Dr Sophie Nesbitt, Consultant Clinical Psychologist and Child and Adolescent Specialist, shares her thoughts.

The experience of the young person in the example above is not uncommon at all. In the first instance there has been an exposure to an allergen and whilst the physical consequence of this was managed in the moment, it represents to the young person that something in the risk management did not go quite to plan. This serves as evidence to the young person that at times, regardless of trying to manage the risk, it can go wrong and creates a fear that it can happen again.

The second issue to consider is the allergic response that if managed effectively can be treated quickly reducing any risk to health. However, this can be a distressing and unpleasant experience for the young person and there will have been an association between certain physical symptoms and behavioural responses. In this example the tickle in the throat has been closely associated with the allergic reaction and, as a result, every tickle creates a physiological response that is experienced as anxiety. This response triggers a thought process suggesting that the young person has ingested an allergen.

At times of fear the experience of anxiety can be intense and this can create a memory that is difficult to erase. In many ways this memory can create a distortion that the event can happen again and sometimes we believe we are identifying the first signs of that as we remember the first signs of it on that day. The young person has made a strong association between the tickle in the throat and the first signs of the allergic reaction and so now whenever the tickle in the throat occurs her brain jumps to the conclusion that it is an allergic reaction. This is the association that needs to be challenged.

In terms of how to explore this with the young person, it may be helpful to:

• Revisit the incident and acknowledge the fear that it may have created. Talking openly about the allergic response and also the fear created by the fact that for some reason on this occasion the risk was not appropriately managed.
• Highlight all the positive steps that were taken to help. At the same time, it feels important to acknowledge that something frightening has happened and when this happens it is very normal to be fearful that this can happen again.
• Do some basic reframing of the event that can help weaken the association. Involve the young person in some simple behavioural experiments to “test out” the association and whether everyone has it. A simple task could be to ask family members when they get a tickly throat what do they think it is and also what they might do to manage it. There will be many answers. This approach challenges the young person’s belief that the tickle in the throat is going to lead to an allergic reaction. As a parent share your own experience of throat tickles and what they represent to you. Talk about this openly and together. This can help normalise the experience.
• Educate them to understand the body’s reaction to worry and allergies. Being able to talk openly about the feelings we have in our body when we feel worried and how this can feel similar to an allergic reaction. The example given is a tickly throat, and it is really important that the young person is able to stay calm as there is more chance the feelings will go away if they know it is not an allergic reaction.

1. Deep Breathing – place a hand on your tummy so you can really feel it moving up and down as you inhale or exhale.
2. Square/Triangle Breathing - imagine a square or a triangle and breath(e) slowly through each point.
3. Grounding Techniques – try to ground yourself in the physical environment – so try to focus on what you can see, hear, how many red things can you see, how many different noises can you hear?
4. Mental Distraction – try to say the alphabet backwards, or work backwards through a times table.

All of these techniques can be helpful but they do need practise. As we know, anxiety can impact thinking, so practising beforehand helps young people to draw on these strategies in the moment. Rather like learning your lines in the school play so that when the curtain goes up you don’t get stage fright. Practising before bed, or in the car on the way to school, are good ways to try and fit this into the daily routine.

Final thoughts

If you feel after working through some of the strategies that this isn’t helping it might be worth discussing further with a child psychologist. Sometimes a young person hears support and advice given from a person they don’t know in a different way. Perhaps there are other things that are on the young person’s mind but they don’t want to cause any problems. A therapeutic space might be helpful for them to explore any further or deeper issues.