Supporting Young People with Anxiety – Strategies for Parents

[Dr Nicola McDonald] Kia ora koutou katoa, hey, welcome to this discussion of how to support young people who are experiencing anxiety. My name is Nicola.

I’m a consultant child and family psychologist and I’ve been working in Christchurch for about 10 years now.

I’m not sure how you came by this video. It might be because you were referred to our Paces program, which was run by what used to be Canterbury DHB, which was a face-to-face group for parents supporting young people who are anxious.

You might have got this video just through I don’t know a mate sent you a link or you came across it over Google. However, you came here. You’re most welcome and I hope that it will be useful for you.

So the name of the game today is to share some information with you around what anxiety is how best to support young people who are experiencing it and just to sort of I guess broaden your kete of things that you’re able to do to support your young person

You’ll notice that I use the words tamariki rangatahi, young person, child really interchangeably and that’s because the stuff that we’re talking about today is actually similarly useful for young people across all ages the principles of anxiety management remain the same no matter how old you are.

It’s just that it might be a little bit different in terms of how you have to translate that for your young person.

Really important to be clear that this is general advice and it doesn’t replace individual case management. So if you’re getting advice from someone who knows your family, well, maybe someone in a different service that’s you know, hopefully going to sit alongside this information really nicely, but this doesn’t replace if I’m seeing someone individually.

So we’re going to look at anxiety through about six different little bits really today six sort of modules if you like and this is what they are and we’re going to work through them from top to bottom and I know that you know, you’re probably really pushed for time and you might be really tempted to skip ahead to the thing that’s going to make the most sense for you.

You might be tempted to just go right, I’m gonna go straight to the strategies if that’s all the time you’ve got that’s fine. Go for it use this however you want to, it’s your video, but I’d really encourage you at least once to view it from start to end because the content is designed to sort of build on itself and you’re probably get a little bit more out of it that way.

So just before we begin, I really want to acknowledge my colleagues Doctor Carolyn Doughty and Cherie Benn’s who were the ones who put together the content for the face-to-face group that this video presentation is based on, so I just really want to acknowledge their contribution.

So let’s get to it. What is anxiety? And it’s funny because when I talk about this with a group of parents, I asked that question and we all think we know the answer, you know, we all think that it’s really clear and yet when we have to really pin it down we have trouble this is the best definition that I’ve come across so anxiety is excessive strong debilitating worry that gets in the way of daily functioning.

So when we think about anxiety, we’re not thinking about moderate amounts of worry, okay, because moderate amounts of worry are normal and their helpful. They help keep us safe. It’s a moderate amount of worry that stops me from walking out in front of traffic without looking both ways. Okay. We need the alarm centre in our brains to function to try and keep us safe.

Where we move from worry to anxiety is where it is recurrent where it’s really strong and where it’s getting in the way of what kids and their families are able to do.

We also know that anxiety often goes alongside with some really strong bodily symptoms and we’re going to talk a little bit about what they are as we move through.

The word anxiety comes from the Latin word anger which means to constrict into narrow and I was really, you know, really interested when I found that out because when I talked to young people about anxiety, even from the ages of five six seven they talk about it as this force that just squeezes the life and shrinks the life down gives them rules around what’s safe for them to do and what’s not safe for them to do and yeah, I thought that really captured the fact that has come from that restriction kind of word from the Latin was really interesting to me.

In te reo Māori we use the word marnika nuka and what that talks about is kind of a pervasive sort of ongoing sense of disquiet and unease so in Te Reo there’s a different word for sort of a bit of worry that sort of pops up every now and again all fear, which is right in that moment of what you’re experiencing marnika nuka talks more about their ongoing.

That sort of that worry that keeps cropping up, you know and gets in your way. So in terms of what we know about anxiety, we know that it’s really really common. I was recently attending a talk and the person giving it went through and talked about different challenges that have faced young people in New Zealand in the past nine years and anxiety epidemic was one of the things that she cited what we know is that prevalence rates the amount of people experiencing anxiety.

It just seems to be going up and up and up at the moment. We know that it’s one of the things that young people in New Zealand say is one of the toughest challenges there’s a survey done every year in high schools and the most recent one high school students talked about the things that were most difficult for them. And one of the top things on the list was mental health particularly managing anxiety.

We also know that anxiety often goes alongside other difficulties. So it might be that you’re a young person struggles with anxiety, but also with mood it might be that your Young Person’s autistic and also struggles with anxiety. We know there’s a huge overlap there or it might be that you’re young person has learning problems or other challenges that that make things difficult for them. So it’s not at all uncommon to be working with anxiety within working with something else at the same time.

There are lots of types of anxiety. So they’re a phobias where it’s a specific thing that you’re frightened of so say, for example, you might have a phobia of spiders.

For example, it might be more generalized and when people talk about generalized anxiety, they talk about it a little bit like that game called whack-a-mole that you might have played in time zone or something like that. You’re acting on a particular thing and that worry pops up and as a family you manage that worry and you knock it down and you think great we’ve managed that one, but then another one pops up and then you have to manage that one and you feel like you’re just hitting different types of anxiety the whole time.

Panic’s are really common particularly in our young people and that’s when kind of that real physiological experience of anxiety just hits you and sometimes there might be a really clear trigger for that and often there isn’t you might be walking out the stairs on the way to English and all of a sudden bam it just hits you like a wave.

There’s also an obsessional flavour so that you might relate to some of that with your young people where they feel they need to do things in a particular way. Maybe they have to flick a lights switch a certain number of times. Maybe when you say goodnight, you have to go through this particular routine and if you skip a step or make a mistake, you have to go back to the start and support them through because they’re worried that if that doesn’t happen things might go wrong somehow.

Another one that another form of anxiety we hear a lot of is social anxiety.

And those of you were teenagers will probably really relate to that one that fear of that judgment or that social scrutiny that might come from other people who you know you who you might bang into day to day and you might look at that list and you might go actually I relate to lots of those ones. That’s really common too. It’s really common for young people to experience more than one sort of flavour at a time.

In terms of where anxiety comes from it. It’s kind of a longer talk. But what we know is that it’s quite a complicated recipe for how young people or how young people come to start experiencing anxiety.

We know that there’s a genetic component. We know that anxiety is highly heritable. So chances are if you’ve got a young person and your family who’s experiencing anxiety, you might find yourself looking back through extended whanau and you might be able to go actually Aunty struggles with it or actually her Grandma struggled with that or something like that. And so yeah just useful to know that is that is the case you can be there’s often a genetic component.

Unfortunately, there’s not much we can do about that by the time a young person has arrived then genetically that’s the situation that we’re in but it’s useful to know that actually the gift that that can bring is that there might be someone else in the whanau who really does understand what it feels like to have their physiological response and lots of my young people can feel really supported by other people and their whanau her experiencing anxiety because they just know that they get it.

We also know that temperament has a big part to play with anxiety. And when I think about temperament, I think about kind of the kind of personality that a young person has so you might have a young person who’s a real go-getter or who everything has to be absolutely perfect for you might have someone who’s a real risk-taker or you might have someone who’s calm slow to warm up, you know, we’ll watch other people do the thing before they have a go those kinds of things.

And then we have a naturally anxious temperament chances are that temperaments actually going to stay pretty stable. So it’s not very often that we turn, you know, someone who has a naturally anxious temperament to someone who’s really out there and really happy taking risks and really happy just leaving that temperament behind, you know, we made the way we made in that tends to day with us.

The two last factors that go into the recipe for anxiety that are important our environment in learning and those are the two that give me the most hope right because when we think about environmental factors that can be different challenges that your young person’s experience in their lives that might be different people.

They’ve come into contact with different things they’ve learned and that’s where we have the opportunity to make the most difference in terms of supporting young people with anxiety because we can help them learn strategies to manage it we can help make the environment calmer we can help change some of those factors to an extent which go into that recipe which can sort of help alleviate things for young people.

You might recognize this character. This is the fear character from inside out. I’m not sure if you’ve seen the movie. Basically the movie is about a young girl called Riley and most of the action happens with the characters in Riley’s head. And those are her emotions. This character is the fear character and that’s basically his permanent expression in the movie. Okay, so everything freaks this character out.

And often young people will come in. They’ll find a little plasticine figure of that on my desk and they go. Oh, that’s they know exactly what that is.

But these are some these are some quotes from young people who experience anxiety. This is how they describe it themselves. They’re a whole range of ages. These are the things we hear really commonly.

It’s like a monster in my mind, which tells me things aren’t safe.

The worry thoughts are turned up really loud like a radio, which drowns out everything else.

The worry won’t let me do things because it tells me they’re not safe. There’s that real constriction, you know that real restriction we were talking about before it’s a heavy elephant which sits on my chest and he thinks he’s protecting me that he isn’t that’s a young person showing insight around the fact that the alarm system and her brain is going off when it doesn’t need to you know, and this part of her is trying to protect you but doing too good a job. It’s getting in a way rather than helping her out.

It’s making my life smaller and smaller again that anger that restriction.

And this last one was from a Māori young person who was in service explaining what worry meant to them.

Ko toku anipa he mea taumaha ki runga i a au, ka whakapono au he raru kino kei te haere… he mataku au ki te haere ki te kura.

My worry weighs me down. It makes me believe that bad things are going to happen to me and it makes me too scared to go to school

We hear that a lot. You know, you’re probably hear that with your young person that fear of going to school because often some of the things that you’re worried about are present in the school context and that can be really hard for them to enter that context in terms of how anxiety impacts our body right because we used to think years and years ago the philosophers right that the mind was over here. The body was over here. They worked really independently.

