Planning a small-steps return
Last updated:Uncovering situations that lead to avoidance
A good small-steps plan should work systematically. It should go from situations or contexts that are lower intensity to higher intensity. This maximises the likelihood that negative responses diminish. An avoidance hierarchy is an emotion-based ranking of situations, contexts or places that a child or young person finds challenging. It should be the basis for any plan.
It may be possible to build a hierarchy through simple discussion and mind-mapping with the child or young person. For example, by asking them about the things that they find hard in school. Some children and young people may not be able to articulate and identify their feelings. The toolkit details activities to do with the child/young person and their family to explore the situations, places and contexts that cause them anxiety.
Please refer to the Exploring Individual EBSNA section of the toolkit if you haven't already.
Choosing your steps
Once you have a list of situations or places, you can begin to work with the child or young person to rank them. You may find it helpful to use visual tools to do this such as a ladder, thermometer or pyramid.
Encourage the child or young person to give a fear or anxiety rating to each level. Keep adjusting the hierarchy until they feel it reflects what they experience.
Remember you may need several hierarchies to capture the situations that the child or young person avoids. For example, the simple act of putting on a uniform in the morning. If this is very anxiety-provoking, there may be many steps from there to being in a classroom.
It is also possible that some steps within the hierarchy will need sub-hierarchies. For example, ‘going into my Drama class’. This could be one step on the ladder, so you may need another ladder that breaks down that situation further. This could include:
- being in the empty drama studio
- walking into the room when the class are already there
- finding a place to sit
- the time before the teacher starts when my classmates are chatting
- warm-up exercises and games
- writing down ideas
- working in pairs
- working in small groups
- acting in front of the whole class
- answering the teacher’s questions
Understanding their experience
It is important to help children and young people understand:
- the functions of anxiety,
- how it is maintained,
- and how to manage it.
By doing so it can help reduce the feeling of hopelessness so many young people experience. The following resources can be useful to show them. It may help them to understand their EBSNA and how you will address it.
- Video: School is not my enemy
- Video: The Happiness Trap - Evolution of the Human Mind
- CAMHS: Resources to understand anxiety and anxiety management
Using anxiety management tools to facilitate regulation
In some situations, the response to a situation may be too large for a diminished response to occur quickly. Teaching techniques that can help to dissipate the thoughts and feelings linked with anxiety is helpful. Such techniques can increase the likelihood that habituation occurs. It can also help the child or young person feel that they have some control over their responses. In your small-steps planning you should allocate time to teaching anxiety management techniques. Once the child or young person is ready to engage with more challenging situations, they will have strategies to use. It is important to consider developmental levels as well as the capacity to put such strategies in place. As part of the small-steps plan the child or young person may be joined by an adult who can co-regulate. This adult should be able to step them through the strategies to increase the likelihood of habituation.
Information about potential strategies for anxiety management is available on the websites below. You may also find other suggested activities online.