Loving Kids Loud Part Four - Anxiety

In 2022, according to the Australian Psychological Society 45% of children aged 6-12 showed symptoms of Social Anxiety Disorder. Whilst we might look to the pandemic as the reason behind this sharp increase, we cannot blame it entirely.  The Australian National Mental Health Commission tells us that in general, Anxiety Disorders impact 1 in 4 Australians at some point in their lives.  Approximately 7% or 278,000 children and adolescents aged 4-17, are diagnosed with an Anxiety Disorder. 

It’s tricky to find accurate comparisons due to the changing nature of data collection over the years but I looked at the OECD data for 2019 so that I could see what the landscape looked like prior to the pandemic.  The average percent of children with anxiety disorders across the OECD countries was 35%.  There is a general view that Australia is doing a bit better than other OECD countries but I think we can all agree that when 45% of Australian children show symptoms of Social Anxiety Disorders, we’re not doing well at all. In fact I would describe it as a crisis for children, whatever country they are growing up in.  With that in mind, I want to explore some of the ways the adults around children can either help or hinder their children. 

Let me start by talking about the SPACE program (Supportive Parenting for Anxious Childhood Emotions).  The SPACE program was developed by Eli Lebowitz from Yale University in the USA.  Lebowitz is an expert in understanding and treating anxiety.  The SPACE program is one of the most successful programs in the world, and I’m lucky enough to have been trained in it.  One of the things that often surprises people when I talk about SPACE, is that whilst the program is fully focussed on the treatment of childhood and adolescent anxiety, the practitioners never see children.  They only ever work with parents.

I am also certified to facilitate the Australian parenting programs; The Anxiety Coach and RIOT.  They were developed by Parentshop to support parents and teachers in how to manage childhood and adolescent anxiety.  I was fortunate to work with Parentshop on the evolution and pilots for these programs, and then the roll out of them within schools.  The thing about The Anxiety Coach (for primary aged children) and RIOT (Resilience in Our Teens) is that like SPACE, they don’t work with children or adolescents either.  They have been specifically developed for parents and teachers who are supporting children.

So why don’t the practitioners of these successful evidence-based programs work with the children and adolescents who are experiencing anxiety?  It’s an uncomfortable answer but multiple research studies are clear; it is the adults surrounding children who either help or hinder the child’s experience of anxiety.  It’s much more effective to work with the adults than the children.  Having said that, I cannot stress enough that nobody is blaming parents or teachers for causing childhood and adolescent anxiety.  Let me say that again really clearly, it’s NOT your fault and zero mental health practitioners that I know, would blame parents or teachers because we all know anxiety is a complex issue.  We also know that parents adore their children and that teachers become teachers because they love working with children and want to make a difference in their lives.  The issue with anxiety specifically is that the treatment or management of it is completely counter-intuitive.  Having said all that, let’s begin at the beginning with a quick zippy tour of neuroscience and how anxiety develops.

The brain develops over time from the bottom up.  First it’s the Brain Stem which is all about basic survival.  Next is the Cerebellum, the movement centre of the brain. Third we have the Limbic system, the emotion centre of the brain.  Finally we have the Pre-frontal Cortex which is the high order thinking part of the brain.  You might be surprised to find out that the pre-frontal cortex doesn’t come on line until the age of about four and it doesn’t finish developing until, generally speaking, the mid-20s (earlier in females, later in males).  Here, we’re going to specifically look at the interplay between the limbic system and the pre-frontal cortex.

You may have heard of the amydala, it’s a little almond shaped area in the middle of the brain within the limbic system.  It’s the early warning system of the brain and it’s designed to keep us alive.  There’s no thinking in the amygdala, it’s all action.  Whilst it’s extremely important, it’s also a bit like the annoying smoke alarm outside my bathroom which gets activated when the steam from the shower gets a bit much.  Whilst the amygdala is essential for keeping us alive, like the smoke alarm when there’s a fire, it does have a tendency to go off when there’s only metaphorical steam not smoke.  When the amygdala is activated, it’s the pre-frontal cortex that helps to calm it down, to reassure it if you like that we’re not about to die if it’s ringing when there’s only steam.  Does that make sense?

The pre-frontal cortex on the other hand, is completely useless at keeping us alive. It likes to think about things, problem solve and analyse, which is problematic if your life is in danger.  If you stay to analyse a wilderbeast coming straight for you, you’d be dead.  What you need is your amygdala screaming at you to get out of the way. 

