1. A perfect storm. Sometimes you just can’t put your finger on anything that seems to explain it. Imagine you have only so much capacity for stress. Like you have a container and you fill it with various liquids. None of them alone are enough but as more liquid is added eventually it will spill out. That is when you get the symptoms. One patient came to see me after having a panic attack at a stop light. He felt it came out of the blue. Well, a partial list of things going on in his life were family conflict, school stress, loneliness, traffic, lack of sleep, hunger, anger…okay you get the idea.
2. Biology. Fear is basic to human survival. It is really good that we have a capacity for fear and it causes our body to react lightening fast. However, some people are very sensitive and they have a tendency to get false alarms. They get the whole danger response when it isn’t warranted by the situation. Sometimes this is called a genetic predisposition. It just means you have a built in vulnerability to certain reactions. It is a certainty, just a tendency.
3. Experiences. Sometimes there is something really scary that happens. This is the case with traumatic disorders. It could be the case with phobias. However, more often than not there is not a clear experience. Some people can point to the first time it happened. For example, one patient with social anxiety remembered an event at school when the blushing started. Blushing became a huge fear for her.
4. Vicarious learning. TV, movies and news sources tend to draw attention to things out of the ordinary and extreme. If you watch the news you would think your child could be abducted on every corner. On any given night there is a show featuring doctors and patients with terrible illnesses. We can be persuaded about how dangerous it is “out there.” This can happen to people who become news channel regulars.
5. Faulty thinking. These are mistaken thoughts and assumptions about how dangerous something might be rather than more accurate views. For example, one reason number 4 is a problem is because of a thinking bias called the availability heuristic (heuristic is learning by experience).  That means we make predictions not on facts but on how easy (available to memory) something is to imagine. Scary stuff is easy to imagine and so we think it is very likely to happen.
6. Avoiding. Rather than testing out something and finding out it is not dangerous it is easy to avoid it. Over time this tends to build strength. Each time you consider reasons to avoid you build a strong case for why it is dangerous. You create physical feelings of fear with thought that are never tested.
7. Modeling. Sometimes we are convinced by other peoples fears. Depending on our receptivity and their influence we can use another persons example as proof of the danger.

This is certainly not an exhaustive list but maybe it will give you some ideas for what happens. If you know some other causes post a response, it would be helpful for readers.

1. Accept the situation rather than wishing it would go away. Anger and frustration are protests that you don’t like the way it is! If you are mad about this in your heart then you will be more reactive when your child’s symptoms show up. You will know you have not accepted it if you find yourself thinking things such as, “Why me?” “I can’t take this” or “Why are you so screwed up?” Here is the plain reality: You child’s anxiety will mess up your plans. If you accept this you will experience more peace while you face a difficult process.
2. Let go of some things in your busy life and spend time on this. This is NOT a normal parenting issue. No one likes this—not you, not your child. But this is what is. You can’t pull out the, “I’m counting to three and then you are in trouble,” lines and expect change. In fact, the louder you get the worse the anxiety will get. The wrong kind of pressure will cause more stress which causes more anxiety.
3. Pursue help/Pursue support. Your child will need way more help than usual and you will have to arrange for that. Here are some options 1) talk to your pediatrician, 2) start learning how anxiety is treated, 3) consult with a therapist, 4) obtain self-help, online and other resources, and 5) if school is impacted, contact the appropriate staff to develop a plan.
4. Face it with hope. Do NOT ignore it and wish it will go away. Sometimes an anxiety disorder may appear to go away, but if not treated, it is very likely to return. The sooner your child gets help, the more likely treatment will be effective.
5. Collaborate with other adults (e.g., spouse, grandparent, partner, etc.) who are actively parenting your anxious child. This can be difficult with happy easy kids much less anxious ones. Take some time and talk about how you think you should approach anxiety. You may need to do some homework to convince other adults that this is not just a simple tell-them-what-to-do-don’t-be-a-wimp situation.
6. Be aware of anxiety’s favorite ploy: avoidance. Anxiety is scary to parents. After a while you figure out that talking to your child about it can make it worse, so you avoid it. Unfortunately that is one of the worst things you can do. Anxiety must be faced for it to go away. Keep working on it. Expect some resistance.
7. Validate and acknowledge your child’s feelings and let them know that you will figure this out together. When they are wound up, they will be unable to accept your solutions or perspective. Don’t push a better perspective if your child is clearly agitated. Your child needs to know you know how bad this feels. In a very intense moment, don’t try to talk them out of it, it will feel like you are discounting their emotion. Compassionately reflect back the emotion. Later after they calm down you can respond to specific comments and behaviors.
8. Be mindful of your negative thoughts. You might be tempted to think your child is being ridiculous and unreasonable. You might think they are faking this to accomplish something else or, if they really tried, they could stop. Those thoughts are almost certainly wrong and either way, they will cause you to withdraw from your child, and that makes it worse. If your child had a purely medical condition would you think these negative thoughts? This can be just as difficult.
9. Let your child handle as much as possible. Praise them each time they make some headway at all. It is important that they feel they have worked through this and not been rescued by mom or dad. Parents are tempted to make more decisions for an anxious child. That is okay at times but look for opportunities for your child to experience control over their own life.
10. Remove unneeded sources of anxiety as much as possible, such as teasing by siblings and others, scary media such as certain movies and news, unexpected surprises and sudden changes in plans. Anxious kids like to know what is coming, so inform them when you can.
11. Be flexible but stay on course. Be willing to adjust treatment as needed but don’t stop. Anyone struggling with anxiety gets impatient. Give options. The more choices provided, the more control and power over events a child experiences, and that is a positive for anxious children.
12. Be hopeful and realistic. Sometimes anxiety seems to go into remission and everyone breathes a sigh of relief. Then just when everyone hopes it is finally over, it returns causing a major MELTDOWN! Anxiety is treatable but complicated. The hope you need is that you will keep working on it until it is better. Don’t base your hope on every up and down. The realism is that it takes as long as it takes.

