Anxiety is a feeling of worry, nervousness, or unease. Everyone feels anxiety at some point in their life like before a big test or on a roller coaster. Anxiety is not dangerous; even though it can be very uncomfortable it will not hurt you. It does not last forever, anxiety will always eventually decrease. One of the hardest parts about helping someone with anxiety is that you often cannot tell someone is having anxiety just from looking at them. In many children anxiety may look like anger or sadness.
Why do we have anxiety?
Anxiety is adaptive. It is meant to protect us by preparing our bodies for danger by releasing cortisol and adrenaline which activates our fight-flight-freeze response. This response is a protective reflex that helped our ancestors survive in the wilderness. If they saw a bear they would: fight it, run away or freeze in place until it went away and this helped them survive. Over time our environment has changed and we aren’t faced with bears very often, but that fight-flight-freeze system remains. Sometimes our bodies think there is danger (when we have to talk in public) and have this response but there is no real danger, this is called anxiety.
What does a person feel when they are anxious?
A person may have any combination of these symptoms:
- Rapid heartbeat and rapid breathing: when your body is preparing itself for danger it makes sure enough blood and oxygen is being circulated to your major muscles which allows you to run away faster or fight off danger
- Hot and cold flashes: these are due to sweating and the fact that blood is flowing away from your skin and towards your muscles
- Sweating: sweating cools the body and makes the skin more slippery and difficult for an attacking animal to grab you
- Nausea and diarrhea: when faced with danger the body shuts down any parts that they don’t need for survival so all the energy can go to the heart, lungs and muscles. The stomach isn’t essential so it gets turned off even if it’s halfway through digesting a meal
- Feeling dizzy or lightheaded: since all your blood and oxygen is going to your muscles you breathe faster to keep up and that can cause hyperventilation which leads to dizziness
- Tight or painful chest: your muscles tense up in preparation for danger which makes it painful to take in large breaths
- Numbness and tingling: hyperventilation can also cause numbness along with the fact that blood is bypassing the fingers and toes since they are not essential for fighting
- Vision changes: when responding to danger our pupils dilated to let in more light so we can see clearly but it also makes things look brighter and fuzzier than normal
- Choking sensation: increased muscle tension around the neck along with rapid breathing dries out the throat to make it feel like you are choking
What is Separation Anxiety
It is normal for children to sometimes feel anxious or insecure when separated from their parents or other important caregivers. Usually, such separation anxiety fades as they grow up and become more confident. If your child’s separation anxiety continues to persist after the age of five and starts affecting his or her life (e.g. refuses to be out of sight of parent), then your child may have Separation Anxiety Disorder, which involves excessive anxiety when a child is, or is expecting, to be separated from home or a loved one (such as a parent or a caregiver). Separation Anxiety Disorder has three peaks: between ages 5-6, 7-9, and 12-14.
Anxious thoughts include: a variety of different worries about separation or being alone. Younger children may not be able to identify any specific worries, and instead just say that they do not want to do an activity. Older children and teens may describe worries about something “bad” happening, either to them or to a parent/caregiver. Common worries include:
- What if something bad happens to mom or dad?
- What if I get lost?
- What if grandma doesn’t pick me up after school?
- What if I get kidnapped?
- What if I get sick and mom isn’t there to help me?
Behavioral symptoms of younger children include: crying, clinging, or temper tantrums when anticipating or actually experiencing separation. They may have difficulty falling asleep alone, and have nightmares with themes of separation or death of loved ones. Often children with this problem will say things like:
- “Don’t leave me alone!”
- “Where are you going?”
- “Mommy, don’t go!”
- Children with this problem might also refuse to:
- Be in a room by themselves
- Stay at school or participate in activities (such as swimming, sports, or other group activities) unless a trusted person stays with them
- Be at home with a babysitter when the parents are out
- Sleep alone
Behavior symptoms of teens: Although Separation Anxiety Disorder is more common in elementary-school aged children; teens might experience separation anxiety when adjusting to a transition or a stressful situation (such as a divorce, or the death of a parent). For example, they suddenly may not be able to:
- Go for sleepovers with friends they know well
- Stay at school if a parent or trusted family member is not there
- Go on a school trip unless a parent comes along
- Use public transportation alone
What makes anxiety worse?
- Negative self-talk: repetitively thinking negative thoughts keeps the anxiety part of the brain activated and doesn’t let the logical thinking brain work.
- High level of stress over a long period of time: stress hormones like adrenaline and cortisol prime the body for a panic attack making it easier to have one
- Caffeine: caffeine activates the same systems in the body used for the fight-flight-freeze response tricking our brains into thinking we are having a panic attack
- Lack of sleep: sleeping 7 to 9 hours per night at least four nights a week will help keep cortisol levels low
- Being too “in tune” with your body: focusing on your pounding heart or tight throat can trick the body into thinking there is real danger and therefor releasing more adrenalin for the fight-flight-freeze response
- Not relaxing enough: the brain can forget how to relax if you don’t practice it enough
- Not using your thinking brain enough: the brain can focus more on emotions if it doesn’t have logical or creative activities to do
Simple Steps to Reduce Anxiety
- Use a coping skill when you find you are engaging in negative self-talk. Go for a walk or draw a picture to distract yourself.
