Subscribe
Share
Share
Embed
A podcast from the Paediatric & Neonatal Clinical Psychology Service in the Northern Trust supporting the psychological and emotional experience of young people and their families, in living with health-related difficulties, or infants and families who need to spend time in Neonatal Care. The series will focus on providing information and sharing experiences that relate to families who are in contact with the Paediatric & Neonatal Services.
Please give your feedback here https://forms.office.com/e/6M0RhzHtjR
Paeds Ep3
===
Hello and welcome to the Let's Talk podcast from the Paediatric and Neonatal Clinical Psychology Service in the Northern Health and Social Care Trust. This series will consider and discuss a range of topics relating to the experiences of children and young people living with health related difficulties and their families.
We also provide a service to infants and families who need to spend time in neonatal care. Along the way, we will be joined by special guests, including young people themselves, their parents, and members of the healthcare teams who support the families. My name is Maeve Cushnahan, and I'm the clinical psychologist working within the pediatric diabetes and epilepsy teams.
With me today, I have Saskia Craig. Hi, I'm Saskia. I'm a trainee clinical psychologist working in the service. Thanks very much, Saskia, and great to have you with us. In today's episode, we are discussing how anxiety may show up for many children, young people, and families. When a health condition such as epilepsy or diabetes comes into their lives.
So, I think the first thing to talk about on this podcast today is what is anxiety and why are we as psychologists talking about it? Firstly, one of the most frequent reasons that young people and their families come to talk to us is because they are struggling with feelings of anxiety in relation to living with diabetes or epilepsy.
I think it's important to say at this point that just because we are talking about how some young people or parents may experience anxiety, that is not to say that it is inevitable. As with a lot of issues we may discuss on this series, just because we are talking about difficult emotions, it does not necessarily mean that everyone will get them or experience them.
For example, we may become anxious or worried in some situations, but somebody else, for example you Maeve, you may not feel as anxious as I am in a certain situation. So the two things to talk about about anxiety are It is a frequent reason for referral to our service, and therefore we thought it might be helpful to name that and recognize it, that it is a natural response, and talk a little bit about how we should think about and understand anxiety.
Secondly, I think it's important to recognize that although it is a very natural response, feelings of anxiety have a tendency to be a bit contagious and can escalate, so it is important that we think about how to approach managing anxiety alongside living with diabetes or epilepsy. Thanks very much, Saskia.
So just briefly to mention this contagious nature of anxiety that you referred to, everyone in a family can feel it, and often we speak with family members and everyone is feeling a bit of anxiety around things. Also, it can ripple. By that, I mean, we often hear of how anxiety after a health diagnosis shows up in ways that may not always be expected, and then how it may ripple to take, for example, a young person with diabetes, perhaps feeling anxious about having to take insulin injections.
This may lead to anxiety around eating, as this would require insulin. Eating together, for many teenagers, as we know, in particular, can be a very social activity. Therefore, anxiety around eating may lead to worries about judgement from others in social situations. For example, thinking, why are you not eating?
Which may lead to a young person becoming avoidant of socialising with friends in the same way. Understandably, we can see how this might go on to affect a young person's mood. Or take another example, for a young person living with the unpredictability of seizures. Perhaps a fear of a seizure occurring away from the safety of home might lead to reluctance to go to somewhere like school, which may lead to falling behind in studies, as well as to separation from peers.
This may ripple on to escalated stress around exams and worries about the future, or feeling excluded from the peer group, which again, very understandably, might also go on to affect mood. So we can see the importance of thinking not only about the anxiety that's presenting at the time, but also how this may ripple, and therefore the importance of supporting young people and their families to develop confidence in living with aspects of their health condition.
Do you think it would be helpful to talk about what anxiety is and why it presents for us all? That sounds good. Anxiety is a very natural and normal emotion. We all experience it, at different points of our life. It is a biological reaction, and basically the reaction is to us feeling under threat. It's the body's response to coping with something our mind is telling us is in danger.
Let's think about this in more detail. We've all heard it before, whether or not it's in social media or through friends and family, but what we really want to talk about today is the process of anxiety. So essentially, as a summary, our brain detects danger. tells our body to respond. And after this, the body prepares itself to be able to cope by either fighting back or by running away.
For example, have you heard of fight or flight? I think it might be helpful now for Maeve to talk about the science in a bit more detail. Thanks very much, Saskia. Yes, like all animals, we as humans have developed ways to protect ourselves from danger. Have you ever seen some of the David Attenborough documentaries?
