HOME MANAGEMENT STRATEGIES FOR SEPARATION ANXIETY DISORDER

Step 1: Teaching your child about anxiety No matter what type of anxiety problem your child is struggling with, it is important that he or she understands the facts about anxiety. Fact 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger. Fact 2: Anxiety becomes a problem when our body tells us that there is danger when there is no real danger. As an important first step, help your child to understand that all the worries and physical feelings have a name:Anxiety. To learn how to explain this to your child, see How to Talk to Your Child about Anxiety. Step 2: Teaching your child about separation anxiety

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First, tell your child that it is normal to sometimes feel anxious when alone or away from mom or dad. Tell your child that you will give him or her some tools to help cope with anxiety and gradually face his or her fears. Help your child identify some of the feelings, thoughts, and behaviors related to his or her separation anxiety. Heres an example of a conversation between a parent and child who has difficulty going to school.

Step 3: Encouraging your child to stop seeking reassurance Children with separation anxiety often seek excessive reassurance from their parents. They ask questions like:Are you sure you wont go further than the neighbors backyard? and Are you sure I wont get sick if I go to school?They do this to try to be 100% sure everything is all right. Parents often find this quite tiring and frustrating! When your child is excessively and repeatedly asking for reassurance:

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Tell your child that this is just anxiety talking. Your child is always asking for reassurance because the anxiety is bullying him or her around. Make a plan with your child about beating back anxiety by not giving reassurance. Tell your child that he or she can only ask you something once.

Below is a sample script between a mother and child with separation fears:

Child: Mom, you are going to be home all day today when I am at school, right? Mom: What did I tell you when you asked me five minutes ago? Child: Please tell me again. Mom: I think you already know the answer. Child: Please, I just want to make 100% sure. Mom: Well, if you werent 100% sure, what would be so bad about that?

To learn how to explain this to your child, see How to Address Excessive Reassurance Seeking.

Step 4: Building your Childs Toolbox The best way to help your child deal with separation anxiety is to give him or her tools that can be used when facing fears. For separation anxiety, tools in the toolbox include: Tool #1: Learning to Relax. One tool involves helping your child learn to relax. Two strategies can be particularly helpful: 1. Calm Breathing: This is a strategy that your child can use to calm down quickly. Explain to your child that we tend to breathe faster when we are anxious. This can make us feel dizzy and lightheaded, which can make us even more anxious. Calm breathing involves taking slow, regular breaths through your nose. For more information, see Teaching Your Child Calm Breathing. 2. Muscle Relaxation: Another useful strategy is to help your child learn to relax his or her body. This involves having your child tense various muscles and then relax them. Your child can also use the flop, which involves imagining that he or she is a rag doll and relaxing the whole body at once. For more information, see How to Do Progressive Muscle Relaxation. Children and teens can use the above tools before school, at school, before bed, or wherever they feel anxious. Both should be practiced repeatedly until your child is comfortable doing them alone. Tool #2: Making Coping Cards Its not easy to face fears, so its a good idea to develop coping cards that your child can carry with him or her during the day to help manage anxiety. For tips on how to help your child develop and use coping cards, seeDeveloping and Using Cognitive Coping Cards with Your Child. Here are some examples of coping statements that your child can use for Separation Anxiety Disorder:

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Thats just Mr. Worry trying to bully me! I dont need to listen! Im feeling anxiety right now. I can do some calm breathing to feel better. Mom is okay, it is just my anxiety talking. I can handle being alone. Ive done it before. What is the best thing that could end up happening?

Tool #3: Facing Fears The most important step in helping your child or teen manage separation anxiety is to face fears. This includes avoided situations or places. For children with separation anxiety, some typical fear ladders might involve gradually sleeping alone in his or her own room, staying at school for the whole day, or reducing reassurance seeking. Remember, these steps are gradual, and are created together with your child. For more strategies and tips on conducting these exercises, as well as example fear ladders, see Helping your Child to Face Fears: Exposure. For children who have worries about going back to school, see Coping with Back to School Worries For children who have trouble sleeping alone, seeWhat to do When Your Child Insists on Sleeping in Your Bed with You How to do these exercises: It is important to prepare your child for the fact that he or she will feel anxious while doing these, but that is good! In order to fight back anxiety, it is normal to feel a little anxious in the beginning. It is also very important topraise (great job!) and reward (e.g. small inexpensive items, extra TV time, making a favorite dinner) your child for any successes, as well as any attempts at trying to face his or her fears. After all, it is hard work to face anxiety! Tool #4: STOP Plan or Realistic Thinking Often, children and teens with separation anxiety have worries that are unrealistic or very unlikely, but when they are anxious it is difficult for them to recognize this. For example, your child may worry excessively about mom and dad being in a car accident if they are late coming home. Below is a dialogue between a parent and a teen who is afraid of something bad happening when dad is gone for the evening: Teen: What if someone breaks into the house tonight when you are out? Parent: Has that ever happened before? Teen: Well, not at our house, but it might. Parent: Remember when we talked about the difference between possibility and probability? So, what is the probability that someone will break into our house tonight? Teen: I dont know. It feels very probable. Parent: But didnt you say it has never happened before? Teen: Yeah... Parent: So what do you really think about the chances of tonight being the night that someone decides to break into our house? Teen: Um, not very much I guess. Parent: That sounds about right! One way to help your child examine his or her thoughts and decide whether the worries are unrealistic is to use the STOP Plan. The STOP Plan helps children recognize their anxiety and unhelpful thoughts, and develop new helpful thoughts. For children, see Healthy Thinking for Young Children. For teens, help your child challenge his or her unrealistic or anxious thoughts. See Realistic Thinking for Teens.

Step 5: Building on Bravery Your child's progress comes from hard work. If you see that your child is improving, then you both deserve credit! Learning to overcome anxiety is like exercise your child needs to "keep in shape" and practice his or her skills regularly. Make them a habit. This is true even after your child is feeling better and has reached his or her goals. Don't be discouraged if your child has lapses and returns to his or her old behaviors every once in a while, especially during stressful times or transitions (for example, going back to school, or moving). This is normal, and just means that one or two tools in the toolbox need to be practiced again. Remember, coping with anxiety is a lifelong process. Helpful Tip: Track Progress! Occasionally, remind your child what he or she was not able to do before learning how to cope with anxiety and face fears. It can be very encouraging for your child to see how far he or she has come! Create a chart that records all of your childs successes!

Why is it important to talk about anxiety? Children and teens often dont recognize their anxiety for what it is. Instead, they may think there is something wrong with them. Children may focus on the physical symptoms of anxiety (e.g. stomachaches). Teens may think they are weird, weak, out of control, or even going crazy! These thoughts might make them feel even moreanxious and self-conscious. Therefore, the first step is to teach your child about anxiety and how to recognize it. Selfawareness is essential! The Facts! Myth: Talking to your child about anxiety will make them even MORE anxious. Fact: Providing accurate information about anxiety can reduce confusion or shame. Explain that anxiety is a common and normal experience, and it can be managed successfully! Once your child understands this, he or she will feel more motivated to make life easier. How to do it: There are three steps to introducing the topic of anxiety to your child: Step 1: Encouraging your child to open up about any fears and worries Step 2: Teaching your child about anxiety Step 3: Helping your child recognize anxiety Step 1: Encouraging your child to open up about worries and fears: Start by describing a recent situation when you observed some signs of anxiety in your child. Yesterday, when Sarah came over, you seemed very quiet and you just sat beside Mom. It seemed you may have been a bit nervous about having a visitor in our house. What was that like for you? Tell your child about some things you were scared of when you were the same age (especially if you shared the same types of fears), and ask if he or she has any similar worries or fears.

