Anxiety plus... stress, depression or trauma

"Anxiety plus" is my own invented phrase for what I see as a "mix-up"!

When it gets bad, anxiety is often linked or mixed up in our minds with stress, depression or trauma, sometimes all three. 

So, I'll tease out the strands a bit here. It’s so easy to think of them woven together, but that makes any problem seem insurmountable!

First, some quick links to further down the page:

Anxiety plus stress

Anxiety plus depression

Anxiety plus trauma

The issue of anxiety, stress, depression and trauma pops up on internet searches all the time, as in:

  • Is my child anxious or depressed?
  • When should I medicate an anxious child?
  • Is my child anxious or manipulative?
  • Anxious child attachments
  • Anxious child dentist
  • Anxious foster child
  • Anxious child meltdown
  • Is my  child anxious or autistic?
  • Is my child sad?

Some of these searches show worries about stress, others about trauma, and others about depression. There are many more versions of these searches (how did we manage before the internet??), but it does show how much parents care about their children's mental health.

So let's look at these three topics in a bit more detail.

Anxiety plus stress

Stress brings to mind “overload”, a danger of snapping.

Usually with children, this ends up with a tantrum, an outburst of yelling, floods of tears or simply stopping everything.

"Anxiety plus" involving stress is mostly due to three things:

  • an “executive function” that can’t yet future-manage tasks
  • imagining the dire happenings that will fall on them when it’s not all done.
  • situations your child is not good at coping with but has to stay in. Eg loud, noisy rooms, very busy places, test rooms (for exams and SATS etc) or being on their own when they need company.

What is executive function?

After birth, and especially between the ages of 3 and 5, you child will be developing the ability to organise things sequentially in their mind so they get done in reality. 

The bad news is that, despite another rapid improvement in adolescence, this function doesn’t mature until around 18 or 20 – and some people never quite manage it!

Stress builds up when your child hasn’t managed to link tasks together to get the overall task done, or done in time – find the right page, research some answers, write them in the exercise book or worksheet and finish the homework task.

Perhaps they don’t finish getting dressed because, although they can do all the bits of that task, they’re already stressing about not having finished their homework. And then anxious they'll be told off or kept in at playtime to do it.

And if your child isn't yet good at controlling emotions and impulses, they can get distracted by the “now” and sidelined from the task they were doing. 

The build-up of not-done tasks then becomes too great and they’re paralysed – leading to anxiety about nothing being done. And the trouble that will follow!

The feeling of things piling up can be made much worse after a death, or illness, or if their opinion of themselves is already low. At these times, their mind is not totally focused on things. They’re anxious about what’s happened and the pile-up. 

Also, as I said, there are some situations and events that are simply stressful for your child. For these, to quell the rising anxiety, your child needs ways of triggering an immediate relaxed state.

Anxiety plus stress is not a good combination ("state") to be in.

Good ways to sort out anxiety plus stress include:

  • talking about what’s making them anxious
  • learning (from you) one good, fun way of organising their time and tasks (I recommend the fabulous Kazutime for younger ones, although it’s not yet available in the UK app store) and possibly being given rewards for success
  • having lots of outdoor exercise and fun – this releases feel-good hormones in the brain
  • finding which way your child relaxes best and doing it at set times as a routine
  • working on one “happy place” image they can summon into their mind when stress starts rising 
  • knowing how to do deep, slow breathing, which brings their body back to normal. All the family could practise this in advance. 

Anxiety and anxious thoughts can obviously be one sign of stress in your child, because anxiety is future-focused and when you’re stressed you worry about what will happen as well as, or because of, what isn't done. 

But it’s the stress and overload you need to help them with first.

A book to help with anxiety plus stress

The 7-Day Stress Buster by Jenny Alexander is packed with a choice of mini activities for each day – you child gets to choose which one on the particular day. It's published by Hodder Children’s Books, but you can get it post free from the author’s site. 

cover for 7 Day Stress Buster book

Anxiety plus depression

Depression brings to mind feeling down – so very down that life is a bother. It feels as if there’s something heavy weighing on both brain and body. 

Your child might lack interest in anything, get nothing done and be tearful and lacking in energy over a period of time. And yet still seem anxious.

"Anxiety plus" involving depression is mostly because 

  • there’s still a worry about things that simply have to be done, however exhausted they feel
  • people are expecting them to perform as usual, but how can they possibly summon the energy to do so?
  • the future looks bleak because it feels as if nothing will ever change.

The main difference for me, when I see depression in a child, is that it’s usually external circumstances that have caused the depressive thoughts. 

Anxiety comes from within (negative thoughts about what might happen) but low, depressive feelings come from outside circumstances. 

So this is anxiety plus depression.

What might these outside circumstances be for a child?

  • having had a house move and not liking their new school
  • a friend moving away
  • testing in school that takes away all the fun of learning and goes badly
  • not being able to take part in some excursions or sports due to lack of money in the family
  • failing at school subjects and no help being offered
  • being expected to achieve something they’re not suited for

I could name more – but the feature of each of these is that the child is powerless and has mostly had no say in the events. 

That's why I call it more external than internal. Whereas anxiety is more internal than external. Not always, but often.

So, because they've been powerless in relation to those events, they then worry – and their mood drops even lower. This makes the link for anxiety plus depression.

But it’s the depression that needs dealing with first.

If your child has been any of these: in a low mood, tearful, sleepless or sleeping more, unable to concentrate, defiant, negative or suddenly falling behind at school, pretty consistently for more than two or three weeks, then it’s time to speak to your GP.

All children, like adults, feel sad occasionally. How else would we recognise joy and hope? But depression is more constant. It affects every part of your child's life.

