Showing posts with label Mental Health. Show all posts
Showing posts with label Mental Health. Show all posts

Wednesday, January 13, 2010

Two Parenting Mistakes with Anxious Children

Tyler begins to cry, raising his hands to cover his eyes. Eleven-year old boys hate to cry, and Tyler is especially fearful of it. It embarrasses him and makes him feel weak, even within the safe environment of my counseling room. His mother knows this, and with watery eyes herself reaches out and rubs his shoulder. "I'm sorry, honey," she says. With that he begins to cry harder, leaning over his crossed legs on the couch. I think to myself. One of the two mistakes parents can make in dealing with an anxious child. Indeed, mothers nurture and comfort their hurting children. Yes, of course. But is it possible with an anxious child that may be the entirely wrong thing to do?

North American children are experiencing clinical anxiety at ever increasing rates. The National Institute of Mental Health reports that thirteen percent of U.S. children experience disordered anxiety, while the figure for adults is twenty-percent. The University of Michigan Depression Center, the nation's first, estimates that fifteen percent of college students nationwide suffer from anxiety. Clearly children are suffering unprecedented levels of clinical anxiety, finding their minds hijacked by a myriad of fears. Even the most well-meaning parent is not intuitively equipped to deal with this. As a professional counselor who, for precisely a zillion years, has helped anxious children and their parents, I've witnessed anguished parents floundering to figure out how to best parent a fearful child. I have seen otherwise competent and good-intentioned parents inadvertently make mistakes that actually hinder the freedom of their children. By recognizing and correcting these two parenting mistakes, a parent can turnaround their child's worries and set them free.

The first mistake parents make in hindering their children's progress in overcoming anxiety is to feel sorry for them. A parent sees their child suffering and it breaks their heart. They project onto the child their own memories of suffering and pain, and mistakenly believe that the child must be feeling just as awful. Sometimes the child does, but often they don't. Anxious children cry easily, and regardless if their tears are releasing tension or, in some cases, manipulating the situation, the wise parent will not respond by feeling sorry for the child.

Seeing Tyler's tears melts mom's heart. She wants his tears to cease, so she suspends his movement forward towards freedom and let's him off the hook. Feeling sorry for him only fuels Tyler's sense of helplessness and hopelessness. He may interpret his mom's concern as, "Gee, she thinks I can't handle it either so I must be really weak!" The shared state of fear by both mother and child creates further dependency. Tyler, believing he is incapable of persevering through emotional stress and seeing that confirmed by his mother's response, seeks mom's comfort ever more. Mom, misguided by her belief that a mother's job is to always show love and support for her child by comforting and easing his fears, believes she is a caring mother and doing the correct thing. They feed off each other and the pattern deepens, sometimes for life. I've worked with many fathers who have tried to break the mother/child emotional dependent bond to no avail. It's only when mom understands the emotional reward she's getting from the relationship, and the price paid by her child, that she ceases to overly comfort him. Failure to let a child struggle perpetuates the child's helpless state and leads to the mistake number two.

The second parenting mistake made by parents of anxious children is to rescue their child from suffering. I once worked with two sisters who were terrified of scary movies. I'm not talking horror movies, but Disney movies! Every time the villain had their big scene, the girls demanded the movie be shut off and their parents promptly accommodated them. They never had watched a Disney movie to the end. The girls were practicing, and the parents were reinforcing, the number one coping behavior that both children and adults use to deal with their fears: avoidance. The whole family moved away from the fear to calm the girl’s anxious response, but it only strengthened the fear in the long-run. I explained the parent that because the children never learned to suffer through the scary parts, they never learned to calm their flight response and experience the happy ending. I called a family meeting, explained the how they all danced the jig of avoidance to Disney movies, and gave them new steps to dance.

A highly effective technique used to help children overcome fear is called exposure. Exposure is the process of introducing the fear provoking stimulus in a gradual way and allowing the child to built up tolerance to it. Slowly, step by step, the child overcomes their fear through successive exposure and tolerance formation. The key component that enables this technique to be successful is the child's willingness to tolerate small doses of suffering. By learning to manage one's temporary states of suffering, the child gains mastery over the anxious producing experience. So my prescription for these sisters was to go home, have the whole family snuggle up on the couch, and watch the movies all the way through, discovering through exposure that they could in fact handle the scary parts and that it all works out in the end. It worked and the girls can now watch the movies on their own.

Just like Tyler's mother who over comforted him during his experience of crying, when we over comfort ourselves through avoidance, we tell ourselves that it really must be bad and that we can't handle it. The way to find freedom from fear is to turnaround the pattern of avoidance into gradual exposure and build up a tolerance to it. It's just like stepping into a hot bath. At first it may be painful, but as your body learns to tolerate the heat, it becomes pleasurable.

"Kids need to feel badly sometimes," says child psychologist David Elkind, professor at Tufts University. "We learn through experience and we learn through bad experiences. Through failure we learn how to cope." It's true! When we workout at the gym, we "stress" the muscle so that it grows and becomes stronger. In the same way, as you allow your child to experience the stress of fear, and no longer feel sorry that they are experiencing short periods of pain while their minds adjust to the negative experience, they have a chance to then turnaround their fear and be free of it.

Though Tyler still doesn't like to cry (after all, he's still an eleven year old boy), he no longer fears it nor fights it. He uses the phrase I taught him from the audio treatment program I co-created called Turnaround: Turning Fear Into Freedom, "It is what it is, just chill with it!" Mom has learned that suffering is not always a bad thing, and focuses on sending him the message through her words and actions, "I trust you can handle this and I'll patiently walk beside you as you solve this problem in your own strength." She feels encouraged and joyous as her son takes flight in his new found strength, and finds that her strength has come out more too. Both have turned around their fears and found greater freedom.

Christopher McCarthy, M.Ed., LPC (www.myanxiouschild.com)

Saturday, December 19, 2009

The ABCs of OCD


Do you or someone you love suffer from Obsessive Compulsive Disorder? What is OCD and how can you recognize it? In all possible instances I advise you to seek professional help, but here I will also attempt to provide a basic description of a mental disorder that is often misunderstood. Unlike other mental disorders which require recognizing anywhere from four nine symptoms, OCD only requires recognition of two problems, obsessions and compulsions.

What is an Obsession?

The term's Latin root, obsidere, means "to besiege," as an army would surround a city for the purpose of forcing surrender. An obsession is truly a battle of the mind. According to the diagnostic manual used by mental health professionals, the DSM-IV, obsessions are "recurrent and persistent thoughts that are experienced as intrusive and inappropriate and that cause marked anxiety or distress." The definition highlights four main qualities of clinical obsessions: intrusive, recurrent, unwanted, and inappropriate. Children may not experience all these symptoms at once.

Intrusive thoughts:

Intrusive describes images and ideas that invade a person's mind interrupting the normal mental flow. An individual will be tracking typical progressive thoughts and suddenly, bam!, a new unwanted, unexpected thought bursts into their mind. It is typically shocking and deemed culturally deplorable, like a mother assailed by murderous thoughts while nursing her child.

What it isn't. An intrusive thought is not merely a passion. As a culture we apply the term obsession to many things that are not true examples of the disorder. A teenager who is obsessed with her new boyfriend, or a point guard obsessed with his team winning the championship do not exemplify what it takes to be diagnosed with an obsessive problem. Thank goodness! Otherwise all of us with a passion for something would have OCD!

Recurrent thoughts:

The individual experiences the intrusive thought repeatedly, described by one person as a "constant bombardment that never stops." The sufferer feels powerless, hopeless, and is prone to addictions which are utilized for escape.

What it is not. An obsession is not a phobia. A phobia can be avoided and therefore the negative thoughts stop. If I'm afraid of flying, I can avoid distress by avoiding planes. No planes, no obsessive fears. An OCD sufferer experiences the recurrent, singular obsessive thought regardless of proximity to the stressor. A person who fears germs can be in a perfectly sterile environment, and know it to be so, yet not prevent the obsessive thoughts.

Unwanted thoughts:

Try as they might, an individual can't seem to stop the intrusive thoughts. They are terrorists who infiltrate all defenses, the army that breaches the parameter. Ironically, the more one resists the thoughts, the stronger their attack.

