This is a guest blog post by Amanda Balkhi, PhD, author of the book One, Two, What Do I Do? A Children's Guide to Talking Back to OCD's Intrusive Thoughts.

Do you remember the first time you felt scared as a child? Not just the butterflies in your stomach before the first day of school, but really, truly anxious and out of control? A shiver in your knees, a weight in your belly, and a freight train in your heart can be absolutely overwhelming for a child. If you are like most of us, many of your anxious thoughts were likely met with “Don’t worry about” or “Just let it go” or even “Stop being so sensitive.” 

Unfortunately, these reassurances rarely led to lasting comfort or change and more often lead to feelings of isolation. So what can we say differently to help children understand that we are here for them? 

“That would be scary! What do you think we should do?”

Agreeing that the child’s thought truly is distressing can go a long way towards a child feeling seen and heard – and let’s be honest – anxious thoughts are scary. Following this acknowledgement with an invitation to brainstorm problem solving strategies helps to put the child in the driver’s seat and sends a strong message that you and the child are on the same team. You can then help steer the child towards solutions that are constructive and adaptive. 

“That sounds like a Worry Monster thought to me. What do you think?” 

Externalizing the child’s anxiety – from a thought they have to a thought that is put upon them by anxiety – can be a powerful way to help children understand and be willing to challenge their anxiety. The Worry Monster is a favorite metaphor of mine for anxiety because it’s visible and concrete. You can see some examples of Worry Monsters and how they grow and shrink in my book One, Two, What Do I Do? 

To explain anxiety in terms of the Worry Monster, I like to say that everyone (even grown ups) has a Worry Monster that we can’t see or hear but that we feel. Worry Monster can say some scary thoughts and give us upsetting feelings like a hot or heavy stomach, a fuzzy brain, or a fast heartbeat. While Worry Monster exists to keep us safe from things that are really dangerous, sometimes it can get out of control and make us fear that things are dangerous that truly are not. 

Another metaphor you may use is a “false alarm.” We know that fire alarms are loud and jarring, but we listen to them to avoid getting hurt in a fire. Anxiety does the same thing to our bodies, making us react like it’s a big emergency when it’s triggered. Just like how fire alarms can go off when there really isn’t a fire, our anxiety alarm can go off when there is no real danger.

“Your worry monster really doesn’t like that. Let’s show that Worry Monster how strong you are!” 

By teaching children that they have the power to challenge their anxious thoughts, we put them in the driver’s seat and allow them a sense of control and purpose. When children are able to label their thoughts as anxious and challenge the thoughts anyway, they adopt a mindset of approach — one of the most powerful ways to increase distress tolerance and build resiliency in children with anxiety. 

“You’re right, we could fall off when we go up. We also might not fall off. We will try our best and use our careful feet.”

When the child’s anxious thoughts are realistic or rational, simply acknowledging that the perceived danger is real sends the message that it’s you and the child on the same team. Just like adults, for children the unpredictability of the situation can be the most distressing component. By modeling a calm and measured response, you can help the child learn to trust themselves and balance the uncertainty of the world with the matters that they can control.It’s important though to maintain this as acknowledgement and not accommodation. What this means is, when the child expresses concern we acknowledge and continue to take steps towards doing the hard and scary thing rather than avoiding engaging in the thing that is scary.   

“That’s a big thought, I wonder if something like that could really happen. Maybe that snake will become my best friend and live in my pocket too!” 

For thoughts that seem fantastical or exaggerated, making the thought bigger and sillier can sometimes make it easier for the child to judge whether an event is likely to happen or not. Many powerful anxious thoughts for children live in a grey area - meaning the child is often unsure if they could really happen or not. Making the thought bigger and sillier pushes it closer to a black and white situation that is easier for the child to judge. This is based on a concept called Cognitive Defusion, and it can be a powerful tool to helping kids step back and observe the thoughts rather than getting washed away by them. For example, if a child is concerned about a lizard popping up in the kitchen (which could happen but would be unlikely) building a story about that lizard becoming your best friend and living under Dad’s baseball cap may make it easier for the child to judge whether the thought is rational and likely to happen or an unlikely thought triggered by anxiety.  

“Thanks for telling me - I felt like something was bothering you and I’m glad to know what it is. Let’s go for a walk together.” 

In some circumstances, simply acknowledging the thought and redirecting the child to another task can be enough to provide the support the child needs to get through that situation. It is important when attempting this that the adult sincerely acknowledge the child’s distress before redirecting them to another activity, otherwise the child may feel that the adult doesn’t care. 

When you redirect, taking the time to choose activities that help the child to relax and reconnect can be helpful. For some children, a high value activity like a favorite game or a time intensive game can be a powerful distraction while for other children a child-driven activity like imaginative play or building with blocks may build a better connection. Going for a photo walk, riding bicycles or scooters, or building with found material like sticks and leaves can all be enjoyable ways to connect with the child out in nature. For children who enjoy arts, picking up a Coping Craft can be helpful. 

When to Seek Help for a Child’s Anxiety

Anxious thoughts are a normal part of child development. However, for children experiencing frequent distressing anxious thoughts or children who have developed numerous behaviors or compulsive routines to mitigate their anxious thoughts, discussion with a professional counselor or therapist is essential. Similarly, if parents, caregivers, and siblings find themselves bending over backward to accommodate and reassure a child’s anxious thoughts, professional assessment and guidance is recommended. 

Effective Child Therapy, a resource created by the American Psychological Association’s Society for Clinical Child and Adolescent Psychology, is a great source for those needing the guidance of a licensed provider. There you can find information for parents on what types of therapy may be helpful for your child and tips to help locate a therapist that has the skills necessary to deliver effective treatment.  

Final Thoughts About Anxiety

It’s important to remember whether you are 3 years old or 63 years old, anxiety is distressing and can feel overwhelming for both the child and those who care about them. As an important person in a child’s life, the best responses we can have are those that help the child feel seen and understood while not reinforcing the anxious thoughts. 

Illustrations and simple text can be a major benefit when explaining intrusive anxious thoughts to children or when young children enter treatment for anxiety or Obsessive-Compulsive Disorder (OCD). That’s why my coauthor and I created One, Two, What Do I Do? A Children’s Guide to Talking Back to OCD’s Intrusive Thoughts. We hope that you find it to be an easy and helpful way to explain the Worry Monster and give young children the tools to shrink it down to size. 

If you found this helpful, you might also enjoy this article on Coping Without Avoidance or these other Whole Child Counseling blog posts about anxiety.

About the Author

Amanda M. Balkhi, PhD is the Founder and Executive Director of the Balkhi Foundation, a nonprofit organization dedicated to enhancing the quality of life of individuals and families through education. Dr. Balkhi's publications broadly encompass child and family health and wellbeing with specific interests in childhood chronic conditions such as Obsessive Compulsive Disorder. Dr. Balkhi is also the author of One, Two, What Should I Do? A Children’s Guide to Talking Back to OCD’s Intrusive Thoughts, an illustrated storybook that challenges young children to talk back to their Worry Monster. For more information visit AmandaBalkhi.com And here is a look at a couple of pages inside Amanda's book One, Two, What Should I Do? A Children’s Guide to Talking Back to OCD’s Intrusive Thoughts: