New therapies help young patients who suffer from shyness and anxiety
Many children are shy or anxious. Most of them grow out of it at some point, yet others develop social phobias. That happens when being bashful becomes a problem that can hinder a child’s age-appropriate development. For several years, Dr. Julia Asbrand of the Institute of Psychology at the University of Freiburg has been researching which therapies help young people to overcome their fears. Verena Adt spoke to the psychologist about encouraging thoughts and spiders in the cellar.
Frau Asbrand, are there social phobias that are specific to children?
Julia Asbrand: In principle, the social phobias children have resemble those of adults. Almost always the fear is about being viewed negatively by other people, to be perceived as embarrassing or stupid. Children are also often anxious about sticking up for themselves in conflict situations. When they are eight or nine years old, children have to learn how to approach groups of similar-aged peers. In the case of older children, add establishing contacts at a more intimate level. Those are all enormous challenges.
How do you recognize if a child is just a bit shy or actually needs therapy?
Social phobias are normal at certain stages. A child needs therapy if phobias slow their development and the child is unable to do what they would do at that age level – if, for example, a child is unable to establish a new circle of friends after changing schools or is afraid to join a sports club, even though the child would really like to.
What do you do to help the children?
For a few years now, we’ve been offering affected children therapy within research projects. The first project was funded by the German Research Association (DFG). It’s called Courage Suits You (“Mut steht dir gut”) and has already been completed. And since the autumn of 2016, we’ve also been taking part in a German Federal Ministry of Education and Research (BMBF) study called Children Overcome Anxiety, (“Kinder bewältigen Angst”), or KiBA for short. Six universities have cooperated in these national projects, with around 400 children with different phobias taking part.
What do the children learn in therapy?
The first thing they need to understand is what the phobia is made of. There are three components: thoughts, physical reactions and behaviors. The thoughts underpinning anxiety about speaking in front of a class might be, “I could stumble over my words and then the others will laugh at me.” In terms of physical reactions, children frequently say they go weak in the knees or have sweaty hands. Behaviors are characterized above all by avoidance of frightening situations. When a child refuses to go to school at all, for example, if it has a presentation or must recite something that’s been memorized. The thoughts are a key point here. The child thinks he or she will be ridiculed, but no one has laughed yet. That’s why we speak of anxiety-generating thoughts and encouraging thoughts.
What are encouraging thoughts?
These are thoughts that can help the child to have confidence in a difficult situation. It’s significant that these aren’t unrealistic ideas. With the children, we work out thoughts such as, “I’ve laughed about someone, too, but didn’t mean it in a bad way,” or “I’ll choose to look at the ones who are listening to me with interest.” What’s decisive is that they try out the thoughts. We practice doing this with exercises and progress in small steps. For example, we might agree with the child to read aloud during a therapy session. Step by step, we work up to giving a voluntary presentation in class. If a child is afraid of spiders, we first work with pictures and videos. Then the child is given the task of going into the cellar with his or her parents to find spiders. There it’s about children learning to face up to these situations and parents knowing how they can coach their child.
What is the course of therapy like this?
Courage Suits You consisted of twelve 100 minute sessions in groups of four to seven children. The KiBA study uses six weeks of individual therapy. For half of the children, the parents are present, too. For the other half, they’re not. The aim of the study is to discover the conditions under which including parents increases the success of the therapy.
You’ve already completed the therapy with a large number of children. How are they doing now?
All-in-all, most of them are better. But it also depends on the severity of symptoms they had when they started. Some are doing really well. They’re simply done with the issue of anxiety. Others are continuing therapy in a different context, because they have several phobias that cannot be treated fully within the space of the sessions.
Could you give us an example of that?
I had an eleven-year-old patient who had very pronounced fear of dogs. She would panic when she saw a dog running around fifty meters away. The girl wouldn’t leave the house anymore, wouldn’t ride a bike, and didn’t want to take walks. The first thing we addressed was what a dog looks like when it’s friendly and how it appears when it’s a threat. We also developed helpful thoughts, such as: “In Germany, the experience is that most dogs are friendly.” Then we went out and watched dogs. What were they doing, when they were running around out there? The reality is that most dogs aren’t really all that interested in people. That’s how we approached the situation. The goal wasn’t to get the girl to where she would go out and get a St. Bernard or start to pet strange dogs. Instead, it was to gain the ability to assess the situation realistically in order to be able to go back outside again. We succeeded.
Courage Suits You (“Mut steht dir gut”), in German
KiBA (“Kinder bewältigen Angst”), in German
Developing helpful thoughts: Julia Asbrand teaches children how they can prepare themselves for difficult situations.
Photo: Klaus Polkowski