Talking to Your Child about Anxiety

Children and teens may not recognize that what they have been experiencing is anxiety. Some youth think the way they are feeling and acting is normal or expected. Often, overly studious or perfectionistic youth believe it is reasonable to study for hours on end, to keep their bedroom as neat as a pin, or to wash their hands excessively after every activity.

Other youth think there is something “wrong” with them. Children may focus on the physical symptoms of anxiety (e.g. stomach aches). Teens may think they’re weird, weak, out of control, or even going crazy. These thoughts might make them feel even more anxious and self-conscious. Providing accurate information about anxiety can reduce confusion or shame. Explain that anxiety is a common and normal experience, and it can be managed successfully.

You can do this in 3 clear steps. Once your child understands this information, he or she will feel more motivated to address his/her anxiety.

Step 1: Encouraging your child to open up about worries and fears.

Start by describing a recent situation where you observed some signs of anxiety in your child.

“Yesterday, when Sarah came over, you seemed very quiet and you just sat beside me. It seemed you might have been a bit nervous about having a visitor in our house. What was that like for you?” Or, “I’ve noticed you’ve been hanging home on weekends, and don’t seem to want to go out like your brother does. What’s up?”

It can sometimes help to share with your child some things you were scared of when you were the same age (especially if you shared the same types of fears), and ask if s/he has any similar worries or fears. You can also describe situations that make other kids his/her age anxious, and gently inquire if this happens to your child too.

Finally, you can try being direct by simply asking about what worries your child the most. Being specific can help your child sort through confusing fears and feelings. Support him/her by saying you believe your child, and that having these feelings is okay. Show acceptance of worry thoughts and anxious feelings. If you stay calm, it will also help your child stay calm.

Ask what worries him or her the most. You may have to prompt younger children by offering an example such as: “I know some kids are scared of ___, do you have that fear too?” When your child expresses anxiety or worry, offer reassurance by saying you believe him or her, and that having those feelings is okay. Remember, your child will take cues from you.

Tip: Does hearing “Don’t worry. Relax!" help you when you're anxious about something? It probably doesn't comfort your child much, either. It’s important to acknowledge that your child’s fears are real. Your empathy will increase the chances that your child will accept your guidance and be motivated to work on reducing anxiety through the tools/ resources you practice.

Step 2: Teaching your child about anxiety

Present the common situations that can be affected by anxiety, as well as how anxiety looks different at different ages and stages. Encourage your child to read this information or go through it with them. As you present all of this information, encourage your child or teen to share personal examples. If your teen is reluctant, use your own experiences with anxiety, or recall shared examples through movies, stories, fables, etc.

Four important points to communicate to your child:

1. Anxiety is normal. Everyone experiences anxiety at times. For example, it is normal to feel anxious when on a roller-coaster, or before a test. Some teens may appreciate some facts about how common anxiety problems are.

For example, “Did you know that one-in-seven children under 18 will suffer from a real problem with anxiety?”

2. Anxiety is not dangerous. Though anxiety may feel uncomfortable, it doesn’t last long, is temporary, and will eventually decrease! Also, most people cannot tell when you are anxious (except those close to you such as your parents).

3. Anxiety is adaptive. Anxiety helps us prepare for real danger (such as a bear confronting us in the woods) or for performing at our best (for example, it helps us get ready for a big game or speech). When we experience anxiety, it triggers our “fight-flight-freeze” response and prepares our bodies to defend themselves.

For instance, our heart beats faster to pump blood to our muscles so we have the energy to run away or fight off danger. When we freeze, we may not be noticed, allowing the danger to pass. This response is also called “anxious arousal”. Without anxiety, humans would not have survived as a species!

How you can explain the Fight-Flight-Freeze response to a child:

“Imagine you are hiking in the woods and you come across a bear. What is the first thing you would do? You may run away from the bear, or you may simply freeze. Another reaction is to yell and wave your arms to appear big and scary. There are three ways humans react to danger: fight, flee, or freeze. When we are anxious, we react in one of these ways, too. We may run away or avoid situations that make us anxious. Or we may freeze, such as when our minds go blank and we can’t think clearly. Or we may fight, get angry and lash out at people. Can you think of some ways you may fight, flee, or freeze because of anxious feelings?”