What it isn't. An obsession is not an addiction. An obsession is unwanted, one-hundred percent of the time. Not so with an addicted thought. A gambler wants to gamble, but resists the urge knowing that it ultimately is a harmful course of action. With an obsession, there is no enjoyment whatsoever.

Inappropriate thoughts:

OCD thoughts are ego-dystonic, meaning "against the person's very nature." The sufferer knows the thoughts are irrational and illogical. Yet, they keep coming. The thoughts are exaggerated, disturbing, and highly inappropriate. For many, the obsessive thoughts are truly awful- thoughts of stabbing themselves or others, being attacked by bloody horror-movie villains, or sexually abusing children. A pedophile enjoys sexual thoughts involving children. An OCD individual experiencing deviant sexual thoughts abhors them.

What it isn't. Obsessive thoughts are not psychotic thoughts. A psychotic individual believes the inappropriate thought is rational. Convinced the FBI is trailing one's car because two hundred dollars was withdrawn from the ATM today rather than the normal forty, is a psychotic thought not an OCD one.

I don't struggle with OCD but I got a taste of it recently. I saw a deer moments after it got hit by a car. Its hind leg remained attached only by a thread of cartilage. It was gruesome to watch it slip-slide across the asphalt, repeatedly falling as it sought to escape the approaching humans seeking to help. Eyes popping out of its head, tongue hanging down; it was truly awful and made my stomach sick. Throughout the day, the horrific images burst into my mind repeatedly. I was besieged with these images even as I attempted to occupy myself with other things. I began to fear that they would not depart and that I would suffer endlessly from these horrible intrusions into my psyche.

What's a Compulsion?

Going "compulsively" to Starbucks every morning to fetch a latte does not meet the criteria for a clinical compulsion. It takes more than that. A clinical compulsion is a repetitive act that is clearly excessive and is performed in order to lessen the discomfort of an obsession. The compulsion is seen as the way out of the obsession. It may, and often does, work for a while, but over time causes more bondage.

Compulsions can take an infinite number of forms but often are logical responses done excessively. The washing of hands to eliminate germs makes excellent sense. Scrubbing repetitively to the point of damaging one's hands or wiping the kitchen counter for the fifteenth time is excessive.

True OCD is a haunting disorder that leaves one feeling trapped in a repetitive cycle of obsessions followed by impotent compulsions. The obsessive-compulsive interplay is vicious, exhausting and debilitating. The good news is that much is understood now regarding the disorder and help is available.

If you or your child suffers with OCD, seek help. Cognitive-behavioral therapy can be very effective in the treatment of OCD. Medication provides relief and, in conjunction with therapy, has been shown to be the most effective treatment modality. If you have an anxious child, the audio program Turnaround:Turning Fear Into Freedom, which uses cognitive-behavioral therapy techniques, can help reduce or eliminate OCD symptoms in children. Follow the link below for further details.

Christopher T. McCarthy, M.Ed., LPC

Reference: Osborn, I. (1998). Tormenting thoughts and secret riturals: The hidden epidemic of obsessive-compulsive disorder. New York: Dell Publishing

The Fear Factor: Four Clues that Ordinary Fear has become a Child Anxiety Disorder

Mary comes into my office looking hopeful yet concerned. She can't hold her question inside any longer. It thrusts out of her like a baby with projectile vomit, "I'm concerned my Andrew's worries have developed into an anxiety disorder." As a clinical therapist who specializes in the treatment of child anxiety, parents come to me seeking professional help for their fearful and anxious children. They don't have a clue concerning the criteria employed to diagnosis a child with an anxiety disorder. As Mary tells me more about Andrew's fears, I pose questions to determine if his struggle is a garden variety, childhood fear or, a more significant problem. Four factors are in my mind as we speak.

1. How intense are Andrews worries? Do they overwhelm him? Does it appear that he cannot control his fear even when he attempts to? Does fear captivate Andrew, becoming all consuming for periods of time? The higher the intensity of a child's anxiety, the more significant the problem.

