Anxiety and Kids [Guest post]

This is the first time I have had a guest post. I am extremely picky about things like that, but I’ve wanted Jen to do a post for me for a long time because she is really good at her work! So, I invited Boulder somatic psychotherapist, Jennifer Delaney, MA, NCC to write a guest post specifically about anxiety, because over the years I have seen that it is a growing problem for our youth. I’ve witnessed more and more kids go to residential treatment centers for anxiety and other emotional problems, whereas those were once just for chemical dependency issues. I work with more and more clients who struggle with debilitating anxiety. For example, one student hasn’t been to school in over a month, because his anxiety is so bad that he can’t get himself out of the house, despite his best intentions. Often parents and teachers do not understand it and that can make things worse, despite trying to help.

Jen is colleague and one of the most talented therapists I’ve ever met. I have sent numerous families to get help from her. Jen teaches body-centered tools to support Brainspotting and other counseling modalities.  She also assists adults and teens struggling with anxiety and transitions such as divorce or beginning college. You can read Jen’s awesome blog here (sign up, it’s fantastic)or check out her Course: Get Calm! Neuroscientific Tips and Tools to Relieve Anxiety 

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The Struggle with Anxiety and How to Support Your Kids

By Jen Delaney

In the Huff Post, Lindsay Holmes states, “Anxiety disorders affect approximately 40 million American adults per year, which is about 18% of the country’s population. They are also one of the most prevalent pediatric psychiatric conditions.”

This is why it’s imperative to identify anxiety early, and to offer kids some skills and understanding about what they are up against, so that they can feel supported to thrive.

The Set Up
It was easier for parents in days of yore, because the emotional well-being of a child wasn’t a top priority. Buck up! Get a grip! I’ll give you something to cry about! were common responses. As psychological awareness increased, life got more complicated. Most parents and caregivers seek to offer kids healthy boundaries and challenge them, while also honoring their emotions and limitations, including anxiety. I have read callous articles bemoaning pandering to kids’ feelings that do not take into consideration the additional pressures kids are under, as well as more subtle influences, such as inherited ancestral trauma.

In the Time Magazine article, “Anxiety, Depression and the Modern Adolescent,” Susanna Schrobsdorff states, “Sometimes called spoiled, coddled or helicoptered… a closer look paints a far more heartbreaking portrait of why young people are suffering. Anxiety and depression in high school kids have been on the rise since 2012 after several years of stability. It’s a phenomenon that cuts across all demographics–suburban, urban and rural; those who are college bound and those who aren’t. Family financial stress can exacerbate these issues, and studies show that girls are more at risk than boys.”

Adverse Childhood Experiences
Sometimes there are more obvious factors called Adverse Childhood Experiences or ACES. The Center for Disease Control and Prevention states, “Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue.” Parents, as well as high school counselors and educators, could offer kids an ACES assessment to have a better understanding of their background.

Awareness = Evolution
I’ve also read articles bemoaning the idea that every kid is getting a trophy, rather than allowing children to experience and navigate loss, and I would agree that protecting children from all inevitable emotional pain isn’t helpful. But human evolution is a messy process. The pendulum will swing, and we will find a happy medium. If you think about it, this long of a stretch of affluence and peace is unprecedented. If we don’t have an external battle throwing humans into survival mode, then we have the opportunity to explore the internal terrain of emotions. This new frontier can be equally terrifying, and often people create internal threats because this newfound peace feels foreign. We recreate what we know.

I Can Relate
Families can be relatively well adjusted and happy, providing a child with every kind of support, and a child might still struggle with anxiety. As a matter of fact, that can contribute to shame if a child is thinking, “I have nothing to be scared about.”

I have a child who struggles with anxiety, and it was particularly difficult for her in high school when academic pressures mounted at a time when she was dealing with social issues. Self-acceptance isn’t exactly on the top of the list at that age. Before they can accept who they are, they need to understand themselves and their limitations, and realize that it’s okay to be themselves. That comes with maturity. Academic and social pressures were hard enough for my daughter to navigate, but throw in a bit of family discord, a personal trauma as well as ancestral trauma (a grandmother who almost died several times in WWII) and a political world full of contention, and it just got to be too overwhelming.