What an animal does when it detects threat. Picture, for example, a meerkat. Usually the image of this that we have is of a little, little animal, freezing, upright. Monitoring, hyper focused, watching everything around to take note of what's going on and to find threat and then take an action. So we have the same process.
We often hear of anxiety as referred to as the body's alarm system. If you think about what an alarm system does, an alarm system lets us know when we might be in danger and when we need to get ready to do something to keep ourselves safe. If you think here of a fire alarm. So for example, if you smell smoke in the house, you might think I'm in danger.
You might feel fear or anxiety. Your body would react to this thought and feeling. So for example, you might start to get some of the symptoms of anxiety like a racing heart or shortness of breath. You'll be feeling quite dizzy. This would all drive you to get out of the house pretty quickly. When we detect what we think is a threat, our brain reacts to this and releases certain chemicals.
Have you heard of adrenaline and cortisol? What sort of situations might you have heard of adrenaline in? So, for example, when we speak to young people about this, they often talk about sports, maybe playing a football match, playing a hockey match, or a competition of some sort. The other situation being when they're doing exams, or studying for exams, they often talk about this phrase of running on adrenaline.
It's one that's very, very common to us. These hormones that our brain creates makes us more alert, so that we can react faster to cope with any threat. They also make our heart beat faster, so that blood can move around the body to where it's needed most. This is really our body prepping us to either fight against the threat, or to run away from it.
When the threat has passed, a hormone called oxytocin is released to help our muscles react, and this may lead us to shake. This is what we have come to know as the fight flight freeze response. It automatically happens in our bodies. I think we can agree that this process is incredibly useful if we are actually in a situation of direct physical threat.
However, it can cause problems or it can intrude on our lives if the threat our brain is detecting is not one that we can actually fight against or run away from. So what we think of this. What about how our thoughts play a part in keeping anxiety going? We're very complicated, aren't we Saskia, when it comes to how we think?
We are Maeve, you're right. And I think that links on to the major ways in which we differ from animals, we might see, say, in David Attenborough, like you mentioned before, on his documentaries, is the extent to which our minds have evolved. The way that we think. Our minds are pretty incredible, I think. We have billions of thoughts per day.
Not only do we have these thoughts, but these thoughts often evoke feelings. And some of these feelings might be neutral, or quite dull. Like, I must remember to put the bins out on Friday. Or it might be for a young person saying, why did I tell that friend I was going to meet them in town? However, other thoughts might have strong, positive, or negative feelings attached to them.
For example, we might feel excited, angry, sad. fearful, or experience joy. So for example, a thought of it's Christmas in seven sleeps. Even from the tone of my voice, it creates a lot of excitement for young children, and including myself. Or a thought of my exams starting at fortnight. I can tell you, that certainly gives me a level of stress.
But as humans, we are even more complicated than that. To add, an even more complex level. On top of our thoughts and our feelings, we then often experience new feelings about our thoughts. So, for example, you might feel angry towards something or someone, judging ourselves for this, and then you might feel guilty about it.
Or, another example, we may feel scared of something. And as a result we may judge ourselves for our fear, and then possibly we might feel shame, another emotion attached. Our brains are very complicated. In a nutshell of all this science, how we think creates emotions, which can cause physical feelings in our bodies, and this can impact on how we react or behave in certain situations.
It makes sense, to be honest, that if a situation makes us feel a bit of difficult or maybe some negative emotions, we may not really want to go out towards that situation, and I think that's totally understandable. When we talk with families about feelings of anxiety, we are often also talking with them about things that anxiety is making them avoid.
This might be social situations or parts of their health treatment, and we will talk about this in more detail in a minute, but in summary, our brains are very straightforward in some ways. And in other ways, they're very complicated. That's great, Saskia. Thank you very much for that. And I suppose now to think a little bit about the thoughts that are more specific to anxiety feelings.
So we know that the perfect ingredients to create the feeling of anxiety is when something is unpredictable, when we feel out of control, and when we feel unsafe. Feelings of anxiety are usually linked to what we call what if thoughts. So, what if such and such was going to happen? These are thoughts that are future based and are usually imagined in the worst case scenario.
These thoughts often escalate and spiral, making the anxiety feel worse. So let's take this away from health for a moment and have a think about a phobia as a way to illustrate this. Not to put you on the spot, but do you have any phobias, Saskia,
and would you tell us a little bit about some of the thoughts that might show up for you whenever you notice that a wasp has come into the room? Yeah, no worries. I can think of an example last week. It was a nice hot day outside and the windows were open while I was working and a wasp came into the room.