How to explain “anxious arousal”:

Sometimes when we sense something is dangerous or threatening, we automatically go into a state called “anxious arousal”. This can happen when there is a real danger, but also when something simply feels dangerous, but really isn’t, such as giving an oral presentation in class, or…(give an example of something relevant to your child). Anxious arousal makes you feel jittery, on edge, and uncomfortable. It may also make it hard to think clearly. This feeling can become overwhelming enough that anxious people stop doing things or going places that make them feel anxious. Do you think this is happening to you?

4. Anxiety can become a problem when our body reacts as if in danger in the absence of real danger. A good analogy is that it’s like the body’s smoke alarm.

“An alarm can help protect us when there is an actual fire, but sometimes a smoke alarm is too sensitive and goes off when there isn’t really a fire (e.g. burning toast in toaster). Like a smoke alarm, anxiety is helpful when it works right. But when it goes off when there is no real danger, then we may want to fix it.”

Step 3: Helping your child recognize anxiety

The third and final step in talking with your child is to help him/her understand the 3 ways that anxiety presents.

Explain to your child the three parts of anxiety: thoughts (what we say to ourselves); physical feelings (how our body responds); and behaviours (what we do or our actions).

USE AGE APPROPRIATE EXAMPLES

A good way to describe the interconnection of these parts is to draw a triangle with arrows

Physical Feelings

e.g. Tummy ache, headache, heart racing

Thoughts

e.g. “What if mom doesn’t come home?”

Behaviours

e.g. Looking for mom, staying home from school

Being a Detective: Recognizing Physical Symptoms

To help your child recognize physical symptoms, draw a sketch of a body and ask your child to identify where he or she feels anxiety in the body.

Prompt your child, if necessary, with an example: “When I feel anxious, I get butterflies in my tummy, and I get a big lump in my throat. What happens when you feel anxious?”

Teens may rather just talk about it, or identify their own symptoms from a list of “typical” physical symptoms.

If age-appropriate, ask your child to come up with a name for anxiety (e.g. Mr./ Mrs Worry). Refer to your child’s anxiety with this new name, particularly in terms of “bossing back” anxiety (e.g. “It’s just the Mrs worry talking. I don’t have to listen!”).

Older children or teens may respond better to a music analogy, such as that the volume of their anxiety is “turned up” a bit louder than other kids. They simply need to learn to turn down the volume.

These strategies help your child adopt an observer role when dealing with anxiety, giving them a greater sense of control.

COPING WITH ANXIETY

The symptoms of anxiety can have a significant impact on how a person behaves and goes about their daily life. The essence of anxiety is worrying about some potential threat. It is trying to cope with a future event that you think will be negative.

You do this by paying more attention to possible signs of potential threat, and looking internally to see whether you will be able to cope with that threat. When you notice your anxious symptoms, you think that you can’t cope with the situation, and therefore become more anxious.

How Avoidance Contributes to Anxiety

As your anxiety increases, you try to reduce the anxiety and prevent what you think might happen by avoiding the situation. If you cannot avoid the situation, then you use subtle avoidance to reduce the anxiety. For example, you may use certain rituals, like standing close to a door to make a quick escape. In some way, you might feel less anxious when you engage in avoidance behaviours.

However, when you have to deal with the situation the next time, you are less confident that you can cope with it because you avoided it the last time or become dependent on safety behaviours. So you feel more anxious. As a result, you avoid the situation or engage in subtle avoidance.

Safety Behaviours and Anxiety

If you feel anxious, or anticipate feeling anxious, it makes sense that you will do things to reduce your anxiety. In addition to avoidance and subtle avoidance, many people use “safety behaviours” to help cope with anxiety. These may include -  

• Using distraction to avoid feeling anxious or thinking about anxiety (e.g. always keeping busy or eliminating free-time)

• Always having an exit plan for potentially-anxious situations

• Making sure you have someone else with you.

• Engaging in excessive research prior to taking a trip, starting a new job, buying something, all to ensure nothing will go wrong

These safety behaviours also play a part in maintaining the vicious cycle of anxiety. When you become dependent on them, it can be more distressing if one day they are not available to you.

Reversing the Vicious Cycle of Anxiety

Vicious cycles play an important role in maintaining anxiety. However, like the vicious cycle of depression, you can turn around this cycle to create a positive cycle that will help you overcome anxiety.

One important step in this cycle is gradually confronting feared situations. This will lead to an improved sense of confidence, which will help reduce your anxiety and allow you to go into situations that are important to you.

Use “graded exposure” by starting with situations that are easier for you to handle, then work your way up to more challenging tasks. This allows you to build your confidence slowly, to use other skills you have learned, to get used to the situations, and to challenge your fears about each situational exposure exercise. By doing this in a structured and repeated way, you have a good chance of reducing your anxiety about those situations.