Ask what worries him or her the most.You may have to prompt younger children by offering an example such as: I know some kids are scared of ___, do you have that fear too? Being specific can help your child sort through confusing fears and feelings.

When your child expresses anxiety or worry, offer reassurance by saying you believe him or her, and that having those feelings is okay. Remember, your child will take cues from you.Show acceptance of worry thoughts and anxious feelings. If you stay calm, it will help your child stay calm, too!

Tip: Does hearing Dont worry. Relax!" help you when you're anxious about something? It probably doesn't comfort your child much, either. Its important to acknowledge that your childs fears are real. Your empathy will increase the chances that your child will accept your guidance, and discuss his or her fears with you in the future.. Step 2: Teaching Your Child about Anxiety:

Four important points to communicate to your child: 1. Anxiety is normal. Everyone experiences anxiety at times. For example, it is normal to feel anxious when on a rollercoaster, or before a test. Some teens may appreciate some facts about how common anxiety problems are. For example, Did you know that one-inseven children under 18 will suffer from a real problem with anxiety? 2. Anxiety is not dangerous. Though anxiety may feel uncomfortable, it doesnt last long, is temporary, and willeventually decrease! Also, most people cannot tell when you are anxious (except those close to you such as your parents). 3. Anxiety is adaptive. Anxiety helps us prepare for real danger (such as a bear confronting us in the woods) or for performing at our best (for example, it helps us get ready for a big game or speech). When we experience anxiety, it triggers our fight-flight-freeze response and prepares our bodies to defend themselves. For instance, our heart beats faster to pump blood to our muscles so we have the energy to run away or fight off danger. When we freeze, we may not be noticed, allowing the danger to pass. This response is also called anxious arousal. Without anxiety, humans would not have survived as a species! How you can explain the Fight-Flight-Freeze response to a child: Imagine you are hiking in the woods and you come across a bear. What is the first thing you would do? You may run away from the bear, or you may simply freeze. Another reaction is to yell and wave your arms to appear big and scary. There are three ways humans react to danger: fight, flee, or freeze. When we are anxious, we react in one of these ways, too. We may run away or avoid situations that make us anxious. Or we may freeze, such as when our minds go blank and we cant think clearly. Or we may fight, get angry and lash out at people. Can you think of some ways you may fight, flee, or freeze because of anxious feelings? How to explain anxious arousal to a teen: Sometimes when we sense something is dangerous or threatening, we automatically go into a state called anxious arousal. This can happen when there is a real danger, but also when something simply feels dangerous, but really isnt, such as giving an oral presentation in class, or(give an example of something relevant to your child). Anxious arousal makes you feel jittery, on edge, and uncomfortable. It may also make it hard to think clearly. This feeling can become overwhelming enough that anxious people stop doing things or going places that make them feel anxious. Do you think this is happening to you? 4. Anxiety can become a problem when our body reacts as if in danger in the absence of real danger. A good analogy is that its like the bodys smoke alarm. How you can explain the smoke alarm response: An alarm can help protect us when there is an actual fire, but sometimes a smoke alarm is too sensitive and goes off when there isnt really a fire (e.g. burning toast in toaster). Like a smoke alarm, anxiety is helpful when it works right. But when it goes off when there is no real danger, then we may want to fix it. More about How Anxiety Works

Explain to your child the three parts of anxiety: thoughts (what we say to ourselves); physical feelings (how our body responds); and behaviours (what we do or our actions). A good way to describe the interconnection of these parts is to draw a triangle with arrows (see figure below). For example:

Step 3: Helping Your Child Recognize Anxiety For younger children, talk about how you will both be detectives, and how you will help your child in an investigation to find out more about anxiety. As detectives, find examples of how your child experiences anxiety in each of the three parts: physical symptoms, anxious thoughts, and avoidance behaviours. Being a Detective: Recognizing Physical Symptoms To help your child recognize physical symptoms, draw a sketch of a body and ask your child to identify where he or she feels anxiety in the body. Prompt your child, if necessary, with an example: When I feel anxious, I get butterflies in my tummy, and I get a big lump in my throat. What happens when you feel anxious? Have your child lie down on a large piece of paper (e.g. butchers paper) and trace his or her body. You can also print and fill out Chester the Cat for young children, and Wheres Anxiety in my Body? for older children. Teens may rather just talk about it, or identify their own symptoms from a list of typical physical symptoms. If age-appropriate, ask your child to come up with a name for anxiety (e.g. Mr. Worry, Worry Monsters). Refer to your childs anxiety with this new name, particularly in terms of bossing back anxiety (e.g. Its just the worry monster talking. I dont have to listen! ). Older children or teens may respond better to a music analogy, such as that the volume of their anxiety is turned up a bit louder than other kids. They simply need to learn to turn down the volume. These strategies help your child adopt an observer role when dealing with anxiety, giving them a greater sense of control. Being a Detective: Recognizing Anxious Thoughts Younger children may sometimes have difficulty identifying their thoughts, and especially anxious thoughts. For more information, see Healthy Thinking for Young Children. Older children and teens will likely be able to identify some of their anxious thoughts, and even challenge their unrealistic thoughts. For more information, see Realistic Thinking for Teens.

Regardless of your childs age, help your child understand that anxiety, and not actual real danger, is causing him or her to miss out on important opportunities and fun events. Being a Detective: Recognizing Avoidance Ask your child to come up with as many answers as possible to the following: If you woke up tomorrow morning and all your anxiety had magically disappeared, what would you do? How would you act? How would your family know you werent anxious? (Your teacher? your friends?) Finish the following sentences: My anxiety stops me from.... When I am not anxious, I will be able to... Once your child has gone through these three steps, and is able to understand and recognize anxiety, your child will be better prepared to move on to the next stage - learning how to manage anxiety!

HOW TO ADDRESS EXCESSIVE REASSURANCE SEEKING

Children and teens look to their parents for information about the world. It is normal and helpful for parents to provide children with information about challenging situations. This information may help children understand that those situations are not dangerous, and show them how to handle them effectively (e.g. what to do or say). For some children and teens, however, asking for reassurance about the same situation over and over again becomes an unhelpful way of coping. What is excessive reassurance seeking? When your child is feeling anxious, he or she will probably turn to you for help in feeling better. One of the ways in which your child might do this is through reassurance seeking, which involves asking you lots of questions, or asking the same question over and over in order to hear from you that things will be okay. Some examples of reassurance seeking:

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Are you sure you locked all the doors? Tell me again that Im a good girl! Did you wash your hands before you cooked dinner? Are you really sure? Calling mom or dad over and over again on the phone from school to make sure they are okay.

Asking parents to check homework repeatedly to make sure there are absolutely no mistakes.

What is the problem with giving reassurance?

Most parents already know that giving reassurance over and over again can be exhausting! Giving your child reassurance quickly becomes a bottomless pit: no matter how much reassurance you give your child, he or she will always want more! In fact, the more you give reassurance, the more youll have to keep giving it. In a way, it becomes addictive for kids!

Giving reassurance is a band-aid solution: it only relieves your child or teens anxiety in the moment. More importantly, giving reassurance actually keeps your childs anxiety alive, because it maintains the problem in the long-term.

Giving your child or teen reassurance also sends the message that theres actual danger that he or she needs to be protected from, when it is in fact the anxiety that is driving the reassurance seeking.