Happily, by supporting her and trusting her process, my daughter is in a successful two-year relationship and is a senior at UCSD. She still struggles with anxiety, but she has learned how to navigate it in her own way and on her own time. Pushing her outside of her “window of tolerance” or shaming her would have exacerbated the problem and led to further disorders.

Window of Tolerance
If you don’t read another word of this article, it is important for children, parents and educators alike to at least watch this 6-minute video about the Window of Tolerance. Each child has different triggers and varying windows sizes. When pushed outside of that window, the cortical brain goes offline and the limbic and reptilian parts of the brain take control. Effective therapies can widen kids’ windows of tolerance and help them to tolerate more pressure.

What is Anxiety?
Some anxiety and fear is usual and customary. After all, if we didn’t have some fear we wouldn’t leap out of the way of an oncoming car that we didn’t hear coming. Some fear protects us. However, when vigilance becomes ongoing hypervigilance, it takes a toll on the body, mind and spirit.

Diagnosis
I am focusing here on what is diagnosed as Generalized Anxiety Disorder (GAD), not Social Anxiety or Panic Disorder, although some people may suffer from a mix of disorders, not just exclusive to anxiety.

I could write a whole post about the advantages and disadvantages of diagnosis, but in a nutshell: The downside is that people may get pigeonholed or labeled based on the diagnosis or a professional potentially might misdiagnose. (Complex Trauma is often misdiagnosed as depression and anxiety.)

Also, it’s important to explain to kids that they are not their disorder. They don’t need to identify as that. It is just a small piece that offers the opportunity to get the right kind of support and helps them to feel less alone. There is nothing wrong with their essential being; they are just dealing with some physiological (not psychological) components that complicate their good intentions and cognitive function.

The Truth about Teens with Anxiety
Most of them are conscientious and have a desire to do well and to overcome their disorder. The internalized shame around the behavioral effects of their anxiety makes the anxiety even worse so to imply that they are weak or trying to get attention exacerbates the issue.

It’s important when talking with teens to tell them that there is nothing wrong with them psychologically. Anxiety is physiological. For some reason, when triggered, their body sends them into survival mode (fight, flight or freeze), which is outside of conscious control. It feels “life or death” to the body and it’s not an option.
Trauma and anxiety triggers are stored outside of the language centers, in the deep brain. When people develop a better understanding about what’s going on in their brain, they can have more compassion for their disorder. Just keep this in mind: Shame makes it worse and sends a person back into the anxiety loop, whereas compassion provides space for the brain to heal.

Symptoms of Anxiety
According to the National Institute of Mental Health, “People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.”

Here is a list of the symptoms associated with GAD:

• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

Many kids suffer in silence, so it’s helpful to consider these symptoms, and if they are exhibiting several of them, to consider GAD as a potential issue.

Common Misconceptions
In perusing the web for myths, I came across many sources.

Here are some of the myths and faulty beliefs listed as blocks to meaningful and lasting recovery:

1. Once you have it, you’ll always have it; there is nothing that can be done.
2. There are quick-fix remedies and miracle cures for overcoming anxiety.
3. If you eat right, exercise, avoid caffeine, and live a healthy lifestyle, your anxiety will go away.
4. Deep relaxation alone can eliminate anxiety disorder.
5. People with anxiety are weak; struggling with anxiety isn’t a big deal.
6. The condition is not that common.
7. Issues with anxiety stem from a poor childhood.
8. People suffering from anxiety should just avoid whatever is causing their fear.
9. The disorder will resolve on its own.
10. Unwinding with a drink can soothe an anxious person.
11. Anxiety disorder is caused by a chemical imbalance in the brain.
12. Anxiety disorder is caused by a genetic predisposition.
13. Anxiety is only born from a certain fear or trauma.
14. There’s nothing you can say to help an anxious person relax.

There are more myths, but this gives you a general idea.

