Neurodiversity Ch 10

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Lois Prislovsky, Ph.D.

Emotional Regulation, SEL, & Performance Training

Chapter 10: Anxiety Don'ts - By Lois Prislovsky

“The will to win is important, but the will to prepare is vital.” Joe Paterno (Our editor thinks I should take this out. But, I figure we can learn something from everybody and quoting only perfect people is limiting. This chapter is about preparing for anxiety.)

To recap: anxiety is not innately bad and can liberate us to be and do more.

It is amazing how quickly the brain complies with what the mind is asking it to do.

Yesterday afternoon, I took Eli and a couple of friends to Jump Jam. I am happy to give an enthusiastic plug for our local trampoline park. We have been to many but Jump Jam is our favorite as it has few rules and dozens of activities. I evangelize often that people should move more and what is more joyous than jumping? Dodge ball while jumping, that’s what! The owner appreciates my old lady diversity addition and gives me free passes for Psychoeducational Network practitioners to give to our clients. Beats smiley face stickers.

One of the more challenging games at Jump Jam is a 2-inch wide flex line stretched out 20 feet and suspended about 3 feet above a foam pit. The idea is to tightrope across. It seems impossible, yet I can do it all the way there and back. Ice-cave sitting monks have no monopoly on doing weird interesting stuff. Now, being 5 foot tall and bowlegged helps, but anyone can do it. It just takes practicing: letting go, focusing on your destination, and taking one step at time.

When working with clients, we are not performing research, where it is important to isolate variables. The intention with a client is to facilitate goal attainment as efficiently as possible, so we often use multiple techniques simultaneously.

For examples in this follow-up anxiety chapter I will discuss another bright young man with Anxiety and ADHD diagnoses who quickly became successful at preparing for and managing his fear-based difficulties.

C.D. was 5-years-young and came to us for oppositional defiance issues related to anxiety. C.D. had refusal meltdowns at school, the dinner table, and doctors visits. “I can’t do it!” was his mantra. In The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, Ross Green says it so well, “Behaviorally challenging kids are challenging because they’re lacking the skills not to be challenging.” Furthermore, in I Might Be You: An Exploration of Autism and Connection, Barb taught us the truth about consequences so often being ineffective with fear-related behaviors plus the critical component of presuming competence. With this “people do better when they know better “ foundation, C.D. quickly learned to better manage his thoughts and behaviors.

Presented with his parent’s permission, below are C.D.’s session notes (emailed to the client 24 hours after each meeting to recap and reinforce) which may help illuminate his progressive steps.

7-16-2014 = First session went well. C.D. and I were able to build rapport quickly. His mom observed and participated in the full session. We began with a few confidence-building exercises to help C.D. understand some of his considerable strengths. He catches on very quickly and was able to work 2nd grade multiplication exercises involving zeros. C.D. enjoyed this and grasped the structure and pattern easily. We even discussed his intellectual strengths as compared to others on a bell shape curve. C.D. thinks best when moving so we did a few fast paced letter reading and catching games while he was on a mini-trampoline to improve his processing speed. It is important to keep this processing speed work fun to have C.D. associate it positively and reduce performance related anxiety. He was beautifully cooperative and open to talking about some fears, social situations, and hand flapping. We began introducing body language exercises to help him regulate his anxiety. The plan is to use a multimodal approach involving the computer, role-playing, games, and mind/body control techniques to help C.D. with self-regulation, anxiety, attention, frustration tolerance, and processing speed. Only minor adjustments to C.D.’s diet are recommended as his parents have done an outstanding job with that. His screen time and home activity levels also seem to be healthful. Exercise is the best treatment for ADHD and Anxiety, so we discussed increasing team activities like soccer. Mom is open to coaching C.D. in AYSO soccer to facilitate more social opportunities in a safe, positive environment. I emailed Mom and the AYSO regional director, to begin the process. C.D. is eager to learn. We will incorporate some challenging activities soon to help him practice breaking through the hard stuff and loosing the “I can’t do it” mentality. = 1 session

