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Breaking free from the prison of intrusive thoughts

Intrusive ThoughtsIntrusive thoughts are the unwelcome, uninvited ugly thoughts that skitter through our heads now and then. Everyone has them. Think about a time when you stood on a balcony and thought, “What if I jump?” That’s an intrusive thought. (Note: Other than this example I won’t be listing other intrusive thoughts because folks who are sensitive may be triggered by them so I’m going to stick with the balcony throughout.)

These thoughts get problematic when they don’t skitter through. Instead of a passing thought, “What if I jump?” the intrusive thought keeps the thinker frozen on the balcony replaying the possibility over and over. People struggling with intrusive thoughts become afraid that they want to jump or that they will jump or that they’re meant to jump. Is the thought telling a truth they don’t want to confront? They wonder if they’re going crazy.

Intrusive thoughts are common in new moms, particularly those dealing with postpartum depression and anxiety. Again, it becomes problematic when those thoughts get stuck and we feel unable to function.

Sometimes in postpartum the intrusive thoughts are ones of us doing harm to our children and this can be terrifying. I haven’t met a new parent yet who hasn’t thought, “Let’s hit rewind. Let’s not do this. Let me get more sleep first. I’m not ready.” But when we couple those super normal feelings along with intrusive thoughts, it’s terrifying. Visions of news stories rocket through her head — what about those moms who did hurt their children? — and it’s no wonder that her anxiety spirals even further out of control.

Children have intrusive thoughts, too, and because kids tend to be very black and white in their thinking, they may think that bad thoughts mean that they are bad people. Many of our intrusive thoughts are embarrassing or shameful, many of them are about hurting ourselves or others or may be sexual in nature. Kids who are trying to figure all of this out — bad feelings, angry feelings, sexual curiosity — may be too ashamed or scared to tell parents.

Intrusive thoughts can be part of a Obsessive Compulsive Disorder (OCD). The thoughts are the obsession and the compulsion is whatever the child or adult needs to do to make the thought stop.

How do you know if you or someone you love is having intrusive thoughts?

  • The thoughts come out of nowhere. You’re unpacking at the hotel, in a good mood because your vacation’s started, and suddenly you’re thinking about jumping off the balcony. The thought is disconnected from your mood and your actions, it may be triggered by a passing piece of the landscape or when someone walks into the room.
  • The thoughts are upsetting to the thinker. The thinker does not want these thoughts and starts to avoid triggers (won’t go near the balcony, for example).
  • There is ritual tied to the thoughts. The thinker has to do something to get the thought out of their head — sing a song, wash their hands, tense their jaw three times. A child continually comes to their parent for reassurance (a sign that their compulsion includes action on the parent’s part to help them turn the thoughts off).

So what can you do?

  1. First of all, know that intrusive thoughts are treatable. Anxiety is treatable. We do not have to be imprisoned by bad or scary thoughts.
  2. Do not try to stop the thoughts because, ironically, that’s what makes them stick around. (It’s that old, “Don’t think of an elephant” joke. Say that to someone and they won’t be able to NOT think of an elephant.) Remember that we all have intrusive thoughts but as long as they come and go quickly, they’re not an issue.
  3. Recognize the anxiety that comes up when the thoughts come up. Practice relaxation techniques — deep breathing, gentle movement, visualizing the thought washing in on an ocean wave and receding with the wave. Help your body relax so that your mind will be able to release the thought.
  4. Remember what I said about not stopping the thoughts? Not stopping them, letting them come and go will help us get used to having them, which will reduce our anxiety about them. When they show up we can learn to say, “Oh look it’s you! That unwelcome, uninvited thought!” Getting used to them will reduce our sensitivity to them.
  5. Another way to reduce our sensitivity is to tell someone about them. This is where a counselor can come in handy because counselors are bound by confidentiality, which means you can trust that they will never ever ever tell anyone what you say in the office. Note: Some people are afraid to tell a counselor because they know that we are also bound by ethics that say we have to alert authorities if someone is going to hurt someone. But we are also trained to recognize intrusive thoughts. (This concern can be especially present for new moms who may also have intrusive thoughts about someone taking their baby from them.) If you’re unsure, ask them. Say, “I think I’m having intrusive thoughts but I’m afraid to tell you about them.” That’s OK; learning to manage anxiety is a process.

It’s easy to get stuck in intrusive thought traps — thinking that there is meaning behind them (there isn’t! They’re just brain blips!), thinking that you have to make sense of them (you can’t! because they don’t make sense!). It does not mean we want to hurt ourselves or someone else. It does not mean we want to perform that sexual act that showed up unbidden. It does not mean that we want to do that embarrassing thing that just occurred to us. Our brains are capable of putting together some weird ideas but having a thought is in no way shape or form the same as acting on it.

Dealing with intrusive thoughts isn’t easy and it’s definitely a place where I think counseling can make a huge difference. A neutral person to hear your thoughts, to help you learn to manage your anxiety around them, to support you and to believe in your ability to heal is a big, big deal.


Anxiety is a Dirty Rotten Liar

Anxiety is a Dirty Rotten LiarAnxiety loves to tell lies. Anxiety likes to stand behind you and reinterpret the world in a negative way. Someone tells you that they like your shirt? Anxiety whispers in your ear, “They just feel bad for you leaving the house looking like that.”

Anxiety blows it all up and makes everything worse. Anxiety is a dirty rotten liar.

But the biggest lie anxiety tells you is that it’s telling you all of these dirty, rotten lies for your own good; anxiety lies by telling you that it’s just trying to keep you safe.

“I just don’t want you to get hurt again!” Anxiety says. “I just don’t want you to get in a wreck so I make you too nervous to drive! I just don’t want you to lose your job so I need you to check that submitted file for the umpteenth time for typos instead of getting some sleep!”

What we need to do is the same thing we’d do with anyone we thought was lying to us — we need to confront them about their lying.

Recognizing Anxiety

The first thing to do is to get good at spotting it when anxiety is doing the talking. This sounds easy but when we get anxious we don’t always know that it’s anxiety; we think it’s real. We think, “Oh lord, am I nervous” or “Oh gosh, am I scared” or “Oh man, I’m overwhelmed” and we run with it. When we acknowledge that anxiety is this voice living alongside us, we can say, “Oh lord, am I nervous but I think that’s my anxiety talking.” That alerts us to look for the lies.

We are having an experience — eating an ice cream cone, seeing a dog run across the field next to the park where we’re pushing our kid on a swing, ironing our clothes for work tomorrow — and then anxiety comes in and colors what’s happening. Suddenly that ice cream is a stand in for every body image issue we’ve ever had. Suddenly that dog is Cujo waiting to spring. Suddenly work is a pit of despair and fear. But when we see that anxiety is the overlay, we can go back and say, “Before I go there, down the anxiety path, I can stop and recognize that I’m just having this very specific moment right now.”

That’s the first step.

Speaking Truth to Anxiety

The next step is recognizing that anxiety is not the expert on the situation. Remember, anxiety is a liar and wants you to see things through it’s lying lens. Anxiety will turn an ice cream cone into a major moral dilemma. What we have to do is talk back to it, speak truth to it. We do this by recognizing the way that anxiety distorts our thinking; these are called cognitive distortions or thinking errors.

Here’s the hand out that I use the most in my office: Unhelpful Thinking Styles You can download it and put it on your ‘fridge or the mirror in your bathroom or just keep the PDF handy on your computer.

This is how it works. You need to call and order a pizza only you don’t like to talk on the phone. Talking on the phone makes you nervous. Your hands start to sweat and your throat starts to close up. You start worrying about making that call. What if they don’t understand you? What if you forget how to order a pizza? What if there are all of these choices and you freeze and can’t remember and the person taking your order thinks you’re stupid?

The first thing you do is take a deep breath (because you have to calm your body down to get to that thinking part of your brain instead of the scared REACT part of your brain). Then you speak truth to those lies.

Jack Nicholson saying that you can't handle the truth

This is you, blowing anxiety’s mind

You look at your handy hand-out posted on the ‘fridge and you say to yourself, “I’m really jumping to conclusions. Why would the order guy think I’m stupid if I get confused by the crust choices? People find those dumb crust choices confusing all of the time. Boy howdy am I practicing some emotional reasoning. Just because I feel scared to order a pizza doesn’t mean it’s actually a dangerous thing to do. It’s not like ordering a pizza on the phone is putting me at any kind of actual risk. And oh my gosh, am I doing some catastrophizing or what? It’s just a pizza order for crying out loud!”

You may still feel the way you feel but this is the first step to dismantling the elaborate false front that anxiety is building around you. You can talk yourself down from this. You can remember that anxiety is a dirty rotten liar but you know the truth or at least you know how to get there.