Here’s what young adults with anxiety had to say
(as reported by BuzzFeed staff writer, Anna Kopsky):

1. Anxiety’s a real condition — not just a buzzword.
2. There doesn’t always have to be a tangible reason behind feeling anxious.
3. Sometimes, it hits out of absolutely nowhere.
4. Having it isn’t a quirk. If someone tells you they are anxious, take them seriously!
5. Anxiousness isn’t just “a phase.”
6. Telling us to calm down actually makes things worse.
7. Suggesting that we meditate isn’t very helpful advice.
8. Medication isn’t an instant fix. If it were, though, that’d be incredible, right?
9. No, we DO NOT enjoy being anxious.
10. We are not pretending to have an illness to get attention.
11. We’re not trying to come off as rude, angry, or lazy.
12. Just because we get anxious about seemingly irrational things, doesn’t mean we aren’t logical people.
13. Living with anxiety can get seriously exhausting.
14. Just because we don’t act like we’re on edge, doesn’t mean we’re not.
15. If you have a friend who’s anxious, the best way to help is to be kind, or just listen.
16. And, most importantly, having anxiety DOES NOT make someone weak.

Self-Control vs. Self-Regulation
In Dr. Stuart Shanker and Teresa Barker’s book, SELF-REG: How to Help Your Child (and you) Break the Stress Cycle and Successful Engage with Life, he states, “Self-control is about inhibiting impulses; self-regulation is about identifying the causes and reducing the intensity of impulses and, when necessary [and possible], having the energy to resist. He offers a five-step method to 1. Recognize when the child is overstressed, 2. Identify and then 3. Reduce the stressors 4. Help, or empower, the child to know how to help herself and 5. Help her to develop self-regulation strategies.

While GAD is more overwhelming than just being “stressed,” learning self-regulation can help. If practiced when an individual is calm, it is more likely to help when they are triggered because in spite of the cognitive parts of the brain shutting down, it will have become second nature or a habit to practice self-regulation.

What do you do when the shit hits the fan?
Ms. Holmes goes on to say: “If you’re looking to put someone you know with anxiety at ease, the best thing to do is to ask questions. Inquire from the person, ‘How can I be helpful?’ ‘What can I do or say that’s going to help you in this moment?’ Take your direction from the person themselves instead of going on the assumption of what they may need from you.”

While breath work can be a helpful preventative measure, telling someone who is seriously anxious to take a deep breath will make the situation worse. Remember their bodies are telling them they are in a life or death situation even if they “know” they aren’t, so slowing the breath down feels counterintuitive and, often, will actually send someone into a panic attack.

Instead, try a vagal maneuver.

The Vagus Nerve
Stimulating the vagus nerve brings on board the parasympathetic nervous system and overrides the physiological fight, flight or freeze reaction. The quickest and simplest one when someone is in a heightened or hypervigilant state is to hold an ice cube or put a cold rag on the face. You can also dunk your hands in ice water. A teen could keep an ice pack in a lunch bag and use as needed. I provide more exercises and vagal maneuvers below.

When the vagus nerve adapts, and is easily stimulated, this is referred to as “vagal tone.”

What kind of support to seek
A combination of good self-help information and working with an experienced anxiety disorder therapist, coach, or counselor is the most effective way to address anxiety and its many symptoms. Find a counselor who practices a somatic or body-centered modality because the roots of anxiety are stored outside of language centers, in the deep brain. That being said, ideally the counselor will be familiar with both a Body-Centered Technique, such as Brainspotting, as well as Cognitive Behavior Therapy (CBT) skills. CBT is an excellent complement, because it helps to set some goals that help to increase the window of tolerance and change habits. However, CBT alone falls short long term, because it does not tap and potentially resolve the source.

Mindfulness is important to learn, and most body-centered therapists model forms of it in their therapies. Dr. David Grand, creator of Brainspotting, for example, refers to his modality as “focused mindfulness.” I provide some mindfulness exercises below.

What to do proactively to help prevent/minimize anxiety
Listening to bilateral music while wearing headphones (which are required for the bilateral effect) can decrease anxiety.

Bilateral Music:
Search on YouTube for “bilateral music – Dr. David Grand”
Here is a sample.

