Anxiety (worry)

Anxiety is a word we use to describe feelings of worry, fear and panic. As well as these emotional feelings, people with anxiety might also experience physical (body) sensations such as a racing heart, breathing fast, sweaty hands, dry mouth and feeling shaky. Many people also have “what if” or negative thoughts when they are anxious.

Anxiety is a normal human response to feeling threatened or in danger, even if that threat or danger is a thought, image or memory. Anxiety can become a real problem if the thoughts, emotions (feelings) and physical sensations are very strong, happen even when there is no real danger or if it lasts for a long time.

Lots of people experience worry and anxiety although for some people it can impact on everyday life and get in the way of school/college, socialising and even home life. The types of anxiety that are most common but cause a lot of distress include:

• Worries about what other people think of you or worries about being judged negatively and not feeling good enough

• Worries about bad things happening to you or the people you love and care about

• Uncontrollable constant worry about lots of things (like school, the future, health, world events)

• Worries about your safety and health (including worries about germs and contamination)

• Phobias (big fears) about specific things

• Worries that you are responsible for bad things happening

• Feeling the need to complete certain routines, rituals or behaviour to stop bad things from happening (commonly known as Obsessive Compulsive Disorder)

 

We have developed workbooks which young people and families can use and can be downloaded from this page.  This book provides a lot of useful information about why we experience anxiety as well as several different types of techniques to help manage and lessen anxiety.  This self-help programme should be completed prior to a referral to specialist CAMHS unless there is an immediate need for the specialist mental health service to assess and intervene due to the level of risk identified.

Top Tips
1

Worries and anxiety are common; everyone worries so it’s important to remember you are not alone. Some worries may seem very real and very scary. Tell someone how you are feeling no matter what your worries are, even if you are worried about doing so. There will be someone who will listen and try to support you.

2

Although anxiety feels horrible, remember these feelings will pass and the physical sensations cannot harm you. Remind yourself that you have been anxious before, that those feelings passed, that you coped and were ok. If you need to, use activities, such as watching TV, spending time with friends, reading, making things and listening to music, to help manage until you feel a bit better.

3

You cannot avoid all the things that make you feel anxious so face your FEARs with confidence following these four steps;

• Focus – rather than worry about the past, future or the unknown, focus on the present moment, the here and now
• 
Expose – the more you face your fears the easier it will become to manage
• Approach – the fear of experiencing anxiety is often worse than the situation you are avoiding. Face your fear and see for yourself that the situation probably isn’t as bad as you are predicting
• 
Rehearse – practice anxiety management techniques.

You can find lots of these on the Youth Anxiety website.

CAMHS Referral Guidance – Worry (Anxiety)

 What we do, what we don’t do and what you can do if you are worried about your child

All young people will worry and feel anxious from time to time. Here’s a guide to help you know how best to support your young person if they are experience symptoms of worry or anxiety. This is not an exhaustive list; young people will experience other types of worry and symptoms which may not be included on this guide:

Mild

These are worries and anxieties that most young people will have from time to time

Type and nature of worry

It is common for children and young people to experience worry as they develop through childhood and adolescence. The typical worries children and young people experience tend to be situation specific, short term and can be managed with the love and support of parents/ carers. Examples might be:

  • Being away from home/ parent
  • Going to school (but settling)
  • Worrying about going to bed/ the dark
  • Worry about something bad happening themselves or to a loved one
  • Doing new things
  • Going to unfamiliar places
  • Doing things independently
  • Public speaking/ performing
  • Tests and exams
  • Change and uncertainty (e.g., family breakdown or conflict)
  • In response to an upsetting event such as being bullied
  • Being in social situations

What you might see or a young person might report

  • Being clingy and not wanting to be separated from a parent/ carer
  • Not wanting to be left alone
  • Seeking verbal reassurance and checking things are ok
  • Not wanting to go to school
  • Avoidance of what they are fearful of
  • Having bad dreams/ mild sleep disturbance
  • Having some physical symptoms such as feeling sick, hot and clammy, tummy aches
  • Feeling restless and fidgeting
  • Appearing unsettled, distracted or irritable
  • May appear more challenging or oppositional/ argumentative
  • Thinking or talking a lot about their worry
  • Crying or becoming distressed

Things to try, support and Next Steps 

  • Normalise that anxiety is a natural emotion, the physical sensations of anxiety can be unpleasant but it’s ok, it will pass and won’t cause any harm
  • Encourage, reward and praise a young person not to avoid; the more a young person avoids, the harder it becomes and the more anxious a young person will become. Instead, encourage the young person to face their fear- the more they face it, the easier it will become.
  • Break things down into steps and do these as often as possible so a young person can habituate and tolerate their anxiety before going onto the next step
  • Use distraction techniques here are some strategies to try:

An A-Z of coping strategies: https://youtu.be/5EXpkVw3fh0

How and when to use a coping box: https://youtu.be/OyfgodSSdV4

  • Role model and demonstrate that you can do things even when you’re anxious
  • Supporting a young person to problem solve any obvious triggers
  • Watch  our parent/ carer workshop on Coping and Resilience Skills here: X (to be uploaded)

Useful Resources:

  • Helping Your Child With Fears and Worries, by Cathy Creswell and Lucy Willetts
  • Helping Your Anxious Child, by Ronal Rapee
  • Stuff That Sucks, by Ben Sedley
  • What To Do When You Worry Too Much, by Dawn Huebnen

Needs Some Support

These are worries and anxieties that some young people experience and may need some support with

