Wellness in Broward

Elizabeth Penela, Ph.D.

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​Parenting a Child Who Struggles with Anxiety

If your child or teenager is struggling with anxiety, chances are you might be feeling exhausted. What likely started off as small worries early on, may have escalated to something that feels unmanageable. Over the years, parents have shared their stories with me as they struggle to help their anxious child or teen:
Woman sitting on mountaintop. Learn to overcome anxiety with CBT tools.
  •  I want to encourage her to be brave, but it’s hard to know when to push and when to let her avoid certain things. Sometimes my partner and I are on the same page about how to help our daughter cope, but other times we disagree. 
  • We started out by skipping birthday parties occasionally because he felt nervous, but now he is missing out on so much more (e.g., play dates, group sports) because he feels so nervous when he’s with other kids his age.
  • I check her homework to make sure everything is right, but it’s never enough!  She just keeps asking me to re-check again and again, and it’s so hard to help her feel calm. I don’t know what to do.
  • I see other kids his age enjoying time with their friends at school and trying out new sports or activities, but he just can’t seem to relax. He’s always thinking about what could go wrong. No matter how much I try to convince him that everything will be okay, he gets so stuck on his worries.

If these struggles sound familiar to you, you are not alone.
But know this: There are effective treatments that can help your child or teen learn to manage anxiety.
​I’d like to help you and your family start this difficult but worthwhile journey.

​Finding Effective Treatment for Anxiety

Finding the right therapist for your child in South Florida might feel overwhelming because (thankfully!) there are so many options across Broward and Miami-Dade. How do you know which therapist will work best with your child? Will your child feel comfortable with the therapist and be willing to talk to them about their challenges?
 
 It is crucial that your child have a connection to their therapist – to feel that the therapist “gets them.” And if your child is struggling with anxiety, it is also critical to find a therapist who specializes in the treatment of anxiety in children. Based on lots of research, we know that what works best in helping children manage anxiety is Cognitive Behavioral Therapy (CBT).

​​What is Cognitive Behavioral Therapy (CBT)?

​Cognitive Behavioral Therapy (CBT) is a type of treatment that will help your child change the way he or she thinks, and as a result, helps them change how they behave in different situations. In therapy, I will work with you and your child to hone in on exactly what kinds of thoughts are going through his or her mind at different times throughout the day. Anxious thoughts can take on a variety of flavors, such as: I’m not good enough. This needs to be perfect. Something terrible is about to happen.
​
Once we have a good sense of what your child’s anxiety is saying (Spoiler alert: Anxiety usually LIES!), your child will practice different strategies to help him or her challenge those nagging, anxious thoughts. In other words, your child will learn how to “talk back” to anxiety and check the accuracy of those worries.
The most important component of treatment is having children learn to gradually face their fears. Psychologists refer to this process of facing your fears as “exposures” because you are gradually exposing yourself to situations that make you feel anxious, and then using the tools learned in therapy to cope with this anxiety. Facing your fears is not easy, but your child CAN learn to do this with the right coping tools, a good relationship with their therapist, and support from parents that makes them feel validated and empowered. 
 
With CBT tools in your and your child’s back pocket, anxiety doesn’t disappear. Instead, your child will begin to feel confident that if they encounter anxiety-provoking situations, he or she will know exactly how to handle it. With the right therapy, their worry or anxiety will no longer be something that holds them back in their everyday lives.

​CBT for Anxiety with Dr. Penela

Man jumping over mountains. CBT can help you manage anxiety and OCD.
​Over the last decade, I’ve helped many children, teens, and adults face and overcome their challenges with anxiety using CBT tools. I have received specialized training in using CBT and enjoy using this approach with children and families for one simple reason: it helps most people feel better. I tailor the treatment to meet each family’s specific needs, and as needed will incorporate other approaches, such as mindfulness, family systems, and acceptance-based techniques.
 
Although some therapists work almost entirely with children in therapy and simply keep parents updated occasionally, I firmly believe that although I may be an expert in anxiety treatment, YOU are the expert on your child. Therefore, as your child learns helpful CBT skills in therapy, it is critical that you (and other primary caregivers) learn them, too! Anxiety can disrupt the parent-child relationship and cause so much distress for the whole family. 

Throughout the course of therapy, it is vital that parents learn how to respond to their child when he or she experiences anxiety, and that parents know what to do when their child tries to avoid situations due to anxiety. Your ability to navigate these tricky situations is critically important to your child’s success in learning to manage anxiety.
Anxiety looks different for each child, and although treatment from one child to the next will have similar components, the way we learn and practice different strategies will be tailored specifically to your child. With children and teens, I often keep things fun and warm. Even though exposures are difficult and will make your child or teen feel anxious, I am always finding ways to make the process fun and engaging.

