Treatment for Separation Anxiety Disorder
Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.The Treatment of Anxiety Disorders
In the previous section, we reviewed the various theories and associated therapies that are used to treat anxiety disorders. We will now turn our attention to specific anxiety disorders to describe the usual treatment approach for each disorder. However, it is important to bear in mind, that therapists tailor their treatment approach for each person.
Treatment for Separation Anxiety Disorder
We previously described this disorder and reviewed its diagnostic criteria.
Behavioral and Cognitive-Behavioral therapies tend to be the most effective methods for treating separation anxiety.
Systematic Desensitization and Flooding are two behavioral techniques that are useful for Separation Anxiety Disorder. Both techniques are variant forms of exposure therapy. All exposure therapies work on the same principle, derived from learning theory, known as habituation. The basic premise of this approach is that anxiety disorders do not go away when people merely avoid the things they fear. Avoidance merely keeps the unpleasant anxiety feelings at bay. In contrast, recovery is possible when people do not avoid or escape from the things they fear. In this way, they learn through new experiences that the object of their fears is not actually harmful.
When people intentionally remain in the presence of fearful situations, it is called exposure therapy. Exposure therapy is a highly effective and efficient way to treat anxiety. However, as you might imagine, it is difficult to get people to agree to this method. A variant form of exposure therapy is called systematic desensitization. This technique avoids overwhelming anxious people. First, the therapist teaches participants age-appropriate relaxation methods. This helps them learn to relax in the presence of fearful situations. After participants have mastered relaxation they are systematically exposed to situations they fear, gradually increasing the intensity. This may include both imaginal and actual exposure. For instance, suppose someone is afraid of elevators. First, the therapist might guide them to practice their relaxation techniques while looking a picture of elevator. Next, they might consciously relax themselves while imagining getting on an elevator. Next, they might step on and off a real elevator. Next, they might step on, allow the door to close and reopen, and then get off. Finally, they might ride one up one story, etc. This gradual, systematic approach enables them to become desensitized to the fearful situation. This occurs because of habituation.
The therapist and the anxious child jointly produce a list of progressively more intense situations. For example, children with Separation Anxiety Disorder might first practice separation from their parent for 10 minutes, while still in their familiar home. As mastery is achieved, the intensity increases. Over time, they may practice longer periods of separation from home. Then they might practice separation in an unfamiliar environment (such as a shopping center).
Another technique is full exposure (also called flooding). This technique is not nearly as gentle as systematic desensitization. Its benefit is it produces more immediate results. In this procedure, the child experiences a sudden, intense exposure to a feared situation. No hierarchy or buildup occurs. Children are initially very anxious, but eventually habituate and calm down. Once calm, children see that nothing terrible has happened to them despite their fears. They also learn they can be calm even when faced with frightening circumstances. Although this method sounds cruel, it's similar to taking off a bandage. You can either pull it off slowly and gradually, with less discomfort, over a longer period of time. Alternatively, you can rip it off and get rid of it once and for all.
Importantly, flooding is not forced upon children. Therapists only use this method with children who are old enough to give meaningful consent. Children are strongly encouraged to stay and tolerate their feared situation. However, children who attempt to flee are not prevented from doing so. Should a child flee, the therapist would discuss the escape attempt with the child and encourage the child to try it again a second time.
Another type of therapy for Separation Anxiety Disorder is cognitive behavioral therapy (CBT). This method is reserved for older children and adolescents who are able to articulate their thoughts and feelings. CBT focuses on children's anxious thought habits that lead them to become anxious in the first place. Children may have unrealistic and exaggerated ideas about how dangerous it is to be alone. Likewise, they may fail to differentiate between past losses and present circumstances. For example, an anxious child may think that because she lost her mother to cancer several years ago, that her father will also die. A CBT therapist helps children to become aware their thoughts. Together, the therapist and child examine the child's thoughts and beliefs to see if they make logical sense. A child who is worried that her father might also die because her mother died might be encouraged to make logical connections between death caused by illness such as cancer, and her father's lack of any similar illness. To make this point, the therapist might ask the child questions, like, "Is your father sick? Will he be participating in a particularly dangerous activity like sky-diving while he goes out to dinner tonight?" This line of questioning helps the anxious child to realize that the actual risk of her father dying is lower than she previously thought.
