Special Needs

Sarah’s Story: Helping Children And Teenagers Who Live With Anxiety

In the first of her new Beyond the Classroom series, Dr Margot Sunderland offers practical guidance for non-specialist teachers and school staff responding to children in distress who ‘behave their trauma’. In this first guidance we meet ‘Sarah’, who struggles with anxiety and Dr Sunderland explores the need to view children’s behaviour within the context of their home lives.

Panic attacks, heart palpitations, somatisation, phobias, social anxiety, worry, catastrophising…

It’s not a way to live life to the fullest. You feel vulnerable, frightened, unprotected and helpless. Fear can be a lot easier to handle, as it’s more clear-cut. Once the ‘scary thing’ disappears, we feel okay again. But anxiety goes on and on continuously, regardless of whether the fearful incident has ended or not. This is because with states of anxiety, the brain triggers high levels of stress hormones, which colour our perception with a sense of threat, danger and deep unease. As Sarah, one particularly anxious 15-year girl, told me, “I have never known one moment of calm in my life.”

How do children and teenagers commonly try to cope with feeling anxious

They act! By controlling, avoiding or both.

Controlling includes behaviours like controlling food intake, purging, checking things (e.g. taps and plugs) carrying out rituals, self-harming.

Avoiding means avoiding situations that evoke feelings of threat and danger, for example not going out to social gatherings, parties where there are lots of people or missing school (phobias or social phobias).

In order to heal, anxious children and teenagers need to stop ‘acting’ on their outer world and start thinking and feeling about their inner world, namely the underlying feelings fueling their anxiety. This is because anxiety is always a symptom, never a cause.

For many children and teenagers, the cause of anxiety is something very frightening that happened in their lives, which left them feeling profoundly unsafe in the world. Common examples include being bullied or shamed at school, parents splitting up, a parent leaving the family home, a frightening teacher or parent, multiple school moves, or living with a parent with addiction issues. For others the underlying feelings of fear, grief, shame etc. originate from living with parents who themselves are anxious. Research shows that it is nearly impossible not to develop an anxiety problem with a parent who is themselves anxious.

How do you transform ‘unbearable feelings’ into ‘thinkable thoughts’

Research shows that the best way to alleviate anxiety as opposed to just trying to ‘manage anxiety’ is to address the feelings experienced at the time of the painful life event. That said, it is never possible to do this alone, only in the presence of an emotionally available adult, one who can listen and empathise and help the child/ teenager to make sense of the traumatic event. This is because the feelings about it are often deemed by the child/teenager as too dangerous to feel on their own (e.g. fear of the strength of their grief, fear of shame, fear of going mad, fear of the strength of their rage) which is why anxiety developed in the first place. As Freud said, “anxiety protects us from fear.”

But here’s the rub. Firstly, teenagers need to know how unaddressed trauma can fuel anxiety because most of them have no idea. Anxious teenagers are often extremely aware and super eloquent about their symptoms: panic attacks, psychosomatic symptoms (after endless ‘all clears’ from doctors,) phobias, obsessions, heart palpitations – but not about the cause of those symptoms. However, with supportive curious enquiry from an adult trained to listen, many will accurately and easily recall the life events that changed everything for them, and left them feeling fundamentally unsafe in the world.

Underlying any anxiety is an impaired ability to meaningfully think about feelings. In other words, anxiety is fuelled by wordless sensations, known by some as ‘unstoried emotions’. With help from the trained adult to make sense of the original ‘trauma’ the anxious child can find relief by putting painful feelings into words. As observed by Heather Geddes, these ‘unbearable feelings’ can transform into ‘thinkable thoughts’, meaning that a traumatic memory can evolve from a haunting nightmare into an integrated part of our life story.

Explaining the causes of anxiety to older children and teenagers

… And why it’s vital to talk to an adult trained to listen

  • Anxiety is not related to ‘bad’ genes or a chemical imbalance in the brain
  • For many people, anxiety is ‘fearing in the present what happened in the past’
  • The traumatic event will typically have happened at a time when your younger child self had few or no coping skills to deal with the event, and no one was there to help soothe you or help you make sense of what was happening. So the feeling of threat and danger fully immersed, which is why it’s left you feeling so unsafe and frightened now
  • In moments of anxiety our minds can trigger back to a time when we felt utterly powerless and utterly vulnerable

In the grips of anxiety

  • You have stress systems in your brain. Metaphorically they are a bit like burglar alarms, (one is called the amygdala). They warn you of danger. If for example a lion is chasing you, the stress systems will tell you there are DANGER. When it comes to anxiety, these stress systems keep going off saying “Danger, Danger” when there is no danger. It’s because there was DANGER in a situation when you were younger.
  • Frustratingly, your brain is often unable to differentiate between current anxiety and past anxiety. You then feel hugely anxious and don’t link your anxiety to the traumatic memory. Once you do make that important connection and talk it through with an adult who can help you, the anxiety will stop blighting your quality of life.
  • So, if you suffer from anxiety be curious about past frightening experiences in your life. Understand how the life event impacted on you – talk about what happened with a trusted empathic adult.
  • Once you address what happened in the past, you’re allowed to get angry about it or grieve with someone who can help make sense of what happened.