Coping Skills: Breathing & Thinking Better

When you are gradually confronting feared situations, there will be a short term increase in anxiety. This is normal— everyone feels anxious about doing things they fear. The important thing to remember is that you can learn other skills as alternatives to avoidance and safety behaviours. 

Breathing: Anxiety is often associated with fast, shallow breathing, which contributes to the physical sensation of anxiety. By slowing down your breathing and using calming and relaxation techniques, you can reduce your anxiety.

Thinking: There are many types of negative thoughts which are associated with anxiety, such as “I will not be able to cope” or “I must avoid this situation.” Learning to challenge these thoughts with more balanced ones can help to reduce the experience of anxiety.

Four Steps to Reversing the Vicious Cycle of Anxiety

 1. Confront feared situations without aid of safety behaviours

 

2. Short term - slight increase in anxiety,

then a decrease in physical symptoms

and attention scanning

3. Use of coping skills, anxiety reduces

to manageable level

4. Greater belief in ability to

 control own responses

 

THE CALMING TECHNIQUE

Everyone knows that breathing is an essential part of life, but did you know that breathing plays an essential role in anxiety? This information sheet will briefly discuss the role of breathing in anxiety and guide you through a simple calming technique that uses breathing patterns to help you relax.

Breathing is a powerful determinant of our physical state. When our breathing rate becomes elevated a number of physiological changes begin to occur. Perhaps you’ve noticed this yourself when you‘ve had a fright; you might suddenly gasp, feel a little breathless and a little light-headed, as well as feeling some tingling sensations around your body.

Believe it or not, the way we breathe is a major factor in producing these and other sensations that are noticeable when we are anxious.

Anxious breathing

You might already know that we breathe in oxygen – which is used by the body – and we breathe out carbon dioxide. In order for the body to run efficiently, there needs to be a balance between oxygen and carbon dioxide, and this balance is maintained through how fast and how deeply we breathe. Of course, the body needs different amounts of oxygen depending on our level of activity. When we exercise, there is an increase in both oxygen and carbon dioxide; in relaxation there is a decrease in both oxygen and carbon dioxide. In both cases the balance is maintained.

When we are anxious though, this balance is disrupted. Essentially, we take in more oxygen than the body needs – in other words we over breathe, or hyperventilate. When this imbalance is detected, the body responds with a number of chemical changes that produce symptoms such as dizziness, light-headedness, confusion, breathlessness, blurred vision, increase in heart rate to pump more blood around, numbness and tingling in the extremities, cold clammy hands and muscle stiffness.

The Calming Technique

While over-breathing and hyperventilation are not specifically dangerous continued over-breathing can leave you feeling exhausted or “on edge” so that you’re more likely to respond to stressful situations with intense anxiety and panic.

Gaining control over your breathing involves both slowing your rate of breathing and changing your breathing style. Use the calming technique by following these steps and you’ll be on your way to developing a better breathing habit.

1.  Become aware of your breath

2.  Take a breath in for 4 seconds (through the nose if possible)

3.  Hold the breath for 2 seconds

4.  Release the breath taking 6 seconds (through the nose if possible)., then pause slightly before breathing in again.

5.  Practise, practise, practise!

By using the calming technique, you can slow your breathing down and reduce your general level anxiety. With enough practice, it can even help to reduce your anxiety when you are in an anxious situation.

 

STRESS RELIEF IN THE MOMENT

Tip 1: Recognize when you're stressed

It might seem obvious that you’d know when you’re stressed, but many of us spend so much time in a frazzled state that we’ve forgotten what it feels like when our nervous systems are in balance—when we’re calm yet still alert and focused.

Recognize stress by listening to your body

When you're tired, your eyes feel heavy and you might rest your head on your hand. When you're happy, you laugh easily. And when you’re stressed, your body lets you know that too. Get in the habit of paying attention to your body’s clues.

Observe your muscles and insides. Are your muscles tense or sore? Is your stomach tight, cramped, or aching? Are your hands or jaw clenched?

Observe your breath. Is your breath shallow? Place one hand on your belly, the other on your chest. Watch your hands rise and fall with each breath. Notice when you breathe fully or when you "forget" to breathe.

Tip 2: Identify your stress response

Internally, we all respond to the “fight-or-flight” stress response the same: blood pressure rises, the heart pumps faster, and muscles constrict. Your body works hard and drains your immune system. Externally, however, people respond to stress in different ways.