Websites

Biolateral.com or Reflections or any album by “Bodhi Tree Bilateral” at CDBaby.com

Vagal Maneuvers and Mindfulness Exercises to practice

Vagal Maneuvers

• Diving Reflex: Considered a first rate vagus nerve stimulation technique, splashing cold water on your face from your lips to your scalp line stimulates the diving reflex. You can also achieve the nervous system cooling effects by placing ice cubes in a zip-lock and holding the ice against your face and a brief hold of your breath. The diving reflex slows your heart rate, increases blood flow to your brain, reduces anger and relaxes your body. An additional technique that stimulates the diving reflex is to submerge your tongue in liquid. Drink and hold lukewarm water in your mouth sensing the water with your tongue. Also, from Dialectical Behavior Therapy, dunking one or both hands in ice can serve to bring the body back to present time and, thus, the prefrontal cortex, or thinking brain, back online.

• Convergence: Hold up a pen or your index finger. Make sure your arm is comfortable with the position. Now, move your focus from the tip of the pen (or finger) to point beyond it on the wall or floor. Spend 3-8 seconds at each spot. “Convergence Brainspotting activates the ocular cardiac reflex (OCR) which leads to rapid, deep processing.” (from Brainspotting by Dr. David Grand)

• Humming: The vagus nerve passes through by the vocal cords and the inner ear and the vibrations of humming is a free and easy way to influence your nervous system states. Simply pick your favorite tune and you’re ready to go. Or if yoga fits your lifestyle you can “OM” your way to wellbeing. Notice and enjoy the sensations in your chest, throat, and head.

• Breath Work:

1. The breath is one of the fastest ways to influence our nervous system states. The aim is to move the belly and diaphragm with the breath and to slow down your breathing. Vagus nerve stimulation occurs when the breath is slowed from our typical 10-14 breaths per minute to 5-7 breaths per minute. You can achieve this by counting the inhalation to 5, hold briefly, and exhale to a count of 10. You can further stimulate the vagus nerve by creating a slight constriction at the back of the throat and creating an “hhh”. Breathe like you are trying to fog a mirror to create the feeling in the throat but inhale and exhale out of the nose sound (in yoga this is called Ujjayi pranayama).
2. (Andrew Weil) If you are stressed (and not seriously anxious), sit comfortably and take a deep, slow breath in through the nose and into the diaphragm for 4 seconds. Hold for 6 seconds and breathe out slowly through the mouth 8 seconds (place tip of tongue on the ridge on the upper palate of the mouth while exhaling). Repeat 10 times. If you are hyperventilating, cup your hands over your mouth (or use a small paper bag) and breathe slowly. Keep breathing as you would normally to regain the carbon dioxide levels in your system.
3. Inhale and pause, and then exhale and pause. Notice if one is longer or shorter and try to make them equal length. You can also experiment with making small movements (like rolling the wrists) on inhale and then be still on the exhale.

• Valsalva Maneuver: This complicated name refers to a process of attempting to exhale against a closed airway. You can do this by keeping your mouth closed and pinching your nose while trying to breathe out. This increases the pressure inside of your chest cavity increasing vagal tone. Also, simultaneously bear down like you’re taking a bowel movement.

Mindfulness Exercises

• Take Your Pulse: Place your left hand underneath your right shoulder. Cross your right hand over your left wrist and feel for your pulse with your index, middle and ring finger. Feel under each finger. In Jin Shin, practitioners read six different pulses in each wrist. Here you will be feeling for three. Notice if the pulses under each finger feel different or the same. They may be pebbly, feathery, pounding or “just right.” Notice if your skin feels warm and soft. Breathe into the diaphragm and continue for 1-5 minutes.

• Self Soothe: From the work of Peter Levine creator of Somatic Experiencing, this practice calms the nervous system and brings a person back into the body, present time. Close your eyes during this exercise once you are familiar with it. Choose a hand to place on your heart – try both hands and pick the hand that creates the greatest sense of calm. Press gently against your chest. Notice the place where your hand meets the fabric of your shirt. Is it soft or rough? Do you feel warmth? Now place the opposite hand on your forehead with a gentle pressure. Notice the place where your hand meets the skin of your forehead. Is it warm? Cold? Tingling? Slow your breath, allowing it to be deeper into the diaphragm and belly. Leaving your hand on your heart, now take the hand that was on your forehead and place it on your stomach. Again, observe the feeling underneath your hand. Can you feel your belly rising and falling with your breath? Can you feel your heart beating underneath the other hand? Do this for 1-10 minutes.

Short version: Just place your hand on your heart and notice your breath without changing it. This can be done anywhere, any time with immediate results.