This can be especially hard for children and parents to understand and accept. Just today I had a young man tell me that his 13 year-old sister didn’t want to come to counseling any longer because she felt things were getting worse rather than better. He stated that he tried to convince his sister that her thinking wasn’t true. ”Actually,” I said, “she’s right in saying that. It may be getting worse for her. But quiting is not the answer.” 

To overcome anxiety, you must learn to tolerate the thing that is making you feel anxious. Your brain must learn that the feared stimlus is not really a danger and that it doesn’t have to be so alarmed by it. Once it learns that, it will calm down and stop sending out false alarms to the other organs in your body. But in order to do that, you must expose yourself to the feared thing so that your brain can build up a tolerance to it. That’s the tough part.

Imagine your child wants to go swimming during the spring-time. The air is warm but the water is still quite cold. She really wants to go swimming but really hates the feeling of being cold. You child has a choice. She can either stay on the side of the pool and avoid the cold feeling, but also avoid the joy of swimming. Or, she can jump in the deep end and swim around for a few minutes until her body builds up a tolerance to the cold (she can also slowly wade in using the stairs). Once it does, she’s free to enjoy the pool. In order for it to get good, it must get bad first.

A fairly common question we receive from parents regarding Turnaround is whether their child will become more anxious as they hear other fears discussed. The answer is potentially yes. The child’s fears may get worse as they begin to address their fears as well as hear about other types of fears. But does that mean they should quit? No. They’ve just jumped in the deep end of the pool. Now they need to learn to how to deal with, and overcome the cold chill of anxiety.

A common mistake parents make is to over-protect their anxious child from experiencing further fear and distress. Avoidance of fear is the most common way to cope with anxiety; however, it only enables and builds the child’s fears. Many life lessons are learned as a child faces their fears. They learn to accept both pain and pleasure, fear and joy, stuggle and success, risk and reward. At some point, in order to develop into a healthy child, they must learn to accept the dual nature of life. Unresolved childhood fears can easily become crippling problems in adulthood.

So, as your child experiences a set back, don’t quickly try to rescue them or help them avoid the negative thing. Walk with them through the negative experience, through the fear. Offer them your strength of resolve until they build up their own courage and resolve. Keep at it until they have learned to master it and/or tolerate it to the point where it’s no longer an issue.

