Imagine if you had a child who cried themselves to sleep at night because they had no friends; who called themselves “horrible” and drew disparaging images of themselves in their journal; who suffered physical pain when they wore clothes or gave you a hug.
This was once the reality for Julie Munko and her daughter Annie, who suffered from an anxiety disorder. But today, their lives are completely different, thanks to skill-based therapy at Seattle Children’s that pushed Annie outside of her comfort zone.
Crawling out of her skin
Munko first noticed Annie’s anxious behavior in fourth grade. Annie desperately avoided the school library and cried at night if she had to go there the following day. She no longer wanted to sleep over with friends or go to parties.
By fifth grade, it began affecting her school life. Annie became distressed if she unexpectedly had a substitute teacher. She ran out of the classroom if her computer was not working properly. Annie was an excellent student but panicked if her teacher’s instructions were unclear or if she was having trouble with an assignment.
“Annie started calling me from the school bathroom saying, ‘I’m not coming out. I can’t do this,’” said Munko. “I would have to go find her and take her home.”
Munko created a plan with Annie’s school to manage her daughter’s anxiety — including having Annie handwrite her schoolwork to avoid computers and carry a notecard she could present to teachers that signaled she was anxious and needed to leave the classroom.
Unfortunately, Annie’s anxiety only worsened. Munko watched her once friendly and outgoing daughter become more fearful and isolated.
“She couldn’t be around people for very long, no matter how well we knew them,” said Munko. “It made her want to crawl out of her skin.”
Annie told her mom she felt “weird” and “different.” She cried many nights, calling herself a “horrible daughter,” “horrible sister, “bad friend” and “bad person.” She wondered out loud, “Why would anyone like me?”
Annie developed a stutter and a nervous laugh when people tried to talk to her.
“I so badly wanted to help her, but she couldn’t get any words out,” said Munko. “It became easier for her to not talk to people. It was like she just decided she was never going to feel comfortable in social situations.”
In sixth grade, Annie developed dermatographia (sometimes referred to as skin writing), a condition in which the body produces too many histamines, causing an extreme skin reaction. Annie broke out in hives all over her body. Lightly rubbing or scratching her skin caused swollen, raised red lines. The feeling of towels, sheets or clothes on her body was nearly unbearable.
“That pushed her over the edge,” said Munko.
When a dermatologist suggested Annie’s dermatographia might be triggered by her anxiety, Munko decided they needed more help.
“Annie knew what was wrong but couldn’t change the way she reacted. It was like she had crawled into a hole and didn’t know how to get out.”
A common childhood mental illness
Anxiety disorders are fairly common, affecting about 6% to 20% of children and teens at any given time. Dr. Kendra Read, attending psychologist and director of anxiety programs with Seattle Children’s Psychiatry and Behavioral Medicine team, says anxiety in children can be a part of normal development, but when it is severe, frequent and lasts for months, anxiety requires professional treatment.
“Research shows once anxiety becomes problematic, most kids do not grow out of it on their own,” said Read. “Left untreated, anxiety can result in problematic long-term consequences that impact academic achievement, employment, substance use, and development of additional psychological disorders, such as depression.”
With effective treatment, Read says kids can learn how to control their anxiety in as little as four months.
Finding a way out
Last year, Annie began Cognitive Behavioral Therapy (CBT) at Seattle Children’s − a short-term, skill-based treatment method that helps patients learn to manage their anxiety through exercises called exposures.
Instead of allowing patients to avoid the sources of their anxiety, exposures challenge patients to face their fears, beginning with easier ones and working toward the hardest.
CBT providers encourage patients to be mindful of their anxiety and how it changes during exposure sessions.
“Many parents are surprised to learn we want to elicit anxiety in youth during exposures so they can learn to ‘ride the wave’ of anxiety rather than avoid it,” said Read. “Our goal is not to eliminate anxiety altogether but to help youth and their families learn to cope with it.”
Some of Annie’s exposure exercises included ordering a beverage by herself at Starbucks, talking to a new person at school each day and raising her hand in class and intentionally giving an incorrect answer.
As Annie participated in exposures, many situations she’d once feared became less overwhelming. When challenges didn’t go smoothly, she worked with her therapist to develop an alternate approach for the next time she faced a similar situation.
“At first, it was really scary,” said Annie. “But when I completed a challenge I was really proud of myself!”
Annie also participated in group CBT at Seattle Children’s, which gave her the opportunity to share her exposure successes and failures with other patients who could relate.
“She discovered there were other kids like her,” said Munko. “She wasn’t weird and she wasn’t alone. It gave her hope.”
Teaching parents, too
Annie’s parents also learned through CBT.
Munko came to recognize she had been enabling Annie’s avoidance by protecting her from uncomfortable situations. Now, she has the skills to encourage Annie to face her fears without pushing her too far.
“When we first came to Seattle Children’s, I felt helpless and broken,” said Munko. “During therapy, I often felt like I was failing Annie, but really, I was learning, too. As our family helped Annie accomplish different exposures, we all began to heal.”
Annie has grown tremendously since completing CBT. She still has dermatographia, but her skin reactions are much less frequent and less severe. She feels more confident talking to people and looks forward to making plans with new friends.
Annie has even begun tutoring another student in social studies.
“Every time I work with him, I feel good about having helped somebody,” she said. “Before, I would have been too scared to try.”
Most importantly, Annie has grown to like herself.
“I feel much happier lately,” she said. “I never used to feel good about myself, but now I’m proud of what I’ve accomplished.”
Munko admits the future is never certain, but she believes her family now has the skills necessary to support Annie through any anxiety she might experience in the future.
“I don’t know where we would be today if we had not gone to Seattle Children’s,” said Munko. “Annie is a completely different, and much happier, person. She’s gotten so much more out of it more than we could have ever imagined.”