Our eight-year-old girl is a very kind-hearted and soft child, but has always been a big worrier. We have gone through numerous periods of her worrying about a wide range of things, but she has always been a good communicator and we have managed to help her through most of these periods, using some of the techniques you have described in previous columns.
But this summer, things have escalated. When starting camp a number of weeks back, she got so anxious that she vomited. This has never happened before. We encouraged her to go anyway and to her credit she did and had a great week. But during that week, she spent a lot of time worrying about getting sick again and each morning, she vomited. It stopped a few days after camp had finished. She went to another camp this week and the same issue has arisen every morning.
We have worked with her on things like a "Worry Box" and "Worry Time", which has helped, but in talking to her this week, she feels the only thing that will stop the worry is if she gets sick. We have talked her through the idea of a "Mean Old Circle" (ie a vicious circle) and she seems to get the concept that the thing that she thinks will make her better is actually the very thing making her worse.
We have also gone to the GP to see if there are any physical issues causing the vomiting, but thankfully the results came back clear. We have tried to use some of the CBT techniques we have learned over the years with her, but are at a bit of a loss as to where to go next and with school starting, we are worried.
We would be grateful for some advice on where we could go to learn some techniques that will help our daughter through. We are slow to bring her to a mental-health professional just yet, as apart for this process in the morning, she is generally in good spirits.
Many anxious children and adults develop physical symptoms related to their anxiety. These can include dizziness, tummy pains, headaches and vomiting, as is the case with your daughter. Often, when physical symptoms happen, this can add a new layer to the worrying. Your daughter might now not only worry about going to camp, she might also start to worry about vomiting.
Sometimes, the physical symptoms can considerably add to the worries of the parents, who can doubt how they are responding the right way and both child and parent can worry that the physical symptoms indicate an underlying illness and sickness (it is good that you have gone to the GP to out rule this). As you are currently doing, what is required is a calm, patient approach to help your daughter. Remind her that she (and you) have managed the worries in the past and so you will be able to manage this worry now. Here are some strategies specific to handing physical symptoms related to anxiety:
Explain how worry affects the body
Take time to explain to your daughter how anxiety affects her body. Explain how a little anxiety is normal when you are doing something new and can be helpful in getting you prepared. Do up a sketch drawing of the body and brainstorm with your daughter the different symptoms people get when worried (eg stiff neck, sweaty palms, unsettled tummy etc) sharing some of your own examples as well as hers. Then explain how when worry gets out of hand it can cause big symptoms and even make you vomit. Say something like “your mind is so powerful that it can affect your body and even make you feel sick. But you know what? Your powerful mind can also help you feel better.”
Teach mindfulness and body-based relaxation
With physical symptoms, it is important to help your daughter become aware of and "tune into" her body and how anxiety affects her in the moment. Mindfulness is one of the best strategies for doing this and is something you can easily teach your daughter (and avail of the benefits yourself). There are great books and resources online such as Sitting Still Like a Frog, or you could consider going to a class (either together or by yourself and then teaching your daughter at home).
In addition, other body-based strategies can be helpful in relaxing her body such as doing her favourite exercise, attending yoga, or counting breaths. Find something she enjoys and that helps her feel in control. It’s interesting that she “thinks the vomiting makes her feel better” and I would be interested in exploring with her other similar strategies that she could employ that would work without the problems associated with vomiting. Could she, for example, take a time out when anxious to gently rub her tummy as she counts her breaths. Finding the right strategy that works for her might take a bit of exploration.
Finally, I understand your concerns about taking her to a mental-health professional at this stage. An alternative is to contact a professional to get some advice yourselves that you can implement at home. It strikes me that you already using lots of creative child-centred strategies. (I like the “mean old circle”) which are largely working, and it is a mainly a case of tweaking and building on these.
John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He has published 14 books including Positive Parenting: Bringing up responsible, well-behaved and happy children. See www.solutiontalk.ie for details of autumn courses