​ Evidence-Based Treatment Guidelines for Anxiety ​

Strategies to calm down the body’s fight or flight response and reduce anxiety.

Deep breathing

1. Belly breathing

  1. Inhale for 3 counts
  2. Hold for 4 counts.
  3. Exhale for 5 counts

3. Fun ways to practice breath control: pinwheels, blowing bubbles, whistling.

Muscle Relaxation: tensing muscles and then releasing them allows them to relax.

  1. First try to be stiff like a robot, keep your muscles tight.
  2. Then relax all your muscles, try to be floppy like a ragdoll.

Progressive muscle relaxation (PMR)

  1. Sequentially tense then relax each muscle group.
  2. Start by curling your toes tight for 5 seconds then release.
  3. Then tense your calves for 5 seconds then release.
  4. Gradually move up to the head.
  5. Analogies, such as shrugging your shoulders like a turtle, can be helpful for younger children.

Imagery

  1. Think of a place that is calming for you.
  2. Imagine every detail, including each sense (sights, sounds, smell, taste, feel)

Mantra – A phrase to help calm and refocus.

  1. Think of a coping thought.
  2. Practice repeating this phrase when you’re anxious.
  3. Examples: “This too shall pass”, “I am enough”, “I can control my panic with breathing”

Cognitive Behavioral Therapy (CBT)

CBT is a type of time-limited therapy based on the concept that thoughts, behaviors, and feelings all affect each other and that by changing our thoughts and behaviors, we can change how we feel. It is often the first choice for children and teens with depression, which ranges from 6-20 sessions. It is the psychotherapy with the most evidence for treatment of childhood anxiety disorders. It consists of five main parts:

1. Psychoeducation to both child and parent about anxiety disorders and CBT

2. Somatic management skills training

3. Cognitive restructuring

5. Relapse prevention plans

First-line recommended medication: SSRI (Fluoxetine, Sertraline)

  1. Limited improvement with therapy
  2. Anxiety interfering with ability to engage in therapy, exposures.
  3. Severe Anxiety (GAD-7 > 16)
  4. Comorbid disorder requires treatment.
  5. Continue SSRI for at least 6 months into remission before considering weaning off medication.
  6. SSRI treatment flow chart

Resources for Anxiety

Connecting for Care

UCSF Child & Adolescent Psychiatry Portal

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