Read an Excerpt

The Anxiety Cure for Kids

John Wiley & Sons

Chapter One

The Dragon

This book must begin with the Dragon, because without the Dragon there is no problem. The anxiety Dragon is the cause of the disability and the distress that your child exhibits. Of course, the Dragon is an imaginary creature. Our explaining that anxiety is like a Dragon may strike some people as simplistic-or, even worse, as condescending. We see the functions of the Dragon, the Wizard, and the Research Notes quite differently. These tools are invaluable in explaining the complex biological, psychological, medical, and research components of anxiety. The field is changing rapidly, and changing for the better, as you will see in Chapter 2. For now, however, the best way to explain anxiety is to begin with the reason you picked up this book: you care about a child who is in distress. We know many children like this. Throughout the book, we give examples of kids with anxiety problems, because it is inspiring to read about other children with similar problems who got well. We have tried to keep these stories nonthreatening. We do not downplay how distressed the child was, but we also show how many options the child had, even in the tough situation in which he found himself. In this book we share with you the stories, strengths, and hopesof people who have overcome anxiety disorders.

We have taken all of the stories in this book from our many years of clinical practice. We've made changes in each story to protect the confidentiality of the families involved. To understand the power of the Dragon, you must be aware of the devastation that anxiety disorders can cause in a child's life. This book is about anxious children and the intense physical symptoms that can cause them to avoid normal activities and the pleasures of childhood. We use words like devastating and intense pain throughout the book. It is too easy for adults or people who do not have an anxiety problem themselves to underestimate the suffering that these problems can cause.

We once worked with a thirteen-year-old boy named Kurt. His parents had adopted him when he was a baby. He was African American and his parents were Caucasian. No one knew much about his biological parents, so there were no genetic clues to help anyone sort out his problems. And Kurt had problems that year. He liked to wear baggy clothes because he had gained a lot of weight over the last year when he felt bad about himself. His psychiatrist said that he was depressed. Kurt had been a worrier all his life. He also had a learning disability. That handicap made it hard for Kurt to do well in school. He had to work harder than the other students to learn things. The kids teased Kurt for being shy and worried all the time and for not being able to spell or to do math easily. Then, when Kurt gained weight, the other kids teased him even more. All Kurt really wanted to do was stay home with his mom, who loved him. He was safe at home. Kurt and his mom had fun together sometimes, but when Kurt was really sad, even being with his mom wasn't much fun. Kurt's psychiatrist helped him by having him take a medicine and then recommended that Kurt see a therapist.

Kurt was worried about seeing the therapist, especially when she asked him to keep a Journal of how he was doing. That sounded a lot like school, and right now he didn't like schoolwork. The first week Kurt didn't fill anything out in his Journal and brought it back empty. He didn't know how his therapist would react. To his surprise, she said that she had set up the Journal wrong. Instead of asking him to write in it, she wrote in it for him while they decided on goals and tasks for the week. She wrote down what Kurt told her. His words were in the Journal, but the therapist wrote them. That made it a lot easier for Kurt. She put check boxes next to the assignments so that Kurt could gauge his progress. She left a blank line for him to record, from 0 to 10, the amount of anxiety he felt during each practice session. This Kurt loved. He liked trying new ideas at school when other kids teased him. He loved having homework that asked him to play outside with a friend. After a few sessions with his therapist, Kurt felt much better. In fact, he realized that he was worrying less than he ever had in his whole life.

Kurt looked at the last assignment on the list: think about the good parts of having anxiety. When his therapist first asked him to do this, it made no sense to Kurt. What could be good about being tortured by the Dragon? It was fun finding out how to get his Wizard to fight back, but, overall, it was a lot more work and pain than not having the Dragon to begin with. Kurt spent a lot of time that week thinking about what was good about his anxiety. He thought about the boy in school who teased him the most. This mean bully had taken things from Kurt and other kids. Most of the students in Kurt's class were afraid to tell the teacher about the bully. Kurt realized that this kid had no anxiety. It didn't bother him to make other kids mad or unhappy. Kurt, on the other hand, would never steal from kids or tease them, because he knew that it would make them sad. He didn't want to hurt other children or anyone, for that matter. Kurt realized that sometimes worry was a good thing. His worry made him a better friend than if he had no worry at all. His worry made him honest. Kurt realized that some worry was a part of who he was, and that he liked that part of himself. It was great to feel that he didn't have to change a part of himself at all. He would be great, just the way he was, now that he could manage his worry.

