Anxiety in Middle�School Students: Strategies and Solutions to Help

Joanna A. Robin, PhD

Westchester Anxiety Treatment Psychological Services, PC

Agenda

• Quick Review
• Distinguish between normal fears and problematic anxiety
• Talking to children about anxiety
• Helping children identify their anxious thoughts and behaviors
• Discuss the CBT Model

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• Support your children in decreasing avoidance and facing their fears

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• Manage worry and concern when parenting

Cognitive Behavioral Model

Cognitive Behavioral Model

1) First ask yourself: Is there something productive I can do (e.g., start studying for a test, do X task that I have been putting off)?

• If the answer is yes, do it!
• If there is nothing productive you can do in response to your anxiety…

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2) Change your relationship with your thoughts

• Try to generate more helpful, adaptive, and balanced thoughts (cognitive restructuring)
• Stop the tug-of-war between you and your anxiety (accept that you will feel anxiety and continue to move in the direction of your goals)

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3) Change your behaviors

• Approach the situations you’re avoiding
• Practice, Practice, Practice approaching!
• Use relaxation and mindfulness skills to manage somatic symptoms of anxiety

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Exposures

• Exposure: Facing all avoided situations in graded fashion
• Places
• People
• Thoughts
• Images
• Feelings
• Exposures help individuals engage in experiential learning to see that they can handle feared situations better than they expect.

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Rescue

Impact of rescue:

remembers situation at the height of fear

prevents habituation

no experience of mastery

escape is reinforced

1^st step

4^th step

8^th step

Impact of exposure:

remembers success that allows habituation

learns anxiety passes on its own

willing to approach increasingly challenging situations

feeling of mastery

reinforcement for hanging in

From Chansky (2004)

How negative reinforcement works

What to Do: Help your child face their fears​

medium

hard

easy

How Parents Can Help Children Approach Anxiety Provoking Situations

What is parental accommodation and how can we reduce it ?

• Parents change their behavior to relieve distress related to their child's anxiety or OCD.
• Research shows that reducing accommodation will reduce anxiety.

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• First Step is to recognize areas or ways that we accommodate our child’s anxiety.
• Subtle
• Clear cut ways

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Examples of Accommodation

i didn’t know i had math hw due today can u pick me up early so i don’t have to go to math????? Pls!!!!

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Sure, I will be there right after Spanish.

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For our community service, we have to collect garbage from the park and I just cannot handle that ☹

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I will have your psychologist write a note that says you don’t have to do that.

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i need extra time on my project can u email my teacher??

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Sure, which teacher?

Examples of Accommodation

• Allowing your child to stay home from school when they feel too anxious to go to school.

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• Engaging in washing rituals for your child to reduce their anxiety.

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• Checking the locks for your child multiple times because your child is anxious.
• Requesting that your child not do oral reports because he/she/they are afraid to speak in front of the class.

Ways to Reduce Accommodation

• Using statements that show acceptance and confidence

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• Creating a plan to reduce accommodation

Statements that Show Confidence and Acceptance

i didn’t know i had math hw due today can u pick me up early so i don’t have to go to math????? Pls!!!!

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I know this is anxiety provoking for you to be unprepared AND I know you will get through the class.

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For our community service, we have to collect garbage from the park and I just cannot handle that ☹

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I understand you are worried you will feel so grossed out. I know how important this program is for you, so I know you will figure out how to get through this.

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i need extra time on my project can u email my teacher??

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I get that this is anxiety provoking to ask for extra time. I am sure you can figure a great email to your teacher.

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Communicating the Plan to Reduce Accommodation

• Family meeting
• Letter format
• Describe what anxiety or worry has been doing
• No blame
• State facts
• Describe your role in accommodating
• Describe how it will look different – Be very specific
• Be willing to problem solve
• Be willing to go in steps
• Reinforce bravery

Managing Discomfort

1. Recognizing your own anxiety

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• Ask yourself what lesson do you

want to teach your child?

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3. Stick to your plan

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4. Practice compassion for yourself

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5. Seek support