And exactly that, I had the thought of, what if this wasp is going to come over and sting me? That's a pretty terrifying thought and one I can identify with. So the thought is, what if this was supposed to come over and sting me? Exactly. What, what emotion do you think came up for you when you had that thought?
Probably fear. Feeling a bit on edge I could feel myself. Just always looking at the wasp and also like, even in my body, I could tell my heart rate was faster and my tummy felt a bit tense as well. So those are the physical sensations? Yeah, I definitely experienced them. It sounds like this wasp in the room turned you into a bit of a meerkat for wasps.
Definitely. So you were keeping a good eye out for them, but your body was reacting with all of those physical sensations that you described. Could you tell us a little bit about what did you do? So what behaviour came from this? For the first... 10 minutes maybe it was going around the room. I just noticed myself looking at it the whole time So I was really distracted from my work And as you said about a meerkat if you could imagine me I my eyes were just focused on it the whole time and I couldn't really take in any of the content I was doing on my work, but after about 10 minutes what I did was I got somebody else in the room to try and get the wasp out of the room And eventually they did and they shot the window.
So that was an easy strategy to get rid of it And then you could relax. The wasp was gone. Yes, that's for sure. Can you remember your thought when that window closed and the wasp was outside? What was your thought? Thank goodness it's not here. It's interesting that cycle that you talk about there because you can hear in that resultant thought that one of, thank goodness it's not here anymore.
You can hear relief. And I guess maybe a thought of it's a good job that wasp is gone or it would have stung me. Yeah. So sometimes avoiding situations in the short term, even though it's really helpful in bringing down our anxiety. It can actually make the fear worse the next time. So in some ways, a very, very, very natural response of good job that wasp is gone, but it didn't challenge your belief that wasps are dangerous.
And this is very typical of an anxiety cycle. And it is a cycle. It's one that often escalates and one that we aim to interrupt if we're hoping to reduce feelings of anxiety, which is where psychology comes in. Phobias are very, very common, and most of us can relate to this in some way. And as you mentioned before Saskia, anxiety is something we all feel, if we think about having to tolerate something that is unpredictable.
Feeling that we don't have control over it. Feeling unsafe. Then we can clearly see why anxiety may show up even more so for people when they're living with epilepsy or diabetes. For the child or the young person with the health diagnosis and also for their parents or carers. Or any health condition.
For the young people and families we meet, seizures are often unpredictable. They may feel out of control. They may feel unsafe or blood sugar levels may feel unpredictable. They may feel outta control, they may feel unsafe. I suppose I'm wondering, is there another way to think about this though? Hear me out.
This might sound a little old, but if we imagine diabetes or epilepsy to be living, breathing people or perhaps characters, I wonder what they would say about feelings of anxiety. So what I'm thinking of Maeve is, I imagine diabetes, the person, or epilepsy, the person, but we're very, very happy or very much consider anxiety to be their friend.
Does that make sense? Think so, but could you tell us a little bit more about that Saskia, in what way might it consider anxiety to be their friend? Well, I'm thinking of what you were saying earlier about the meerkats. So if we think about what anxiety does and how this turns us into little meerkats, we are always looking out for danger.
Monitoring, or seeing anything for threat, like I was there in that incident with the wasp. Concentrating solely on keeping ourselves safe, that's what we want to do and have to do. Diabetes would love this, but it not always think it was good. For example, always monitoring and watching blood sugar levels 24/7.
That's one way to try and keep and control the diabetes, and to keep it happy and safe. So, I mean, does this make sense that these diabetes or epilepsy characters might want someone to feel anxious or worried, or want someone to be looking after them and keeping them safe? You know, it doesn't fit with living with life.
So we need to factor in relationships, school, work, hobbies, relaxation, and the best of all, my favourite, sleep. Living in a constant state of anxiety may mean we may be prepared for when threat comes. But if it doesn't come, if it doesn't fit, how does this interfere or affect us in our full life? It must be awful.
Yeah. Thank you for that, Saskia. That makes sense. So, we know that anxiety is one of the most common reasons for young people living with epilepsy or diabetes, or for their parents and carers, to seek support from psychology. Saskia, could you tell us about some of the ways this anxiety may show up in the context of a health condition?
