It’s completely understandable that the first plan of attack when anxiety hits is to turn and run in the other direction, or at the very least, to stop moving towards it. What sort of madness would it be to keep walking straight into trouble, right? Avoidance makes sense, but it can also make trouble.
Avoidance is the handywork of the fight or flight response. Flight. As in to flee – to get out of there. It isn’t your child trying to be difficult or manipulative. It’s your child being persuaded by a brain that is fiercely warning them that there might be danger – not that there is danger, just that there might be. This warning system is the reason we humans have survived for as long as we have.
Avoidance can be wonderfully soothing. And deceptive.
It’s completely understandable that loving parents would want to protect their children from bad feelings, and avoidance might seem like a good way to do this. Anxiety has a way of wearing everyone down, so avoidance might bring very welcome relief for a while. Avoidance will help kids feel better in the short-term, and that’s the pull. It can actually make everyone feel better in the short term. It can be beautifully soothing like that, and deceptive.
Avoidance teaches children that the best way to control anxiety is to avoid whatever triggers it. The problem with this is that it takes away the opportunity for children to learn that fear is a warning, not a prediction. They become less reluctant to explore the world, looking instead for experiences that come with security and comfort. This can shrink their world and stop them from building their own scaffold between their anxious thoughts (‘what if […] happens’), and their brave behaviour (‘even if […] happens, I’ll be okay’/ ‘I’ve been worried about […] happening a heap of times before, and it hasn’t happened yet’).
How avoidance works to keep itself as option ‘A’, option ‘B’ and option ‘C’ … and every other letter of the alphabet.
Anxious kids (and adults) will tend to see the world through a filter of possible things that could go wrong.The capacity to see potential danger in the environment is a really healthy, adaptive trait that keeps us alive. We’re wired to pay more attention to negative information, and to have emotional experiences embed themselves as powerful, enduring memories. There’s a good reason for this. Our survival depends more on us noticing negative information (potential threats) more than it does the happier things that shimmy across our paths. It’s more important, for example, that we notice the dog with swords for teeth is in a gnarly mood, than it is that we notice its cuddly fur coat and its perfect posture.
Our survival also depends on us learning the important lessons that can quickly and effectively guide our future behaviour. We don’t want to have to constantly relearn or analyse the situations we need to move towards (food, affection, safety) or the things we need to avoid (harm, threat, danger). Important experiences generally come with strong emotion. This is no beautiful accident – it happens for a very good reason. Emotional experiences will become powerful memories that drive future beahviour, often without us realising it. For example, we know not to touch a hot stove because we know that hot things hurt. Ditto for dangerous animals, dark alleys, busy roads or anything else that could hurt us.
A frightening experience with a dog, for example, will mean future experiences with dogs, even non-threatening ones, will evoke the fear that came with the original experience. The more that similar situations are avoided, and the less experiences there are that provide contrary information to the learning that ‘dogs are dangerous’, the more the learning becomes fixed, and avoidance confirmed as the only way to stay safe.
But what if anxiety just ‘happens’, without any obvious trigger or previous experience to explain avoidance.
Often, anxiety can happen without any memorable, identifiable trigger. Again, as with so many of the things we humans do that don’t seem to make sense, there’s a very good reason for this. Here’s how it works.
There are a number of different memory pathways in the brain. Emotional experiences often come with important information about what can cause harm. The emotional memories of these experiences (for example ones that come with feelings of fear or helplessness) lay themselves down in the amygdala. This is because the amygdala is the part of the brain that has the very important job of responding to threat. It carries out this task by using the information provided by emotional memories to recognise potential danger and direct behaviour accordingly. Your child might not consciously be aware of what is triggering their anxiety, but the amygdala knows. If the amygdala senses threat, it responds in less than one-tenth of a second with a physiological response that is designed to deal with a potential threat through fight or flight (as in avoidance). The physical symptoms that come with anxiety can feel awful, (racy heart, sick tummy, butterflies, clammy skin, shaking or tense muscles, flushed face, nausea) but each one is evidence of a strong, healthy brain and body working exactly as they should to get stronger, faster, more powerful, more alert and more able to deal with a potential threat.
