Enhancing Quality in
School Mental Health

Teaching clients how to cope with anxiety

Anxiety disorders adversely affect multiple areas of child and adolescent development. As the most prevalent form of psychopathology in youth, anxiety occurs alongside other disorders such as depression and substance abuse. Therapists address physiological, cognitive and behavioral symptoms of anxiety in order to equip clients with effective coping strategies.
The literature on evidence-based therapy reveals an integrationist approach to treating anxiety in youth (Kendall, Aschenbrand, & Hudson, 2003). Instead of looking at causes, this treatment provides cognitive and behavioral models for mediating the effects of anxiety. The treatment protocol emphasizes flexibility by adjusting goals to fit the child’s needs.
Clinicians demonstrate different strategies so clients can begin building their own framework for coping with anxiety. During the first half of treatment, clients also learn to acknowledge the physiological correlates of anxiety and to think critically about the consequences of negative expectations. Lastly, the therapist highlights the benefits of gaining control over anxiety by shaping and reinforcing more adaptive thinking.
Action characterizes the second half of this treatment. By exposing clients to both imaginal and real anxiety-provoking situations, therapists allow clients to employ some of the strategies rehearsed earlier in therapy.
Therapists walk children through a hierarchy of fearful situations, progressing from in-office exposure to more stressful situations. Therapists strive to instill competency as clients become “experts” by creating a commercial that highlights their positive coping skills.
Research reveals a reduction of anxiety due to treatment across gender and ethnicity. While translating research to practice presents an obstacle for school mental health clinicians, manuals such as these increase fidelity by specifying key components of the treatment process. Clinicians should present themselves as capable coaches who show children and adolescents how to confront fears associated with anxiety.
Kendall, P.C, Aschenbrand, S.G, & Hudson, J.L. (2003). Child-focused treatment of anxiety. In A.E. Kazdin and J.R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 81-100). New York: Guilford Press.

Putting the evidence base into practice

Fear is a normal part of development since it can protect all of us from unnecessary harm. As children grow into young adults, their experiences confirm or deny their fears. Young children overcome their fear of the dark; adolescents cope with peer pressure; and adults manage stress at work.
Children react to fear differently depending on genetic and environmental factors. Because a single fear can evoke multiple responses amongst developmental peers, clinicians and parents alike should remain sensitive to individual differences. Unfortunately, some children do not learn how to mitigate the debilitating effects of anxiety. They avoid fearful situations to prevent the onset of anxiety. This avoidance can then hinder their academic, social and emotional development and well-being.
In Helping Your Anxious Child (2000), authors describe ways in which parents and educators can help children cope with anxiety. The following is a summary of suggestions drawn from evidenced base practice:
Teach how to re-think catastrophe — Teach them how to question their fears. Guide them in coming up with possible solutions for acknowledging and preventing anxiety.
Reward non-anxious behavior — Commend children for confronting fear and encourage them to continue doing so. Involve children in selecting the rewards as well.
Allow breathing room — Allow children to act on their own. Too much attention may ultimately reinforce anxious behavior.
Rapee, R., Spence, S., Cobham, V., & Wignall, A. (2000) Helping Your Anxious Child. Oakland, CA: New Harbinger Publications.

Helpful resources for child anxiety:
http://www.nimh.nih.gov/publicat/anxiety.cfm
http://www.aacap.org/publications/factsfam/anxious.htm