Treating and managing anxiety in school

Treating anxiety that occurs in school includes using strategies that have been shown through research and clinical experience to be effective, and using temporary accommodations at school, which allow the child to work gradually on the treatment goals.

One of the most important tools to maximize the success of interventions in school is the fear thermometer. Ask the child to brainstorm all the situations that cause worry and to rank them from easiest to hardest. To help the child brainstorm these situations, ask the child specifically what they would do if they were to try to bring on a small amount of fear. It is frequently the case that the situations that are the most important to the child, parents, and teachers are also the hardest, and that those most important situations are the culmination of a trail of related anxiety and avoidance behaviors. If you are working with a fear thermometer, then you will be able to identify the relative difficulty of different situations easily. The fear thermometer will also guide the identification of temporary accommodations.

Learn as much as possible from the child about his or her anxiety, and increase the child’s awareness of the specific symptoms of anxiety. Ask the child to journal anxious thoughts, anxious feelings, and anxious actions. Ask the child to be like a spy or detective and write down the anxiety-provoking situations that occur over the course of a week, what the worry said, the amount of worry they feel from 0 to 10, and what the worry wanted them to do. Ask them to pay particular attention to those situations that cause a little bit or a moderate amount of worry since it is most effective to start challenging worry in these easier situations. Anxious thoughts frequently come in the form of “what if…” Anxious feelings can include both emotional feelings of stress and anxiety, as well as physical symptoms such as muscle tension, headaches, stomach aches, nausea, diarrhea, constipation, dry mouth, and fatigue. When recording anxious feelings, the child should write down where in their body they feel worry. Anxious actions are behaviors or mental responses the child feels compelled to engage in to feel less anxious. Anxious actions can be anything; however common examples include avoidance, asking for reassurance, washing, checking, perfectionism, and distraction.

Many children and parents find it helpful to externalize the child’s worry. Externalizing worry helps to make the point that the child should not be punished for their worry; helps the child, parents, and teachers team up to help the child defeat the worry; and helps the child develop insight into their particular symptoms of worry. Asking children to draw a picture of their worry, perhaps in the form of a ‘worry bully’ can help them to visualize their externalized worry.

Help the child boss their worry back with words and actions through the use of exposure with response prevention, a specialized form of cognitive-behavioral treatment and the first-line treatment of the anxiety disorders. Encourage the child to take risks and not get caught up in disproving the worry. For instance, a child could boss their worry back with words by saying to the worry, “you’re trying to tell me that I shouldn’t ride the bus home because I might get a stomachache, but I’m not going to listen to you. I’m going to ride the bus home anyway and take the risk that I might get a stomachache.” In addition, encourage the child to boss their worry back with actions. In my example, the child would take the risk and ride the bus home. These behavioral exercises work by helping the child gradually risk the things that they are afraid might happen, and by bringing on the anxiety in gradual amounts until the child gets used to the anxiety in that situation.

Help the child to chart their progress using a behavior chart. You can encourage them by providing rewards for being brave.