Normalize, Normalize, Normalize
First, I want to normalize anxiety. It’s normal to worry. We should expect it. Before getting to me, families have usually told many people their long, miserable story of continual, expanding anxieties, the escalation of attempts to protect the child from any and all anxiety triggers, and their growing fear that something is terribly, unusually wrong with their child. Many professionals have responded with grave and serious nods, confirming their fear. So when they tell me their story, I usually nod a bit nonchalantly and say in a matter-of-fact voice, “Yes, I’ve heard that before; lots of families I’ve seen tell me the same things.” When Beth tells me of her pediatrician’s confused and disconcerting shrug, I say, “Really? Because you’ve been talking to me for seven minutes and I have a really clear picture of what we need to do.” My ho-hum response tends to both reassure the child and his parents that their situation isn’t uniquely terrible and model for the parents a way they can lower their own emotional temperature—which is critical for calming their child.
During this first session, I want to hammer the “anxiety is normal” message home to the whole family. I’ll say to the child, “You’re a human being. That means you’re going to have nervous feelings every single day. It’s normal to feel nervous. First day of school? Little League tryouts? Math test? Recital? Normal, normal, normal.” I’ll ask parents in a session to talk about something they did well, but were nervous about. Or an unexpected situation that was frustrating or scary that they managed to handle without disaster—lost luggage, flat tire, getting cut from their high school basketball team. I coach parents on how to move away from a “catastrophic response” and be more matter of fact. “Yep, I’d be nervous, too, if I was going away to camp,” I say. Or, “I’d be totally frustrated if I struck out, too.”
I ask Beth and Perry to review times they were anxious but successful, and they come up with plenty of examples. Beth had some minor surgery a few years ago, and she’d been nervous as she’d gone in for the procedure. Perry tells me how all the kids at school are nervous when they have to do the standardized testing required by the state. “The teachers tell us we have to do our best. They make a big deal out of it, so we get scared!” We talk about what it must be like to pilot an airplane for the first time, and Beth and I remember out loud our shakiness while taking our driver’s license tests when we were 16.
“That reminds me of the time I got my car stuck in the mud when I was a teenager,” I tell Perry. I want to suggest to him early on that it’s not the content of the anxiety that gives children problems, but how they react to it. Tuna, I want him to understand, isn’t the villain in his story. “My friend and I kind of panicked and she kept yelling at me to step on the gas pedal more, which just made the wheels spin and sank us deeper and deeper into the hole we were making. When the tow-truck driver finally came, he told us what to do next time: “‘Just hit the gas lightly and take it slow; stay calm and feather the pedal,’ he said. (I show Perry with my hand what that looks like.) Now I know how to handle mud. Your worries are just like mud. Not super-tricky, sticky-weird worries—pretty normal, actually. You just need a better plan.”
In short, kids don’t need to avoid forever the “mud” they fear in their own lives—parties, school, cafeterias, their own beds at night—but just work out better ways of dealing with it. “It’s not the mud, it’s the reaction,” I say again. I imitate pressing the pedal to the metal and make a revving engine sound. “It’s not the food, it’s the reaction,” echoes Beth.
I also want to address the physical symptoms that are getting everyone’s attention. This is one of anxiety’s trickiest strategies, and I need to blow its cover from the start. Anxious children are often somatic and focus on how bad their body feels. Even after they’ve been cleared medically, it can be hard to convince kids and adults that anxiety can create such dramatic symptoms. Kids who are anxious about being in school find an ally in the school nurse, who tends to daily tummy aches and headaches. Vomiting, as Perry discovered, makes grown-ups jump to attention.
Earlier, I said that teaching kids to manage anxiety is not about simply teaching them to relax and feel comfortable. It’s the cognitive shift and new perspective that changes things. That said, I want kids to know how to interrupt their physical symptoms, because it gives them a chance to reboot for a moment and immediately shows them how malleable this whole anxiety experience really is. When they learn to slow down and shift their bodies’ reactions, they feel capable of shifting their emotional reactions as well. They feel powerful and autonomous—a huge accomplishment for kids who’ve been bossed around by anxiety for so long. So before Perry leaves that first day, we make a recording together, a self-hypnosis CD that teaches him how to calm his body, loosen his throat, and disconnect from his too-automatic gag reflex. He’s learning to send different instructions to his body and to override the demanding voice of anxiety. I tell him how I used my imagination to make my hand very heavy—which calmed me down enough to stop me from fainting at the doctor’s when I was a kid. He decides to imagine petting a cat. He practices on my cat, who’s excited to be invited into the office. It’s a win-win. “You’re like a superhero,” I tell him. “Your superpower is your imagination. In comic books, when people discover their superpowers, they must decide whether to use them for good or for evil. Your imagination, your superpower, was making you vomit because that evil worry part was in control. Now you’re going to use that power for good, and you’ll be unstoppable!” It’s a lot to cover in a first session, but the momentum is moving in a different direction, and we all feel it.
