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Anxiety, Avoidance, And What Lies Beneath · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello, this is Kimley, and this is episode seven of the Facing Psychological Reality series.
• 0:08
  SPEAKER_00: This episode is going to focus on anxiety as an avoided reality, and I wanted to deepen it slightly because it's an absolutely huge subject.
• 0:20
  SPEAKER_00: We can look at it from an emotional experience point of view through to the ways in which it finds behavioral expression, in which we can look at the neurobiological activity that's going on.
• 0:35
  SPEAKER_00: And so that's rather a lot to cover in one podcast.
• 0:40
  SPEAKER_00: But what I'm going to try and do is to look at it from slightly different perspectives as well as the obvious ones.
• 0:48
  SPEAKER_00: Now, anxiety ranges from mild apprehension all the way through to crippling disorder.
• 0:59
  SPEAKER_00: And it doesn't follow that a person will naturally progress along that line.
• 1:06
  SPEAKER_00: But what we do see is when patients are experiencing anxiety that is powerful, very often it will move into avoidance.
• 1:19
  SPEAKER_00: And avoidance is situational, avoiding school.
• 1:23
  SPEAKER_00: Not because they don't want to go to school, but because something happens that blocks them.
• 1:29
  SPEAKER_00: Avoidance of separating.
• 1:32
  SPEAKER_00: Avoidance of coming into contact with things that feel overwhelming.
• 1:37
  SPEAKER_00: And sometimes what we see is that these things emerge sometimes seemingly out of nowhere.
• 1:46
  SPEAKER_00: And when they do, sometimes we make of we make the mistake of thinking the anxiety is the problem.
• 1:56
  SPEAKER_00: Well, yes, it is a problem, but it's a bit like a plant.
• 2:01
  SPEAKER_00: You can see the plant, or in this case, the anxious problem.
• 2:06
  SPEAKER_00: But what about the roots?
• 2:08
  SPEAKER_00: Because all anxiety, in fact, all disorders and behavioral expressions have roots and meaning.
• 2:15
  SPEAKER_00: And it's one of the most common things, it's one of the most common reasons why parents seek professional help.
• 2:23
  SPEAKER_00: Because when they have children who are experiencing anxiety, they're impacted upon as well.
• 2:33
  SPEAKER_00: The whole family very often is.
• 2:35
  SPEAKER_00: Situations where families have to change plans or have to be incredibly malleable and flexible in order to accommodate the anxious behaviours of the child.
• 2:46
  SPEAKER_00: And whilst at one level this is entirely understandable, it also causes a maintaining potentially of the problem.
• 2:58
  SPEAKER_00: So it's quite rare for anxiety to be seen as the beginning of an end of a problem.
• 3:08
  SPEAKER_00: It's a signal.
• 3:10
  SPEAKER_00: It's a series of signals.
• 3:13
  SPEAKER_00: So what I'd like to do is to explore this situation from a different perspective.
• 3:25
  SPEAKER_00: Anxiety is essentially a survival mechanism.
• 3:30
  SPEAKER_00: It's the the body's anticipation of threat.
• 3:35
  SPEAKER_00: The primitive brain or the alarm bell gets touched, the heart races, the muscles tighten, thoughts speed up, and a whole series of nervous system activity kicks in.
• 3:50
  SPEAKER_00: It's essentially preparing for danger even when no obvious danger is present.
• 3:57
  SPEAKER_00: So from a developmental perspective, anxiety is protective, it mobilizes survival.
• 4:05
  SPEAKER_00: But when it becomes chronic, excessive, or really disproportionate, we've got to ask some different questions.
• 4:13
  SPEAKER_00: Because although those mechanisms are taking place, a question we need to ask is what is the mind trying not to feel?
• 4:24
  SPEAKER_00: Or what purpose is the anxiety serving, which can't be served in another healthier way?
• 4:37
  SPEAKER_00: The mind doesn't tolerate emotional overload.
• 4:42
  SPEAKER_00: And what happens is that if feelings are too heavy or dangerous or exposing, then the nervous system may translate those feelings into anxiety instead.
• 5:00
  SPEAKER_00: Because anxiety is active, it feels like movement, it feels like urgency.
