The step-ladder approach for the treatment of anxiety is medically known as graded or hierarchical exposure. It’s one of the ‘behavioural’ components of cognitive-behavioural therapy (CBT) and it’s useful to know about when encouraging your child to address their fears.

This treatment approach can be applied to many common childhood anxieties such as the fear of separation (see the last blog entry), fear of social situations or fear of sleeping alone. It can be used to help anxiety in children (and adults) of all ages.

To make a start, picture a simple step-ladder with several rungs. Decide on the final goal (this task becomes the top of the ladder), then determine what an easy starting point might be (this becomes your first step). Next, work out what tasks might serve as intermediate steps with each situation a little bit more challenging than the last as you get closer to the top of the ladder.

When planning your child’s step-ladder, it’s important that the leap between steps isn’t too daunting. If the jump from one step to the next seems too great, consider how you might break it up into a few smaller steps by creating variations based on what it is your child does, how long for, where they try it or who they’re with.

This step-by-step approach allows your child to practise coping with their anxiety in manageable doses. In this way, your child also experiences successes along the way which builds up their confidence and sense of mastery.

Here are a few hints to improve your chances of success:

1.    Let your child decide what tasks they add to their ladder. If you do need to help with this, make a few suggestions from which your child can choose. As much as possible, your child needs to feel like they’re an active, motivated participant in this process as this makes it more likely that they’ll stick with it.

2.    Teach your child some strategies for managing their anxiety before you start. An example might be slow relaxed breathing, or a simple message to think about, for example, “I’m safe and this worried feeling will go away” or “I’m okay and Dad will be back soon”. It’s a good idea to plan and practise these strategies with your child before starting so that they know what to do as soon as they start to feel anxious.

3.    Encourage your child to try to stay in the situation until their anxiety has passed. Anxious feelings don’t last forever. In fact, our bodies can only maintain high levels of anxiety for a matter of minutes (rather than hours) but if your child always flees while they’re still anxious, they might never learn this.

4.    Wait until your child has mastered one step on their ladder before moving onto the next. This might take one attempt or it might take ten before a step is no longer considered anxiety provoking. It’s always best to work at your child’s pace.

5.    Reward success. This doesn’t need to be something expensive or chocolate-coated... Praise, letting your child know how proud you are, suggesting they call a grandparent/close adult to share news of their success or spending some special time together are all great ways to reward your child.

6.    Be a good role-model. Children learn so much from us. If they watch us panic each time a dog approaches, they’ll soon be doing the same. Consider what you say and how you behave when you become anxious. Sometimes we have to be as brave as we’d like our children to be!

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