Surprising Anxiety Trigger 7: Something That Happened a Long Time Ago

Your daughter watches “Finding Nemo” for the first time and becomes very upset when Nemo’s mother dies at the start of the film. You comfort her appropriately, and she seems to recover. After all, children are surprisingly resilient, and your daughter will surely forget all about the scene soon. Weeks (or even months) later, your daughter starts displaying unusually severe separation anxiety. She’s reticent when questioned, but you assume something very recent has triggered her increased anxiety.

Unfortunately, though children are indeed resilient, they often become haunted by the scary things they see in life, on TV, and even in dreams. Sometimes they dwell on things that frighten them, spending days reliving their fear. In other instances, the scary event only slips into their minds when triggered by unrelated anxiety, random association, or perhaps a relevant song. Either way, children often feel embarrassed by their inability to release scary memories from the past. Encourage your child to share her feelings by listening with interest, respect, and love. Never mock a child for dwelling on old fears; you may be tempted to say “You’re still upset about that?” but it’s important that you display support instead.

If your child expresses lingering or recurrent anxiety about a minor trauma in the past, explain that it’s normal to sometimes feel stuck with a fear, and then help her address the fear directly. Humor can be helpful (“I promise not to get eaten by a fish”) if your child fears supported and respected. If your child cannot release her fear, it may be necessary to discuss the issue with your pediatrician or mental health professional.

If your child has experienced significant trauma in the past, it’s crucial that you speak to an expert as soon as possible.

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Surprising Anxiety Trigger 6: Music

This is the sixth installment of the ongoing series of surprising triggers of childhood anxiety.

We all know that music can dramatically influence mood, but it’s easy to forget that songs have different effects on different people. Songs are often strongly associated with specific memories: Though I believe the song came out years earlier, “We’re Going to Be Friends” by The White Stripes conjures my senior year in high school so dramatically I get almost giddy when I hear it; 12th grade was one of the best years of my life. Alternately, I can’t listen to Sum41’s first album (and luckily wouldn’t care to anyway) because it brings me back to the anxiety and despair of eighth grade. Children have fewer things to remember, but they may also associate songs with memories. A favorite family lullaby heard while away from parents might trigger separation anxiety, or a song from a scary movie (and remember, children are often scared by seemingly benign movies) might cause sudden unease. These associative memories are too complex for most young children to express, so it’s up to parents, caregivers, and teachers to help anxious children explore their fears.

Even if you’ve never heard a song before or don’t have any strong associations to it, some music just makes you feel bad. Sometimes a piece of a lyric can be scary, or sometimes there’s a scary story being told. I mentioned before that “She’ll Be Coming ‘Round the Mountain” was agonizing for me in preschool because I took the lyrics to mean that the singer’s mother was coming but hadn’t yet arrived–and she never even gets there! Also, don’t underestimate the effects of a “plaintive melody” or a dramatic swell. For most people, the melody of the song is actually more powerful than the lyrics. (Yesterday, my roommate pointed out the story being told in “Sittin’ on the Dock of the Bay.” It’s not as whimsical as you might guess.)

If your child or student becomes distressed during a song, it may be helpful to ask the child whether she’s heard the song before, and where. Next, explain that songs can make you remember something really strongly or even just make you feel a strong emotion. Education, understanding, and training are the best tools to mitigate anxiety, so always use anxiety attacks as “teaching moments.” Then, after the anxiety has been addressed, use distraction to help your child feel normal again. And consider changing the song!

Class Participation Part 4: Can We Fix Class Discussion?

Welcome to what I expect will be the final installment of my series on forced participation in class discussion!

One More Example of How Class Discussions Fail

Class discussions can be used to achieve a variety of objectives, and there are several “teaching methods” that rely of class discussion. One simple method used for class discussion is concept attainment, “the search for and listing of attributes that can be used to distinguish exemplars from nonexemplars of various categories” (Bruner, Goodnow, and Austin, 1967). Here is a very simple example of a lesson using the concept attainment teaching method:

Mr. A writes a word on the board: Hat. “What are some things you notice about this word?” he asks.

