The 3 Rs of Anxiety Management for Children

A skill set for families that have a solid understanding of what anxiety is and isn't

Steve P. O'Brien, PsyD

As the child anxiety epidemic continues, so does the need for evidence-based interventions that can be readily applied in a variety of settings… even beyond the therapy office. In my new book, The Essential Guide to Treating Child and Adolescent Anxiety, I offer more than 75 tips, scripts, and strategies that are evidence-based and developmentally modified. Many of these techniques are whole-family, meaning they consider the parent-child relationship as well as household dynamics. I believe this systemic aspect is vital to managing children’s anxiety, as their environments play a significant part in either strengthening or lessening their symptoms.

One such technique that I use consistently with kids, teens, and parents is the 3 Rs of anxiety management. This intervention is essentially a skill set that I teach for families to gain a solid understanding of what anxiety actually is… and isn’t… and how anxiety affects the body and mind.


The first R is to Recognize when anxiety strikes, including the form it takes in a particular child. For example, does the child begin worrying and asking for reassurance, or do they complain of a stomachache? An important part of recognition involves helping kids and their caretakers recognize that anxiety is primarily chemical. This means we need to teach children that brain chemicals can convince them that a worry is factual or inevitable when it isn’t. Similarly, anxiety persuades kids to believe that their stomach discomfort warrants medical attention (or at least a day off from school to recover!) For this reason, the recognition of anxiety means understanding that despite very real distress, the symptoms are based on elevated brain chemistry and do not represent actual events.


The second R of anxiety management is teaching children… and caretakers… to Relax. Relaxation is typically a big challenge for anxious kids because they often feel overwhelmed by their anxiety-based thoughts and bodily complaints. Both initially and intermittently, young kids will need relaxation assistance from a trusted caretaker or therapist who can help them to take some slow, deep breaths, stretch, and perhaps find something soft like a favorite blanket. When teaching kids to relax, it’s equally important to teach their adults similar effective self-regulation strategies—so they can keep their own anxiety at bay while maintaining the child’s distress.


Finally, the third R is Redirection, and it can take one of two forms. If the child’s anxiety manifests as a potentially realistic concern, such as the fear of failing a test, then redirection should be a practical solution, such as creating a study plan. However, if such a plan is already in place and having little impact on reducing anxiety, or if the anxiety is unrealistic or somatic in nature, then redirection should take the form of a distraction. Distraction can be any engaging physical activity, such as a playing a game, going for a bike ride, or jumping rope. Alternatively, the distraction can be a form of entertainment, such as watching a show; however, care should be taken to limit technology as the go-to distraction, as it may not always be available and may limit the child’s capacity to develop other methods. Keep in mind that redirection can also be mental/cognitive, such as encouraging a child to imagine how they’d like to redesign their bedroom or think about what kind of snacks they should bring to an upcoming school event.

Like any skill, the 3 Rs require practice beyond the office, such as at home, school, and any other frequented environment. I also am careful to continually help a child’s caretakers self-regulate in follow-up sessions so that they can maintain as relaxed a composure as possible during times of the child’s heightened distress. The more that kids—and their caretakers—can regularly initiate use of the 3 Rs, anxiety will certainly have a much less negative impact on a child’s quality of life.

Get Over 75 Integrative Strategies to Empower Anxious Kids and Their Parents
The Essential Guide to Treating Child and Adolescent Anxiety
Clinical psychologist Dr. Steve O’Brien knows firsthand how challenging, even overpowering, it can be when a child presents with anxiety. So often, their struggles send a ripple effect that disrupts the entire family system.

In The Essential Guide to Treating Child and Adolescent Anxiety, clinicians will find an integrative, whole-family approach for treating the most common anxiety-related issues in childhood, including school fears, social anxiety, excessive worry, separation anxiety, and more. Drawing from cognitive behavioral, family systems, and client-centered therapies, this book provides over 75 handouts, worksheets, scripts, and tips to help you navigate the most common treatment obstacles so you can empower anxious children and their parents to live healthier, happier lives.
Meet the Expert:
Dr. Steve O’Brien is a clinical psychologist with close to 30 years of experience treating children, adolescents, and families in his Clearwater, Florida practice. His specialty areas include treatment for childhood anxiety and depression, ADHD, Autism Spectrum Disorders, and divorced/blended family adjustment. Dr. O’Brien utilizes an integrative model which tailors treatment to the developmental level of both children and parents. His approach integrates individual child therapy with intensive parental and familial interventions. Dr. O’Brien has worked in a variety of clinical settings including community mental health centers, psychiatric hospitals, and medical clinics. He earned his PsyD at Nova Southeastern University and received specialized training in applied developmental psychology. Pediatric, child psychiatric, and school consultation is a significant part of his clinical work, and he is a frequent guest speaker in the Tampa Bay area. Dr. O’Brien previously worked as a continuing education provider for the Juvenile Welfare Board, and is a well-received speaker for PESI, training professionals primarily in the areas of child/adolescent mental health treatment and complex family issues.

Learn more about his educational products, including upcoming live seminars, by clicking here.

Topic: Children and Adolescent Behavioral | Book Club | Children & Adolescents

Tags: Anxiety | Children

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