We know now that’s not the case. We know that actually our systems are so into connected and how we’re experiencing things physically can impact how we experience and mentally and vice versa. So one of the things I’ll often do with young people right across the age groups, this will draw a gingerbread man, and we’ll put on the floor and we’ll talk about you know, what do they notice in their body with their experiencing anxiety? And these are the things that often go up for them when they have that discussion. They talk about their heart racing they talk about breathing really fast.

They talk about having a really worried facial expression. They talk about tension and shaking and they talk about either needing to go the toilet heaps or not ready to go the toilet at all. Just their bowels completely shutting up shop. They talk about having low appetite and they often talk about feeling sick or sore and I think that’s really important to know is that sometimes when young people are talking about nausea and talking about just feeling really feeling pain even in their body, sometimes that can be linked to stress then we can do things that help sort of ease that a bit.

I got some young people. I asked them to draw what worry means to them for me and they were happy for me to share this with you. So I’m going to do that now.

This one on the left, which you’ll see is by from a seven year old girl, and she drew you can see that there are tears and her picture you can see her person looks really worried. You can see that it’s hard to tell but in the we’ve got a butterfly in the tummy.

She Drew those little shaky lines on the outside that too showing tension and shaking.

She knew that her heart was beating really fast. You’ve got a wee heart in the picture and she knew about overthinking and that’s that pink sort of splodge up by the eyes that you can say. I thought that was remarkable that at seven overthinking was a word that she knew and that was how she described what that was like for her and her body.

On the right hand side. We’ve got a nearly 12 year old. I think he’s 12 and about a month and he drew again. Again.

You have those tears at a presence and present in both pictures. Yes, really common to see tears when

kids and young people are anxious and you’ll know this from your young people again, he drew that heartbeat going fast and he drew snakes and his tummy. So again, we’ve got a representation of just a feeling in the puku which just doesn’t feel right.

And again with that worried expression. So just really interesting seeing how you know across age groups. These are things that kids and young people notice and probably while I’m talking you’ll be thinking about lots of other ones that you see in your young person as well or maybe you notice in yourself just really useful to notice that that’s what’s happening and know that’s why that was the case.

When these young people were drawing their pictures for me to include in this presentation, their wee brother wanted to get in on the act and he’s nearly three and so he got he got given his gingerbread man and he had a go and I thought it was really interesting what he drew. So this is his picture.

And I thought it was really interesting that you know, he knew he understood what he was being asked to do and obviously he hasn’t got the fine motor that you need pretty butterflies or snakes or whatever but I thought it was interesting that the colour he picked was read and he just went for it. You know, this isn’t a calm picture is it this isn’t a picture of someone feeling relaxed. This is a picture of someone feeling not okay, and I thought actually will include that because it’s really interesting that even at just under three. He knows that anxiety to him feels not okay, and it feels like this big thing in his body.

It’s useful to know that those are some of the situations some of the bodily sensations that come with anxiety. You might have heard about a fight flight or freeze. So what we know is that anxiety is associated with our fight flight freeze response. Okay. It’s like our biological alarm system. And the thing that goes off on our brain and goes danger danger. Something’s not okay here we need to do something to keep ourselves safe.

So the alarm system in their brain, it automatically activates, right the part of the brand we’re talking about is called the amygdala and the amygdala will you know will go off for the lack of a better word, you know without our permission. It doesn’t go to me oh, Nicola. Would you like to feel anxious now? We’ve got this data. It just goes for it, right?

And its job is to send signals which prepare our body for action. And that’s where lots of the physiological things come from. Right? So it’s preparing us to either fight the threat take an action and try and get rid of it.

It’s preparing us to flee to run away or it’s preparing us to freeze and just shut down. Okay, so when you think about that from years and years ago if you imagine that you were I don’t know your on Safari and suddenly you see a tiger right chances are that alarm Centre in your brain is going to go off. Okay, and it’s going to make you do one of three things, right?

You’re either gonna fight the tiger you’re either gonna freeze and hope the tiger doesn’t see you we’re gonna take off as fast as you can and that’s kind of the directive that our body is given from our amygdala when we feel really anxious.

That’s really important and useful when we’re actually unsafe. Okay, so if it was that we were walking, you know, we were walking around somewhere and suddenly we saw a tiger. It’s really important that our brain is able to act in that situation to keep us safe.

It becomes a challenge and becomes a problem when that alarm system is going off when there’s no threat. Okay, and the absence of threat and we’re getting flooded with these physiological feelings. When actually we don’t really need them. They’re not keeping us safe an example that I often use with young people is the idea of a smoke alarm and I bet you can relate to the idea of maybe you or your young person cooking and the kitchen and maybe the maybe they’ve burnt some toast. Right and suddenly the smoke alarm is blearing that smoke alarm blears exactly the same way whether it’s burnt toast or raging inferno.

Okay, if your house is burning down you will hear that smoke alarm, and so what we know there is that, you know, your body’s having the same response whether there’s actual danger or not.

So often what our key way forward to managing anxiety is trying to help that alarm system and a young person’s brain kind of learn to tell the difference between when there’s smoke and when there’s a raging inferno helping it sort of calibrate when it needs to go off and helping it learn to calm down when actually there’s no threat.

The other thing that’s useful to know from a fight flight freeze perspective is I mean, you might look at that and you go are your I’m a freezer. Oh, yeah. I’m a fleer right for me. I noticed this in the earthquakes. I noticed there as a general rule. I was a freezer. I would stop I would be still and I would feel my brain tick tick tick tick ticking over I would feel myself analysing how much things were moving. I would feel myself looking at other people to see how they were reacting.

I just felt like I was analysing but I was still right and so that was what I thought was my general response until we had an earthquake. I think it was in the June and it came out of the blue and I was sitting on my couch at home.

And in that moment my alarm system and my brain went off and I admit my reaction from the alarm system was this time it told me to get up and to run right? So I got up off my couch. I made it two steps before I fell over and in the bookshelf that was sitting behind me came down behind me. Okay.

And so in that moment, I thought my God, we’ve got a really awesome system, you know whether you really believe in design or evolution for whatever reason we’ve got the system which actually can act to keep us safe without us making a conscious decision.

So our job isn’t to turn that off right? I need to react within one of these ways if there’s an earthquake, but we just need to calibrate it and make it go off when we need it and stay calm and we don’t.

It’s also really important to know that once you’ve had their adrenaline response that gets all these physiological things going. It’s really important to know that that adrenaline response can be set off again really really easily kind of in that almost come down period after that main adrenaline response.

And that’s why kids who can seem really calm actually after having a bit of an anxious meltdown or feeling really awful. That’s why a small thing can kind of push them back again. It’s more thing that wouldn’t normally make a difference because your adrenaline is ramped right up and it’s easily re-triggered. So that’s a bit about understanding I guess what’s happening in our brain and why it is that we have a fear response. We have an anxiety response that might stick around a bit more than we would like it.

The other thing that’s really useful to understand about the Neuroscience of anxiety is how our brain is organized and how different parts of our brain can work really well at different times. Okay. So you might have noticed that when your young person is in fight or flight, you might be talking away to them reassuring them trying to help them problem solve, right?

And it’s like it’s not even going in. The reason for that is kind of about how our brain is organized. So if you think about our brain being represented by my hand and my wrist here, right, so if you think about this is our brainstem which goes down to our spinal cord, then we’ve got a part of our brain which is in charge of our emotions. Okay, and that’s represented by my thumb.

And then over the top of that what we have is humans which sits us apart from lots of other mammals as we have our frontal lobe and that sits in behind my forehead and your forehead, okay?

That’s the bit of us that’s in charge of problem solving of thinking our way out of a situation of calming ourselves down of helping moderate our behaviour to be calm to others that’s their executive function the stuff that the whiz-bang part of our brain really which sets us apart from other mammals and what happens when we’re under significant stress is it’s like our brain all of our brains input that we’re getting and all of our focus is on that emotional part of our brain and what happens is stress  makes your lid flip it basically disconnects the thinking part of your brain from the emotional part of your brain and you’re fully in your emotions. And you might see that with your young person where you might be working. You know, you might have a 15 year old who most of the time is kind quiet calm mature, but when they’re completely beside themselves with anxiety.

It’s like they almost revert back to being much younger, you know, you might have tears you might have crying you might have stomp and you might have what looks like a tantrum really coming out of your 15 year old and that’s because it’s the emotional part of the brain that’s driving the bus at that moment.

So you might be trying to appeal to the thinking part of your teenager’s brain, you know helping trying to get them to slow down helping them to see that. It’s not the end of the world. It’s not going to work because of thinking part of the brand that you’re trying to talk to isn’t online.

It’s got disconnected from the emotional part. So what we need to do is give it a little bit of time so that people are able to calm down enough that actually they’re thinking playing and their emotional brain can sort of connect it back up again because that’s going to be a situation where its going to be far more able to problem solve and think their way out of a challenge.

So that’s why we use the phrase flipping our lid, it’s when we get stuck in our emotional brain and that frontal lobe that thinking part just gets a bit disconnected. And so I think it’s just useful to know that that’s why that’s happening. That’s not happening because you’re reassurance isn’t high quality. It’s not happening because you’re not giving a great explanation of what’s happening and what needs to happen next. It’s purely because the part of your brain that you’re trying to talk to isn’t working very well at that moment because of the stress that young people are under.

