I received a request from an Employee Assistance Program (EAP) asking if I would see Jake (not his real name), a 10 year-old boy with anxiety. I learned from his mother that Jake hadn’t spent a full night in his own bed since he was 2 years old. During the night he would either sneak into his parent’s bed or he would make a bed on the floor in the parent’s bedroom. The parents were concerned, not only for their son’s well-being, but also for his six year old sister who was learning from her brother that there was something frightening about being in their own beds.
Mom brought her son in. He was a polite and engaging kid, did well in school, played soccer and basketball and said that he had a lot of friends. There didn’t appear to be anything weird going on at home and the family seemed pretty healthy with the exception of dad’s family history of anxiety. I decided to start out simply.
I talked to Jake and his mother about how our minds and bodies will work together to maintain an internal state to which they have become accustomed. In his case, his mind and body were accustomed to feeling anxiety. To his mind/body, anxiety is what is now familiar and, thus, feels safe. I talked to him about actual vs. perceived safety. He was intrigued with the idea that we have some control over how we interpret information that comes into the mind/body and that we could either process raw data in a way that would produce anxiety or peace. Of course, I, somehow, found a way to describe these things in a way that his 10 year-old brain could understand.
We started with breath. When I asked him to take a deep breath, practically all the air went into his chest. I had him place one hand on his chest and the other on his belly. I challenged him to make his chest hand remain still until his belly hand had moved away from his body as much as it could. This proved to be challenging and he started to get it. We practiced counting as he inhaled and taking longer to exhale. I suggested to him that, when he woke up in the night, he could lie in his bed and take 5 of these deep breaths while he reminded himself, “I am safe in my house. I am safe in my room . I am safe in my bed.”
The family already had a fairly good bedtime ritual for the kids that included bath and book reading. To it we added the turning off of all screens including TV, phones, computers and tablets one hour before bedtime. Screen viewing at night can fool the brain into thinking that it is daytime, interfering with the release of sleep chemicals in the brain. (See earlier post, below) Since Jake’s major concern was that someone would come into the house at night and take him, we included a ritual door locking ceremony where the whole family would make sure that the house was secure. I also gave them a variation of the Buddhist Loving Kindness Prayer:
May I be well.
May I be at peace.
May I be safe.
May my mom be well.
May my mom be at peace.
May my mom be safe.
May my dad be well.
May my dad be at peace.
May my dad be safe.
(Repeat for any and all friends, family, pets, etc.)
May all people be well.
May all people be at peace.
May all people be safe.
To be honest, I was shooting from the hip, never having been faced with treating anxiety in someone so young. What amazed me was how well these simple concepts resonated for this 10 year-old. The concepts seem to make so much sense to him.
The next week, I called Jake’s mother to arrange a second session. She was so excited. Jake had spent the previous five nights in his own bed, something that hadn’t happened in eight years. She said the whole family was invested in the bedtime rituals and that they were all sleeping better. Dad was so impressed with the effects of the breathing exercises that he started his own meditation practice.
While I’m sure the cognitive and behavioral interventions had some impact, I think the most powerful aspect of what Jake had learned was how to use his breath to move from sympathetic (fight or flight) nervous system activation to parasympathetic (rest and receive) nervous system activation. His knowing that there was something that he could do to slow his racing heart and settle himself gave him a feeling of confidence and sense of control. Utilizing our breath to move into a quieter state is something that each of us can access whenever we need it. The trick is to remember that we can.
Check out this infographic from The Huffington Post, Change Your Breathing, Change Your Life, on the effects of focusing on your breath. If you want to experience the effects of managing your breath, go to Learn To Meditate.