The best way to quickly relieve stress often relates to your specific stress response:

Overexcited stress response/HYPERAROUSAL – If you tend to become angry, agitated, overly emotional, or keyed up under stress, you will respond best to stress relief activities that calm you down.

Underexcited stress response/HYPOAROUSAL – If you tend to become depressed, withdrawn, or spaced out under stress, you will respond best to stress relief activities that are stimulating and energizing.

The immobilization or “frozen” stress response

Do you freeze when under stress? The immobilization stress response is often associated with a past history of trauma. When faced with stressful situations, you may find yourself totally stuck and unable to take action. Your challenge is to break free of your “frozen” state by rebooting your nervous system and reactivating the body’s natural “fight-or-flight” stress response. Physical movement that engages both your arms and legs, such as walking, swimming, running, dancing or climbing can be particularly helpful. As you move, focus on your body and the sensations you feel in your limbs rather than your thoughts. This mindfulness element can help your nervous system become “unstuck” and move on.

Tip 3: Bring your senses to the rescue

To use your senses to quickly relieve stress, you first need to identify the sensory experiences that work best for you. This can require some experimentation. As you employ different senses (sight, hearing, touch, smell, taste), note how quickly your stress levels drop.  What is the specific kind of sound or type of movement that affects you the most? For example, if you’re a music lover, listen to many different artists and types of music until you find the song that instantly lifts and relaxes you.

Explore a variety of sensory experiences so that no matter where you are you’ll always have something you can do to relieve stress.

LEARN ABOUT THE POWER OF VULNERABILITY

"Vulnerability is not knowing victory or defeat, it’s understanding the necessity of both; it’s engaging. It’s being all in". 

Brene Brown

 

How do we step towards vulnerability?

I think the first thing we have to do is figure out what’s keeping us out of the arena. What’s the fear?

Where and why do we want to be braver? Then we have to figure out how we’re currently protecting ourselves from vulnerability.

What is our armor? Perfectionism? Intellectualizing? Cynicism? Numbing? Control?

It’s not an easy walk into that arena, but it’s where we come alive.

LEARN ABOUT SELF-ESTEEM

What is Self-Esteem?

As human beings, we tend to place a value or a measure of worth on ourselves or aspects of ourselves. So, self-esteem usually refers to how we view and think about ourselves and the value that we place on ourselves as a person. If the value we place on ourselves is often negative, this is when we run into problems with self-esteem.

Low Self-Esteem

Have you ever been dissatisfied or unhappy with yourself on the whole? Do you ever think that you are weak, stupid, not good enough, flawed in some way, inferior to other people, useless, worthless, unattractive, ugly, unlovable, a loser, or a failure?

Everyone uses these words on themselves at times, usually when they experience a challenging or stressful situation. However, if you often think about yourself in these terms, then you might have a problem with low self-esteem.

Low self-esteem is having a generally negative overall opinion of oneself, judging or evaluating oneself negatively, and placing a general negative value on oneself as a person.

People with low self-esteem usually have deep-seated, basic, negative beliefs about themselves and the kind of person they are. These beliefs are often taken as facts or truths about their identity, rather than being recognised as opinions they hold about themselves.

The Impact of Low Self-Esteem

• Frequent Self-Criticism.

A person with low self-esteem probably says a lot of negative things about themselves. They might criticise themselves, their actions, and abilities or joke about themselves in a very negative way. They might put themselves down, doubt themselves, or blame themselves when things go wrong.

• Ignoring Positive Qualities.

When compliments are given to them, they might brush such comments aside or say that “it was all luck” or “it wasn’t that big a deal.” Instead, they might focus on what they didn’t do or the mistakes they made.

• Negative Emotions.

A person with low self-esteem might often feel sad, depressed, anxious, guilty, ashamed, frustrated, and angry.

• Impact on Work/Study.

A person with low self esteem might consistently achieve less than they are able to because they believe they are less capable than others. They might avoid challenges & opportunities for fear of not doing well. They might work extremely hard and push themselves to do more because they believe they need to make up for, or cover up, their lack of skill. They might find it hard to believe any good results they get are due to their own abilities or positive qualities.

• Relationship Problems.

In their personal relationships, people with low self-esteem might become upset or distressed by any criticism or disapproval, bend over backwards to please others, be extremely shy or self-conscious or even avoid or withdraw from intimacy or social contact. They might also be less likely to stand up for themselves or protect themselves from being bullied, criticised, or abused by partners or family.

Cause or Effect?

