Anxiety Management
Anxiety Management Exercises
The goal to calming an anxious child is to understand their triggers before it escalates to a hyperventilation stage. However, we may not always be able to prevent anxiety attacks or hyperventilation, but we can use a few exercises and methods to either prevent them from happening or use them for faster results when you find your child in an anxious state. It is also important to encourage self-regulation because you may not always be around when a child experiences hyperventilation or anxious behaviour. Simple exercises that can be done at home will also encourage your child to begin doing them on their own when they are at school or in a place where you are not there to help.
There is no magic bullet for teaching children self-regulation. Not all of the following strategies will work. However, some of them will. But to find out which ones work, 2 things are essential. First, accept that trial and error is a feature of learning how to control emotions. And second, because these are primarily aimed at children who are still finding their way in the world, ALL of these require an adult to model and rehearse with the child. If children see us adults use these strategies repeatedly, both in real scenarios and fabricated ones, the chances of the strategies working increase significantly. Here are a few exercises to try at home:
1.Vagus Nerve (pronounced Vegas as on Las Vegas)
The vagus nerve passes from the brain, by the inner ear and vocal chords, through the lungs and down to the digestive tract. It follows that by activating this nerve, it can have a significant effect on reducing stress and anxiety.
Try the above exercises out yourself and notice the effect. If you feel these would be beneficial for your child to do, model and practice with them.
2.Breathing
When kids are anxious, they tend to take rapid, shallow breaths that come directly from the chest. Taking slower, deeper breaths (from the abdomen or diaphragm) can relax them. Again, we as the adults need to do these exercises alongside them, or, if they are too stressed to engage, do them anyway for ourselves so that they can still see them and perhaps use them on the next occasion.
When you reach "one," open your eyes again. Total exercise should last about 90-100 seconds.
Breathing can be a very effective strategy, but some children respond better to more direct physical input. The following exercises can be beneficial for children who are very active.
3. Cross the Midline
Crossing the midline, or moving one's hands, feet, and eyes across and to the other side of the body can help reset the brain. Research suggests that when you move your arms or legs across the centre of your body, the brain hemispheres are activated and work together so you can think with both logic and emotion. Further information can be gathered at www.braingym.ie . and https://www.cpft.nhs.uk/Documents/Miscellaneous/Sensory%20Motor%20Circuits.pdf Exercises are demonstrated on www.youtube.com and also at https://www.growinghandsonkids.com/crossing-midline-exercises-for-kids.html
4.Heavy work activities/Physical Activity
Heavy work activities (any activities that push or pull against the body) provide input to a child's muscles and joints, increase a child's focus and attention, and centre a child. The following activities can help kids calm and regulate their emotions
Doing wall pushups, carrying a backpack, pushing a vacuum, brushing floors, cleaning mirrors/windows, climbing a jungle gym, carrying a pile of books, or pulling a wagon, sitting on an exercise ball to bounce or rock, space hopper, trampoline, lifting small dumbbells, reading a favourite book/comic, listening to music, head compressions, short walk around house, up and down stairs, drinking water through a bottle with a sports cap Further ideas for heavy work ideas can be found at https://drive.google.com/file/d/0B86bxhFxYKGzQ3NKZENLM19JVVU/view
The way we use language has a crucial role to play in managing anxiety. The following exercises would support children whose inability to express their feelings exacerbates their already anxious mind. The concept of changing children’s language is simple, but can be quite difficult to put into regular practice. Consequently, the focus of all the remaining activities here is to enable children to become aware of their thoughts and to challenge and replace them if they are negative. Again, as adults, we must model and practice these strategies ourselves.
5. Name It
When children are in fight or flight mode, their emotions are raging and they have “lost touch with their upstairs brain.” It is recommended to help children to “name it to tame it” by assisting them in telling the story about what’s upsetting them. By talking, children will use their left brain to make sense of their experience and feel more in control. In other words, they separate themselves from the heightened emotion, and therefore, its intensity reduces. The strategy involves teaching children to identify the emotion they feel as anger/anxiety/frustration etc. You can use words , pictures, 5 point scales (see below) or youtube clips to help them identify the emotion. Next, teach children sentences to describe what their body is doing, e.g. My fists are clenched, My face feels hot, My body feels sweaty, My face is red, I want to run away, I feel butterflies, My breath is short etc. The consequence of this approach is that it brings the child back to reality. By dealing in facts, it distracts them from the thoughts which have been running away with themselves. Some children work better when they give a name to the word “anxiety” e.g. Mr Dictator, Grotbags etc. For example, Mr Dictator is causing my heart to race etc. https://www.6seconds.org/2018/01/21/getting-unstuck-power-naming-emotions/
In addition to this, a checklist can be used as a visual aid http://autismteachingstrategies.com/autism-strategies/upset-body-worksheet-to-help-for-kids-with-asd/ * Although this website is focussed on children with autism, the strategies are universal. Once the emotion and physical traits have been identified, use some of the strategies above and below.
