Anxiety Management Strategies
When considering strategies to assist a student in reducing anxiety, it is useful to think of proactive strategies and reactive strategies. Proactive strategies are essentially preventative measures which aim to stop the student becoming anxious.
Reactive strategies are implemented when the student has become anxious and aim to calm the student and reduce the anxiety levels. The anxiety management strategies will be individualised to the unique needs of each student and are likely to consist of a combination of proactive and reactive strategies.
A list of anxiety management strategies is provided below. This is not an exhaustive list and not all strategies will be effective with every student. Allow time to observe the triggers for the student’s anxiety and the measures which are effective in reducing anxiety.
1. Remove the source of anxiety
If possible, eliminate the factor which is creating anxiety for the student, for example:
- If a specific activity creates anxiety and it is not mandatory, excuse the student from the activity e.g. it may not be essential for the student to be part of the school play; the student may prefer to stay in school instead of going on the trip. It is worth considering the aims of the activity and if these can be achieved through an alternative activity.
- The student may be able to have a differentiated timetable in which they are excused from subjects which increase anxiety. The student then attends a different class or goes to the library.
- The source causing the anxiety in certain environments could be removed e.g. fluorescent lighting (the hum/flickering is upsetting for some students), the smell of an air freshener in the school toilets, the noise of the school bell.
2. Reduce the source of anxiety
It is not always possible to completely eliminate the source of anxiety but it is usually possible to reduce the anxiety triggers, for example:
- If a specific activity creates anxiety (e.g. Assembly, the playground), limit the amount of time the student is expected to participate in the trigger activity and gradually increase the time over a number of weeks. Provide supports if the trigger is sensory e.g. noise.
- If the student becomes anxious in certain subjects, differentiate the work expected in the trigger subject to reduce the demands placed on the student
- If social interactions are a source of anxiety for the student, limit the amount of paired and group work in which the student is expected to participate. 1-2 paired/group tasks each day may be adequate for this student. Remember that if the student has participated in group work in class, he/she may need quiet alone time at Break or Lunch to calm down.
- If homework is causing anxiety, reduce the expectations and ensure deadlines are spread over a reasonable time.
Desensitisation is a way of very gradually introducing the student to the source of their anxiety and increasing their tolerance of it, for example:
- Gradually increasing the time the student spends in the environment/activity which causes anxiety e.g. playground, dining hall, Assembly, messy play activities. Use a visual timer and very gradually increase the time over several weeks or months.
- Allow the student to wear ear defenders, headphones or ear plugs in noisy environments, but ensure the student removes these for the last minute in the environment, and then the last two minutes, the last three minutes etc, and gradually work backwards until he/she can tolerate the full required time in the noisy environment.
- In Home Economics and Art, if the student does not like the texture of some materials (e.g. paint, clay, wet food items), allow the student to work with alternative materials and then very gradually introduce other textures.
- When using desensitisation methods, always monitor the student’s reaction and stop the activity if he/she is showing signs of distress. Ensure the student has a way of communicating anxiety and then follow with a calming activity.
Further desensitisation reading and strategies are available on the MCA Sensory Resource.
4. Calm breaks
Calm breaks are a way of ensuring the student stays regulated throughout the day.
Introduce calm breaks at regular intervals throughout the student’s day and include on the timetable/visual schedule. This will then assist the student in coping more effectively with challenges as he/she will be in a calmer state when approaching activities. The following tips are useful when establishing calm breaks:
- When used as a proactive strategy, calm breaks should be a consistent part of the student’s daily routine and should be given even when the student is having a ‘good’ day.
- Identify the potential trigger points for the student’s anxiety and schedule calm breaks before these trigger points. Do not wait until the student is in a heightened state of anxiety.
- Calm breaks can also be scheduled for times after an activity which you know will be challenging for the student to allow them time to calm down and regulate.
- Calm breaks are not a ‘reward’ and therefore should not be used as a contingent which can be removed the student. The student will need calm breaks even more on a challenging day.