Anxiety plus depression is treatable. Your GP will probably offer access to CBT (cognitive behavioural therapy) before medication, simply because your child’s mind is still developing and some of the antidepressant medicines can affect them in unpredictable ways.

Children’s therapists are trained to recognise and treat mild- to moderate-level depression, so you may prefer to use my Help page and find your child a good counsellor yourself.

CBT works well, but so do several other varieties of therapy for depression. Have a look round. 

And remember – do not be afraid to ask your child if they feel so bad they wish they weren't alive. A "yes" is your prompt to act now.

There is always a solution for younger children that they haven't thought of because they're young. We have to think for them.

But with teens, too, never be afraid to ask how bad it is – asking never causes someone to take their life. It actually offers support and help. Relief that the problem is now known and help available.

A book for parents about depression plus anxiety 

So Young, So Sad, So Listen is a guide for parents to help them think about and consider their child or teenager’s low feelings. 

Philip Graham and Nick Midgley are good authors and practitioners. I can thoroughly recommend them from my editorial days. And this Cambridge University Press title is in its third edition – which is probably a testimony to its usefulness.

cover for so young so sad book

Anxiety plus trauma

The word trauma has become terribly misused these days.

The original Greek word means a wound, but medically it's often used to refer to anything that presents a huge shock to the system. Essentially something that:

  • threatens life 
  • is outside the range of usual experience 
  • is terrifying and 
  • brings a feeling of helplessness.

"Anxiety plus" that involves trauma is mostly due to the fact that

  • after a shocking or life-threatening event, we have no idea what to expect next – the landscape has changed, we’re disoriented and therefore anxious
  • we store all our experiences as information ready for next time – especially things to avoid at all costs, which provokes anxiety, and
  • if we want to avoid something similar to the shocking event, we have to be anxiously checking out our surroundings all the time. Just in case. We're hyper-alert.

You can see that a child is going to be anxious when they’ve experienced something that shocked them or frightened them, beyond what their limited experience can cope with.

They will certainly have registered this experience in their brain – but without the cognitive “making sense of it” ability that adults can use, to varying degrees.

This inability to “make sense of it” leads to the event only being stored as emotion and feeling. Adults, too, store the emotion, of course. But they have better skills to think about it.

Traumatic shocks store the emotional information in a much more intense fashion anyway – you'll maybe have experienced "old" feelings when something even vaguely similar starts to happen. It affects our bodies.

And when something is too traumatic, our decent thinking skills go offline anyway – which is why, for instance, returning soldiers often need counselling for PTSD (post-traumatic stress disorder). I’ll mention PTSD in a moment.

Children, trauma and anxiety

We can divide trauma into categories. It sometimes helps when thinking about impact.

We can have little-t traumas and big-T traumas (I’m not sure how to write that so it makes sense!).

Little-t traumas for children might be:

  • A cat pouncing on them when they didn’t know it was there
  • A dog jumping up at them, taller than they are
  • Cutting themselves really badly on a sharp bit of tree trunk
  • A pet dying
  • Being bullied on one occasion
  • Losing a significant (still alive) person from their everyday lives
  • Anything very distressing to a particular child

These are not life-threatening, but appear so to a child.

Big-T traumas for children might be:

  • Staying in hospital while ill or for an operation
  • Serious physical injury like losing a leg in an accident
  • Sexual violence
  • Neglect and emotional abuse from birth parents
  • Being bullied endlessly

There are many others. But you can see that there is a difference in quality between the two sets.

On the other hand, a build-up of little-t traumas can have a larger emotional impact than a single big-T trauma. 

And different children have different amounts of natural resilience, which dictates how emotionally damaging the trauma is. More resilience, less anxiety, more chance of coping.

The important thing to know is that an anxious child may have any of these traumas in the background of their anxiety.  

That’s “anxiety plus trauma”.

What can you do?

1 You may know the source of the little-t trauma and ensuing "anxiety plus". Eg a small child has been greeted by an Irish Hound-sized dog and now fears all dogs.

Things like this can be dealt with by listening, talking, and setting up a system of little trials/steps to take to overcome the fear. There’s an example of this here.

There are many practical suggestions on this site for dealing with anxiety around a scary experience, and more are being added as the site grows.

And as your child gets older, they can talk more about anxiety in general if you approach it in a relaxed way. The trick here with “anxiety plus” is to find out if there is trauma behind the anxiety. 

For instance, there’s no point in trying to help with supposed “separation anxiety”, if you then find out that something bad happened to your child last time they went to play at their friend’s house. 

2 If the trauma is a very big one, it can be useful to find a therapist trained in EMDR for children. This is Eye Movement Desensitising and Reprocessing.

Briefly, this therapy intervention helps in a child-friendly but thorough way to remember the trauma safely while focusing on the here and now (via the eye movements, or sometimes tapping) and reprocess it so it no longer intrudes into their everyday life.

EMDR works really well for PTSD too. Whether diagnosed or not, if “anxiety plus trauma” seems to be what’s wrong, you can assume a little bit of PTSD anyway. That's when the trauma keeps jumping into the child's head as if it's still happening.

You can read up about EMDR online if it seems relevant. And you can find a list of trained child EMDR practitioners in your area in the UK.

In the US, I recommend consulting the Child Trauma Institute to find help. I know Ricky Greenwald, who heads the Institute, but I don’t know the individual practitioners themselves.  

It’s worth saying that skilled play therapists also deal with trauma really well. You can find details about them on my Help page.

A book that I recommend

The Simple Guide to Child Trauma: what it is and how to help by Betsy de Thierry (published by Jessica Kingsley and illustrated by Emma Reeves) gives you a lot of very readable and practical information. But check first to see if it's more than you need right now!

You might also find these helpful