7-21-2014 = Mom, C.D., and I worked together the entire session. C.D. was very focused and cooperative. We began with a visual memory exercise to help C.D. remember words and eventually entire paragraphs and pages with detailed and novel visual memory techniques. We also did a “flinching game” activity to help C.D. with mind body control and improving processing speed. He seemed to enjoy all our exercises today. C.D. showed remarkable attention to detail on a memory for faces computer game designed to help him to improve social skills. We did many above grade level math problems and mazes to encourage working through difficult times, but he found those not challenging enough to be difficulties. Instead we worked on him being more mindful of saying, “I can’t do it” by positively reinforcing “I can do it” activities with an enthusiastic chair spin. Action oriented positive reinforcement works well with C.D. We also discussed and practiced the use of a large ball to help him stimulate his core muscles enough to remain conversational and appropriate at the dinner table. Mom and I made a plan for her to email me any current struggles prior to each session so we may plan specific coping strategies. We also talked about how this strong-minded young man does well with the Socratic method, where we don’t correct him but instead ask C.D. questions so he can find his own answers. Excellent progress. Soon we will work on his doctor anxieties and I also look forward to doing some roll playing exercises with C.D. next week to help him deal with a long school day next Wednesday. = 1 session

7-28-2014 = Today, we focused on helping C.D. with his fear of doctors. Just like Mom reported, C.D. has developed considerable denial over the situation. By the end of the session, we were able to finally break through that and C.D. began using the language that his shot and doctor’s visit is going to happen. We empowered him by letting him play with the contents of a pediatric medical bag and opportunity to wear the white lab coat. C.D. was open to this and roll played some while he processed what was going to happen on Wednesday. He also cooperated fairly well with me doing a brief guided relaxation “with his Mom”. The idea was to introduce C.D. to hypnosis by listening with his Mom and being calm as she did a short hypnosis exercise designed to help him be able to mentally experience an enjoyable bowling time whenever he wished to feel happier and in control. We also reviewed some pictures of other children his age who got shots to show that it is a reality. Next, we helped C.D. prepare a 3 point request letter to give the doctor who will be giving his shot on Wednesday: “To the doctor who will give me my shot. 1. I want you to slow down 2. I want you to be nice to me, C.D., 3. I want to play monster truck game on my ipad immediately after getting my shot.” Mom also agrees to take him bowling after he does the doctors visit well. She also understands the importance of keeping her expectations positive and rewarding him ASAP. I think CD is ready to be successful at the doctors. I look forward to hearing how it goes. = 1 session

A week later, C.D.’s Mom emailed me the great news: “Check up went the best it ever has. He sat still for the shot, expressed his anxiety and did not defer or deny, and we went bowling afterward. Success!” She also reported he is loving soccer and is thriving at school.

The following Anxiety Don’ts further breakdown proactive anxiety management steps.

Don’t:

1. Don’t overprotect. You are a model for your child regarding how to handle stress, fears, and problems. Renowned thinker and science fiction writer Robert A. Heinlein wrote, “Don’t handicap your children by making their lives too easy.”In Norman Doidge’s book, The Brain That Changes Itself, we are reminded that scientists know physical exercise prolongs extant neurons, while exposure to new experiences, environments, and challenging thinking promotes neurogeneration of glial cells. With experience and practice, these neural pathways establish tracks and quicken, just like a sled going down a snowy hill. Parents who assist their children with anxiety in gaining exposure to novel environments and working through problem solving as independently as possible promote brain growth and development.

C.D.’s parents wisely prepared him with the tools to discover his own solutions BEFORE meltdowns. When C.D. felt seen, safe, soothed, and secure, he worked with his Mom and me on collaborative and proactive problem-solving approaches. In Ross Green’s The Explosive Child, he describes this model as “Plan B”, consisting of three steps: Empathy, Define the problem and Invitation. “The Empathy Step involves gathering information from your child to understand his concern or perspective… The Define the Problem Step involves communicating your concern or perspective… The Invitation step is when you and your child discuss and agree on a solution that is realistic.”