6. Narrow Focus/mindfulness
Parents can help children become more mindful because research suggests that relaxation can be achieved by narrowing attention. An example would be the 54321 technique. LOOK for 5 things you can see, FEEL 4 things, LISTEN to 3 things, SMELL 2 things, TASTE 1 thing. A check box can be used if your child requires a visual aid.
Use guided imagery/visualization by asking kids (when they are not anxious) to think of a "happy place" or "happy symbol." www.relaxkids.com has sample scripts for visualisation.
Youtube have plenty of guided meditations and bodyscans for children. In addition, there are a variety of podcasts and apps (see below) for children too to assist with mindfulness and visualisation. Alternatively, if your child is more visually orientated than aurally, make a calm down glitter jar with them. Calm down bottles are one of the most effective tools for both prevention and hyperventilation when your child becomes overly anxious at home or in school. You can easily create your own with varying objects like glitter, toys and other small items. Calm down bottles provide your child with visual stimulation that can help reduce their heart rate, regulate their nervous system and control their breathing. Shaking the bottle improves your child’s proprioception, which provides them with the “heavy work” their physical body needs to calm the anxiousness. Watching the glitter fall helps the child visually track the items in the bottle, which creates slow and steady movement to calm the nervous system, heart beat and shallow breaths. Mindfulness colouring books, worry beads, fidget spinners and sensory toys can also be a great support. You can get an idea of price for sensory toys from www.thinkingtoys.ie , but shop around.
7. Make a Plan
Making a plan (MAP) or My Anxiety Plan (MAP) can help your child learn how to tolerate rather than eliminate anxiety. This is a (currently) free online course which can be found at https://maps.anxietycanada.com/
8. Calm breaks and visual timetables
Calm breaks are a way of ensuring that your child stays regulated throughout the day. For anxious children, it can be very helpful to have a schedule of the day up in the house. This can be written on a dry erase whiteboard with words or pictures. As part of the schedule of activities, calm breaks can be built in as a means of preventing overload in the first place. If you know what your child’s triggers are, the calm breaks can be placed before the event and directly after the event. Any of the activities listed above can be used as a calm break. The consequence of using a time table like this, (or in a small diary or a diary app on the phone), is children become more self aware of what their triggers are and also what to do about them.
9.Location of calm area/chill out corner
Children benefit from a safe place containing calming resources (e.g. weighted items, relaxing music, special lighting etc.) while other children simply need a quiet space with minimal stimulation. Some ideas for calm areas include a screened off corner of a room/ a pop up tent/ area underneath the stairs/ large beanbag/favourite arm chair.
10. Incredible 5 point scale
This is a tool to help children better understand their emotions and reactions in different situations. By involving the child in making the scale, it enables them to make their worries and solutions concrete. https://www.5pointscale.com/ It is useful to rehearse using the scale at home when the child is calm. Practice recognising and naming feelings. Practice rating the feeling and identifying the strategy chosen to deal with the feeling. Rehearse several times before expecting the child to generalise to a real scenario. The scales are used in many schools and have proven to be very effective in enabling children to self-manage their emotions.
11. Cognitive Based Strategies
These are more suited to children above 10+ years. Cognitive strategies teach the child to become more self-aware, enable them to identify their own anxiety triggers and emotional state and to recognize physiological changes in their body. By enabling the child to do this, they are then in a position to identify dysfunctional thoughts and beliefs and to challenge them. https://www.youtube.com/watch?v=af04iwPN6vI is a useful starting point and http://autismteachingstrategies.com/free-social-skills-downloads-2/ have quite a few practical resources for CBT. (Although it is an autism website, the resources are absolutely appropriate for children who are not on the spectrum. Anxiety is universal) In addition, a free app called Mindshift is very good for helping older children to create a plan for their anxiety. Can be found in app store or at https://anxietycanada.com/
12. Apps
Some apps are better than others so it’s worth downloading them yourself and using them for a week or so before deciding if your child would benefit from them. Some are free, some have a fee but generally with a free trial period.
13.Podcasts
In addition, there is a wealth of general parenting podcasts which have links to individual episodes on children’s anxiety.