“It starts with an H,” says a student.

“It has three letters!” shouts another.

“Good,” says Mr. A. “Okay, what about this word?” He writes Home on the board.

At this point, most of the students have guessed that Mr. A is listing words that start with H. Some of the class begins to lose interest.

“Have you guessed what the words have in common?” asks Mr. A

“Yes,” replies much of the class. One student explains, “They both start with H.”

“Hmm, that’s true,” says Mr.A, “but let’s keep looking at the list.” Mr. A writes another word on the board and asks more students to guess what the words have in common. He then begins listing words that don’t belong on the list. He encourages his class to offer any ideas they have about the lists, and he allows students to politely challenge each other’s theories. Eventually, Mr. A’s whiteboard looks something like this:

YES
Hat
Home
Drum
Student

NO
Hairy
Red
Run
Sing
Quick
Quickly

I’m bored just describing this scenario.

The theory behind this activity is that Mr. A’s students will more thoroughly understand the concept of nouns and will retain their knowledge longer than if they’d simply been provided with a definition and list of examples. That may be true. However, to many students, slow generation of knowledge is excruciatingly boring. Mr. A encourages all his students to participate in the discussion, so the weaker members of the class struggle to make guesses and are often explicitly wrong. Mr. A is a nice man and a good teacher, so he works with these weaker students and avoids saying “No, that’s incorrect.” Thus, other students become confused, and the discussion takes most of class. Worse, Mr. A requires each student to offer at least one guess during the discussion, and he gives additional points to students who are especially engaged, so the extroverted students babble on and the introverts lose points. Anyone who doesn’t have a guess is forced to make one up. Several students, included those who are introverted, shy or anxious, gifted, or suffering from ADD/ADHD completely lose interest early in the discussion and miss any relevant information.

Here’s the strangest thing about this kind of discussion: giving the correct answer ruins the exercise! Imagine that Jahruba, a gifted student, immediately understands the list once Mr. A explains that “hairy” does not belong on it. He raises his hand and says, “All the words on the list are nouns.” It’s been five minutes, and Mr. A scheduled half an hour for this activity. He wanted his students to explore possible answers and slowly come to understand the lesson. Jahruba just ruined the whole exercise, so Mr. A can’t help but act a little angry as he stutters, “Well….yes…uh…but I wanted you to think about it longer.” Jahruba understands that he has done something wrong, so he stops raising his hand as often, and Mr. A worries that Jahruba will ruin future activities, so he avoids calling on him when he does raise his hand.

How Can We Fix The Exercise?

Having lived through public school, I’ve seen the above scenario play out a thousand times. Here are some tips for teachers who want to engage students in discussion without torturing them.

1. Ask a question and let students privately answer.
If the purpose of your discussion is to guide students toward a correct answer, give students a chance to write the answer down and hand it to you. If the student is right, let her opt out of the discussion.

2. Keep student responses focused.
If a student is so off track she’s prolonging the discussion and confusing her peers, cut her off. You can be polite about it, but be sure to be firm!

3. It’s okay to say “that’s wrong”!
Praising every guess confuses students and discourages active thinking. Thank every student for his participation, but be clear when an answer is wrong

4. Encourage peer support, but point out even subtle errors.
It’s great to allow students to answer each other’s questions, but watch out for subtle errors in each answer. If you find an error, praise the student for the rest of her answer and then explicitly correct her mistake.

5. Ask specific questions.
Kids who don’t speak up during discussion may simply not have anything to say. Asking a specific question can help. Instead of saying, “What do you think about the US Civil War, Jenny?” try asking Jenny whether she believes that the war was primarily about slavery. If she says, “I don’t know,” give her a little guidance and then ask a related question.

