Clinical Kung Fu: Managing Anger in Children and Teens with Anxiety Disorders

Clinical Kung Fu: Managing Anger in Children and Teens with Anxiety Disorders

Julieanne Pojas, PsyD

pojas

Dr. Julieanne Pojas received her doctorate and masters’ degree in clinical psychology from Midwestern University in Downers Grove, Illinois. As a licensed clinical psychologist, she specializes in the treatment of anxiety and related conditions. She is trained in cognitive-behavioral therapy and exposure response prevention. Dr. Pojas has received specialized training and certification from the Behavior Therapy Training Institute (BTTI) at the International Obsessive Compulsive Foundation.

Dr. Pojas has experience working in a variety of clinical settings in Illinois and California treating a culturally diverse population. She believes in providing culturally appropriate treatment. She has done several talks training mental health professionals and educating parents about mental health topics. Dr. Pojas is a member of the Anxiety and Depression Association of American (ADAA), the International OCD Foundation (IOCDF), and the Asian American Psychological Association (AAPA).

Alison R. Alden, PhD

alden

Dr. Alison Alden earned her Ph.D. from Northwestern University in Evanston, IL, where she focused on researching and treating anxiety. She also completed a post-doctoral fellowship at Northwestern Memorial Hospital. She has extensive training and experience in cognitive behavioral therapy for anxiety, OCD, and mood disorders, and integrates mindfulness and dialectical behavior therapy (DBT) into her practice. Dr. Alden has published several research articles and book chapters on anxiety, depression, and emotion regulation, and has presented talks and posters to state and national professional organizations. She has also taught in Northwestern University’s School of Continuing Studies. Dr. Alden is a member of the Anxiety and Depression Association of American (ADAA), and was the recipient of the highly competitive ADAA Career Development Leadership Program award in 2014.

Clinical Kung Fu: Managing Anger in Children and Teens with Anxiety Disorders

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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!

Julieanne Pojas, PsyD

pojas

Dr. Julieanne Pojas received her doctorate and masters’ degree in clinical psychology from Midwestern University in Downers Grove, Illinois. As a licensed clinical psychologist, she specializes in the treatment of anxiety and related conditions. She is trained in cognitive-behavioral therapy and exposure response prevention. Dr. Pojas has received specialized training and certification from the Behavior Therapy Training Institute (BTTI) at the International Obsessive Compulsive Foundation.

Dr. Pojas has experience working in a variety of clinical settings in Illinois and California treating a culturally diverse population. She believes in providing culturally appropriate treatment. She has done several talks training mental health professionals and educating parents about mental health topics. Dr. Pojas is a member of the Anxiety and Depression Association of American (ADAA), the International OCD Foundation (IOCDF), and the Asian American Psychological Association (AAPA).

Alison R. Alden, PhD

alden

Dr. Alison Alden earned her Ph.D. from Northwestern University in Evanston, IL, where she focused on researching and treating anxiety. She also completed a post-doctoral fellowship at Northwestern Memorial Hospital. She has extensive training and experience in cognitive behavioral therapy for anxiety, OCD, and mood disorders, and integrates mindfulness and dialectical behavior therapy (DBT) into her practice. Dr. Alden has published several research articles and book chapters on anxiety, depression, and emotion regulation, and has presented talks and posters to state and national professional organizations. She has also taught in Northwestern University’s School of Continuing Studies. Dr. Alden is a member of the Anxiety and Depression Association of American (ADAA), and was the recipient of the highly competitive ADAA Career Development Leadership Program award in 2014.

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