Yeah, sure. I think there's so many ways. As we are all so different, we're all individual people, so therefore the way we think is different, and the things we think of as a potential threat are different. I suppose if we think about, I'm
thinking here of a young person maybe with a diagnosis of epilepsy, who has experience of having had seizures that have been very frightening for them, and how they might develop an anxiety around social judgment for this. So if you think about, you know, what it means for a young person living with seizures to feel confident leaving the house and leaving their safe person, they might fear going out with friends in case a seizure were to happen, and maybe feeling that their friends wouldn't know what to do.
Maybe worried about being away from a safe person like a parent or a sibling. We also find, and I think it's important to say, that there isn't always a straightforward correlation between the type of seizure and the amount of anxiety. We often speak with young people who experience absence seizures and feel very, very anxious about this.
Whereas some young people who experience tonic clonic seizures don't always necessarily describe high levels of anxiety. We can't assume, and that's the important thing to remember, that it's all to do with individual experience and perception. Let's think about that cycle in this scenario. So, for example, that young person with epilepsy.
Perhaps the thought of, what if I go out and have a seizure and I lose consciousness and my friends are shocked or frightened or maybe some people find it funny. You know, that can lead to thoughts of, well, what will happen with my friends? What if they don't want to hang out with me anymore? You know, what if people think that I'm someone to be made fun of?
And these are thoughts that we hear a lot of whenever young people attend our sessions. These what if thoughts, well these create worry and anxiety and they create the physical sensations that go with it. As we mentioned before, things like maybe a racing heart or difficulty breathing or feeling dizzy, feeling short of breath, feeling hot or cold.
It's very, very understandable then to think about how any young person I may cope with this feeling by avoiding certain situations. So for example, if I don't go out, well then I don't need to worry about any of this. Or, on the flip of that, by only going out if a safe person is there. So, for example, I will go out to the shops, but if my mum comes with me.
Or if my dad comes with me. I think this that these are very natural feelings to have following a diagnosis. And what our hope is, is that with time that they will pass. And that makes me think as well, it can be quite similar for somebody living with diabetes. So for example, somebody might have a thought, again, of what if my blood sugar goes low when I'm out with people who maybe don't know that I have diabetes.
And understandably, I know if I was that person, I would feel scared to go out, and as well, the person might experience some physical sensations in their body, such as a fast heart rate, might feel a bit sick, they might have a sore tummy. And understandably, these thoughts and feelings are very unpleasant and no one wants to experience them.
And as we talked about before, it's natural. And it's a normal response that our body wants to avoid these situations. So some behaviours might be, well, they might not go out with people they don't know, but they might want to stay close with their family or, you know, with their friends, for example, who maybe know how to manage their diabetes.
And as well, I'm just thinking of, you know, the other hand, somebody might behave in a way where they're often maybe feeling nervous, might not want to go out in the room, so actually they might make their blood sugars high so that then it mitigates or stops them from having low blood sugars to try and prevent this.
And as you talked earlier on, Maeve, about the worst scenario with me, I guess that maintains or sort of feeds into that cycle of thinking, well, what if my blood sugars go low? And like what we're talking about here, it's normal to have this response to get that sense of safety. Right. Okay. Absolutely.
Saskia, and as you're talking there and thinking about the other thought that's so common and very sort of linked with anxiety, which is that thought of, I cannot cope, and we do hear young people talk about that. And to add an even bigger complication to the scenario you were just describing, we often do hear young people talk about, you know, symptoms that come with low blood sugars as being the same as symptoms of anxiety, so you can understand how that would feed into that even further.
So thank you for that. I think it's also important that we think about what is all of this like for a parent or a carer. They often hold fear for all of the above scenarios with their child. You know, worried about them going out without them around, worrying about letting them take steps into independence that they need.
But also, they're very concerned about how they'll manage if something was to happen with their health. So, it can be a very, very worrying time for parents. And let's not forget that parents will also have had their own experiences growing up. You know, we don't know what's in a parent's background, possibly they have had their own struggles with worries or anxieties, and maybe these struggles are made even bigger with the worries as they try to live with the added worry of the child's health.
We think about that more typically within sometimes a teenage scenario, you know, we have a situation where a parent is possibly quite anxious about a young person maybe going out with their friends at night. And doesn't feel that they want them to do that. The young person might feel very angry with this or frustrated by it and it can lead to a lot of arguments and discussions and it can be a very difficult time.