What is the solution? In order to help your child face fears and cope with anxiety in a healthy and adaptive way, YOU NEED TO STOP GIVING YOUR CHILD REASSURANCE. If your child does not rely on reassurance seeking to relieve anxiety, he or she can gradually learn to cope with anxiety on his or her own: this can give your child a sense of independence and competence. Easier said than done?

For most parents, not giving their child or teen reassurance sounds very difficult. When your child asks for reassurance, he or she is obviously very upset, and many parents feel it is cruel to deny their children the reassurance they seem to need. However, if you want to help your child manage anxiety over the long term, he or she needs to learn a more effective way of coping.

There is a way to help your child to stop asking for reassurance without feeling as if you are being mean or uncaring.

How to Do It! Step 1: Make a Clear Plan Before you start any anxiety management skill with your child, you need to have a clear idea of what exactly you will be doing. For example:

What specific behaviours are you trying to change? (e.g., Whenever my child asks me if the house is clean, I will no longer give reassurance that it is, or I do not want my child to call me at work several times every day to make sure I am okay)

Is everyone in the family on board? If you plan to stop giving reassurance to your child, it is important that everyone else in the family agrees. If your child can simply get reassurance from someone else, this strategy will not work.

Make sure your child or teen understands and agrees with the plan . When he or she is calm (not experiencing anxiety), explain what the plan is, and why you are doing it.

HOW TO TALK TO YOUR CHILD ABOUT THE NEW PLAN: AN EXAMPLE

Parent: We are going to set up a new plan in the house to help you to boss back your anxiety. For example, whenever you get anxious or worried that your homework isnt perfect, what do you usually do? Child: I ask you to read it. Parent: Thats right. And you do that many times every time you have homework. The reason you do this is because your anxiety starts bullying you around, telling you that you made a mistake and that not being perfect is really bad. But is your anxiety right or wrong when it tells you that? Child: Well, I guess its wrong. Parent: Exactly. Thats because anxiety can be a big liar. So we need to stop anxiety from bullying you. We are going to do that by not listening when anxiety tells you to call me. So your job is going to be to try to do your homework without asking me to read it, even if you get anxious. My job will be to help you boss back your anxiety by asking you to read over your homework yourself. This is going to be our new plan, okay? When you ask me to help you, I am going to remind you that your anxiety is bullying you, and that you can do it fine by yourself. Eventually, anxiety is simply going to give up and stop bossing you around. Step 2: Following Through on the Plan Once you have explained the new plan to your child or teen, you need to follow through on it. There are a number of things you can say to your child when he or she comes to you for reassurance. Here are some examples:

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You already know the answer to that question. I am not going to answer that. What if you didnt do your homework perfectly -- what would happen? Maybe you did make a mistake on your exam; what could you do to cope with that?

It sounds like your anxiety is acting up. What could you do to boss it back? Could you maybe do some relaxed breathing? Are there any helpful thoughts that you can tell yourself?

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What do you think? How could you handle that? I guess youll just have to wait and find out.

Active ignoring involves deliberately ignoring the question and not paying attention to your childs demands. However, once he or she stops asking for reassurance, give him or her lots of praise and attention. Return to not giving your child attention or reassurance if he or she starts asking you questions again. This strategy quickly teaches your child that reassurance

will not be rewarded or answered by you, and that it is more beneficial not to repeatedly ask the same questions. Step 3: Give lots of praise! Because this is hard work, make sure to repeatedly praise your child for any efforts made to not seek reassurance from you, or attempts to manage anxiety independently. Some positive comments you can make are:

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You are doing such a great job! Look how well you bossed back your anxiety! Im so proud of you!

What to expect When you first stop giving reassurance, your child or teen will probably be very anxious. In fact, he or she might become very angry or frustrated, and even throw a temper tantrum. This is normal. It is important that if you have decided NOT to give reassurance, that you stick with it! Children and teens often get very angry when they do not get the reassurance that they have come to expect. If you keep at it, and stick to the plan, your child will stop seeking reassurance from you, and start managing anxiety in more healthy ways. THE GOLDEN RULE: CONSISTENCY! Sometimes parents will say they tried to stop giving reassurance, but it didnt work, and that their child or teen simply kept asking for reassurance. This usually happens when you have given in once or twice, and gave reassurance. Many parents will break down and give reassurance if their child has a really bad temper tantrum, cries, or delays a task that needs to get done (for example, wanting reassurance before going to school in the morning). This is understandable because it can be very difficult for parents to stop themselves from soothing their upset child or teen. Nevertheless, it is necessary. REMEMBER For this strategy to work, you need to resist giving reassurance every single time! HELPFUL HINT: THE PROBLEM WITH INCONSISTENCY If you give in to your childs demand for reassurance even once, your child has learned a powerful lesson: If I persist and ask enough times, eventually I will get the

reassurance that I want. So, rather than getting rid of the problem behaviour, you have increased and strengthened it! This is why if you give reassurance, even once, your child will keep asking until he or she gets it. However, if you consistently stick to the plan, your child or teen will start using other strategies to cope with anxiety, and stop asking you for reassurance. Teens and Reassurance Anxious teens seek reassurance just as younger children do, and parents need to use the same strategies to deal with this, using language and examples that are appropriate for the teenagers age. Because they are older, parents can give their teen a more detailed explanation of why excessive reassurance-seeking is not a helpful coping strategy. Some of the points you can talk about are:

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Reassurance seeking only works in the short-term: the more you ask for reassurance, the more you will want it in the future. We ask for excessive reassurance when we feel that there is a danger; but, in fact, anxiety is driving the need for reassurance.

When you stop receiving reassurance, it is normal to feel anxious. However, this might be a good opportunity to start using other, more helpful coping skills.

HELPFUL HINTS: FOCUS ON POSITIVE BEHAVIOUR, NOT ANXIOUS BEHAVIOUR Because your child will probably be quite anxious at first when not getting reassurance, your first instinct might be to soothe him or her in other ways (for example, giving lots of affection and attention, treats or rewards).

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By doing this, you are actually rewarding the anxious behaviour. If you stick to the plan, resist giving reassurance, and encourage your child to handle anxiety on his or her own, you are ignoring the anxious behaviour.

Encouraging your child to reassure him or herself, and to problem solve independently will help your child to become independent and confident.

After your child has calmed down, or if he or she is using a coping tool to deal with anxiety, then you can praise this positive behaviour!

HOW TO TEACH YOUR CHILD CALM BREATHING

What is calm breathing? Calm breathing is a technique that teaches your child to slow down his or her breathing when feeling stressed or anxious. Why is calm breathing important? When your child is feeling anxious, his or her breathing will change. When we are anxious, we tend to take short, quick, shallow breaths or even hyperventilate.

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This type of anxious breathing can actually make the feeling of anxiety worse! Doing calm breathing can help lower your childs anxiety, and give him or her a sense of control

Calm breathing is a great portable tool that your child can use when feeling anxious, especially in situations when you are not there to help him or her through it.

