What is anxiety?
It is very normal for children and young people to have specific fears throughout their childhood and adolescence. Usually, these fears and worries go away on their own as your child grows and expands their experience. Anxiety is the feeling we get as part of the normal human response to danger. The danger does not have to be real or happening in the present moment, it can be worries or fear thoughts, images or memories; but our body reacts as if the danger is actually happening or is going to happen. We say we are ‘anxious’ or have ‘anxiety’ when our body goes into this threat/self-protection reaction, which can sometimes be very strong and overwhelming. The body’s threat/self-protection reaction is commonly called the ‘fight/flight/freeze’ reaction.
The fight/fight/freeze reaction
Over the millions of years that human evolution has been happening, there have been no changes to the brain or body in the last 30,000 – 100,000 years. Imagine what the world would have looked like then and the dangers we faced. We were not the strongest or fastest species and yet we managed to keep safe and not be killed before having children. This is because we developed a highly sensitive threat-detection system that was constantly scanning the environment and was ‘switched on’ 24/7. It worked on a ‘better safe than sorry’ principle. It was better to think “That brown shape in the grass IS a lion”, than to think it was a rock. If you thought it was a rock and you were wrong – you were almost certainly lion lunch! If you thought it was a lion and it was a rock – you’d get home safely for lunch.
We don’t lose what has helped us to survive, so our threat/self-protection system still operates in this way, even though there are fewer daily life-threatening dangers. The problem is, it means that we are always on the ‘look out’ for danger, for things that could go wrong, or terrible things that could happen. This does not have to be threats to our physical safety, it could also be threats to our self-esteem – worries about the future, that others may not like us or will judge us badly, or that we will fail in some way.
Many fears are ‘hard-wired’ into our development as they helped to protect us. Babies have a fear of separation from birth, and develop a fear of heights when they start to crawl. Teenagers develop a strong fear of rejection or disapproval from peers as they are at an age when belonging to a social peer group as part of tribe formation was essential to their survival. These fears still remain.
When someone worries or fears that something may happen, or remembers something bad that happened, the nervous system in the body reacts. This happens, even if the ‘danger’ is not present but is a thought, image or memory. This diagram shows what happens in the body when the threat/self-protection reaction is activated:
The Human Safety System:
This is why children commonly experience physical symptoms such as their heart racing, dizziness, breathlessness, nausea and stomach pains when they feel anxious. Click here to help explain to your child why they are experiencing these feelings.
How is the mind involved?
The mind/brain has evolved over time. Our automatic, life supporting systems developed first and this included the threat self-protection system. In mammals this was followed by the soothing system. The soothing system is about care and nurture, which is needed for babies that are dependent on a caregiver for a relatively long time. The last part of the brain to develop is called the ‘neo cortex’ the new part of the brain. This is what we call the ‘grey matter’ – the part of the brain that is involved in more complex functions, such as language and communication, planning and reasoning, abstract thinking, consciousness, and importantly it is where empathy and compassion are. Empathy and compassion are needed to engage in helpful social behaviour in order that we survive together, because we need each other.
Why do we lose control of our emotions?
When the threat self-protection system is activated, and if it goes into fight/flight/freeze, it is important that this old part of the brain (focused on survival) is disconnected from the new brain, as this would slow down our reactions to threat and decrease our chance of survival. Here is a helpful video that explains why we lose control of our emotions.
How to manage anxiety
You can see from the diagram that the ‘Soothing’ system is part of the overall ‘safety’ system. You CAN’T stop your thoughts that caused the anxiety, and you CAN’T stop your body from reacting to them. To manage anxiety, the first thing to do is to notice the change in the body and then focus on calming the body’s threat self-protection reaction using these simple strategies:
BREATHE: Breathe in for a slow count of 4 and breathe out for a slow count of 6.
COME to YOUR SENSES: find and focus on:
5 things you can see
4 things you can hear
3 things you can touch
2 things you can smell
1 slow, deep breath
When you feel calmer CHOOSE: whether the thought/s is helpful or unhelpful:
The workbooks on this page offer an evidence-based approach to overcoming anxiety. Being able to calm the body’s threat/self-protection system, choose how to respond and expand your experience and comfort zone are the key steps. These self-help programmes should be completed at the ‘AMBER’ level – see below.
Make Mindfulness your superpower
Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.
While mindfulness is something we all naturally possess, it’s more readily available to us when we practice on a daily basis. Daily practice will improve your ability to NOTICE anxious thoughts and worries and the early physical signs of the body’s threat/self-protection reaction.
Whenever you bring awareness to what you are directly experiencing via your senses, or to your state of mind via your thoughts and emotions, you’re being mindful. And there’s growing research showing that when you train your brain to be mindful, you’re actually remodelling the physical structure of your brain.
The goal of mindfulness is to become conscious of the inner workings of our mental, emotional, and physical processes.
