Supporting Children who experience Panic
Panic disorder can be an overwhelming experience, especially for young children. In this article, I will describe a therapeutic approach for children dealing with symptoms of panic, with a focus on Cognitive-Behavioural Therapy (CBT) techniques alongside creative techniques. Additionally, I will discuss the relationship between panic and depression, highlighting how these conditions can coexist and intertwine.
What is Panic?
Panic disorder in children often presents through intense and unpredictable panic attacks. These episodes are characterised by an overpowering sense of fear and anxiety, accompanied by physical symptoms such as a racing heart, sweating, and shaking. To effectively address panic with a young client—for example, an 11-year-old—it is important to create a personalised plan of CBT.
Cognitive-Behavioural Therapy (CBT)
Building a Therapeutic Alliance
Sessions begin by getting to know one another in a warm, safe and friendly way. I would ask about hobbies, what they enjoy doing in their spare time, and explore what they already know about the panic they experience. These sessions will make use of validated psychometric measures aka. questionnaires about their mental health.
Psychoeducation
This is followed by sessions where I provide age-appropriate information to help them develop a scientific understanding of panic and its symptoms. It is crucial for them to grasp what they are going through and to know that they are not alone in facing these challenges.
Working with Thoughts
CBT empowers children to identify and challenge negative thought patterns that contribute to panic attacks. For example, a child might think, “Last time I went into town, I panicked. I don’t want to go again, and I can’t control the panic, so I won’t go into town.” Through therapy, they learn to recognise these unhelpful thoughts and replace them with more constructive ones, such as, “Yes, last time I panicked, and it was awful, but maybe it won’t happen this time. I have my friend with me, and it will be different. And even if I do panic, I can handle it.
Exposure Therapy
A fundamental element of CBT is gradual exposure to situations or sensations that trigger fear. This process starts very gently and slowly, allowing children to build their confidence and gradually diminish their fear responses over time. Sometimes, this can be done in a playful way, by for example using balloons.
Relaxation Techniques
Equipping children with relaxation techniques—such as deep breathing, progressive muscle relaxation, and visualisation—provides them with invaluable tools to manage their anxiety effectively. Whether or not these techniques are used, and to what extent, depends on the individual presentation, as we want to ensure they do not inadvertently reinforce the panic.
Creativity
Integrating creative techniques into therapy can make it more engaging and, therefore, more effective:
Drawing
Encouraging children to express their feelings through drawing offers a creative outlet for externalising anxiety and gaining insight into their emotional world. It also makes experiencing emotions feel less intimidating.
Storytelling
Collaboratively creating stories that incorporate their experiences with panic allows them to build their own understanding, reframe beliefs, and develop coping skills using metaphor and imagination.
Arts and Crafts
For panic you could create a glitter bottle to visualise how quickly emotions can create a storm inside of us and how long it can take for these emotions to calm down.
The Intersection of Panic and Depression
Panic and depression can coexist, with depression sometimes underlying panic symptoms. In cases of prolonged emotional suppression due to depression, unresolved emotional distress can accumulate. This build-up can heighten the body’s sensitivity to stressors, resulting in an overactive stress response system and an increased vulnerability to panic attacks. Additionally, children experiencing depression may have intense feelings of hopelessness and general emotional distress, which can serve as triggers for panic attacks.
Panic symptoms can be effectively treated using the evidence-based approach of CBT. Children may benefit from a more creative approach that utilises the same underlying techniques to enhance engagement. However, if depression is the underlying cause of panic, it is advisable to focus on treating depression as the primary concern. It is crucial to remember that every child’s experience is unique, and effective support should be thoughtfully tailored to their specific circumstances and needs, guided by the expertise of qualified mental health professionals.
