Helping Your Child with Fears and Worries

Name: Helping Your Child with Fears and Worries
Author: Cathy Creswell & Lucy Willetts
ISBN: 1472138619

by Cathy Creswell & Lucy Willetts

My third choice is Cathy Cresswell and Lucy Willetts’s CBT book for parents called Helping Your Child with Fears and Worries . I worked with Cathy straight after my undergraduate degree, at the University of Reading, while they were running the trials that inform the book. Their principle is that most anxiety disorders start in childhood and adolescence. You could get the child to go to a therapist, but actually, it’s the parents who are going to be with that child much of the time. So might it not be more useful to teach the parents some of the basic CBT principles, so they can go through them with their child? The book was a result of that work. I chose it for this list partly because I want to cover CBT somewhere here, because it is so useful and so important. But I have always loved the idea that parents can help their children in useful ways with worrying, without pathologising it or telling them they have a disorder. If they can just say, ‘Okay, you’re worrying, but there are more useful things you can do about it, and I’m going to help you do them.’ If they could break it down like that, I think that would go a long way to helping anxious children. Exactly. Reframing is the key word for the cognitive side of CBT. It’s first about identifying what your worry is—’I’m worried that a burglar is going to break into my house’; ‘I’m worried that I’ve got a serious illness’; ‘I’m worried that I’m going to go to the party and no one’s going to talk to me.’ You capture exactly what the worry is first. Even that can be quite a tricky or revealing process: to figure out in one sentence what you’re actually thinking and worrying about. Then you try and figure out if there’s a more useful way of thinking about it. Normally, because the worry is something disastrous, you might ask yourself or write down what the worst thing that could happen is; and then the best thing that could happen; and finally, the most likely thing that could happen. Those second and third questions are a revelation for someone anxious. If you’re prone to anxiety, you don’t think in terms of best-case scenarios, ever. So, you write all this down, or talk it through, and then figure out a more realistic way to think about it. That’s a classic CBT approach. Definitely. The downside of CBT is that the onus is very much on you. The solution is to think differently, but that can be incredibly difficult. It takes a lot of work. In particular, you might be trying to implement CBT principles when you feel terrible – when you’re depressed, or extremely anxious, or struggling in all sorts of different ways. Trying to change the way you think can be extremely demanding. I guess that’s maybe more related to the physical side of things, feeling physically keyed up. CBT might help there with interpreting those feelings, which could escalate to becoming a panic attack if you interpret them in the wrong way. You might think, ‘My chest feels tight,’ then ‘Oh, my God, I can’t breathe properly’, and then you hyperventilate… That is exactly what a panic attack is: a catastrophic overinterpretation of bodily signals which then escalates. Panic disorder is an extension of that, where you get into a horrible cycle of having panic attacks, and then being worried that you’re going to have panic attacks, which then causes you to have panic attacks. If the problem is more about those kinds of physiological aspects of anxiety, it’s still possible that CBT could help. Definitely. Cathy’s work, along with colleagues, has shown that CBT given by therapists is helpful for anxious children. They’ve also shown that therapists can teach parents CBT principles so that the parents can go and do it with their children, and that’s effective too. So, the ‘C’ bit is about breaking down your thoughts. And then the ‘B’ bit is particularly about exposure—we discussed earlier the importance of avoidance in anxiety, and the need to expose yourself to the things that you’re scared of. And what this book is so good at is taking you through ‘graded exposure’. Often, if you have a child who’s terrified of doing something, it can feel like the only options are to push them to do something they’re terrified of or, conversely, tell them they never have to do it. Actually neither are helpful because both of those maintain anxiety. The same is true for teenagers and adults who are anxious. “We’re starting to talk about all anxiety as a medical problem or health problem. And actually, unless you’re right at the extreme end, it’s just part of the human condition” So, graded exposure—for a child or with an adult—involves working out steps that become increasingly hard, that make you increasingly anxious and taking one at a time. So, for example, with the spider phobia, you might begin by doing things like looking at pictures of spiders, or looking at cartoon drawings of spiders, then being in the same room as a spider in a jar, and so on. You then very gradually move up the ladder. You do each step repeatedly, and relax at each step and reward each step until they (or you) feel safe enough to move up to the next level. In theory, by doing that, you can eventually tackle the thing that you couldn’t go near before. You eventually move to level 10, which might be having a spider on your hand. It can be extremely empowering. It’s so useful to know that there’s this principle, this thing that you can try. The options aren’t just ‘do it and be terrified’ or ‘avoid the thing forever’. You don’t need to avoid it forever. You just might need some help to do it more slowly and with more support. But the goal is always that you should try and do the thing that you’re scared of. And when you do it, and you realise you coped—that’s an amazing feeling. That’s also important. I think we shouldn’t over-medicalize it, but we also shouldn’t under-medicalize it either, because it is a spectrum. At the extreme end, anxiety is awful—it’s all-consuming. When you’re in that state of anxiety it takes over your body and your mind, it’s incredibly difficult to cope with. It feels absolutely horrendous. It comes back to the idea that this is about navigating and managing anxiety. The goal, especially if you’re at the sharp end of things, cannot be to eliminate it. The last book I’ve chosen is about someone who’s very much at the severe end of anxiety, and a demonstration of just how serious it can be. In the current public conversation, the problem is that people will say, ‘Just have CBT’ or, ‘Just do this, and then you’ll solve your anxiety.’ For some people that works, but for others the anxiety is just too overwhelming. It’s not their fault; they just can’t solve it in a straightforward way.

