Chapter 6
At this stage of the program, your child should be working on challenging him- or herself by facing fears, gradually moving up a stepladder, and combining this with detective thinking. In this chapter we will give your child a way to make the detective thinking quicker and easier. We also introduce some stepladder approaches that address the unnecessary things children do to try to control their fear.
As your child gets better at detective thinking, it is helpful to simplify the process so there’s no need to complete an entire Detective Thinking Worksheet every time he or she gets worried. With new worries, particularly ones that are very distressing, the full process (in other words, using the complete original form) is important. However, you will also find that a lot of your child’s worries are the same old ones going around again and again. In these cases, once your child has used the detective thinking successfully a number of times, he or she will be able to switch to using simple prompts to be reminded of the evidence.
Although there are many types of evidence you can look at when you do detective thinking (such as past experience, alternative 7upossibilities, etc.), we have found that many people will have one or two particular types of evidence that really work best for them. For example, your child may discover that asking, “What happened last time?” is the best way to change most of the worried thoughts into calm ones. Or it may be that thinking about past experience doesn’t usually work too well for your child but that trying to find another explanation usually does work well. Discovering which thoughts and questions are most useful for your own child is a good way to make detective thinking work more quickly. Once your child has found one or two good questions and one or two good thoughts, he or she should record them on “cue cards” that can be used as a reminder of how to think or what to ask when he or she starts to feel nervous. This will make it easier for your child to manage anxious feelings independently. For example, your child may find the question, “What would Janice think?” (where Janice is a particularly confident friend) useful to ask when about to talk in front of other people. If your child has this question written on a small card in a pencil case, he or she can use it as a reminder just before answering a question in class. On the other side of the card, your child might write a realistic thought such as, “Lots of kids get some answers wrong, and it doesn’t matter.” Your child then has two prompts that can help when he or she is feeling worried. Importantly, your child can use these prompts without help from you or other adults, and these prompts can become a shortcut to helping remind your child of his or her calm thought quickly and easily.
There are two important points to remember if you are going to use this technique. First, the technique does not work for everyone and will only work for those children who begin to discover patterns to their worried thoughts and find the same (or very similar) thoughts coming up again and again. Second, these shortcuts will only work after your child has done the full detective thinking several times so that he or she really believes the evidence and understands where it has come from.
Finally, if your child has not been doing the full detective thinking but has only been trying to identify calm thoughts, this technique can work just as well. As mentioned above, you may have found that there are a few particularly important calm thoughts that your child gets the most benefit from. These can also be listed on a cue card to help remind your child of these important thoughts.
Stepladders are an essential tool for overcoming fears and combating worry. Some fears are very concrete and are easily broken down into a series of steps. For example, a fear of dogs can be manipulated by changing the size, distance from, and activity level of a variety of dogs. Similarly, fears of separating from a parent can be manipulated by changing concrete factors such as the length of time away, the time of day, or the person doing the caregiving. However, some fears are much harder to break down into steps because they are not as concrete, and so working out how to manipulate steps can sometimes be quite difficult. In this section we will look at ways of addressing some of the more complicated and less obvious sorts of fears.
What You Need to Know to Create Successful Stepladders
As a first stage in developing stepladders for these less obvious fears, there are two questions you can ask yourself to help to make the source of the fear more concrete.
What Is Your Child REALLY Afraid Of?
This may sound like a silly question but consider this. You have a friend who is afraid of flying. That’s how she describes it—“a fear of flying.” If you wanted to work on a stepladder for this person, you might start with her reading about planes, then going to the airport, then walking on a plane, then taxiing in a plane, and finally going on a flight. Now this might work, but if it didn’t, you would need to consider that fears of flying can actually involve several very different fears. Some people who are scared of flying are actually afraid of the flight itself—that is, they are afraid that the plane will crash. But others are more afraid of having to sit in those cramped seats, and they really have a fear of small spaces. Others are actually afraid of the fact that the plane is flying so high, and they have a fear of heights. So if your friend was actually afraid of being up that high, reading about planes and being on the plane while it’s on the ground would not be of any use. When it came to taking off for the first time, however, she would still be terrified because she wouldn’t have done any gradual steps to address her real fear of heights. Obviously, to create an effective stepladder you need to know what it is that the person is really afraid of; otherwise you might do a lot of steps but not get anywhere.