So then we have a parent who's maybe worrying about their young person being upset and you can see how all of these things just escalate and build. It's a difficult time for families and usually one that we find is really helped by talking it of
paediatrics, we are meeting with children and young people. And if we think about this age group, there are so many constant changes, pressures, anxieties that occur unrelated to health based worries. If we think back to being teenagers ourselves, you know, what is important at that age group? Fitting in with peers, how they look, how they feel about their appearance, not wanting to stand out, unless of course they're choosing to stand out, in which case they do want to stand out.
of this up. So for young people living with a health condition, we're often talking with health condition worries, but also within the context of the wider anxieties that they may also be experiencing. I think you're right there Maeve to point that out, there's so many different types of anxieties or worries that might be impacting the young person and their families.
It's completely normal and natural considering the circumstances, but I think it's really important for us now to talk about one of the main and frequent reasons for people being referred into our service, and this is what we call procedural distress. Is that okay if we talk about that now, Maeve? Yes, I think that would be very useful, Saskia.
It's one of the highest rates of referral that we receive in psychology. Procedural distress is a type of anxiety. I suppose it therefore flows and follows on from the anxiety cycle that we talked about earlier, but in a very specific situation. That is, at times when a medical procedure is required.
Often we find that if someone feels highly distressed about a procedure, they will then have had a difficult experience with a procedure in the past. And it's completely understandable and normal why they would feel like this now. Even with the most gentle and caring of hospital staff. Procedures can hurt, or can be uncomfortable.
This is not an imagined threat, like a phobia, such as me with the wasp situation earlier on. But actually, this threat is real, and it really is not nice and pleasant, and we do recognise that. As we mentioned earlier, anxiety generally occurs when we feel When it comes to medical procedures, this can be very true.
For example, a hospital can, I suppose, feel very big and frightening for anyone, but particularly a young person. And on top of that, having to get blood tests, or having an MRI scan done, or having a cannula inserted. All of these in any situation can really feel overwhelming for us, for anybody, never mind a young person.
And I guess it can lead us to a sense of not feeling like we are in control. So I do think it makes a lot of sense that needing to have a procedure done can be what we call a trigger. for anxiety or stress. So for example, it sets off the anxiety or the feelings of distress. As we also mentioned earlier, we are all individual and therefore all different, and I think that's a great thing.
So the reason that something may be a trigger to one person for an anxiety may be different for the other, and it's important to recognise that, and we do in our clinics if you come to see us. Thank you for that, Saskia. Absolutely. And I think sometimes to follow on that conversation earlier about the meerkat, sometimes our meerkat can do too good a job.
Let's think about the five senses in the context of a procedure that is needed and how this might relate to the triggers you discussed. Let's start by imagining a situation in which we were very frightened, maybe felt out of control, maybe felt under threat, maybe felt unsafe or unable to escape. And imagine this from the perspective of being a child or a young person.
Physically smaller, maybe harder for them to speak up and articulate their feelings. There may be things about the situation that we remember seeing. So for example, a needle coming towards us. Or if it's an MRI scanner, perhaps going into the actual scanner itself. So those are the things that we see, and that's a trigger.
Or, there may be things that we remember hearing. So maybe a lot of voices. Loud voices, or voices that sounded sharp and toned at the point of time. Think about the busyness of hospitals and the volume in that place, you know. And especially if the room can be a lot of sound. Or maybe the sound itself is connected to the procedure.
So, for example, the noise of the MRI scanner. We might remember a certain taste, and young people often talk about this, like the taste of a medication that made them gag, that made them feel sick. Surely difficult then for them to, to want to take that medication again if they've had with it. Especially if they've had to take it in a bit of an emergency situation.
We might remember a smell, like the clinical smell, and
it might be something that might trigger a memory. Or touch, we might remember having been held and feeling unable to move. So for example, for a blood test, particularly in an emergency situation that might have been necessary or an aversive sensation to the procedure itself. Pain perhaps we know, as you said earlier, Saskia, we're all different and everyone has got a different pain threshold.
Some people don't like to be touched lightly. Some people don't like the tickle that they feel, so it could be any sort of a touch that might be aversive to them. This situation may have been necessary in order to keep us safe. But that may not be the association that a young person's brain has made with what they've experienced.
So a smell, a sound, or a taste may make a young person feel like they are right back in the time of that distressing situation, and this may very likely make future procedures very difficult for them, as the brain will, understandably, detect this as a threat, and they feel out of control, and anxiety shoots up.
