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Treating Childhood Anxiety: PTSD, CBT, Phobias

Paul WANG, Chair of Psychology, Acting Chair of Psychiatry, Clinical Psychologist

For many, occasional displays of anxiety are a normal part of childhood. But if an adolescent (ages 12 to 18) shows symptoms of severe and persistent worrying that interfere with normal functioning, he or she may have an anxiety disorder. These individuals experience fear, nervousness and shyness to a degree that makes them avoid certain places and activities.

Anxiety disorder is one of the most common types of childhood mental illness and it can occur in conjunction with other disorders such as depression, eating disorders, and ADHD.

There are many reasons why children and adolescents develop an anxiety disorder. Regardless of the cause of the disorder, it’s important to treat childhood anxiety early so that it doesn’t worsen in adulthood. Many adults with anxiety problems report having felt anxious as children and excuse their condition as “normal behavior,” often saying, “I’ve just always been this way.”

In addition to general anxiety disorder, some other common types of anxiety disorders include school phobias, social phobias, and post-traumatic stress disorder (PTSD).

School phobia

School phobia and separation anxiety have roots in normal patterns of development. Younger children may have problems thinking of themselves as truly separate from mom or dad. To an extreme degree, they fear being alone without their caretakers.

A child with separation anxiety may:

  • Have an unrealistic worry that something bad will happen to the parent when separated from the child
  • Fear being alone
  • Have nightmares about separation

A child with an unreasonable fear of school uses persuasive or extreme tactics to avoid going. She or he may:

  • Complain of an imaginary headache, sore throat, or stomach ache
  • Refuse to leave the house entirely
  • Throw a big tantrum when forced to go to school

Social phobia

Social phobia is prevalent in 1% of children and adolescents. Psychologically, these individuals overestimate the physical or social threat of interaction and underestimate their own coping ability. Poor social skills may be a cause.

A child with a social phobia may:

  • Be extremely shy and withdrawn
  • Exhibit selective mutism (she or he is capable of speech but doesn’t speak in given situations or to certain people)

Post-Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that can occur after a person goes through a traumatic event. Trauma can be brought on by chronic physical or sexual abuse, community violence, natural disasters, or motor accidents. PTSD can worsen depending on the adolescent’s pre-existing anxiety, family stress, and parental response to the trauma.

Common symptoms include:

  • Flashbacks to and nightmares of a traumatic event
  • Avoidance of any reminders (conversations, places) of the traumatic event
  • Inability to remember important parts of the traumatic event
  • Difficulty falling or staying asleep
  • Feeling irritated, distant, or disinterested

Treatment of anxiety disorders

Anxiety disorders can be treated with cognitive behavioral therapy (CBT), which takes a goal-oriented approach to treating dysfunctional emotions, behaviors, and thinking. A basic tenet of CBT is that avoidance perpetuates fear. CBT looks at the way an individual thinks about and reacts to the source of anxiety and often encourages gradual exposure to the feared object or situation. Rewards are given for positive behavior in approaching the object. Some studies have shown that CBT leads to sustained, long-term mental health benefits.

CBT can be used together with cognitive restructuring, a process that teaches positive thinking. In cognitive restructuring, a person is taught to become aware of self-defeating thought habits, identify unreachable goals, and to learn to challenge negative thinking and beliefs. The person is encouraged to generate positive thoughts and set reachable goals instead. Social phobia has been successfully treated with a combination of CBT and cognitive restructuring.

In any anxiety treatment for children, family should be involved in the treatment to prevent relapse and to ease the child’s transition to his or her new behaviors.

With a combination of anxiety therapy and positive encouragement, treatment can allow your child to let go of fear and embrace a better life.