I Want to Hear from You!

Teachers: do you “force” students to participate in class discussions? Why or why not? How do you keep your students focused and interested?

Parents: do your children complain about class discussion? What are your thoughts?

Homeschool parents: did you consider class participation when choosing to homeschool?

Post a comment or tweet at me. I’ll RT or respond!

Class Participation Part 3: Introversion, Shyness, and Social Anxiety

This is the third installment in my Class Participation series. Today, I’d like to discuss how forced participation in class discussion affects introverts, shy kids, and students with social anxiety.

Introvert, Shy Kid, or Student with Social Anxiety Disorder?

The term “introvert” is most useful when considered as distinct from “shyness.” Introversion relates to the desire to engage in social interaction, whereas shyness relates to difficulty engaging in social interaction. One of my favorite definitions of introvert is “someone who is energized by being alone.” In this context, an extrovert is someone who is energized by being in a group. I’m an introvert, so I’m easily exhausted by large groups. I often crave time alone. Extroverted friends have expressed confusion about my desire for alone time. I’m similarly confused by these friends’ desire to spend the majority of their time surrounded by others. “If I’m alone, I get depressed,” says the extrovert. “If I’m surrounded by others, I get tired,” says the introvert.

The most important thing to remember about introverts and extroverts is that neither is better that the other. It’s unnecessary and potentially harmful to try to force someone to switch from one to the other.

Shyness or social anxiety can occur in both introverts and extroverts. Shyness can prevent students from expressing themselves and engaging in positive social interaction, so it may actually be beneficial to lovingly encourage shy students to “come out of their shells.”

Social Anxiety Disorder (SAD) is distinct from shyness primarily in that people with SAD experience “fear and avoidance… so severe that they significantly interfere with … daily functioning, school, work, or relationships.” Social Anxiety Disorder is a serious disorder that must be diagnosed by a mental health professional.

Should a teacher allow her students to opt out of class activities just because the student doesn’t like the activity?

All children are born with temperaments and tastes, but it’s important for adults to encourage and allow children to try a variety of activities and personas in order to facilitate emotional growth and self-discovery. Parents know to insist that their children try at least “one bite” of new foods. We know to take children to ballet class and soccer practice and chess club because young children really don’t know what they’ll end up loving. But, when a child clearly expresses an opinion about something that they’ve tried, it’s important to listen. Remember, children are human beings, and they do understand suffering and pleasure. If your child adamantly insists that she hates soccer, you probably shouldn’t sign her up for the team next year. (Obviously issues like these can be somewhat complex, and parents have to use their own judgement. A child who hates vegetables, for example, is likely to benefit from continued exposure.)

We all know that classrooms can be overcrowded and teachers can be overtaxed. As I’ve mentioned, class discussion is a relatively easy way to ensure that students are engaging in some way with class material. I dislike class discussion for several reasons, but today I’m focusing on whether it’s appropriate to force introverted, shy, and anxious students to participate in discussion.

Introverted children who are not disordered are unlikely to suffer psychological harm due to forced participation in discussion, but they’re also not particularly likely to benefit from traditional discussion. As an introvert, I learn best working on my own or in a small, intimate group of intelligent peers. Class participation tends to bore and alienate me, and I only speak up when I have something relevant and unique to say. Reducing the grade of students who share selectively is, in my opinion, absurd. However, a dedicated teacher might engage introverted students by directly asking them specific, interesting questions, or by asking whether they agree with the dominant discourse of the discussion.

Shy kids will suffer when forced to participate in class discussion, but they may also benefit from gentle encouragement. A shy extrovert in particular is likely to thrive in a supportive classroom with a teacher who slowly increases the amount of required participation in class discussion.

How much can a teacher help a student with Social Anxiety Disorder?

As with all anxious children, students suffering from Social Anxiety Disorder can greatly benefit from gentle encouragement. Incremental increases in participation in class discussion may help a student with SAD reduce the severity of her disorder. However, a teacher without proper training is NOT a therapist and should not be prescribing a therapy regimen. I can’t stress this enough: a child with Social Anxiety Disorder should be under the care of a mental health professional, and that professional is likely to prescribe exercises designed to help the child manage her anxiety. Teachers of anxious students should educate themselves, treat their students with respect and empathy, and work with the parents and therapists of their anxious students.

Everyone needn’t be the same!

It’s common knowledge that students have different learning preferences, tastes, and strengths. Trying to homogenize students is futile and, more importantly, bad for society! We need students who love limelight and students who work backstage, students who love reading and students who prefer creating, students who obey and students who rebel. Every student deserves the chance to be her best self. Moreover, school should be enjoyable! Hard work and joy are not mutually exclusive. While it’s important for teachers to push children out of their comfort zones, students should never be punished for anxiety, and they should not be expected to become little copies of their teachers.

Coming up: how to make class discussion effective and enjoyable for everyone

Classroom Participation Part 1: What Happens During Class Discussions?

Last week, The Atlantic ran an article titled, “Introverted Kids Need to Learn to Speak Up at School,” a statement that offends me as both an introvert and a teacher. The article, written by New Hampshire teacher Jessica Lahey, is a thoughtful argument in support of including class participation as an element of grading. I hate class participation points, and it isn’t just because I’m shy or anxious. I hate forced class participation because I hate forcing students to engage in activities that they find unpleasant. I strongly believe that education should be mostly enjoyable and never unbearable.

Participation points are typically awarded in exchange for contributing to class discussions. In my opinion, traditional class discussion has very limited benefits for students. Imagine this scenario, based on countless experiences I had in school:

Mr. A’s students are reading Lord of the Flies. Today, Mr. A has asked his class to discuss symbolism in last night’s reading. Amanda is having trouble understanding the definition of “symbolism,” and she begins by expressing confusion and impatience. Mr. A asks his class to help Amanda understand symbolism. Thomas, a gifted student, explains symbolism correctly but does not emphasize the details that most confuse Amanda, simply because he doesn’t quite understand Amanda’s confusion. Amanda becomes more confused and is now somewhat embarrassed, but she bravely admits that she still doesn’t understand. Most of the class begins to lose interest. A couple more students try helping Amanda, but no one realizes exactly what she’s missing. Finally, Mr. A is forced to move on. He asks the class for an example of symbolism from last night’s reading. Several extroverted students offer examples, some of which are wrong. By now, most of the gifted students have completely lost interest in the discussion. Mr. A asks leading questions in order to help the students discover information, but his weakest students are completely lost and his strongest students are bored and angry. The rest of the discussion is dominated by students of average ability. These students are able to gain some knowledge, but they aren’t given the opportunity to practice more advanced thinking because their gifted classmates are disengaged and alienated by the current level of discourse. Everyone who spoke gets a point for participation, even though most of what was said was, frankly, inane. Amanda is still totally lost, and some of the gifted students have decided to stop listening in class.

Have you or your children/students had similar experiences with class discussions? Do you find my characterization of class discussion inaccurate or offensive? Leave a comment or tweet at me!

Coming up in this series:
Introverts, Anxiety, and Class Participation
My Alternatives to Traditional Class Discussion

Why I Love Labels, Part 3

I truly love labels, but I also acknowledge that labeling a child can cause the child to self-limit. To combat this, I use two cool exercises with my students. I also use these exercises when I’m feeling limited, and they help me overcome self-stigma and stagnation.

The I Can List

A common exercise to improve self-estem in students with disabilities, diseases, or differences involves listing the things that the student can do despite or because of her diagnosis. When I use this exercise, I ask my students to begin by very specifically describing their illness. I’ve found that students with mental illness sometimes believe that they are limited in ways other than those included in their diagnosis simply because they are unclear about what their diagnosis really means.