Sarah. age 14

When Sarah was 14 she developed phobias and suffered from panic attacks. She dealt with them by avoiding any social situation outside of school. Her friends gave up on her as she never wanted to go out with them anymore. She then started to become fearful of going to school, and her attendance plummeted to only 6 percent.

Sarah began to visit Miss Anderson, who was a trauma trained teacher at her school. It was the first time Sarah had really trusted an adult. One day, Sarah told Miss Anderson about having been badly bullied in her primary school when she was 10. The bullies had put her head down the toilet and she thought she would die. It all happened at a time when her parents were splitting up. Miss Anderson listened so well. Her reflective words “so alone”,” so un-helped”, “no one knew” helped Sarah feel her feelings about bullying for the first time. It was particularly helpful when Miss Anderson used the word shock as Sarah realized it was exactly that. The words terrified and utter aloneness also brought her particular relief.

Before these vital conversations with Miss Anderson, Sarah had played down the bullying in her mind. Her parents often told her what a strong confident girl she was, which meant she implicitly received the message that forgetting about painful events, burying them and moving on was the ‘strong’ course of action. In actual fact, all of the research shows that the opposite is true.

With Miss Anderson, Sarah cried about the awful bullying for the first time and felt angry instead of a helpless victim. With Miss Anderson’s help, she drew pictures of the bullies and wrote angry words all over them, tore up the paper and threw it in the bin (research shows that the key to therapeutic change is to change ‘emotion with emotion’). Sarah also grieved about multiple losses she experienced from her parents splitting up.

Miss Anderson received permission from the Headteacher to text Sarah – particularly because she was so school phobic. This is a sample of one of the texts:

Sarah – Miss I feel horrible this morning, my tummy is going crazy I feel crazy I feel like I am going mad

Miss Anderson – Oh Sarah how painful this must be for you, and frightening, I guess. I am so sorry you are feeling so overwhelmed in this way.

Sarah: Yes, that’s right Miss. It’s exhausting

Miss Anderson You are in my mind and in my thoughts Sarah. I suggest you do that breathing exercise I told you about

Sarah – Ok miss I’ll do that now

Miss Anderson That’s brill Sarah – and hope you feel calm enough to come in: remember I’ll be here for you at break.

Over three months, Sarah’s attendance shot up and went from 6 percent to 90 percent. She talked of feeling calm for the first time in her life.

So how did Sarah get better?

It was a combination of factors:

  • Sarah was able to focus on the traumatic memory (which was fueling her social anxiety) and was able to talk about it and process her feelings for the first time. This is known as ‘memory reconsolidation’. If a memory is talked through and met with compassion and understanding, it ‘reconsolidated’ in the mind as something manageable. As the famous neuroscientist Jaak Panksepp says, “Bad memories are not like a big impenetrable mountain, they are changed by dynamic interaction with the environment through human interaction. “
  • Sarah changed ‘emotion with emotion’ (meaning instead of fear and shame she felt empowerment, anger and grief)
  • Through repeated soothing and emotionally regulating connection with Miss Anderson, Sarah developed effective stress regulatory systems in her brain, calming the amygdala
  • Sarah developed a secure attachment with Miss Anderson. Secure attachment triggers optimal levels of opioids and oxytocin in the brain (these are anti-anxiety neurochemicals)
  • Sarah knew she really mattered to Miss Anderson. Research showed a marked decrease in troubled behaviour when a child/ teenager feels they really matter to a mentor. (Kelley et al 2018)

In conclusion, schools need many more Miss Andersons who are trained to be emotionally available adults for children like Sarah. Training doesn’t have to be long, drawn out or complicated – it’s simply about training existing school staff with natural empathy to listen, understand, and be there.

And if we do nothing?

… Children and teenagers are likely to carry on doing extreme things just to calm themselves down, including:

  • Self harm
  • Drink alcohol (it releases calming chemicals in the brain)
  • Practice controlling behaviours like counting calories which can transfer the focus of their anxiety to their body
  • Adopt extreme avoidance strategies – continuing to miss even more school
  • Use prescription drugs to self- medicate. There have been several tragic cases of teenagers becoming addicted to Xanax and taking their own lives due to this.

I strongly believe that doing nothing and failing to train teachers in basic empathetic and listening skills is tantamount to physical and emotional neglect. It’s time for radical change, which has an easy solution already being implemented up and down the country. Please visit Trauma Informed Schools for more information.

Dr Margot Sunderland is Director of Education and Training at the Centre for Child Mental Health and Co-Director of Trauma Informed Schools UK

References

  • Brosschot JF, Van Dijk E, Thayer JF (January 2007). “Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period”. International Journal of Psychophysiology. 63 (1): 39–47.
  • Margaret S. Kelley, Meggan J. Lee. When natural mentors matter: Unraveling the relationship with delinquency. Children and Youth Services Review, 2018; 91: 319
  • Jaak Panksepp from psychiatric ward to understanding happyness
    https://www.youtube.com/watch?v=Xevjwe1qQ7c

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