CBT and Mindfulness for Anxious Kids

Everyone has some anxiety – it’s a normal human emotion and a part of life that helps protect us from danger. The problem is when that anxiety gets in the way of functioning. I look for those changes in functioning children – mostly when a child stops doing things they were previously involved in and starts avoiding things that other kids his or her age are doing.

Look for symptoms of anxiety in three areas:

1. Thoughts: These are typically worries about specific or general issues (for example, fears of animals, the doctor, high places, social concerns and so on). Some kids are very expressive about what they’re anxious about, while others have difficulty identifying their anxious thoughts.

2. Physical feelings: Anxiety always comes along with some somatic concerns, whether or not a child is aware of them. This might include muscle tension, headaches, stomachaches, frequent trips to the bathroom and quickened breathing or heart rate. If your child expresses frequent physical complaints in the absence of illness (check with a pediatrician first!), this may be the physical side of anxiety.

3. Behaviors: Anxiety doesn’t only make you feel a certain way, it makes you want to do something; mostly, escape or avoid the thing you’re afraid of. Look for whether your child is consistently avoiding something that he or she used to enjoy, or that other children his or her age tend to enjoy. Avoidance is one of the biggest signs that a child is suffering from anxiety.

Since anxiety is an emotion, you need some of it throughout life to make sure you don’t jump in front of moving cars or into burning buildings. It wouldn’t be healthy to grow out of all anxiety. However, if anxiety in a child is the kind that causes problems or changes in functioning, they do not tend to grow out of it. Instead, anxious kids become anxious adults. If you see your child showing patterns of avoidance, expressing a lot of worry and showing some of those fight or flight symptoms described above – it’s a good time to seek expert help. 

Mindfulness is awareness – it’s paying attention to something. You can pay attention to your worries, but you can also change your attention the same way you can choose to play with different friends or play different games. With kids, I do a lot of active mindfulness activities. Play “I Spy” to focus on the world around them or play with slime and focus on texture and color. My focus is to help them realize they can harness their attention by keeping to whatever task they’re currently doing.

I focus on why a parent wouldn’t want to do exposures. We know that exposures are the best way to treat anxiety and if a parent is in my office, they presumably want to help their child with anxiety. Therefore, we have mutual goals – to help a child learn to cope.

I cannot recall a parent I’ve worked with that didn’t want me to do exposure with their child. Maybe this is self-selecting as I am an exposure therapist, but I spend a lot of time with parents and children explaining why we’re going to do what we’re doing. After this, we pick a step that seems almost too easy to start with that helps parents and kids feel confident. I’ll also add that I don’t do exposures with a child as much as with the family – when everyone is involved, the process is much easier.

Perhaps those just aren’t the coping skills he wants right now. A child (and adult!) can use a whole host of coping skills – not just mindfulness and meditation. I’m often with your eight-year-old in that I don’t like meditation, but I love exercise and realized that it keeps me centered and mindful. I actually have many different coping skills in my book, When Harley Has Anxiety – maybe some of them will appeal to him.

Acting brave is like building a muscle or learning a skill. You don’t learn to write or read in one shot – you need to practice over and over. Initially, the learning process is challenging, but it gets easier and there’s always more to learn. When you act brave, you’re learning to do the opposite of what anxiety tells you to do. This can be really hard in the beginning, however, the more you practice the easier it gets.

It depends on how you see CBT. I work with parents of kids as young as two, but the goal at that age is for the parents to learn solid CBT techniques for anxiety that will carry a child to the point where they can learn their own skills.

Approaches like PCIT (Parent Child Interaction Therapy) and SPACE (Supporting Parents for Anxious Childhood Emotions) are parent-based therapies that help parents to support their kids. As children reach elementary school, they start to be able to engage with CBT techniques on their own. The younger the child, the more parental involvement there is. Therapy is very age dependent, so it will change as children grow.

Learning to make friends is a developmental skill, like learning to talk or walk. Kids start off not playing with each other and then progress towards noticing each other, parallel play (playing the same thing but not together) and then, around three to four, cooperative play. Anxiety can impact friendships even in very young kids, where it keeps a child from hitting these milestones because the child avoids playing with other kids.

If you don’t learn how to play with other kids you’ll continue to be anxious around them, because now you don’t know how, and everyone else figured out that skill and left you behind, which makes things even worse. This is the case for young kids, but the same basic idea applies to all ages; a child with social anxiety avoids some social interactions, which means they miss out on friendships, which makes friendships even harder.

The more you can do to encourage friendships and help a child cut out their avoidance, the more you can help your child. Obviously this is age-dependent, but curating playdates and helping your child learn to feel more comfortable in social situations go a long way. Anxiety means that sometimes, kids don’t want to go on playdates or to birthday parties, but helping a child systematically face their fear and stopping their avoidance is key to helping them cope.

To tell you the truth, I sometimes have a hard time identifying my anxious thoughts! Figuring out what you’re thinking is a difficult skill. It relies on metacognition – the ability to think about what you're thinking. Also, when you’re anxious, your body is in overdrive, which makes it harder to think logically about what you’re thinking.

Kids can start identifying their anxious thoughts – at least in theory, when they’re calm – around seven to eight, but this skill gets a lot easier when they’re teens. It’s just a cognitively taxing task. Kids as young as two to three can identify their emotions and preschoolers can describe their body sensations.