After each student has identified and described her diagnosis, I have her list the things she can do in spite or because of her illness. It’s important to include personal things that are difficult or took a lot of work.

Child-Kiri would be in awe of the things I can do as an adult. I’d love to show her this I Can list:

I can…

live 3,000 miles away from my family and hometown
fly six hours to see my family
say “okay” and “I’m bored” without whispering or thinking “shut up”
sing onstage in front of tons of people
make new friends
spend the night away from my significant other without having unbearable separation anxiety
ride the subway UNDERGROUND and even in the dark!
wait calmly in a stalled elevator
navigate large crowds
etc.

Even if a student’s I Can list is very short, there’s merit in the exercise. Remember, it’s always amazingly beneficial to emphasize and reward partial successes. Also, have the student include accomplishments and abilities that aren’t directly related to her illness. For example, I can…

write pretty awesome fiction and creative nonfiction
sing
do the splits
etc.

Exploring Identity

The second exercise I use to help my students avoid self-limiting is an original activity I’ve yet to name. I love this exercise and use it all the time with students of all ages.

Step 1: Have each student make a list of ten (or whatever number is age-appropriate) of their most prominent traits. I like to have everyone write “I am:” at the top of the page. Be sure that each student includes both positive and negative traits. While some of the traits can be physical or external (I am beautiful or I am poor), most should focus on personality and ability (I am smart or I am bad at math).

Step 2: Ask each student to convince you, either orally or through an essay, that the traits they’ve listed do NOT in fact describe them at all.

Step 3: Have each student make a second list, this time of the traits they wish to embody. I call this the “ideal traits” list.

Step 4: Now ask each student to convince you that each trait on the list is NOT ideal.

Step 5: Have students revise their ideal traits list. You’d be surprised how often they convince themselves with their own arguments!

Step 6: Finally, have each student share an example of a time when s/he embodied each of her ideal traits. It’s important to end on a positive!

Much of what we think of as our “selves” seems to come from habit. We practice thinking of ourselves as smart or boring or disorganized, and we increasingly inhabit those labels. Labels are incredibly useful shorthand for complex realities, but they are not curses or life sentences. As the poet Dorothea Tanning said, “It’s hard to always be the same person.”

Why I Love Labels, Part 2

Labels are limits. Labeling a child is limiting her. Children, disobedient as they may sometimes be, listen. So why would any parent want to label her child as mentally ill?

A label saved my life. A term, and a list of defining traits that flattened my complex human emotion into bullet points, saved me from a waking nightmare. I can’t overstate it. Words are pure magic.

Labels are limits, and they limited my panic. Knowing its name gave me power over it.

As an educator, I’ve been taught to use what’s called “people-first language” when describing disabilities, impairments, and differences. People-first means you say the person before the label: person with Autism instead of Autistic person. The idea, of course, is that people needn’t be defined by their conditions. If you read my blog or scan my website or follow me on Twitter, you’ll notice that I say “anxious kids” at least as often as I say “kids with anxiety.” First of all, it’s much shorter (and, on Twitter, that’s hugely important). But, more than that, I’m okay with using “label-first” language to describe my students because they are to some extent defined by their illness. And so am I. Anxiety didn’t happen to me. Anxiety is me. I have facets and layers and contradictions (upcoming post topic!) like everyone, but I can’t deny that the “self” that I acknowledge as “me” could not exist independent from childhood anxiety. Calm, prepared, responsible adult Kiri grew from panicked child Kiri, both because panic forced me to learn life skills that other adults lack and because my brain simply has anxiety wired into it.

Some modes of therapy encourage patients/clients to imagine their illnesses as separate from themselves, and I find this tactic extremely useful, especially in children. However, I believe that it’s important to ensure that this kind of thinking doesn’t lead to self-stigmatizing. I am more than my anxiety, but I am my anxiety. I once had a peer ask, “how do I know what is my [mental] illness and what’s me?” While I understand and respect her question, the truth is, brains don’t work like that. Mental illness is, as far as we can tell, pretty complex. An anxiety disorder can’t be cut out like a tumor. Rather than trying to identify a disease-free self, we should focus on becoming as healthy as we can be.

I believe that teaching children to identify and label their symptoms and conditions is the single best thing you can do to facilitate recovery. However, there are definitely some risks involved in labeling children. Children (and adults) may internalize the limitations implicit in their labels and thus impede their own success. A child diagnosed with an anxiety disorder might, for example, believe that he cannot take risks. Part three of this series will include the exercises I use to combat self-limiting in my students, and myself!

This post continues the theme of the disclosure and destigmatization of mental illness. For more information about stigma, check out the Stand Up for Mental Health campaign by HealthyPlace.

Why I Love Labels, Part 1

The insert in a sample pack of Zoloft saved my life.

The Zoloft helped, too. So did cognitive-behavioral therapy, my family, and a couple great self-help books. But the first and most dramatic step away from agony and toward relief was taken the moment I read the insert beside a small cardboard blister pack.

The insert described a panic attack.

Nearly six months before I read that insert, I had my first real panic attack. An anxiety attack is different: the horror I felt when separated from my mother was emotional. Panic, alternately, is in the body. You suffocate. You trade hearts with a hummingbird. The beating isn’t heavy like when you run; it’s faster and wilder, and it hurts. It’s a punch from inside your chest, over and over and loud in your ears. Maybe sort of like drowning. And your hands fall asleep or go numb. You sweat, and you feel sick to your stomach, and you notice a million little signs of death, like how your tongue is choking you or the subtle pop of an artery exploding and wasting all your blood. Yes, there’s terror, but it’s bodily, from your core and in your veins. The fear isn’t in your mind, it’s in your brain. And, though sometimes the panic is triggered by a stalled elevator or news from North Korea, a panic attack is a narcissist. It turns you inward, dampens the world. Panic gets caught in its own reflection.

I was young, and it came without warning and then refused to leave, haunting me instead with convincing warnings about aneurysms and punctured lungs. I realized I was dying. Over and over, I realized it. The attacks, which last only a few interminable minutes, became more frequent and then constant. Eventually I was having several complete panic attacks every day, and symptoms of panic between each attack. I went to bed every night with my heart speeding and woke up every morning gasping and shaking. I never had a chance to catch my breath. I literally couldn’t get an hour of relief. It was like that for almost three months. My pediatrician, whom I begged for answers, told me it was anxiety. Ha! I knew anxiety. I’d been diagnosed with separation anxiety at five or six. This wasn’t anxiety, this was me dying! Obviously.

Finally, after a particularly awful night spent struggling to breathe, my mom took me to a psychiatrist. He listened to my symptoms and immediately identified my condition as Panic Disorder, something I’d never heard of. Medicine and therapy, he said, would fix it. I didn’t believe him, though, until he showed me the insert in the sample pack of my new prescription. It listed the symptoms of a panic attack: rapid heartbeat, feeling like you’re being smothered, dizziness, nausea, believing that you’re dying, feeling like you’re going crazy. Tingling extremities. Feeling dreamy and confused and pixilated.

My face basically exploded. “This is exactly what I have!” I said. “Every single thing on this list. All of them! Every day!”

“That’s Panic Disorder,” said the psychiatrist. And, just like that, my life was saved.

Surprising Anxiety Trigger 5: Medications

A variety of medications can cause anxiety, especially in individuals with anxiety disorders. Before giving your child even over-the-counter medications, consider the risk of increased anxiety. Because the benefits of medication sometimes outweigh the side effects, it may be necessary to coach your child through her anxiety or combat the anxiety with medication prescribed by your pediatrician.

