Hey Boys, I’m Baaaack.* What To Do When Child Anxiety Returns

When your child becomes symptom free from anxiety it feels like a miracle. You sure don’t want it to come back. This post is about why it might come back and what to do if it does. I remember bracing myself at any hint of anxiety in my daughter hoping it wasn’t coming back. Sometimes, unfortunately, it can reawaken. This may feel even worse than the first time. Could be because you were exhausted and the thought of going through it again is overwhelming. Might have to do with the loss of hope. When your child gets better your hope soars. There is a proverb that goes, “Hope deferred makes the heart sick.” A relapse of child anxiety can be heart breaking for you and your child. Do NOT despair! There are reasons this happens and steps to take that can make this a short-lived bump in the road.

What Can Cause a Relapse of Child Anxiety?

Here are some of the reasons that researchers have determined might cause the fear to reactivate.**

1. A long time passes since facing the original fear and then a child experiences the fear trigger again. For example, if a child overcomes the fear of vomiting and then a year later a sibling gets the flu and vomits the fear can come back. A child may overcome the fear of spiders and then see the movie “Arachnophobia” and it triggers the old phobia.
2. The situation surrounding the fear changes. For example, someone with a fear of tornados who lives in Virginia no longer reacts to storm alerts on the phone or television and then the family moves to Oklahoma. Or a child has panic at the thought of going to elementary school. This fear is overcome but returns when there is a change to middle school.
3. At situation of unrelated stress or anxiety reinstates the fear. In other words, something traumatic or frightening can stir up the old fear. For example, an obsession about getting contaminated can return upon hearing that a beloved relative has been in a car accident.
4. The anxiety is better but your child was still playing it safe. For example, a child stops checking doors and windows at night to make sure they are locked and everyone is safe. However, he is still asking for reassurance, hall lights are left on and alarm is checked over and over. He overhears that the neighbors had a break-in and the anxiety is reanimated.

What Can You Do if There is a Relapse?

If you used cognitive behavior therapy with exposure and response prevention as part of your successful treatment, you don’t need to go find something new because the old approach didn’t work. It did work. Anxiety is stubborn and the fear is not forgotten. I wrote about that here. A relapse is like an old memory that is remembered vividly. This key is to apply the same principles. Ultimately the goal is NOT to reduce the anxiety first. The goal is to disprove the fear. Then the anxiety will come down.

Go back to the basics. What are the mistaken beliefs? Challenge those beliefs. Face the fear. Develop a fear hierarchy and face each step over and over until it is not so distressing. Stop any behavior or thinking that makes the exposure safer. You know your child overcame this once; he or she can do it again. Here are some steps.

1. Stay calm and don’t get mad at your child. It is terribly frustrating but do your best to present a calm presence to your child.
2. Build up your child’s confidence. Provide encouragement that overcoming obstacles is part of life and to not lose hope. This is the time to be a major cheerleader.
3. If you used Turnaround and your child is still of age then start it again.
4. Face the newly activated fear. The sooner you challenge it by facing it the easier it is to extinguish the flare up. Make a list of everything feared and avoided. Put in order from easy to hard and then start to face those fears. Don’t go back to the old ways of avoiding and reassuring.
5. When you face the fear, go all the way. Don’t stop when it is a little better. This happens in therapy all the time. Things get good enough that the anxiety isn’t significantly interfering with life and patients lose momentum to keep pressing. Face all the fears. Any thing avoided needs to be faced.
6. Face the fear in a variety of situations, times and combinations. The principle is that major change will happen when the exposure takes place in conditions where the feared outcome is believed to be MOST likely to occur. The more real life the exposure, the more effective.

*Said by Randy Quaid in “Independence Day”.

**Craske, M., Treanor, M., Conway, C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 10-23.