Step-Ladder Approach to Help Anxiety in Children | Dr Kaylene Henderson, Little Children Big Dreams

Written by Dr Kaylene Henderson, Little Children Big Dreams

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, fear of sleeping alone or fear of social situations. It can be used to help anxiety in children of all ages.

To make a start, imagine a simple step-ladder with several rungs. Decide on the final goal (this task becomes the top rung 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 climb towards 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 then allow your child to choose between them. 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 my Mum will be back soon". It's a good idea to plan and practise these strategies with your child before you start so that they know what to do as soon as they start to feel worried.

3. Encourage your child to try to stay in the situation until their anxiety passes.

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 leaves the situation while they're still feeling anxious, they may 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 twenty before a step is no longer 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, spending some special time together or suggesting they call a grandparent or close adult to share news of their success 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 storm clouds appear, they'll soon be doing the same. Consider what you say and how you behave when you become anxious. Sometimes we need to be as brave as we'd like our children to be!


Dr Kaylene Henderson

MBBS FRANZCP Cert C&A Psych

Dr Kaylene Henderson is a Child & Adolescent Psychiatrist and Founder of Little Children Big Dreams which provides online help for children who are afraid of the dark or scared of monsters - http://www.littlechildrenbigdreams.com/

Little Children Big Dreams offers personalized printable stories and parent guides to help children beat their fears of monsters or fears of the dark and sleep better at night. Parents are also invited to read Dr Kaylene Henderson's blog on the Little Children Big Dreams website or to visit the Little Children Big Dreams Facebook page for parenting tips and Child Psychiatry information - http://www.littlechildrenbigdreams.com/.

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