The other part of this to remember is that this is an experience that may also be very, very difficult for a parent to observe, and we also I often hear parents talk about this. They speak about feeling out of control when watching their child have to have a procedure completed. And for many families we speak with, sometimes the parents and carers may be the ones that have had to be required to complete the procedure with their child once they've come home from hospital.
This is particularly true when it comes to things like maybe insulin injections or having set changes. In the same way, it can be the same around having to get their child to take medication that they're really, really aversive to, and they can present very, very distressed in these situations. Parents often talk about the guilt they feel.
They talk about feeling as though their child now sees them differently. We need to remember that parents often didn't expect to have to play this role with their child, but a diagnosis of epilepsy or diabetes has pushed them into it. Me, if you think when you're talking about all that, you know, it just shows the complexity of this sort of situation.
Procedures are the perfect storm for creating anxiety for the whole family, am I right? Absolutely. It makes a lot of sense as to why procedures are often a trigger for anxiety, and why procedural distress is one of the most common reasons we meet with families in our service. And speaking of this... This relates to a wide range of procedures, for example, taking medication or having injections or maybe having a pump set change, as you already mentioned, or I suppose procedures that might be less frequent, such as getting blood taken or having an MRI scan.
Absolutely. Thank you, Saskia. So we've been talking today about anxiety and the fact that many families speak about experiencing anxiety in relation to living with a health condition such as diabetes or epilepsy. The question that people are probably interested in at this point is. Either how can we help ourselves or how do we as psychologists help with this?
What is it that we do? So just to answer that question specifically for everyone whenever we've talked so much today about individuals, but if we break it down into two parts, let's have a think first about self help. We do have some resources and links on the trust website that will be able to guide through some of this, but in a nutshell, if we think about that cycle that we've touched on before, the idea that what we think creates emotional response.
How we feel emotionally, for example, anxious, creates physical sensations. So things like the heart racing, feeling sick, feeling dizzy, and these physical sensations, these emotions and these thoughts, they all create and contribute to a behavior. So how do we cope? And one of the things that we see mostly, I guess, when we're speaking with families is a real strong urge to avoid.
So a lot of avoidance, a lot of coping with anxiety. through avoidance, which does work in the short term. So let's have a wee think about how that cycle might be something that, from a self help perspective, you could think about. We think about, for example, a young person who maybe has seizures, so has a diagnosis of epilepsy, and is struggling with social contact.
So maybe a teenager who would like to go out with their friends a bit more, but who is very, very nervous to do so in case a seizure were to happen. Some of the thoughts like that, as we touched on earlier, might be around what if a seizure was to happen when I'm out with my friends and nobody knows what to do and nobody knows now how to you know, help me.
That thought of I can't cope or I'm unsafe. What we know about anxiety is that anxious thoughts will create further anxious thoughts. So it's almost like our brain looks for Evidence that we have reason to be anxious. So for a young person sitting down to think about going for a social situation, if they feel terrified about it and you were to say to them, tell me why you're terrified, they will have a million ideas as to this.
Those thoughts are all creating this emotion of anxiety and the physical sensations. And that is being coped with by not going out. Often, we do look at the cycle and how we can interrupt it. We can think about looking at thoughts differently. That can be a little bit more difficult to do by yourself from a self help perspective.
It's not impossible, but it can be thought about. So maybe it's around trying to think about, well actually, what other circumstances have I been in where I have been? Able to manage, you know, where have I felt more confident and to try to identify those places. If we have a little think about the physical sensations, we want to be thinking about things like, how do I slow down my breathing?
If I feel short of breath, how do I use, you know, breathing techniques to help sort of with some deep breathing to help slow that down? That will automatically then slow down your heart rate. That should ease the feelings of nausea, should calm down all the sweats, and it should lead to feeling a lot more settled.
We will have some information for this, as I said, on our website, so there'll be things there to look out for. There'll be a bit of information on what is anxiety, and there is a document specific to techniques to soothe and calm that has an apps guide at the end, which will give a lot of information around how you know to think about your emotions and how to manage them.
So what I would say is to have a look at this information and to have a, a read through it and decide what is it that works for you best, which app connects with you more. Some of them may be for younger kids, some of them more for teenagers. So maybe for parents as well, they could have a look at that.
And maybe from a behaviour point of view, and this is to
start, is to avoid something. So, we don't want to minimise this. If we're feeling anxious about something, the urge to avoid it is going to be very, very strong. But maybe we want to be thinking about that idea of, what is the longer term goal? In the situation to be able to go out comfortably with friends, what are the smaller goals that you could create in the meantime?
So things like how do you get confident with separation maybe from someone that you see is your safe person and how do you do that safely? If there are any concerns here at all about safety or possible risks, ask the medical teams. Ask the nursing teams, you know, ask them what they think is an okay goal to be aiming for.
So for example, I'm thinking about a teenager who maybe was feeling quite anxious and separating from parents and maybe started going for, you know, short walks with their phone. Maybe for the first walk, they were actually talking to their parent on the phone for the duration. The parent knew exactly where they were going or the parent was nearby.
These little separations will start to build confidence and will start to introduce other thoughts, so rather than the thoughts being about I can't cope, the thoughts then can become about, well I managed that short journey by myself, maybe I can do two minutes longer, or five minutes longer, or I can manage to walk a few hundred yards more, that type of thing, so setting goals that feel safe and achievable.
Suppose the other situation to think about this in is something along the lines of maybe a young person who might be struggling with their insulin injections. And we do see this a lot, particularly in the early stages where they're trying to get used to them. So things about a thought of this is going to hurt, emotions, anxiety, physical sensations, all the ones that we discussed there, things like heart racing, sick tummy, feeling dizzy, and the behavior being either, you know, run away for some of the younger kids.
And even for some of the older ones, I think it's fair to say we can act out, we can kick out whenever we're frightened. So maybe behavior is pushing away from other people or a lot of tears and a lot of distress and a lot of arguments in the lead up to it. Again, let's think about here, how do you manage the physical sensations?
So things like deep breathing, things like grinding techniques, you know. So for example, when you're sitting in a chair, what can you feel? Can you feel your feet flat on the floor? Can you feel your back supported by the chair? Can you feel your hands on the arms of the chair? These, these exercises all bring your mind back into the here and now.
They ground you and they're not in that what if future thinking. And so for parents in this situation, you might be wanting to have a conversation with your young person, asking them what it is about the situation that feels frightening, that feels daunting and creates anxiety. It might be about helping them to think.
You know, clearly about what environment would be easier for them. How do you give this young person a sense of control? So, for example, does the young person have a person that they would like to choose to do their injections for them? Would they like, say, for example, they choose their mum or their dad or a grandparent or, you know, even a sibling sometimes.
Would they like to choose? where they would like the injection to go? Would they like to place their hand over that other person's hand to feel what it's like to hold the injection? Parents might also want to encourage the young person to think a little bit about the site where they would be getting the injection.
So, for example, for a young person who experiences pain and it's the pain that's putting them off, maybe things like desensitizing the site might help. You can talk with your diabetes team about this and they have lots of little tricks and ideas that can, that they can be advising on or, you know, you can think about which site feels more comfortable just to build up confidence.
Think about maybe the time of day. Think about who's around when they're doing it. Think about do they want to be on their Xbox when they're having an injection in the first place. You know, all of these things are really important and I guess at this point as well, it's important to say, you know, it is okay to set incentives.
Parents often come along and talk about that idea of, I don't want to feel like we have to bribe our child. I suppose bribery is one way to think about it. Another way to think about it is as a reinforcer, or an incentive, or a recognition that a young person is managing something that's really quite scary.
So, have a think about... You know, what goals would work for your child? Are they achievable? Make sure they're achievable. We would never want to be expecting a one year old, for example, to be able to tie their laces. So why would we set goals that are above and beyond what any young person can do? That's only going to discourage them.
So for parents to have those types of conversations with their young person and to think about goals, to make them clear, to make them visual and to provide a concrete agreed upon reward for whenever they're achieved. Again, there's information on procedural distress, and this will be on our website, and it should have a lot of information in there, and if you are unsure about any of it, just ask a team member.
It's, I guess, getting a sense of control where possible, like pausing or reversing the cycle. But I guess then this leads to, I guess, what we were talking about earlier on, maybe there's that sense of, maybe, maintaining the cycle in terms of those behaviours. And one of our role in psychology is maybe thinking about, you know, as the young person gets older, whilst these are really important for them in terms of their risk management, you know, if you're maybe a teenager or getting older, we start to consider the young person's sense of independence and their choice, because sometimes this can be deemed as quite invasive.
And it's supposed to think then again about a young person maybe experiencing procedural distress. So how do we create a sense of control and safety around this? As we mentioned before, this is one of the reasons, you know, that we, we have a lot of frequent referrals for a lot of young people struggling with this aspect.
