Doing Better Therapy

A Blog For Mental Health Professional's

Treating Anxiety: Why Exposure is Essential

 

By Jennifer Powell-Lunder, Psy.D

It is no surprise to mental health professionals that the prevalence rates for anxiety among tweens and teens seem to be escalating at alarming rates. A recent feature in The New York Times magazine verified this concern. It is certainly important to understand why so many kids today are overwhelmed by anxiety. Of equal importance is an in depth discussion regarding the most efficacious approaches to treatment. While different schools of thought tout different strategies, one common supposition is that the best way to treat anxiety is to face it head on. When it comes to anxiety, avoidance rarely gets an individual anywhere except eventually overwhelmed and overloaded.

In ‘clinicalese’ then we are referring to an exposure approach. In order to manage the distress it first has to be experienced. The goal of treatment then becomes helping the client to develop the skills to cope. This can often be an arduous task: asking the client to face and then slay the very beast they fear.

It is difficult to watch someone suffering from anxiety. On more occasions than perhaps we want to acknowledge, a well meaning parent or professional can inadvertently collude with the client by offering an opportunity for avoidance. This is especially common if the sufferer is a child. A child for example, who becomes overwhelmed by anxiety in the classroom will be offered a free pass to leave when and if they are experiencing anxiety. While on surface this may sound like a very empathetic response, in reality it serves to encourage avoidance of anxiety. A more helpful response is to teach the child how to use distraction and mindfulness to manage even the most overwhelming waves of anxiety in the classroom.

It is important to understand that when we talk about the treatment of anxiety, the initial goal is simply for the individual to be able to sit with it aka, tolerate the distress. This is a very different expectation than setting a goal of fixing or stopping. A key to treatment is experiencing oneself as competent. When a client can successfully sit with the distress even for a moment longer than he did before, he has experienced success. One success begets others. When in doubt he can say “Yes, I can, because I already did!”

The development of skills leads to the ability to manage anxiety. Because tweens and teens are often purveyors of technology, technological tools may enhance a child’s treatment experience. Sometimes the solution can be as simple as making sure there are calming pictures available to access on a child’s smartphone at times when the anxiety begins to build. There are also a multitude of apps offering for example, Cognitive Behavior Therapy (CBT) exposure schedules, guided imagery and mindfulness, and distraction activities. Teaching a tween or teen when to use what technique is also essential. It would not be a good idea for example, for a child to consistently avoid the anxiety a particular academic subject may instill by consistently playing games, albeit therapeutic in nature, on a smartphone. The first step in an exposure protocol however, could entail simply asking the child to sit in the class in lieu of leaving. Once this has been mastered the classroom participation expectations should be consistently raised.

Validation, or an acknowledgement that the anxiety a tween or teen is experiencing is real, is the first step toward providing successful treatment. Nothing resonates louder than the assurance that the people trying to help you, get ‘it’. Once this has been achieved, the child will most likely buy in to treatment. It is important to clarify from the onset that it may be hard work, but in the end exposure is the beginning of a successful solution.

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