one particularly successful form has been shown to be via Yoga. This may be because Yoga supports children to pay attention to what is happening within their bodies rather than just outside of it – teaching them that all sensations peak and fall, with a beginning, middle and end (Van der Kolk, 2014). This can be of particular benefit to children who rely on either sensory numbing or over-stimulation, or who may need additional support to feel ‘safe’ in their bodies.

In my clinical experience, I regularly find that children, even without a history of trauma, can still benefit hugely from mindfulness-based breathing exercises. For this reason, I am very grateful to Dr Emma Stevens (Clinical Psychologist), for recommending a lovely book of breathing for young children based on the principles of Yoga – “Frog’s Breathtaking Speech” (Chissock and Peacock). My children have loved reading this story and learning the techniques. I hope yours will too!

 

References:

Chissock, M. & Peacock, S. (2020). Frog’s Breathtaking Speech How children (and frogs) can use Yoga breathing to deal with anxiety, anger and tension.

Hopper, J., et al. (2006). Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. Journal of Psychosomatic Research, 60 (1), pp. 83-90.

Pilkington, K., et al. (2005). Yoga for Depression: The Research Evidence. Journal of Affective Disorders, 89, pp.269-85.

Sherman, K., et al., (2005). Comparing Yoga, exercise and a self-care book for chronic low back pain. Pain, 115, pp. 107-17.

Streeter, C., et al. (2010). Effects of Yoga versus walking on mood, anxiety and brain GABA levels: A randomized controlled MRS study. Journal of Alternative and Complementary Medicine, 16, pp. 1143-52.

 

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes Practice.

 

Further reading by Dr Laura Tinkl

Why behavioural approaches do not work for all children

Tips for talking to young children about their behaviour

Parenting Styles

‘Ghosts in the Nursery’ – The Power of Family Scripts

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Why behavioural approaches do not work for all children

One of the most frequently asked questions put to me in clinic, is why some children do not respond to traditional reward/punishment based behavioural strategies. The answer is simple – because, contrary to popular opinion, these strategies do not work for all children in all situations.

This is because the ability to make a mental link between a behaviour and a punishment, and to then be to be subsequently less motivated to use that behaviour again, actually involves quite sophisticated cognitive processes. It also requires specific parts of the brain to be functioning well. Difficulties with this may apply to children with learning disabilities or neurological conditions. It may also apply to children who are anxious, fearful or traumatised. This is because anxious or fearful children are often operating from a very primitive part of their brain that physically impedes their ability to access more developed parts of their brains. This in turn makes it harder for them to make cause and effect links, to generalise, to suppress their impulses, to make rational decisions, to maintain empathy for others and, in some cases, even to trust in the motivations of others. Punishing these children without supporting them to understand what is happening for them, therefore, is actually more likely to increase their fearful behaviours and further undermine their trust in those around them. For some children, it can also exacerbate feelings of shame.

A second concern with an overly heavy reliance on behaviourist principles when applied to children, is the theoretical and research origins upon which these principles are based. Behaviourism was largely developed in the 1950s and 1960s in laboratories with small mammals such as dogs, cats and rats – animals with significantly less developed brains than our own. Whilst these experiments can teach us a lot about how to shape behaviour in its purist sense therefore (i.e. classical and operant conditioning), they offer nothing in terms of how we build children’s self-esteem, build their intrinsic motivation, or even how to protect their attachment relationships. For instance, classically conditioning young babies to sleep by ignoring their attachment-seeking behaviours, can have detrimental effects on a child’s subsequent relational security and internal regulation skills. Similarly, a heavy reliance on operantly conditioning ‘good behaviour’ in young children with external motivators (e.g. star charts) has been shown to undermine a child’s natural desire to problem solve, be creative and to keep building on their successes when these external motivators are later removed.

Whilst some behavioural principles within a parenting repertoire can undoubtedly be helpful, therefore, when used to excess, and particularly when used in the absence of a broader context of sensitive, loving and developmentally appropriate care, they can quickly become damaging. This is because human children have brains that require so much more from the parent-carer relationship than simple behavioural conditioning.

Part of my role as a Clinical Psychologist, therefore, is to help parents, carers and professionals, to find new and more effective ways of supporting children to reach their full potential.

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Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes Practice.

 

Blogs by Dr Laura Tinkl

Tips for talking to young children about their behaviour

Parenting Styles

‘Ghosts in the Nursery’ – The Power of Family Scripts

When praise becomes harmful to children

The role of ‘attunement’ in relationships with babies and young children

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Covid-19 – talking with children in uncertain times

How do we contain our children’s anxiety in such uncertain times, when we too feel anxious and unsure ourselves?

When children are nervous we may notice them continually searching for reassurance – the usual advice would be to acknowledge this but keep reassurances to a minimum, modelling to them that fundamentally the adults in their life believe that the world is a safe place.

However, here we are – smack bang – in the middle of unprecedented times where it may be difficult for us, ‘the grown ups’, to keep level heads ourselves around our families health and economic future.

Our most important job is to manage our own anxiety whilst engaging with our children honestly and openly about the developing situation. Their worlds of home and school have been thrown into orbit; they had to say a hastened, brutal goodbye to friends and teachers not knowing when they would see them again.  The novelty of not being is school has now probably faded a little – time at home with parents is usually pleasurable but sometimes not.  Relationships can be put under extraordinary pressure when we are in lockdown with an unclear future.

Whilst we need to talk to children openly and find out their understanding of the pandemic, our responses should contain reassurances aplenty but we must to be careful not to give absolute guarantees.

It is within human nature to endeavour to provide an environment for our children in which they feel safe. Maybe we can begin to appreciate how these trying times can be viewed as an opportunity for us to model kindness, resilience and compassion.  We can hope that our children will remember these formative times as a period in which they learnt important life lessons along with resilience for their futures.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Family Therapy for Beginners

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Tips for talking to young children about their behaviour

When talking to young children, most people know that ‘open’ as opposed to ‘closed’ questions are helpful. That is, questions that cannot easily be answered with a simple “yes” or “no” answer and invite the child to give more information. These questions typically start with “who..?”, “where…?”, “what…?” and “how…?”. What many people don’t realise, however, is that the most frequently used open-question starter – “why…?”, can be hugely counterproductive to conversations with young children.

This is because young children can easily experience the word “why” as threatening. A “why” question implies that the child should have (and the adult expects them to have) a level of insight about their behaviour that they genuinely might not have at this stage. For some children it can cause them to close down by becoming silent or simply saying “I don’t know”, which can feel infuriating to parents. Other children may feel the pressure to just give an answer – any answer – which might not even make sense (e.g. “I did it because my tummy was hurting”). This is because they just feel the pressure to say SOMETHING, which can also feel upsetting to parents. (Incidentally, when a child says that their tummy is hurting, that actually can be a sign of anxiety).

Much better, is to side-step the “why” question altogether with young children (e.g. “what made you do that?” or “when you did that, what did you think might happen?”) These kinds of questions keep the dialogue flowing and importantly, help the child to start to understand for themselves what their thoughts, feelings and motivations were when they used a particular behaviour.

This is an important foundation step towards impulse control and emotional regulation.

 

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes Practice.

 

Blogs by Dr Laura Tinkl

Parenting Styles

‘Ghosts in the Nursery’ – The Power of Family Scripts

When praise becomes harmful to children

The role of ‘attunement’ in relationships with babies and young children

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