The fundamental difference between the amygdala and pre-frontal cortex when it comes to danger, is that fear sits in the amygdala and anxiety sits in the pre-frontal cortex.  Let me give you an example.  You’re driving home from work one day, you hear the sirens from a fire engine and then all of a sudden it’s screaming up behind you, overtaking you without any warning, so close you can feel the rush of wind in your hair through the open car window as it rushes to a fire.  You panic, you’re terrified, is this fire engine going to crash into you?  You take evasive action, stop the car and take some deep breaths.  Once you’re a bit calmer, you think about what just happened and realise you were very nearly in a catastrophic car crash.  That’s fear.  You were absolutely 100% in danger but your amygdala in a flash, had your back and prompted you to make an instantaneous decision to get out of the way, then your pre-frontal cortex helped you calm down by analysing the situation and letting you know you’re ok.

Let’s think about the same scenario.  You’re driving home from work, you hear the sirens and see the fire truck in your rear vision mirror racing down the street.  You pull over to the side and it overtakes you.  You immediately think to yourself, oh no it’s heading in the direction of my house, oh no my house is on fire, oh no was anyone at home?  This is your pre-frontal cortex analysing the situation.  You feel sick.  You nearly throw up.  That is anxiety, it sits in the pre-frontal cortex.  It feels overwhelming and terrifying but you’re not actually in any current danger.  Just like the amygdala, our pre-frontal cortex sometimes gets it wrong too.  

The fire truck isn’t about to hit you.  You have no idea whose house is on fire, or even whether a house is on fire.  There is certainly no evidence your own house is on fire.  The fire truck just happens to be heading in the direction of your house.  What has happened is that your pre-frontal cortex thinks about the scenario, analyses it and comes up with the wrong answer.  The more you think about it, the more scared you become and it keeps on going until someone or something helps you to stop.  In this scenario it would be getting to your house and realising it’s not on fire and the fire trucks are nowhere to be seen. When there is a situation that causes anxiety the pre-frontal cortex yells at the amygdala, which then switches on and feelings of fear develop.  When there is a situation that causes fear, the amygdala yells to the pre-frontal cortex to get out of the way.  Your brain’s response to the situations start in different places but either way a feedback loop develops with which just builds and builds.  In order to manage anxiety, the feedback loop needs to be interrupted.

Ok so that’s neuroscience 101 around fear and anxiety.  Let’s look a bit more at the way that feedback loop starts and then gets worse and worse until someone is almost paralysed by anxiety.

I recently watched a British reality series called Shark! Celebrity Infested Waters.  I never watch reality tv but I watched this one because Ade Adepitan was in it and he uses the same type of wheelchair as me.  I was actually watching it more for the wheelchair than anything else but I got hooked and I’m so glad I did.  The premise was that the general public is pretty much terrified of sharks and so want them culled but environmentally this would be a terrible thing.  The hosts of the show are shark experts and their job was to guide this group of celebrities, over a three week period, to go swimming with Tiger sharks hoping that they could then become ambassadors for sharks and the environment.

The celebrities were obviously pretty scared when they started but very soon it was clear that some were more scared than others.  Helen George (Trixie in Call The Midwife) was absolutely terrified, Lenny Henry and Ade Adepitan were probably not far behind.  Helen was so terrified of pools and the sea that she wouldn’t even swim and if she forced herself into the water there was no way she would put her head under it.  As the series went on Helen explained that when she was a child, she was swimming under water in a pool and when she came to the surface, it was completely blocked by those large foam floaties that people who are learning to swim use.  She couldn’t get out and, completely understandably, panicked.  She was in real danger at the time and her amygdala was activated.  

What happened then was her pre-frontal cortex took over and the message it told her was that pools and the sea are dangerous so you need to avoid them otherwise you’ll die.  Helen then spent her time avoiding pools and the sea which was fine for a while, but then she had children and of course her children wanted to go swimming.  Helen’s anxiety prevented her from going into the water with them and because she wanted her children to be safe, they couldn’t get in the water either.  Helen recognised that this wasn’t a healthy way to parent her children so she signed up for the series in the hope it would cure her anxiety.

