Facing My Fears

There are many useful tools outlined on this website that are designed to reduce anxiety. Perhaps the most important of all those tools is facing fears. The process of facing fears is called exposure. Exposure involves having your child repeatedly go into feared situations, experiencing less and less anxiety, until s/he is no longer anxious. Exposure is not dangerous and will not make the fear worse. In fact, up until now your child may have been avoiding or escaping from the people, places and things s/he fears, which has maintained the anxiety. By engaging in gradual exposure to his/her fears, your child can learn that these people, places and things are not dangerous, and s/he can cope. Done correctly, exposure can eliminate anxiety once and for all.

Doing Exposure in 3 Easy Steps

Exposure begins with the development of a list of the situations, or the parts of a situation, that are scary for your child. Next, you and your child will rank these steps from least to most scary using a 0-10 rating scale. Finally, your child or teen will work his/her way up the list, facing things that initially cause him/her anxiety, but developing confidence and experiencing success along the way. This process often happens naturally. For example, a child or teen that is afraid of water takes swimming lessons every week. S/he starts by putting feet and legs in the water, then the whole body and, finally, diving underwater. Children and teens with a fear of water can learn to love swimming. The same process occurs when children and teens learn to ride a bike, skate, or drive a car. Exposure is one of the most effective ways of overcoming fears, although it takes some planning, encouragement, modeling, and rewards.   Note: there are some areas of anxiety that require modifications to the standard exposure method. For more information see Special Topics.

Step 1: Build your ladder

Project materials for Step 1 & 2: Craft paper, pens, index cards, tape, and ribbon or string.

Find a time when you and your child can work on this project for about 30 minutes. For younger children, it's okay to accomplish this task at more than one time. You can explain this project as follows; “A few days ago we talked about how anxiety is a bully and has been bossing you around. Together we learned some tools you can use to squash anxiety, and today I want to teach you another important tool. It is important for you to face your fears, to learn that school is fun and that you can stay there without a parent. Although being at school without me might be scary at first, with practice you will feel less anxious. Eventually you will be able to go to school and have lots of fun. To help you face your school fear, we are going to make a ladder with 8-12 steps of “challenges.” You will get to choose your “challenges” and together we will help you climb your ladder.”

While most youth find this project works best by writing out 1 “challenge” per card, simply drawing a ladder on a piece of paper, and writing out 1“challenge” per rung, also works well. Work with your child to list as many parts to his/her fear, or as many different but related fears (i.e. groupings) as possible. If your child has a lot of different fears, build separate ladders for each fear theme. Adjust elements to make the “challenge” easier or harder. These elements can include length of time, distance, time of day, number or type of people nearby, etc. In addition to breaking down the fear into parts, it is important to describe each rung or step on the ladder clearly and specifically. If you and your child cannot clearly describe what s/he is going to do, s/he might not be able to do it. In addition, the more specific you make the description the less anxious and more confident your child will feel in being able to do his/her “challenge.” For example, writing out “go to school for first block and sit with Melissa while mum waits in car,” is clearer and more specific than “go to school.”

 

An example of a ladder list for fear of dogs might look like this:

Go to pet store and interact with many dogs

Go to park with mum and pet “safe” dog while owner has dog on leash

Pet and play with Rover off leash with owner for 5-10 minutes

Pet Rover and stay next to him while he is on a leash for 5 minutes

Let Rover sniff my hand and, when I am ready, pet him while he is on a leash

Go to neighbor’s house and look at Rover while he is on a leash, 2 feet away for 5 minutes

Go to neighbor’s house and look at Rover while he is on a leash, 6 feet away for 5 minutes

Watch a video clip of a big dog for 10 minutes

Watch a video clip of a small dog for 10 minutes

Look at real pictures of dogs for 10 minutes

Look at animated pictures of dogs for 10 minutes

 

Step 2: Rank your ladder

Once you have made a list, help your child order the items from least to most scary. You can do this by having your child rate how much fear s/he has for each situation on the list, from “0” (No fear) to “10” (Tons of fear). You can use the Fear Thermometer to help your child make the ratings (for younger children, use the Scaredy Cat rating system). If you have used index cards for the project, lay these out on the floor or table in order of least to most scary. Then, cut 2 pieces of ribbon the length of the card stack, and stick the cards to the ribbon using tape or glue. Your finished product will look similar to a Jacob’s Ladder. You may need to go back and forth a little bit with your child to get agreed upon, accurate ratings. If your child is rating items as much easier than you believe they will be for s/he, keep working together. It’s not about being right or wrong but about being realistic. Each ladder should include a whole range of situations. The ladder should identify 3-5 things your child can do now with some anxiety, 3-5 s/he can do now with moderate anxiety and, finally, 3-5 things s/he finds too difficult to do now. It is important to start small and take gradual steps. It may help to remember that when we climb a ladder, it is easier to do so 1 step at a time. Therefore, your child will need to have at least 1 “challenge” per step. If half of your child’s “challenges” are situated on steps 2-5, and the remainder on steps 8-10, your child will have great difficulty getting from step 5 to step 8.

 

Step 3: Climb your ladder

Once your child has a ladder, with “challenges” on steps 1 or 2 through 10 (or in all 3 scaredy cat levels), your child is ready to climb the ladder. Consider including a Points Plan to provide some initial motivation to your child to take the first important step on his/her ladder. Starting with the situation that causes the least anxiety, encourage your child to repeatedly engage in that activity (e.g. repeatedly saying “Hi” to an unfamiliar person) until h/she starts to feel less anxious doing it. If the situation is one that your child can remain in for a period of time (such as being close to a dog), encourage him/her to stay in the situation until his/her fear level is reduced by half. Pick a time to start the practice when you know you have enough time to see it through until the end (usually 20-30 minutes is sufficient). It’s okay if the first practice turns out to be really easy. This way your child will have a successful experience and will want to try for harder “challenges.”

 

Helpful Hints:

  • Keep your child on the current “challenge” step until s/he is experiencing little to no anxiety. Then s/he can climb to the next step. Proceed 1 step at a time until you reach the top.
  • Don’t end an exposure practice when your child’s anxiety is still high because you have run out of time. This is worse than not starting at all because it leaves your child with the memory that this step is scary. S/he will be reluctant to get back on the ladder the next time.
  • Exposure practices spaced apart, close in time, will result in faster progress. This is akin to strengthening a muscle; 5 sets of 10 muscle reps once per day, will strengthen your muscle faster than an hour of training once per week.
  • Some exposure situations are hard to generate "live." For example, it is not cost effective to buy multiple plane tickets to climb a "fear of flying" ladder, nor is it recommended to stage a kidnapping for a child with separation fears. These scenarios are best addressed through use of imaginal exposure, where the exposure is created in your youth's imagination. Work with your child to create a story or script of the "worst case scenario" that anxiety tells your child in his/her imagination. Use all 5 senses to capture as much detail as possible. When the story is complete, develop an audio recording and have your child listen to this over and over again just like you would with a traditional exposure situation.
  • Some youth will do better if you or another trusted adult show them how to do the exposure practice first. For example, you pet the dog before your child does.
  • Record your child’s progress. Use a piece of paper to record your child’s fear rating before, during and after each practice (see chart below). This will help your child to know when s/he is ready to move up the ladder. When ratings are at the 0-2 level for several days, your child is probably ready to move.
  • Finally, don’t rush. It can be hard to start facing the things you have avoided for so long. Be encouraging and recognize that your child needs to go at his/her own pace. For some youth this process can take weeks, for others months.

 

DATE/CHALLENGE

START

HIGHEST DURING

END

1/2/15   Pet Rover on leash 5 mins

3

5.5

2

2/2/15   Pet Rover on leash 5 mins

2

3

1

3/2/15 Pet Rover on leash 5 mins

1

2

1

4/2/15 Pet Rover off leash 5 mins

3

6

2

5/2/15 Pet Rover off leash 10 mins

3

4

2

 

 

 

 

 

 

Special Topics

Using the steps outlined above can effectively treat many anxiety disorders and areas of worry and fear, however, there are several anxiety disorders that require a more specific Facing My Fears approach. These include Exposure and Response Prevention for OCD; Anxiety Sensitivity Exposure for Panic Disorder and Agoraphobia; Exposure Therapy for PTSD; and, Exposure for Selective Mutism. For additional information about these special topics, please click on the links below:

Exposure and Response Prevention for obsessive-compulsive disorder (OCD)

Panic attack exposure for panic disorder and/or agoraphobia (PD/A)

Exposure for post traumatic stress disorder (PTSD)

Exposure for selective mutism