NAPNAP 2012: Helping Kids to Handle Anxiety


Cognitive behavioral therapy, mindfulness, and breathing techniques are among several nonpharmaceutical interventions that have been shown to help children with anxiety. Rebecca Kajander, MPH, BSN, CPNP, PMHS, discussed these and other techniques that providers can use as part of effective therapy.

During her presentation Thursday at the 2012 NAPNAP annual conference, Rebecca Kajander, MPH, BSN, CPNP, PMHS, author of the Be the Boss of Your Body book series, shared effective nonpharmaceutical interventions that help kids with anxiety to help themselves. She said that her practice is based on the philosophy that the more kids understand what they are experiencing, the quicker and better they can help themselves.

When kids learn how their bodies work and the effects that mind-body connections have on their reactions it demystifies the problems. Kajander explained that when providers ask questions, it helps them gather information and at the same time allows the child to explore their triggers and identify their strengths.

Learning to problem solve through cognitive behavioral therapy is especially valuable for kids with anxiety. Kajander advised that providers throughout treatment should encourage the use of positive self-talk that facilitates inner healing. An example of positive self-talk would be “I will help myself sleep better” versus “I can’t sleep.”

Mastery of self-regulation techniques is of paramount importance for kids with anxiety. Mindfulness and breathing techniques can be very helpful. Kajander strongly encouraged the use of breathing exercises. “If I could teach one skill, I would teach kids to breathe,” she said. She told the audience that, often, former patients who return for a visit say it is the breathing techniques that stuck with them.

When she teaches breathing techniques to kids, Kajander has them put one hand on their abdomen and imagine there is a balloon directly underneath the surface. She instructs them to inflate and deflate the balloon by taking a deep slow breath followed by a long and slow exhalation. This should be repeated at a pace of six-to-eight breaths per minute. She explained that muscles relax during exhalation, and that when people are anxious, they tend toward fast-paced inhalations with little exhalation. Kids should practice this technique when they are not anxious, she said.

Relaxation imagery (hypnosis), aromatherapy, and self-applied acupressure are also useful in children and adolescents suffering with anxiety. Kajander advised that providers should also pay close attention to patients’ nutrition and dietary habits, promote good sleep hygiene, and counsel them on the importance of staying active. She said that rhythmic movements like walking or swimming calm the mind, and aerobic exercise offers an opportunity for the brain to experience a healthy physical response.

While she did not cover the use of medications or supplements in depth, Kajander noted that, in some cases, consideration of medications and supplements may be warranted to promote engagement in behavioral interventions. Often, they may be used for a relatively short period of time.

Kajander’s presentation slides are available here.

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