Treating childhood and adolescent anxiety : a guide for caregivers

338 Pages·2013·2.33 MB·English

by  Lebowitz

T R E A T I N G
C H I L D H O O D
AND
ADOLESCENT
ANXIETY
A G U I D E F O R C A R E G I V E R S
(cid:2)
E L I R . L E B O W I T Z H A I M O M E R
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LibraryofCongressCataloging-in-PublicationData:
Lebowitz,EliR.
Treatingchildhoodandadolescentanxiety:aguideforcaregivers/EliR.Lebowitz
andHaimOmer.
pages cm
Includesbibliographicalreferencesandindex.
ISBN978-1-118-12101-6(hbk.:alk.paper);ISBN978-1-118-26275-7(ebk);
ISBN978-1-118-23802-8(ebk);ISBN978-1-118-22469-4(ebk)
1. Anxietyinchildren. 2. Anxietyinadolescence. 3. Anxiety–Treatment.
I. Omer,Haim. II. Title.
BF723.A5L3932013
618.92'852206—dc23
2012048965
PrintedintheUnitedStatesofAmerica
10 9 8 7 6 5 4 3 2 1
I dedicate this book to Sergeant Zeev Buzaglo, a fearless
young man whose smile could make anyone brave.
—
ERL
I dedicate this book to all the people who helped me
live better with my own fears.
—
HO
I fear not might
’
Nor weathers blight
But the daily death of night
Not confrontation
Condemnation
But your salty accusation
I fear not arrow, sword or spear
But you do. Making distant near
And all I truly fear, is fear
Contents
Preface vii
PART ONE: INTRODUCTION
CHAPTER ONE
Anxiety Disorders of Children and Adolescents 3
CHAPTER TWO
Anxiety and Emotion Regulation 23
CHAPTER THREE
When Anxiety Takes Over—Family Accommodation 35
PART TWO: WORKING WITH THE ANXIOUS CHILD
CHAPTER FOUR
Cognitive Tools for Treating Anxiety 53
CHAPTER FIVE
Behavioral Tools for Treating Anxiety 75
CHAPTER SIX
Physiological Tools for Treating Anxiety 99
CHAPTER SEVEN
Emotion-Based Tools for Treating Anxiety 111
v
CONTENTS
PART THREE: WORKING WITH PARENTS
CHAPTER EIGHT
Parental Support and Protection 123
CHAPTER NINE
Childhood Anxiety and Family Boundaries 139
CHAPTER TEN
Introduction to Parent Work and the SPACE Program 151
CHAPTER ELEVEN
The SPACE Program—Treatment Process 157
CHAPTER TWELVE
Tools for Troubleshooting the SPACE Program:
Session Modules 207
CHAPTER THIRTEEN
Increasing Collaboration Between Parents 235
PART FOUR: ANCILLARY ISSUES
CHAPTER FOURTEEN
School Refusal and School Phobia 267
CHAPTER FIFTEEN
Highly Dependent Young Adults 281
CHAPTER SIXTEEN
Medication for Childhood Anxiety 295
Appendix One Family Accommodation Scale – Anxiety (FASA) 305
Appendix Two Coercive Disruptive Behavior Scale for Pediatric OCD 309
Author Index 315
Subject Index 321
vi
Preface
W A B A ?
HY NOTHER OOK ON NXIETY
There are quite a few good books about children’s anxiety. There are
alsoexcellentmanualsforthetreatmentofanxiouschildren,whichdoa
great job of presenting what have become accepted standards of treat-
ment in the field of pediatric anxiety. So, one question in setting out to
write a guide for caregivers working with fearful children and their
parents is: What for? Why go to the effort of creating one more book?
And,nolesscompellingly,whywouldanyonebuythisbookratherthan
the others that have come before?
In the end, the answer to this question has been the same one that
guidesmuchoftheworkthatweandourcolleaguesdointhesearchfor
ways to help the families of children suffering from anxiety. It comes
downtothetroublingfactthatalthoughthetreatmentsthatareavailable
todayarehelpfulformany,perhapsevenamajority,ofthesechildren—
many are still left unaided. As psychologists, psychiatrists, and care-
givers in the field of childhood anxiety disorders, we pride ourselves on
theabilitytoeffectivelyhelpmany.Butasubstantialminority,probably
around a third, is still crying out for us to try harder. And when we’re
talking about anxiety in children, one third is a great many kids.
So although one important part of this book covers territory that has
become familiar to at least some of the professionals, and even many of
the parents who through circumstances have become lay experts in the
field of anxiety, other parts chart newer and more exciting waters.
vii
PREFACE
Rather than being satisfied with presenting the state of the art, we are
trying to show the state of some of tomorrow’s art.
I I F
NTEGRATING THE NDIVIDUAL AND THE AMILY
An unfortunate accident of history is the divide that has traditionally
existedbetweenfamily-orientedtherapistsandtheoreticians,whoviewa
child’s disorder as the manifestation of a systemic family problem, and
most others in the field of child mental health. The paradigm that has
dominated psychiatry and clinical psychology for much of its history
has been more individually focused—treating the child with only little
attentionpaidtofamilialfactors.Thisisunfortunatebecausetheabsence
ofcross-fertilizationofideasandskillshashamperedthedevelopmentof
treatment models that straddle the gulf, benefiting from and adding to
the knowledge of each.
This kind of integration could be helpful in most disorders of child-
hood,butnowhereisitmoreneeded,oritsabsencemoreglaring,thanin
the context of anxiety disorders. At their very heart anxiety disorders
areinterpersonalandsystemicinnature.Yetachild’sdisorderisalsoan
individual feature of that child. Some problems exist encapsulated
within the individual suffering from them. If a child has a dental cavity,
forexample,that problem existsin his mouth.If achild hasflat feet the
problem lives in her shoes. However, when a child suffers from anxiety
the problem exists both within the child and in the interpersonal space
of the relationship between parent and child. As we discuss in depth in
the second half of this book, parents, to whom children look for pro-
tection when they feel threatened, are intricately caught up in the
disorder of a child who experiences chronic threat.
Throughout this book we attempt to integrate the individual and
familyperspectives,learningfrombothandofferingstrategiesthatstem
from this assimilation. This is particularly true of the SPACE Program
manual presented in the third part of this book. The SPACE Program,
or Supportive Parenting for Anxious Childhood Emotions, is a treat-
mentprotocolforchildhoodanxietyandobsessivecompulsivedisorder.
However, it is a completely parent-based intervention. The integration
of a family perspective with the knowledge and experience that have
beengainedinthepastdecadesinthetreatmentofanxietyiswhatmake
viii