The producers had a psychologist on board (thank goodness) and the experts on the show were incredibly knowledgeable and helpful.  Helen didn’t manage to swim with the Tiger sharks but she did amazingly well and it was incredibly moving to watch.  Ade and Lenny had different stories but with very similar consequences.  They were both afraid of the water and avoided it as much as they could.  I should say at this point that Ade is an accomplished Para-Olympian.  He has done some amazing things in his life and pushes the boundaries at a rate of knots.  Ade and Lenny both managed to conquer their anxiety and swam with the sharks.  Inspiring is a word that is over-used but honestly, seeing the way these three challenged themselves really was inspiring.

So let’s unpack how their anxiety developed and how they managed to control it over a 3 week period.  I have no idea how the adults around Helen, Ade and Lenny responded to the situations they found themselves in as children but I can make a very informed guess.  Anxiety starts because the response from the surrounding people is to either under or over manage the anxious person.  This is the bit where parents, teachers and others who support children can, unknowingly, make it worse.  

Some people might say to the individual who has had the scary experience things along the lines of, “you’ll be fine”, “ you can get over it”, “nothing happened so what are you worrying about”.  None of them are said maliciously, in fact usually they’re done from a place of care, thinking that if they don’t talk about it or minimise, it will just get better.  Others do the exact opposite, they almost over comfort the person.  When the person says that was too scary I’m never going to do that again, the supporting people say that’s ok, you don’t have to and they help the person avoid whatever the particular trigger is.  They do it out of a place of love, care and concern. 

There are two other responses the adults around children can do which triggers anxiety.  The first is when an adult experiences their own chronic anxiety.  When the child does something that causes the parent to be anxious, they swoop in and stop whatever the child is doing.  The child wasn’t anxious about it but the parent is unknowingly passing on their own fear to the child so the child thinks whatever they are doing is dangerous.  The final response of parents is to chastise a child who is anxious about something.  This is probably the most harmful of all the adult responses because not only does it completely ignore the child’s anxious feelings but it causes the child to feel ashamed about the very emotions they need support with.  What that teaches the child is that feelings are bad so I can’t tell anyone when I have these feelings.

The problem with these responses is that the individual never actually deals with what happened to them.  For Helen, nobody comforted her and then said, “here come with me, let’s do this together” or “I’m with you, you’re safe now, how about you try that again”.  I am sure Helen was comforted in the moment but comfort isn’t enough when it comes to anxiety.  In fact comfort by itself just makes it worse, there needs to be follow through so that child, in a way that helps them feel safe, attempts the situation again.

Let’s move this from shark infested waters to real life.  One of the most common things I hear from teachers is that children are really scared of public speaking, so when it comes to doing a presentation in class, the child panics and refuses to participate.  Teachers, not wanting to make it worse, then allow the child to do something slightly less scary, for example present the information to the teacher, or record it on their phone at home or to just present in front of their friends.  Those are all good things to do to help a child’s confidence but it actually doesn’t address the task.  They are steps along the way to fulfilling the expectation of the assessment task; presenting to their class.  If this happens in primary school, by the time the child gets to high school the anxiety just builds and by the time they’re adults and out in the world, their anxiety about speaking in public is prohibitively extreme.  We can accurately predict that allowing the child to not fulfill the assessment task in year four is going to impact their functioning as an adult.

Back to the shark series.  What we saw for all of the celebrities is the gradual and very planned progression to build their skills and their confidence.  First they were in a cage with sharks swimming around them.  Then they learned how to scuba dive, next they paddled in water with baby sharks, then larger sharks and so on.  The end result was all of them, except Helen, were able to confidently swim with the Tiger sharks and appreciate them in their awesome beauty. Helen had her own journey, she got her scuba diving accreditation and she successfully completed every other task.  She was somewhat relieved but also, amazingly, considering where she had started, a bit disappointed that the experts decided she wasn’t yet ready.  

What we forget is that when we support children to avoid the task in case their anxiety becomes worse, we actually get in the way of them succeeding and feeling the joy at being able to conquer the thing that causes the feelings of anxiety.  Watching all of the participants as they succeeded with what, three weeks prior, had been a seemingly impossible task, was a privilege.  I felt that I had witnessed something very very special.  We need to give our children the opportunity to succeed and experience that excitement and celebration.