- Students with adequate self-awareness who can self-regulate, can request calm breaks when they require them, rather than being scheduled for them. These students will need to have insight into what anxiety feels like and relate this to a need for a break. See section on ‘Teach emotional self-regulation’. Link to section on ‘teach emotional self-regulation’.
- The frequency and duration of calm breaks will be dependent upon the individual needs of the student. The key factor is to be flexible as some days the student will require more breaks and longer breaks than on other days.
- The decision about where to have the calm break will depend on a variety of factors, including the individual student’s needs, school policies and space available. Some students need a space containing calming resources (e.g. weighted items, relaxing music, special lighting) while other students simply need a quiet space with minimal stimulation. Some ideas for calm areas include:
- A room specifically allocated as a calm room
- A screened off corner of a classroom
- A quiet office in school
- A quiet classroom e.g. while the student’s class is participating in music, he/she may be able to go to another class which is participating in a quieter activity
- Resource classroom
- Sitting outside classroom in a quiet corridor
- Standing in toilet cubicle for a few minutes when toilets are not being used by others
- For more information on calming resources and activities which can be used during calm breaks, go to the relevant sections.
5. Calming resources
Resources used to help a student to calm down will be dependent on the unique needs and preferences of the individual student. Items which reduce one student’s anxiety will not necessarily be effective with another student. A discussion on what helps me feel calm is helpful with students who can verbalise and understand their feelings. For those students who have difficulty with understanding or talking about their feelings, give the student a choice of resources to try and allow the student to tell you what works. If the student is unable to communicate this, observe reactions to different items and select those which seem to calm the student. Below is a list of ideas for calming resources but it is not an exhaustive list, and sometimes the most effective item is simply the student’s favourite object e.g. a favourite toy or something related to the student’s special interest.
- Photograph album containing photos of the student’s favourite places/people/pets/cartoon characters etc.
- Calming music
- Fidget objects e.g. blu tac, pencil top, textured ball, paperclip, coins
- Resistance items e.g. theraband, stress ball
- Weighted items e.g. weighted lap cushion, weighted belt, weighted blanket
- Fibreoptic lights
- Bubble tube
- Visual items e.g. spinning top, light-up toy
- Favourite book
- Puzzles (jigsaws, Sudoku, word searches)
6. Calming activities
Activities used to reduce anxiety will vary from student to student and it may take time to work out which activities are effective for different students. Initially, allow the student to try a range of activities tell you what works. If the student is unable to communicate this, observe reactions to different activities and select those which seem to calm the student. Some examples include:
- Sitting on an exercise ball to bounce or rock: this provides deep pressure input and rhythmical movement which can be calming.
- Space hopper
- Jumping on a trampoline
- Lifting weights e.g. a set of small dumbells
- Engagement in ‘heavy work’ activities (the input to the muscles can be calming) e.g. wiping benches, carrying books, stacking chairs, setting out P.E. mats
- Reading a favourite book or comic
- Listening to music
- Going for a short walk e.g. taking a message to the school office
- Drinking water through a bottle with a sports cap
- Chewing e.g. a chewy tube/pendant, dried fruit
7. Visual communication supports
When students with autism experience anxiety, it is often difficult for them to communicate how they are feeling. Visual communication supports not only assist the pre-verbal/non-verbal student, but also assist the very articulate students who cannot communicate easily when stressed. The supports remove the need to communicate verbally and ensure that the student has a way of conveying anxiety.
- It is critical to teach the use of these visual supports when the student is calm rather than waiting until he/she is in an anxious state.
- The use of the supports will have to be first taught in a one-to-one setting before generalised to the real setting of the classroom.
- Emotion thermometers: these can come in a number of formats; some use numbers to rate emotions while others use colours, words or symbols. It is important to choose the format which the student can best relate to. The thermometer is usually printed and laminated and kept on the student’s desk or in pocket/schoolbag. The student then uses this to indicate if he/she is becoming anxious. Depending on the level of anxiety indicated, the assistant or teacher gives the student access to an appropriate calming strategy. See the video and downloadable resource.