Here is a video on why mindfulness empowers us
Here is a link to some video resources
Worries and anxiety are normal; everyone worries so it’s important to remember you are not alone. Some worries may seem very real and very scary. Tell someone how you are feeling no matter what your worries are, even if you are worried about doing so. There will be someone who will listen and try to support you.
Although anxiety feels horrible, remember these feelings will pass and the physical sensations cannot harm you. Remind yourself that you have been anxious before, that those feelings passed, that you coped and were ok. If you need to, breathe in slowly for a count of 4, and out slowly for a count of 6. Use the ‘Come to your senses’ exercise above.
Expand your comfort zone and by discovering what you can do (even when your anxious mind says you can’t)
PAUSE: when you notice sensations of anxiety - PAUSE
ANCHOR: yourself to the present moment and BREATHE to help calm your body
UNDERSTAND: anxiety is normal, and is an old system of helping you survive.
STEP BACK: take a different perspective and ask if your mind is being helpful? Is it taking you towards doing what matters to you, or away from that?
ENGAGE: in taking action and doing what matters, carrying your anxiety with you if you need to.
These are worries that young people have from time to time.
Type and nature of worry
It is normal for children and young people to experience worry as they develop through childhood and adolescence. The typical worries children and young people experience tend to be situation specific, short term and can be managed by yourself or with the support of parents/ carers. Examples might be:
· Being away from home/ parent
· Going to school (but settling)
· Worrying about going to bed/ the dark
· Worry about something bad happening themselves or to a loved one
· Doing new things
· Going to unfamiliar places
· Doing things independently
· Public speaking/ performing
· Tests and exams
· Change and uncertainty (e.g., family breakdown or conflict)
· In response to an upsetting event such as being bullied
· Being in social situations
What you might see or a young person might report
· Being clingy and not wanting to be separated from a parent/ carer
· Not wanting to be left alone
· Seeking verbal reassurance and checking things are ok
· Not wanting to go to school
· Avoidance of what they are fearful of
· Having bad dreams/ mild sleep disturbance
· Having some physical symptoms such as feeling sick, hot and clammy, tummy aches
· Feeling restless and fidgeting
· Appearing unsettled, distracted or irritable
· May appear more challenging or oppositional/ argumentative
· Thinking or talking a lot about their worry
· Crying or becoming distressed
Things to try, support and Next Steps
· Normalise that anxiety is a natural emotion, the physical sensations of anxiety can be unpleasant but it’s ok, it will pass and won’t cause any harm
· Encourage, reward and praise a young person not to avoid; the more a young person avoids, the harder it becomes and the more anxious a young person will become. Instead, encourage the young person to develop courage by doing what they are afraid of, which gets easier each time.
· Develop an anxiety ladder – start at the first rung with a relatively easy challenge, and increase the challenges. Challenges can be broken down into many rungs of needed.
· Role model and demonstrate that you can do things even when you’re anxious
· Supporting a young person to problem solve any real issues
· Watch the parent/ carer workshop on Coping and Resilience Skills here: X (to be uploaded)
Under 12s – Parent/carer lead interventions:
· Helping Your Child With Fears and Worries, by Cathy Creswell and Lucy Willetts
· Love in, Love out: A compassionate approach to parenting your anxious child, by Malie Coyne
Over 12s – young person self-help with support from parent/carer
· Stuff That Sucks, by Ben Sedley
· Your Life, Your Way, by Joseph Ciarrochi and Louise Hayes
· Little Blue book of sunshine - a mental health booklet that has been developed for children and young people living in Hampshire, Southampton and the Isle of Wight. The book aims to help children and young people by sharing tips on how to deal with many problems, such as anxiety, body image, relationships and anger. It also includes information about where to get help when needed, including information about local services. Click here to access the PDF or access the booklet via Apple Books or Google Play Books.
Young people: 16+
• Stuff That Sucks, by Ben Sedley
• Your Life, Your Way, by Joseph Ciarrochi and Louise Hayes
• The Worry Trick, by David A. Carbonell
• Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety, by Kelly Wilson
Needs help: These are challenges that some young people experience and may need some support with.
