Anxiety Psychologist Sydney

Anxiety is part of normal human experience. In fact, we need anxiety to help us survive and even thrive. In the right amount, anxiety can actually have a positive effect on our performance, however like many things, too much of it can be impairing, and for some, extremely so. Whilst we might all be able to recall times where feeling nervous about something propelled us into action or maybe focused our attention so as to be able to give all our energy to the performance of a task, we may not all have experienced the debilitating effects of an anxiety disorder.

Anxiety disorders in children are relatively common, affecting approximately 1 in 14 children in Australia. That is around 2 children in every classroom. Even when anxiety is “sub-clinical”, meaning symptoms are not sufficiently intense, frequent or pervasive enough to warrant a clinical diagnosis, anxiety can still cause difficulties in that young persons life and in turn disrupt a family’s functioning.

Whilst anxiety in any form boils down to the anticipation of future threat (as distinct from the feeling we get when we are responding in the moment to real or perceived threat, which is fear itself), there are many different forms that anxiety can take. These include:

Separation Anxiety
Selective Mutism
Specific Phobias
Social Anxiety
Panic
Agoraphobia
Generalised anxiety
Anxiety induced by substance, medication or medical condition

It is important to know that whilst many people relate to these types of anxiety (which to some extent are part of the range of normal experience), for some, the effects have a disproportionate impact on a person’s life.

Left untreated, anxiety disorders tend not to get better on their own and may develop over time to become more incapacitating and lead to other difficulties such as depression. The good news is however that anxiety in children can be very successfully treated with the right approach.

Anxiety Treatment Sydney

Anxiety is a highly treatable condition in children and much research exists to show that timely intervention can mitigate the significant impact anxiety may have on a child and their family’s life.

The psychological interventions with the most evidence for treating a range of anxiety disorders are those based on principles of cognitive-behavioural therapy ( https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders# ). This type of therapy involves the use of cognitive strategies (addressing the thoughts the person might be having) and behavioural strategies (what a person does in response to their fear or anxiety). Other therapy modes that may be used to support the treatment of anxiety in young people include ACT (Acceptance and Commitment Therapy) and DBT (Dialectical Behaviour Therapy).

It is normal to feel some hesitation about embarking on a course of treatment for anxiety as it generally involve some discomfort. However it is important to know that the process is very gradual and therapy is meant to be supportive, Psychologists are trained to deal with hiccups in treatment and help you and your child through the process.

Parents very often play an important role in therapy and we endeavour to help you understand what is going on for your child and how you can help. You may be part of the therapy process, especially for young children. If children are too young for 1:1 therapy, we can provide you with the necessary tools and skills to help your child.

Whilst cognitive behavioural therapy or CBT is the umbrella term that applies to the type (or flavour!) of therapy, your child’s treatment plan will be highly personalised, depending on the content of their worries, and what factors are specifically maintaining the anxiety for them.

How does CBT work with anxiety?

To understand how treatment works, firstly we have to understand what is typically happening when a young person is experiencing anxiety. To break it down into the two aspects that CBT targets:

Cognitions: The young person overestimates how likely it is that a bad (or feared) thing will happen and/or how bad it would be if it did actually happen (ie underestimating their ability to cope).

Behaviours: The young person usually engage in two types of behaviours that maintain the anxiety (keep it going) including avoidance of the feared situations or situations that might be related in some way to the fear AND the use of safety behaviours that may give some perceived protection but serve to reinforce the idea that they are not safe and that it is actually the special object or action that is keeping them safe.

CBT follows a process of developmentally appropriate psychoeducation (learning about what fear and anxiety is, how the body and brain work and normalises their responses), bringing attention to thinking that might be contributing to the anxiety and learning to catch these unhelpful thoughts and challenge them (this process looks very different at different ages), using behavioural experiments to “test out” some of these new ideas to work towards the goal of doing some gradual exposure activities to the feared situation using a series of small steps towards their goal (for example to attend a friends birthday party). This is an important part of anxiety treatment and is often talked about as the “active ingredient” to the therapy. Without it, the anxiety is unlikely to shift.