 It is important to know that low self-esteem is a common problem for many people in our society - so you are not alone. Low self-esteem can occur as part of a current problem (such as depression), or as a result of other problems (such as chronic illness, relationship problems) or it can be a problem in itself. Either way, the good news is that you can take steps towards developing more healthy self-esteem.

Developing Healthy Self- Esteem

If you were asked to list some positive qualities about yourself, how would you respond? If you suffer from low self-esteem, you might struggle to bring things to mind. 

In order to promote a balanced evaluation of yourself, it is ok to notice and acknowledge your positive aspects, and to behave like someone who has positive qualities and who is deserving of happiness and fun.

If most of the time all you pay attention to are your negative qualities and you feel comfortable dwelling on these negatives. Ask yourself how fair is that? By getting you to begin acknowledging your positives, you are really tipping the scales of self-evaluation back into balance.  

1. Start with a ‘Positive Qualities’ Record

When we notice something and it’s really important for us to remember it, what is it that we do to help us remember? We write things down, make a note of it, or make a list if there are many items. The same approach applies here. To start acknowledging your positives, you need to write them down. Before you start on the Positive You Journal, you need to make a Positive Qualities Record - list down all the positive qualities you can think of, no matter how small, insignificant, modest, or unimportant you think they are.

 If you get stuck, ask yourself questions like:

What do I like about who I am? What positive characteristics do I have? What are some of my achievements? What are some challenges I have overcome? What are some skills or talents that I have? What do others say they like about me? What are some attributes I like in others that I also have in common with? If someone shared my identical characteristics, what would I admire in them? How might someone who cared about me describe me? What do I think are bad qualities? What bad qualities do I not have?

 

2. The ‘Positive You’ Journal

Using the Positive You Journal, recall specific examples of how you have demonstrated each of the positive attributes you have listed in the Positive Qualities Record. For example:

Considerate I took my friend some flowers and a book when they were sick. I offered a listening ear to my colleague who was going through some difficult times. I lent my brother some money when he was down on his luck.

Once you have listed some past examples like the one above, use the journal to start noticing your positive qualities on a daily basis. Each day, set out to record three examples from your day, which illustrate certain positive qualities you have. Write exactly what you did and identify what positive attribute it shows in you. For example, on one day you may note down that you mopped the floors (house-proud), finished writing out a budget (diligent), and played with your children (fun to be with).

Doing this will take some time, but is well worth the effort. Noting down the specific incidents that illustrate your positive qualities will allow the list to have an impact on your view of yourself, making it real.

3. Healthy Self-Esteem

Self-esteem is about thinking about ourselves and our worth in a BALANCED way. It is absolutely okay and appropriate that we recognise our weaknesses. What we need to do is accept that we all have weaknesses, and make a decision about whether or not we want to improve on them. We also need to recognise, acknowledge, and celebrate our strengths and successes. Also, don’t forget any skills and abilities that might be neutral. Remember, it’s all about being balanced!

4. Coping with At-Risk Situations

Having healthy self-esteem doesn’t mean that you will never encounter an at-risk situation again, that is, a situation where you might be reminded of that old negative view of yourself. It also doesn’t mean that you will never again think of yourself in a negative light. If you have done some work on your self-esteem, then the situations that are risky for you will be less frequent than before, as the threshold for activating a negative view of yourself will now be higher. That means it will take a lot more to ‘set off’ your low self-esteem than before. Everyone might think of themselves in a negative way or get down on themselves at times. The important thing to remember is not to do it too often.

So even after improving your self-esteem, you will still encounter at-risk situations in which the rules and assumptions you have for living are broken or threatened to be broken. But you can handle them differently, cope differently, respond differently.

Remember that the effect of your past experiences on how you see yourself today can be worn down by practicing new ways of thinking & behaving day-to-day.

LEARN ABOUT ASSERTIVE COMMUNICATION

ASSERTIVE COMMUNICATION

Assertiveness means expressing your point of view in a way that is clear and direct, while still respecting others.

Communicating in an assertive manner can help you to minimise conflict, to control anger, to have your needs better met, and to have more positive relationships with friends, family and others.

Assertiveness is a style of communication which many people struggle to put into practice, often because of confusion around exactly what it means. 

People often confuse assertiveness with aggression, because it involves sticking up for yourself. But the two are actually quite different. Look at the following examples:

Aggressive communication                                              Assertive communication

Forces your needs or opinions onto others                       Expresses your needs clearly but respectfully.

Often involves bullying or pushing others around            Others are treated with respect.

Ignores the needs of others.                                              Considers the needs of others as well as yours.

Hinders compromise.                                                         Promotes compromise.

Damages relationships.                                                      Strengthens relationships.

May lead to shouting or physical aggression                    Uses clear language to get your point across.

Damages self-esteem                                                         Builds self-esteem

For example, imagine you are standing in line at the bank and someone else pushes in front of you.

An aggressive response could be to grab them by the shoulder and say loudly: Hey! What makes you so important that you don’t have to wait in line like the rest of us?

This might make you feel better in the short term, but you will probably also spend the rest of the hour feeling annoyed about the interaction. Or perhaps the other person will shout back at you and the situation will get even worse, really leaving you in a bad mood.

A more assertive response could be to gently tap the person on the shoulder and say in a clear but respectful voice: Excuse me, there is actually a line here. It would be better if you could wait your turn like the rest of us.

Chances are you will get a more positive response to this - perhaps the other person will apologise and move to the back of the line, or they may explain their reason for wanting to push in and you may feel happy to do them this favour. They may still respond badly - your assertiveness does not guarantee others will not be aggressive

 Here are some tips for practising being assertive:

• State your point of view or request clearly

• Tell the other person how you feel as honestly as you can, and remember to listen to what they say as well

• Tone and volume of voice: how you say it is as important as what you say. Speak at a normal conversation volume, rather than a shout or whisper, and make sure that you sound firm but not aggressive

• Make sure your body language matches - your listener will get mixed messages if you are speaking firmly while looking at the floor. Try to look the other person in the eye, stand tall, and relax your face

• Try to avoid exaggerating with words like always and never. For example: You are 20 minutes late and it is the third time this week, rather than: You are always late!

• Try to speak with facts rather than judgement. For example: This report has important information missing, rather than you have done a bad job again

• Use “I Statements” as much as possible, to tell the other person how you feel rather than be accusing. For example: When you leave your dishes on the table, I feel frustrated because I don’t like the mess but don’t want to clean it up for you, rather than: You’re such a pig!

• Practise often - assertiveness is a skill which requires you to practise in many different situations

LEARN ABOUT SLEEP HYGIENE & SLEEP HYGIENE TIPS

Learn about Sleep Hygiene & Sleep Hygiene Tips

‘Sleep hygiene’ is the term used to describe good sleep habits. Considerable research has gone into developing a set of guidelines and tips which are designed to enhance good sleeping, and there is much evidence to suggest that these strategies can provide long-term solutions to sleep difficulties. There are many medications which are used to treat insomnia, but these tend to be only effective in the short-term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits independent of medication, thereby prolonging sleep difficulties. Talk to your health professional about what is right for you.

Sleep Hygiene Tips

1) Get regular. One of the best ways to train your body to sleep well is to go to bed and get up at more or less the same time every day, even on weekends and days off! This regular rhythm will make you feel better and will give your body something to work from.

2) Get up & try again. If you haven’t been able to get to sleep after about 30 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again. Sit quietly on the couch with the lights off (bright light will tell your brain that it is time to wake up), or read something boring like the phone book. Avoid doing anything that is too stimulating or interesting, as this will wake you up even more.

3) Avoid caffeine & nicotine. It is best to avoid consuming any caffeine (in coffee, tea, fizzy drinks, chocolate, and some medications) or nicotine (cigarettes) for at least 4-6 hours before going to bed. These substances act as stimulants and interfere with the ability to fall asleep

4) Avoid alcohol. It is also best to avoid alcohol for at least 4-6 hours before going to bed. Many people believe that alcohol is relaxing and helps them to get to sleep at first, but it actually interrupts the quality of sleep.

5) Bed is for sleeping. Try not to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep. If you use bed as a place to watch TV, eat, read, work on your laptop, pay bills, and other things, your body will not learn this connection.

6) No naps. It is best to avoid taking naps during the day, to make sure that you are tired at bedtime. If you can’t make it through the day without a nap, make sure it is for less than an hour and before 3pm.

7) Sleep rituals. You can develop your own rituals of things to remind your body that it is time to sleep - some people find it useful to do relaxing stretches or breathing exercises for 15 minutes before bed each night, or sit calmly with a cup of caffeine-free tea.

8) Bath time. Having a hot bath 1-2 hours before bedtime can be useful, as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again. Research shows that sleepiness is associated with a drop in body temperature.

