A Stepped Guide to Developing Chandra's MAP

Meet Chandra:

Chandra is an 11-year-old girl in the fifth grade who has recently been diagnosed with social anxiety disorder. Although Chandra has always been a quiet child, she has become more irritable and withdrawn this year, refusing to hang out with her friends, struggling to do school work with dropping grades, and most recently seeming to “shut down” in social situations by refusing to make eye contact and mumbling. This has been going on for almost a year, but has worsened over the past five months. Chandra was assessed by her family physician who referred the family to a community mental health provider. She has recently been assessed and diagnosed with Social Anxiety Disorder, and possible Generalized Anxiety Disorder. For more information about Chandra click here.

Introduction

To provide you with an example of how a real children's My Anxiety Plan might look, we have created a MAP for Chandra, a fictional 11-year-old girl with social anxiety disorder described above. The following information outlines session to session material highlighting how you the parent, can work with your child, to teach him/her about anxiety while demonstrating how to use the relevant tools and worksheets on this website to create a complete and comprehensive MAP.

Session 1

Topic: Learning about how anxiety affects me

Tools:

  • Anxiety 101 "My mum and I read this together"
  • Talking to Your Child About Anxiety "My mum and I read this together"
  • When Anxiety is a Problem "Both my parents read this to me, and we talked about where my anxiety is causing problems. We came up with this list."

Example Worksheets:

Session 2

Topic: The science of anxiety

Tools:

  • Anticipatory Anxiety "My dad and I read this together"
  • Avoidance "My dad and I read this together"
  • Fight Flight Freeze "My dad and I read this together. We looked at the body diagram on Anxiety and Me to see what specific things happen in my body when I’m scared."

 Example Worksheets:

Session 3

Topic: “Getting Ready” tools: Developing a team to fight back against unwanted anxiety and other tools

Tools:

  • Coping with Back to School Anxiety "My dad read this to me as I have anxiety every August when I know school is about to start"
  • Happy Home "My mum and I are going to schedule some daily physical activities to help me get out a bit more. I know it will help, even if I don’t want to leave the house sometimes. She’s also going to help me start a better bedtime routine."
  • Healthy Child "My parents read this"
  • Healthy Parent "And this one too!"

"My parents and I made a plan that I can earn some points for prizes as I start this program and begin to use my tools. I think this will help, as I’m not sure I want to be doing all of this work. Its summer right now and I’d rather do other things."

"NOTE**Because there were quite a few topics to cover, my parents reviewed these with me over the course of 2 weeks. Sometimes these conversations happened in the car on the way to places, and at other times we scheduled a 15-minute “session” to talk. I think it helped to break it up like this."

Example Worksheets:

Session 4

Topic: Relaxation

Tools:

  • Learning to Relax: Calm Breathing
  • Learning to Relax: Muscle Relaxation

"I’m practicing these with both my parents. Sometimes I do them with dad first thing in the morning before he leaves for work. Or, with mum right before bed. Also, I’ve downloaded the MindShift Ap on my i-pod so I can use the audio file to help me."

 Example Worksheets:  

  • None

Session 5

Topic: Relaxation continued, and starting to build my anxiety Ladder

Tools:

  • Learning to Relax "I’m practicing deep breathing and the short version of the relaxation training every day. Its become a good routine for me."
  • Facing my Fears "My dad went over how to do this. I totally get it, but I’m pretty scared about the things I wrote down I’m agreeing to do! Yikes! Take a look at my ladders in the Worksheet section below."

 Example Worksheets

  • Ladder (Soccer-No-Ranking, School-No-Ranking, Sleepover-No-Ranking"Because there are three different areas in my life where anxiety is bossing me about, we made three lists or ladders: Soccer, School, and, Sleepovers. Since I didn't have time to rank the ladders in our meeting today, I will rank them next time from least scary and hard, to most scary and hard. My dad helped me make these lists, and it took about 45 minutes."

Session 6

Topic: Finish building my anxiety Ladder

Tools:

  • Facing my Fears "Now that I have reviewed this a few times and talked with my parents, I'm feeling a little less scared about what I am going to be doing. It still seems hard, but I think I can start with the easier items and move my way up over the next few weeks."

Example Worksheets:

 

Session 7

Topic: Self-Talk – Using helpful “pop ups” to talk back to my anxiety

Tools:

Example Worksheets:

  

Session 8 & 9   

Topic: Cognitive Restructuring - Changing the way I think 

Tools:

  • Balanced Thinking "My parents took time to read this section. I could hear them talking about it. They told me some of the information over a few weeks. During those weeks we took 15-20 minutes every couple of days to do these worksheets."

Example Worksheets:

 

Session 10       

Topic: Introduction to exposure therapy

Tools:

  • Avoidance
  • Tolerating Uncertainty

"Just like in some of the previous sections where there was a lot of new information to learn, my parents took time to explain how exposure therapy works. They told me that avoiding situations and acitivities, and/or wanting certainty all the time, has been keeping me trapped. We then reviewed my three ladders that I made a few weeks ago: Soccer, School, Sleepover. I’m nervous to start, but I'm also kinda excited. We will use the Exposure Tracker worksheet (below) each time I engage in an exposure challenge to help track my progress. I have decided to stick to doing one ladder at a time. To start, I chose to focus on my fear of being alone at soccer. This means for the next few sessions, I'm going to focus on only doing exposures during soccer practice. But once that gets easier I'll move on to doing exposures around my fears in school. The truth is I’m tired of always being anxious and if exposure can help, I’m willing to try. And of course it helps to have some rewards to earn! I made some additions to my Reward chart to keep me motivated."

 Example Worksheets:

  • Ladder (Soccer-Ranked, School-Ranked, Sleepover-Ranked)
  • Facing my Fears - Exposure Tracker  (Soccer-Before-Exposure, and Soccer-After-Exposure) "As you can see the "Before" version of my Exposure Tracker shows a list of my planned Soccer exposure tasks before doing the exposure. Whereas, the "After" version of my Exposure Tracker shows the Soccer exposure tasks after I have completed them and recorded fear ratings at the start, during, and end of each exposure session. With exposure, I learned that it is important to keep doing the same challenge over and over until its not scary or hard anymore. Only then will you be ready to move on to the next challenge. This meant that when I started doing exposure for my fear of being alone at soccer practice, for the first four practices I needed my parents to stay for the whole practice until my fear lowered. Then I felt ready for them to try staying only for the first 45 minutes. I needed them to do this for the next three practices in a row, until i was ready for them to be able to stay for just 30 minutes. It got easier over time, but I had to repeat the same challenge several times until I was ready to move on to the next challenge."

 

Session 11-17+

Topic: Continuing exposure

Tools:

  • Facing my Fears (Review as needed)
  • Avoidance (Review as needed)
  • Tolerating Uncertainty (Review as needed)

"Since I made my first ladder a month ago, my parents have helped me to schedule time to do my exposures most days. At the start of each week (or after about 5-7 exposure practices or sessions), we would re-rank my Ladder challenges by crossing out my old ratings and inserting new ones, OR, by making a new Ladder if it was getting hard to read all the re-rankings. We then would create an Exposure Tracker worksheet to use, which helped me keep track of my progress. It was cool to see that my challenges got easier the more I did them, and what was once a “6” on my ladder soon became a “4,” then a “3,” and eventually just a “1." I was able to see these changes quite quickly because I decided to stick to doing one ladder at a time."

 Example Worksheets:

 

Session 18-19  

Topic: Exposure: Special Topics OR continue exposure work

Tools:

  • Overcoming Perfectionism "Even though I don’t have GAD/OCD, I sometimes want things “perfect” and if they aren’t perfect then I won’t hand in my school work. My parents helped me understand how this could be managed using exposure exercises and adding things on my ladder."

Example Worksheets:

  • Ladder (Perfectionism)  "The order of challenges on this ladder is not ranked easiest to hardest, top to bottom, like on previous ladders. Instead, there are a few groupings of items, or "exposure chunks" all on one ladder. This is because there are a variety of areas where I notice I am being a perfectionist, so I have chunked these into one ladder."
  • Facing my Fears - Exposure Tracker (Perfectionism)  "As you can see, my Exposure Tracker shows my progress mid-way through working on one of my "exposure chunks" where I am being a perfectionist."

 

Session 20       

Topic: Creating an exposure lifestyle to maintain progress, and Wrapping up

Tools:

Relapse Prevention - Continuing my Journey 

Example Worksheets: