The best researched treatment for generalized anxiety disorder in children is cognitive behavioral in nature. Cognitive behavioral therapy aims to address the different components that contribute to and perpetuate the anxiety. Very young children with anxiety require the therapist to be creative with interventions because of their limited ability to process verbally. Below are some of the main components of treatment for children.
Assessment focuses on determining where the worry is coming from, what the worries are, what happens during the worries and what helps with the worries. Assessment will also explore family issues and dynamics that need to be addressed in therapy. For example, parents may be reinforcing anxiety by helping their child engage in avoidance, by predicting that they will fail or by modeling anxiety themselves. Assessment helps the therapist and family to strategize how to approach the child’s anxiety. After the assessment period, which could last from four to eight weeks, the child, family and therapist come up with a treatment plan which outlines goals and some strategies to meet those goals.
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Psychoeducation is just education about the psychology of something, in this case, anxiety. Treatment for generalized anxiety disorder in children must focus on the different components of a child’s anxiety. These consist of physical symptoms, worry thoughts, and behaviors associated with that anxiety. Worry thoughts are often accompanied by physical symptoms and lead to the anxiety behaviors. For example, in one child, the symptoms may be sick to my stomach, the worry thought “if I go to school everyone will laugh at me", and the behavior crying and avoiding the school bus. Psycho education would help the child and family understand the components of this particular sequence and others.
If parents are able, they can be asked to be co therapists at home. They can help coach a child through anxious times, process their daily anxiety level, and assist their child with their therapy homework assignments. Generalized Anxiety Disorder treatment can consist of joint sessions with parents or split sessions ( half child alone, half parent and child). Parents may be included in the entire therapy session or part of the therapy session depending on what works best for that particular child or family
Treatment for generalized anxiety disorder in children must include some family work. Parents need assistance with managing their children’s anxiety. Parents often need help managing their own anxiety, understanding why their child is anxious and learning how to help their child to conquer anxiety. Some family work occurs in joint sessions, while some work must occur in separate sessions with the parents.
Play therapy is a very useful component of treatment for generalized anxiety disorder in children. Most young children are unable to benefit from traditional talk therapy, so creative ideas must be employed to assist them in communicating their anxieties and learning techniques to manage them. Art, doll houses and puppet play are great ways to illustrate ideas of anxiety to a child and also to suggest coping skills and new ways to think about the anxiety. Play is also a great way to assess anxiety. For example a six year old child may be much more likely to show us through doll house play that they are afraid of a dog then to actually verbalize it.
Because Generalized Anxiety Disorder in a child often consists of many fears about different things a fear hierarchy is great tool. Children are asked to rank their fears and then the therapist addresses those fears one by one. Children can create this as an art project and cut out each individual fear ranking it by gluing in on the paper from the least anxiety provoking to the worst or from he worst to the least.
In therapy, we can expose the child gradually to thoughts of the things they fear, beginning with the one that is least anxiety provoking. We can then pair more neutral thoughts and images with that thing they fear in the office, and often will assign homework designed to help the child slowly face that fear. Treatment for generalized anxiety disorder in children is different from other anxiety treatments because the child’s worries are so numerous and diverse. This kind of strategy may need to be used many times
Generalized Anxiety Disorder treatment teaches parents how to effectively reward the brave behavior. The reward helps to reinforce the new brave behavior. Anxiety is reinforced by avoidance. Its power decreases once the fear is faced and the child realizes it isn’t nearly as bad as they thought.
Physical symptoms of anxiety can be managed with techniques such as progressive muscle relaxation (learning to tense and relax individual sets of muscles), deep breathing and guided imagery (thinking of peaceful and relaxing thoughts and images). Children can be taught these techniques in therapy and asked to practice them while thinking about anxiety provoking situations. Later, they can be instructed to use these techniques as coping skills outside of the therapy session when they become overwhelmed. Kids love this!
Restructuring thoughts is a primary focus of treatment for generalized anxiety disorder in children. In therapy children and parents are taught to challenge the thoughts that accompany the anxious behavior until the child experiences less anxiety. There are many ways to do this with younger children. A scenario can be created with puppets and one could be and anxious puppet, expressing worried thoughts. A child could create a comic book where the main character is anxious and is verbalizing their worry thoughts.
It is very important for parents and therapists to take the attitude that the child is capable of conquering their anxiety. The attitude that they can do it, lots of confidence and positive reinforcement for the child will go a long way in reducing their anxiety. It is also important that the child knows that everyone is rooting for them, and that there are a team of people who know that they can conquer their anxiety.
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