- Calm tokens: the student can use a calm token to request a calm break. The number of tokens available to the student each day can be limited but ensure an adequate number is provided to meet his/her needs and increase the number of tokens available on more challenging days. See Sensory Resource video and downloadable resource.
- Self-regulation prompt cards: The student can be given a card with options for calming activities to remind him/her what to do when feeling anxious. Link to video and downloadable resource.
8. Stress kits
Stress kits are individualised kits containing resources which are calming for the student. The contents of the kit will depend on the specific needs and preferences of the student. Some examples include:
- Photograph of a favourite pet
- Plastic figure of a favourite cartoon character
- Fidget object
- Pen and paper for drawing/doodling
The student access the kit when feeling anxious.
9. Progressive muscle relaxation
This is a relaxation strategy which involves tensing muscles, holding for several seconds and then releasing. The student works through different muscle groups e.g. clenching fists, tensing arm muscles, tensing leg muscles, curling toes. It can be carried out in a calm area or while the student is seated in the classroom. It will need to be taught in a one-to-one setting at a time when the student is calm before being transferred to a more stressful scenario. The student is likely to benefit from a visual prompt to guide him/her through this process. Link to video clip.
10. Breathing exercises
The student can be taught how to control breathing when feeling anxious as this can significantly reduce stress. The student is taught this skill in a one-to-one setting and when calm before generalising to a stressful scenario. Visual supports can be used to remind the student how to breathe when anxious, for example:
- ‘Take Ten’ computer programme http://www.taketenteam.co.uk/
- Visual prompt cards of ‘smelling a flower’ (breathing in) and ‘blowing out a candle’ (breathing out).
- Play Therapy NI resource: https://s-media-cache-ak0.pinimg.com/originals/bf/c8/49/bfc8493f8e85093f09acd84cacbc58e0.gif
For more examples of breathing exercises please see this video.
11. How to teach Emotional Regulation
Adults can do a significant amount to monitor when a student is feeling anxious and how to support the student in calming down. An important life-long skill, however, is to teach the student to independently recognise the signs that he/she is becoming anxious and what strategies to access in order to return to a calm state. This is called self-regulation. There are 3 stages when teaching self-regulation:
Self-regulation can be taught in a number of different ways, using a variety of different supports. It is important to teach these skills when the student is in a calm state and in a quiet one-to-one setting. The student is taught 3 skills:
- How do I know I am becoming anxious?
Teach the student to recognise the signs of anxiety relevant to him/her (e.g. breathing more quickly, feeling flushed or warm, sweating, loss of concentration, irritability, desire to escape the situation, nausea). This is often best taught using a diagram of the body and labelling the physiological signs of stress in different parts of the body. It is likely to be easier for a student with autism to recognise these concrete signs of anxiety than to understand the emotions.
- What triggers my anxiety?
Facilitate the student to identify the triggers for his/her anxiety (e.g. a certain activity, specific sensory input, crowded environments). The student then knows to be alert for signs of anxiety in these environments/activities and to be prepared to use calming strategies.
- What reduces my anxiety
Allow the student to try different strategies and then select what makes him/her feel calm.
Give the student time to practise anxiety management strategies in a safe environment and when he/she is calm. Rehearse several times before expecting generalisation to real scenarios.
When the student is transferring skills to real scenarios, he/she is likely to initially require prompting from an adult to access the anxiety management strategies. Adult support can then be gradually phased out over time. Visual prompt cards as described in previous sections can act as long-term supports which the student can always access as reminder of what to do when feeling anxious.
Programmes to teach self-regulation
There are a number of published programmes and books which can be used to facilitate the teaching of emotional self-regulation. These include:
- ‘How does your engine run?’: The Alert Programme for Self-Regulation http://www.alertprogram.com/
- Take Ten http://www.taketenteam.co.uk/
12. The Incredible 5-Point Scale
The Incredible 5-point Scale (Burin & Curtis, 2013) http://www.5pointscale.com/ click here for link to Best Practice Video on 5-point scale
13. Emotional Toolkit
CAT Kit- developed by Tony Attwood http://www.cat-kit.com/
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