Somatic Symptoms of Child Anxiety

Somatic Symptoms of Child AnxietyLast night for the Parenting Kids with Anxiety group we discussed the way anxiety can affect our kids’ bodies.

Somatic symptoms are often mistaken for something else, which can get in the way of getting appropriate help.

The most common somatic symptoms of child anxiety are these:

  • Restlessness (inability to sit still, fidgeting with clothes or objects, chewing on fingernails, etc.)
  • Stomach problems (butterflies, pain, nausea, a need to go to the bathroom)
  • Blushing
  • Heart palpitations (also panting, wheezing)
  • Muscle tension (headaches, other aches & pains)
  • Sweating
  • Shaking

Behavior problems are common in anxious kids for several reasons including the somatic symptoms. Kids who are too tense and fidgety to sit still may be reprimanded in school, which may increase their anxiety. Anxiety is sometimes misdiagnosed as ADD/ADHD because it can make it so hard for kids to focus. However children with ADD/ADHD can also have anxiety and it may be missed because observers assume it’s part of the child’s attention problems.

Kids who are anxious may act irritable, mouthy, weepy and generally difficult. Part of this has to do with the somatic response; most of us act yucky when we feel yucky.

The physical symptoms of anxiety are real — they’re part of the Fight/Flight/Freeze fear reaction. In other words kids aren’t making them up or making themselves sick to get out of the things that make them anxious.

When we are afraid, our bodies go into protective mode. Our muscles get tight so that we’re ready to react. Our adrenaline kicks up, which makes us get sweaty and makes our heart and breathing come faster. The cascade of chemical reactions in our bodies can also wreak havoc on our tummies. This physical response not only prepares us to stay safe, it also tells us that we need to be afraid. In other words, anxiety happens on a self-perpetuating loop.

Imagine a 9-year old who wakes up worried about a report she has to give later that day in front of her class. As she’s getting dressed, thinking about the report, her stomach starts to hurt. She heads down to the kitchen only to find that she can’t eat breakfast. She starts to worry about throwing up in front of the whole class and this makes her stomach hurt even more. She can’t stop picturing how awful it will be to humiliate herself and she finds herself worrying even more about the report she spent all last evening getting just right. Her thoughts are worried. Her emotions are worried. Her body is worried, too.

As parents we need to help our kids spot the loop and interrupt it. This takes practice and attention.

For somatic symptoms, parents can help their children identify their physical response to anxiety. In the kids’ groups we’ve taken outlines (like Gingerbread Men) and drawn in where we feel our worries. Kids are often surprised and relieved to find out that symptoms like sweaty hands or shakiness are common. Knowing what’s happening can help children feel more in control of their anxiety response.

Interrupting the physical part of the anxiety loop means addressing the physical symptoms. Deep breathing, hugs, rocking, and taking a time-out can all help children get their bodies and minds calm. Taking a cool drink of water or splashing cold water on one’s face or wrists can help decrease sweaty symptoms or decrease blushing.

I also really like a set of muscle relaxation exercises created for children with autism who need to prepare for blood draws. They’re simple and easy to remember even for very young children. Some of them are unobtrusive enough that kids can do them under their desks at school or in the car before heading off to an event. You can find them in this PDF, Taking the Work Out of Blood Work, on pages 11 to 13.

The exercises take practice to get good at them and parents can do them with their kids before bed since that’s a great time to practice getting calm. That way when children do start to feel anxious, they’ll be prepared with familiar exercises they already know how to do.

If you’d like to come to the next group, just sign up for an email reminder at the Parenting Kids with Anxiety web page.

Five Nights at Freddy’s: What it is

tunneldark-inside I decided to write this after someone on my Facebook posted about how scared her child is about this game. I’m hearing about it a lot these days — in the anxiety groups, in sessions and in my own home.

Five Nights at Freddy’s is a video game that has both computer and app versions (for Kindles, iPads, etc.). The plot is this: You work at a place like Chuck E. Cheese where animatronic animals come alive at night. You’re the security guard. Your job is to stay alive over all five nights. The animatronics are murderous and the game relies on a lot of jump scares to keep you tense. Here‘s the whole back story if you want to read it.