How To Do It Step 1: Explaining calm breathing to your child This is a tool your child can use anywhere, anytime! Other people will probably not even notice when your child is using this tool. For older children and teens, explain that taking short quick breaths actually increases other feelings of anxiety (e.g. heart racing, dizziness, or headaches). Calm breathing will slow down his or her breathing. Step 2: Teaching the calm breathing technique

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Take a slow breath in through the nose (for about 4 seconds) Hold your breath for 1 or 2 seconds Exhale slowly through the mouth (over about 4 seconds) Wait 2-3 seconds before taking another breath (5-7 seconds for teenagers) Repeat for at least 5 to 10 breaths

Calm Breathing for Younger Children: Bubble Blowing A fun way to teach your younger child how to do calm breathing is the bubble blowing technique. Using a toy soap bubble container and wand (available at any toy store), have

your child practice blowing bubbles. The breathing required for blowing soap bubbles is the same as what is used for calm breathing. Simply make sure your child waits a second or two before blowing another bubble. Then practice blowing bubbles without a bubble wand. Important Hint: Although bubble blowing is a great way to practice calm breathing, it is important to remind your child that he or she is doing this to learn how to breathe calmly. In other words, do not simply ask your child to blow bubbles without explaining this tool is used to help to manage anxiety. Heres a script of how to introduce bubble blowing to your young child Talking about bubble blowing Today we are going to practice a new skill called calm breathing. This will be a new tool that you can use when you feel anxious, such as when you are at school. When you use calm breathing, you take slow breaths. A good way to practice it is to do some bubble blowing, because you have to take a slow, deep breath to make a big bubble, and you have to blow the bubble really slowly or it will pop! So lets practice. Take a slow, deep breath in, hold it for a second, and then slowly blow some bubbles. Good job! Now lets try that again.

For Older Children and Teens: Belly Breathing Since calm breathing involves taking slow, controlled breaths from the diaphragm, another way to explain this technique is to present it as belly breathing. The steps for this exercise are as follows:

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Inhale slowly for 4 seconds through the nose. Ask your child to pretend that he or she is blowing up a balloon in the belly, so your childs belly should inflate when inhaling.

Wait 2 seconds, and then slowly exhale through the mouth. Ask your child to pretend that he or she is emptying the balloon of air, so the tummy should deflate.

Wait 2 seconds, and then repeat.

Helpful Hint: When belly breathing, make sure your childs upper body (shoulders and chest area) is fairly relaxed and still. Only the belly should be moving! Step 3: Practice, practice, practice! In order for your child to be able to use this new tool effectively, he or she first needs to be an expert at calm breathing.

The only way to become an expert is to practice this skill daily! Rules of practice:

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Until your child is comfortable with this skill, he or she should practice it at least twice a day, doing 10 calm breaths in a row. When you are practicing calm breathing, start when your child is relaxed, before he or she is feeling anxious. Your child needs to be comfortable breathing this way when feeling calm!

Once your child is comfortable with this technique, he or she can start using it in situations that cause anxiety.

As a final note If you are using cognitive coping cards with your child (see Developing and Using Cognitive Coping Cards), calm breathing can also be used as a coping statement. For example,

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Im feeling a little anxious right now. Maybe I should do some belly breathing! I dont need to worry if I feel scared. I can always do some bubble blowing !

HOW TO DO PROGRESSIVE MUSCLE RELAXATION

This exercise will help your child learn how to relax when he or she is feeling anxious or stressed. It can also help reduce physical problems such as stomachaches and headaches, as well as improve sleep. The technique involves tensing and then relaxing different muscles in the body. This can help your child learn the difference between being tense and feeling relaxed. Helpful Hints:

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Set aside 15 to 20 minutes to complete this exercise. Find a place where you and your child can complete this exercise without being disturbed.

Teens may prefer to do this exercise on their own. Encourage them to find a quiet place to practice.

When reading the instructions, speak slowly and use a calm and soothing voice. Pause after each instruction to allow your child time to carry it out.

You can also record the instructions on a tape or CD. This can be helpful for teens who may want to do this on their own.

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For teens, change some of the wording. Use stomach instead of tummy. Make sure your child is not tensing too hard. He or she should feel tightness in the muscles, but not pain. Ask your child to tense each muscle for 5 seconds before relaxing the muscle.

Getting ready Have your child find a comfortable place to sit or lie down, close his or her eyes, and let the body go loose. Instructions Once your child is sitting comfortably with eyes closed, slowly read the following instructions: Take a deep breath in through your nosehold your breath for a few secondsand now breathe outgoodtake another deep breath through your noseimagine your tummy is a big balloon filling up with airhold your breathnow breathe out and imagine that the air in the balloon is slowly escapingNow I want you to pay attention to your body and how your it feels.

Lets start with your legsI want you to stretch out your legs in front of you and point your toessqueeze the muscles in the top of your legsnow squeeze the muscles in the bottom of your legshold itnow relaxlet your legs go limpimagine that your legs are floppy cooked spaghetti noodlesrelax all the muscles in your legsnotice how heavy your legs feel now take a deep breath and holdand breathe out Now, make a fist with your left hand and squeezeimagine that you are holding an orange and you are squeezing all the juice out of the orangefeel the tightness in your hand and arm hold it tightand now relax your hand notice how your muscles feel when they are relaxednow make a fist with your right hand and squeeze tightimagine that your holding a lemon and squeeze all the juice outfeel the tightness in your hand and armhold itand now relax your hand enjoy feeling relaxed now take a deep breath and holdand breathe out Lets focus on your armsstretch your arms out in front of you like you are reaching out to somethingkeep stretchinghold itand now relaxlet your arms drop to your sides imagine your arms are cooked spaghetti noodles that are dangling at your sidesnotice how relaxed your arms feelrelax your armsnow stretch your arms up above your headtry to reach for the clouds with your finger tipsholdkeep reaching above your headnow let your arms drop to your sidesrelax you armslet your arms go very floppynotice how calm you feel now take a deep breath and holdand breathe out Lets move to your shoulder pull your shoulders up to your earsholdkeep holdingnow relax notice how relaxed you feel now take a deep breath and holdand breathe out Now, pull in your tummy musclesimagine that an elephant has just stepped on your tummysuck in all the muscles in your tummyhold itgoodnow relaxlet your stomach outrelax all the muscles in your tummynotice how your muscles feel when you relax them now take a deep breath and holdand breathe out Finally, wrinkle up your faces as much as you canwrinkle your nosemoutheyes foreheadcheeksand push your lips togetherNotice how tight the muscles in your face feelhold itgoodnow relaxlet all the muscles in your face go limpnotice how relaxed you feel now take a deep breath and holdand breathe out Now relax your whole bodyimagine youre a rag doll and try and relax all the muscles in your body. Notice how good you feelso relaxedso calmnow take a deep breath and hold itand breathe outyouve done very well! When you are ready, you can slowly open your eyes.

Quick Tense & Relax!

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After your child has had some time to practice the full version of the muscle relaxation exercise, introduce thequick tense and relax strategy. In this approach, your child learns how to tense all the muscle groups (for 5 seconds) and then to relax all the muscles in his or her body at one time.

Your child can do this by taking a big breath, lifting up the shoulders, pushing out the chest and wrinkling up the face. Then, silently saying the word relax and letting the whole body go limp like a rag doll. Over time, your child can start to practice this strategy in more stressful situations (for example, in the playground or while in the car).

Quick Relax!

Once your child has learned to tense and relax the whole body, the next step is to practice relaxing without tensing so that your child can easily use this strategy in a wide range of situations.

Ask your child to take a deep breath, then slowly let out the breath while silently saying the word relax and letting the whole body go limp like a rag doll. If the child wishes, he or she can go through several breaths, each time letting the body become looser and more relaxed after each breath.

The goal is to help your child develop a quick strategy to help him or her relax in any situation.

Helpful Hints:

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Practice! When your child is first learning these strategies, encourage him or her practice Do it together! It can also be helpful to do the exercise along with your child or have the whole family participate. Make it a family project! However, some teens may prefer to do it on their own, so you might want to ask how much help they want.

Break it up! If your child is very young, break up the exercises into two parts and take a break in between.