So basically when lids are flipped when anxiety is really high. Okay, we know that anxiety comes and goes like a wave, right and I think we can put a lot of energy into trying to fight that wave and trying to get in too early with trying to support but basically what we know is that we live the flipped like this the best thing to do is let the wave come through keep them safe and then deal with things when calms restored. I think it’s a useful concept to keep in mind that talking to a flip lid isn’t going to help. It’s about letting the wave come and go and then being able to support after that has happened.

So I’m sure that if you were in front of me, and I asked you, you know, what sort of behaviours that you see when you’re young person is anxious regardless of whether your child is really little or you’ve got a 15 16 year old, you took me through a list, right? And I’ve captured the most common ones that

I hear on the slide. So you might see that withdrawal that shutting down and I think that’s what the media tells us anxiety looks like right if you think about what an anxious child might look like we tend to think of a girl we tend to think of a girl who doesn’t want to talk and has just really closed and you know, just sort of makes themselves small, sits out of the way in the classroom never sees boo to a goose, right? That’s what we think of what anxiety looks like, all we think of the person on stage, you know with shaking with stage fright just shaking or things like that.

What we know is the anxiety presents in a really really broad range of ways, right? And so absolutely you might see the withdrawal you might see the shutting down you might see lots of tears, you remember that our friends who did our did our pictures for us they were tears and all the pictures.

But you might also see anger. You might also see, you know, hitting and hurting and the reason for that is that for some young people when they’re anxious they go to fight right? That’s not a decision that you’ve made. They haven’t chosen their path. It’s like not like a Choose Your Own Adventure. They their brain has gone into fight flight. It’s automatically put them into fight. Right and so you might see kids storming out of classrooms, you know, knocking tables over here.

You might see kids punching teachers, you might see all those things that you can’t imagine an anxious young person doing and that’s because anger and fear can go alongside each other and that movie we were talking about earlier with that fear character most of the time that he’s in a scene. He’s alongside the anger character they’re kind of travel together and I took from that movie that sometimes anger is a bit like fear’s body guard. You might be feeling really worried and really anxious but how you look might be really really angry.

And so sometimes it’s useful to know that that can be what’s behind their anger and trying to support in both ways can be a useful thing. You might have kids who flee you might have kids who run away who take off.

When I started working as a psychologist, I had to learn the word absconding which means to take off, you know, and that might look like kids clearing the fence at school that you wouldn’t think they’d ever be able to clear that might look like young people running out your front door and just taking off into the night and you’ve got no idea where you’re going or it might look like a young person getting overwhelmed and just going to be room right and just taking off and being somewhere else.

Parents talk about kids asking lots of questions as well. Just like a bottomless pit of what if what if what if what if what if yeah and they talk about it as being a wee bit like tennis, you know, where a ball come over the net. Well what if this happens and they give the best answer that they can give to that but then the trouble is the ball comes back, you know.

There’s more questions and they’re sort of trying their best to play their shots and answer the questions as much as possible what you’ll know though from having a young person who experiences anxiety. Is that often you might be giving the best answer in the world, but anxiety can’t hear it. And so the questions will keep coming you get that bottomless pit.

You might have kids that feel like they need a lot of reassurance. They need lots of cuddles. They need to talk things through a lot. They need to hear from you that everything’s going to be okay. They might even have particular things particular phrases they coach you to tell them because it helps them feel a bit better.

You might also see avoidance and we’re going to talk about that a lot, you know going forward because it’s a really big component of anxiety and when you think about it avoidance makes sense when you’re anxious, right? Because if I’m terrified, let’s imagine of dogs.

The best way for me to imagine that in short term is to don’t get a dog don’t go to any houses where there are dogs, and don’t go walking where dogs go walking the best way for me to manage my worry and to feel better is to just not put myself in the situation, which makes me anxious.

The trouble with that is that avoidance actually grows anxiety, which we’re going to talk about in a little while. You might see kids taking a long time to calm down and we’ve talked about that, you know, and we talked about why that is you might have difficulty sleeping and when you think about that that makes so much sense because

If I’m feeling super wired if I’m feeling really, you know tense and my heart’s beating fast and I’m breathing really quickly. That’s not conducive to me relaxing and going to sleep. Okay, and the other thing people notice is that sleep, you know, when you go to bed all those other strategies that you might normally use to manage anxiety. Like I don’t know distraction talking to people doing things you enjoy watching something on YouTube or you’re concentration is just naturally on something else because you’re at school or whatever all of those things kind of drop away because when you’re in your bed by yourself at night time,

You can’t use lots of those other strategies and so lots of kids have lots of trouble going to sleep. You might see lots of over-planning you might see, you know kids who are packing for every eventuality or you know need a game plan for you for all these different what ifs that they’ve got and you’re might as a young people wanted to control things because you’ll know this in your own life.

Generally, if we’ve got a little bit of control about things we tend to feel a bit better. One of the real challenges about being alive is that actually we can’t control there’s a lot we can’t control and that can feel really intolerable and to kids experiencing anxiety. So they seek they search for their controls as quickly as they can as best they can.

So up to summarize this bit that we’ve talked about together. Anxiety is an all bad. Right some worry is helpful some worry is normal. Everybody gets worried. Sometimes it becomes a problem when it starts getting in the way of what you and your whanau and your child can do.

We know that it’s associated with fight flight freeze and it has all that body stuff that goes with it and we know that when we’re anxious, they’re emotional and they’re thinking part of our brain disconnect from each other, you know, our frontal lobe doesn’t work well and executive function their planning our problem solving just go offline.

We also know that anxiety can look a lot of different ways. It might look like the stereotypical girl under a desk, you know, really small and just not making eye contact or it might look like, you know a child flipping a table and then exiting English without consent, you know all the way through that can look really different.

The other thing we know is the anxiety can present lots of different ways. Right from that stereotypical child being imagined shrunk under a desk somewhere not making eye contact just wanting to be a small as possible and not draw any attention right all the way through to that child who looks really angry who walks out of

I don’t know year 11 English flipping a table and punching the teacher in the stomach on their way out, you know, anxiety can be can present in any ways within those spectrums and it used to be that we thought that you know, anxiety was a woman’s issue that was things that girls and women experienced and guys didn’t tend to experience that we know that now is rubbish. Okay, we know that the prevalence is slightly higher and people who identify as female but we know that actually prevalence for people who are male or gender diverse is also really high. So it’s a really common issue.

And lastly, we know that some young people experience anxiety alongside other difficulties.

So hopefully that’s been helpful and kind of giving you a bit of an introduction in terms of what we’re trying to manage and how it feels for young people who are experiencing it.

[Dr Nicola McDonald] Moving on to the second part of this talk which is around how anxiety and families kind of come together and interact. It’s really important to know that helping a loved one who’s experienced anxiety is really really tough because you we are designed to ease the distress of others.

You’ll see this if you’re on the playground and a child comes a cropper, right even if that child isn’t your child you will find yourself looking around for that child’s parent, you might find yourself picking them up and dusting them off right because we are humans are designed to be social beings. We’re designed to, you know, look after each other and try and support and when you think about it, you know when your young person was born their only superpower was the ability to make you fall in love with them.

They couldn’t walk they couldn’t talk. They couldn’t feed themselves. They couldn’t run away in a crisis or they could do was lie there make noises be cute and make you fall in love with them. And so exactly that same process which bound you to them. You know exactly that same process is what comes into play when you see someone you love distressed. So it makes perfect sense because of how we’re designed that we’re going to have our own reaction to that. Right?

And that’s a little bit what we’re going to talk about in this next part. So I really like this picture. I really like the picture on this slide. And the reason I like it is because when you think about a mobile above a child’s bed, right if you think about how to make a mobile move, you just have to move one piece. Okay, so if the whole system is intertwined and you pull on one piece in the whole thing moves the whole thing wobbles.

It’s like that with anxiety when one person in your whanau is experiencing anxiety, it has an impact on everybody. Okay, and it changes things in the family system a bit.

These are some of the impacts that that whanau I’ve spoken with have talked about with me and parents particularly. They notice that they experience when they’re young person is anxious.

So often when we see someone who’s really really anxious and particularly someone we love we will notice that we start feeling anxious too. Okay, your child comes home with a letter about Camp. They have completely flipped their lid, they’re running around the house. They’re super upset.

They’re super anxious. Okay, really really normal for us to then find ourselves feeling really anxious about a young person going to Camp. Okay, so it’s really really normal for other people’s anxiety to kind of amp our anxiety up and that’s what parents talk about a lot when we do this face-to-face group.

One they talk about a little bit less, but what usually happens is we’re in a group. Someone finally says it’s really frustrating and the whole group goes “oh it is!”, you know, it really is it’s incredibly frustrating. Why can’t they just get out the door?

So again really normal to experience anger and frustration about the fact that your child is being anxious about something. Okay, and I just want to really normalise that, people will say that in group and then they will say you’re going to think I’m a terrible parent but it just makes me really frustrated. Of course it makes you really frustrated.

Okay, it makes sense. Things that should that feel like they should be easy and manageable aren’t, and that’s really really hard.

People can also feel really upset and really sorry for the young people because you know, they they get the leader from camp and they immediately go to this worried scared place other people’s kids might get the letter from camp and go woohoo. I’m going to Camp. It’s really, you know, and it’s easy for them and there can be that real compassion that real sadness for young people that parents experience.

The other thing that can be really challenging that people talk about in the group is uncertainty, just not knowing how something’s going to go. Right? So you get a letter that says that there’s a field trip. I don’t know, to a particular place and you go, huh?