So if we take, for example, maybe a blood test, let's think about that feeling of being out of control, feeling that things are unpredictable, feeling that you don't have any sort of way of, of communicating your feelings. And so we want to be thinking about this maybe in the lead up. Small things can make a difference, like for example, knowing when a blood test might be requested.
It's not uncommon for a young person to go to a clinic, whether that's for the diabetes or for the epilepsy, and maybe, you know, a blood test might be needed on that day or requested on that day. And for a lot of young people, this will not be a problem, but for anyone who struggles with procedural distress, this could be incredibly difficult that this has landed on the last minute.
So, we want to think about the communication from the team to the family, and from the family to the team. So from the team to the family, they can let them know when a blood test might be, you know, required, how that might be organized, and who might be doing it. We want to be thinking then about how do we communicate the young person's needs to the team, and that's where psychology steps in.
So often we will speak with a young person about creating an individual plan, like a blood test plan. So what would help them feel a little bit in control? For example, what about their environment? Where would they be getting the blood test taken? Where would they be at? What size of a room? Where would they be in the waiting time up until they go in to get their blood test?
Do they want to wait in the waiting area? Do they want to go outside and have a walk and just be called in whenever they're ready? Do they want to have a seat? Do they want to be lying down on one of the couches? Who do they want to have there? Do they want just the doctor or nurse or whoever's taking the blood?
Or do they want a parent? Do they want a best friend? You know, do they want us as psychology to be there? Or do they just want, you know, does it not matter to them? Are they okay with that? The other thing they can think about is what would they like to be doing whenever the procedure is being completed.
So, for some young people, they will want to know every detail. And they'll want to see everything, and they'll want to watch, and they'll have lots of questions. You know, it's important for the team to know that this young person thinks that way. For another, they don't want to even think about it. They want to go in and have their earphones on from the moment they go into the room.
Or they want to have a book with them. Or they want to have music playing. Or maybe they want to be on the phone, chatting to their friends as a distraction. Whatever works, works. And this is all a young person's input. It really creates a sense of control for them, the team feel more confident because they know how to approach it with a young person and the young person themselves can feel that they have a bit of control in a situation that was previously probably very frightening.
You know, we need to remember that they may never like the procedure, but this is about feeling more able to tolerate it. So communication and control are the priority. And it's wider than the child or young person. It's very important that we consider the wider system and how to help reduce anxious feelings all around.
Anxiety, as we mentioned before, is very contagious. We often hear families talking about no longer having the same childcare options. You know, maybe extended family no longer feel confident in caring for a child when they have had a health diagnosis. It must be very frightening for them to feel that they're in a position of responsibility for a child if they don't feel that they know enough.
This is understandable. But it can leave families feeling very isolated and alone and it can leave a child with the feeling that their health condition must be very unsafe if the adults around them don't feel able to manage it. So education and support for relevant others in the system around the family is incredibly important.
Maybe relatives or school staff or sometimes friends. And I know that that our colleagues within the epilepsy and diabetes teams work really, really hard to do this training and to have this communication. It's also so lovely to hear young people talk of their friends that's interested and know how to support them.
So, you know, So the more the merrier, if a young person wants to bring a friend to their clinic appointment or to their psychology appointment, they're always very, very welcome. I think, you know, as we come towards the podcast, I guess it's so important for us to highlight, myself and Maeve, that when it comes to anxiety, it really is such an individual experience, a very natural and understandable one too.
And as we've talked about, it's normal for our bodies to react like this. But it's something that can be really helpful to talk about. We have some resources on the Northern Trust website for some support. As well, you can link in with the paediatrician or your nursing or any of the team if you want more support or information from them.
It's also important to say, if you would rather, you can contact us directly if you see us at your clinic. And even if you just wanted to ask us what support may look like, or if you have any other questions that might follow up from this podcast, we're happy to have a talk with you. Saskia, thank you very much for that.
So, in this episode, we have discussed how anxiety may show up for families when a child or a young person is living with a health condition, such as epilepsy or diabetes. We hope that this is helpful. If you're wondering about whether psychology would be something that might benefit you or your family, and thank you for listening.
In the next episode, we will hand over to Aiveen, who is the consultant clinical psychologist working in the neonatal unit, in Antrim Hospital. Aiveen will introduce you to psychology and her role on the neonatal unit. In the podcast summary, you'll find a short survey link, which we would really appreciate you Take a few minutes to complete and help us to receive feedback on the podcast you've been listening to today.
There will also be a link to the Northern Trust website about our service, what we offer, and information about other podcasts in the series. Thank you.