When to practice? It can be helpful to practice the full version of the muscle relaxation exercise in the evening before your child goes to bed. Try the quick tense and relax or quick relax exercise at different times during the day.

Records! Have your child record his or her practice sessions. For younger children, make up a poster and give your child a star every time he or she practices. For teens, encourage them to note practice times in their day planner or on a calendar, and to check it off once they do it.

Coping Card! Encourage younger children to include muscle relaxation on their coping card.

Praise! Give your child lots of praise for completing this exercise! It can be difficult to learn to relax. Let your child know that it takes time and practice, just like learning any new skill.

DEVELOPING AND USING COGNITIVE COPING CARDS

An important tool in your child or teens anxiety toolbox is the ability to change anxious thoughts to more relaxed and balanced thinking. However, it can be very difficult for children and teens to remember to use coping toolswhen they are anxious. They are so focused on their feelings of being in danger that they forget they have a way of telling whether or not danger actually exists (and it usually doesnt). With practice, however, your child can learn to use coping thoughts on his or her own. This is really helpful as you might not always be there to remind your child to use the tools (for example, when at school, or sleeping over at a friends house). A good tool to help your child or teen is Cognitive Coping Cards! What are Cognitive Coping Cards? Cognitive coping cards can be small index cards with short sentences of some of the coping skills your child can use when experiencing anxiety. The cards are portable reminders to boss back anxiety! What sorts of things are helpful to put onto a coping card?

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A reminder that physical symptoms (e.g., sweaty palms, stomach-aches) are just anxiety The name your child has given to anxiety (e.g. Mr. Worry, the pest, the bug) A reminder that anxiety is not dangerous and doesnt last forever Positive coaching statements (e.g. I can get through this!) A reminder to use some coping skills (e.g. I can do relaxed breathing) Some calming facts your child or teen has used before (e.g. the odds of getting kidnapped are really low)

HOW TO DO IT! Step 1: Make sure your child is involved In order for coping cards to be useful, your child needs to feel that the coping statements will actually bepersonally helpful! Children and teens are more likely to use them if they have been involved in developing them. It is NOT a good idea for you to simply write them up and hand them over.

What to say to get your child involved: You have been really good at bossing back your anxiety these days! Now we can learn another way for you to be the boss. Why dont we try to figure out some things you can tell yourself when your anxiety is acting up? We can write down some things on cards that can help you feel calm. These cards will be another tool in your anxiety-fighting toolbox!" For teens: Although you should encourage your child to develop coping statements, older children and teens can be more independent when writing out their coping cards. They can decide what skills are most helpful for them. You can explain that when we feel anxious it is sometimes difficult to remember all the skills weve learned to battle that anxiety. Writing out those skills on coping cards might help them remember what has been helpful for them in the past, and what skills they would like to use next time. Step 2: Make it a game! Making up the cognitive coping cards should not be a chore! Have fun trying to come up with good statements that your child will find helpful in managing his or her anxiety. Here are some ways you can make this tool a fun task:

Get the family involved! Like all the tools in the anxiety toolbox, the whole family should work together on the goal of tackling anxiety. Parents, brothers, and sisters can all get involved in making these coping cards!

Make it an art project! Decorate the cards with coloured ink, sparkles, stickers, gold stars, and different colours of poster board cardboard. This turns developing and using coping cards into a fun project.

Step 3: Remember to praise your child As always, it is very important that you give lots of praise whenever your child is successful at managing anxiety, or whenever he or she tried to manage anxiety (but was not quite able to do it). This can include saying, You are doing a great job! Im so proud of you, but it might also involve small, simple rewards (story time; playing a fun board game together; having a fun family day; or getting a new video game if your child has been working hard to boss back anxiety for a while). Some examples of coping cards: Coping card #1: Billy

Billy has panic attacks, and is afraid he is going to have a heart attack. He has started to boss back his anxiety by doing muscle relaxation, and facing his fears about his panic attack symptoms. My Coping Card to Beat Anxiety! 1. Anxiety is not dangerous. It cant hurt me! Its just a bully! 2. I can boss back my anxiety. I have done it before! 3. If my heart is racing, I get sweaty, and my tummy hurts. That means that my anxiety is acting up. Im not in danger. 4. I could do some relaxation now. 5. Am I falling into a Thinking Trap?* *For more information on Thinking Traps, see Realistic Thinking for Teens. Coping card #2: Susan Susan gets very anxious when she is at school. She is worried that the other kids dont like her, and that, if they knew she had anxiety, that they would laugh at her and make fun of her. She has been learning to recognize her anxious thoughts and to try to challenge them and think of more realistic thoughts. My Coping Card to Beat Anxiety! 1. My face is getting hot and my head is getting dizzy! My anxiety is acting up again! 2. Maybe I need to use the STOP plan now!* 3. If Im feeling anxious, I could do some calm breathing to calm down. 4. I have lots of friends at school, and they like me even when I get anxious. They told me so. *For more information on the STOP plan, see Healthy Thinking for Young Children.

HELPING YOUR CHILD FACE FEARS

BEHAVIORAL EXPOSURE An important step in helping your child manage irrational fears involves facing feared situationsor places. It is normal for children and teens to want to avoid the things they fear. However, avoidance prevents them from learning that feared situations or places are not dangerous. The process of facing fears is called EXPOSURE. Exposure involves having your child repeatedlygo into feared situations until he or she feels less anxious. Exposure is not dangerous and will notmake the fear worse. After awhile, the anxiety will naturally lessen. Starting with situations that are less scary, children and teens work their way up to facing things that cause them a great deal of anxiety. Over time, they build up confidence in those situations and may come to enjoy them. This process often happens naturally. A child or teen who is afraid of the water takes swimming lessons every week and practices putting feet and legs in the water, then the whole body and, finally, diving underwater. Children and teens with a fear of water can learn to love swimming. The same process occurs when children and teens learn to ride a bike, skate, or drive a car. Exposure is one of the most effective ways of overcoming fears. However, it takes some planning, encouragement, modeling and rewards. How to Do It! Step 1. Understanding

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Help your child understand the importance of facing fears. Use an example. Ask your child the following question:

Tim is afraid of the water, but really wants to spend time with his friends at the swimming pool. What can he do to stop being afraid of the water? Most children and teens understand that, in order to stop being afraid of something,they need to face it.

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You can give your child the following explanation to help him or her understand.

It is important for you to face your fears so that you can learn that those situations are safe.Although it can be scary at first, with practice you will feel less anxious. You can start with some things that are less scary and take small steps towards facing the things that are scarier. Over time, you will feel better in those situations and may end up really enjoying them.

Step 2. Make a list

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Working with your child or teen, make a list of situations, places or objects that he or she fears. For example, if your child is afraid to be away from you or to do things on his or her own,the list might may include: staying at a friends house while you leave for 10 minutes;playing alone for 20 minutes; or getting dropped off at a friends birthday party for 30 minutes. If your child is afraid of social situations, the list might include: saying hi to aclassmate; asking the teacher a question; or calling a friend on the phone.

Helpful Hints:

Group Fears Together. Sometimes children or teens have a lot of different fears, so it can help to group similar fears together. For example, your child might have a fear of bugs, as well as a fear of going to schooland being away from parents. Common fears among children include:being separated from parents or family members; interacting with adultsor other children; physical danger (swimming or riding a bike); fears relatedto the natural environment (animals or insects); and fears related tomedical procedures (doctor, dentist, injections).

Work together. Work with your child to come up with a list of feared situations. Although younger children may need more help, some teens may prefer to do it on their own. You may want to ask how much help they want.