9) No clock-watching. Many people who struggle with sleep tend to watch the clock too much. Frequently checking the clock during the night can wake you up (especially if you turn on the light to read the time or are using our phone) and reinforces negative thoughts such as “Oh no, look how late it is, I’ll never get to sleep” or “it’s so early, I have only slept for 5 hours, this is terrible.”

10) Use a sleep diary. This can be a useful way of making sure you have the right facts about your sleep, rather than making assumptions. It is a good idea to only use it for two weeks to get an idea of what is going on and then perhaps two months down the track to see how you are progressing.

11) Exercise. Regular exercise is a good idea to help with good sleep. Morning walks are a great way to start the day feeling refreshed!

12) Eat right. A healthy, balanced diet will help you to sleep well, but timing is important. Some people find that a very empty stomach at bedtime is distracting, so it can be useful to have a light snack, but a heavy meal soon before bed can also interrupt sleep. 

13) The right space. It is very important that your bed and bedroom are quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you have curtains or an eye mask to block out early morning light and earplugs if there is noise outside your room.

14) Keep daytime routine the same. Even if you have a bad night sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities because you feel tired. This can reinforce the insomnia.

Stages of Sleep

Research tells us that there are two types of sleep:

1)  REM rapid-eye-movement sleep: this type of sleep occurs for about 25% of the night, and is characterised by electrical activation of the brain, very relaxed muscles and body becoming immobile, and rapid eye movements as the eyes dart back and forth under closed eyelids. REM sleep provides energy to the brain and body and supports daytime performance. Dreams often occur during REM sleep, although they can occur at any stage.

2)  NREM non-rapid-eye-movement sleep: this type of sleep occurs during the other 75% of the time, and can be further broken down into 4 stages:

• Stage 1: this stage is light sleep, between being awake and falling asleep

• Stage 2: this stage is the onset of sleep, when the person begins to become disengaged from their surroundings. Body temperature drops and breathing and heart rate become regular.

• Stages 3 & 4: These stages are the deepest and most restorative sleep, known as ‘delta sleep’ - Stage 3 is a transition into Stage 4, or ‘true delta.’ During these stages, blood pressure drops, breathing becomes slower, muscles are relaxed and receiving more blood supply, tissue growth and repair occurs, and hormones are released (including growth hormone, which is why growing teenagers need to sleep more).

LEARN ABOUT MINDFULNESS & LETTING GO

Mindfully Managing Negative Thoughts

Trying to control or avoid worries or other negative thinking by answering back, chasing, or suppressing these negative thoughts can sometimes strengthen this negative experience rather than diminish it. Mindfulness is one way of skilfully disengaging from or letting go of negative thinking. This approach involves practicing how to notice when you are automatically drifting into negative thinking and then skilfully redirecting your attention back to the present, to the here and now. It may be helpful to think of this approach in terms of a radio. That is, imagine that the negative thoughts that drift into your mind as coming from a loud radio that is tuned to a station where the thoughts are very negative and seem to be shouting at you.

The skill in mindfulness is not so much about trying to turn the radio off, but changing the way you listen to the radio.

In this way the volume of the radio station can be reduced, and therefore seem less disruptive and distressing. However, the important thing to remember is this is not a quick fix, it is not easy, and requires regular practice. The thoughts may still shout at you, but you are changing the way you listen. Begin with the formal practice described in this information sheet. Just like any skill, such as learning a musical instrument, you need to practice, practice, practice! By practicing daily you may eventually become better at letting go, and be able to do this in a more informal way.

Steps for Letting Go

STEP 1.

To begin the practice, sit down in a chair and adopt a relaxed and alert posture, then ask yourself, what am I experiencing right now? What thoughts are around, what feelings are around, and what body sensations?

Allow yourself to just acknowledge, observe and describe these experiences to yourself, without trying to change them or answer the thoughts back.

Spend 30 seconds to 1 minute just doing this.

STEP 2.

Now bringing your focus of awareness to your breath, focusing on the sensations of your breath as it moves back and forth in your belly. Binding your awareness to the back and forth movements of the sensations in your belly from moment to moment, and letting all thoughts go.

Maybe say to yourself ‘relax’ or ‘let go’ on each outward breath.

Spend about 30 seconds to 1 minute doing this.

STEP 3.

Now expanding your awareness to sensing your whole body breathing, being aware of sensations throughout your body.

If there are any strong feelings around, maybe saying to yourself “whatever it is, it is OK, just let me feel it.”

