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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 (and adults) 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!

  • I have a child with a food anxiety who will not try new things without a LOT of praise and coaching.

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  • I do think quite often that parents place fear in their children.
    A friend of mine is scared of heights and scared of all amusement rides. Her daughter was the same but when we took her to Dreamworld to start with she was scared crazy. I told her that she didnt have to go if she didnt want to so she decided not to go on the ride. As she and I sat and waited I asked her what she was scared of and she said that she was scared of dying. I said that sounded reasonable but told her to watch the people as they got of the ride and see how they were reacting. She was quite surprised to see that they were all smiling and laughing and some ran straight around to go on it again. She then decided that when my girls got off the ride that she would go on it with them. She loved it. She wanted a photo to prove she went on the ride and she was so very proud of herself. Her mum couldnt believe it.

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  • Good advice for children with identifiable fears, eg. afraid of the dark, sleep overs or leaving mum etc. However, for those with less ‘rational’ (for want of a better word) anxiety or where no trauma has brought it on….in other words, it’s part of there psyce and God forbid, genes, well for that, there is no quick fix and whilst the ideas here work in theory, it’s a much longer, drawn out process. It takes a LOT of patience and those times where you ask your child to ‘sit’ with the fear for while, might be school days or for mum/dad a work day…it’s hard to be patient then! To those parents, i say, stick with it….and persist. Kids with anxiety need to learn that pushing past the fear teaches them to be strong, and they realise that their fear is usually unfounded. The best piece of advice I ever received-it was only recently, was from my daughter’s psychologist. I felt at at witts end (again, lol), and she told me I neeed to stop worrying so much about what other people thought, I’m not dealing with a normal situation, so the normal rules don’t apply. She assured me I was doing a good job and in the moment’s of my child’s meltdowns, all i needed to think about was her-nobody else, because others don’t understand and nor do they need to! It helped me put things in perspective – for example, if she’s having a bad day and I can’t get her to school till 10am, then that’s actually a good day, because I persisted and she got to school – as opposed to many who would give up and just let their child stay home….so we both moved forward that day, instead of stagnating or worse, going backwards….so that’s a win for a kid with anxiety. And persistence pays off too when maturity and hormones start kicking in, because that can be a time of heightened anxiety and if they haven’t learned that they can survive their fears, then things can escalalate.

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  • Thank you. we are going to be working on fear of the dark. this will help greatly.

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  • Some great advice thanks 🙂

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  • An interesting approach to anxiety. Makes sense too!

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  • Excellent and timely info. thank you so much

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  • thank you, I suffer from anxiety, and will be trying these steps on myself, to try and ease it

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  • so hard when your child suffers from anxiety

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  • This will give my DIL some help with handling her little ones anxiety going to school. Thankyou.

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  • thank you sharing this article good read

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  • Very useful information to reac

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  • thanks for sharing was a great read

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  • maybe this technique could also be used on adults


    • I would say yes great tips and advice for adults also.

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  • so useful and informative !

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  • Thanks a lot for sharing. I enjoyed reading it. Great ideas

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  • This was very helpful cheers

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  • Enjoyed reading – thanks for sharing.

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  • Great article. Some really good practical tips

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  • I am always trying to be a better role model – sometimes it seems so hard though!

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