With children, working out what they fear in a situation is important, but it can also be difficult if they can’t tell you what the problem is. At times you will need to experiment with different steps that cover different things that they could be afraid of until you find the ones that do cause their worry ratings to rise. It will be a matter of trial and error. A related “trick” might be to ask your child a set of hypothetical questions. In other words, ask your child to close his or her eyes and really imagine being in a situation that you will describe and then have your child tell you how frightened he or she would be. Then you can change the situation in various ways to work out what sorts of things make a difference to the level of fear. For example, with the situation we described above with your friend’s fear of flying, you could have asked her to imagine sitting near the window or sitting near the aisle. If she was afraid of crashing, this really wouldn’t make much difference, but if she was afraid of small spaces, she would probably be far more anxious jammed in next to the window. Similarly, if she told you she was more frightened looking out of the window than looking at the seat in front of her, it might tell you that she was afraid of heights since looking out of the window would make her much more aware of how high the plane was.
When working out what questions to ask your child, make sure you think of the situation from a child’s-eye view. What a child understands the situation to be will be very different from your understanding of it. For example, say you are about to take your child on his or her first trip to the snow. Your child has never seen snow but loves vacations so is excited. As you start driving up into the mountains, your child starts to get upset while looking out the window. Your child starts crying, and you have to turn back. To you, there is not much that is frightening about driving in this area; you’ve done it before. To your child, these are the new things that he or she is dealing with: high rocks on one side of the car and a big drop on the other; signs that warn of falling rocks; strange-looking clothes and equipment; the noise from the chains on the car’s wheels; and snow—which doesn’t always look like the pictures in the travel brochures. There are a lot of things here that a child could be frightened by, while from your adult point of view, these things are expected. Take a moment to look at the world from your child’s point of view—it can help you to work out what your child still needs to face.
What Is Your Child Avoiding?
Once you know what it is that your child fears, you then need to take yourself one step further and establish what your child avoids because of the fear. This can be particularly difficult if what he or she mostly does is worry about things. A child who’s a worrier may avoid going into an unknown situation by asking many questions so that situation won’t be an unknown anymore. You might just think of that child as a worrywart, but to help you develop stepladders, you need to think in terms of avoidance and realize that your child is avoiding anything that he or she does not know or cannot plan for.
In a similar way, your child might be very perfectionistic and work really slowly or check his or her work many times. But you need to think about what your child is avoiding—most likely a possibility of making a mistake. Or consider that the child who always sticks to the rules and does the “right thing” might be avoiding getting into trouble. There are a lot of possibilities for each fear. The key is often to look at the motivation for different actions. If you are unsure of what avoidance is going on, ask yourself for each of your child’s actions, “Why is my child doing this right now? What is my child trying to avoid?”
When you know what the fear is and what your child has been avoiding, then you will be able to begin to create stepladders. The techniques listed below can help you to create appropriate steps when the fears are harder to grasp.
Response Prevention
We all understand avoidance when it involves not doing something. For example, children who won’t go to school because they are afraid of leaving their mothers are pretty easy to understand. But in some cases, avoidance might involve actually doing one behavior in order to avoid another. This is often much harder to understand and identify.
A good example might be the child who is afraid of burglars breaking in at night. This child might check and recheck all the locks on the doors and windows every night before going to bed. In this example, the child is doing something—going around the house and checking. But notice that this behavior is still a type of avoidance—the child is avoiding the possibility that a burglar might break in.
A child who is afraid of germs provides a more complex example. This child might avoid touching certain dirty objects. This is obvious avoidance—the child is not touching. But that child might also wash over and over again, just in case he or she had touched something dirty. In that case, the child is also doing something—washing. But not doing something (not touching dirty objects) and doing something (washing repeatedly) are both types of avoidance—they are both aimed at that child avoiding contact with germs.
When a fear causes your child to do something to avoid it, like checking that the doors and windows are locked, you need to gradually get your child to stop doing that behavior. When your child builds a stepladder, stopping that particular behavior should be included among the steps. This is called response prevention—in other words, stopping your child from doing an action that gives him or her comfort. This type of stepladder is very commonly needed for children who have obsessive-compulsive disorder. But it is also very useful for children with many other fears, such as those who are very perfectionistic or those who seek a lot of reassurance. When you are trying to create stepladders for these issues, you are trying to reduce the way something is done or the number of times it is done. Below are some examples.
Kurt is afraid of having germs on his hands. Because of this fear he spends a lot of time washing his hands many times during each day. When he washes his hands, he has to do it in a certain way. Kurt first washes his hands all over, then the bottoms of his arms, then his hands again. After this first wash, Kurt washes the taps to make sure that he won’t get germs from the tap when he turns it off. Once the tap is washed, he washes his hands again, then turns the tap off and dries his hands on a clean towel that he pulls out of the cupboard (which he opens with his feet). The whole process takes between three and eight minutes, and at the moment, Kurt has to wash many times each day. In the following stepladder, each step builds on the last, so when he moves on to step 2 he continues to do step 1 at the same time.
Kurt’s goal: To not wash my hands for a whole day
Children with obsessive problems need to do more in their stepladders than most of us would usually do in our daily lives. For example, for Kurt’s fear of germs, one step might involve urinating a few drops on his hands and then not washing it off. Most of us would never want to do this, but it is not actually dangerous, and to learn this lesson, children with these obsessive types of fears will need to do this until it no longer scares them.
Here is another example of a stepladder for a child who has to check three times that all of the doors and windows are locked before going to bed:
Goal: To go to bed without checking locks
In both of these stepladders, two things are done: first, the order in which a routine is done is changed; second, the person is prevented from doing the routine as often as he or she is used to. This type of approach can also be used for reassurance seeking and perfectionism.
Here is an example for a stepladder that is aimed at reducing the number of questions a child asks about homework:
Goal: To complete homework within twenty minutes
There are many times when stepladders will include steps that prevent a response; typical examples of such steps might be not sleeping in a parent’s bed, stopping a child from constantly organizing objects into a pattern, covering mirrors so a child cannot check how they look before going out, and not allowing a child to talk about worries at bedtime.
Exposure to Consequences
Many children who worry also overestimate how terrible the consequences of a feared event will be. This overestimated fear leads them to avoid taking the risk of having the catastrophe happen by avoiding the original task completely or by taking care to ensure a reduction of the risk. For example, a child may take special care to find out what friends will be wearing when they all go out to ensure that he or she won’t look different. This type of fear is particularly common in children who generally worry a lot and also in children who have social fears. To conquer these fears, children need to be exposed to the potential risks so that they learn not only that it is unlikely that the feared event will happen but also that if it does, it really isn’t that bad and life will go on.
As an example, a child who is overly conscientious about appearance because of fears of looking different will need to start taking the risk of looking different rather than sticking to the rules observed from peers.
Goal: Not to be bothered by how I look when I go out
In this example the “problem” clothes were very individual to this girl and what she saw as appropriate. Consequently, much negotiation was needed as to what risks would be taken. During implementation of the stepladder, her parents developed awareness of small avoidances, like spraying perfume on clothes that had already been worn. New steps consequently had to be developed and then implemented to help her progress.
A second situation where exposure to consequences can be appropriate is for children who avoid making mistakes. These children might check their work repeatedly or do the work very slowly. Getting them to stop checking (response prevention) or to do their work faster is a great first step, but it is not enough. All this will teach them is that they are pretty careful kids and so, even if they don’t check, they probably won’t make a mistake. But to really manage their anxiety, they need to also learn that even if they do make a mistake, it is not the end of the world. Therefore, their stepladder has to include actual mistakes in it—in other words, they need to be exposed to the consequences of making mistakes. An example of a stepladder about learning to accept making mistakes was included in George’s examples in chapter 5.
When using exposure to consequences, it is especially important to include detective thinking about the implications of what really could or did happen. This is important because otherwise the level of worry may not reduce across the different steps. Sometimes children might believe that something really terrible happened when in fact it wasn’t so terrible at all—so using detective thinking after the step is important. It can also be important to prepare teachers if a child who never makes errors suddenly begins to. You want teachers to notice and give the appropriate consequence, but you do not want them to overreact or express their disappointment or anger. Dealing with that kind of reaction would be a much higher step on any stepladder.
Exposure at School
Many fears that children have are intensified when they are at school, particularly social fears. Consequently the stepladders for these fears need to be completed at school. There are a number of difficulties when completing these stepladders, including checking on step completion, providing immediate rewards, and dealing with the many unknown factors introduced by the other children.
Creating Stepladders for School
Stepladders that are done at school need to be simple and doable by the child on his or her own. It is usually only possible to do a single step each day (although that step could be done more than once during the day). As a reminder, it is useful to write the step for the day on a piece of paper that is put into the child’s lunchbox or into their homework diary so that the child is prompted as to the details of what should be done. Steps should specify what a child will do (e.g., ask for a ball), who he or she will do it with (e.g., ask the gym teacher), and when it should be done (e.g., at recess). School stepladders often require research as to what steps are possible. For example, say you are trying to reach the goal of not worrying about breaking school rules and the step is to walk outside the appropriate play area. You will need to know where “out-of-bounds” is and to specify this in the step. Otherwise there may be confusion as to whether your child achieved the step or not.
Involving Teachers
When attempting school-based stepladders, it is useful to have teachers directly involved, and they are often more than willing to assist. This is particularly important if the steps involve in-class behavior like answering a question (the teacher will need to be ready to call on your child when he or she puts a hand up) or if it involves deliberately making mistakes or breaking a rule like forgetting to bring library books back. In this last case, you want your child to experience the normal consequences of forgetting (like a reminder note and not being able to borrow books that week), but you don’t want your child to be yelled at in front of the whole class for this “first offense.” When involving teachers, you will need to get their view of the difficulties being faced and you will need to make it as simple as possible for them to implement the steps so as not to disturb the normal running of the class. Teachers will also have ideas for steps that you may not have thought possible.
Teachers may also be able to help monitor step completion. For example, say a step for a socially anxious child is not tucking in a shirt for the whole day. You may inform the class teacher by way of a short note in the morning that this is today’s step and ask that they write a note back on whether it was completed. That way the class teacher is aware, but your child still has to risk being scolded by other teachers for being messy. By having the teacher let you know about step completion, you can be confident that your child is progressing or know where you need to adjust steps.
Occasionally you may come across a teacher who is less than willing to be involved with implementing stepladders. That teacher may feel that there is no problem, that it is not the teacher’s or school’s responsibility to help, or worse, think that you, as a parent, are the problem. In this case it may be better not to involve that teacher and either rely on your child’s integrity or find a more sympathetic teacher or perhaps the school counselor to support your efforts from within the school.
Rewards at School
Remembering that rewards are more effective when delivered quickly, it may be useful to create rewards that can be given at school wherever possible. Special snack-time treats that can be handed out by the teacher for step completion, or tokens that can be exchanged for rewards when your child gets home are effective. It may also be possible for your child to work toward school rewards like certificates. The most important thing is that the rewards are consistently given.
Other Children
When completing steps at school, other children, or at least their reactions, might become involved. This can bring in an element of extra risk in completing the step. When preparing your child for a step that might involve things going badly, such as getting teased after answering a question incorrectly, it is worth talking about what could go wrong and what that means before the step is attempted. This can be incorporated into the detective thinking about the worst possible consequences. At times steps may involve social skills that your child is not yet particularly confident at using, like being able to handle teasing. If this is the case, then developing these skills before attempting the step that uses them will be important. Developing social skills and assertiveness are covered in chapter 8.
Overlearning
When you take a fear to its extreme and really challenge the consequences, it can help consolidate the learning that takes place when you complete a stepladder. By doing the worst possible feared event, or by doing what seems very much out of the ordinary, your child can gather very convincing evidence that even when the worst occurs, nothing much happens that will be important after some time passes. In the stepladders described in the section “Response Prevention” above, each last step is something that most people would not normally do—like not washing for two days. However, if your child does do any of these last steps, he or she certainly won’t be concerned about the original thing that was feared. This is called overlearning, and other examples of it include having a child who fears doing something embarrassing wear his father’s oversized clothes to a shopping center or having a child who fears making mistakes deliberately answer every question wrong in a test. This last one will require you to also let go of the need for your child to achieve his or her best all the time. The lesson to be learned by doing this final step is that even when you really do “mess up,” the worst that happens is a bad grade on the test and a not-so-good end-of-term report on that subject—the world certainly doesn’t end and the child won’t get held back, both consequences a child might have feared before working on stepladders. Your child might also learn that mistakes can be overcome so it is worth persisting. Overlearning is not a necessity for learning to manage anxiety, but it can bring about significant change in your child’s fear and worry levels. The sense of freedom a child can get when he or she manages to do something “really crazy” is definitely worth the effort.
