Home Management Strategies for Separation Anxiety Disorder
We will be removing this page on Dec 15, 2017. The material has been replaced by the MAP (My Anxiety Plan) session to session program. If you have any questions or comments please send them to this e-Mail address.
Step 1: Teaching your child about anxiety
No matter what type of anxiety problem your child is struggling with, it is important that he or she understands the facts about anxiety.
Fact 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger.
Fact 2: Anxiety becomes a problem when our body tells us that there is danger when there is no real danger.
As an important first step, help your child to understand that all the worries and physical feelings have a name: Anxiety.
|To learn how to explain this to your child, see How to Talk to Your Child about Anxiety.|
Step 2: Teaching your child about separation anxiety
- First, tell your child that it is normal to sometimes feel anxious when alone or away from mom or dad.
- Tell your child that you will give him or her some tools to help cope with anxiety and gradually face his or her fears.
- Help your child identify some of the feelings, thoughts, and behaviors related to his or her separation anxiety. Here’s an example of a conversation between a parent and child who has difficulty going to school.
Parent: One of the problems with anxiety is that it feels like a lot of bad stuff happening in your body for no reason. For example, how do you feel in the mornings before school?
Child: Um, bad. Really bad. I have stomach aches. My head hurts too. I hate it…”
Parent: Yeah, it feels really terrible, doesn’t it? Probably the worst part is not understanding why you are feeling all those things and when it will go away.
Child: Yeah, it sucks.
Parent: Well, remember what we were saying about anxiety? Anxiety feels like a big confusing ball of bad feelings. However, anxiety actually has three different parts. One of the parts is how you feel when you are scared. For example, having a sore stomach or a headache on the morning of a school day. The second part is what you think, or say to yourself, when you are scared. What are some of the things that you are thinking about in the morning when you don’t want to go to school?
Child: I don’t know, I’m just thinking that I don’t want to go.
Parent: What do you think might happen if you did go to school?
Child: Um. Lots of things I guess. I think something bad will happen to you. Sometimes I feel like puking in the mornings, and I don’t want to throw up at school because you won’t be there to help me.
Parent: That sounds like some pretty scary thoughts. I can understand why your “smoke alarm” is going off if you are having those kinds of thoughts. Those thoughts are examples of that second part of anxiety: what you think, or say to yourself. The third part of anxiety is what you do when you are scared.
Child: Like what?
Parent: For example, like leaving or avoiding a place like school, or staying with someone you feel close to.
Child: Like you and dad?
Parent: Yes, exactly.
Child: When I feel anxiety, I want to stay home with you. It helps it go away.
Parent: That’s right. So, your action is staying home with me.
Child: Yeah, I guess.
Parent: So, let’s go back to thinking about anxiety as a broken “smoke alarm.” Those three parts of anxiety - your body signals, your thoughts, and your actions - are all part of what is making your “smoke alarm” go off when it doesn’t really need to. What do you think we should do to fix your “smoke alarm” so that it only goes off when there is a real danger?
Child: I don’t know. I guess if I want to fix it so that my “smoke alarm” doesn’t go off, then I need to fix those three things...
Parent: I’m going to help you build yourself a toolbox. In it, you will have tools for each of those three parts: your feelings, your thoughts, and your actions. For example, let’s say you didn’t think “I might throw up”, but instead you thought “I haven’t thrown up at school yet and so what if I do? Lots of kids get sick at school, and I could go to the girls’ washroom! How do you think you would feel then?
Child: Um, less scared I guess.
Parent: Do you think if you didn’t have scary thoughts about school, or you had more helpful thoughts, you would feel less scared?
Parent: Remember,all three parts are connected, so changing one part can help change the other two parts. So, if you change how you think, you can change how you feel and what you do.
Step 3: Encouraging your child to stop seeking reassurance
Children with separation anxiety often seek excessive reassurance from their parents. They ask questions like: “Are you sure you won’t go further than the neighbor’s backyard?” and “Are you sure I won’t get sick if I go to school?” They do this to try to be 100% sure everything is all right. Parents often find this quite tiring and frustrating! When your child is excessively and repeatedly asking for reassurance:
- Tell your child that this is just anxiety talking. Your child is always asking for reassurance because the anxiety is bullying him or her around.
- Make a plan with your child about beating back anxiety by not giving reassurance.
- Tell your child that he or she can only ask you something once.
Below is a sample script between a mother and child with separation fears:
Child: Mom, you are going to be home all day today when I am at school, right?
Mom: What did I tell you when you asked me five minutes ago?
Child: Please tell me again.
Mom: I think you already know the answer.
Child: Please, I just want to make 100% sure.