If the memory is stored in the amygdala, it’s possible that your child won’t be conscious of the particular memory or experience that triggered their anxiety. This is because emotional memories in the amygdala aren’t stored as images or words. Rather, they are experienced directly, as an emotional state. This is one of the reasons anxiety can feel so awful. It can seem to have no identifiable trigger, but the emotional and physiological experience that comes with it, as well as the thoughts it drives, can make it feel as though there is actually something that can cause harm. A gently passing, but frightening, ‘what if’ (as in ‘what if something bad happens while I’m at school’) can stir feelings of dread or fear in the moment, and can be enough to lay little seeds that grow into persistent anxiety at school drop-off.
When our emotional memories are working as they should, they are a brilliant part of our human working – they can save us a lot of heartache by steering us away from trouble or potential harm. The problem is that not everything our brains read as a threat is actually a threat. The amygdala will act first and think later, so sometimes it can respond unnecessarily – just in case, and without any real need.This is when avoidance can shrink the world a little (or a lot) more than it deserves to. This can happen when all experiences are read the same way – as equally threatening as the original experience. Research has found that people with anxiety have a unique wiring which drives them to ‘overgeneralise’ experiences. What this means is that people who are prone to anxiety tend to interpret things as harmful even if they aren’t. This isn’t always a bad thing and in fact, it can be a great thing.
The tendency to be able to see around corners for potential trouble means that people are prone to anxiety will often be brilliant planners and organisers. They’ll see potential trouble early and they’ll think of things other people haven’t thought of, which is one of the many things that makes them pretty extraordinary to have in your tribe. The risk though, is that being particularly tuned in to threat can mean that anxious kids will be quick to perceive threat even when harm is unlikely. This will show itself as the ‘what ifs’ that drive avoidance. It’s likely that if you have a young person in your world with anxiety, you and their ‘what-ifs’ speak to each other often.
The more something is avoided, the more the brain will change to support that response.
Our brains are always changing to be the best possible brain for us. It does this through experience. When an experience is repeated, the brain strengthens the corresponding connections. It will change itself according to what it thinks we need, and it will base this around the behaviours we repeat. If avoidance is a repeated response, the brain will shape itself to support this.
But we can change that.
As much as the brain changes itself passively, without any deliberate effort from us, by actively exposing the brain to certain experiences, we can also change it in ways that are more in line with what we need. It’s called experience-dependent neuroplasticity and it happens in all of us. The more we are exposed to certain experiences, the easier and more automatic those experiences will be. In relation to your children, the more they are able to push through their anxiety – as impossibly difficult as that will feel for them sometimes, the more their brains will change to accommodate this, and make brave behaviour easier for them in the future. This will take time, but know that it’s happening. The important thing is to focus on progress towards the goal, not the goal itself. Little steps are what the big ones are made of.
Anxiety in kids and teens – How to manage avoidance and move them towards brave behaviour.
Research has found that creating new, safe memories that can compete with old memories (or learnings) (whether or not they are consciously remembered) is a powerful way to override a fear or anxiety. The new, safe memory is encoded in the prefrontal cortex, a part of the brain that is able to calm and temporarily override the amygdala (the part of the brain that holds emotional memories and drives anxiety) and use the information from the new memory to think, reason, and plan. The frightening memory or association might still be there, but it becomes less intrusive and less likely to drive behaviour.
The key is to gradually and gently create new memories and experiences that will compete with the original learning. The original learning might be, ‘I feel scared and awful at school dropoff’. By gently and systematically providing new experiences of school dropoff that feel safe, the competing memory becomes, ‘I feel calm and safe at when I’m dropped off at school.’ The power of the competing memories to override the original memories will be built up slowly – it won’t happen straight away. The negative feelings will be more powerful and dominant than positive feelings for a while and there’s a good reason for this. Our need to avoid things that feel unsafe is an instinctive, primal response that is there to ensure our survival. Our bodies are and brains are wired for this, and they won’t let go easily or quickly – but they will eventually. Remember the key is to be gentle and patient.