That could go great, or it could go really terribly, and you might not be quite sure, and it’s really hard to live in uncertainty. You’ll know that from living through the pandemics. It’s really hard to live an uncertainty. What levels are we going to, all those kinds of things, and that can make things really tricky when you’re parenting someone with anxiety and you’re not quite sure which way that’s going to fall.

I hear about a lot of guilt in our groups too, you know, whether that’s because people go. Oh, well, I was anxious. So I’ve passed it on or whether it’s about going, you know, I just feel like I should be able to support them better. I should be able to help get them through this and that feeling of guilt can sit really heavily in the stomach of some parents that I see.

Anxiety can cause tension in relationships too. You know, you might relate to that, you might be I don’t know if you’re parenting with someone else you might have a different style from them, you know.

Some parents take a “oh harden up” kind of approach, others take a “oh gently gently” and almost overly reassuring, and I think whenever there’s a difference, that can cause some tension, and tension in your relationship with your young person, but also in relationships within the family as well.

There are broader family impacts too. So if you think about the impact on siblings and you know, maybe knowing that your young person is anxious means that you don’t do particular things, that you said that their sibling now then misses out.

Or maybe the sibling is is seeing the young person escalate all the time and find that really hard, or maybe you know, they are trying to sort of calm them down and get in there and support them with you. But yeah just really important to acknowledge that anxiety has a huge impact on whanau, and if it’s having a huge impact on your whanau, that makes a lot of sense, and that’s really normal to notice that actually it’s it’s not just about one person struggling. It’s about a whanau system together, having trouble with this stuff.

The last one down the bottom there is avoidance, and we hear about that a lot, and it’s like we talked about before, you know, the easiest way for me to feel better about you know, doing something I’m scared of, is just not do it. It’s to choose not to do it. I’m not going to get anxious about it if I don’t do it.

And that’s a challenge with anxiety, is that anxiety gives really poor advice.

And the main piece of advice that anxiety gives you is just avoid it and you’ll be sweet. Okay, what we know is that it’s more complicated than that.

The reason I’ve picked the picture of the snowball running down the hill is because that’s where those sort of what-if questions, and the anxiety asks, they can kind of pick up speed and I saw it recently on Facebook a great example of this. It was a young person who’d forgotten a pen.

Right they’d arrived to a test and forgotten a pen, and how we went was, oh my goodness i’ve arrived at a test and forgotten a pen. If I don’t have a pen I can’t sit the test. If I can’t sit the test, I’ll fail the unit. If I fail the unit then I fail in NCEA if I fail NCEA then

I won’t get University entrance. I don’t get University entrance. I’ll never get a job. If I don’t get a job, I’ll never have any money. If I don’t have a money, I can’t live anywhere, and I’ll be homeless under a bridge, okay?

And you can see how what if what if what if what if the snowball kind of picked up speed, and all of a sudden, you know, it’s this cartoon-esque big snowball that’s really difficult to deal with when actually the immediate problem the young person needs to find a pen.

Okay, but they’ve gone through all the rest of that stuff in their mind when they found they can’t find the pen. That’s what worry and anxiety looks like, and I think anxiety gives the advice that if we can’t do something, it’s not safe, so we need to avoid it.

The trouble with that is that avoidance actually grows anxiety. So, when we’re anxious it feels like anxiety is going to keep coming and coming and coming and coming and coming like a rocket, and it’s just going to keep going on and on and on forever.

Okay, what we know about anxiety is that a physiologically it can’t do that. Our systems just can’t get more and more and more and more and more anxious forever and ever, amen. What happens is it builds, it plateau’s, and then it drops away, which is shown in this graph. Okay, so you start, you encounter something that you’re scared of, your fear quickly rises.

It feels like it’s going to rock it away and away and away. So in that moment the great temptation is for us to get out of the situation that’s scary, because we go, actually this feeling’s going to get worse and worse and worse, I can’t tolerate it, I need to get out. Okay, and so what happens is often, we’ll escape, we’ll avoid, we’ll decide we won’t go to camp. We’ll decide, you know, to cross the road. We’ll take an action, and then our brain learns us taking that avoidance action was what helps the anxiety drop away, okay.

So a lot of the time, the name of the game with anxiety management, is actually about exposure. It’s about doing the thing we’re frightened of, experiencing that way of come and go, and then taking the learning that it’s actually safe for us to do the thing that was frightening us. And over time, the more practice we get at that what happens is the peak of anxiety starts getting a bit lower.

And then the amount of time it takes us to come down gets a bit shorter, and that’s how we kind of acclimatise the things that make us anxious. The thinking about this in a whanau right, we’re going to go through a couple of examples. One example is where we go with avoidance, and the next example is we choose not to.

I want to be really really clear, that I don’t want you to take from this talk that avoidance is a terrible terrible thing, which must be avoided ironically at all costs. Okay, sometimes, avoidance, making a call, that something’s not going to be a useful experience for your child. Sometimes, that’s absolutely the best call, okay. But if there’s something you’re trying to help your child grow into, it’s more likely that exposure is going to help you with them.

So in this example, let’s imagine that a letter comes home from school the camp letter arrives the inevitable camp letter arrives.

And what you see is your child, you know, if they even show you the letter in the first place, your child is anxious. You see that clinging, you see that crying, you you imagine your young person right? What they do when you’re anxious you see that? Okay, and then unsurprisingly you as their parent experience your own reaction to their emotions. Okay, because we are we’re interconnected beings, you know, we don’t just operate, you know, completely separate from other people’s emotions. You you have your reaction too?

Okay, and then you respond by you reassure and you’re kind, and you answer all their questions as best as possible, and you go, you know what, actually this is gonna be a bit hard so you go right. Don’t worry; we won’t worry about going to camp this year. It’s going to be okay.

What immediately happens for the child after that is that worry just kind of goes away. You know the child immediately feels better because the threat is removed. Okay, the alarm system can turn off because the threat is removed, and for you as the parent, immediately, you might feel a bit better too because that crisis has passed. You know, that that big emotion explosion is over.

The trouble is that then as adults we have enough nouse, to then go, oh, the next time I get a camp letter that’s going to be really really hard. You know, and so parents will talk to me about having made a decision and then go. Oh, no, you know, I feel like I’ve shot myself in the foot. I feel like I’ve made things harder for next time.

The other thing that’s really important with avoidance to understand is that we’re always thinking about in games in terms of the child’s views of themselves and of the world. Okay. So if you go around that circle, you’ve made the decision that camp is too hard. Sometimes the message that children can get from that, even though we’re not saying these things but kind of, what we learn from that situation, is that phwoar! Actually, camp must be really really scary because mum and dad have said I don’t have to go.

Mum and dad must know that I wouldn’t cope with camp. So, you know camp is too scary for me. I can’t manage it, the world’s a scary place and I’m better staying where I am, you know those kinds of examples.

And then that learning is taken into the next situation that you’re managing. Okay? So that’s just a brief example of going around that cycle and going, okay, this is kind of the direction that that might take us in. So this time we’re going to go around the cycle and a slightly different way and we’re going to think about what it might be like actually if we stick with the situation that makes us feel a bit anxious, what the learning might be from that situation. So in this situation, we imagine the camp leader comes, your child is anxious. You have your reaction, your natural reaction to their anxiety.

And you make a decision about what you’re going to do next, you know. And let’s imagine that decision is that you’re going to go, Right! Actually, a five-day camp I think probably is a really big step. Um, but maybe actually they do need to go to camp for a bit of it, you know to sort of learn they can do that. So let’s imagine, that you decide they will go to camp during the day for a day.

Okay, So you’ll say things like, I can tell you feeling really scared about camp and I can tell that’s really really tough for you. You know, it’s really important that we have a crack at things that frighten us. So how about we do it this way, and you make your proposition that that’s going to be how you manage it. Chances are, you’re going to have an initial spike in anxiety, right? Because you haven’t removed the scary thing in the child’s mind.

You’ve left it there. Okay, the child will become more anxious initially. Usually though after they’ve done the scary thing if they’ve experienced some sort of success with that scary thing, what they take from that is that they often feel a better.

And then for you as your parent, you know, you probably find that tougher initially too because you’re going up that anxiety spike together, but then afterwards you’ve got an experience you can build on for the next time and when we think about your young person’s learning, they’re learning there is, you know what? I don’t have to love camp.

Camp’s might just be something that I don’t enjoy, but actually, I can do it, and I was okay. You know, it becomes a nuisance or a thing that was tough, but they managed, and that’s a learning that we’re wanting people to get the hang of with anxiety is I can do tough stuff.

I don’t have to like it, like it might be really tough, but I can do it, and I can be safe. That’s the learning will help we’re hoping we’ll take with them, and then into the next experience. So to manage anxiety, it’s about learning strategies to help you face what frightens you, rather than avoiding it.

And then it’s about facing those things over and over and over, so that you get the hang of them, you get the hang of doing that so that you can learn that it’s safe to face your fears. That’s kind of if we were to really dilute down how you’re manage anxiety. It’s about learning ways to face your fears and get through it. Even if you don’t like it. So that’s what we’re trying to help our young people do.

So to summarise this part, supporting someone with anxiety is tough. If you’re finding it tough, you are not alone. If you were in a group of parents, you know listening to this the way we would normally do the content, you’d have so many people nodding with you when you were telling your story. Okay, it’s really hard and as adults, we have our own reactions to our young person’s anxiety. It might be that we get worried too. It might be that we feel really hōhā, really irritable really on edge, you know. It might be that we have more arguments with our young person because we just up the letter a bit too.

