Nothing to Talk About but Fear Itself: How to Interact with Children About Anxiety

Presenter: Joelle Beecher-McGovern, Ph.D.
View this webinar by clicking here

Dr. McGovern broke down Cognitive Behavioral Therapy (CBT) and showed us how to apply the principals to children/adolescents with developmentally appropriate games, play and talk. She discussed how we can help our children to develop positive self talk so they can achieve a full life despite their anxiety issues.


  1. tsquillace04 says:

    I have a 12 year son has a severe tic disorder,he is vocal and i guess you would say he BEEPS alot,he jerks his body also,it started when he was around 9,and it really wasnt that bad…and I was so against medication.Things got worst and at the age of 12 he went to his first dr app.that was in March of this year…so far he has been on three different medications,yet he never had a brain scan,is that normal?

    • Dr. McGovern says:

      I unfortunately cannot provide you with an answer about brain scans and medication, as a psychotherapist I am not trained in this area and don’t have experience in this area. I suggest following up with your prescribing physician, who would have that expertise. I can tell you that Habit Reversal Training, a type of psychotherapy for tics, has been shown to help kids decrease their tics without medication in some recent empirical studies.

  2. KelleyT says:

    Would the anxiety in children discussed in this Webinar also apply to children with Selective Mutism?
    Please discuss little about how anxiety might apply to Selective Mutism.

    • Dr. McGovern says:

      Yes, absolutely, the principles presented apply for selective mutism. I have seen many kids with SM begin communicating after several sessions of CBT. The outreach needs to be more extensive for some though, because at times the communication does not easily generalize across settings. Having a point person in the school who can work directly with the child and therapist and pass info to the other staff is important, as is having a provider who can go into the school and work with the child (not always needed, but sometimes). Schools are usually very flexible and receptive re: help. The only caveat is that the although you do want the child to practice communicating in a hierarchical way, at the same time the main message to all involved is to not make it their goal for the child to speak. Starting with non-verbal communication, nodding, pointing, etc. and then moving up to verbal gradually as they are ready as well as starting with a comfortable peer at home and then moving to the school with that peer when no one else is there, etc is important. Everyone needs to drop the pressure of expectation temporarily and follow the lead person who is led by the child when intervening.

  3. KelleyT says:

    How do you approach a child who sometimes resists doing exposures?

    • Dr. McGovern says:

      Many kids who resist are just truly frightened and overwhelmed, connecting with them is the first step. Really hearing them and reflecting how they feel cannot be skipped, it may seem like a silly fear to you, but it is not to them. Think of a fear you have and how scary it would feel to face it and connect with them on that level. Helping them to see what anxiety is taking away and see you as an ally who is going to help them get back their life (albeit through very hard work) vs. someone who is “making” them do things they don’t want is important. Staring where they are – let them succeed with something that makes them a little anxious first and then move up – is also important, it is hard for them to believe it will work just being told that it will, they need to do it. But, they are not going to engage in an exposure if it is too overwhelming. Having a skilled therapist who has knowledge and experience in CBT and exposure is important. If all of those interventions don’t work, there are some intensive outpatient therapy programs (for OCD) as well as inpatient (for OCD) and/or parents may opt for a psychiatric consult re: medication.

  4. KelleyT says:

    How can school professionals deal with students with anxiety when there is limited time or access to in school counseling, and those parents that refuse to do anything outside of school or medication?

    • Dr. McGovern says:

      Being creative with time and working collaboratively are the two most important steps re: schools, parents and conflicts about needs. When all step back from the situation, normally parents and schools have the same goal: to help a child become more independent, confident, and not let fear get in the child’s way. The process by which this happens is where the break down occurs. Try not to judge or point fingers at the person you believe is the problem – this is important for both parents and school staff. Rather put the child’s needs at the center and engage in communication about concerns and best ways to meet those needs. It is always pleasantly surprising what results once defenses can be dropped because it feels less about blame and more about supporting the child. Shortage of time in schools is always an issue, a point person can be assigned as a main communicator between parent, child, therapist and school – that person should be someone who has a little more leeway with their time. Creative ways to work concepts into the classroom work too, each teacher has to figure out what fits best in their classroom. So much literature discusses facing fear and the positive outcomes, weaving those concepts into lessons and homework can help. All school projects can incorporate learning about anxiety and courage just like they often do re: learning about being kind and not bullying. Hallways filled with famous people who had to face fears in order to accomplish the great thing they accomplished could be very powerful.

  5. KelleyT says:

    How can a teacher help parents recognize anxiety and accept help?

    • Dr. McGovern says:

      Please see answer above to a similar question. Ask the parent for a meeting to discuss issues, discussing in the hall or classroom when the chance arises catches parents off guard. Ask for a sit down due to concerns you want to share and problem solve together. Follow suggestions above re: how to approach families in order to be able to communicate well.

  6. KelleyT says:

    Discuss a little more about the “value” if that is the right word about good anxiety.

    • Dr. McGovern says:

      “Value” is a great word – what does a child want in their life, what do they value, how does anxiety interfere with them reaching their values? Overall, their values guide what they want to become and basically present the “big picture”. So what is important to them? How can they make sure they go toward those goals instead of being thwarted by false alarms?

    • joellebe@mail.med.upenn.edu says:

      I apologize, I think after re-reading the question about the “value” of good anxiety that I answered a different question above. The value of good anxiety is that the function of anxiety is help keep us safe/out of danger, react quickly without thinking, and also focus on things that are important. We all need anxiety to cue us when something dangerous is about to happen so that our body can react (fight or flight) in a way that protects us or others we love. The problem only comes in when we have “false alarms” and react as if we are in danger when we are not — too much anxiety. Anxiety also helps in social situations because we care enough to want to make a good impression and thus follow social norms which help us to enter into and maintain a social group. When we worry a bit about our performance it helps us to narrow our focus to the important task at hand, and thus perform at a higher level. All emotions have a very important function, acceptance of all emotions, negative and positive, is a very important part of adaptive functioning.