What to Do (and Not Do) When Children Are Anxious

Then children are chronically anxious, even the most well-meaning parents can fall into a negative cycle and, not wanting a child to suffer, actually exacerbate the youngster’s anxiety. It happens when parents, anticipating a child’s fears, try to protect her from them. Here are pointers for helping children escape the cycle of anxiety.

1. The goal isn’t to eliminate anxiety, but to help a child manage it.
None of us wants to see a child unhappy, but the best way to help kids overcome anxiety isn’t to try to remove stressors that trigger it. It’s to help them learn to tolerate their anxiety and function as well as they can, even when they’re anxious. And as a byproduct of that, the anxiety will decrease or fall away over time.

2. Don’t avoid things just because they make a child anxious.
Helping children avoid the things they are afraid of will make them feel better in the short term, but it reinforces the anxiety over the long run. If a child in an uncomfortable situation gets upset, starts to cry—not to be manipulative, but just because that’s how she feels—and her parents whisk her out of there, or remove the thing she’s afraid of, she’s learned that coping mechanism, and that cycle has the potential to repeat itself.

3. Express positive—but realistic—expectations.
You can’t promise a child that her fears are unrealistic—that she won’t fail a test, that she’ll have fun ice skating, or that another child won’t laugh at her during show & tell. But you can express confidence that she’s going to be okay, she will be able to manage it, and that, as she faces her fears, the anxiety level will drop over time. This gives her confidence that your expectations are realistic, and that you’re not going to ask her to do something she can’t handle.

4. Respect her feelings, but don’t empower them.
It’s important to understand that validation doesn’t always mean agreement. So if a child is terrified about going to the doctor because she’s due for a shot, you don’t want to belittle her fears, but you also don’t want to amplify them.You want to listen and be empathetic, help her understand what she’s anxious about, and encourage her to feel that she can face her fears. The message you want to send is, “I know you’re scared, and that’s okay, and I’m here, and I’m going to help you get through this.”

5. Don’t ask leading questions.
Encourage your child to talk about her feelings, but try not to ask leading questions— “Are you anxious about the big test? Are you worried about the science fair?” To avoid feeding the cycle of anxiety, just ask open-ended questions: “How are you feeling about the science fair?”

6. Don’t reinforce the child’s fears.
What you don’t want to do is be saying, with your tone of voice or body language: “Maybe this is something that you should be afraid of.” Let’s say a child has had a negative experience with a dog. Next time she’s around a dog, you might be anxious about how she will respond, and you might unintentionally send a message that she should, indeed, be worried.

Donation
7. Encourage the child to tolerate her anxiety.
Let your child know that you appreciate the work it takes to tolerate anxiety in order to do what she wants or needs to do. It’s really encouraging her to engage in life and to let the anxiety take its natural curve. We call it the “habituation curve”—it will drop over time as she continues to have contact with the stressor. It might not drop to zero, it might not drop as quickly as you would like, but that’s how we get over our fears.

8. Try to keep the anticipatory period short.
When we’re afraid of something, the hardest time is really before we do it. So another rule of thumb for parents is to really try to eliminate or reduce the anticipatory period. If a child is nervous about going to a doctor’s appointment, you don’t want to launch into a discussion about it two hours before you go; that’s likely to get your child more keyed up. So just try to shorten that period to a minimum.

9. Think things through with the child.
Sometimes it helps to talk through what would happen if a child’s fear came true—how would she handle it? A child who’s anxious about separating from her parents might worry about what would happen if they didn’t come to pick her up. So we talk about that. If your mom doesn’t come at the end of soccer practice, what would you do? “Well I would tell the coach my mom’s not here.” And what do you think the coach would do? “Well he would call my mom. Or he would wait with me.” A child who’s afraid that a stranger might be sent to pick her up can have a code word from her parents that anyone they sent would know. For some kids, having a plan can reduce the uncertainty in a healthy, effective way.

10. Try to model healthy ways of handling anxiety.
There are multiple ways you can help kids handle anxiety by letting them see how you cope with anxiety yourself. Kids are perceptive, and they’re going to take it in if you keep complaining on the phone to a friend that you can’t handle the stress or the anxiety. I’m not saying to pretend that you don’t have stress and anxiety, but let kids hear or see you managing it calmly, tolerating it, feeling good about getting through it.

Read More

Fears of Losing Mental Control in Psychosis Linked to Suicide

Psychiatrists should emphasize a recovery-focused approach and an optimistic outlook when working with people with psychosis.