• Gravity Exploration: Sit comfortably in a chair. Feel the weight of your feet on the floor, as though they are sandbags. Imagine that you are an ice cube melting as you release as much tension as possible. Notice your breath. Now feel the effects of gravity. Notice how much effort it takes to hold your head upright. Gently tip your head forward and feel its weight. Bring it back up in line with the body. Open your mouth and notice how much effort it requires to keep it closed. Feel gravity pulling at you and relax even more deeply – notice where you were still holding on. Try to stay out of judgment in this exercise the primary objective is to explore and observe. Pick up a hand and allow it to slowly move back to your lap, allowing it to drop the last 6 inches. Just play with the effects of gravity and notice how relaxed you feel after 10 minutes of exploration.

• Grounding: Dr. Peter Levine’s version is to stand barefoot, legs wide and feet firmly planted; place hands on belly and sense your center of gravity; sway gently feeling the connection between your feet and the ground. You can even take off your shoes to feel connection to the earth or imagine roots growing down out of the feet. (Set an alarm to go off 2-3 times a day to remember you are in a body.)

• Outside-In: (Dr. Levine) Choose something in the room that is appealing to look at. Name two qualities/aspects that you like. Briefly describe the qualities. What is the feeling sense these qualities give you? Now imagine these feelings have a texture or color that could move towards and into you. For instance, if the warm light of a lamp comforts you, imagine the warm light moving into you like a golden stream. The act of focusing on something outside of you helps you to become fully present, removed from the past incident that continues to trigger you – whether the initiating incident is conscious or not.

• Constructive Rest: This position calms the psoas muscle, one of the largest muscles in the body that joins the upper body to the lower body. It holds deep-seated fear and trauma, which can cause it to shorten over time and tense regularly. Constructive rest allows this muscle to relax and lengthen.

• Emotional Freedom Technique (EFT): There are many YouTubes about EFT otherwise known as “Tapping.” One taps on specific meridian points while repeating the phrase: “Even though I feel ______, I completely love and accept myself. I recommend to clients to choose the favorite spot (that creates the most inner peace) to tap when feeling anxious.

Great Resources

• Badenoch, B. (2008). Being a Brain-wise Therapist: A Practical Guide to Interpersonal Neurobiology, New York, NY: W.W. Norton & Company
• Baum, B. (1997). The Healing Dimensions: Resolving Trauma in BodyMind and Spirit. Tucson, AZ: West Press
• Cozolino, L. (2015) Why Therapy Works. NY: W. W. Norton & Company
• Grand, D. (n.d.) What is Brainspotting? Retrieved June 13, 2013 from http://www.brainspotting.pro/page/what-brainspotting
• Levine, P. (2005). Healing Trauma, Boulder, CO: Sounds True, Inc.
• Levine, P. (1997). Waking the Tiger: Healing Trauma, Berkeley, California: North  Atlantic Books
• Marie, D. (2016). Finding Calm In a Moment:108 Practices in Movement, Mindfulness and Meditation for All Ages
• Maté, G. (2011). When the Body Says No: The Cost of Hidden Stress, Vintage Canada
• McLaren, K. (2010). Language of Emotions, Sounds True
• Mellin, L. (2010). Wired for Joy, Hay House
• Ogden, P. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York, NY: W.W. Norton & Co.
• Porges, S. (2012). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation, NY, NY: W. W. Norton & Co.
• Ralston, P. & Ralston, L. (2006) Zen Body-Being: An Enlightened Approach to Physical Skill, Grace and Power. Berkeley, CA: North Atlantic Books
• Scaer, R. (2005). The Trauma Spectrum: Hidden Wounds and Human Resiliency, New York: W.W. Norton & Co.
• Schwartz, A. & Knipe, J. (2017). The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole, Althea Press
• Shanker, S. & Barker, T. (2016). SELF-REG: How to Help Your Child (and you) Break the Stress Cycle and Successful Engage with Life, NY, NY: Penguin Books 
• Siegel, D. (2015) Brainstorm, New York: Tarcher
• Strozzi-Heckler, R. (2014). The Art of Somatic Coaching, Berkley: North Atlantic Books
• Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, New York: Viking

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