Medications are also used to treat Separation Anxiety Disorder. Both antidepressants (e.g., Clomipramine or Imipramine) and anxiolytic medications (anxiety reducing medications such as Buspar®) have been used with success. Various side effects can occur with the use of medications. This may include dry mouth, dizziness, seizures, aggressive behaviors, drowsiness, etc. Many antidepressants have a "black box" warning for use with children. Studies have shown that in a small number of children, these medications can increase suicidal thoughts and behaviors. A mental health professional should closely monitor children taking these drugs. This professional should closely monitor possible suicidal thoughts and behaviors.
Resources
-
Articles
- What is Anxiety?
-
The Biopsychosocial Model of Anxiety
- The Biopsychosocial Model: Causes of Pathological Anxiety
- Biological Explanations of Anxiety Disorders
- Biological Explanations of Anxiety: Part II
- Biological Explanations of Anxiety: Part III
- Biological Explanations of Anxiety: Part IV
- Psychological Explanations of Anxiety Disorders
- Psychological Explanations: Part II
- Social Explanations of Anxiety Disorders
- Development & Maintenance of Anxiety Disorders
-
Classification & Diagnosis of Anxiety Disorders
- The Classification and Diagnosis of Anxiety Disorders
- Panic Attacks: A Classic Symptom of Several Anxiety Disorders
- Panic Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Agoraphobia
- Specific Phobias and Social Anxiety Disorder (Social Phobia)
- Generalized Anxiety Disorder (GAD)
- Other Anxiety-Related Disorders
- Anxiety and Other Psychiatric Disorders
-
Anxiety Disorder Theories and Therapies
- Anxiety Disorders: Theories and Therapies
- Behavioral Learning Theory and Associated Therapies
- Operant Conditioning
- Operant Conditioning and Avoidance Learning
- Contemporary Views of Behavioral Learning Theory
- Behavioral Therapies for Anxiety Disorders
- Cognitive Theory and Associated Therapies
- Cognitive Therapy
- Cognitive-Behavioral Therapy
- Adjunct Therapies
- Pharmacologic Treatments (Medication)
-
Treatment of Anxiety Disorders
- Treatment for Separation Anxiety Disorder
- Treatment for Selective Mutism
- Treatment for Panic Disorder
- Treatment for Specific Phobias and Treatment for Social Anxiety Disorder (Social Phobia)
- Treatment for Generalized Anxiety Disorder (GAD)
- Treatment for Obsessive-Compulsive Spectrum Disorders (OCSDs)
- Conclusion
- Anxiety Disorder References & Additonal Resources
-
News
-
Questions and Answers
- Anxious About Opinions
- Possible OCD and Anxiety issues
- Fear
- Stay in Therapy Because I Like it?
- Is My Anxiety a Normal Reaction?
- What am I Supposed to do With a Hypochondriac Step Daughter?
- Need Help
- Husband Continually Annoyed/Angry With Me
- How Can I Overcome my Debilitating Shyness and Fear of Life?
- Really Desperate..Please Help
-
111 more
- OCD and Trauma?
- Depression
- I Don't Care For Anything, I Feel as Though I'm Wasting my Life.
- Unwanted Thoughts
- Anxiety Has Taken Over My Life...
- CBT Therapy and Transference
- Transference II
- OCD
- 19 Yr Old Naive Daughter
- Fear of Choking
- Help
- Should I be Worried?
- Too Much Time doing Homework
- Falling Apart
- Can't Stand Noise
- What Is Intimacy, Exactly?
- Is She Ill?
- Social Anxiety, Depression and More...
- Do I Have Just Social Anxiety or Other Diagnoses Combined with SA?
- Need To Ask Someone
- False Memories
- Help! Please!