The goal to calming an anxious child is to understand their triggers before it escalates to a hyperventilation stage. However, we may not always be able to prevent anxiety attacks or hyperventilation, but we can use a few exercises and methods to either prevent them from happening or use them for faster results when you find your child in an anxious state. It is also important to encourage self-regulation because you may not always be around when a child experiences hyperventilation or anxious behaviour. Simple exercises that can be done at home will also encourage your child to begin doing them on their own when they are at school or in a place where you are not there to help.
There is no magic bullet for teaching children self-regulation. Not all of the following strategies will work. However, some of them will. But to find out which ones work, 2 things are essential. First, accept that trial and error is a feature of learning how to control emotions. And second, because these are primarily aimed at children who are still finding their way in the world, ALL of these require an adult to model and rehearse with the child. If children see us adults use these strategies repeatedly, both in real scenarios and fabricated ones, the chances of the strategies working increase significantly. Here are a few exercises to try at home:
1.Vagus Nerve (pronounced Vegas as on Las Vegas)
The vagus nerve passes from the brain, by the inner ear and vocal chords, through the lungs and down to the digestive tract. It follows that by activating this nerve, it can have a significant effect on reducing stress and anxiety.
- Humming: The vibrations of humming are a free and easy way to influence this. Simply pick a favourite tune and you’re ready to go. Or if yoga fits your lifestyle you can “OM” your way to wellbeing. Notice and enjoy the sensations in your chest, throat, and head.
- Conscious Breathing: The breath is one of the fastest ways to influence our nervous system states. The aim is to move the belly and diaphragm with the breath and to slow down your breathing. Vagus nerve stimulation occurs when the breath is slowed from our typical 10-14 breaths per minute to 5-7 breaths per minute. You can achieve this by counting the inhalation to 5, hold briefly, and exhale to a count of 10. You can further stimulate the vagus nerve by creating a slight constriction at the back of the throat and creating an “hhh”. Breathe like you are trying to fog a mirror to create the feeling in the throat but inhale and exhale out of the nose sound.
- Diving Reflex: Considered a first rate vagus nerve stimulation technique, splashing cold water on your face from your lips to your scalp line stimulates the diving reflex. You can also achieve the nervous system cooling effects by placing ice cubes in a ziplock and holding the ice against your face and a brief hold of your breath. The diving reflex slows your heart rate, increases blood flow to your brain, reduces anger and relaxes your body. An additional technique that stimulates the diving reflex is to submerge your tongue in liquid. Drink and hold lukewarm water in your mouth sensing the water with your tongue.
Try the above exercises out yourself and notice the effect. If you feel these would be beneficial for your child to do, model and practice with them.
2.Breathing
When kids are anxious, they tend to take rapid, shallow breaths that come directly from the chest. Taking slower, deeper breaths (from the abdomen or diaphragm) can relax them. Again, we as the adults need to do these exercises alongside them, or, if they are too stressed to engage, do them anyway for ourselves so that they can still see them and perhaps use them on the next occasion.
- Blow bubbles. The act of blowing bubbles forces people to stop what they are doing and focus on their breathing, which can help lower anxiety levels. We also use it as a focus to actually move that anxiety away.
- Blow into a pinwheel. Can be shop bought or child can make one. https://www-tc.pbs.org/parents/curiousgeorge/activities/pdf/cc_pinwheel_bw.pdf
- Smell the flowers/ Slowly blow out “candles” on your fingertips. When you notice your child’s breathing escalate or a panic attack on the rise, have them close their eyes (if it doesn’t frighten them) and pretend to smell a flower. Tell them to take a long slow breath in as they smell the flower and hold for three seconds. When your child is ready to breathe out, hold up three fingers and tell them to blow out the candles. Encourage them to use as much breath as possible and breathe out slowly. You can even have them blow out each candle individually to help even their breath. Remember, blowing air out of their respiratory is just as important as taking deep breaths in.
- Whistling. https://mentalhealthtalk.info/whistling-anxiety-depression/
- Imagine that with each breath they take in, their body becomes filled slowly with a soothing colour, aroma, sound, light, or warmth. More details on visualisation below.
- Calming breath exercise. 1.Take a long, slow breath in through your nose, first filling your lower lungs, then your upper lungs. 2.Hold your breath to the count of "three." 3.Exhale slowly through pursed lips, while you relax the muscles in your face, jaw, shoulders, and stomach.
- Calming Counts. 1.Sit comfortably. 2.Take a long, deep breath and exhale it slowly while saying the word "relax" silently. 3.Close your eyes. Let yourself take ten natural, easy breaths. Count down with each exhale, starting with "ten."