Allowing yourself to breathe with these feelings, and if your mind wanders to bothersome thoughts just acknowledge and let go of these - focusing back on sensing your breath. Continue doing this for about 1 minute. TIP: You can try increasing the time of steps 2 & 3 as you start to get more familiar with this skill.

LEARN ABOUT SOCIAL ANXIETY

Social Anxiety

Sometimes known as social phobia, social anxiety disorder (SAD) is a surprisingly common form of anxiety disorder that causes an individual to experience intense anxiety in some or all of their social interactions in everyday life.  Given this, social anxiety can be defined as the persistent fear of one or more social or performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others, and where exposure to such situations provokes intense anxiety.

It should be noted that some level of anxiety in social situations at times is very normal.

The Individual

Individuals who suffer from social anxiety typically have a stronger than usual desire to make a good social impression. We all like to think we are making a favourable social impression! Unfortunately, they also fear that they are not as good socially as other people and will fail to come up to an acceptable standard of social behaviour – that they will not make the favourable impression they so crave.

In this sense, social anxiety can be understood as an intense fear of embarrassment. Individuals with social anxiety experience a wide range of unpleasant symptoms of anxiety from muscle tension, increased heart rate and dizziness to nausea, dry mouth, and breathlessness. However, of particular concern to them in social situations are the clearly visible signs of anxiety such as blushing, perspiring, shaking and stammering. 

The Social Situation

Individuals with social anxiety tend to either avoid or endure with severe anxiety or distress these much-feared situations. Because the anxiety is so intense and distressing, it’s much easier just to stay away from social situations and avoid other people altogether. Individuals can isolate themselves to such an extent that they give up work and remain at home.

In some circumstances their social contact can narrow down to their immediate family or in extreme circumstances to no one at all. This then can lead to feelings of sadness and even depression. Others can turn to alcohol in an attempt to ease their social discomfort and this can lead to serious problems with alcohol misuse and dependency.

Unfortunately, the avoidance, anxious anticipation, or distress experienced in social situations interferes greatly with the individual’s normal routine at work, in school, during social activities, and/or in relationships.

Most individuals with social anxiety have jobs that are well beneath their capabilities and capacities because of their social concerns: the nightmare of job interviews, the agony of working in a job where there is a lot of public contact or the dread of being promoted to a position of authority over other or that involves team meetings or formal presentations.

It is important to note that individuals who suffer from social anxiety do recognise that their fear is unreasonable and/or excessive, but try as they do they cannot simply stop themselves having these irrational or excessive concerns. Finally, without proper treatment social anxiety tends to develop into a longstanding and unremitting condition.

Symptoms

Behavioral & Emotional Symptoms:

• Anxiety reaches such a point that daily tasks, school, work and activities become affected
• Avoiding situations where the sufferer feels he/she may be the center of attention
• Kids with possible SA tend to be worried about being embarrassed in front of peers
• Considerable fear of being in situations with strangers (people the sufferer does not know)
• Dread over how they will be presented to others
• Excessive fear of being teased or criticized
• Excessive fear that other people may notice that the sufferer looks anxious
• Excessive worry about being anxious, which makes the anxiety worse
• Excessive worry about embarrassment and humiliation
• Fear of meeting people in authority
• Having severe anxiety or panic attacks when in the feared situation
• Refraining from doing certain things or talking to people because of a fear of embarrassment
• The individual worries excessively about being in situations where he/she may be judged
• When in a situation that causes anxiety the sufferer’s mind may go blank

Physical Signs and Symptoms:

• A feeling that the heart is either pounding too hard or fluttering (palpitations)
• Abdominal pain and/or stomach upset
• Avoiding eye contact
• Blushing
• Children with SA may weep, have tantrums, cling to parents, or shut themselves out
• Clammy hands
• Cold hands
• Confusion
• Crying
• Diarrhea
• Difficulty talking; this may include a shaky voice
• Dry mouth
• Dry throat
• Excessive sweating
• Muscle tension
• Nausea
• Shaking
• Trembling

TREATMENT

Mindfulness & Relaxation Training: Cognitive Behavioural Psychotherapy 

Mindfulness and relaxation training can be very helpful in minimising the disabling effect of bodily symptoms during periods of anxiety. A number of useful strategies will be taught in order to approach problematic thoughts associated with your condition. Another area of intervention is helping you to become more aware of the vicious circle of avoidance. You will be trained in a variety of strategies to equip you to face anxiety provoking situations in small, manageable steps. Throughout all these endeavours you will be supported and psychotherapy will be conducted at a pace comfortable for you