- Two Year Old Son Wandered
- Infections and The Brain
- Are Personality Disorders For Life?
- I am Terrified of Death.
- Anhedonia
- Our 23 Year Old Son Refuses to Get Help for His Anxiety Attacks and Depression.
- Anxiety
- Anxiety Disorder vs. Personality Disorder: Differences?
- Restroom Phobia
- I'm Afraid I'm Going Crazy
- Post Brain Surgery Mental Problems
- Would Medication Help?
- obsessive strange thoughts about life and existentialism
- Am I Crazy?
- Is it Anxiety? Is it Normal to Be Like That?
- Depressed 19 year old college student
- Depression helps to contribute to my unemployment! - Paula
- Relationship Anxiety
- Disconnected
- I'm Scared
- Please help fix my mom. - Kenny
- OCD?
- Saving my Son
- Scary thoughts, dark feelings, help?
- Swallowing fear
- Is there something wrong with me?
- I have PTSD and I feel nothing
- OCD Cure
- Repressed Memory
- I have OCD. Will this increase my child's chance of developing Autism?
- Crazy Thoughts
- 20 Year Old Female: no friends, depressed, what should I do?
- unwanted thoughts!
- crazy thoughts... all the time
- A very low threshold for stress tolerance
- Why can't I get gross images out of my head?
- fear of expiration
- SPECIFIC PHOBIA
- anxiety or going crazy?
- OCB
- visions of what could have been
- about depersonalization
- obsessive compulsive disorder
- OCD/ANXIETY while pregnant
- Amnesia
- Social Phobia
- Constant Counting Disorder
- Anxiety
- Is this OCD?
- Worried about my therapist
- No Friends
- Teenager...angst vs. mental health issue
- phobia regarding uncertainty
- Obsessed with running out of things
- Do I Have OCD?
- Do environmental factors hold a person back?
- Never Had a Relationship
- Shy Rural Student
- Nursing Student's Anxiety
- I'm Afraid They Are Judging Me
- Part Time Work and Stress
- Anxiety
- Panic
- Bathroom Phobia
- Anxiety?
- Mastery Of Anxiety And Panic
- Very Determined Panicker In The South
- Panicking Boyfriend
- Alternatives For Anxiety Treatment
- Is Anxiety A Hereditary Factor?
- Unable To Keep Eye Contact
- Is It Really Panic? And How Do We Get Help
- A Cure For Claustrophobia?
- Panic Attacks
- Shyness And The Post Partum Blues
- Klonopin
- Alternative Treatment
- Can't Afford Therapy
- Driving Phobia
- Indecisive
- Agoraphobia?
- Social Fear
- A Cure For Anxiety?
- Panic Attacks
- Fear of Driving
- Shy Guy
- Anxiety?
- Social Anxiety
- Linda writes:
-
Book & Media Reviews
- 8 Keys to Stress Management
- A Brief History of Anxiety
- Anxiety
- Anxiety
- Anxiety Disorders
- Anxiety, Phobias, and Panic
- Been There, Done That? DO THIS!
- Calm Beneath the Waves
- Elsewhere
- Exercise for Mood and Anxiety
-
31 more
- Getting Control
- Helping Students Overcome Depression and Anxiety
- Just Checking
- Mind-Body Workbook for Anxiety
- Monkey Mind
- My Age of Anxiety
- Overcoming School Anxiety
- Panic Disorder
- Passing for Normal
- Phobic and Anxiety Disorders in Children and Adolescents
- Repressed Spaces
- Self-Coaching
- Stress
- Stress Survival Guide
- Textbook of Anxiety Disorders
- The 10 Best Anxiety Busters
- The Age of Anxiety
- The Anxieties of Affluence
- The Dutiful Worrier
- The Emotional Eater's Repair Manual
- The Male Stress Survival Guide
- The Places That Scare You
- The Stress Cure
- The SuperStress Solution
- Treating Affect Phobia
- Under Pressure and Overwhelmed
- Viniyoga Therapy for Anxiety
- When Words Are Not Enough
- Wish I Could Be There
- Yoga for Anxiety
- Yoga Journal's Yoga for Stress
-
Self-Help Groups
-
Links
-
Videos
- How to Manage ADHD and Anxiety
- What You Need to Know about Students with ADHD and Anxiety
- How To Make Room For Gratitude In An Anxious Brain
- How to Stay Calm When You Know You'll Be Stressed
- Anxiety and Teen Girls with Lisa Damour, PhD
- Is it Anxiety or a Heart Condition?