The degree to which a young person believes their thoughts as accurate truth or predictions can make anxiety worse. Episodes of anxiety might be more frequent or prolonged, cause significant distress and have a mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. Examples might be:
· Fears that something bad might happen to themselves or someone else
· Worry about not coping
· Worry about performance in exams or the future
· Worries related to being habitually bullied or experiencing regular conflict or distress either at home or school
· Worries about what others might think, say or do
· Worries about negative judgements by others or social rejection/ exclusion
What you might see, or a young person might report
· As well as the features in Green, the following might also be present:
· Disrupted sleep (difficulties getting to or staying asleep, nightmares/ night terrors)
· Persistent reassurance seeking
· Increased avoidance of doing things
· Becoming very distressed or agitated when triggered by a situation or thinking about a situation
· Some repeated patterns of behaviour or routines which seem to help the young person but don’t make sense to others (e.g., repeated checking or counting)
· Panic - such as getting distressed, racing heart rate, quicker breathing, upset tummy, feeling sick, feeling dizzy or faint
· Requesting things be done in certain ways or requesting others to do things for them
· Families might also find themselves struggling to do things as they normally would as they may make adjustments to accommodate how the young person is feeling or responding
Things to try, support and Next Steps
· As well as the steps in Green the following might be helpful:
· Support your young person to access self-help resources (podcasts, videos, downloads, links below)
· Watch this parent/ carer workshop on how to support a young person who is anxious here: https://youtu.be/LMFQHABnH1M
· Share concerns with your child’s school/ college
· Access pastoral support from school/ college
· Consider accessing help from a local counselling service
- Kooth is a free online counselling and emotional wellbeing support service offered to young people aged 11 - 25 years (up to their 26th birthday) living in Dorset, Hampshire and the IoW with a safe and secure means of accessing support with their emotional and mental health needs from a professional team of qualified counsellors.
By accessing Kooth young people can benefit from a free, confidential, anonymous and safe way to receive support online, online counselling from a professional team of BACP qualified counsellors is available via 1-1 chat sessions or messaging on a drop in basis or via booked sessions including out of hours’ availability - counsellors are available from 12pm to 10pm on weekdays and 6pm to 10pm at weekends, every day of the year on a drop in basis.
No referral is required, young people can access the service directly and in complete confidence at www.kooth.com.
· Seek advice, guidance and support from Young Minds Parent Helpline on 08088025544. If you live in Hampshire or on the Isle of Wight, the NHS 111 mental health triage service can provides advice, support and guidance, 24 hours a day, seven days a week. The Mental Health Triage Team has a wide range of skills, including on the phone brief psychological support and has access to key services and organisations that can offer mental health support to you and your child in your time of need. Just dial 111 or online at www.111.nhs.uk.
· Depending on the context and/ or the origins of the anxiety being experienced, other services may be helpful e.g., family guidance if there is family breakdown or conflict.
· Under 12s – Parent/carer lead interventions:
· The Anxiety Workbook For Teens, by Lisa Schab
· Little Blue book of sunshine. a mental health booklet that has been developed for children and young people living in Hampshire, Southampton and the Isle of Wight. The book aims to help children and young people by sharing tips on how to deal with many problems, such as anxiety, body image, relationships and anger. It also includes information about where to get help when needed, including information about local services. Click here to access the PDF or access the booklet via Apple Books or Google Play Books.
Needs Specialist Treatment: These are difficulties that cause a significant impact and a young person may need specialist support.
These anxieties are severe and enduring. These cause significant distress to a young person and significantly disrupt daily life such as school/ college, socialising and even self-care activities (e.g., sleep, bathing, eating). Despite fully engaging with the strategies outlined in the green and amber stages, the young person still experiences overwhelming anxiety that significantly disrupts daily life.
· Strong, unwavering beliefs that something bad might happen or that there is danger
· Persistent, intense and overwhelming “What if” thoughts that are seen as accurate predictions or truths.
As well as the features in Green and Amber, the following might also be present:
· Repeated routines or rituals that impact on a young person’s day such as being on time for or coping at school, being able to socialise and engage in hobbies or interests, being able to get up or go to sleep.
· Persistent refusal to leave the house or attend/ take part in activities such as school, hobbies, interests, seeing friends.
· Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise (ill health) as a result of this.
· Withdrawn and uncommunicative or not wanting to be left alone at all- this may seem uncharacteristic or age inappropriate for some teenagers.
· Frequent episodes of panic that may include, feeling dizzy, faint or vomiting.
· Thoughts and beliefs are rigid (e.g., 100% belief that something bad will happen).
· Becoming agitated, distressed, oppositional or aggressive towards others when anxious.
· Reactive and impulsive behaviour such as running away, which may place them or others in danger.
· Families will find themselves struggling to do things as they normally would, that family functioning is disrupted and they are required to make significant adjustments to accommodate how the young person is feeling or responding
As well as the steps in Green and Amber the following might be helpful:
· Speak with your child’s GP. If you live in Hampshire or on the Isle of Wight, the NHS 111 mental health triage service can provides advice, support and guidance, 24 hours a day, seven days a week. The Mental Health Triage Team has a wide range of skills, including on the phone brief psychological support and has access to key services and organisations that can offer mental health support to you and your child in your time of need. Just dial 111 or online at www.111.nhs.uk.
· Speak with the School Nursing Team.
· Depending on the context and/ or the origins of the anxiety being experienced, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support if there are clear triggers for anxiety e.g., abuse, domestic violence, bullying, being a young carer etc.
· Seek advice, guidance and support from Young Minds Parent Helpline:
· Consider making a self-referral to a CAMH Service in your area.
• The Anxiety Workbook For Teens, by Lisa Schab
• What To Do When You Worry Too Much, by Dawn Huebner
• The ACT workbook for teens with OCD, by Patricia Zurita
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