Types of Anxiety and Anxiety Disorders We Assist With

Children and teens often experience developmentally appropriate fears or anxieties as well as more transient worries as part of normal life. Sometimes this anxiety can become excessive or continue past the usual developmental window or may persist for a longer time than expected. It can be difficult to navigate how to respond to a child’s anxious behaviour when this occurs and the problem tends to persist when not treated. We treat children and adolescent anxiety problems including when these difficulties meet criteria for a disorder. Young people may have one or more types of anxiety problems and a individually tailored treatment plan can take into account the specific nature of your child’s anxiety. You do not need a formal diagnosis to benefit from treatment for anxiety.

Separation Anxiety

Whilst it is developmentally appropriate for very young children to fear being separated from their parents, separation anxiety disorder is characterised by an excessive fear or anxiety about being separated from their main caregiver. It may be seen in terms of excessive distress in anticipation of separation from home or their parents, worry about losing their parent, or an untoward event (eg getting lost) that causes separation, fear of being alone or sleeping away from home, separation themed nightmares, or even physical symptoms such as a headache or stomach ache when parent is not there or separation is anticipated. These are not one off symptoms, but rather persistent and repeated.

Social Anxiety

The central feature of social anxiety is a fear of negative evaluation by peers (not just adults). Situations that might induce this anxiety could include social interactions, being observed such as when eating or drinking and performing in front of others (such as doing a presentation at school or competing in a sports event). Children with social anxiety will be fearful of being humiliated and worry about being rejected or offending others. You may see your child cry, have tantrum-like behaviour, freeze, cling, shrink away or be unable to speak in social situations. Some children will avoid these situations as much as they can or they may endure them with intense anxiety.

Panic

Whilst it is common for people to have experienced panic as a normal human emotion, a panic attack is different to this. It is also different to a period of intense anxiety. The thing that sets it apart is that it is a sudden surge of fear that reaches a peak in a very short amount of time (minutes) and is accompanied by quite intense physical symptoms that are often mistaken for some dreadful physical event or a sense that the person might lose control in some way. Whilst the incidence of people having at least one panic attack in their lifetime is quite high, when a person becomes persistently worried about having panic attacks or changes their behaviour significantly because of the panic attacks (to avoid having more), this becomes what is known as panic disorder.

Health Related Anxiety

Health anxiety tends to emerge from a preoccupation about getting sick and they experience unexplained (though not imagined) somatic symptoms such as headaches, nausea etc which impacts on being able to participate in everyday life. When this develops, you might see a Somatic Symptom Disorder or Illness Anxiety Disorder emerging which may have a significant impact on school and family relationships given the degree of impairment on the family’s functioning. Young people may be particularly alarmed about hearing of others falling ill or reading health related news stories and they may avoid situations or people to avoid becoming ill.

Perfectionism and Procrastination

Perfectionism is the disproportionate concern about doing something in a way that meets an excessively or unrealistically high standard. Very often procrastination may be the consequence of this. Some young people may find that the very high standards that they had ascribed themselves worked well enough during their younger school years but may begin to experience greater difficulty as they progress through to high school and the demands begin to outweigh capacity to complete the work to the same standards. This might lead to burn out and as a consequence lack motivation. Or it may lead to procrastination or delaying starting a task due to feeling overwhelmed by the enormity of having to complete it perfectly.

School Anxiety and Avoidance

When a young person is anxious about going to school it can have knock on effects for everyone in the family. For the young person, they may experience a range of symptoms from the somatic (aches and pains or nausea) to panic like feelings when anticipating going to school. It may present behaviourally in a refusal to attend. Usually children refuse when they become too overwhelmed by their emotions and feel they will not cope. Parents and carers may feel frustrated and overwhelmed also, and unsure how to help their child engage. It is important to know that this a a problem many more young people are facing post-COVID and intervening early is important to change the trajectory of this problem.

How Anxiety Treatment Can Help

Typically, if anxiety is not addressed, it will grow. A good metaphor to think of is an inkblot on a piece of paper – it starts off as a small circle but then gradually increases in size as the edge of the ink blot moves upwards, encompassing more of the paper as it spreads. When we let anxiety flourish – it tends to spread to more aspects of our life.

Treating anxiety early helps children and adolescents to understand what is going on for them, identifying strategies to overcome their worry and prevent future worries from becoming overwhelming.

