Avoidance

Avoidance of feared situations reduces anxiety initially, but makes it worse in the long run. For example, a child with social phobia may avoid making telephone calls, fearing that he will become embarrassed or "tongue-tied" during the call. For similar reasons, he may also avoid picking up the telephone when it rings. The more the telephone is avoided, however, the more frightening the prospect of making a call becomes. As avoidance continues, conversation skills are lost, making it even harder to change. Without intervention, the problem becomes self-perpetuating.

For younger children, one of us (KM) has written a parenting book on helping with anxiety symptoms and overcoming avoidance. It is called Keys to Parenting Your Anxious Child (see Bibliography). The same principles used with young children can be adapted to teens. Basically, the teen must face each feared situation, starting with the easiest and working up to the most difficult, in order to desensitize to the fear.

Just like younger children, teens benefit from encouragement, praise, and positive reinforcement when trying to face a fear. Unlike younger children, however, teens' reinforcements for progress tend to be different. (Money or a special privilege may motivate teens, whereas stickers, prizes, or special time with a parent motivates younger children; praise is appropriate for all age groups.) You probably know better than anyone else what motivates your child or teen! To encourage desensitization:

• Help your teen approach the situation in gradual steps with positive reinforcement for every little step. In Tammy's case, several "levels" could be developed to overcome her avoidance. The first level would consist of spending time on her front porch, the second of venturing into the garden, the third of standing on the sidewalk, and so on. She should spend at least half an hour a day practicing leaving the house (a minimum for desensitization), with graduated rewards for progressing to higher "levels." For the socially anxious child mentioned above who won't talk on the telephone, a different system of levels would apply. In this case, having someone else place the call (to a familiar, non-threatening person previously informed of the exercise) and then asking the child to provide a whispered, one-word response to a specific question on the telephone may be the first step. You need to use the same principle: gradual approximations. Setting up appropriate desensitization systems is a whole course (or book) in itself.

• Gradually withdrawing support in a situation can also be a step. For example, one mother of a young teen encouraged her daughter to travel on the public transit system to her appointments by accompanying her at gradually increasing distances until they were essentially traveling independently. She praised this "grown up" behavior throughout the process (no other reward was needed).
• Relaxation and coping self-talk (see below) can also help children go into avoided situations with less fear.
• Because going into a feared situation is an activity, you may also wish to review the earlier chapter on motivating teens to engage in activities.



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