We also used the Socratic method to help C.D. know his thoughts. This old timey philosopher – even old timeir than Bill Clinton, promoted Ask, Don’t Tell. Don’t just tell the child the solution; have the child think it through on their own while you give positive reinforcement and active listening support. This stimulates critical thinking and such dialogue illuminates ideas because the learning is now multimodal. Multimodal learning (using as many senses as possible) is best for mastery and retention. We remember about 10 % of what we read, 20% of what we hear, 80% of what we speak, and about 90% of what we do. Having your child teach the information to you is a wonderful strategy because when you implement what you have just learned, you instantly make mistakes. Mistakes force the brain to focus and rethink alternatives.

Children need to practice handling stress, fears, deadlines and mistakes. The acceptance of “Not always getting it right” is a lesson we need to demonstrate and teach. It promotes brain growth and life long learners.

Socrates Joke: Plato says to Socrates on their first meeting, “Why don’t you ever have a girlfriend?” Socrates responds, “You ask too many questions.”

Persevere and remember to laugh. Laughter is like cross fit for the brain. It engages and strengthens multiple regions across the whole brain and promotes flexibility. Dr. Daniel Goleman a brilliant psychologist who conducted vast research for his Emotional & Social Intelligence books, states, “Laughter helps people think more broadly and associate more freely.”

2. Don’t be too permissive. Letting children do whatever they want, whenever they want does not “take the pressure off”. In fact, too much freedom may cause a child anxiety. Children become fearful and overwhelmed when given too many choices and denied limit setting. Set boundaries. Provide structure and clear, consistent rules so your children may concentrate on learning, growing, and exercising self-control, leaving the responsibilities of mature decision making to you.

C.D.’s Mom followed through on the structured agreement. After completing what he was expected to do, C.D. earned bowling fun as planned. Understanding that clinical trials show that regular exercise works just as well–or better than–medication for anxiety, C.D.’s family also helped him increase his daily exercise which again added structure and consistent rules.

“If you do what is easy, your life will be hard. If you do what is hard, your life will be easy”. Less Brown

3. Don’t forget to practice relaxation. It is physically impossible to be in a relaxed state and experience anxiety. The states are mutually exclusive. There are many self-regulation relaxation techniques you may teach your child. Research simple breathing and mindfulness exercises to see which may best fit your family’s needs. Then, practice those with your child several times during non-stressful, quality one-on-one times. Later, when anxiety does arise, the child is armed with more ability to self-regulate with these now familiar exercises that have been paired with happy, calm times.

Here are the exercises C.D. practiced with his Mom:

Practice the following steps 3 times a day for 5 days for 3 to 5 minutes per session:

Step 1. Breathe on purpose – to increase blood flow to the thinker. (Reversing fight-or-flight blood flow) Inhale through nose deeply.
Step 2. Hold a deep belly breath for 10 seconds – SMILE and assume dominance posture.
Prior to learning this strategy, we taught C.D. about the power of body language and his power to program his brain.
Step 3. Blow out through mouth verbally or mentally saying, “release”, “peace”, “batman” …or whatever word works for you.

If your child learns well through videos, I highly recommend these two TED talks:

Amy Cuddy’s “Your Body Language Shapes Who You Are” = http://bit.ly/1wRPBDC
Kelly McGonigal’s “How to Make Stress Your Friend” = http://bit.ly/1rF7KXp

Some of the concepts from the aforementioned videos we shared with C.D. were examples of how our physiology affects our feelings. CD knew that when people are happy they smile; however, he also learned that when people put their mouth muscles into the shape of a smile (like when holding a pencil across their mouth) it also makes them feel happy. C.D. learned feeling powerful also works both ways. Like Amy Cuddy suggests, C.D. practiced standing in a powerful Batman-like posture so he could make his brain release chemicals that would make him feel more safe, confident, and strong. Cuddy is a social psychologist who presented significant research showing how 2 minutes of such dominant body posture literally raises testosterone and lowers cortisol, your stress hormone.

C.D. also learned from psychologist Kelly McGonigal’s content that if he thought about his worry as beneficial – it would be by giving him more oxygen to think and move.