Type and nature of worry

The degree to which a young person worries appears out of context or disproportionate to the reason why they might be worrying. Episodes of anxiety might be more frequent or prolonged and cause the young person distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. Examples might be:

  • Fears that something bad might happen to themselves or someone else
  • Worry about not coping
  • Worry about performance in exams or the future
  • Worries related to being habitually bullied or experiencing regular conflict or distress either at home or school
  • Worries about what others might think, say or do
  • Worries about negative judgements by others or social rejection/ exclusion

What you might see or a young person might report

  • As well as the features in Green, the following might also be present:
  • Disrupted sleep (difficulties getting to or staying asleep, nightmares/ night terrors)
  • Persistent physical or verbal seeking reassurance
  • Resistance to doing things; requiring a lot of cajoling or persuading
  • Becoming distressed or agitated when facing fear or even thinking about facing the fear
  • Some repeated patterns of behaviour or routines which seem to help the young person but don’t make sense to others (e.g., repeated checking or counting)
  • Some episodes of panicking such as getting distressed, racing heart rate, quicker breathing, upset tummy, feeling sick, feeling dizzy or faint
  • Demanding things be done in certain ways or requesting others to do things for them
  • Families might also find themselves struggling to do things as they normally would as they may make adjustments to accommodate how the young person is feeling or responding

Things to try, support and Next Steps

  • As well as the steps in Green the following might be helpful:
  • Support your young person to access self-help resources (podcasts, videos, downloads, links) on the Hampshire CAMHS website: hampshirecamnhs.nhs.uk
  • Watch our parent/ carer workshop on how to support anxiety here: https://youtu.be/LMFQHABnH1M
  • Share concerns with your child’s school/ college
  • Access pastoral support from school/ college
  • Consider accessing help from a local counselling service
  • Seek advice, guidance and support from Young Minds Parent Helpline:

08088025544

  • Depending on the context and/ or the origins of the anxiety being experienced, other services may be helpful e.g., family guidance if there is family breakdown or conflict. There is a lot of information on the Hampshire CAMHS website: www.hampshirecamhs.nhs.uk

Useful Resources:

  • Overcoming Your Child’s Fears and Worries, by Cathy Creswell and Lucy Willetts
  • Helping Your Anxious Child, by Ronal Rapee
  • Stuff That Sucks, by Ben Sedley
  • What To do When You Worry Too Much, by Dawn Huebner
  • The Anxiety Workbook For Teens, by Lisa Schab

Needs Specialist Treatment or a Crisis Response

These are worries and anxieties that cause a significant impact and a young person may need specialist support

Type and nature of worry

These anxieties are severe and enduring. These cause significant distress to a young person and significantly disrupt daily coping such as school/ college, socialising and even self-care activities (e.g., sleep, bathing, eating). Despite trying advice in the green and amber stages, the young person still experiences anxiety symptoms.

  • Strong unwavering beliefs that something bad might happen or that there is danger
  • Repeated, intense and overwhelming “what if” thoughts that are catastrophic in nature

What you might see or a young person might report

As well as the features in Green and Amber, the following might also be present:

  • Repeated routines or rituals that impact on a young person’s day such as being on time for or coping at school, being able to socialise and engage in hobbies or interests, being able to get up or go to sleep.
  • Persistent refusal to leave the house or attend/ take part in activities such as school, hobbies, interests, seeing friends.
  • Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise (ill health) as a result of this.
  • Withdrawn and uncommunicative or not wanting to be left alone at all- this may seem uncharacteristic or age inappropriate for some teenagers.
  • Regular episodes of panicking such as getting distressed, racing heart rate, quicker breathing, feeling dizzy or faint, vomiting, shaking.
  • Thoughts and beliefs are rigid and cannot be challenged or thought about from a different perspective (e.g., 100% belief that something bad will happen).
  • Becoming agitated, distressed, oppositional or aggressive towards others when in a situation they are particularly fearful of.
  • Reactive and impulsive behaviour such as running away which may place them or others in danger.
  • Families will find themselves struggling to do things as they normally would, that family functioning is disrupted and they are required to make significant adjustments to accommodate how the young person is feeling or responding

Things to try, support and Next Steps

As well as the steps in Green and Amber the following might be helpful:

  • Speak with your child’s GP.
  • Speak with the School Nursing Team.
  • Depending on the context and/ or the origins of the anxiety being experienced, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support if there are clear triggers for anxiety e.g., abuse, domestic violence, bullying, being a young carer etc.
  • Seek advice, guidance and support from Young Minds Parent Helpline:

08088025544

  • Consider making a self-referral to a CAMHS Service.

Useful Resources:

  • Overcoming Your Child’s Fears and Worries, by Cathy Creswell and Lucy Willetts
  • Helping Your Anxious Child, by Ronal Rapee
  • Stuff That Sucks, by Ben Sedley
  • The Anxiety Workbook For Teens, by Lisa Schab
  • What To Do When You Worry Too Much, by Dawn Huebner
  • Breaking Free From OCD, by Jo Derisley
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Watch: Previous Next Video 1 of 4

  • How to support a young person who may have Anxiety
  • Struggling with Anxiety? Try on a new perspective - credit AnxietyBC
  • Guided Mindfulness: Passing Clouds - Dr Natalie Roberts
  • Guided Mindfulness: Leaves on a Stream
  • How to support a young person who may have Anxiety
  • Struggling with Anxiety? Try on a new perspective - credit AnxietyBC
  • Guided Mindfulness: Passing Clouds - Dr Natalie Roberts
  • Guided Mindfulness: Leaves on a Stream