Now for the how.
Change the template.
Extensive research has found that for old learnings to be open to editing, it’s best if the old memory or experience is reactivated (recalled) at the same time as a new experience is introduced. (This isn’t always possible if the old memory is out of awareness – and that’s okay.) The idea is for the new experience to provide information that is in conflict with the original learning, either by showing that the feared outcome didn’t happen or that it wasn’t as bad as expected. By doing this, fearful memories can be ‘overwritten’ by ones that feels safer and more able to be dealt with.
Dr Karim Nader of McGill University found that when an old memory is reactivated, there is a five-hour window in which the memory is unstable enough for a new experience to provide new, competing information that can gradually empower the child to feel safer and stronger in the face of the anxiety trigger. One way to reactivate the memory is by chatting to your child about the experience or memory that is driving their anxiety, provided of course that it doesn’t retraumatise them. This might look something like, ‘Do you remember when we were at the park and that big dog frightened you?’ When the memory is reactivated, this is the time to provide new, competing information. Any of the following strategies can be a way to do that. (The following strategies can also be powerful on their own, without the reactivation of an earlier memory.)
Experiment with strategies that will compete with the learning that avoidance is the only way to feel safe.
Feeling calm, instead of feeling anxious, will provide competing information that it is possible to feel safe without avoiding the situation. This might take practice during calm times, as well as patience and practice during anxious times. Here are some strategies to try:
Deep breathing. (But not just any deep breathing!).
Strong, deep breathing initiates the relaxation response. This is a response that neutralises the fight or flight neurochemicals that cause the physical symptoms of anxiety. The response was discovered by Herbert Benson, a Harvard cardiologist. The relaxation response will decrease blood pressure, lower heart rate, lower pulse rate, reduce the oxygen in the bloodstream and increase alpha brain waves which are associated with a relaxed state. It’s hardwired into us, so children don’t have to believe it will work – it just will – but it does have to be activated first. Breathing is one way to do this. Try hot cocoa breathing (imagine you’re holding a mug of hot cocoa – breathe in the warm, chocolatey smell for three, hold for one, blow it cool for three.
Anxiety is the sign of a brain that’s been hauled into the future by a troublesome bag of ‘what-ifs’. Bring it back to the present with a grounding technique – ‘What are five things you see? What are four things you hear? What are three things you feel? What are two things you smell?’
Discuss times the feared ending hasn’t happened, or hasn’t been as bad as expected.
Use this strategy in conjunction with others to explore alternatives to the times avoidance wasn’t needed. What was different? What can they try next time? What helped them to feel safe?
Remind them of their own power to influence how they feel.
Anxious kids are powerful, strong, brave and resilient – but sometimes you might need to remind them. When you see anxiety starting to take over, ask them to close their eyes, breathe, and imagine themselves feeling calm. They don’t have to feel calm, just to imagine what it would be like if they were. How would they be standing? What would they notice? What would they be thinking? How would their body feel different to how it is feeling now? This can help them to realise their own power to influence their experience. The mind is powerful – when the mind is anxious the body will be too, but when the mind is imagining calm, the body will also follow.
Help them to understand why anxiety feels the way it does.
Anxiety can have a way of feeling like a prediction that something bad is going to happen. The truth is that anxiety comes from a strong, powerful, healthy brain that is a little overprotective. Understanding why anxiety happens and why it feels the way it does, can take away that awful feeling of dread or fear, as well as ‘anxiety about the anxiety’, and it can empower kids to find calm in the face of anxiety. (See here for a detailed way to talk about this with kids.)
The idea of the stepladder is to gently create new memories that will compete with an old learning. It’s super important that this is done slowly, and that your child is on board with the plan. This will give them an opportunity to be their own hero, and to feel as though they are in control. Here are some words that can help.