But our reactions to young people’s anxiety can help shape what happens next time. We’ve actually got some agency here. There are things that we can do and change up slightly to support our young people. Really important to remember that avoidance strengthens anxiety. Doing the scary thing and surviving it, and learning that you can do it, is what shrinks that anxiety down.

And challenging anxiety maybe with a modified plan, like we were talking about with camp. An extra step that pushes them a little bit beyond their comfort zone, helps them, just take back a little bit of ground from anxiety works much better than avoidance.

[Dr Nicola McDonald] So in the next part of this discussion, we’re going to talk about strategies for managing anxiety. Okay, and it’s presented like a smorgasbord. I’m going to tell you about a whole different heap of different ways that you can manage anxiety. And what I want you to do is treat it treat it like a buffet. I’m going to lay it all out in front of you, and you might pick different ones that you want to try right and you might have something that you save on there for later, and you might have some that you go. Oh,

I’m pretty sure that would be that wouldn’t work, you know and until you leave that. For me, that’s the fish! You know at a buffet I leave that alone because I know I don’t like it, you know. But pick and choose around what you think could be useful and hopefully it will just help fill out some of the things that you already doing.

So just going to go through them one by one. The first one to be really aware of is that our nervous systems talk to each other. That’s why we amp up when someone else is anxious. That’s why we find ourself feeling on edge or upset or having a reaction right, it’s because our nervous systems are designed to seek information from other people’s behaviour. And from their nervous systems.

So our job when a young person is anxious, even though it is really hard, is to be as calm as we possibly can. You’ll know what it’s like to ring someone in a bit of a flap and be feeling really nervous about doing something, and then have that person get nervous about doing the thing with you too. You know, it doesn’t help, it makes it bigger, you know, and you’ll leave that conversation off and feeling more amped up than you were when you got there, which is why our job when we’re supporting someone with anxiety is to try and model calm.

And I don’t care if you’re faking it till you make it. You know, it might be that you can be genuinely calm if you can all power to you that’s often not a service I offer when someone is really anxious, you know, but it’s about deliberately slowing myself down.

Deliberately, you know presenting what I want them to see which is that I’m calm and I’m not bothered by the situation. Okay, and that is what can help drop people’s nervous systems back down.

That’s why it’s really important. I really like this kind of diagram, and I don’t want to for a second suggest that anxiety is catching but you’ll notice that if you’re around a bunch of people and they’re in a bad mood.

You know often we’ll find ourselves getting a bit irritable as well. If we’re around someone who’s super worried, it can be really hard to maintain a sense of calm, but that can be the most useful thing that we can do for our young people when they’re anxious.

The other thing that can be really helpful is when you think about kids and young people right? They’re still learning how the world works, and they’re learning how their body works in the world and how their mind and how they’re feelings work.

And so they often need us to help coach them through what’s happening in their brain and their body. If you imagine that I suddenly clicked my fingers now and when I clicked my fingers you all of a sudden experienced all those body signs of anxiety, but you didn’t know what was going on. That’d be really scary. Why is my heart beating so fast? Why am

I sweaty? Why am I feeling really tense? Why am I breathing so quickly all of those things, you know to help give people the words for what is happening to them can be really really helpful. And so

I think about that sometimes as being a bit like an emotion narrator, you’re almost narrating what is happening for them, saying things like, “it’s really frustrating when things don’t go the way we plan”. You know giving that word frustration.

You look like you’re feeling really māharahara, which means sort of unsettled about dress-up day and they might go I’m not māharahara, I’m hōhā! I’m not worried. I’m angry! you know, or whatever. Kids are really great at, kids and young people are really great at correcting us if we’ve got it a bit wrong. Okay, but what we’re doing is kind of offering a suggestion for what might be happening for them.

And sometimes naming and validating a feeling can actually be enough. We feel heard. And we can move on.

You’ll know what it’s like to talk with someone who it just feels like they don’t get it. You know, you might be talking about how worried you’re feeling or how sad you’re feeling about something and they’ll say “Oh buck up”, you know, and they’ll give you a strategy about how to manage it going forward, that can just be profoundly unhelpful because we feel like they don’t get it.

They might be giving us the best strategy in the world about what we should do next, but we won’t be able to hear it because we don’t feel heard by that person.

Just using the naming word for that emotion can be really helpful and you might read those examples and go. Oh, that’s not how I’d say it my child would think I was really weird if I said, oh, look, it’s really frustrating when things don’t go to plan. Take this idea, tailor at the way you want to do it, use your words. Okay, but often it can be really helpful and just in helping young people feel like you get it.

Avoid the reassurance trip. One of the tricky things about anxiety right is that we have a really natural response where we want to just help it be okay. We want to be really reassuring we want people to, understand from their interaction with us that it’s going to be okay, and what that can look like sometimes as being way too reassuring which can actually grow anxiety rather than shrinking it.

So say for example, imagine I don’t know, imagine that you are you’re at work and there’s a new guy going to be starting on the staff tomorrow. Okay, let’s say his name is Mark. I really hope your name’s not Mark watching the video.

So let’s say that Mark’s coming tomorrow and your boss comes and said, oh, you know Mark’s starting tomorrow. Mark’s really great. He’s really really good. I think he’ll be really good. He’s never had any complaints made against him. I think it’d be a really good collar. You guys will get on really really well, you know, I wouldn’t have any concerns about his work.

He’s got really good referees. I think Mark will be great addition to the team. I think you’re really enjoy working with Mark, no need to worry about him. It will be great. Pretty soon we start going why is all this reassurance necessary? Just how long is Mark’s list of prior convictions or how many jobs has he been fired from, or whatever.

We start to go, if this was just a normal day at the office, I wouldn’t be being this reassured about this thing happening.

And I think it’s useful to think about that when we’re thinking about our young people, when we’re overly reassuring it can actually amp up anxiety rather than amping it down, and I think of it as being a bit like a pendulum okay. So, sometimes people would just go with “oh for God’s sakes, harden up”! No reassurance. No validation. No nothing.

Or they might be the other end of the pendulum. Oh, it’s gonna be fine. Don’t worry about Mark, it’ll be totally fine. But you know and reassure too much. To manage anxiety best.

We want to sit somewhere in the middle. Okay having just enough validation, having just enough reassurance, for the child to know, we get it, without kind of amping things up, and that’s what I mean by the reassurance trap. Reassuring too much which actually grows anxiety. So just keep it simple.

You’ll know lots of people will have said to you about breathing to regulate anxiety. Right and I used to as a kid. I thought this was happy drippy rubbish. So I would fall over I’d bang my knee and my mum would tell me to take some deep breaths, and I did not want to take some deep breaths. I thought that was a waste of time and I just was completely overwhelmed with how upset I was right.

But what we know from the science around how our bodies work is that breathing slowly calms our body down. Okay, so when you breathe out your heart rate actually drops.

So if we breathe in slowly, don’t worry about deeply, people used to think it was about getting as much air and your lungs as you possibly can, that’s not it, it’s about slowing the process down. That can help regulate those physiological signs of anxiety we’ve talked about before.

There are loads of different breathing exercises you can do. If you talk with your young person, chances are, they’ve learned some at school. It might be three four five breathing. For example, you breathe in for three seconds, hold for four seconds, breathe out for five seconds, that kind of thing.

And it can be really useful to use apps, there are lots of apps that you can you know, you can follow a bubble that goes up, and then you hold it, and then you breathe out as it comes down. Those kind of things can be really helpful. Really important to know with breathing, and with relaxation, which we’re going to talk about in a minute, when someone is really anxious, and you might know this in yourself, it can be really hard to slow your breathing down in that moment.

So it’s not necessarily a thing you do in the middle of a crisis, but it can be something that you do regularly throughout your day, to try and help balance your nervous systems.

We’ve got we’ve got three nervous systems. I won’t take you through it in any great detail, but one of them is fight flight. One of them is rest digest. Okay, when we’re really anxious, often fight flight is the one that’s getting most of the airtime. So strengthening that rest digest system with a bit of breathing, with some relaxation regularly, can just help them operate together much better, and help you experience the world and I guess in a more relaxed or in a calmer kind of way.

In terms of relaxation, right? You might hear that word and think about a wine and the bathtub, with the kids somewhere else. That might be what relaxation feels like to you. Or, that might sound like your personal version of hell, and relaxing for you is about going for a run, or it’s about going fishing, or it’s about gardening, or it’s about tidying.

Okay, and that’s because we all have different ways of relaxing we might be really active, you know, active relaxers, who want to do things while we’re relaxing, or we might be passive relaxers, where we just want to do nothing, and have a breather, right? Or we might go both ways.

I think, relaxation for young people kind of gives them a bit of a break from feeling worried. And so we’re going beyond, it’s really important to know what does relax your young person, that’s really cool.

But, also being able to use particular strategies to deliberately reduce anxiety and sort of deliberately relax your rangatahi’s body, can be really important. So when I talk you through one called progressive muscle relaxation, or as one of the dads I work with called it “goodnight toes”.

And the idea with progressive muscle relaxation is, at the moment my hands feel relatively relaxed, you know, but if you were to put you know sensors on my muscles, and have me squeeze my muscles for a short time, not so hard that it hurts, just so hard that I can feel it.

And then have me let them go, my muscles would be more relaxed, after being tense and relaxed, tensed and released, sorry, than they were beforehand. Okay, so we can take deliberate steps to relax our muscles, that can be really helpful in preparing us, you know to just drop down a little bit.

