Alison R. Alden, Ph.D., and Julieanne Pojas, Psy.D. are Licensed Clinical Psychologists at the Anxiety Treatment Center of Greater Chicago in Deerfield, IL.
Dr. Alden graduated from Northwestern University (Evanston Campus) and has extensive training and experience in cognitive behavioral therapy for anxiety, OCD, and mood disorders. She was the recipient of an ADAA Early Career Development Leadership award in 2014 and works with both children and adults. Dr. Pojas specializes in cognitive-behavioral therapy for anxiety and anxiety-related disorders. She treats children, adolescents, and adults.
Kids and teens often react with anger to the prospect of facing their fears. Doing things like engaging in exposure therapy or going to school when they are feeling panicked or overwhelmed, can trigger fight-or-flight responses, in which anxious children not only experience a desire to avoid things but sometimes actively fight or resist when we try to push them.
In our recent ADAA continuing education webinar, we discussed dealing with angry behavior in kids and teens with anxiety disorders. Topics covered included how to deal with tantrums, treatment refusal, school refusal, and threats of violence. To effectively deal with these sorts of issues, we believe that clinicians and families need two primary things: a solid understanding of basic behavioral principals and tremendous personal courage.
Important behavioral principles to understand include:
- Reinforcement—strengthening a behavior through positive consequences (either giving a child a reward or removing an aversive state). Judiciously applied rewards can go a long way toward motivating kids to do things they are scared of and are always the first thing we try when kids are reluctant to engage treatment or school.
- Punishment—weakening a behavior through negative consequences (taking away something the child enjoys or giving them something they don’t enjoy, like a chore). Punishment works best when we are trying to discourage bad behaviors, like hitting.
- Extinction—refraining from reinforcing unwanted behaviors until those behaviors cease. For example, research dating all the way back to the 1950’s suggests that tantrums are reinforced by attention, and that other literally ignoring them can lead to extinction of these behaviors.
In our webinar, which is available as a recording through ADAA’s website, we go into more detail about how we can apply these principles to help families deal with their children’s angry behavior.
However, in dealing with problems like treatment refusal and school refusal, we believe that both clinicians and families also need to have courage, strength, and willingness to do whatever it takes to help our child patients ultimately lead better lives.
For example, it takes courage for parents not to accept a child’s decision not to work on their anxiety and for clinicians to do things like show up at a family’s home to work with a child knowing that the child will be hiding from them in their room. It takes strength to refrain from responding when children scream that they hate you or that they’re going to kill you or themselves if you keep pushing them to face fears. Likewise, it takes tremendous willpower and resolve to refuse to let a child stay home from school, (safely!) dragging the child into the school building if need be.
We as clinicians need to model the sort of courage that we are asking our patients and their parents to have. Being willing to step outside our personal comfort zones can make a big difference in helping kids and teens overcome angry behavior.
Tune into our webinar for more information!