2. What is the impact upon Andrew's life? How impacted is the whole family? Is the fear interfering with obligations, social relationships, academic progress, developmental progress, and the physical well-being of the child or other family members? The impact of the child's anxiety on the child and other family members is the second factor used to assess the problem.

3. How exaggerated is the fear? Does Andrew worry about age appropriate fears or are his worries beyond what other children consider normal? Are his concerns out of proportion given the circumstances? Did the freight appear to "come out of nowhere?" The exaggeration of a fear is third factor used in shaping my assessment of Andrew's anxiety.

4. What is the duration of time Andrew has struggled? Many fears are consistent with normal child development and abate with the passage of time. Mary's account of his struggle leads me to believe that the first three factors are affirmed and his fears are persistent and intensifying with time. The duration of Andrew's struggle is particularly significant. The problem is deepening as the roots of fear grow with time.

To prevent worry and anxiety from becoming a long-term struggle (when untreated it can last into adulthood), get help immediately. Mary sought out my help first but she could have also started with her pediatrician. Child anxiety is on the rise, and they are on the front lines recognizing the signs of it and recommending treatment. If your doctor advices further help, request a referral. Most communities have therapists who specialize in child anxiety.

Common child anxiety disorders include Generalized Anxiety Disorder (GAD), Panic Attacks, Social Phobia, Obsessive-Compulsive Disorder (OCD), and Separation Anxiety Disorder. The symptoms can vary to a great degree and therefore so do the treatments. One child's OCD may need to be treated with medication while another's may only need education and encouragement.

Many parents are uncomfortable taking their child to a therapist, or may be unable to afford it. Materials are available online regarding childhood anxiety, but in most cases they are tailored to the parent, not the child. While parent education is absolutely vital, a parent is not a therapist and must be cautious in treating their own child. Among the books available, some are based on clinical research, while others contain the personal experience of the writer with their child. Such wisdom often lacks broader application.

Informed Therapy Resources (ITR) has released an excellent audio program called Turnaround: Turning Fear into Freedom. Developed by two clinically experienced therapists, it uses cognitive-behavioral theory and technique, which research shows to produce the best results in the treatment of anxiety. The uniqueness of the program is that it uses children to speak to children, while adults play a secondary role. Over the course of ten days in an adventurous outdoors/hiking/camping setting, the children meet entertaining characters and face life-changing challenges that teach them how to manage, and ultimately overcome, their anxieties. From knock-knock jokes to talking beavers, from cliff-jumping to eating s'mores by the campfire, the band of young hikers gradually learn to master their fears. Each episode of the program lasts 20-30 minutes. Once the child finishes listening to each day, they complete exercises in the Turnaround Journal. Further information can be found at the link below.

If you're a parent, and are concerned about your child's worries, seek help immediately. Treating it now can eliminate potential escalating problems in the future. Mary's concerns for Andrew were well founded and he benefited from additional help. He enjoyed listening to Turnaround in the comfort of his own home while I saw him twice a month to reinforce Turnaround's message. Many child anxiety issues can be treated without medication, and many children who need medication, only need it for a season if they are they are taught coping strategies at the same time. Research shows that medication and treatment have the best results in greatly reducing, or eliminating, child anxiety. Help is available. Don't delay.

Christopher T. McCarthy, M.Ed., LPC (www.myanxiouschild.com)

Monday, May 19, 2008

Thinking Positive Thoughts About Your Anxious Child: Avoiding Four Common Negative Beliefs.

Parenting an anxious child can be mentally taxing and it's easy to become a sour grapefruit in their presence. Family members can develop a bitter mood as the child whines and complains. Anxious complaints can restrict a parent's movement, demand a great deal of time, and can suck the life right out of the caregiver. No parent chooses to be negative, it just happens as a consequence of the anxious disorder. When I see this taking place in the families I counsel, I review the four toxic parenting beliefs associated with anxious kids. Four strategies are then offered to cleanse the mental wasteland and contaminated relationships, restoring the home to healthy, happy place to inhabit.

Vicky Flory defines four common beliefs mistakenly held by parents of anxious children, namely seeing the child as hostile, unreasonable, exaggerated with their emotions, and the child not being emotionally dependent upon the parent. Accommodating one or more of these beliefs collapses the emotional bridge between parent and child, leaving the child stranded on an island of anxious fear. The repetitive thought of seeing the child as hostile interferes with parental support because the parent views the child as mean and their intentions motivated by malice. The parent overly focuses on the child’s negative behaviors and misses the distressed emotions fueling them. Reckoning the child as unreasonable, the parent sees the child as beyond help and unable to respond/learn in a normal manner. They increasingly grow ambivalent toward the child, focusing solo on controlling the child's behavior through angry verbal and non-verbal responses. The child views himself or herself more negatively and anxious thoughts and behaviors worsen. Believing the child’s demonstrated emotions are not genuine leads to mistaken assumptions. The parent becomes mistakenly convinced their child is manipulative, dramatic, and cunning. Verbal and non-verbal suggestions of anxious distress are misconstrued by the parent, leading to anger, harsh punishments, and withdrawal. The fourth hindering belief that the child is not emotionally dependent upon the parent is inaccurate because the child is solely dependent upon the parent. The child is limited in his or her ability to garner support from adults. Though their attempts may be clumsy, and demonstrated affection and appreciation sparse, the parent is the child's best chance at getting his or her emotional needs met. The dilemma for parents is balancing the natural desire for affirmation and affection from their child with the young anxious sufferers inability to express such positive and soothing emotions. The child's handicap leaves the parent's love tank empty, cripples their expressions of support, and leads to parental withdrawal. Summarizing, four common mistaken parental beliefs can weaken the parent-child bond and worsen a child's anxiety. Maintaining an active awareness of these mental parasites can trap them as they arise and foster for the implementation of healthier responses.

Four mental paradigms and techniques can be implemented to heal the relationship and cultivate support. First, recognize that many of your child's negative behavioral patterns are rooted in feeling anxious and depressed. The negative expressions are consistent with symptoms of child anxiety and depression. Developing empathy for the sufferer is one of the most effective ways to change your interactive patterns with that person. Sit down with your child and ask them what it feels like when they feel afraid. Patiently encourage them to speak about their inner feelings and what types of things make them upset. You may have to do this a few times for trust to build. Apologize for your past offenses, reaffirm your unconditional love and support, and commit to do better.

Second, work through books and programs designed to treat child anxiety. This can be a great way to gain empathy for your child and show support. An excellent resource is the audio program Turnaround: Turning Fear Into Freedom which invites your child on a ten day camping adventure with six other children who struggles with various types of fears. Unlike any other program available, Turnaround has children lead the lessons while adults take a secondary role. Created by two clinically experienced therapists, the program is professional and based upon the proven treatment methods of cognitive-behavioral therapy and yet, manages to be highly entertaining kid friendly. Parents report it facilitates healthy dialog with their child by giving them a shared language to pull from. For further information, visit www.myanxiouschild.com.

Third, offer your child a fresh start, a new day each and every day. Deal with each day's issue as a separate incident from the past. Cease vexing expressions, repeatedly bringing up the past and stating that nothing ever changes. Vexing comes from the parent feeling despondent and grasping for anything that might change the child's behavior, even if it's negative and shaming. Mentally prepare yourself each morning to respond patiently and with support. Exercise, diet, stretching, and any other expressions of self-care has been shown to greatly help. As a sage once said, "You cannot impart what you do not possess." Do whatever works best for you to fill your love reservoirs so that it can overflow and nourish your anxious child.

Finally, watch your assumptions and slow down your responses. Focus more on their heart, their emotions, rather than just their behavior. Pay attention to their facial expressions. If they look angry and frustrated, chances are they really feel more fearful or depressed. Address their hurt. Give them hope. Give them a vision of what they'll life will be someday when they are free from their fears. A child who can see a future free from fear, and deeply believes they can achieve it through continuous effort, can move towards it. The fact that his or her parent can see it too makes it all the more believable.
Christopher T. McCarthy, M.Ed., LPC. http://www.myanxiouschild.com/

Ref. Flory, V. (2004). A novel clinical intervention for severe childhood depression and anxiety.
Clinical Child Psychology and Psychiatry 9(1), 9-23.