Anxiety is the fear, worry, or discomfort we experience when faced with an object or situation we think is harmful. In many cases, anxiety is both normal and necessary. In fact, it is in part what has allowed the human race to survive thus far! Anxiety kept our ancestors vigilant while hunting for food, so as not to be eaten by a lion. It is what keeps us aware when we are crossing a busy street. 

Anxiety becomes a problem if it begins to interfere with the way we act or feel on a daily basis. When this happens, regular anxiety has become an anxiety disorder. A child or teenager with anxiety may start to do poorly in school, stop spending time with friends, or become depressed. The good news is that anxiety disorders are very treatable. Exposure therapy is one of the treatments that can be helpful for many types of anxieties.

Dr. Alanna Propst’s book, The Not-So-Scary Dog, explores how a mom helps her child, Tommy, reduce his fear of dogs using exposure therapy. Here’s an excerpt from the Reader’s Note.

Exposure therapy is a form of cognitive behavior therapy in which one is exposed to something that triggers anxiety. When we avoid an object or situation that causes anxiety, we learn that we stayed safe because we stayed away. Instead, we need to learn that we can be close to whatever we are scared of and still be safe.

Being near something we are afraid of can be unpleasant and uncomfortable, so exposure therapy often occurs in small steps, getting a little bit closer to the feared object or situation with each task. It may seem as though exposure therapy gets harder as it progresses, but this is not the case. Each step is done until the anxiety is gone or minimal and serves as practice so that the next steps do not actually feel as difficult as they would before therapy. 

Parents can help their children through this process in several ways:

Share your own anxieties with your children. Children suffering from anxiety may feel alone or ashamed about what they are going through. If you talk about your own experiences, your child can see that they are not strange or different. Knowing that you have dealt with anxiety can also help your child feel that you understand their experience. If you have been able to overcome your anxiety, talking about your story can show your child that fears can indeed be conquered.

Pause throughout the book to explain how exposure works by using examples from the book. The main idea to convey is the difference between avoidance and exposure. Avoidance teaches our brains that we are safe only because we stayed out of harm’s way. Exposure lets us see that what we are scared of is not actually dangerous. For example, in the book, as Tommy looks at pictures of dogs in his first task, he is slowly able to see that he is not in danger and calms down with each photo until he is not afraid. It can help to draw a parallel to something your child has learned how to do that got easier with practice and ultimately increased in complexity. For example, learning to ride a bike with training wheels and then taking the training wheels off.

Stop throughout the book and ask your child questions. Children learn best when they are engaged and actively participating. Here are a few suggestions: Throughout the book ask, “What do you think Tommy is feeling?” After Tommy completes the first few tasks ask, “Why do you think Tommy’s anxiety is going down?” “What does it mean when Tommy says the dog had been bigger in his head?

Plan your own list of tasks to conquer your child’s fear. The list should appear to increase in difficulty. You can start by simply having your child name the thing that frightens them the most related to their fear–something that would rate as a 10/10 on a fear scale. Then have them name something related to their fear that frightens them much less, that they think they could accomplish with minimal distress—something that would rate as a 1 or 2/10. Once these benchmarks are established, they can then fill in the steps in between. Once you’ve come up with the steps, you can start to tackle them! It’s important to repeat each individual step until it causes minimal or no anxiety. This allows your child to gain practice and confidence so that the next step doesn’t seem so hard.

Be present to support and encourage your child. Parental involvement in exposure therapy is extremely important. Exposure techniques can be stressful. Even thinking about exposure to the frightening object can cause anxiety. This type of anxiety is called “anticipatory anxiety,” since it occurs when someone is waiting for something to happen. By supporting, encouraging, and being by your child’s side throughout exposure techniques, you can decrease their stress level and make it more likely that they will stick with their tasks until they succeed. 

Sometimes, in order to decrease their child’s anxiety, parents will help their child avoid the object of their fear. While this is done with the best of intentions, it is not particularly helpful and will cause the anxiety to continue. Another way to help your child is to stop helping them avoid the thing that scares them.

If your child’s daily life is being affected by their anxiety, they may benefit from professional help. Do not hesitate to ask your child’s primary care physician for guidance and a referral if needed. Click here to find a psychologist near you.

Hear The Not-So-Scary Dog read aloud.

by Alanna Propst, MD

This Article's Author

Alanna J. Propst is a psychiatrist who graduated from McGill University in both the Psychiatry Residency Program as well as the Child and Adolescent Psychiatry Subspecialty Program, and has worked in inpatient, outpatient, and emergency room settings. This is her debut picture book. Alanna lives in Montreal, Canada.

Related Books from Magination Press

  • The Not-So-Scary Dog

    Alanna Propst, MD

    Tommy is terrified of dogs. When he gets an invitation to a big birthday party at his neighbor’s house, his heart sinks—he can’t possibly go, the dog is enormous and scary!

    But instead of staying away, he and his mom hatch a step-by-step plan to face and overcome his fears in time to enjoy the party. This gentle introduction to the concept of exposure therapy for kids will help them deal with phobias.

    Includes a Note to Parents and Caregivers about how to support kids working through exposure therapy.