Exposure to fears can control kids’ anxiety, Victoria-based expert says
- February 12, 2018
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In the face of overwhelming anxiety — be it a math test, a big, hairy spider or a classroom setting — occupational therapist Sean Boulet shows children with anxiety disorders the path to set themselves free.
Boulet, 42, works with children and youth with anxiety disorders at Ledger House, an intensive in-patient assessment and stabilization home at Queen Alexandra Centre for Children’s Health at 2400 Arbutus Rd., Victoria.
He previously worked on an outpatient basis. He saw children with anxiety who were unable to go to school, step out in nature, ride in an airplane or an elevator, write a math test or take part in social events.
It’s a problem that Boulet thinks is increasing.
Judy Darcy, B.C.’s first minister of mental health and addictions, says she doesn’t know if the rate of anxiety disorders among children and youth is rising, or if there’s better reporting and detection by family doctors and parents. But anecdotally, she says: “I hear it everywhere I go.”
Anxiety and mood disorders are among the most common mental-health conditions in children and youth and can hamper social and academic functioning. That can lead to problems in later life: 70 per cent of mental-health problems begin in childhood and adolescence, the Ontario-based Centre for Addiction and Mental Health reported Wednesday, as part of Bell’s Let’s Talk Day.
A 2015 report from the Mental Health Commission of Canada said seven per cent of youth reported receiving a diagnosis of an anxiety disorder and/or mood disorder in 2011-2012, up from just over four per cent in 2005.
We all need anxiety, says Boulet — the surge of adrenalin that kicks in and lets our instincts take over. But there is a right level for every task. The Yerkes-Dodson law dictates that performance increases with physiological or mental arousal, but only up to a point. When levels of arousal become too high, performance decreases.
However, when a child’s anxiety level is too low, that might manifest in a child being bored or disengaged. Just the right amount of anxiety and excitement can bolster motivation, concentration and enjoyment of a task.
When children are too anxious, it can produce a fight, flight or freeze/appease response, Boulet says. They can become physically or verbally aggressive and feel cornered. When they take flight, they can literally run away or avoid or procrastinate. The child who freezes or appeases might shut down or go along, but be disengaged or disassociated.
Counselling and medication are used to treat anxiety, but as a first step, Boulet relies heavily on time-proven approaches based on cognitive behavioural therapy.
Children are shown how to reframe their thinking to assess the validity of the threat. They learn how negative thinking distorts their perceptions and warps the facts.
In the behavioural exercise, with the patient’s consent and with the help of parents and allies, kids are exposed gradually to things they fear. Exposure is the key to treatment and to living a full life, says Boulet, who has found himself riding in elevators with kids who are fearful of elevators, at the bug zoo with kids afraid of insects, and poring over math exams with kids.
For a child who is nervous about math tests, first exposure after cognitive treatment might be to visit the school with Boulet or a parent, then the classroom, then write mock tests, until the child, in a best-case scenario, can take and possibly even enjoy the tests.
Boulet says an amusement park provides a great visual example of graduating levels of exposure — from the small rollercoasters to a series of bigger ones. A first exposure for some kids might only be getting as far as the park’s front gates.
Successful treatment doesn’t mean the child won’t again experience discomfort, Boulet says, but the anxiety will be manageable and in proportion to the task.
Boulet suggests parents encourage their children to be courageous. He believes in rewarding bravery afterward, saying bribes are not as effective.
So what is to blame for increasing anxiety in children? Despite his love of technology and media, Boulet points to the constant barrage of killings, other crimes and natural disasters on Twitter, television screens and in newspapers, distorting some people’s perception of actual risks.