Treating Separation Anxiety
Anxiety is the most common mental health condition for both adults and children. For children, the most common type of anxiety is separation anxiety. Separation anxiety is distressing for both children and parents who feel they are stuck with the current situation. This brief post summarises the approach we use at CBT Australia in helping children and parents manage separation anxiety.
When is it normal or when is it separation anxiety?
It is usual for all young children to feel temporarily anxious about separation from their primary caregivers and sometimes to feel worried about new situations. However, for some children, the anxiety they feel is substantially higher than what other children experience at the same age (or developmental) level. This anxiety can seriously interfere with their participation in activities that other kids at their age can enjoy. Some signs that may indicate that your child is experiencing separation anxiety can include:
Excessive clinginess;
Unwillingness to fall asleep without a caregiver next to them;
Frequent checking on adults;
Excessive worry about upcoming points of separation;
Refusal to attend sleepovers with friends or family or go on events like school camps;
Needing a caregiver to come with them when they want to go to the other end of the house;
Oppositional behaviour such as refusing to get into a car to go to school or another event that involves separation;
Withdrawing and being sad/distant when separated; &
Complain of nausea, headaches, other unspecific physical complaints.
What can be happening for the child?
Separation anxiety occurs from (1) the child's beliefs about the world and (2) patterns of their behaviour that get set within the family. In Separation Anxiety, children commonly have some mix of the following beliefs:
Fears of Being Alone;
e.g. I can't handle being on my own, but I can be in control if I am around others
Fears of Abandonment;
e.g. The parent is abandoning me if I go to school; I will never see Mum again if she goes out!
Fear of Physical Illness:
e.g. I feel awful when Mum goes out, I could be getting sick, and that would be BAD!
Worry about Calamitous Events;
e.g. I could get kidnapped if Mum is not there OR Dad could die if he goes out!
Overall, the child feels the world is a dangerous place, which they risk facing alone while they feel physically awful. To try and cope with this danger, the child will be using a lot of "safety signals." Safety signals refer to people, places, objects, and actions that help the child feel safe. Unfortunately, with separation anxiety, these safety signals become too strong and serve to feed the separation anxiety.
Examples of safety signals include: calling out for a parent and having them respond ("Are you there Mum? Yes, I am, and I am OK"); getting parents to make specific promises about when they will be back; having to have a safety object (blankie, soft toy); only going to familiar places, or requiring a parent to attend an activity such as school camp.
What helps with the separation anxiety?
To successfully reduce separation anxiety, we work with both parents and children. We use an evidence-based CBT approach known to be effective in reducing separation anxiety.
Firstly, we need to work with you as parents to help you identify all the safety signals that exist for your child. It is easy as a parent faced with a highly distressed 'clingy' child to comply with the "safety signals." However, in the long run, this can make it more difficult for the child to adapt without these signals. We work through reducing the reliance of your child on the safety signals gradually and warmly that allows them to cope with greater separations. We will also work with you as the parent to deal with the oppositional/defiant behaviour that can come with separation anxiety.
Secondly, at the same time, we work with the child. The best way to reduce anxiety is to get them to experience more separation gradually. We help the parent and child set up "experiments" where the child experiences small separations without the safety signal to realise that they can cope. To help the children do this, we train them first in ways to relax and help them get used to feelings of discomfort. We can also work on giving the children a plan to have when they feel anxious so that they can experience a greater sense of control. We also work on changing the unhelpful beliefs about the separation from a caregiver that are listed above.
How long can this take to treat?
It depends on how severe the separation anxiety is, the age of the child, and the willingness of the family to change existing patterns. However, the goal with our CBT based treatment is for us as psychologists to become redundant as soon as we can. We aim to skill up the parent and child as fast as possible to manage this on their own.
If you feel that your child may be experiencing difficulties with separation anxiety, you can speak to our team at either Narre Warren or Mentone about an appointment.
Dr Nathan Wilson
Clinical Psychologist
References
-American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013
-Eisen and Schaefer, Separation Anxiety in Children and Adolescents, 2005