Spontaneous Practice
As your child gains more confidence and becomes used to the idea of taking steps, you and your child will come across opportunities for what we call spontaneous practice. “Spontaneous practice” refers to opportunities to practice facing fears that were not actually part of your child’s stepladder but have just come up in your child’s daily life. For example, if your child is shy and has a fear of meeting new people, you may be sitting in a park one day and notice another child shooting a basketball by him- or herself. Although this specific situation may not be on your child’s stepladder, you should encourage your child to grab the opportunity to join the other child as a way of facing the fear of meeting a new person. If your child is hesitant, don’t forget to help with his or her detective thinking and come up with a good reward for doing the spontaneous practice. In some cases, these opportunities may even be a few steps higher than your child is currently at on his or her stepladder. If your child is willing to try, he or she should be encouraged and rewarded. However, if your child is really too worried, don’t force the issue—it may simply be too soon.
Other Resources
Use resources in the community, family, and school system to provide a wide range of stepladder situations. Most people are willing to assist children who are learning new skills and readily understand the basic concepts involved once they are explained. Encourage grandparents and others not to be too helpful and to allow the child to experience some anxiety to overcome fears. Even store clerks, park attendants, or bus conductors can be relevant in certain situations.
Parent Activity: Facing a Fear of Your Own
As we discussed in the section “Modeling Brave, Nonanxious Behavior” (chapter 4), a great way of modeling anxiety management to your child is to actively face your own fears. It is even better when you get your child to help you design your stepladder or to find evidence. Take a simple fear of your own and work with your child on facing this fear. Use the same steps and materials that you are familiar with. Allowing your child to help you face a fear helps to make worry and fear seem normal, it shows the benefit of managing fear, and it gives your child a great boost in confidence—being the “expert” by helping Mom or Dad to do something is a powerful experience. It is a good idea to pace each other—set your goals together earlier in the week and then go over your achievements at the end of the week. If you do this, you can both monitor your efforts and get special rewards (maybe one of your chosen rewards can be your child making you a cup of tea in the morning—the more you involve him or her the better).
Activities to Do with Your Child …
Children’s Activity 21: In-Your-Mind Detective Thinking
Assuming that your child has had several weeks of practicing detective thinking, work with your child to identify the most useful thoughts and questions that help him or her to think more realistically when anxious. Have your child write these on a small cue card to be carried in difficult situations. Your child may need to write out more than one card, for example one to carry in a pencil case at school and one to have beside the bed at night. Each card may also be specific to the situation that causes anxiety.
Children’s Activity 22: Revising Your Child’s Stepladder
After completing two weeks of working on stepladders, children and parents will both have a better understanding of how the facing-fear process works. This is a good time to revise your child’s stepladders. With your child, examine the first stepladder to see if the steps have these qualities:
If you identify problems, work with your child to change the steps to overcome the problems.
Children’s Activity 23: Creating New Stepladders
It is very likely that you will need two, three, or even many stepladders to work through your child’s different fears. Create stepladders for the next few and most important fears that your child needs to face. Make sure that your child has the greatest say in which fears are most important. Granted, they may not be your highest priorities, but it is highly likely that what your child chooses will be the fears that are giving him or her the most trouble. There will be time as your child’s confidence grows to get to other fears that cause you concern.
Use the same process as the one that you used to create your child’s first stepladder (see “Steps to Teach Children Stepladders” in chapter 5):
Children’s Practice Task 5: Doing Steps
Children need to keep working on their stepladders. Write down plans for what step will be done, when, and the skills that will be used to help your child to cope. You should try to make these plans at the beginning of each week to ensure that progress continues to be made. Remember that decisions on the steps that will be faced should be led by your child. If progress seems too slow, then the step choices can be discussed, but children should still feel that they are in control of the process. If your child really seems to not want to do the step, then this reluctance may suggest that the step is too large and an intermediate step should be designed. While practicing steps, your child should use the new cue cards and, when needed, should continue to use detective thinking and problem solving to reduce feelings of anxiety.
In this chapter, you learned …
In this chapter you and your child learned . . .
Your child will need to do the following: