eNewsletter - October 2015

Behavioral health partners


Getting an Anxious Child to School
By Megan Schmitz, PsyD and Laura Koehler, PsyD


With school anxiety increasing in prevalence, those in the mental health profession have surely come across the following scenario: an anxious child presenting somatically in an effort to get their parents to call them out of school sick so they do not have to attend. 

If that does not work, the anxious child may attempt to refuse to get out of bed, get dressed and get ready for school  in hopes that his/her parents, who need to leave for work, will give in and let him/her stay home from school. 

Other behaviors to attempt avoiding going to school may include refusing to get into the car, missing the bus, verbal or physical aggression, locking themselves in rooms, making excuses, struggling to get out of the car in the school parking lot, and potential threats to harm self. 

If these scenarios seem familiar to you, you may be looking for strategies to help a child manage his/her emotions in a healthy way rather than through avoidance, thereby improving the child’s functioning. 

Dialectical Behavior Therapy (DBT) is an evidence-based treatment approach that offers skills the anxious child can practice to help him/her respond more adaptively to distress. If the child’s anxiety is so high that refusing to go to school is the most attractive option and he/she is demonstrating extreme avoidant behaviors, the child should be considered to be in crisis. 

At this point, the child’s ability to rationalize reasons to attend school will be diminished or absent altogether.  Therefore, trying to talk the child out of their anxiety will not only be ineffective, it may actually increase his/her anxiety level as he/she will likely come up with counter arguments to every point that is made.

The goal at this point is to decrease the child’s anxiety and increase rational thinking through DBT Distress Tolerance Crisis Survival Strategies.  The first step is to align with the child and validate his or her struggles without directly addressing the anxiety. Continuously discussing triggers or worries will often lead to an increase in the child’s distress. 

Among DBT Crisis Survival Strategies, distraction and self-soothing have been found to be particularly effective with this population. The distraction group of skills is meant to occupy cognitive resources to the degree that there’s no resources left to focus on the anxiety, thereby creating the space needed for the child to calm down. The self-soothe group of skills is meant to focus on providing present moment information through the five senses that serves to ground the child and comfort them.   

Creating a skills tool box stocked with concrete items to facilitate coping is especially beneficial as those in a crisis zone will likely find it difficult to think beyond the anxiety and identify healthy responses. 

Some distraction skills include: word searches, Sudoku, logic/math problems, timed puzzles, extreme dot-to-dot, mandalas/adult color pages, sour candy, spices and pictures of bright colors. Various self-soothe  tools include: stress balls, kinetic sand, silly putty, gum, mints, favorite treats, pictures of family/friends, beautiful nature scenes, letters from support, scented lotion, wax melts, perfume, as well as an IPod loaded with upbeat songs, comedy sketches and nature sounds. Furthermore, an index card of non-object coping strategies can be added to the skills tool box to supply additional ideas. For example, breathing exercises, physical activity, playing with pets, playing games such as 20 questions/I Spy, counting backwards by 7’s, encouraging statements/quotes/lyrics, and imagery suggestions.


It is critical that when the child is practicing the aforementioned skills, he/she should be encouraged to fully focus on the task at hand, again without discussing the cause of their anxiety. Ample time should be given to practice each skill to allow time for the anxiety to decrease.  However, once it is evident that the child is no longer in crisis, they should be prompted to stop practicing crisis survival skills and go to school.

As anxiety can fluctuate throughout the day, it is suggested the child also create a portable skill tool box to take with him/her for the car/bus ride or to make coping in the classroom/hallways easier.  Moreover, it is important to positively reinforce all efforts the child displays, big or small, to positively cope with their anxiety. This reinforcement will help to increase the likelihood that the child will demonstrate that positive behavior/ coping skill again.   

Additional resources for the application of DBT include:
Books
  1. The Extended Dialectical Behavior Therapy Skills Training Manual, by Lane Pederson, Psy.D., LP, DBTC
  2. DBT Skills Training Manual, 2nd Edition, by Marsha M. Linenhan
  3. The Dialectical Behavior Therapy Skills Workbook for Anxiety by Alexander Chapman, Ph.D. Kim Gratz, Ph.D. and Matthew Tull, Ph.D.
Websites
  1. Marsha Linehan’s Behavioral Tech, LLC: www.behavioraltech.com
  2. Lisa Dietz’s DBT Website: www.dbtselfhelp.com                  

For more information on these treatment skills, contact the Linden Oaks Anxiety Program at 630-305-5027.  

Megan Schmitz, PsyD, Licensed Clinical Psychologist
Megan Schmitz (formerly Moller) graduated with a doctoral degree in clinical psychology from the American School of Professional Psychology – Argosy University. She has 10 years of experience in the mental health field working in a variety of settings, including private practice and providing in-home intensive treatment. She has primarily concentrated on working with adolescents and their families, with a variety of presenting problems including but not limited to anxiety disorders, ADHD, autism spectrum disorders, and disruptive behavior disorders. Megan’s approach to treatment integrates Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), along with exposure therapy to provide patients with concrete skills to increase personal accountability for behavioral choices and to improve their daily functioning.

Laura Koehler, PsyD, Licensed Clinical Psychologist
Laura Koehler graduated from the American School of Professional Psychology with a doctoral degree in clinical psychology. She has been working in the mental health field for over 10 years in a variety of settings, including community mental health, private practice, and residential treatment centers. Her work has mainly focused on working with adolescents and their families. Laura’s approach to treatment integrates Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), along with exposure therapy to provide patients with the skills they need to increase their ability to regulate emotions, as well as tolerate overwhelming emotions.