Chronic Illness and Anxiety in Children

Abstract

Children with chronic illnesses may experience internalizing problems, such as anxiety. Distraction (through imagery and play) and relaxation may be powerful strategies for children facing medical procedures. Parents can be coaches for their child, teaching anxiety management strategies. This can provide parents with a role in the child’s positive functioning so that they feel they are helping their children. Having a role can reduce parent anxiety and increase their support of the child, and both of these actions can reduce child anxiety. Moreover, parents who have a role can teach the child to cope, and reduce chances of unexpectedly reinforcing or accommodating a child’s anxiety responses. Research in the field supports the use of cognitive-behavioral strategies to reduce anxiety for children who have different types of illnesses. Strategies include distraction (games, toys, music), relaxation, social support, and imagery.

Appendix

Excerpts from the Coping Positively with My Worries Manual for Kids (Nabors & Elkins, 2017): Explaining Worries and Three Ways to Deal with Worry (Positive Talk, Relaxation, and Imagery).

Explaining Worries to the Child

What does worry do?

• Worry is a normal part of life.

• Everyone worries.

• But sometimes, if you think about your worries too much, they can take over and get too big.

• Let’s pretend you are a race car.

• When you let the worries take over, your race car runs in circles around the worry race track over and over and cannot get to the finish line.

• It is important to realize when you are thinking of the worries over and over and letting your race car go in circles.

• If you have the same worry thought over and over,

• If your heart beats fast,

• If your breathing gets faster,

• If your body starts to feel heavy like a rock,

• You might be letting the worries take over and getting your car stuck in circles on the worry racetrack.

Explanation of How Worries Work in One’s Body

• Worry speeds up the body. You breathe faster and your heart beats quicker. Your mind races and thinks about the worries over and over again. If you think of the worries over and over, they grow. The more the worries grow, the more your body speeds up.

• Worries can also make your muscles tighten up. Sometimes, when your muscles tighten up, you feel worse and feel more pain. If you tighten up your body and muscles, shots or needle sticks can hurt more.

• It is important to push pause on the worries and relax. When you do this, you can slow your body down. Do your best to relax and try not to worry.

Three Ways to Deal with Worry: Positive Talk, Relaxation, and Imagery

Positive Talk

• It is good to use positive talk against the worries so you get your brain off the worry racetrack.

• Positive talk mean saying to yourself, “I can deal with this needle stick because I have had them before and it turned out OK” or “I can deal with being in the hospital. I can help the doctors and nurses and talk to my family if I need to cheer up.”

• Say positive things inside your head, like, “I can deal with this.”

Relaxation

Here are two techniques to help you relax. Being a rock then a sponge and focusing on your breathing.

Rock–Sponge Technique

• Relax by practicing making muscles tight like a rock and then relaxing like a sponge and taking deep breaths. The sponge squeezes out the worry.

• Now, it is your turn practice being the superrelaxation sponge kid. Here is what you do …

• Sit in a chair or you can lay in your bed.

• Make your muscles tight, like a rock (when you do this, if a part of you hurts, do not make it like a rock! Just do the rock where it does not hurt).

• Then, make your muscles loose, like a sponge sinking in to your chair or bed.

• Take some deep breaths and close your eyes. Repeat until your mind is not going round and round on the worry racetrack!

Focus on Your Breathing

• Focusing on your breathing can take your mind off your worry and get you off the worry racetrack.

• Close your eyes.

• Breathe in nice and slow. Imagine your tummy is a beach ball and you are slowly filling it with air you breathe in.

• Hold the beach ball inside your belly until you count to five on your fingers.

• Now, slowly breathe out and imagine the beach ball slowly getting smaller.

• How many beach balls will you fill and make smaller to help shrink your worry? I will fill ___________ beach balls.

Using Imagination

• Imagining a happy place can help you to take a break from your worries.

• Trudy’s favorite spot is the beach. She thinks about the beach and the ocean and warm sun when she wants a vacation from her worries. Trudy likes to make sand castles and relax at the beach. She pretends the warm sun makes her worries get small. She sees a boat in the water and the birds flying over the water. She hears the waves as they hit the sand. Can you see the beach? Can you hear the water? Now, is your worry smaller?

• Take a vacation from your worry … practice going to your favorite place in your imagination.

• What is your favorite place?

• What is it like?

• What happens there?

• What does it sound like?

• What do you see?

• What are you doing?

• What happens next?

• Note. The interviewer helps the child imagine his or her happy place (a birthday party, vacation spot). The interviewer helps the child imagine all the details, in a linear fashion (What happens next?). The child is encouraged to see him or herself in the event. Examples of questions are, “What do you see, hear, and feel?”