Creating a Toolbox For Your Child's Anxiety

As with any DIY adventure, the proper tools can make a project easier. The first step in helping your child conquer their anxiety are these basic tools you and your child can use.

The fear thermometer

The fear thermometer allows both parent and child to assess the level of fear or stress the child feels in any given situation. This tool has been widely used in treating anxiety for many years (March and Mule 1998.)
 In my experience, children of all ages readily grasp the concept of the fear thermometer and use it effectively. You and your child will use the fear thermometer too!
– collect data about the level of fear or distress your child experiences
– gain information about her anxious feelings, communicate with each other without becoming overly emotional
– plan/ find the best course of treatment

As this downloadable PDF will show, a 10 on the fear thermometer indicates the highest level of anxiety and 1 being the lowest. 
The goal is for your child to assess his or her degree of fear when experiencing an anxious reaction. Your child will provide a subjective rating of the degree of anxiety, distress, or discomfort he is experiencing in that particular situation. Alternatively, you can estimate the level of fear he or she suffers in that situation. Children typically say a fear rating of 10 corresponds with such anxiety that they will explode. There are no right or wrong answers for the thermometer readings, but you want to understand your child's perceptions as accurately as possible. In other words, find out what constitutes a 10 for him/her, what constitutes and 8,5,2 and so on. 
As you begin to use the fear thermometer with your child, ask enough questions so that you both feel you are on the same page. I encourage you and your child to make friends with the fear thermometer because he/she will use it extensively as they learn to conquer his or her fears. Keep it simple and convey a 'matter of fact' attitude about using the thermometer. The more you use it, the more comfortable and routine it will feel. I love the fear thermometer because it is so simple, versatile, and useful.

Habituation curve – the worry hill
A worry hill is a tool to illustrate your child how habituation works and to motivate participation in exposures. I borrowed the term worry hill from Irene Pinto Wagner 2005, who use it to make the concepts of exposure and CBT more accessible to children. 
The worry hill is used in conjunction with the fear thermometer. The vertical axis presents fear thermometer readings, (that is the level of anxiety or distress in a given situation.) The horizontal axis represents the number of exposures or the duration of a single exposure. 
The worry hill – the habituation curve.

Even children who are too young to understand math can grasp what it means to go up and down the worry hill. Use the graphic to show your child how he or she climbs up the left side of the worry hill when anxiety rises in a fearful situation. (You can walk your fingers up the mountain to show her how anxiety reaches a peak and then down the other side as anxiety declines and habituation occurs.) This helps your child understand that anxiety may get worse when in a stress-inducing situation, but it will get better, it will pass.

Nicknaming the fear
Nicknaming can help both you and your child maintain objectivity and get a handle on his or her fears. A nickname provides a constructive way to refer to anxiety, rather than to engage in behaviours that feed her fears. Anxiety tends to come in spikes, and your child is more likely to believe her fears during a spike then after the spike passes. Using a nickname to refer to a fear puts you and your child in a position of control because it reminds you both that his or her brain is in a spike. Nickname in the fear also fosters a neutral attitude about anxiety. No one likes having intense feelings of anxiety, and children can naturally develop and negative attitude towards their anxiety. This attitude only intensifies the anxiety – research shows that when children are less negative about a particular fear, they experience less distress and are able to make more significant gains from exposure therapy.

To use this tool, ask your child to come up with a nickname for his or her fear and anxiety, one that is simple and direct. It should have meaning to your child, and it should be lighthearted and not frightening or negative. For example, a child who fears germs might select germ worm or germ stir. You and your child will use this nickname as much as possible when the anxiety is triggered. After your child decides on that nickname, help her learn to use it. When she has a high fear of thermometer rating, she should think to herself "hi germ worm!" 
NOTE: Using the nickname should be done mostly silently as children sometimes create a ritual around the nickname when they repeatedly speak it out loud, And that can interfere with recovery.
The goal is to simply have your child accept, welcome and greet the fear each time. You don't want her to think things such as "go away, germ worm!" Or "I hate you, germ worm!" The idea is to remain objective, without adding any more negative thoughts. The more readily your child can respond to anxiety by identifying it with a nickname, the more easily she can view the bad feelings in a much healthier way. Some children find that nicknaming alone helps them a great deal. You can introduce the nickname tool to your child with the following exercise which involves imagination.

Trying out a nickname, if your child is fearful of germs, for example, suggest imagining being in situations in which it is necessary to touch a doorknob she believes is not clean. Ask if she feels her thermometer reading arise when picturing herself touching the doorknob. Just imagining being in the situation may be enough for this to happen. If so, that's great. When your child feels anxiety developing, instruct him/her to say, "hi germ worm" silently. Tell her to use the nickname whenever her fear thermometer temperature rises in real life.