‘I know you’re really scared of the ocean and I understand why. It was scary when you got tossed around that time by the waves wasn’t it. At the moment your brain is telling you that the ocean will always do that. That must be really frightening for you. It’s not your brain’s fault, it’s just trying to keep you safe. It’s kind of taken over though, and what we need to do is to make you the boss of your brain again. We can do that and I want to talk to you about a plan that we’re going to do together – as a team.
We’re not going to do anything you don’t want to do, and we’re definitely not going to do anything that could hurt you. For this to work, you will need to do some brave things – but the decision will always be yours. The plan will have different steps. You can say no to any of those steps if they feel too big, and we can find something else that feels better for you. At the end of this, the things that feel really scary won’t feel as scary any more.’
• Next, explain how a stepladder works.
A stepladder works by gently and progressively exposing children to experiences that are similar, but not as anxiety-inducing as the experience that triggers their anxiety. An example for someone who gets anxious at school dropoff might be something like:
– You can watch funny Youtube/ cat/ dog videos on the way to school (because it’s harder to feel anxious while you’re laughing), then we can stay in the car for five minutes and watch funny things together, then three deep breaths, I’ll walk you to your classroom, stay for 5 minutes, then say goodbye.
– When we get to school we can watch one quick funny cat video, three deep breaths, then I’ll walk you to class, stay for 5 minutes, then say goodbye.
– When we get to school, funny videos go off, then three deep breaths, I’ll walk you to class, give you a quick hug, then say goodbye.
– When we get to school, three deep breaths, I’ll give you a hug and you’ll walk to your class on your own – because you’re brave and brilliant and kind of a rock star – and by then you would have had plenty of practice at doing hard things.
Start with an example using something that other kids might be scared of, but which your child is fine with. Keep letting them know there will be an out, and that they will have full control.
‘So this is how it works, and remember, I’m just going to explain it – it doesn’t mean you have to do it. Let’s say there was someone who was scared of dogs, even if they saw a dog that was behind a fence. This would make it pretty to go to someone’s house if there was a dog there wouldn’t it. What do you think they could do to make themselves more okay with dogs? How could they get used to dogs little by little?’
See what they come up with (and remember, kids with anxiety often have a beautifully quirky way of looking at things). This process of planning and analysing will be strengthening the connections in their pre-frontal cortex – the part of the brain that is needed to bring calm during anxiety, but which is usually sent offline at just the wrong time.
If things go to plan, they’ll say something like, ‘Well maybe they can look at a little cute dog first, then when they get used to that they can look at a bigger cute dog than a bigger one and a bigger one. If they come up with something like this, they understand the stepladder approach. If they come up with something completely out of left, like, ‘Well maybe they should just go to houses that only have cats or kids,’ then you might need to give them a little guidance.
• Break it down.
Work with your child to find the steps of the ladder. Start with the smallest, easiest thing your child feels as though he or she can handle, then work up from there. It’s really important to make sure that the steps aren’t too far apart. Let there be as many steps as there needs to be and spend as long as you need to on a step. If they get stuck between steps, explore how to make the next step in the ladder a little easier.
To avoid a fearful incident becoming a phobia.
Incidents that create a scare can turn into fears or phobias that drive avoidance for all similar experiences. Examples are a scary encounter with a strange dog that turns into a fear of all dogs, choking on food that turns into a fear of swallowing, or a scare at a swimming pool that turns into a fear of water. JournaResearch has found that fear from a frightening incident is consolidated in memory at two critical periods – at the time of the trauma, and the second is three to six hours later. Over this time, a series of chemical and electrical processes in the brain work on transferring short-term memories into long-term ones. If something happens to interrupt this process, the memory will be more fragile, and the fear attached to that memory will be less. New research, published in the journal Molecular Psychiatry, has found that engaging in visual-spatial tasks, such as drawing or playing the popular computer games Tetris, or Candy Crush after a traumatic experience can interrupt the formation of recurrent, intrusive memories that can potentially drive avoidance.