Negative thoughts about psychotic experiences and fears of losing mental control may heighten the risk of suicide in patients with psychosis who were not taking antipsychotics, suggests a report posted November 2 in Schizophrenia Bulletin.

“Overall, our findings emphasize the importance of clinicians promoting a recovery-focused and appropriately optimistic outlook when working with people with psychosis, taking care to avoid providing information that might heighten negative illness appraisals and/or fears of losing mental control,” wrote Paul Hutton, Ph.D., of the Edinburgh Napier University in the United Kingdom and colleagues.

They analyzed data on the effect of “metacognition” on suicidal thinking. Metacognition refers to knowledge and beliefs relating to the structure and integrity of the self and one’s own cognitive processes.

In their report, they noted that estimates of suicide rates among individuals diagnosed with schizophrenia spectrum disorders range from 5 to 10 percent, making it a leading cause of premature death in this population.

“Given antipsychotics have their strongest effects on the positive symptoms of psychosis, it is plausible that individuals not taking this medication may have greater positive symptom severity than those who do—and that this accounts for their increased suicide risk,” Hutton and colleagues wrote. Yet the researchers said evidence on the contribution of positive symptoms to suicide risk remains unclear, with some studies suggesting no association.

Other studies, however, have found that the way a person interprets or “appraises” their psychotic experiences may be more important than symptom severity for predicting suicidal behavior. For instance, a review published in the British Journal of Psychiatry in 2005 found that people with psychosis who die by suicide were more likely to have “fears of mental disintegration” than those with psychosis who did not die by suicide.

Read More

Anti-Anxiety Drugs Could be a Hidden Epidemic in the Making

As someone who struggles with anxiety, I can understand the desire to find something that can help protect yourself from haunting feelings of dread that cripple your peace of mind. Anxiety is a complicated condition that can creep in from the most unexpected places, and people experience it in many different ways. While some may think it’s based in fear or weakness, the reality is far more complex. Those people may say all you need to overcome anxiety is a more grounded and positive outlook. But the truth for most people with an anxiety disorder is that battling anxiety goes a lot deeper than promoting optimism. Especially when your condition convinces you that all levity is just you lying to yourself. Sometimes, you need a little outside help, and anti-anxiety drugs can be very useful when a physician and an individual decide on the right route to take.

However, anti-anxiety medications can also be dangerous. These anti-anxiety drugs may not be in the spotlight the way opioids are, they are commonly abused, extremely addictive and can be just as lethal.

With recent reports showing a rise in deaths associated with anti-anxiety medications, some experts are saying there is a hidden epidemic being overshadowed by the opioid crisis.

ANTI-ANXIETY DRUGS UNDERESTIMATED
It is true that opioids are doing massive damage all across the country, but that doesn’t mean the death rates due to anti-anxiety drugs should be ignored. While focusing on prescription opioids, heroin and synthetic opioids is important, we should also keep in mind the other dangerous medications out there.

The usual suspects are benzodiazepines, which include drugs like:

  • Valium
  • Klonopin
  • Librium
  • Ativan

While these anti-anxiety drugs may be useful in helping some people, they still carry their risks, which can be devastating and even lethal.

According to the director of the Scripps Mercy Hospital emergency department Dr. Roneet Lev, benzodiazepines are responsible for more drug deaths in San Diego County than people may expect. She says,

“THAT COMES FROM PEOPLE WHO COME INTO OUR TRAUMA CENTER FROM CAR ACCIDENTS BECAUSE THEY’RE ON BENZODIAZEPINES, PEOPLE WHO COME IN BECAUSE THEY’RE FALLING DOWN BECAUSE THAT AFFECTS THEIR BALANCE AND COORDINATION ON BENZODIAZEPINES,”
“WE’VE SEEN TERRIBLE WITHDRAWALS, WHEN THEY’RE USED TO HAVING IT, WITH SEIZURES, THAT END UP IN THE ICU.”
And it isn’t just people who are buying these drugs off the street. Concerning drug-related deaths by legal prescriptions, benzodiazepines are not as far behind opioids as people may think. Dr. Lev adds that while oxycodone is the number one prescribed drug associated with death, hydrocodone is second, and benzodiazepine is in third place.

But San Diego County is definitely not the only area experiencing a surge in benzodiazepine-related deaths. According to the National Institute on Drug Abuse (NIDA), deaths involving these anti-anxiety drugs have more than quadrupled between 2002 and 2015.

Something that does make these medications even more treacherous is when they are mixed with opioids.