Besides the game, there are a number of YouTube videos of people playing it with commentary. (My daughter wants me to tell you that there are “not scaries” of it, too, for kids who want in on the game but can’t watch videos with the scary parts. But there are still a lot of jump scares in them. If I had to watch a Five Nights at Freddy’s commentary video, I’d watch this animated one because it’s not scary at all.)

I’m hearing from kids that this is at peak attention right now (in fact, as soon as I publish this they will probably move on to something else terrifying because it’s so peak it’s probably peaked) but I’m talking about it because if you’re not aware of it you should be and because the issue of viral fear on the internet is going to be an issue whether it’s Slenderman or Five Nights or whatever else the kids are talking about that we’re not hearing about yet.

And that’s really what’s important to know here. In our day it was Ouija boards and Bloody Mary in the mirror at sleepovers and in their day it’s what the internet has to offer. The big difference is that the internet has the capacity to make things more real. People can create whole worlds online to populate their creepy fantasies, which makes urban legends feel a lot less legendary and a lot more like fact. (My friend on Facebook says that what pushed her child over the edge is that people have created a digital footprint for the pizza place featured in the game to help cement the idea that the whole thing is real. Here’s a kid who made a video about that.)

What I’m saying is that Five Nights at Freddy’s may be what’s happening now but the challenge is not Five Nights at Freddy’s. The challenge is helping our kids be critical thinkers, to manage their anxiety, to figure out how to curate their own internet experiences and to stand up to people out to scare them.

Middle grade kids have some developmental demands that make them particularly vulnerable:

  • They are shifting to be more peer-oriented and independent, meaning that if their 10-year old friend says it’s true then his voice might carry a tad more weight than your voice of reason does;
  • They become more aware of the wide, wide world and the scariness in it, which is why they may be fascinated by scary stories;
  • Their bodies are changing and/or their friends’ bodies are changing and/or they’re becoming more aware of impending change, which may cause them to sublimate this fear into urban legends. Think about it, adulthood is for real and true pretty scary but kids can’t really verbalize this kind of existential fear. It’s a lot easier to be terrified of murderous robotic rabbits.

And now you see why Goosebumps were all the rage for middlegrade 90s kids, too, right? These fears serve a developmental purpose and many of our kids will need grown up help to meet that challenge and grow past it.

So what can concerned parents do?

Set limits: Learn about parental controls. Turn on YouTube safety mode. If you want to install a blocker then by all means do. You may want to create rules like screen time happens in community rooms of the house or that certain apps may not be installed on a child’s tablet. You decide and stick to it.

But be realistic: You can limit access to these games and web sites and videos but you do need to know that your ability to do this will be hampered both by the limits of parental control and by all the kids whose parents don’t block access. Between phones and iPods and Kindle Fires and family computers at someone else’s house, you need to expect that even the most protected child is going to catch sight of these things. That doesn’t mean you should throw up your hands and have a Freddy’s free for all. No, you can still limit it in your home because you’re not just trying to protect your child from the sight of it, you’re also modeling how we care for ourselves in the internet age. We are modeling that if something disturbs you, you should click out. So, yes, live out your family values and set those limits up but don’t assume your work then is done. You’re still going to need to deal with it because your child is going to need to deal with it.

Focus on real consequences instead of punishment: Part of learning to handle the internet and peers is messing up. Kids have to watch a video sometimes to know, oh rats, I should not have watched that. Very often that sinking feeling is a big enough consequence that you won’t need to create any of your own. The internet has a lot of yucky things on it and even the tightest of parental controls won’t keep all of it from slinking through. It is very likely that children will see naked ladies and creepy videos on purpose and on accident. Talk about this possibility before it happens. Talk about what your family values are around this. Talk about what you expect them to do. Let them know that if they see something online that they don’t like, you want to hear about it. When the time inevitably comes, listen with sympathy and then reiterate the rules. What can they do (if anything) to prevent the likelihood of that happening? What should they do if it happens anyway?

Explain to them about their vulnerability: Let them know that this is part of being 8 or 9 or 10. Explain that scary things won’t always feel this scary. Let them know that you are there to help them get through this developmental hurdle. Talk to them about fears that they used to have (that they’d go down the bathtub drain, for instance) and tell that this is like that. You can say, “I know Five Nights at Freddy’s seems really real but it’s no more real than the bathtub drain.” Promise them that they won’t always be this scared. Sometimes knowing that there is a way out (even if you can’t see it) can help. And along those lines…

Share your own middle-grade struggles: I’m not saying sit down and watch old school Poltergeist with them but talk to them about the thing that scared you when you were their age and tell them how you grew out of it. This can be a good exercise for you, too, to remember how scary unreal scary things can be; to maybe come up with solutions (what worked for you?); and to give your child a concrete demonstration that these fears can be conquered. (Ok, maybe you still wouldn’t keep a clown doll at the end of your bed but I bet you no longer quake in fear about that tree outside your window, right?)

Help them get to the bottom of things: You don’t need to bookmark Snopes.com on your kid’s tablet but you can teach them basic information about truth, lies and urban legends. Understanding the way stories get written, how they spread and why we do it can help diminish some of their power.  How Stuff Works has a series of posts on urban legends and AmericanFolklore.net has resources for teachers and parents who might want to delve in further. For some kids, being able to get control in this way can help them feel more powerful and less scared.

Ask for help: Come to the Kids & Anxiety workshop next week to learn more about helping kids handle their worries appropriately. If you can’t be there, contact me and ask for my hand outs. If you think your child might benefit from counseling, let me know. If I’m not the right person to help him or her, likely I know a therapist who can. I’m also going to be running a group again this summer and you can learn more about that here.

Is it all my fault?

Is it all my fault?It’s the therapy stereotype, right? It’s always your mother’s fault! No wonder then that many of the parents I see come in feeling defensive or feeling guilty.

“Did I do something wrong?” they ask me. “Did I create these issues? Is it all my fault?”

My answer to this is probably going to feel frustrating: I don’t know and what’s more, I don’t think it matters.

Here’s the deal: different kids need different kinds of parents and sometimes those different kids live in the same family, which means the fool proof technique you had for dealing with one child’s tantrums is not necessarily going to work with dealing with the next child’s tantrums. In fact, it might make things worse. Remember there is no one size fits all parenting.

Let’s take childhood anxiety. Anxiety has at its core a whole lot of nature and a healthy dose of nurture. Parents with anxious temperaments often give birth to children with anxious temperaments. That’s not anyone’s fault; that’s genetics. Also parents who deal with the world in an anxious way inadvertently model that anxious way of dealing with the world for their children. That’s nobody’s fault either anymore than the way parents who read a lot tend to have kids who read a lot. Modeling is powerful.

That said, once the family realizes that their child is struggling with anxiety there is an opportunity to explore the way that parenting choices may be influencing that struggle.

Let me give you an example. Consider bedtime routines. Any parenting expert type out there will tell you that bedtime routines are terrific, right? Do a quick google and you have people promising you that having a routine will make your evenings “battle-free” and “sleep-inducing.” And I agree — having a predictable routine before bed is great sleep hygiene. But if you have a child with an anxiety disorder then that friendly little routine can become a prison where mom or dad has to stand in the doorway and say “Good night” exactly this way with exactly that inflection or the whole routine has to start over again.

Then it may be that changing the parent’s behavior is part of what needs to happen next — the solution may lie in part in the parent’s actions — but that’s not the same thing as saying that it’s all the mom and dad’s fault for creating a bedtime routine in the first place.

When my son was small I used to fantasize about having a Sims-type game where I could program all of my son’s characteristics into the computer and try out different parenting choices to see which would be the best one. Like, this Sim-baby I could send to preschool and that one I could keep home. This one I could be really stern with and that one I could lean more towards permissive. At the end of the game I’d know exactly the right way to raise my actual baby here in front of me.

Unfortunately we don’t have that. Instead we have a lot of advice and a lot of research, (which is helpful but not definitive) and a lot of books and neighbors and teachers and therapists and then we have our own hopes and dreams and histories and expectations. Then throw in kids with wildly different temperaments, abilities, interests, talents and challenges and well, we end up with a whole mess of confusion.

In short, we’re going to do some things right and we’re going to do some things wrong. Sometimes the wrongs are no big deal and sometimes we’re going to have to course correct. Sometimes a bedtime routine is awesome and sometimes it’s ripe with dysfunction for no other reason than there’s a perfect storm of this parent, this technique and this child and it’s not working.

(This is also why none of us should ever be smug with each other. Show me a parent who has a child who is a shining beacon of perfection and I’ll show you a parent who got lucky. In parenting, like in all things, some of us have it easier than others just because.)

So if you come to me and say, “Is this all my fault?” I’m going to say that I think you’re asking the wrong question. I’m going to encourage you to say, instead, “What can we do now to help things be better?”

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