Step 3. Build a Fear Ladder Once you have made a list, help your child arrange things from the least scary to the mostscary. You can do this by having your child rate how much fear he or she has for each situation on the list from 0 (No fear) to 10 (Tons of fear). Use the Fear Thermometer to help your childmake the ratings. Younger children may not be able to give a rating, but can usually tell you which situations are easier and which are more difficult. Once your child has rated each situation, usethe Fear Ladder Form to make a final list. For younger children, you may want to use a shorterversion Hopping Down My Worry Path.

Helpful Hints:

Ask your child to identify a specific goal (such as sleeping alone in his orher own room), and then list the steps needed to achieve that goal (suchas sleeping in mom and dads room on the floor; sleeping in ones own room with door open, etc.). See Examples of Fear Ladders for some ideas on buildling your child's Fear Ladder.

If your child has a lot of different fears, build separate ladders for each fear theme.

Reward Brave Behavior

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Its not easy facing fears. Using rewards can encourage brave behavior. Children and teens respond to praise and encouragement. For example, you can say:You did it! You played at your friends by yourself. You did a great job of introducing yourself to the other kids! and Im proud of you for sleeping in your own room.

When your child is facing strong fears, it may be helpful to use specific rewards asmotivation to achieve

Each ladder should include a whole range of situations. The ladder should identify some things your child can do now with some anxiety, some things he or she can do now with moderate anxiety and, finally, the things he or she finds too difficult to do now. It is important to start really small and take gradual steps. Some things on the ladder can be broken up into smaller steps. For example, if your child isafraid to talk to classmates, this could be broken up into a number of steps such as saying hi toa classmate, asking a quick question, and then talking about his or her weekend. It can also be important to consider other factors that may affect fear level. Some examplesinclude: length of time (e.g., talking to a classmate for 30 seconds is probably less scary thantalking for five minutes); time of day (e.g., spending time alone in ones room in the afternoonversus evening); environment (e.g., swimming at local pool versus swimming in a lake); and whois with your child (e.g., going over to a friends place with mom versus an older brother). See Examples of Fear Ladders for some ideas about building your childs fear ladder. Step 4. Facing Fears (Exposure) Starting with the situation that causes the least anxiety, encourage your child to repeatedly engage in that activity (e.g., repeatedly saying hi to an unfamiliar person) until he or she

startsto feel less anxious doing it. If the situation is one that your child can remain in for a period of time(such as being close to a dog), encourage him or her to stay in the situation long enough to seeanxiety lessen (e.g., standing next to a dog for 20-30 minutes). Once your child is able to enterthat situation without experiencing much anxiety, he or she can move on to the next thing on the list. For some children or teens, it can help to model behaviors ahead of time. For example, practicewith your child saying hi to someone or model petting a dog. Encourage your child to track his or her progress. See the Facing Fears Form, which helpsyour child identify how anxious he or she was before and after facing the feared situation, andwhat he or she learned. Make copies and have your child fill one out each time he or she faces fears. Helpful Hints:

Dont Rush! It can be very scary facing the things one fears. Be encouraging and recognizethat your child needs to go at his or her own pace.

Step 5. Practice It is important to practice on a regular basis. Some things can be practiced daily (e.g., spendingtime alone in a part of the house without the parent in the same room), while other things canonly be done once in a while (e.g., sleeping at a friends place). However, the more often a child practices the faster the fear will fade! Step 6. A goal. For example, offer a special gift (DVD, CD, book, treat, toy, craft) or fun activity (rent a movie or game, go to movies, amusement park, go out for lunch or dinner, play a game, make a special meal together). Once your child has successfully faced a specific fear, specific rewards may be phased out, but dont stop praising! Encourage your child to reward him or herself with positive self-talk (for example, I really triedhard!) and enjoyable activities (for example, watching a favorite movie) after facing a fearedsituation. Helpful Hints:

Plan! It is important to plan out rewards in advance and to be consistent in using them.

Record it! For younger children, you can make up a poster that charts their progress and awardstars each time they face their fears. This can help them work towards bigger rewards.

HELPING YOUR CHILD COPE WITH BACK-TOSCHOOL ANXIETY

Anxious feelings are normal and expected during times of transition or change. This is especially true for children and teens going back to school, or for first-timers starting kindergarten. This transition can be stressful and disruptive for the entire family! Prior to the first day of school, your anxious child may cling, cry, have temper tantrums, complain of headaches or stomach pains, withdraw, and become sullen or irritable. Worries are Common. Anxious children and teens worry about many different schoolrelated issues, such as teachers, friends, fitting in, and/or being away from their parents. Some common worries include:

o o o o o o o o o o

Who will be my new teacher? What if my new teacher is mean? Will any of my friends be in my class? Will I fit in? Are my clothes OK? Will I look stupid? Who will I sit with at lunch? What if I miss the bus? What if I cant understand the new schoolwork? What if something bad happens to mom or dad while I am at school?

Although it is normal for your child to have worries, it is crucial to make your child attend school. Avoidance of school will only increase and reinforce your childs fears over the long-term, and make it increasingly more difficult to attend. Besides missing school work, children and teens who stay home because of anxiety miss:

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valuable opportunities to develop and practice social skills important chances for success and mastery being acknowledged and praised for talents fostering close friendships with classmates

Most importantly, anxious children and teens who miss school cannot gather evidence that challenges their unrealistic and catastrophic fears! How To Deal With Back-to-School Worries! Below are some general strategies parents can use to deal with back-to-school worries, followed by a schedule leading up to the first day of school. Look after the basics. Nobody copes well when they are tired or hungry. Anxious children often forget to eat, dont feel hungry, and dont get enough sleep. Provide frequent and nutritious snacks for your child.During this time, you also need to build in regular routines, so that life is more predictable for your child. These routines can involve the morning and bedtime habits, as well as eating schedules. See Healthy Habits for the Home Encourage your child to share his or her fears. Ask your child what is making him or her worried. Tell your child that it is normal to have concerns. Before and during the first few weeks of school, set up a regular time and place to talk. Some children feel most comfortable in a private space with your undivided attention (such as right before bed, or during mealtime). Teens often welcome some sort of distraction to cut the intensity of their worries and feelings (such as driving in the car, or taking a walk). Avoid giving reassurance...instead, problem-solve and plan! Children often seek reassurance that bad things wont happen in order to reduce their worry. Do not assure them with Dont worry! or Everything will be fine! Instead, encourage your child to think of ways to solve his or her problem. For example, If (the worst) happens, what could you do? or Lets think of some ways you could handle that situation . This gives you the opportunity to coach your child on how to cope with (and interpret) both real and imagined scary situations. You will also be giving your child the tools he or she needs to cope with an unexpected situation that might arise. See How to Address Excessive Reassurance Seeking for more details. Heres a sample script for engaging your child in problem-solving and planning (instead of giving reassurance): Role-play with your child. Sometimes role-playing a certain situation with your child can help him or her make a plan, and feel more confident that he or she will be able to handle

the situation. For example, let your child play the part of the demanding teacher or bullying classmate. Then, model appropriate responses and coping techniques for your child, to help them calm down. For more information on role-playing, see Helping your Anxious Child Make Friends Focus on the positive aspects! Encourage your child to re-direct attention away from the worries, and towards the positives. Ask your child, " What are three things that you are most excited about on your first day of school?" Most kids can think of something good, even if it's just eating a special snack or going home at the end of the day. Chances are that the fun aspects are simply getting overlooked by repetitive worries. Pay attention to your own behavior. It can be anxiety-provoking for parents to hand over care and responsibility of their child to teachers. Children take cues from their parents, so the more confidence and comfort you can model, the more your child will understand there is no reason to be afraid. Be supportive yet firm. When saying goodbye in the morning, say it cheerfully once! Ensure you dont reward your childs protests, crying, or tantrums by allow him or her to avoid going to school. Instead, in a calm tone, say: I can see that going to school is making you scared, but you still have to go. Tell me what you are worried about, so we can talk about it. Chances are, your child is anxious about something that requires a little problem-solving, role-playing, planning, and/or involvement from the teacher. Timeline Leading Up to the First Day of School (You may not need to take all of these steps) At least one week before:

Start your child on a school-day routine waking up, eating, and going to bed at regular times. Explain that everyone in the family needs to adjust to the new schedule, so he or she doesnt feel alone with these changes.