And finally …
Your child’s brain is strong and magnificent. It’s been designed by evolution to make sure his or her safety is at the top of the to-do list, and an anxious brain does this beautifully – even if a little too often and too unnecessarily at times. Anxiety and avoidance are primal responses that will need a little bit of work to reshape them into something less intrusive. With an understanding of what’s happening in your child’s brain to drive anxiety and avoidance, it will be easier to make the necessary tweaks to bring out their resilience and courage that is already in them.
I have a 14 year old son who is a Freshman in high school. He has been going through anxiety issues for the past few months and they are triggered by the most normal situations and events. I help him at home with breathing techniques, some herbal tea, massaging his feet which feel shaky. He also says his heart races. We also see a psychologist who is trying to help him
navigate these feelings.
I feel like I need to help him more significantly deal with this while at school when he feels alone. Any suggestions would be most welcome. Thank you.
Hi there. You’ll find loads of information on this link, with plenty of practical things you can do to support your son https://www.heysigmund.com/category/with-kids/anxiety-in-kids-and-teens/. This article might be especially helpful https://www.heysigmund.com/anxiety-in-teens/. Wishing you and your son all the very best.
Love the article. I have an ASD child who has a demand avoidance presentation ( PDA profile). His anxiety levels run at a ‘few rungs up the ladder’ to begin with then if a few events happen he climbs further until it is ‘in his head’ near the top of the ladder, then ‘comes out’ at the top of the ladder. Whoosh, flight/fright response and someone gets hurt. Your advice would be very useful so he can navigate school safely without being excluded.
Fabulous article, which really made sense of everything and the various tactics we’d been told to do by various professionals. Thank you.
Our 15 year old daughter suffers from some school anxiety but particularly getting in to school – she cannot physically get out of the car. Breathing and distraction have helped and having a friend with her, but since Sept it has got worse again and having the friend there no longer helps.Although I think we understand things better now and what needs to be done, with gradual exposure of positive experiences at school (she’s on reduced hours), we are still struggling with the getting out of the car. She desparately wants to get out and go in but can’t.
Any ideas that may help?
This sounds so frustrating and confusing for your daughter. Anxiety can be awful like that. Here are some resources that might help. Here is a video that explains why anxiety feels the way it does https://www.heysigmund.com/why-anxiety-feels-the-way-it-does-what-you-need-to-know-to-strengthen-against-anxiety/. There is also loads of information on this link https://www.heysigmund.com/category/with-kids/anxiety-in-kids-and-teens/. Take your time over it and talk to your daughter about it. Hopefully there will be something that helps to make sense of things for her, and strategies that help her move forward. I wish her all the best.
Great information! I am dealing with a high school freshman son who doesn’t seem motivated to try any harder than a “C” grade and seems to choose the path of least effort. Someone mentioned Avoidance as an issue which led me to this article. I’ll keep reading the newsletter for more insights.
Great site, I have read a lot on anxiety as I suffer myself and so impressed by this site. Love the style. I am researching again because my son, who has so much to offer the world cant pick up the phone and contact some people for work experience, he starts to stutter and feel sick. He know the avoidance is leading him to get more stressed and I fear he will have a breakdown. He looks so ill and constantly worries about it. I will see if we can use the step ladder approach somehow. Thanks again
Thanks for the thoughtful article. What would you recommend to help kids that struggle with anxiety that stems from perfectionism and not wanting to forgive themselves / accepting mistakes as part of learning?
It’s about the incidental conversations you have along the way. Anytime you can, weave into the conversation how there is no such thing as failure – it’s all learning. Also be mindful of how you deal with your own failures and mistakes. Speak openly with her about the mistakes you make, and let her see you being okay with them and grateful for the learnings they’ve given you. Let her see you being self-compassionate and open to looking for the opportunities in the mistakes, and what you can gain from them (knowledge about what works, what doesn’t, what to do differently) rather than the regret. Of course it’s okay to acknowledge the losses, but it’s also important to acknowledge the opportunities that come with that – and there will always be opportunities. Undoing perfectionism isn’t easy, but be patient and keep the conversations going, and bit by bit she will open to a new way of thinking.