- Reduce any stressors that you are in your control
- Seek out social support (friends, family, therapy) to process stressors that you cannot change
- Limit the amount of caffeine you drink
- Problem-solve any sleep difficulties, and aim for 7-9 hours at least five nights/week.
- Remind yourself that bodily sensations can mean multiple things. A racing heart may be due to dehydration and not a panic attack. Nausea may be from a stomach bug and not anxiety.
- Practice relaxing at least once per day (eventually it will become part of your daily routine)
- Increase activities that engage your thinking brain, such as reading, socializing, doing puzzles or writing, creating artwork
- Have a plan for when a panic attack occurs. Know who you can talk to or what coping skills you will try ahead of time
Treatment
During therapy, children are encouraged to play out their fears with toys so that they can brainstorm new solutions and be comforted. They may also track their worry level with a thermometer. It can also be helpful for children to have a worry box to keep their worries in and periodically check in on them.
Helping a Loved One with Anxiety:
It is difficult to watch a loved one suffer but often we don’t know what to do when anxiety is present, especially if you don’t have an anxiety disorder yourself.
What Not to Say
Sometimes, well-meaning family members offer advice that really doesn’t help at all, and in some cases, may make the anxiety worse.
Some examples of what not to say are:
- Just relax
- Think about something happy
- Don’t worry so much
- Don’t think so much about _______
Although these sentiments are nice, they really are not helpful. It is hard for someone to just “turn off” their anxiety and worry. This may be possible after a great deal of practice or after treatment has been successful but for someone in the throes of anxiety, telling them not to worry is as useless as telling them you plan on taking a trip to the moon.
These types of statements may also cause the anxiety to worsen, at least for the short term. Calling attention to the family member’s inability to relax or to stop worrying can increase their feelings of anxiety and cause even more stress.
What Not to Do
Another way in which we often reach out to help another person is by doing things for them. It is natural to want to be helpful but there is a limit to how much you can and should help. For example, when a family member feels he or she could not possibly go shopping without you by their side, you may choose to go. But this can help to foster the belief that shopping alone is too difficult. It creates feelings of dependency.
Being too helpful can also cause a sense that it is you, the companion, which helps to alleviate anxiety rather than finding internal mechanisms to calm anxious feelings or fend off panic attacks.
What will your family member do if you are not available to go to the store? By being helpful have you left your family member defenseless when you are not there?
Another common response to anxiety disorders is to become angry or resentful. For those without anxiety, it is hard to understand why someone is so nervous about going to the store that he or she would stay home rather than go and get needed items. You may become angry, “Just go!” or become resentful that you must carry an extra burden. Neither of these approaches are helpful and may also cause the anxiety to worsen.
How to Help
Anxiety is a treatable mental illness. Mental health professionals can help a person with anxiety live a productive life. Treatment options include medication, cognitive behavioral therapy, group therapy and individual therapy. Additional methods of dealing with anxiety include exercise, meditation and deep breathing techniques.
Learning about anxiety disorders and how they impact people’s lives can be helpful. The more you understand about their illness, the better prepared you will be to help in following a treatment plan and offering the appropriate help. Your family member needs your support and understanding. With it, recovery, although difficult, can be made a little easier.
Encouraging your child to stop seeking reassurance
Children with separation anxiety often seek excessive reassurance from their parents. They ask questions like: “Are you sure you won’t go further than the neighbor’s backyard?” and “Are you sure I won’t get sick if I go to school?” They do this to try to be 100% sure everything is alright. Parents often find this quite tiring and frustrating! When your child is excessively and repeatedly asking for reassurance:
- Tell your child that this is just anxiety talking. Your child is always asking for reassurance because the anxiety is bullying him or her around.
- Make a plan with your child about beating back anxiety by not giving reassurance.
- Tell your child that he or she can only ask you something once.
Being Supportive
Recovering from anxiety is an individual process. It may not follow a set pattern and there may be setbacks along the way. Being supportive requires patience and acceptance.
The following may help you:
- Recognize all accomplishments, no matter how small. Let your family member know you appreciate the effort he or she has put forth. Find positive improvements no matter what, even if your family member only partially met a goal.
- Measure success based on your family member’s progress rather than measuring based on “societal” standards.
- Expect stressful times to cause increased anxiety and change your expectations during these times.
- Help your family member stay on a daily routine. Structure can help to minimize anxiety symptoms. Predictability can help maintain stress levels, surprises can increase anxiety.
- Rather than assuming you know what the family member needs, ask what you can do.
Anxiety does not need to be permanently disabling. Accept that treatment may take some time and be patient as your family member goes through the steps to recovery, but don’t accept or settle for permanent disability.