This is how the Anxiety Cure works for kids. As therapists, we are lucky to see this story unfold, with endless variations, day after day. It starts out, in classic fairytale fashion, with pain and unhappiness and almost always ends with satisfaction and joy. What happens in this story may seem like magic to you, but it isn't. Though it takes hard work, the rewards are tremendous.

Anxiety and Fear

Before you are introduced to the Dragon, the Wizard, and the Research Notes, we want to explain a few important ideas. Let's start with the word anxiety. It needs to be separated from fear. Fear is what you feel when you confront a real, immediate danger. For example, when a big bully directly threatens your daughter in the school playground, your child feels fear. When your son is climbing a tree and his feet slip out from under him, he feels fear. When your child is not facing a bully but fears going to school because a bully might be there, that is anxiety. When your child finds even looking at a tree to be scary because he might fall, that is anxiety. Fear occurs when the danger "is." Anxiety occurs when the danger "might be." Fear is generally uncommon-but familiar-in a child's life. Almost every child experiences fear in some situations. Anxiety, in clear contrast, can be a constant companion to your anxious child, in situations that would not provoke anxiety in most of your child's peers.

Anxiety Is Made of Thoughts, Feelings, and Behaviors

Anxiety is a vaguely defined and commonly used word that also has a strict scientific meaning. In modern mental health research the word anxiety describes the thoughts, feelings, and behaviors that occur when a person has the perception of serious danger in situations where other people do not perceive danger. Anxiety means worrying that something really, really bad might happen at any minute. For example, a younger child might worry about a monster jumping out from under his bed. An older child might worry that she will be embarrassed in front of her classmates at school. For a child of any age, another serious cause of anxiety might be a major illness or the loss of a parent. Thoughts like these scare anyone. They sure can scare a child. Disturbing as these thoughts are, anxiety is more than just troubling thoughts. Strong feelings, such as tension and emotional pain, also come with anxiety. The pain can be a low-level chronic ache or a severe and acute pain. It can show up in any part of the body. Children commonly feel anxiety as a stomach ache or a headache. A person's whole body participates in the experience of anxiety, with a racing heart, tight muscles, and shallow, fast breathing. Anxiety can make a child feel that he has to urinate, defecate, or vomit.

Anxiety is even more than disturbing thoughts and painful feelings. Anxiety shows up in the anxious child's behavior. Anxiety causes the sufferer to pay absolute attention to the source of possible danger and to prepare to fight for his life or to immediately flee to safety. In the modern world, fighting is seldom a realistic option when anxiety makes its appearance, but flight is all too commonly the behavior that intense anxiety causes. "Get out of here right now!" "Don't go near that dangerous place!" Anxiety takes up a lot of mental capacity. Anxiety makes it hard to read or study or even to think about anything except the object of the anxiety. Anxiety is exhausting. It leads to intense fatigue and depression-to feeling defeated and helpless. These problems affect not only the child with anxiety but his entire family as well.

The Holes Dug by Anxiety

Most anxiety-caused behaviors are children's attempts to take certain activities out of their lives. You can detect the presence of anxiety by the absence of other things, the "holes" that occur in the anxious child's life. Anxious children stick close to home and have limited social activities. There is one exception to this general rule. When children have compulsions-repetitive rituals used to ward off anxiety (such as hand-washing, for contamination fears)-then you see something abnormal added to their lives. Yet more typical of anxiety-caused behaviors is children's failure to go to school, to speak up in class, or to spend the night at a friend's house. Travel can be avoided; so can petting a dog or being in the same room with a cat. Those are important activities, the loss of which is common in the lives of anxious children. Literally thousands of abnormal holes in children's behaviors are caused by anxiety, as part of the brain's powerful automatic fight or flight response to the perception of imminent danger.

