Childhood anxiety disorders: Raising awareness with the MHA NSW

It might surprise you to learn that anxiety disorders typically start in childhood; around 1 in 10 children will experience an anxiety disorder at some point in their early years. If they don't receive professional treatment for their anxiety, children become much more vulnerable to depression in adolescence, as well as a range of other disorders including developing a secondary anxiety disorder, drug/alcohol use, and personality disorders in adulthood. Although the "1 in 10" statistic is alarming, if children with anxiety disorders receive evidence-based treatment (CBT has the most evidence for effectively treating childhood anxiety), they usually improve to the point of being anxiety disorder free. CBT for children with anxiety teaches a range of skills including challenging negative or worried thoughts, relaxation training, and learning to tolerate anxiety. Parents are also involved in the treatment process.

The Mental Health Association (MHA) NSW runs the Small Steps program, which is about raising awareness of childhood anxiety disorders amongst primary school teachers and parents in NSW. I will be partnering with the MHA NSW to deliver Small Steps seminars in the Blue Mountains region. The seminars are free (funded by NSW Health), run for about 1 hour, and provide a comprehensive overview of what anxiety looks like in children, and when and how to help.

If you're interested in having a Small Steps anxiety seminar held at your child's school, contact the MHA NSW on (02) 9339 6003, or follow this link to the website.

Managing fear on the cliff face

I've recently started outdoor rock climbing. What's interesting about this experience, as a psychologist who's interested in emotional responses, is the way I find myself responding to my fear while on the cliff face. It also gives me insight into what my clients might experience in anxiety treatment, as I ask them to expose themselves to their fear (exposure treatment is one of the most effective anxiety treatments, although uncomfortable). So I thought I'd write this blog post given its relevance to my anxiety treatment approach.

On the cliff face, the most frightening experience is feeling like I'm going to fall off backwards. At these moments, my fear makes me forget the super-strong equipment that keeps me safe. At these moments, instinct takes over and I feel mortal panic.

What has helped me to keep going up despite encountering moments of panic:

- Saying to myself "here is fear" when I feel fear. Naming it seems to help calm my mind, although it doesn't always make fear ease off or go away

- Thinking about people I know who've overcome immense fear and anxiety (inspires me to keep going)

- Taking a moment to slow, steady, and deepen my breathing

- Being honest with myself about how I might feel after either stopping and coming down, or continuing despite being fearful. If I give up before I feel like I've given it all I can manage in the moment, I'll feel disappointed with myself. But if I honestly feel it's too challenging, acknowledging that, at this particularly moment, it is beyond what I can cope with, and that I can try again later, helps manage any self-criticism. Acknowledging what I managed to achieve even if I stop before reaching the top also helps.

Are you a people-pleaser?

If you're a people-pleaser, you'll probably:

• Find yourself worrying more than most about what other people think of you
• Try to ensure that you don't upset anyone
• Try to be liked by everyone
• Avoid saying anything controversial
• Put your needs after everyone else's

I should note that people-pleasing isn't all bad news: It can be very helpful to get along well with others. However, if we become overly concerned about pleasing others, it can be a pathway to anxiety and depression. This might also sound strange, but if we become accustomed to always pleasing others, we never get the chance to learn that it's not catastrophic when we do sometimes upset or offend someone.

If you think you need to reduce your people-pleasing tendencies, here are a few ideas to help you behave in a way that's a little less 'pleasing':

• Experiment with being slightly more assertive than usual, e.g. clearly stating your preferences for an activity on the weekend, or a TV show you want to watch, or a place you want to eat at for dinner
• Say 'no' to requests sometimes
• Tell someone when you disagree with them

I should point out that I'm not advocating unnecessary conflict. However, it's important for your own wellbeing that keeping everyone else happy doesn't become your main mission in life.

Being human: it's complicated

There's no doubt that being human is complicated. In fact, being human is so complicated that trained practitioners (psychologists) are needed to help people untangle from the psychological knots they find themselves in. Part of what makes being human so complicated is that the nature of the human internal experience is somewhat paradoxical: if we don't want a particular feeling or emotion (e.g. anxiety, guilt, anger), then we are more likely to act in a way which leads that feeling to persist. And so we often fall into behaviour patterns aimed at getting rid of what we don't want, but which just exacerbate or only give temporary relief: drinking, smoking, watching TV, excessive exercise, binge eating, to name a few. So often, the solution to psychological problems is paradoxical, often involving acceptance of distress, and facing feelings instead of fleeing. And like many psychological interventions, this may seem simple but it's definitely not easy.

The trap of social phobia

Unfortunately mind-reading was not taught in my clinical training. 

But if you have social phobia, chances are you believe you are fairly good at mind-reading negative or judgmental thoughts others have about you. And maybe others do have negative thoughts about you, because when you're trying to converse with them, you're so desperate to check you're not doing anything embarrassing that you end up missing what they said.

Self-focused attention is the "engine-room" of social phobia: when we fear others will judge us harshly, we turn our attention towards ourselves to check we aren't doing anything that might be embarrassing or awkward. Unfortunately, the act of turning our attention towards ourselves means we're no longer paying attention to those we're talking to, leading to more gaffes, embarrassing comments, or not knowing what to say, thereby increasing the risk others will judge us negatively.

Social phobia is a terrible disorder for the debilitation it causes; robbing people of the chance to make new relationships, or any relationship. It's also tragic because we will never really know what someone else thinks about us, but we can spend a lifetime worrying about it without appropriate psychological intervention.