Anxiety is Paralzing

By, Danny Qian, M.A.Ed.

The child of one of our very close friends (I will just call her Cindy) was diagnosed with Generalized Anxiety Disorder (GAD) with many Obsessive Compulsive Disorder (OCD)-like behaviors, not too long ago. Since I am a certified behavior analyst, when Cindy was younger, our friends asked me for ideas on behavior interventions to help Cindy. The results from the behavior interventions appeared to be very good, as all of their friends thought that Cindy was the model child, behaviorally speaking. To their friends, Cindy was respectful, caring, thoughtful, gentle, fun-loving, and kind. The only issue with the picture presented to everyone else outside of their immediate family, is that it was an incomplete picture of Cindy. Cindy suppressed and held in all of her anxiety and OCD thoughts and exploded when she was in a safe environment, like when she was at home. Her explosions included 20 minutes to 2 hours of non-stop crying and screaming, only able to weep and point with her fingers when asked “what is wrong?” She was unable to communicate with her words at all (even though her IQ test results had her in the High IQ range, she had met all of her typical developmental milestones, and usually was a chatterbox and would not stop talking). Anxiety is paralyzing. Near the tail-end of each episode, she would finally be able to force out an utterance or a short sentence, and sometimes she would exclaim, “I hate my brain!” over and over again. My friends were emotionally drained after each episode from Cindy’s anxiety attack. Anxiety is devastating not only for the individual with GAD, but also to everyone close to that individual.

In all things, God works for the good of those who loves Him (Romans 8:28). God seemed to have used the pandemic, to help our friends, who were home more, focus on Cindy’s mental health issue, and really get the help she needed. After her evaluation, the child psychologist (who also happens to be a behavior analyst) made a recommendation to have Cindy receive cognitive behavior therapy (CBT). As they went through the therapy sessions with the therapist, to our friends’ surprise, the behavior interventions I suggested earlier on for Cindy, when she was younger, were not far off from the cognitive strategies the therapist directed them to use with her as well. Of course, there were modifications to those interventions, but the principles were the same, and are empirically supported. They are now starting to see Cindy being her kind, gentle, caring, thoughtful, fun-loving, self, almost all of the time. There is still about one percent of the time, when her anxiety and OCD thoughts creep into her head, and she would have a meltdown here and there, but they are no longer afraid of the mysteries of GAD and OCD, and neither are they as emotionally drained (since they now know it is the OCD thought inside of her head causing her to act a certain way and not really her, per se). In addition, they now have many teaching tools to prevent or re-direct her to avoid a complete meltdown from an anxiety attack.

There are many children in the world with OCD (1 in 200 children are diagnosed; and probably many more that are undiagnosed); however, the behavior interventions that my friends are using can effectively help with any child with or without mental disorder or cognitive delays.  Below are the very effective behavior interventions infused cognitive strategies that are currently being used for Cindy and revised to help any child:

  1. More structured day with many activities (to keep her mind busy and typically, if a child is busy, it will keep him or her out of trouble).
  2. Teach her that having “bad thoughts” are normal, but also train her to also practice thinking about positive thoughts (i.e., sunsets, favorite food or desserts, favorite vacation, etc.). This strategy is more GAD and OCD specific; but the principle can help with any bad behaviors. For example, if a child does a bad behavior for attention (i.e., hits parent and the parent scolds the child, which is a form of attention), you can teach that child to replace that bad behavior with a good behavior to get the same attention (i.e., tap the parent’s shoulder, or using words “dada,” “mama,” “daddy,” “mommy”).
  3. Behavior contracts: you can call it a “challenge.” A game written on a white board, where there are three rows. Row one is the “waiting challenge;” when she waits to do an OCD act (i.e., wait until shower time to wash her feet and not wash her feet right after she comes into the house every time). Row two is the “opposite challenge;” when she does something opposite of what her OCD tells her to do (i.e., go and unlock the door in her home, even though she constantly, every 15 minutes, scans all the doors in her home to make sure that they are locked). Row three is “the reward;” she picks a reward that she will earn after earning certain amount of points from these challenges (i.e., going to Baskin Robins for ice cream). Just like a video game, to start off, she only needs a few points to earn her reward, but it gets more challenging, and she will need to earn more points as time goes by and she becomes better at doing her challenges.
    • This can also be tailored to help with any type of “bad” behaviors that we want to change. This type of contract will work better for older children or children who understands the video game concept, level system, or is able to wait for a while to receive a reward. For example, if a child is always having tantrums during mealtime, the parent can set up a behavior contract with the child to only give a reward if the child has a successful mealtime (the parent will have to define what is considered successful).
  4. Review some actionable things she could do if she is anxious about a certain activity (which then usually leads to a meltdown). For example, if she is anxious about being late to school, she can set alarms 1 hour before and 5 minutes before she has to leave for school. She can pack everything she needs the night before school and be ready to just grab her bag.
    • This can be tailored to help with any difficult transition activities. For example, if the child has difficulties and has tantrum whenever going to new places or old places that he or she hates (i.e., the dentist). The parent can show videos of virtually going to a new place, like a zoo, before the child actually goes. The parent can also help the child be less anxious to go to a place (s)he hates, like the dentist office, by having make-shift dentist items around and whenever (s)he does one thing in the make-shift dentist office, (s)he gets a small reward (i.e., a few pieces of favorite potato chips). So, (s)he will go through each step (i.e., reception area, the dentist chair, putting on the bib, putting on goggles, having light shining in his eyes, etc.) of going to the dentist office by going through it at home first with the make-shift dentist office.
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