When you reach "one," open your eyes again. Total exercise should last about 90-100 seconds.
- Use a heart rate monitor, found on a fitness watch to measure current heart rate. Take deep breaths to reduce the numbers if the rate is too high. This has been found to be a very effective strategy because it has the twin effect of motivating the child to slow their breath, but also distracts them from the cause of their anxiety because their focus is on reducing the numbers.
- Bodyscanning/Progressive Muscle Relaxation Teach your child to isolate different body parts and relax them with each slow breath she exhales. For example, while lying on the floor, instruct her to tighten or squeeze her toes on the left foot, then relax with a deep breath. Now tighten her left knee and upper leg . . . then relax and breathe. Proceed in this fashion to the right side of the lower body, to the abdomen and upper body, each arm, hand/fingers, chest, neck, jaws, and face. See https://www.youtube.com/watch?v=cDKyRpW-Yuc for an idea of how it works.
- Further guidance on breathing and self-soothing can be found at www.copingskillsforkids.com
Breathing can be a very effective strategy, but some children respond better to more direct physical input. The following exercises can be beneficial for children who are very active.
3. Cross the Midline
Crossing the midline, or moving one's hands, feet, and eyes across and to the other side of the body can help reset the brain. Research suggests that when you move your arms or legs across the centre of your body, the brain hemispheres are activated and work together so you can think with both logic and emotion. Further information can be gathered at www.braingym.ie . and https://www.cpft.nhs.uk/Documents/Miscellaneous/Sensory%20Motor%20Circuits.pdf Exercises are demonstrated on www.youtube.com and also at https://www.growinghandsonkids.com/crossing-midline-exercises-for-kids.html
- Cross marches, child marches in place while touching their opposite knee (right arm touch left knee)
- Windmills, have your child reach out to the side with their arms straight; then pretend that they are a windmill by moving their arms in a circle while crossing across the middle of their body
- Wipe the table with one hand
4.Heavy work activities/Physical Activity
Heavy work activities (any activities that push or pull against the body) provide input to a child's muscles and joints, increase a child's focus and attention, and centre a child. The following activities can help kids calm and regulate their emotions
Doing wall pushups, carrying a backpack, pushing a vacuum, brushing floors, cleaning mirrors/windows, climbing a jungle gym, carrying a pile of books, or pulling a wagon, sitting on an exercise ball to bounce or rock, space hopper, trampoline, lifting small dumbbells, reading a favourite book/comic, listening to music, head compressions, short walk around house, up and down stairs, drinking water through a bottle with a sports cap Further ideas for heavy work ideas can be found at https://drive.google.com/file/d/0B86bxhFxYKGzQ3NKZENLM19JVVU/view
The way we use language has a crucial role to play in managing anxiety. The following exercises would support children whose inability to express their feelings exacerbates their already anxious mind. The concept of changing children’s language is simple, but can be quite difficult to put into regular practice. Consequently, the focus of all the remaining activities here is to enable children to become aware of their thoughts and to challenge and replace them if they are negative. Again, as adults, we must model and practice these strategies ourselves.
5. Name It
When children are in fight or flight mode, their emotions are raging and they have “lost touch with their upstairs brain.” It is recommended to help children to “name it to tame it” by assisting them in telling the story about what’s upsetting them. By talking, children will use their left brain to make sense of their experience and feel more in control. In other words, they separate themselves from the heightened emotion, and therefore, its intensity reduces. The strategy involves teaching children to identify the emotion they feel as anger/anxiety/frustration etc. You can use words , pictures, 5 point scales (see below) or youtube clips to help them identify the emotion. Next, teach children sentences to describe what their body is doing, e.g. My fists are clenched, My face feels hot, My body feels sweaty, My face is red, I want to run away, I feel butterflies, My breath is short etc. The consequence of this approach is that it brings the child back to reality. By dealing in facts, it distracts them from the thoughts which have been running away with themselves. Some children work better when they give a name to the word “anxiety” e.g. Mr Dictator, Grotbags etc. For example, Mr Dictator is causing my heart to race etc. https://www.6seconds.org/2018/01/21/getting-unstuck-power-naming-emotions/
In addition to this, a checklist can be used as a visual aid http://autismteachingstrategies.com/autism-strategies/upset-body-worksheet-to-help-for-kids-with-asd/ * Although this website is focussed on children with autism, the strategies are universal. Once the emotion and physical traits have been identified, use some of the strategies above and below.