• 5:08
  SPEAKER_00: Sadness, grief, shame all feel like vulnerable emotions.
• 5:13
  SPEAKER_00: And for some children and adults, anxiety is easier to tolerate than vulnerability.
• 5:21
  SPEAKER_00: But it's not a choice, it's actually what we call displacement.
• 5:25
  SPEAKER_00: So what we see is that the anxiety the difficult feelings, the ones which cannot be tolerated, are transformed and moved into another expression.
• 5:38
  SPEAKER_00: This is displacement theory.
• 5:41
  SPEAKER_00: Now in children, we sometimes see perfectionism, irritability, avoidance, physical complaints, excessive reassurance seeking.
• 5:54
  SPEAKER_00: But underneath there's something quieter that's going on.
• 5:58
  SPEAKER_00: And it's normally fear-based, fear of not being in control or of disappointing or of being abandoned or alone, or of not being enough.
• 6:09
  SPEAKER_00: So anxiety becomes the visible symptom.
• 6:12
  SPEAKER_00: And this is important because children and young people and sometimes adults are unable to describe what it is that's being displaced because they're locked into this very powerful self-maintaining cycle of thinking, feeling, neurobiological reactivity and behaving.
• 6:37
  SPEAKER_00: So if we focus on reducing the anxiety, which is a reasonable thing to do, but if we do so without understanding its function, we risk silencing the signal without addressing the cause.
• 6:53
  SPEAKER_00: And it seems to me that a lot of behavioral therapies work on the principle of dealing with symptoms, which there is a place for.
• 7:02
  SPEAKER_00: In my own practice, I do that as well.
• 7:06
  SPEAKER_00: But I have to say that paying attention only to symptoms is a bit like deheading weeds, because they will grow again, or they'll find another form of displacement.
• 7:22
  SPEAKER_00: But also parental anxiety is an important consideration because parents also experience this and sometimes in very powerful ways.
• 7:31
  SPEAKER_00: You know, concern for a child can quickly become hypervigilance, or it can find expression through control.
• 7:39
  SPEAKER_00: Protection can become a preoccupation.
• 7:44
  SPEAKER_00: Often parental anxiety is rooted not only in the present circumstances, but in the parents' unresolved experiences.
• 8:07
  SPEAKER_00: But when we look at why is it that I have the reactions that I do, well, it may very well be the case that there is something inside you that's being alerted.
• 8:19
  SPEAKER_00: Now, this isn't wrong and it's not criticism, but it helps us to understand something because, as I've said before, children are exquisitely sensitive to the emotional states of others.
• 8:32
  SPEAKER_00: So if beneath your protective behavior there is anxiety, they will feel it and they won't be able to understand it.
• 8:42
  SPEAKER_00: But it's what happens, and again I stress the point this is not wrong, it's about illuminating something.
• 8:50
  SPEAKER_00: I've come to understand professionally and personally that anxiety can sometimes feel like strength because it can feel like responsibility, it can feel like love in action.
• 9:07
  SPEAKER_00: But when anxiety begins to organize decision making, then perception narrows and the world can become more threatening.
• 9:16
  SPEAKER_00: And children are so sensitive to that shift, and they don't need perfect calm, but they do need emotional steadiness.
• 9:28
  SPEAKER_00: So when anxiety becomes chronic, it often points towards something unprocessed, perhaps a loss that was never grieved, a conflict that was never resolved, a shame that was never spoken, a fear that felt too destabilizing to put into words or to acknowledge.
• 9:57
  SPEAKER_00: The mind moves the feeling into anxiety because anxiety feels more manageable than vulnerability.
• 10:06
  SPEAKER_00: I've seen and at times experienced how anxiety can sit on the surface of experience while the deeper emotional truth waits quietly beneath it.
• 10:20
  SPEAKER_00: And the longer the underlying reality remains unexamined, the more insistent the anxiety becomes.
• 10:29
  SPEAKER_00: It's important to say this clearly.
• 10:33
  SPEAKER_00: Helping a child regulate anxiety is essential.
• 10:38
  SPEAKER_00: And there are techniques, breathing exercises, structure, reassurance, routines.