The physical and mental experience of intense worry, sometimes called a "panic attack" when it is very severe, can come out of the blue at a completely unexpected time; it's the emotional equivalent of a sudden clap of thunder on a cloudless summer day. More often, panic occurs in particular situations that are feared by the anxious child. A child with social anxiety may have panic attacks only in social settings where embarrassment is the danger, like being in a school play or even being called on to give an answer in class.

Anxiety does not always show up in a child's life as a panic attack. Anxiety can also be the low, steady rumble of a scared-to-death feeling, as if you knew there was a hungry saber-toothed tiger hiding just out of sight but ready to spring on you at any minute. Maybe that tiger is just ahead of you right now. Maybe he isn't where you think he is. You cannot be sure where he is because you don't see the tiger. Anxious children's fears tell them that the saber-toothed tiger could be almost anywhere at almost any time. Imagine trying to live a normal life with that level of fear as a menacing companion, day in and day out.

The Good Side of Anxiety

Anxiety has a valuable biological function. Scary things do happen to children. In many situations it is good to anticipate problems because your child can then prepare for danger. That is why the capacity for anxiety is built into the human brain. Anxiety can work well to get your child's attention and to get him ready for "fight or flight" in response to real dangers. A child who is anxious about failing a test studies for the exam. A child who is anxious about a car crash wears a seat belt.

For the anxious child, this healthy brain mechanism has run amok. In most circumstances, the danger is not the saber-toothed tiger or the bully in the schoolyard but the "false alarm" itself. Nothing is there for the child to face except his own anxiety, with its associated thoughts, feelings, and behaviors. This experience of anxiety is unlike that of fear because in the child's life, it is neither rare nor brief. Pathological anxiety is often recurring and may be continuous. The problem of anxiety, however, is deeper than the false alarm because the anxious child soon comes to doubt his own body, feelings, and thoughts. He sees that other people, including children his own age, do not feel this way in this situation. Then comes an inevitable, more disturbing thought, "Something is wrong inside. Something is seriously wrong with me!" When your child has anxiety, he fears not only dangers from outside. Worse still are the terrible dangers from inside. A fearful child does not suffer from deteriorating self-esteem because the dangerous problem is outside. The anxious child inevitably does suffer from lowered self-esteem because the deeper, more persistent problem is clearly seen to be inside.

The core problem is the false alarm of danger, which produces a predictable and understandable cascade of anxious feelings, thoughts, and behaviors. The alarm is in the mid-brain, the most primitive part. It is located there because danger is such a big problem in all of life, not just in human life. The uniquely human part of the brain is the extensive cortex, the gray matter on the outside of the brain. The brain's cortex is where thinking takes place. That big cortex is the part of the brain that most makes us human. When the alarm of danger goes off, the entire cortex of the brain is put on alert. It starts working to understand and to explain the alarm, to solve the dreadful crisis that triggered the alarm in the first place. When the cortex does not immediately find a saber-toothed tiger lurking in the bushes, it uses its immense powers of imagination. That's where the "worry machine" comes into this story. In every anxious child's brain is a built-in worry machine. The worry machine harnesses the highly developed imagination that generally goes with anxiety, to spin a steady stream of stuff to worry about.

Panic happens from time to time. As the anxiety problem matures in a child, the panic typically becomes less common. In its place is worry, the "What if" syndrome of possible danger. Here is the way this works. Worry requires doubt, uncertainty. Certainty of safety is what the worried mind craves. The slightest sliver of doubt opens the floodgates of worry.

Continues...

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Excerpted from The Anxiety Cure for Kids by Elizabeth DuPont Spencer Robert L. DuPont Caroline M. DuPont Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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