How can you best manage anxiety in children with skin conditions?

Anxiety is a universal term that gets used in a variety of ways, but what does it really mean? Anxiety is the emotion we experience when we anticipate a threat. That threat can be anything: an impending test, an awkward social situation, or worry about medical conditions. Skin conditions are often accompanied by anxiety. Perhaps your child has anxiety about others noticing their skin condition or judging them on it. Or perhaps they have a skin condition that causes pain or itching, and they become anxious when thinking about things that may trigger this reaction. Although anxiety is an emotion that everyone experiences, too much anxiety can interfere with daily life. If your child is constantly worrying, reporting physical symptoms of anxiety such as stomach ache and headache without a medical cause, or avoiding things because of the anxiety it may be time to help them learn to handle these feelings.

There are many different kinds of anxiety: panic attacks, worry, social anxiety, phobias, and more, but they are all treated by anxiety specialists similarly. The evidence-based treatment for anxiety is called Cognitive-Behavioral Therapy (CBT) and suggests that anxiety itself is not a problem; instead, over-reaction to and avoidance of anxiety triggers is the problem. For instance, if a child has vitiligo (a condition where patches of skin and hair lose their pigment and become white) they may rightfully have anxiety about others noticing them. However, anxiety may turn that real concern into the unrealistic thought that they will never have friends who accept them. As a result, they may avoid social situations thereby confirming the idea that they cannot find meaningful relationships with peers. CBT calls this the downward spiral of unhelpful thoughts (“others will judge me!”), feelings (anxiety, shame), and behaviors (avoidance of others).

A parent or family member may try to help children with their anxiety in a way that is ultimately unhelpful. “Thinking positively”, “ignoring it”, or a “just do it” attitude are often well-meaning but may cause kids to feel invalidated. Instead, try going through the following steps in an anxious moment with your child:

  1. Acknowledge the concern and associated anxiety
  2. Observe and accept the thoughts and feelings of anxiety instead of avoiding them, pushing them away, or simply saying “it will be alright, stop worrying about it”. For young children, parents may have to help their children recognize their anxiety, older children may be able to do it more independently.
  3. Remind children that facing their anxiety will cause it to get better, but avoiding it will cause it linger
  4. Work on moving forward in the face of anxiety instead of finding a way around it
  5. Repeat as necessary

For instance, a child with early-stage vitiligo may be invited to a birthday party and feel too anxious to go for fear of being judged by others. A natural parenting instinct may be to help them avoid the judgement by not going to the party or tell them that everything is fine and other kids will love them. The first option only reinforces that the child could not have handled the difficult situation, while the second invalidates his or her concern. Instead, try acknowledging their concern with phrases such as “I’m sorry you’re worried about this, it can be so hard to worry about what other people will think about you”. Next, discuss their thoughts and feelings by saying “You’re worried that the other kids will make fun of you and that will not feel good. You’d rather stay at home and miss the opportunity to have fun at the party to avoid the chance of being made fun of”. Then, remind them that avoiding anxiety only makes it worse by saying “If you choose to skip the party we’ll never know how the kids will actually react and the next party will probably feel even scarier!”. Help them move forward with anxiety instead of around it. An example of how to express this could be “I think your brain is playing tricks on you. Some people have noticed your skin before, but most people don’t say anything and you’ve made great friends before who loved you regardless of your skin. Let’s go to this party and see if these kids are the same, I imagine they will be”.

If your child needs more help working through anxious moments finding a psychologist who specializes in anxiety may help. Dr. Brandt is a therapist at the Houston OCD Program and regularly works with children, adolescents, and adults with anxiety and health issues, including skin disorders. Dr. Brandt can be reached at 832-900-1276 or cbrandt@houstonocd.org. You may read more about anxiety and evidence-based treatments at www.houstonocdprogram.com or from the Anxiety and Depression Association of America at https://adaa.org/living-with-anxiety/children/childhood-anxiety-disorders