C.D. was only five years old, so we just explained highlights, but McGonigal’s research is fascinating. The Harvard study reported that those who re-envisioned their stress as energizing and helpful became less anxious. Additionally, “the physical stress response changed.” McGonigal explains that, “in a typical stress response, your heart rate goes up, and your blood vessels constrict… And this is one of the reasons that chronic stress is sometimes associated with cardiovascular disease. It’s not really healthy to be in this state all the time. But in the study, when participants viewed their stress response as helpful, their blood vessels stayed relaxed… Their heart was still pounding, but this is a much healthier cardiovascular profile. It actually looks a lot like what happens in moments of joy and courage…And this is really what the new science of stress reveals, that how you think about stress matters.

4. Don’t reinforce negative perceptions. Teach your children to choose accountability over victim-hood. As Victor Frankl writes in Man’s Search for Meaning, “In the concentration camp, every circumstance conspires to make the prisoner lose his hold. All the familiar goals in life are snatched away. What alone remains is “the last of human freedoms – the ability to choose one ’s attitude in a given set of circumstances.” Parents and children can do this. When roadblocks come up we have the power to choose our response.

C.D.’s repetitive “I CANT do it!” phrase let him know he was feeling afraid to fail. By trying new hard exercises with him where we all failed often, we modeled and reinforced the perspective that messing up is not a problem. In fact, failing really helps us get better faster. C.D. learned he could respond to his fear of failure differently-he practiced trying and thus growing.

We encouraged C.D. to feel his fear then be grateful for it, as FEAR is needed for courage.

C.D. learned that failures teach us how to be successful. He replaced his self-defeating maxim with, “I can try.” (I was rooting for “I can do it!” but the growth choice was his.

5. Don’t give up. Avoidance is the primary way most of us deal with anxiety – which is not best practice. In her book, Mindset: The New Psychology of Success—How We Can Learn to Fulfill Our Potential, Carol S. Dweck confirms how a “growth mindset” can change the meaning of failure, not by eliminating the distress and anxiety, but by taking control of the painful experience so that it does not define you but rather is processed as a problem to be faced and learned from for betterment.” When we take advantage of the opportunity to change and better ourselves, it takes the hurt out of the pain.

Furthermore, Dweck writes, “People with the growth mindset know that it takes time for potential to flower,”as she accounts researching Paul Cezanne’s early paintings and finding they were pretty bad. It took time for Cezanne to become Cezanne. Give your child the time and permission to make mistakes and learn while becoming his/her highest self.

Understanding the logic behind strategies is essential to help a child better manage fear. Be straightforward about what you are suggesting and the reasons why it works. C.D. learned the whys and he was inspired to do and be more.

Meaning matters. Meaning automatically improves motivation. Whenever possible, explain the “Why”. A child with test anxiety may say, “Why do we take tests? It’s so stupid, I know this stuff.” A parent may explain that actually research shows test taking significantly improves learning and recall. The act of being tested requires the learner to reshape and categorize the information into personal, meaningful associations, which then become accessible, long-term memories.

Meaning matters. That is why placebos have an effect on the brain. The human brain anticipates outcomes and that anticipation has a real effect. C.D. understood the reasons why his trying would improve his performance and decrease his fear. His choice to try made sense to C.D.; so the positive outcome was a product of both his practice and expectation.

The Worry Solution: Using Breakthrough Brain Science to Turn Stress and Anxiety into Confidence and Happiness by Martin Rossman expands on the positive side of worry. Rossman sees it as a way for us to turn over and solve a problem in our minds. Worry need not be a negative cycle. One can learn to “worry well” and “harness the very power of imagination that creates worry and stress… sort them into those you can and cannot do something about, and tap the wisdom buried deep within you to help solve problems creatively.…Not only can you start to see a change in your stress levels immediately, but with regular practice, you may literally alter the worry pathways in your brain—and ‘hardwire’ yourself for calmness and clarity.”

You matter. Thoughts become chemical. Treat yourself well in advance.