Mom: Well, if you weren’t 100% sure, what would be so bad about that?
|To learn how to explain this to your child, see How to Address Excessive Reassurance Seeking.|
Step 4: Building your Child’s Toolbox
The best way to help your child deal with separation anxiety is to give him or her tools that can be used when facing fears. For separation anxiety, tools in the toolbox include:
Tool #1: Learning to Relax. One tool involves helping your child learn to relax. Two strategies can be particularly helpful:
1. Calm Breathing: This is a strategy that your child can use to calm down quickly. Explain to your child that we tend to breathe faster when we are anxious. This can make us feel dizzy and lightheaded, which can make us even more anxious. Calm breathing involves taking slow, regular breaths through your nose. For more information, see Teaching Your Child Calm Breathing.
2. Muscle Relaxation: Another useful strategy is to help your child learn to relax his or her body. This involves having your child tense various muscles and then relax them. Your child can also use “the flop,” which involves imagining that he or she is a rag doll and relaxing the whole body at once. For more information, see How to Do Progressive Muscle Relaxation.
Children and teens can use the above tools before school, at school, before bed, or wherever they feel anxious. Both should be practiced repeatedly until your child is comfortable doing them alone.
Tool #2: Making Coping Cards
It’s not easy to face fears, so it’s a good idea to develop “coping cards” that your child can carry with him or her during the day to help manage anxiety. For tips on how to help your child develop and use coping cards, see Developing and Using Cognitive Coping Cards with Your Child. Here are some examples of coping statements that your child can use for Separation Anxiety Disorder:
- “That’s just Mr. Worry trying to bully me! I don’t need to listen!”
- “I’m feeling anxiety right now. I can do some calm breathing to feel better.”
- “Mom is okay, it is just my anxiety talking.”
- “I can handle being alone. I’ve done it before.”
- “What is the best thing that could end up happening?”
Tool #3: Facing Fears
The most important step in helping your child or teen manage separation anxiety is to face fears. This includes avoided situations or places. For children with separation anxiety, some typical fear ladders might involve gradually sleeping alone in his or her own room, staying at school for the whole day, or reducing reassurance seeking. Remember, these steps are gradual, and are created together with your child. For more strategies and tips on conducting these exercises, as well as example fear ladders, see Helping your Child to Face Fears: Exposure.
For children who have worries about going back to school, see Coping with Back to School Worries
How to do these exercises:
It is important to prepare your child for the fact that he or she will feel anxious while doing these, but that is good! In order to fight back anxiety, it is normal to feel a little anxious in the beginning. It is also very important to praise (“great job!”) and reward (e.g. small inexpensive items, extra TV time, making a favorite dinner) your child for any successes, as well as any attempts at trying to face his or her fears. After all, it is hard work to face anxiety!
Tool #4: STOP Plan or Realistic Thinking
Often, children and teens with separation anxiety have worries that are unrealistic or very unlikely, but when they are anxious it is difficult for them to recognize this. For example, your child may worry excessively about mom and dad being in a car accident if they are late coming home. Below is a dialogue between a parent and a teen who is afraid of something bad happening when dad is gone for the evening:
Teen: What if someone breaks into the house tonight when you are out?
Parent: Has that ever happened before?
Teen: Well, not at our house, but it might.
Parent: Remember when we talked about the difference between possibility and probability? So, what is the probability that someone will break into our house tonight?
Teen: I don’t know. It feels very probable.
Parent: But didn’t you say it has never happened before?
Parent: So what do you really think about the chances of tonight being the night that someone decides to break into our house?
Teen: Um, not very much I guess.
Parent: That sounds about right!
One way to help your child examine his or her thoughts and decide whether the worries are unrealistic is to use the STOP Plan. The STOP Plan helps children recognize their anxiety and unhelpful thoughts, and develop new helpful thoughts. For children, see Healthy Thinking for Young Children. For teens, help your child challenge his or her unrealistic or anxious thoughts. See Realistic Thinking for Teens.
Step 5: Building on Bravery
Your child's progress comes from hard work. If you see that your child is improving, then you both deserve credit! Learning to overcome anxiety is like exercise – your child needs to "keep in shape" and practice his or her skills regularly. Make them a habit. This is true even after your child is feeling better and has reached his or her goals.
Don't be discouraged if your child has lapses and returns to his or her old behaviors every once in a while, especially during stressful times or transitions (for example, going back to school, or moving). This is normal, and just means that one or two tools in the toolbox need to be practiced again. Remember, coping with anxiety is a lifelong process.
Track Progress! Occasionally, remind your child what he or she was not able to do before learning how to cope with anxiety and face fears. It can be very encouraging for your child to see how far he or she has come! Create a chart that records all of your child’s successes!