Let’s unpack some of the more lasting impacts of not supporting children to challenge themselves with things that make them anxious.  One of the things I hear, almost daily, is people talking about “their anxiety”.  It’s as if anxiety was a biological part of them, like the colour of their hair.  Anxiety is simply an emotion.  It’s not the truth of a situation, it just tells us how we’re experiencing a situation.  Emotions change all the time.  We know it within ourselves and we see it with little children.  Yes, some people have a diagnosed anxiety disorder which requires professional help but for a good proportion of this group of people, their anxiety disorder was created when they weren’t appropriately supported the very first time something scary happened to them.

The other society-wide consequence is the evolution of what some people call “the snowflake generation”.  The generation who are “triggered” at what feels like the drop of a hat.  A generation of people who silence other people who have different opinions to them.  A generation of people who now have children and push back at teachers who try to hold children to account or encourage children to “feel the fear and do it anyway”.  A generation of young adults who make complaints about their university lecturers so serious that the academics are dismissed.  This directly relates to the issues I raised in the previous article about Respectful Relationships.

Let me recommend a book to you called I Still Find That Offensive! by Claire Fox.  Some people may know of Claire Fox, a British politician with a somewhat colourful reputation. Her reputation however, doesn’t preclude the importance of what she has written about in this book.  She gives example after example of the often egregious and always serious result of people being ‘offended’ by other people due to this issue of being ‘triggered’.

One example has a stark consequence.  She talks about law students who are expected to learn about all aspects of the law but when it came to studying legislation about rape, some students were triggered by this so they called on the university to remove all aspects of sexual assault from the syllabus.  The university complied.  Now I don’t know about you, but I really want lawyers to be very clear about the law regarding rape and sexual assault so that victim-survivors get the best representation possible.  How on earth is that supposed to happen when the whole issue of sexual assault is removed from the syllabus?

I am not saying we just need to get on with it, irrespective of the impact on some students.  What I am saying is that there will be some students who are directly impacted by, in this case, sexual assault.  That is terrible but what those individuals need is support to manage their experience and the emotional impact of it.  We are not helping them if we ignore it and hope it will go away.  I think we can be clear now, that ignoring something terrible is just going to make it worse.

So what do we do?  You’ll be glad to know it’s not rocket science.  First and foremost I must be clear; people who have an anxiety disorder need to have professional psychological support but that group are, believe it or not, a minority of people who experience anxiety.  We all experience anxiety.  Imagine if everyone who experienced anxiety was told, or believed, that they need to see a psychologist?

First and foremost, people need to be validated and supported.  In my second article in this series; The Manosphere, I talked about John Gottman’s Emotion Coaching.  It is essential that this is the first part of a supportive person’s response to someone’s experience of anxiety.  It may be that someone still needs a bit more help after they have been emotion coached and that is where something called Graded Exposure comes in.  This is what the participants in Shark! went through.  We supportively work with the individual at their pace, to set up a series of challenges to get them to the point of being able to tackle the anxiety causing issue.  

Let’s go back to the school presentation.  Students need to be supported to get there, not thrown in the deep end.  So it might be in Year One, they are asked to write a story and read it aloud to their parents.  In Year Two they might be asked to research a topic they are interested in, create a powerpoint presentation and talk their teacher through it, in class whilst their classmates are working on something else.  They’re in the room but they’re not engaged with what is happening between the teacher and each individual student.  In Year Three, they might prepare a speech and present it to a group of their peers.  In Year Four, they research a topic in pairs and both present it to the whole class.  In Year Five they individually prepare a topic and present it to their class.

I mentioned at the start of this article the SPACE program from Yale University.  This is a documentary about the program.  It’s about 20 minutes long but I encourage you to watch all of it. You will see the profound impact of emotionally supporting someone and challenging them to succeed. My favourite part of the documentary is from 6.50 to 9.20 minutes.  Take a look.  I’d be interested in knowing what you think.

Imagine what our world would look like if we all knew how to effectively support someone experiencing anxiety?  How resilient it would be.  How healthy our children would be.  How respectful of others we could be.  It’s a big topic so I’m going to add here some links to resources that are helpful.  The authors of all the books linked to below have written others which I also thoroughly recommend.  And yes, I’ve read them all.

Hey Warrior 

Raising an Emotionally Intelligent Child

The Whole Brain Child

Brainstorm

Rewire Your Anxious Brain

Breaking Free of Child Anxiety & OCD

Please share this article widely because I know, without a shadow of a doubt, that at least one person in your world needs to read it, maybe that’s you.