“SPLATTING OUT” THE ANXIETY:

A P L AY F U L E M D R I N T E R V E N T I O N

Alice Stricklin, LMFT, MPH EMDR Trainer and EMDRIA Approved Consultant

ANXIETY

• 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety.

• For children aged 3-17 years with anxiety, more than 1 in 3 also have behavior problems (37.9%) and about 1 in 3 also have depression (32.3%).

• -Gandour et al. 2018

• “Ever having been diagnosed with either anxiety or depression” among children aged 6–17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011–2012.

• “Ever having been diagnosed with anxiety” increased from 5.5% in 2007 to 6.4% in 2011–2012.

• - Bitsko et al. 2018

• Stats pulled off CDC.gov/childrensmentalhealthdata

DEVELOPMENTALLY NORMAL FEARSInfant/Toddlers Preschool School Years

Loud noises or sudden movements

Strangers

Large looming objects

Separation

Changes in the house

The Dark

Noises at Night

Masks

Monsters/Ghosts

Animals such as Dogs

Snakes and Spiders

Storms/Natural Disasters

Being Home Alone

Angry Authority Figures

Scary News/Tv Shows

Failure/Rejection

Injury/Illness/shots/Doctor/Death

Tamar Chansky, PhD

CHILDHOOD ANXIETY SYMPTOMS

• When the normal developmental fears persist and impact functioning (i.e. child’s ability to play, learn, go on outings, sleep, etc.)

• Being very afraid when away from parents (separation anxiety)

• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)

• Being very afraid of school and other places where there are people (social anxiety)

• Being very worried about the future and about bad things happening (general anxiety)

• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

PHASE 1: HISTORY TAKINGPregnancy and Post Partum Assessment

1. Pregnancy and Birth-Pregnancy stress ( did the mother experience a lot of stress during pregnancy, trauma during pregnancy e.g. car wreck, DV, natural disaster, etc.) what was health of baby and mother during pregnancy? -Normal Delivery?- Traumatic Birth? (forceps used, cord wrapped around

neck, breech, emergency c-section, infant stuck in birth canal, etc.)

2. Maternal Post Partum? -Post Partum Depression?-Post Partum Anxiety/psychosis?-Did they nurse? For how long? Was that easy or hard?-Was the child colicky, sickly, difficult to soothe?

Assessing Attachment Trauma:

1. Pregnancy and Birth-Unwanted pregnancy? -Adoption at birth?

2. First 5 years of life (any separations from mom or primary caregiver?)

-Parental vacations -Parental business trips-Parental Medical leave/hospital stay?

4. Major Medical Procedures first 2-3 years of life? -Child hospitalized?-NICU stay?

SEPARATION TIMELINES BY AGE

• Children in their vulnerable state, experience separation different from adults. Below are the lengths of time that can impact the child based on time away from a caregiver.

• Birth – 2yr - damage can occur after 3 days of separation.

• 2-5 yr. old - after 2 months

• School age - after 6 months

• Older school age - after 1 year

• Adolescence is the same as adulthood

• The Theraplay Institute

AGING UP ASSESSMENT

• Start with infancy and age up every year assessing child health, parental health, child and parental injuries, change response (e.g. daycare)

• Pre-School – Did they hit developmental milestones?, assess child health, parental health, injuries, separation experiences (e.g. starting pre-k).

• School Age – Same questions, assessing both the child and family system.

• Middle School – Same

• High School - Same

PHASE 1: HISTORY TAKING

• Assessing Family History of Attachment Trauma:

• 1) Maternal or Paternal Separation from Primary Caregivers early?

• 2) Maternal/Paternal birth trauma?

• 3) Grandparent birth Trauma or Separation early?

• Mark Wolynn

UNDERSTANDING THE ROLE OF ANXIETY

• * In what way did hypervigilance help them stay safe? Or stay Attached?

• * In what way did worry help them stay safe? Or stay Attached?

• * In what way did predicting worse case scenarios help them stay safe? Or stay Attached?

• * In what way did counting, washing, checking,….. Help them stay safe? Or stay Attached?

• * In what way did holding their breath/clenching their gut help them stay safe? Or stay Attached?

Begin to be curious about how the way their anxiety presents, once helped them stay safe, or stay attached.

EMDR PROTOCOLS

• Conceptualize it as somatic or internal experience of trauma

• Phase 1 – history (resources, family of origin, parental style, parental interaction with anxiety)

• Phase 2 – Offer Resources (parent coaching, psychoed, coping skills for calming the sympathetic and parasympathetic nervous system)

• Phase 2 – Mechanics and Targets

• Phase 3-7 – With each target Memory

• Phase 8 – Reevaluation of symptoms, triggers, target memory

PHASE 2 RESOURCING

• Psychoeducation as a Resource

• Teaching parents co-regulation (theraplay, parent coaching, Mindfulness)

• Teaching child Auto-regulation (deep breathing, progressive muscle relaxation, movement, body containment, figure eights, tapping, vagal nerve massage, progressive counting)

• What does this child/teen need to be able to be present with the disturbance?

PSYCHOEDUCATIONTelehealth Resource:Youtube channel: Social Sprouts Story Time

COACHING CO-REGULATION

• * Help Parents recognize the signs of overstimulation – Fidgeting, lost of questions, checking out, lots of meltdowns, aggression

• Help Parents with how to intervene with Co-regulation• Deep Breathing with the child

• Holding the child’s hands, make eye contact and do slow bi-lateral squeeze on hands as they talk slowly and deep breathe

• Hold the child and rock

• Invite the child to hug them and squeeze as tight as they can while parent squeezes back

AUTO-REGULATION

• Deep Breathing

• Shaking out the anxiety

• Progressive Muscle relaxation

• Counting

• Running in place

• Drawing/coloring

• Writing Affirmations

• Body Squeeze/Body Containment

ANXIETY PROTOCOL (PHOBIA, PANIC ATTACK, ANXIETY ATTACK)• We are looking for specific targets related to the type of Anxiety.

• First Experience

• Ancillary Events – What else was happening in their life/family life around the time of the first incident.

• Worst Experience

• Most Recent

FIRST INCIDENT

• When is the first time they remember experiencing a panic Attack/Phobic Experience/Anxiety Attack?

• * Get a specific moment in time.

• * How did those with them/around them respond? (assess attachment trauma as well)

ANCILLARY EVENTS

• What else was happening in your family/life around the time of that first panic attack/phobic experience/anxiety attack?

• Whatever their response, Ask – “how was everyone else responding to that”

• If you are hearing anything connected to an attachment trauma/wounding explore a little more here…you can ask “was that how they normally responded? What was that like for you? When is the earliest time you remember needing them to respond a certain way but they responded this way instead?”

• If the client indicates no other ancillary events no need to explore further

• If the client indicates there is an ancillary event(s) but it seems the response from family/loved ones was appropriate move on to the next question.

WORST INCIDENT

• Then ask them to describe in a few words their worst incident with the panic attack/phobic response/anxiety attack.

Sometimes the first one is the worst one, or the most recent incident is the worst

• *Remember we just want a moment in time and a brief description

MOST RECENT INCIDENT

• When was the most recent incident of the panic attack/phobic response/anxiety attack?

• *remember we want a specific moment in time

• * remember we want just a brief description (not the whole story).

ORDER OF TARGETS FOR PROCESSING

• First Target Memory - Touchstone memory of Attachment wound (if you were able to get one)

• Second Target Memory – Ancillary Event(s) (if more than one ancillary, process them in chronological order with earliest event first)

• Third Target Memory – First Panic Attack/Phobic Response/Anxiety Attack

• Fourth Target Memory – Worst Panic Attack/Phobic Response/Anxiety Attack

• Fifth Target Memory – Most Recent Panic Attack/Phobic Response/Anxiety Attack

• Future Template

SPLATTING OUT THE TRAUMA: THE ORIGINS

• Female age 7 developed fear of Storms which morphed into phobia of any dark clouds. • Overall Anxiety had increased and was complaining of stomach aches, separation anxiety with mom, and a lot of

‘worry talk’ as described by mom.

• Mom and Dad going through divorce. Client was number 3 of 4 children.

• Client showed anxiety in sessions anytime we would get close to talking about either divorce or storms. Around the time the parents announced their divorce a large F3 tornado tore through and destroyed a community 10 miles from where this client and her family lived. She saw the devastation on the news. I conceptualized that the fear of storms became linked to the trauma of the parental divorce. To the children it went from everything was fine, to one day the parents are divorcing and not talking and one parent constantly demonizing the other parent. I began with family therapy to help with divorce adjustment. As this client began to increase in fears and anxiety I targeted her treatment to more individual work around the phobic responses. The other children seemed to be adjusting to the changes and showed no additional stressors or symptoms. As I began working with her individually, she withdrew even more in sessions and spoke very little. It was hard to engage her. I knew that in order for us to get close to addressing the trauma I needed to make it seem fun and engaging. I came up with the idea of Splatting out the Trauma. I have since learned that this technique has helped many children, particularly active boys, engage with their trauma in a fun and interactive way that feels empowering to them.

SPLATTING OUT THE TRAUMA

• 6 year old Caucasian Male. Allergic reaction that resulted in the use of an epi-pen injection and subsequent ER visit. While at the ER, the nurse setting the Iv, missed the vein and had to ‘dig in his arm’, then on second attempt blew the vein and blood started ‘going everywhere.’ 2 years later, the client had another allergic reaction and had to have epi-pen and another ER visit. The client was preoccupied with fears of the IV. Six months after the second incident client continues to worry about hospitals, needles, and allergic reactions.

SPLATTING OUT THE TRAUMA

GENERAL PROCEDURES

Complete phases 1 and 2.

Phase 3: Draw the picture, assess emotion, NC, PC, VOC, SUD, body scan

• Tape the picture gently on the wall

• Run in place while looking at the picture

• Splat – throw the splat ball at the picture trying to knock it down

• Once the picture falls down think about the memory and draw a picture of the worst part now.

• Tape it on the wall and repeat.

• Continue until there are no more pictures to draw.

SPLATTING OUT THE TRAUMA

• You can find the script for this technique and many others in:

REFERENCES

• Data and Statistics on Children’s Mental Health https://www.cdc.gov/childrensmentalhealth/data.html

• Chansky, Tamar. Freeing your Child from Anxiety, Revised and Updated Edition: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life—from Toddlers to Teens. Harmony; July 29, 2014.

• Bitsko RH, Holbrook JR, Ghandour RM, Blumberg SJ, Visser SN, Perou R, Walkup J. Epidemiology and impact of healthcare provider diagnosed anxiety and depression among US children. Journal of Developmental and Behavioral Pediatrics. Published online before print April 24, 2018

• Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ. Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 2018. Published online before print October 12, 2018

• Wolynn M. It Didn’t Start with You:How Inherited Family Trauma Shapes Who We Are and How to End the Cycle. Penguin Books, 2016

HOW TO FIND ME

• www.Alicestricklin.com

• Alice.Stricklin@gmail.com or Alicestricklincounseling@gmail.com

• 615-574-0474