Any ideas on how to curb the fear of walking to the bathroom by yourself? My 7 YO daughter has always struggled with this. She HAS to have someone go with her or sing to her while she’s in there. I’m talking about the bathroom on the same floor as everyone in the whole house. She is homeschooled so there was no incident at school or at home. I just don’t want her to live in fear. It makes me sad for her. My husband says it runs in the family…he was a scared kid and his mom was as well. Not sure what to do. Maybe have her try to sing while in there so she can do it alone. I never know whether it’s better to make her just do it alone or to have someone go with her every time. We’ve done both.
Grace try the stepladder strategy explained in this article here https://www.heysigmund.com/phobias-and-fears-in-children/. It’s the third option to making her do it alone and going with her. The idea is to gradually expose her to walking to the bathroom by herself, so she can gently ‘re-experience’ walking to the bathroom as feeling okay.
Wonderful article! I don’t have a kid but I am a young adult who’s just finishing recovery from a severe case of anxiety disorder. And I LOVED all of your tips! If it was difficult for me, I can’t even imagine how difficult it must be for a child, who doesn’t really understand what is happening to them during a panic attack! But your tips sound very useful. I haven’t had a panic attack in a while, thankfully, but I’m a person who’s passionate about mental health, especially young people’s mental health. So I’ll definitely keep these ideas in mind, so I can share them when I meet someone who needs them. Thank you for this article!
Thanks Andressa. I’m pleased you have found a way through your anxiety. It takes strength and courage to live with anxiety, and it takes the same to get through to the other side. It sounds as though you have a lot of wisdom and insight, and I’m sure you will be a great source of comfort to many people who are lucky enough to find their way to you in the future.
Such a wonderful article, Karen! As the mom of a son who struggles with this, I am delighted to say we just had a major breakthrough this summer, but I know this is a constant for him, for us. And having these wonderful tools at hand is such a gift. Thank you!
Thanks Abigail. It’s such great news that you have seen a breakthrough in your son’s anxiety. I know what a relief that must be! Anxiety can make things tough, but every time finds his way through to the other side, he’s gaining new insight into his own resourcefulness, resilience and courage. It sounds as though he will continue to grow to be a compassionate, strong, courageous young man – just what the world needs more of.
What a beautiful article about anxiety – I have a feeling that many adults will also benefit from the loving and thorough explanations you have given here, as well as the stepladder strategy to approaching rather than avoiding what triggers our anxiety.
Great article, Karen! You really did your research on this one.
Here’s another idea. Have your child draw a picture of the anxiety. Then draw a picture of how you’d like things to be. Tell your child, “Close your eyes and think of 3 ways you can move from the anxious picture to the better picture. When you have them open your eyes. Please share your solutions.
I will share this article on my social media sites and hope others share it too.
Oooh, I like this idea! Especially for children who’re visual learners.
This website is ROCK STAR as far as I’m concerned. The advice is spot on.
My husband and children all struggle with anxiety and I’ve figured out quite a few of your suggestions over the years, although I’d have been a whole lot more helpful to them if I’d had this information 40 years ago. 😉
I love this idea! Thank you for sharing it.
Very well written and informative, eady to digest. I love shearing your posts on Face book. I hope every body especially parents can learn from your posts. Keep up the good work.
Cheers Glenda Paul
Great suggestions that I found very useful! It’s so refreshing to hear that there is hope and light at the end of the tunnel!
This is an incredible article. We have lived through this with my daughter…now that her brain is maturing we are seeing less and less of the anxious feeling through all the above listed techniques.
Thank you so much! My Prep (who is prone to anxiety) waslate to school first day of term and has experience anxiety with school drop offs ever since. We’ve been trying the step ladder and have gotten a few steps from where she was but with these tips we’ll persist and try few other techniques too.
So grateful you posted this!
Your so welcome Kate. I hope it helps.