Introduction

There are two approaches to managing anxiety. The first is to reduce or avoid the situations and contexts that lead to the anxiety. For example, not climbing a tree if you are afraid of heights. Unfortunately, though this may work for certain types of phobias and anxiety creating situations, there are many contexts that are difficult to avoid. For example, if you become anxious having to talk in front of other people this can be more difficult to avoid and is also an essential life skill that ideally needs to be overcome. 

The second approach is to become better at coping with contexts that cause anxiety. This involves developing self-awareness of how anxiety affects the body and taking proactive actions to remain calm by using exercises and other strategies. 

When dealing with very anxious individuals it is often necessary to combine both approaches at least initially. As they become more skilled in self-management of their anxiety symptoms it is then possible to gradually increase exposure to the anxiety creating context. Psychologist often refer to this as systematic desensitisation. For example, a selective mute child may very gradually learn to talk to a partner in class, then quietly to the teacher, later to speak in front of a small group and finally to read out something with the whole class.

Avoiding contexts that lead to anxiety

In schools, and similar settings, the management of a child with additional needs caused by anxiety requires careful observation and recording of their behaviour. Often behaviour becomes noticed when there is problem such as refusal, avoidance or meltdown. Documenting the whole context and the chronology of events that preceded the issue helps to correctly identify the trigger for the anxiety. This is particularly so for younger children who may not be able to explain this for themselves. Older children and adolescents may also struggle to communicate the cause of their anxiety. This may be more likely to be when there are social or performance anxieties.

Coping better with anxiety symptoms

As it is not possible to remove all anxious situations, nor is this desirable, we need to support the child to regulate their anxiety. This must always be done safely so that the child develops confidence in their ability to cope with each stressful context. This is achieved by building up exposure gradually and directly teaching self-calming strategies.

Limiting Exposure

How you limit exposure to anxiety inducing stimulus will depend on the specific nature of it. This may include one or more of the following:

duration
frequency
intensity
quantity
location
audience
timing

Example: A child that has anxiety about going into the school hall for assembly could have their exposure limited by:

duration - only attending part of the assembly
frequency - only attending assembly once a week
intensity - avoiding special assemblies that are less predictable
quantity - attending assemblies on alternate days
location - sitting somewhere different within the hall such as by a trusted adult or friend
audience - attending assemblies that only have part of the school
timing - only attending assemblies in the morning or afternoon

Teaching anxiety self-management

Developing a child's ability to self-regulate in response to anxiety requires considerable support over an extended period of time. This is usually achieved through 1-1 or small group withdrawn support where calming strategies are explicitly taught and practiced. Discussion of contexts that induce anxiety is also necessary in order to help the child develop the language to express and process their thoughts and feelings. Use of social stories can be helpful in recording each specific anxiety and suggested ways of coping better with it. Through these interventions the child can build up a portfolio of help sheets that include calming strategies and social stories as well as rewards and certificates for demonstrating progress towards overcoming their anxieties.

Though this article is written specifically with schools in mind it is ideal when parents also support their children through active teaching of calming strategies and use of social stories.