6. Narrow Focus/mindfulness
Parents can help children become more mindful because research suggests that relaxation can be achieved by narrowing attention. An example would be the 54321 technique. LOOK for 5 things you can see, FEEL 4 things, LISTEN to 3 things, SMELL 2 things, TASTE 1 thing. A check box can be used if your child requires a visual aid.
Use guided imagery/visualization by asking kids (when they are not anxious) to think of a "happy place" or "happy symbol." www.relaxkids.com has sample scripts for visualisation.
Youtube have plenty of guided meditations and bodyscans for children. In addition, there are a variety of podcasts and apps (see below) for children too to assist with mindfulness and visualisation. Alternatively, if your child is more visually orientated than aurally, make a calm down glitter jar with them. Calm down bottles are one of the most effective tools for both prevention and hyperventilation when your child becomes overly anxious at home or in school. You can easily create your own with varying objects like glitter, toys and other small items. Calm down bottles provide your child with visual stimulation that can help reduce their heart rate, regulate their nervous system and control their breathing. Shaking the bottle improves your child’s proprioception, which provides them with the “heavy work” their physical body needs to calm the anxiousness. Watching the glitter fall helps the child visually track the items in the bottle, which creates slow and steady movement to calm the nervous system, heart beat and shallow breaths. Mindfulness colouring books, worry beads, fidget spinners and sensory toys can also be a great support. You can get an idea of price for sensory toys from www.thinkingtoys.ie , but shop around.
7. Make a Plan
Making a plan (MAP) or My Anxiety Plan (MAP) can help your child learn how to tolerate rather than eliminate anxiety. This is a (currently) free online course which can be found at https://maps.anxietycanada.com/
8. Calm breaks and visual timetables
Calm breaks are a way of ensuring that your child stays regulated throughout the day. For anxious children, it can be very helpful to have a schedule of the day up in the house. This can be written on a dry erase whiteboard with words or pictures. As part of the schedule of activities, calm breaks can be built in as a means of preventing overload in the first place. If you know what your child’s triggers are, the calm breaks can be placed before the event and directly after the event. Any of the activities listed above can be used as a calm break. The consequence of using a time table like this, (or in a small diary or a diary app on the phone), is children become more self aware of what their triggers are and also what to do about them.
9.Location of calm area/chill out corner
Children benefit from a safe place containing calming resources (e.g. weighted items, relaxing music, special lighting etc.) while other children simply need a quiet space with minimal stimulation. Some ideas for calm areas include a screened off corner of a room/ a pop up tent/ area underneath the stairs/ large beanbag/favourite arm chair.
10. Incredible 5 point scale
This is a tool to help children better understand their emotions and reactions in different situations. By involving the child in making the scale, it enables them to make their worries and solutions concrete. https://www.5pointscale.com/ It is useful to rehearse using the scale at home when the child is calm. Practice recognising and naming feelings. Practice rating the feeling and identifying the strategy chosen to deal with the feeling. Rehearse several times before expecting the child to generalise to a real scenario. The scales are used in many schools and have proven to be very effective in enabling children to self-manage their emotions.
11. Cognitive Based Strategies
These are more suited to children above 10+ years. Cognitive strategies teach the child to become more self-aware, enable them to identify their own anxiety triggers and emotional state and to recognize physiological changes in their body. By enabling the child to do this, they are then in a position to identify dysfunctional thoughts and beliefs and to challenge them. https://www.youtube.com/watch?v=af04iwPN6vI is a useful starting point and http://autismteachingstrategies.com/free-social-skills-downloads-2/ have quite a few practical resources for CBT. (Although it is an autism website, the resources are absolutely appropriate for children who are not on the spectrum. Anxiety is universal) In addition, a free app called Mindshift is very good for helping older children to create a plan for their anxiety. Can be found in app store or at https://anxietycanada.com/
12. Apps
Some apps are better than others so it’s worth downloading them yourself and using them for a week or so before deciding if your child would benefit from them. Some are free, some have a fee but generally with a free trial period.
- Calm (for adults and children)
- Headspace (for adults and children)
- Mindful Minutes (for adults and children)
- Positive Penguins (for children)
- Mindful (for children)
- Stop Breath and Think (for adults and children)
- Smiling Mind (for adults and children)
- Take A Break (for adults and children)
- Mindshift (for adults and children)
- HelloMind (aimed at adults but could be used with children)
- TakeTen (for adults and children, but APPLE only for now)
13.Podcasts
- Your Anxious Child (for adults)
- GoZen Anxiety Relief for children (for children)
- AT Parenting survival podcast (for adults)
In addition, there is a wealth of general parenting podcasts which have links to individual episodes on children’s anxiety.