​Starting treatment

​If you are considering starting the challenging but rewarding journey toward helping your child or teen beat anxiety, I'm here to help. In a warm and empowering environment, we will work together to help your child learn to effectively manage his or her anxiety and lead a full life.
I am Ready to Help My Child Beat Anxiety

Social Anxiety

Worry Talking Back Exposure
  • Identify worry thought:

    If I make a mistake while ordering my food at a restaurant, I’ll look so stupid.

  • Talk back to the worry with facts/evidence:

    I’ve been to this restaurant before, and the waiters are usually friendly, so even if I fumble over my words, he/she probably won’t think much of it.

  • Gradual exposure:

    • Go with a friend, and have him/her order my food. I might order my drink.
    • Go with a friend. Order both my food and drink order on my own.
    • Go to restaurant alone, and order both my food and drink.

Panic Attacks

Worry Talking Back Exposure
  • Identify worry thought:

    I notice that my heart is beating a little faster than usual, so I should probably leave this situation in order to prevent a panic attack.

  • Talk back to the worry with facts/evidence:

    My heart could be beating faster than usual because I’m walking quickly. I’ve had this sensation before and it does not usually lead to a panic attack. If I do have a panic attack, it will be very uncomfortable, but it will pass quickly.

  • Gradual exposure:

    • Do activities that lead to the experience of a fast heart beat (e.g., run vigorously or do jumping jacks for a minute)
    • Do these activities in situations where it might be difficult to leave quickly

Obsessive Compulsive Disorder

Worry Talking Back Exposure
  • Identify worry thought:

    I’m not sure I did that quite right (e.g., a task, a conversation), and that makes me feel very anxious/uncomfortable. I will [insert compulsion] to help myself feel better

    Compulsions are quite varied and can include: mental rituals (counting or repeating a phrase in your mind), reordering/arranging, hand-washing, etc.

  • Talk back to the worry with facts/evidence:

    Even though I feel uncomfortable about messing up, the compulsion will not actually fix anything, it’ll just help me take the edge off or now.

  • Gradual exposure and response prevention (ERP):

    In OCD treatment, the focus is on reducing the compulsive responses and learning to manage the obsessions in a more effective manner. To engage in ERP in the current example, you might start with purposefully doing something not quite right (e.g., mess up on a minor task) and experiencing feeling some anxiety/discomfort. Then, you would gradually work on the response prevention component:

    • Allow myself to engage in the compulsion minimally (e.g., repeat phrase in mind only two times rather than ten times).
    • Delay the compulsion: wait one minute before repeating the phrase
    • Do the compulsion differently: Say the phrase, but only part of it or say it backwards.
    • Do not engage in the compulsion

Separation Anxiety (child)

Worry Talking Back Exposure
  • Identify worry thought:

    After Mom drops me off at school, I will miss her too much and will have a long, terrible day at school. So I’m going to try to stay with her as long as possible.

  • Talk back to the worry with facts/evidence:

    Even though I will miss Mom while I’m at school, there are some things that I could do, like talk with my friends or go to the playground.

  • Gradual exposure:

    • Spend time separate from Mom in fun places (e.g., at a friend’s house).
    • At school drop-off time, walk with Mom into the classroom and stay with her for a few minutes before she leaves.
    • At school drop-off time, walk with Mom to the school entrance and say goodbye there.

Specific Phobia: Vomit (also known as emetophobia)

Worry Talking Back Exposure
  • Identify worry thought:

    My stomach feels a little queasy, which means I might throw up. If I throw up, I will feel terrible/disgusting/very nervous. Others might notice, and think I am gross.

  • Talk back to the worry with facts/evidence:

    Since my stomach is feeling queasy, there’s a small chance that I may throw up. I’ve thrown up before and it is uncomfortable, but it is not harmful and I can handle it.

  • Gradual exposure:

    • Read stories about vomiting
    • Look at pictures and watch videos of people vomiting
    • Engage in activities that could lead to nausea (e.g., spin in chair to get dizzy, shake head quickly from side to side for a full minute, eat foods that may have been previously avoided due to fear of vomiting)
Dr. Penela proudly provides evidence-based therapy services in English and Spanish throughout Broward County: Weston, Miramar,  Pembroke Pines, Davie, Cooper City, Coral Springs, Parkland, Hollywood, Fort Lauderdale, Plantation, and surrounding areas.

Both tele-health and in-person appointments are available.
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©2020 Wellness in Broward
  • Home
  • Therapy
    • Adults >
      • Anxiety Treatment
      • OCD Treatment
    • Kids + Teens >
      • Anxiety Treatment
      • OCD Treatment
    • Therapy for Parents of Anxious Children
  • Coaching
    • Online Course for Parents
    • FREE email Newsletter
  • About Me
    • Areas of Specialty
    • Meet Dr. Penela
    • Education + Training
    • Curriculum Vitae
  • Info
    • Contact + Fees
    • Online Therapy
  • En Español