Another tactic is to invoke support from a favorite superhero. Ask the child: “What would Michael Jordan say to you? What would Kim Possible do in this situation?”
Relaxation and interoceptive exposure are CBT techniques that can allay physical symptoms of anxiety. “Relaxation training is the most common approach in kids but also the least effective,” Dr. Pinto Wagner said. “Some kids might need it when they are very worked up, but in general this only works with mild anxiety in kids who get anxious occasionally. I use it in about 10% of the kids I work with.”
Exposure is the most potent technique for overcoming anxious behaviors, Dr. Pinto Wagner said. “I tell patients [that] to overcome your fear, you must face your fear. Do the things you are afraid to do, and stop the avoidance and escape.” From exposure, patients habituate and get to test the reality of their fear. “Because 99.9% of it does not come true, it gives them an ability to invalidate their fear,” she added.
Rather than use a flooding approach, take little steps toward gradual exposure in children, Dr. Pinto Wagner advised. “It's more natural and less frightening for kids. Start with almost ridiculously easy things. Experience easy success and build confidence. If you go too far, the child gets scared, and you have to backtrack.”
Any child can relate to the metaphor of riding a bicycle, Dr. Pinto Wagner said. “I tell children [that] facing their anxiety is like riding up a big hill. You may want to quit and go back down, which is escape and avoidance. But if you keep going, you will get to the peak of your anxiety and then you will be able to coast downhill on the other side.”