So with your young person, this might look like you get them to lie down on their bed at night time, you pull it into the bedtime routine for example, that’s what lots of my whānau do.

And you talk them through it. First of all they scrunch their toes up for 10 seconds

And then they relax them and they notice how much more relaxed they feel and then you look up, through the calves through their knees, through their thighs, through the bottom, through the tummy, all the way up.

And if you pull this into your bedtime routine, often what young people find is just helps them sort of switch off of it before bed. But, also doing muscle relaxation throughout the day and other realisation things during the day rather than at crisis point is really important.

If your child is super anxious because camp letters come home, lie them down the bed and get them to do progressive muscle relaxation probably isn’t gonna be your way to go, right? But actually, building this in as another way of strengthening that rest digest system, that can just sort of quiet and things down that little bit more, so a useful one to have in your kete.

Exercise, this is generally like the top strategy that my children and young people talk to me about an our sessions. And you might hear the word exercise and go “oh god”, she wants me to run 10 kilometres every day. No, I don’t, not one bit. Exercise is purely about getting moving above your baseline, and that could look like going for a run, or it might look like a dance party in your living room.

It might look like you parking further away from school than you normally would. Saying, “oh, sorry, I couldn’t get a car park”, you know and just you know, having them scoot a little bit further. Being on the trampoline, I work with a psychiatrist who used to prescribe certain amounts of time on the trampoline alongside any other intervention that he was doing, because for particularly for kids who are sensory, and you might be watching this because your child gets really anxious when sensory things are overstimulating for them. All of the sensory profiles and ways of being in a sensory world, most of them are regulated by movement. Okay, so generally adding more movement works pretty well for most people. So absolutely getting moving, doing some exercise is really helpful in managing anxiety, and it can be more helpful with managing mood than some medications and some other interventions. So absolutely get moving, however, way you can.

Distraction is one you’ll probably have used an awful lot, right? And that might be about using distraction and lack sensory tools like in the picture. It might be talking about other things, just trying to get your child’s mind off it. It might be about YouTube, or outside play, or it might be about listening to music, anything that just pulls their brain in a different direction, right? You might pay deliberate games like A for Aardvark, B for Bat, C for

Cat, you know working your way through. What most people find with restriction is that it’s kids go to strategy, distraction and exercise, and it can work really really well until it doesn’t, okay. So I’m thinking about young people for example, who I might be supporting to have a blood test, for them, distraction works really really well, until the needles in the room, at which point actually the fear is too big, their brain is too smart to be distracted, and they focus on the needle, right? So that’s why you need these other strategies in your kete as well. But, distraction can be really helpful for young people.

One of the strange things about anxiety, and you know, you’ll know this through watching a young person, is that anxiety makes us live in the future an awful lot. What if this happens tomorrow? What if camp next week is difficult? What if my friends aren’t kind to me when I go to an after school program? What if he doesn’t ask me out? All these kind of things, things that might happen in the future, generally in the moment, we’re okay, and we’re safe. Okay in this moment, I’m a bit nervous about doing a video, but I’m perfectly safe.

And so it’s about using strategies which help us connect with the present moment, without letting our brain pull us into the future to worry about what’s going on there. So grounding can be one really useful way to do that. And what grounding is about is, it’s just about, trying to pull your attention to where you are right now. Okay, so you might go through a grounding exercise like this one, the five senses exercise, where you go through and you think about five things you can see in a room.

Then you go through and think about four that you can hear. Three that you can touch or feel outside of your body. So, for me that might be I can feel my bottom on the chair.

I can feel my feet in my shoes. I can feel a little bit of air circulating in the room on my face, you know, those kind of things. Two things I can smell and one thing I can taste. And going through and doing those things to just help your child connect with their senses about what’s happening right now can be really helpful.

Mindfulness is a word that you’ll have heard before. And mindfulness I think can be misunderstood really easily. But all it’s about is focusing on the present moment, similarly to grounding, pulling your brain back from what might happen, and going what’s happening right now, okay.

And mindfulness like realisation can be passive or active. It might be something like, you’re sitting in a chair, you’re listening to a recording encouraging you to focus on your breathing, right. Or it might be something that you’re doing actively, mindful eating for example, people can find really helpful.

For me, the most mindful thing that I do is when I go fishing, right and any of you who do this, you’ll know that you go you cast you click your reel over, and you wind.

And you look at the tip of your rod, and that’s what you’re doing, that whole time. Because if you take your eyes off the tip of your Rod, you might miss a fish right? And so you find yourself you find I find my attention just going [focusing type noise from Nicola] into what I’m doing in that moment, okay.

This doesn’t have to be [that]. It might be around listening to a recording with your young person, that can work really well for lots of young people. Or it might be pulling mindfulness into what you’re doing normally.

There are great scripts and apps available online for this. Chances are a young person will have been doing some of this [not understandable] at school. But yeah, just have a have a play around with it, I know lots of people who play mindfulness recordings in the car on the way to school and they find that helpful. And it might as

I say just be focusing on things that kids already do, like colouring, or like you go for a walk together, for example, and you notice the different greens and the trees, all of those kind of things can be really helpful too, to be mindful while you’re doing them.

We’ve talked a little bit about the wave of anxiety, right. And we’ve talked about how it comes, and it peaks, and it goes. And we’ve talked about the fact that one of the keys to managing anxiety is just being able to go with the wave, just being able to tolerate the fact that it feels like we will go on forever. But then it breaks and then it drops away. And there’s a really great whakataukī, which I think captures this really well and it goes like this.

Āta tirohia te ngaru nui,
te ngaru roa,
te ngaru pae whenua

Notice carefully the great wave,
the long wave,
the shoreward wave.

And it speaks of, there will be a time where the pull of that really big wave starts to drop away. Okay, and that wave will give way there’ll be a sense of change and it will give way to smaller waves, that are easier to navigate, where we can find, you know a way back to shore, and we can get a sure footing, that’s what distress tolerance means to me. Getting a hang of the feel that the wave will come, it will feel awful.

But, the wave will come, and then it will go, and then it will drop away, and the more we learn to go with that wave without fighting it, and just let it happen, and then move forward, the better off we are. So I think the stress tolerance is really important both for young people and for adults.

Another hugely important thing is self-talk. What we say to ourselves matters, and this cartoon I’m sharing with you is one of my favourites, it’s called heart and brain understandably.

And you’ll see in that cartoon, you know hearts the optimist, in the cartoon and he’s trying to pull brains attention onto the good things that his butterflies resting on, but brain can’t pay attention to the good things, its busy trying to analyse a bad thing. Okay, and this is what our brains do. We’re designed to attend to threat.

We’re designed to notice the things that aren’t going well and try and fix them.

And you’ll know this from it might be a school report from yonks ago, or an appraisal at work, or even just having coffee with a friend who talks about all the things that they really like about you and thinks are really great about you, and they have one small criticism, and we find our attention is going to [Nicola makes focusing noise] into that criticism.

I can absolutely remember, you know my last appraisal, [it was] really really great, and one thing I could improve on. I couldn’t tell you what the really great things were, but I could tell you almost word for word, what the thing I could improve on is.

And I think when we notice how our self-talk is in our minds, you know, we can talk to ourselves that really critical ways which can be really unhelpful. And I think we often hear young people self-talk in their speech. I could never manage that that we’re far too difficult. What if, what if, what if, what if, what if I do that it will go really poorly. There’s no way if I ask him out that will go. Well, I won’t manage camp. I can’t you know, I won’t be able to read this book. It’s too hard. I’m too stupid, all these kind of things that’s kind of like hearing how they’re talking to themselves in their minds coming out through their mouths.

And that gives us a really good opportunity to notice when how they’re thinking about something doesn’t actually match how things are in reality. Okay, it gives us a chance to notice when they’re catastrophizing, when that snowball is running down a hill, and it gives how to manage that is to go is to take what they’re thinking, and rather than just try and turn that into a positive, you know. It’s about seeing things in a more balanced way. So worry will be giving them all of the evidence that something bad might happen.

And our job with self-talk is to think about what else might happen instead. What other evidence do we have that things might actually be okay. And just gently bringing that into their seeing things in a more balanced way. We’ll talk about self-compassion in a while. But also we often notice that our self-talk in, our own minds, to ourselves.

So much harsher than how we would talk to somebody else if they’d made a mistake.

Oh for God’s take Nicola. This is really, you know, you’ve made a really poor job of this, and it’s not going well Nicola makes noise indicating ongoing self-talk]. Where there is somebody else is in the same situation you’d be encouraging.

You’d be forgiving of the fact that you’d made a mistake, or something wasn’t expressed as clearly as it hoped, or something like that. You’d just treat them really differently. I think it’s useful to keep in mind how we treat ourselves, and how we’re talking to ourselves.

I’ve put problem solving in here, and you’ll notice that its my second last strategy. The reason for that, is because if we jump into early with problem solving often, we’ll lose our rangatahi.

Often they’ll feel really misunderstood. Okay, because you know and you know, you have people in your lives who are absolute pros at this who will feel discomfort, when you’re anxious, discomfort when you’re unhappy,

And they want to jump in with a solution before you feel like they’ve actually properly understood what’s going on.

So this is why I leave this far far down in the background, you know, it’s a useful skill to have, but maybe don’t lead with it, lead with that validation, and then move to problem solving.

These are just five steps to think about how you might look at problem solving with your young person. The first one is thinking about what the problem is, you know. And you might actually write this out, often kids with anxiety are better solving a problem that’s on paper then a problem that’s whirling around in their minds.

So what’s the problem? What options have we got, and use all options. Some might be silly and ridiculous, others might be more sensible, but list all your options. Think about what the consequences of those options might be.

Choose the best one, try it out. And then at the end of that kind of come together and evaluate how it went, if you need to go around again, and try something different, do that. But this can just be a useful model for thinking about how you might encourage a young person to help problem solve.

Another strategy that’s really useful for managing anxiety is medication. Okay, and that’s often useful in situations with a volume of the anxiety is turned up so high, the other strategies that you’re trying to offer your young person are getting drowned out, and aren’t helping so young people talk about anxiety is being like there’s a radio on the corner of the room that is cranked as high as it will go and they, you know, you might be over here talking with them around breathing talking with them around problem solving using all your strategies.

The anxiety is too strong, you know, and you can’t get through. And I think you know medication, I’ve seen be a really useful strategy, when they’re volume is really high.

Over time with medication, usually it’s a short term-short to medium term prescription with anxiety. So it’s generally not something you’re on for the rest of your life. Okay, but the idea with it is that medication can turn that volume down a bit, to give the other strategies the air time that they need, and then with practice your young person starts to rely on those strategies more so that probably when they come off the medication, those strategies, those behavioural strategies become their primary way for managing anxiety.

Get a lot of questions about medication and my job, which I’m sure you’d understand. So I thought I’d summarise some of the best ones here, that I hear the most of, and run you through some of the answers.

So people will often ask me who they can talk to about medication. If you’ve listened to this talk and you’ve gone actually, I’ve been trying lots of those strategies for ages, we’re not getting anywhere and I think that anxiety is just too big. You can talk to your GP, or your case manager, or your paediatrician. They’re sort of your first port of call.

People worry that medication for anxiety will sedate their te tamaiti, their child, you know, and if it does that the dosage needs reviewed or the medication needs reviewed, [it] breaks my heart when I hear stories of people who trial the medication, found that it’s sedated them, and so just came off it, and they never tried another one again.

The dose was wrong. Or the med [medication] needed reviewed. You know, that’s the time to talk to your GP, if that’s happening. But usually what happens with prescriptions for young people. Is that a very low dose is prescribed, and it’s amped up very very very slowly to try and minimise the chance of that happening.

Will they have to be on this forever? Medications for anxiety are generally prescribed for a time limited period. Okay, so the vast majority of time when I’ve been alongside a psychiatrist prescribing for a young person.

They’re expecting that will be for a period of time, often sort of 6 to 12 months, because that depending on the medication can be a sweet spot where basically if you’re on it for that length, that makes at least like that your anxiety will occur when you come off it right. So generally, if you are trialling a medication for your young person, for anxiety, expect to be on it for more than a couple of months, but, it will be a time limited period.

Can medications be addictive? SSRI’s which is the most commonly common family of medication prescribed for anxiety aren’t addictive. Okay. They’ve been some anxiety medication in the past that from a very different family of medication, and they were really, sometimes people found them really hard to get off. SSRI’s, that’s not the case, generally. Will it change their personality? Generally not. Okay, but some people find that actually when the anxiety is damping down, but they start to see parts of the child’s personality that they used to see a lot more of before they were anxious.

More of a sense of humour, or just interests they used to love doing, that they’ve sort of dropped away from, those kind of things. So rather than be a personality change, often it’s about, you know, allowing space for the personality to show through a little bit more.

Will we need to tell anyone that they’re on medication not?

Nah! Absolutely not! You know, its your health information, and it’s your call. Um, obviously your

GPs gonna know, because they’ll often be helping prescribe, but then it’s actually your decision as a whanau about who you tell, about what. I’ve got lots of young people who will you know, go on sleepovers with their medication, and some people are really open with being on medication, and that’s fine for them. Others have the medication shoved in a sock somewhere, and they just take it subtly when they’re able to.

It’s up to you who you tell. Sometimes, it can be helpful for school to know, but that’s your call. And so no, you don’t have to shout it from the rooftops. How will it be monitored? By close review, from either a psychiatrist or you’re a GP, with the oversight of a psychiatrist. So it’s a medication trial in a young person is an important thing. It’s taking really seriously, and it’s really closely monitored.

So hopefully it’s helpful to have some of those answers for you. In terms of other strategies for our smorgasbord, writing stuff down can be really helpful for young people.

Having a worry box, writing it down, putting them in the box, and you might decide that once a week, or once a day, you open that box. You take out the worries, and you talk about them.

There’s this great story about someone who decided he worried an awful lot, and he decided that he was only going to worry on a Wednesday. And so he would write down his worries every day that wasn’t Wednesday. And he put them in the box, and every Wednesday, he would pull them out, pull them into the light, read them to himself.

And what he noticed was a lot of the time the worry that he might have had in a Monday for example, by Wednesday it was gone. The situation had resolved itself. And what he noticed that my scheduling a time for worry, it actually made the rest of his life more manageable. So that can be useful for some people.

Make a worry time and stick to it. Try not to make it just before bed.

It’s the hardest time to get off your worries, before you go to sleep. But it might be that you decide that you know at four o’clock you guys sit down and have a chat about how the day was, and is there anything that’s been difficult that day and sort of pull that time into a more manageable time.

And lastly, visualisation can be a really really helpful tool for young people. And that’s where you sit with them and you talk with them around, what actually makes them feel relaxed and calm. Can they imagine a place they could go to in their mind, which would make them feel relaxed and calm. That might be an actual place for them, or it might be a place that they make up, you know, and they are design and their mind. And help them, you know describe that to you really really richly in terms of the senses.

What they can see, what they can hear, all those kinds of things. So they have a place in their mind, that they can go to, almost for a bit of a vacation from their worries.

Some of my young people like to draw that place if they really artistic, or others like to write a poem about it, others just like to know they’ve got it in their mind, and they can go there when they need to. That can be really helpful particularly before bed.

So in summary, there are heaps of strategies we can use to managing anxiety. I’m sure if you were in front of me, you’d have even more to add to the list.

Try some, you know, try some, and see how you find them and you might find that some strategies will work well for a while and then they’ll sort of feel like they stop working. Change it up a little bit, you know, we need to be flexible, anxiety is a flexible thing. We need to meet it flexibly.

And also if strategies aren’t helping and you’ve been having a really good crack, you know managing things through strategies for a while, or just the anxiety seems far too big, medication can be a useful thing to consider. A lot of young people find really helpful.

[Dr Nicola McDonald] Given, we know what anxiety is we know strategies for managing it. What do we do when there’s something that a young person wants to be able to do, or needs to be able to do, but actually they’re far too frightened of.

How do we get them from where they are now, where for example, they I don’t know can’t go into a shop by themselves to pick up the fish and chips, to being able to go in there pay for them, smile at the cashier, and leave. How do we get from here to here? Right. It’s all about exposure. So for the next couple of minutes, we’re going to talk about how you do that.

There are two different ways that we can use exposure to our advantage right. One is flooding, flooding you can think of as the person being “chucked in at the deep end”, to use a common expression. So that’s when you’re exposed to the thing that they’re frightened of, to help them learn that they can survive it, and decrease that wave, you know, decrease their fear and avoidance.

Floodings are really quicker. It’s the quickest way of exposure and it can be really effective. It can be really helpful.

It can be quite challenging to do right because we know that a flooding situation is going to be a situation which does flip the lid. Okay, it’s 10 out of 10 anxious feels really really difficult. But sometimes it’s the only option so when I think about young people that I support with having blood tests.

You know, it’s not an option for them to sort of, you know to an extent the needles in or it’s out isn’t it? You know and you can use a combination but with flooding it’s important to know that actually facing the thing and getting through it in itself can be really helpful.

Another way of managing towards something that you’re trying to do is called gradual exposure and that is where you create a list of small steps between where the child is now and where they need to be. And you describe, you do your staircase or your ladder together, to try and work out how they work towards conquering this fear.

People often experience gradual exposure as gentler than flooding, because they’re just a little bit out of their comfort zone, and then a little bit more and then a little bit more where it’s flooding is like out of your comfort zone, right. The trouble with it, is that gradual exposure can take a long time. Okay. So if you’re going to use this you need to give yourself enough lead in time.

So this is just a quick example for you about how gradual desensitisation might work for a fear of water. Okay. So if we imagine that this is a child who’s really terrified of swimming in water. Okay, you’d start off with, you might even start below this, you might start off by going and driving past the swimming pool and going, “Oh look the swimming pool”, and driving off.

That might be your first step, right. And then eventually you’ll get in, you know, get into the swimming pool. You might have them paddle in ankle deep water, and tolerate that, and you might go home at that point.

You might go brilliant, “Tick!”. We’ve got a wee way along our staircase right, or you might go a little bit deeper and over time using steps like these ones in these examples. You’re gently gently gently, using strategies to manage anxiety on the way. You will gently work your way up to where the young person wants to be.

I find it really interesting young people often have a really natural understanding of this. If I say to a young person, even a six year old. If I was really really really frightened of water, and your job was to help me jump off a diving board into the water.

How would you do it? Like how would you help me do that? And some of them will say, I push you off the diving board, flooding. It would work, I’d be in the water, right?

And others will go. Oh take you by the hand and I take you to the paddling pool and we just start there, you know. And if you got really scared, I might throw a ball with you, or I do something that helps take your mind off it. And then we might go a little bit better, and I’d be, I’d be really encouraging like I say you’re doing really well Nicola.

This is really good. Look how deep, you know you’ve done so well, and I work your way through. So kids often have this inherent understanding that this is going to be helpful.

So in terms of how you design a hierarchy like this. Here are some keys for you. Work towards some easy ones first. Okay, don’t make the first step too difficult to be conquered. We want to get some momentum. We want to get some sense of success.

Where it’s possible, talk about this with your child, about the order of the steps for them. Because sometimes as adults we might think we’ve got the right order, but actually it might be really different for that young person.

I remember working with a young person who was, found it really hard to go to sleep in their own bed, and so she’d have six different types of lights, and a radio on, and the hall door open, so she can hear mum and dad in the living room. You know, watching T,  and that was what needed to happen for her to go to sleep. And so we were trying to work gradually towards her needing less and less of these things, right?

And I thought the lights would be the hardest to get rid of, that lights will be the hardest for her. And so we you know, we designed this thing, and we went to move the lights first. And when I went to see her a couple of weeks later, she’d got really stuck with the light, you know, the lights were fine. The lights were all off that wasn’t an issue, but she’s got really stuck on the radio.

I had thought the radio would be the first to go, the lights would be the main thing she needed, but no it wasn’t. For her she needed the radio because she needed to hear something other than silence. So really important to do this alongside your child, if you can. To help them tell you what the next step might be.

It might be useful to use a visual like drawing a fear thermometer for example. To help them understand how anxious they think that a step might make them feel. And we want the steps to be tricky but not impossible.

Okay. So about seven out of ten for anxiety is great, that’s what we’re after. That the seven out of ten is a challenge, but it shouldn’t have flipped. It shouldn’t result in a flipped lid. Okay, so working your way through tricky steps, but not impossible steps. It’s alright to stay on a step for a little while.

Okay, if actually you just need to solidify and bed in on a particular step that’s totally fine. But the aim is to try and make the ladder or the staircase sort of a one-way ladder. So if you’ve got to a certain step trying to stay there without going backwards is important.

If you get stuck moving to the next step, put another little step in between them. You know, and just work towards that one.

And it’s also really important to practice, because the brain needs lots of repetition. But the time we’re working with a child who’s anxious the brains already given them lots of repetition that things aren’t safe. So actually, we need lots and lots of practice, to help them get a slightly different message.

It’s also really important, you know, and can be really helpful to reward any kind of effort up another step.

With praise, or attention, or a tangible reward, okay. Because there has to be something actually in it for your child to put themselves through this level of discomfort. And I know that people feel very differently about rewards, you know. I’ve had lots of conversations with people who feel you know, I’m not going to reward because it’s bribing, and it’s not okay and they should just do the thing they have to do.

And often will reflect then on what it’s like, even an adult life, about what we do because of the consequences of our actions. So, you know, I’m more likely to come to work if I get paid. I’m less likely to speed, because I’m worried I might hurt someone, or I might get a ticket.

You know, I find myself doing a video about anxiety because I’m hoping that it’ll be helpful for people. So is it the consequences of our actions which determine what we do. So these forces are already at play around your child whether they’re in the form of a tangible reward or not.

It’s really important that if you are using rewards make them manageable. I’ve had lots of kids say yeah, sure, I’ll sleep in my own bed for five nights if you take me to Disneyland.

And I’ve had parents get really stuck, because they go “okay great” thinking the child will never do it, and the child just goes and does it. You know, so it has to be a manageable route. It has to be something that you can follow through on.

Deciding them alongside your young person to make sure that we actually be an effective currency. We only work for rewards that we actually want. You know, if it was that I had to come to work earlier let’s imagine for a week. And if I did that I could have unlimited access to a horror movie streaming channel, okay.

I’m not going to come to work early for that. I hate horror movies. I’m not built for horror movies. They’re terrible. That’s not going to motivate me at all. Okay, if it was that I did that and I got a free Netflix for a month. Now we’re talking, you know, now we’ve got something that I’d be interested in. So it’s about working alongside your young person to make sure that the currency is actually effective.

It’s also really important to think about you know, we’ve talked about rewards as being like temporary modifiers. You aren’t always going to be, you know, you’re not going to be rewarding your 27 year old for sleeping in his own bed at night. Okay, you’re gonna phase them out over time, when you and your child are ready. It’s a temporary strategy, like the other things that we’ve talked about.

So hey, the last thing I really want to discuss together is you know, we’ve talked about the fact that looking after and supporting a young person who is anxious is really hard yakka. We’ve talked about the biological reasons why it’s really hard, you know.

We’ve talked about the reactions that we can have and how tough it can be on us as adults to be supporting kids who are anxious. And so just before we finish I want to touch briefly on how we look after ourselves in on that journey. You might have heard the phrase you can’t pull from an empty cup, and the idea of that being that if you are knackered, you know, if you’re knackered and you’re not coping and things are really really tough.

It’s going to be really hard to support your young person. It’s about doing things that we can use to fill your cup, you know to help you be in the best position you can to support your young person. Which I know is important to you, because you’ve got all the way through this talk, you know, trying to, you know, get more information under your belt about how to do this. Lets talk a little bit about looking after ourselves.

We’ve talked a little bit about that humans are designed to be connected beings that support each other and our supported by each other. Right? So it’s really important to have a support crew in your life, you know who can who can help you out with this stuff. And sure that might look like having a psychologist, or a counsellor, or a social worker.

Or it might look like a neighbour over the back Fence who’s just really good for a yarn and who if your young person was completely freaking out and having a big meltdown, and you need to support, you’d give them a ring.

You know, it might be something as simple as, it might be like having a support crew at school. You know for your young person who knows that actually if the chips are down, they can go to X Y and Z person. And that might not be their teacher.

When I was growing up, we had a caretaker at my school and his name was literally Mr. Hope I do not joke.

So many of the kids at our school just really loved Mr. Hope. And if they were having a meltdown, or things really difficult, they’d go and hang out with Mr. Hope, and they’d rake some leaves, or they’d do something like that. So your support group might be people who are unexpected, but if you can get some people in there, that can be really helpful.

You might find other people in your life who are in a similar situation to you, you know, who you can build some connections with. It’s tricky to do but it’s worth the investment.

The other thing to keep in mind that I’ve kind of snuck in, is that the strategies we’ve talked about how to manage emotions and kids and young people secretly work just as well for adults, okay. So you might be able to take some of your learning from what you’ve watched, and go actually, I’m going to try out progressive muscle relaxation. I’m going to build some exercises into my day. I’m going to build, you know, noticing how I talk to myself, and just trying to hold myself with a bit more compassion and hopefully that will be really helpful for you, too.

And on that note, self-compassion. Okay, so often when I sit in a room with parents who are receiving this content, and we have a conversation. What I see is lots of parents who are super compassionate towards their children, they will move Heaven and Earth to support their tamariki, you know. They’re really prioritising that.

But they’re so hard on themselves, you know. They can be so kind, so compassionate towards a young person, but then they’ll go away at night and go. Oh God, I should have handled that better, or I should have this, or I should have that.

It’s really important to notice that we’re often much harder on ourselves than we are on other people, and to try and get in the habit of including ourselves in that circle of people that we care about okay. And sort of being able to go gently with ourselves as best we can.

When you’re young person was born, they didn’t come with an instruction manual. You are doing your best, you know in this situation and you’re always learning more that you can do.

But being able to hold that sort of self-compassion and that belief that actually you’re doing your best and to treat yourself the way you treat your best friend if they were struggling the same way. Try it, sounds really easy, really, really difficult in practice. But hugely important to be able to treat ourselves, kind of, as a friend, rather than as a disappointment, you know.

Again, there’s a whakataukī, which I think captures us really really well.

He taonga rongonui te aroha ki te tangata – ki a koe anō hoki.

Kind-heartedness towards others and yourself is a really precious treasure.

And I think it will stand you in good stead, to be able to just gently, just gently, work towards developing a little bit more of that. Before we finish I wanted to bring your attention to a few more resources that are out there, that might be helpful for you.

There are lots of websites about how to support kids who are anxious. The beyond blue website is great. The Healthinfo website is great. Hey Sigmund is great, which is on this list. There’s another course called Fear less triple p.

And that’s a really good evidence-based course about how to support young people with anxiety, that you can do online. It’s free in New Zealand at the moment, share that link around with anybody who needs it, and that will complement this too if you decided to do it

As always, there are loads of apps I think will be really helpful. And these are just three that I’ve used that I find really helpful. But have a Google, have a try, you know. And think about your young person while you’re doing it, and just help them just gently work towards finding some things.

And likewise, you know, there are apps, there are also tons and tons of books out there. There’s so much information we can get and gather and use. And so yeah, if you’re interested in learning more, you know talk with your GP. They might have some good options for you, or yeah, have a Google make sure you reading reliable stuff, you know when you do it, but have a Google and see what’s out there.

So hey, just to finish off. Thank you so much for your attention, I hope that this has been really really helpful. And as I said before, you know, you’ve just listened to a long video, you know about how to support kids with anxiety, which is testament to the fact that you really wanting to support your rangatahi and

I really hope that this leaves you a little bit better equipped to do that. Just want to acknowledge the support that I’ve had with putting the video together with some of my colleagues have helped contribute to it, and also that original content from Carolyn and Cherie which we’ve built on for this group.

But now there’s nothing left to say, but just that I hope it’s been helpful, go well, and all the best with your journey. Thanks.