You probably already know that stimulants, like caffeine or amphetamines, can trigger anxiety. Children with ADD/ADHD are often prescribed a stimulant as treatment. Some children with comorbid ADD/ADHD and anxiety can tolerate stimulants. Other children, especially those with Panic Disorder, may experience very rapid heart rate combined with feelings of terror. Talk to your pediatrician or psychiatrist for more information.

Some cough and cold medicines, like the decongestant pseudoephedrine (Sudafed), are also stimulants. These medications can cause increased heart rate, shaking, nervousness, and anxiety. Talk to your pediatrician before giving your anxious child pseudoephedrine or similar medications, and report side effects, especially those that are severe.

Antihistamines like Benadryl (diphenhydramine) typically cause drowsiness, but some children experience a paradoxical effect and become excited or energetic. Anxiety can also occur in this situation.

If your child has asthma, you may already have noticed that his inhaler can cause shaking and increased heart rate. If your child’s asthma medication is causing anxiety, it’s important to ensure that the child is still taking the medication appropriately, in spite of his discomfort. Talk to your pediatrician, and check back for an upcoming post about asthma and anxiety.

Oral steroids, which are sometimes used to treat persistent allergic reactions* can cause anxiety and other changes in mood. A doctor should monitor your child while she is taking oral steroids.

20130116-162753.jpg
*like if your mosquito bites somehow lose their minds and turn your usually beautiful leg into this monstrosity…

The above medications are some of the most likely to cause anxiety, but any drug that makes a child feel “weird,” sick, “antsy,” groggy, or dizzy can inspire panic. Warn your child about possible side effects before they start, but skip mentioning any real dangers associated with the medication. Utilize relaxation techniques and distraction while your child acclimates to new medication, and, most importantly, always discuss medication changes and effects with your doctor.

Surprising Anxiety Trigger 4: Upset stomach

Welcome to part four of my Surprising Child Anxiety Triggers series!  Today’s trigger is gastrointestinal distress, or “upset stomach.”

The stomach flu is, in my opinion, the worst (non-serious) thing ever. The worst. Worse than stubbing your pinkie toe or getting ten paper cuts. Worse than reality TV. The worst. In fact, like many children with Obsessive-compulsive Disorder, many of my compulsions were done to prevent throwing up.  Gastrointestinal distress is so horrible I’ve separated it from other illnesses and given it its own post.

If an anxious child feels sick to her stomach, two separate things can cause her to panic:

First, if she’s afraid of the stomach flu/food poisoning, she’s likely to panic if she thinks that’s what’s causing her discomfort.  In fact, she might panic even if she knows she’s only sick because she ate too much or too fast, because feeling like she’s going to throw up is terrifying no matter what. (This is especially true for children who are afraid of losing control or embarrassing themselves.) If your child or student is specifically worried about GI symptoms, teach her how to minimize her risk of upset stomach by eating slowly and calmly.  A coach or a cognitive-behavioral therapist can help create a plan to help overcome fear of stomach upset.  In the meantime, have your child or student practice slow, steady breathing, and help her minimize her discomfort by addressing the possible cause.  Note: anxiety can cause or increase nausea, so address anxiety symptoms first or concurrently.

Second, like many of the triggers on this list, GI distress can mimic anxiety symptoms.   Both panic and GI distress can cause nausea, stomach pain, lightheadedness, and increased heart rate.  Anything that mimics panic can cause panic.  In part, this is because panic is terrifying, so thinking that you’re going to panic can …make you panic.  To combat this, encourage children to relax into their panic with complete acceptance.  Say, “you’re having a panic attack.  It’s very common, and it can’t hurt you.  It’ll be over soon even if you don’t do anything.”  Remind anxious children to breath slowly (without gasping or hyperventilating) and simply allow the panic to rise and then fall.  Accepting panic is extremely difficult, even for adults, but it’s extremely effective.

Coming soon: how to coach a child through a panic attack.

More in this series:
Hunger
Dehydration
Illness