Recommended by

Lucy Foulkes

"My third choice is Cathy Cresswell and Lucy Willetts’s CBT book for parents called Helping Your Child with Fears and Worries . I worked with Cathy straight after my undergraduate degree, at the University of Reading, while they were running the trials that inform the book. Their principle is that most anxiety disorders start in childhood and adolescence. You could get the child to go to a therapist, but actually, it’s the parents who are going to be with that child much of the time. So might it not be more useful to teach the parents some of the basic CBT principles, so they can go through them with their child? The book was a result of that work. I chose it for this list partly because I want to cover CBT somewhere here, because it is so useful and so important. But I have always loved the idea that parents can help their children in useful ways with worrying, without pathologising it or telling them they have a disorder. If they can just say, ‘Okay, you’re worrying, but there are more useful things you can do about it, and I’m going to help you do them.’ If they could break it down like that, I think that would go a long way to helping anxious children. Exactly. Reframing is the key word for the cognitive side of CBT. It’s first about identifying what your worry is—’I’m worried that a burglar is going to break into my house’; ‘I’m worried that I’ve got a serious illness’; ‘I’m worried that I’m going to go to the party and no one’s going to talk to me.’ You capture exactly what the worry is first. Even that can be quite a tricky or revealing process: to figure out in one sentence what you’re actually thinking and worrying about. Then you try and figure out if there’s a more useful way of thinking about it. Normally, because the worry is something disastrous, you might ask yourself or write down what the worst thing that could happen is; and then the best thing that could happen; and finally, the most likely thing that could happen. Those second and third questions are a revelation for someone anxious. If you’re prone to anxiety, you don’t think in terms of best-case scenarios, ever. So, you write all this down, or talk it through, and then figure out a more realistic way to think about it. That’s a classic CBT approach. Definitely. The downside of CBT is that the onus is very much on you. The solution is to think differently, but that can be incredibly difficult. It takes a lot of work. In particular, you might be trying to implement CBT principles when you feel terrible – when you’re depressed, or extremely anxious, or struggling in all sorts of different ways. Trying to change the way you think can be extremely demanding. I guess that’s maybe more related to the physical side of things, feeling physically keyed up. CBT might help there with interpreting those feelings, which could escalate to becoming a panic attack if you interpret them in the wrong way. You might think, ‘My chest feels tight,’ then ‘Oh, my God, I can’t breathe properly’, and then you hyperventilate… That is exactly what a panic attack is: a catastrophic overinterpretation of bodily signals which then escalates. Panic disorder is an extension of that, where you get into a horrible cycle of having panic attacks, and then being worried that you’re going to have panic attacks, which then causes you to have panic attacks. If the problem is more about those kinds of physiological aspects of anxiety, it’s still possible that CBT could help. Definitely. Cathy’s work, along with colleagues, has shown that CBT given by therapists is helpful for anxious children. They’ve also shown that therapists can teach parents CBT principles so that the parents can go and do it with their children, and that’s effective too. So, the ‘C’ bit is about breaking down your thoughts. And then the ‘B’ bit is particularly about exposure—we discussed earlier the importance of avoidance in anxiety, and the need to expose yourself to the things that you’re scared of. And what this book is so good at is taking you through ‘graded exposure’. Often, if you have a child who’s terrified of doing something, it can feel like the only options are to push them to do something they’re terrified of or, conversely, tell them they never have to do it. Actually neither are helpful because both of those maintain anxiety. The same is true for teenagers and adults who are anxious. “We’re starting to talk about all anxiety as a medical problem or health problem. And actually, unless you’re right at the extreme end, it’s just part of the human condition” So, graded exposure—for a child or with an adult—involves working out steps that become increasingly hard, that make you increasingly anxious and taking one at a time. So, for example, with the spider phobia, you might begin by doing things like looking at pictures of spiders, or looking at cartoon drawings of spiders, then being in the same room as a spider in a jar, and so on. You then very gradually move up the ladder. You do each step repeatedly, and relax at each step and reward each step until they (or you) feel safe enough to move up to the next level. In theory, by doing that, you can eventually tackle the thing that you couldn’t go near before. You eventually move to level 10, which might be having a spider on your hand. It can be extremely empowering. It’s so useful to know that there’s this principle, this thing that you can try. The options aren’t just ‘do it and be terrified’ or ‘avoid the thing forever’. You don’t need to avoid it forever. You just might need some help to do it more slowly and with more support. But the goal is always that you should try and do the thing that you’re scared of. And when you do it, and you realise you coped—that’s an amazing feeling. That’s also important. I think we shouldn’t over-medicalize it, but we also shouldn’t under-medicalize it either, because it is a spectrum. At the extreme end, anxiety is awful—it’s all-consuming. When you’re in that state of anxiety it takes over your body and your mind, it’s incredibly difficult to cope with. It feels absolutely horrendous. It comes back to the idea that this is about navigating and managing anxiety. The goal, especially if you’re at the sharp end of things, cannot be to eliminate it. The last book I’ve chosen is about someone who’s very much at the severe end of anxiety, and a demonstration of just how serious it can be. In the current public conversation, the problem is that people will say, ‘Just have CBT’ or, ‘Just do this, and then you’ll solve your anxiety.’ For some people that works, but for others the anxiety is just too overwhelming. It’s not their fault; they just can’t solve it in a straightforward way."

Anxiety · fivebooks.com