Everyone blushes and typically this is a result of embarrassment, surprise, modesty, or shame. However, for some people there is no clear reason for it to happen. This painfully unpredictable disorder is called Idiopathic Craniofacial Erythema (ICE). The phobia of blushing is called Erythrophobia. Because reddening of the face can be quite visible (depending on natural skin coloration), someone who is socially anxious might connect blushing with the possibility of embarrassing attention and so it becomes part of their anxiety. It may be for others that the biological tendency to blush easily is first and then anxiety about it follows. When anxiety associates with blushing then the anxiety activates the sympathetic nervous system and that causes blushing and so a self-reinforcing cycle forms. This can be debilitating as people avoid any circumstance that might lead to blushing. This is often social because it is one of those things that people seem to feel free to comment upon, “Wow, your face is so red! Why is your face red?” Research shows that verbal feedback like this increases blushing. Fearing or expecting to blush can be a self-fulfilling prophecy. Often the anxiety starts in childhood because kids are more likely to comment about it.

Here is a working list of suggestions for treatment that I have found in various places. I am curious if you have some suggestions. If you have this or know someone who does, is there anything that has helped you on my list or not?

1. Task concentration training (TCT) appears to be most effective treatment based on research I found. The theory is that anxiety and blushing cause an inward focus thus increasing subjective awareness of feelings, thoughts and symptoms. This increases the blush response as well as anxiety. Training in outward focus (a similar treatment is effective with athletes) has been proven to be the most effective approach even after a year. This article has a good summary of the process although it is a bit technical.
2. Cognitive-Behavioral Therapy. More specifically that would mean examining and revising beliefs (cognitive) about blushing. Also, it would involve behaving differently. Rather than avoiding it could mean voluntarily exposing yourself to a fearful situation. A number of suggestions I found fall under this treatment
   1. Activate the counterbalancing part of your nervous system (parasympathetic) by relaxing and breathing differently. This has to be practiced at some length before it will be effective.
   2. Draw attention to it rather than hiding it. This paradox, as hard as it seems, often works with anxiety. Many people with social anxiety mistakenly think that disclosing anxiety is worse than hiding it.
   3. Accept it rather than resist it. Accept that at this point you are a person who blushes easily and that is simply the way it is. You may wish it was different but it is what it is.
   4. Revise what you imagine other people are thinking. Collect some data. Ask some people what they think. What would a friend tell you about it? Explain it to people. Research suggests that blushing-fearful people inflate the both the probability it will happen and the social cost of blushing. In other words, they think it is way worse than it is and that others are thinking more critically than than they are.
   5. Practice the symptom. Try to make yourself blush by creating the circumstances. Do that over and over on purpose. You can do this gradually or all at once. This process is called systematic desensitization or exposure.
   6. Reframe the meaning of blushing. Historical evidence demonstrates that redness of cheeks is a sign of beauty and youth as well as markers of modesty and charm. As an expression of shame or embarrassment that can be very positive depending on the context.
3. Some sites suggest hypnosis. I couldn’t find any research support but there are a number of personal stories or single cases that showed improvement on the web.
4. Medication. Some people experience relief with medications that treat anxiety. Typically these are medication like Celexa, Prozac, Zoloft and other similar medications. Medications like Xanax, Klonopin and other benzodiazepines are sometimes prescribed. Sometime blood pressure medications such as beta blockers can be effective. A few sites suggest that botox may be helpful. Consult your physician for more information about this treatment.
5. There is a surgical operation available for severe cases. It is called Endoscopic thoracic sympathectomy. Frequently this is used to treat severe sweating but there appear to be cases that have been effective for blushing. It is recommended that a dermatologist be consulted if this disorder exists to rule out any underlying disorders.

It seems that there has been an increase in research and treatment options in the last 10 years. This is hopeful for those struggling with this. Please respond to this blog if you have addition knowledge of this subject or would be willing to share your experience.

• 58.2% in the waiting-list group
• 21.4% with immediate prolonged exposure
• 18.2% with cognitive therapy
• 61.9% with escitalopram (medication)
• 55.6% with placebo

The prolonged-exposure and cognitive-therapy groups had significantly lower rates of PTSD than the other three groups (P<0.001) but did not differ from each other. The medication, placebo, and waiting-list groups also did not differ significantly with respect to the proportion of patients with PTSD. You can read the full summary of this research here: http://www.medpagetoday.com/Psychiatry/AnxietyStress/28852

http://www.wcnc.com/charlotte-today/How-to-protect-teens-from-drug-use-131462648.html

http://www.blogtalkradio.com/thecoffeeklatch/2011/09/15/dr-david-russ–turning-anxiety-around-in-children

Glad that wasn’t my baby.