Frequently Asked Questions About Treatment for Anxiety

Are your sessions conducted in person?

Yes. We offer both in person sessions in our clinic as well as the option to utilise Telehealth services.

How many sessions are typically required for anxiety related issues?

The number of sessions required will typically be determined by individual circumstances, and this is usually discussed at your first appointment. We suggest booking in a minimum of 6 sessions initially, however the number of sessions required for effective treatment is likely to be more than this.

How frequently will my child need to attend therapy sessions?

In most cases, we find that initially weekly sessions are required to build rapport and momentum. Once treatment is underway, the frequency may be reduced to fortnightly and then monthly to ensure treatment outcomes are maintained. Following this, we sometimes find that ‘top-up’ sessions once every 3-6 months can be helpful.

How does anxiety treatment differ from general counselling?

Anxiety treatment involves the use of evidence based procedures and strategies which have been identified as effective ways to reduce symptoms of anxiety. It requires a detailed formulation and treatment plan for the individual. General counselling may focus on supporting the client with issues that may arise but may not follow a specific structure and focus.

Can I choose which psychologist I want my child to see?

Sometimes clients request specific psychologists based on recommendation or referral or from reading through the detailed clinician descriptions on the website. We will always try to accommodate your preferences, but we can also recommend who might be best suited to your individual needs.

Are parents involved in the sessions?

How much parents are involved typically depends on the child’s age. For young people under the age of 15 attending the clinic, we generally invite parents to attend an initial consultation with the psychologist to provide important background information prior to their child attending. Young people who are 15 and over typically attend the initial appointment with their parent and may elect to what extent they wish for their parent to be involved. Similarly as therapy progresses, we try to involve parents of younger children in having information around the strategies their children are learning, however the specific aspects of what your child discusses in therapy is considered confidential. This is important to preserve the therapeutic relationship and to be able to retain trust. We do acknowledge that parents are their child’s best resource and will often play a vital role in the therapy process. You may like to read more in our article “What does therapy look like” in our Latest News and Articles section.

Do you provide information to parents to help them assist with their child’s anxiety?

Yes we do. Even with older adolescents, we hope to give you important information about how anxiety works and how you can be best placed to support your child in all contexts, as parents typically need to respond to their child in the moment.

Do you offer formal assessments or diagnosis for anxiety or other psychological or behavioural issues?

As part of any new therapy referral, we conduct an initial assessment, however a formal report is not required unless specifically requested (at additional cost). Typically the focus for those being referred for treatment is on understanding the problem and what maintains this – whether this reaches a formal clinical cut off for a disorder or not. In some circumstances, it will be necessary however such as when applying for special provisions or seeking clarification for schooling etc.

We do however offer formal assessments for ADHD, Autism, Learning Disorders, Intellectual Disability and giftedness. A comprehensive report is provided as part of these assessments.

Do you use medication as part of anxiety treatment?

No. Whilst medication may be appropriate as part of the treatment of an anxiety disorder, a psychiatrist or paediatrician will often be the ones to prescribe this in the first instance. Whilst we do not have medical expertise to advise clients on their use of medication, we will commonly collaborate with the young person’s GP or specialist, providing feedback where useful and contributing to the bank of information required by the prescribing doctor and assisting with any formulation they may be seeking to understand.

Do you work with my child’s other health professionals and school?

As child psychologists, we understand the importance of collaborative care. We know that communication is key both between the child (and their family) with health professionals and the child’s school. When clients are referred by their GP or other specialist, we provide timely progress reports in the form of a letter summarising treatment and future recommendations regularly and may arrange to speak to the child’s classroom teacher, school counsellor or other health professionals to build a clear picture of your child’s situation and to contribute to a better understanding of how to help them in their various contexts.

Do I need a referral for anxiety treatment?

You do not need a referral to access treatment with one of The Young Mind Clinic psychologists, however in order to receive a Medicare rebate for services under an eligible Mental Health Treatment Plan (MHTP), you will need to speak to your GP. Up to 10 sessions are able to be rebated each calendar year under a MHTP. Private health insurance rebates may be applicable depending on your cover and the conditions associated with that cover. Contact your insurer for details specific to your policy.

Anxiety in Children and Adolescents