• 10:44
  SPEAKER_00: These are all valuable, but regulation is not the same as avoidance.
• 10:50
  SPEAKER_00: If we only calm the nervous system without exploring the meaning of the anxiety, the signal often returns.
• 10:58
  SPEAKER_00: Because the mind is still protecting something.
• 11:01
  SPEAKER_00: So the task is gentle curiosity.
• 11:05
  SPEAKER_00: What might this anxiety be guarding?
• 11:08
  SPEAKER_00: What feels too risky to name?
• 11:12
  SPEAKER_00: Now, when the underlying emotion begins to surface, sadness, disappointment, fear of rejection, grief, it can feel very uncomfortable.
• 11:25
  SPEAKER_00: But something generally important happens.
• 11:29
  SPEAKER_00: Anxiety softens.
• 11:31
  SPEAKER_00: Because once vulnerability is acknowledged, the mind no longer needs to signal danger in the same way.
• 11:37
  SPEAKER_00: And it's not quick fix, it's not a quick process, and it requires safety.
• 11:44
  SPEAKER_00: Now, for parents listening, if your child struggles with anxiety, please don't rush to eliminate it.
• 11:52
  SPEAKER_00: First, seek to understand it.
• 11:55
  SPEAKER_00: Ask yourself what might my child be protecting themselves from feeling?
• 12:02
  SPEAKER_00: What is it that might feel so big that doesn't have words, but it can only be managed in this way?
• 12:11
  SPEAKER_00: And how can I remain steady while helping them to find the words?
• 12:16
  SPEAKER_00: And if you recognize anxiety in yourself, then approach it with the same compassion.
• 12:22
  SPEAKER_00: Anxiety isn't failure, it's often the mind's attempt to manage something that once felt too much.
• 12:32
  SPEAKER_00: Anxiety can be very, very loud, but the deeper emotion is often quiet or even silent.
• 12:40
  SPEAKER_00: Psychological growth doesn't come from silencing anxiety alone, it comes from gradually becoming able to face what anxiety has been protecting.
• 12:53
  SPEAKER_00: Because when emotional reality is acknowledged, the nervous system no longer has to remain on guard, and steadiness begins to replace vigilance.
• 13:04
  SPEAKER_00: I've worked with children and young people who self-harm, who have OCD, eating disorders, generalized anxiety, and ritualistic patterns of behavior which they fear abandoning because they would become overwhelmed.
• 13:27
  SPEAKER_00: Now we understand the clinical formulation for these disorders, we understand how they are put together, their expressions, the sorts of ways in which the behavior can be intervened in.
• 13:43
  SPEAKER_00: But every one of these disorders is underpinned by something that is unbearable.
• 13:49
  SPEAKER_00: It's an expression of anxiety.
• 13:52
  SPEAKER_00: So the young adolescent who has to restrict her food intake or his intake, who has to ensure that they exercise in a way which is way beyond what's required.
• 14:07
  SPEAKER_00: The patient who has to walk through a doorway and back again and forward again and back again until they have a thought that is not bad but is good.
• 14:22
  SPEAKER_00: The person whose overwhelming feelings can only find expression through making themselves bleed.
• 14:31
  SPEAKER_00: These alarming and these very distressing symptoms do need attention, but we have to understand what's driving them.
• 14:44
  SPEAKER_00: And it will be something which is too powerful to put into words, and anxiety is the thread.
• 14:54
  SPEAKER_00: Now, if any of this sounds concerning and you have a child or young person who is experiencing this, and I'm experiencing my phone ringing, um, I think really you you need to try as soon as possible to get some guidance because these things don't dissipate of their own accord, they do need intervention.
• 15:21
  SPEAKER_00: But in the meantime, being able to say to young people or or or children who are really struggling in this way, something along the lines of look, I I understand that you're really struggling with this.
• 15:36
  SPEAKER_00: I can see that because it's like you're showing me, and let's get some help because we all it looks like we could all use some help so as to make you feel better.
• 15:47
  SPEAKER_00: I hope this has been informing.
• 15:51
  SPEAKER_00: And in the next episode, I'm going to look at collapse, withdrawal, and shutdown.
• 16:00
  SPEAKER_00: Thank you for listening.