When Perry returns a few weeks later, things have improved significantly. He reports that he’s staying at the dinner table longer and was able to stay in the cafeteria for an entire lunch. He’s strung together several vomit-free days and is eating more. We exchange smiles as Mom and Perry tell me we’re on the right track. Maybe this anxiety thing isn’t so catastrophic after all.
Laugh It Out of Power
The leitmotif of anxious families is unalloyed grimness about their situation. Any levity or humor about their truly awful, serious, exhausting, probably unsolvable problem is unthinkable to them. But the little-known secret about anxiety—which it works hard not to reveal—is that it can’t stand being laughed at, and tends to shrivel up at the first giggle or joke at its expense. So I spend much of my time being a comedian, getting kids and parents to see how silly and puny this monster is. Humor and creativity allow us, as Jay Haley said, “to change the framework of the situation in the spirit of play.”
Early on, I give families a lesson in how the worry part hijacks the brain, firing off the not-so-bright but obedient alarm system called the amygdala. I describe how that alarm system gets them ready for danger—making kids’ bodies feel weird, and convincing them to get out whenever possible—even when the “danger” is just in their imaginations that are being controlled by worry parts. With a big dry erase board and colorful markers, I draw cartoon caricatures of the anxious child in front of me, along with the bossy worry part, amygdala, and frontal cortex. It’s a simple rendition of the brain, but that’s the point—keep it simple. Using thought bubbles and arrows, I show kids the trap of “uh-oh” or “oh-no” thoughts, and how the amygdala just does what it’s told. The final drawing is of a child with big eyes and an open mouth, shaking and scared. Then I erase and draw the new and improved pattern I’m teaching them, this time depicting a determined kid with hands on hips telling the worry part to back off while the “thinking part” gets called into action. They become the star of their own comic strip as it unfolds in real time before their eyes.
In a trancelike state, Perry watches as I take him through his own story. He falls back onto the couch when I’m done, amused and laughing. Together, Perry and I draw pictures of more worry parts on my dry erase board. I ask Perry what his worry says to him on mashed potato day in the cafeteria, or tuna day, or at a restaurant.
“It says, ‘You’re going to throw up. Don’t think about food. You have to puke.’ And then I go throw up.”
“And you listen every time, don’t you? Your worry part is really predictable. And all this time you thought it was so powerful! You thought you had to listen! That’s your oh-no thought. Let’s show worry who’s boss.”
I explain to Perry that we’re going to play a game. I’m going to be Perry and he’s going to be his worry. His job is to say what his worry says, over and over. “I’m going to make you throw up!” he says. “You’re going to puke.”
I roll my eyes and shake my head dismissively. I pretend to nod off or yawn dramatically as Perry repeats what his worry has been telling him for years.
I act like a texting teenager being called to dinner: “Oh, I’m sorry, were you talking to me?”Then we switch roles. As Perry’s worry part, I’m unrelenting, but predictable and repetitive. I coax, beg, and demand. I remind Perry that we’ve been together for years, that I understand what’s good for him and that this Lynn lady doesn’t know what she’s talking about. Perry gets the hang of it and loosens up, talking back with some sass and swagger. He’s learning how to keep anxiety off balance.
I move in and out of character, laughing and encouraging, cueing Perry when he’s looking for words. Beth is laughing and watching, too, the mom and the student of anxiety. She’s going to use this with her own worry.
I explain to Perry that when his worry shows up—when it starts pestering him with its predictable, boring, and annoying demands—he can talk to it and let it know he has other plans. At school, at home, at restaurants, he should expect his worry to show up and try to boss him around. It’ll tell him he can’t handle looking at food and to get out as quickly as he can—same old stuff. But instead of leaving, he’s going to stay longer. Anxiety will protest, but I want him to practice a different dialogue and a different response. He’s going to change his relationship with his worry and see what happens. Before coming to see me today, I tell him, he didn’t know this was possible. Now he knows. It’s time for him to use his imagination, that award-winning imagination, to put anxiety in its place.