For older children who having troubles getting up and out of bed, give them a big person alarm clock, and let them practice using it.

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Ask your child to help plan school lunches for the first week. Create a list of school supplies together and plan a fun shopping trip. Teach and practice coping skills to use when feeling nervous, such as How to Do Calm Breathing andDeveloping and Using Cognitive Coping Cards

A couple days before school:

Go to school several times walking, driving, or taking the bus. For young children taking the school bus, describe and draw out the bus route, including where the bus goes and how long it takes to get to school. Talk about bus safety.

For new students, take a tour of the school. Show your child the classrooms, the cafeteria, and the bathrooms. If possible, meet your childs teacher with your child present.

Ask your child to help choose the outfits for the first week of school. Let your child wear his or her favorite outfit on the first day.

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Together with your child, pack up the schoolbag the night before, including treats. For younger children who are nervous about separating, suggest taking a special object to school that reminds him of home. A reassuring note in a childs lunch can also help ease separation anxiety.

The first day of school:

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Have your child go to school with a friend for the first couple of days. Tell the teacher that your child is having some separation anxiety most teachers are experts in this area, and have years of experience!

Most importantly, praise and reward your child for brave behavior!

HELPING YOUR CHILD SLEEP ALONE OR AWAY FROM HOME

Many anxious children and teens feel a sense of security by sleeping close to their parents. In particular, children and teens with separation anxiety may plead, beg, or have a tantrum in order to sleep in your bed. This can cause problems, not only for your child, but also for you. When anxious children and teens sleep in their parents bed, they are not facing their fears, and will continue to be afraid of sleeping alone. They do not learn how to calm themselves down, and do not see that everything will be okay. Co-sleeping makes it difficult for parents to get a good nights sleep or find alone time with a spouse or partner. Even though most parents know it is not appropriate for their child to be afraid of sleeping alone, they are unsure of how to change this behavior. Getting Your Child To Sleep Alone: HOW TO DO IT! Step 1: Preparing your child Before starting any new plan in your home, it is important that your child understand what is going to happen and why. For younger children, you might want to read books with them about co-sleeping, and explain that wanting to sleep in mom and/or dads bed is another way that anxiety is being a bully (for more information on teaching your child about anxiety, see How to Talk to Your Child about Anxiety). For teens, explain that sleeping alone is a normal part of growing up, and although it sounds scary, it is important to face this fear gradually. Step 2: Make your childs bedroom fun! It is important to make this new change as easy as possible for your child. Get your child involved in making his or her bedroom more appealing. Be creative, and encourage your child to decorate his or her room with enjoyable and fun things (e.g., pictures, posters, a nightlight, wind chimes, and/or a bedspread in a favorite color!). Focusing your childs attention on the positives will reduce anxiety when he or she first starts sleeping alone. You can also try to focus your childs attention on the benefits of sleeping in his or her own bedroom, including:

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For younger children, being a big boy or a big girl, and sleeping alone. Getting to sleep in a bedroom that is all his or her own! If your child shares the room with a sibling, make sure each child has a personal space that they can decorate.

Older children and teens may look forward to future sleepovers at a friends house, or camping trips with the school.

Step 3: Establish a bedtime routine As a parent, you probably already have a bedtime routine with your child, which might involve reading a story and goodnight kisses. This entire routine should take place in your childs bedroom. Even if your child is not ready to sleep alone right away, it will be easier if your child is used to getting ready for bed in his or her own bedroom, rather than in your bedroom. For more information on bedtime routines, see Healthy Habits in the Home Step 4: Gradually facing fears It may be unrealistic to expect your child to be able to sleep alone immediately. Instead, you can make a fear ladder with your child, with the goal being to sleep in my own bed for the entire night. When asking your child to gradually face his or her fears, it is important to

progress at your childs pace. Every child and teen is different, and will be able to start on a different step. Some suggestions for a first step include:

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Having your child sleep on a cot in your bedroom. Having your child sleep on a cot near the door of your bedroom or on the floor in sleeping bag.

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Having your child sleep on a cot just outside your bedroom (with the door open). Having your child sleep in his or her bedroom, with you staying in a chair in the room until he or she falls asleep (do not lie down with child in his or her room).

Having your child sleep in his or her bedroom, with a nightlight, with you staying in the room for 10 minutes.

For more information on making a fear ladder, see Helping your Child to Face Fears: Exposure.

Helpful Hint: Easing the transition For some children and teens, gradually starting to sleep alone can be very scary, so you might need to include some extra steps in your childs fear ladder, such as:

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Agreeing to check on your child once or twice during the night (or more frequently, if needed, with a plan to reduce checking over time). Giving your child a baby monitor or walkie-talkie to use when sleeping in bed alone.

Anything your child feels he or she can do to gradually stop sleeping in your bed is a step in the right direction! Step 5: Praise, praise, praise! No matter what fear your child is facing, it is difficult. Therefore, it is important to give your child lots of praise and reward! Every time your child is able to move up his or her fear ladder, be sure to praise this success! Helpful Hints:

Make a poster board with the days of the week, and put a gold star or a sticker for every night your child is able to accomplish his or her goal on the fear ladder! Display it somewhere in the house so everyone in the family can see how well your child is doing! Make sure to never take a star or sticker away for bad behavior. You want these rewards to be a motivator for your child, not a punishment.

Some children will complain of nightmares. Your child may come to you for comfort in the middle of the night. For more information on how to deal with nightmares, see Helping Your Child Cope with Nightmares.

Helping Your Child Sleep Away from Home Many children and teens with separation anxiety are afraid to sleep away from home. They may be afraid to go to camp, have a sleepover at a friends house, or even stay with a grandparent. Fortunately, you can help your child manage his or her fear of sleeping away from home in the same way that you manage sleeping alone at home: by gradually facing fears. Step 1: Explain the plan Some children and teens might want to be able to sleep away from home, but are too worried or anxious to try it. If this is the case with your child, explain that the best way to deal with this fear is to take small steps. For children who do not want to sleep away from home, explain that anxiety is bullying him or her, and that together you will start fighting back. Helping hint: Anxiety is normal! Tell your child it is normal to be anxious or worried when you first sleep over at someone elses house. Everyone is a little afraid the first time, but that doesnt mean something bad will happen. Ask your child how he or she felt the first time a new activity was tried, like riding a bike or learning how to swim. It is always scary the first time, but it gets easier after

awhile. Also, staying over at someone elses house can be fun! Talk to your child about the fun activities or games he or she can do while staying somewhere new. Step 2: Make a Fear Ladder When you are planning to manage anxiety about being away from home, it is important to have a goal for your child, such as staying over at grandmas house, sleeping over at a friends house, or inviting a friend to stay overnight. Whatever the goal, you can work with your child to make a fear ladder, with steps that move towards that goal. (see Helping Your Child Face Fears - Exposure for more information). For example, if your childs goal is to go to a sleepover at a friends house, some of the steps on the fear ladder might be:

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Have a friend come over and spend the day at your house. Have a friend sleep over at your house. Have two friends sleep over at your house. Go to friends house to play with mom in the other room. Go to friends house to play without mom there for an hour. Go to friends house to play without mom there (mom calls once). Stay over night at a friends house, calling mom once, if feeling anxious. Stay over night at a friends house, without calling mom.