- Identifying and Treating Anxiety in Kids and Teens
- Child Anxiety, It’s Real
- Helping Children Cope with Anxiety
- Anxiety, Trauma and How Prolonged Exposure Therapy Works For PTSD
-
26 more
- OCD, Phobias and Anxiety
- How Weighted Blankets May Lift Anxiety
- Controlling Anxiety
- Too Scared: Social Anxiety Disorder
- Panic Disorders Video
- Phobias Video
- Treating Anxiety Disorders: A Unified Protocol
- Treating Youth Anxiety and Social Phobia
- Overcoming Anxiety in Children and Teens
- Treating Anxiety in Children and Teens with ASD
- Back-to-School Anxiety
- No More Shame: My life with Anxiety and Depression
- Adolescent Depression and Anxiety
- What is Social Anxiety Disorder?
- Living Without Fear
- What is Generalized Anxiety Disorder?
- What is Generalized Anxiety Disorder?
- School Anxiety! Activities To Help Kids and Teens Manage It
- Recognizing and Treating Problematic Fear and Anxiety in Children
- How To Stop Overthinking When You Have Anxiety
- My Anxiety Is Making Me Anxious!
- Evidence-Based Treatment Planning for Generalized Anxiety Disorder Video
- Managing Anxiety in Youth: More Action Than Talk
- Treatment of Social Anxiety Disorder
- Cognitive Behavioral Therapy for Anxiety
- Recent Advances in Anxiety - Children/Adolescents
-
More Information
- Wise Counsel Interview Transcript: An Interview with David Barlow, Ph.D. on the Nature and Treatment of Anxiety and Panic Disorders
- Wise Counsel Interview Transcript: An Interview with Dr. Michelle Craske on Anxiety Disorders Research and Treatment
- Wise Counsel Interview Transcript: An Interview with Richard Heimberg, Ph.D. on Anxiety Research and Treatment
Topics
-
Related Topic Centers
-
Addictions
-
Aging & Elder Care
-
Assessments & Interventions
-
Career & Workplace
-
Emotional Well-Being
-
Life Issues
-
Parenting & Child Care
-
Abuse
-
ADHD: Attention Deficit Hyperactivity Disorder
-
Adoption
-
Autism
-
Child & Adolescent Development: Overview
-
Child & Adolescent Development: Puberty
-
Child Development & Parenting: Early (3-7)
-
Child Development & Parenting: Infants (0-2)
-
Child Development & Parenting: Middle (8-11)
-
Child Development & Parenting:Adolescence (12-24)
-
Child Development Theory: Adolescence (12-24)
-
Child Development Theory: Middle Childhood (8-11)
-
Childhood Mental Disorders and Illnesses
-
Childhood Special Education
-
Divorce
-
Family & Relationship Issues
-
Intellectual Disabilities
-
Learning Disorders
-
Oppositional Defiant Disorder
-
Parenting
-
Self Esteem
-
-
Psychological Disorders
-
Anxiety Disorders
-
Bipolar Disorder
-
Conversion Disorders
-
Depression: Depression & Related Conditions
-
Dissociative Disorders
-
Domestic Violence and Rape
-
Eating Disorders
-
Impulse Control Disorders
-
Intellectual Disabilities
-
Mental Disorders
-
Obsessive-Compulsive Spectrum Disorders
-
Personality Disorders
-
Post-Traumatic Stress Disorder
-
Schizophrenia
-
Sexual Disorders
-
Somatic Symptom and Related Disorders
-
Suicide
-
Tourettes and other Tic Disorders
-