Make sure to go at your childs pace, and always reward and praise your child for every attempt they make at moving another step on their fear ladder. Helpful Hint: Listen and Problem Solve Your child may have lots of worries, such as what if something bad happens while Im gone? or what if I have a panic attack? First, listen to your childs worries without judging or saying they arent real or true. Remember, these fears are very real to your child. Next, help your child problem-solve and plan. For example, if your child is worried about having a panic attack, ask: well, what could you do if that did happen? Could you go to the bathroom and practice your calm breathing? Could you call me? Could you tell your friends mom and maybe talk to her for a little bit? Lets come up with a plan together. Have your child write out the plan, and take it to the sleepover in a secret pocket. This can be reassuring, and sleeping away from home will feel less scary.

HEALTHY THINKING FOR YOUNGER CHILDREN

**For older children and teens, see Realistic Thinking for Teens. In general, anxious children think differently than other children. For example, they can easily come up with 101 ways that things can go wrong! They also tend to see the world as more threatening and dangerous. If a parent is late coming home, an anxious child may think Mom got in a car accident! What your child says to himself or herself is called selftalk. Anxious children tend to have negative or anxious self-talk. Some examples include:

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I will fail the test. What if I cant do it? Things are not going to work out. They dont like me. Im stupid. Im going to get sick and die. That dog is going to bite me!

It is important for children to identify their self-talk, because anxious thoughts lead to anxious feelings, which lead to anxious behavior. For example: Situation = First day of school

Thus, the first step is to get your child to start paying attention to his or her self-talk, especially anxious thoughts!

HOW TO DO IT! Step 1: Teach younger child about thoughts or self talk

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Thoughts are the words we say to ourselves without speaking out loud (self talk). We have many thoughts each hour of the day. Thoughts are private other people dont know what were thinking unless we tell them.

People can have different thoughts about the same thing.

Here is an example of how to explain thoughts: We all have thoughts about things. Thoughts are words we say to ourselves without saying them out loud. Other people cant tell what you are thinking unless you tell them. Because we have thoughts all the time, we usually dont pay attention to them. They just come to us automatically! Lets try and slow our thoughts down and pay attention to them. The What am I Thinking? activity can help with this explanation. You can also use picture books or movies to teach your child about thoughts. For example, point to a picture of a character and say, Hmmm, I wonder what he is thinking? Remember, it can be difficult for young children to understand the concept of what a thought is, and it can be especially difficult to tell the difference between a thought and a feeling. For example, your child may say his or her thought is Im scared (which is actually a feeling) versus That noise is a burglar trying to break in (which is a real thought). It is important to expose the thoughts underneath the feelings! For example, What is making you scared? What do you think that noise might be? Hint: One way to describe the difference between a thought and a feeling to a young child is to explain that a thought comes from your head, and a feeling comes from your heart. Step 2: Help your child identify thoughts (or self-talk) that lead to feelings of anxiety.

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Often, we are unaware of what we are thinking, and it can take time to learn to identify our specific thoughts. Questions to ask, in order to help your child identify his or her anxious or worried thoughts include:

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What is making you feel scared? What are you worried will happen? What bad thing do you expect to happen in this situation?

For young children, this may be as far as you can progress. Just identifying their thoughts is a big step in a long-term plan to help fight anxiety. One way to get your child to continue to pay attention to anxious thoughts is to use an actual stop sign as a visual reminder to stop and pay attention. Remind your child that just because he or she thinks something, doesnt mean its true! For example, just because your child thinks the elevator will get stuck, doesnt mean it actually will (even though it might feel really scary). While children can usually describe thoughts that go with feelings of anxiety, in some cases children are unable to identify anxious thoughts, especially children who are very young or not very talkative. At any age, anxiety may be present before there are thoughts about the situation. If you and your child do not identify anxious thoughts, it is best not to press your child about this too much about this. By making too many suggestions, you may create anxious thoughts where there were none before. Instead, watch to see if your child mentions anxious thoughts in the future. The other approaches to managing anxiety work even when anxious thoughts are not identified.

(The concepts below may be too difficult for younger children to grasp)

Step 3: Teach that what we think affects how we feel

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When we expect bad things to happen we feel anxious. What we think affects (or controls) how we feel.

For example, imagine you are out for a walk and you see a dog. If you think the dog is cute, youll feel calm; however, if you think the dog will bite, youll feel scared. Use the Thoughts and Feelings sheet to help explain this idea to your child. Step 4: Changing unhelpful thoughts to helpful thoughts

First, explain the difference between a helpful thought and an unhelpful thought:

Thousands of thoughts run through our head every day. Some of these thoughts are helpful thoughts, and some are unhelpful thoughts. A helpful thought makes us feel confident, happy, and brave. An unhelpful thought makes us feel worried, nervous, or sad. Can you think of some examples of helpful and unhelpful thoughts?

Once your child can identify the difference between helpful and unhelpful thoughts, ask him or her to imagine being in a particular scenario. It is best if the scenario is a bit uncertain. Ask: What is an unhelpful thought you could have? What is a helpful thought? For example,

Situation A group of kids looking at her and laughing

Unhelpful Thoughts

Helpful Thoughts They are probably laughing about something funny, and I just walked by. I don't actually know that they were laughing at me!

Oh no, they are laughing at me. I must look stupid!

Not being invited to a birthday party

They probably just forgot. She doesn't like me. I bet I am the only Or maybe it was just a small one who didn't get invited in the party. whole class. I have other good friends. Well, I tried my hardest. It's only one grade!I will practice more next time.

Getting a low grade on I suck. I am never going to do well in a quiz spelling.

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Once your child can come up with his or her own helpful thoughts, refer to the Developing and UsingCognitive Coping Cards guidelines, to help your child create, write down, and remember some of these helpful thoughts!

It is very useful to help a child identify unhelpful thoughts and create helpful thoughts. At the same time, anxious thoughts and feelings are normal. It is important to communicate that you and your child can accept anxious thoughts and feelings. They are not stupid or foolish. They are just one way of thinking and feeling, and there are lots of other ways of thinking and feeling. Step 5. Introduce the STOP Plan to your older child: 1. Pay attention to signs of anxiety (= S) 2. Pay attention to anxious thoughts (= T) 3. Think of other helpful thoughts (= O) 4. Praise and Plan for next time (= P)

Scared?

Thoughts?

Other helpful Thoughts? I can ask to go to the bathroom and do my calm breaths.

Praise and Plan Good job for remembering to use the STOP Plan! Next time, I will remember that

Sore tummy I might throw up, and Heart racing mom won't be here to Knees help me.

Trembling

I can get a drink of water. My teacher cares, he will help me.

feeling panicky doesn't last forever, and drinking water helps.

Now, use the STOP Plan Handout with your child! You will need to print several copies. First, go through the chart together with your child. You will likely need to do this several times over a couple of days. Once your child gets the hang of it, have your child complete it alone when faced with a scary situation. Eventually, your child will get used to the steps in the plan, and may not even need to write it down. Remember to praise and reward effort!