What is the stepladder approach for anxiety?

The stepladder approach is a step-by-step way of helping children and teenagers learn to handle anxious situations.

It works like this:

• Start with a situation or thing that causes your child the least anxiety. Sometimes your child might need to practise the situation a few times until they feel comfortable with it.
• Move on to another situation that makes your child feel a bit more anxious. Again, go through it a few times until your child can handle it. Practice is important.
• Work with your child on tackling situations that gradually get more challenging. Older children can choose these situations themselves.

Why and how the stepladder approach works

The stepladder approach works because children and teenagers:

• get used to facing the situations that make them anxious, which is better than avoiding them
• create new, safe memories of situations, which become stronger the more your child practises
• face their fears and find out that they can manage them
• use and practise the coping skills and techniques that they’re developing
• get a strong sense of achievement as they progress ‘up’ the stepladder.

Before starting the stepladder approach or moving on to the next step of a particular stepladder, check that your child has the skills to cope. These skills include self-regulation and the ability to understand and manage their emotions.

Tips for using the stepladder approach

When using the stepladder approach for anxiety, these tips can help your child get started and keep progressing through the steps:

• Talk with your child about how you’re going to help them with their stepladder. Younger children might need you to choose steps for them. Older children and teenagers might want independence in choosing and working through steps of their choice.
• Turn the stepladder into a game for younger children. For example, if your child is afraid of dogs, make a game where your child gets points every time they point out a dog in a book you’re reading together.
• Help your child to come up with helpful self-talk they can use in anxious situations. For example, ‘I can be brave’, ‘This is a friendly dog’ or ‘Mum will come back’. This works well for children aged 3-6 years.
• Encourage your child to think realistically in anxious situations. For example, your child could ask themselves, ‘What happened last time?’ or ‘How likely is it to happen?’ This works well for children aged 7 years and older.
• Talk together after your child attempts or completes a step. You could talk about how it went and what your child could do next time. Then you could plan the next step together.
• Use rewards when your child tries or completes a step on the ladder. Rewards could be an extra book at bedtime, a trip to the park or a later weekend bedtime. Make sure rewards match the difficulty of the steps and your child’s age.
• Give your child plenty of praise for achieving each step on the ladder.

You can use the stepladder approach with children of all ages. Below are sample stepladders. You can adapt them to your situation and your child’s age and particular fear or anxiety. If you’re unsure about how to do this, consider talking to a professional – perhaps a child and family health nurse, GP, psychologist or school counsellor.

Stepladder approach for a 4-year-old with social anxiety

Here’s a stepladder for a child with social anxiety who’s afraid of meeting and talking to new people:

1. They say goodbye to one friend that they’ve met only a few times.
2. They say goodbye to a child they don’t know at the park.
3. They say hello to a child they don’t know at the park.
4. They say hello to the person at the supermarket checkout.
5. They say hello to an adult they’ve just met.
6. They say hello to an unfamiliar child at preschool.
7. They say, ‘Hello – can I play with you?’ to a child they don’t know at the park.
8. They talk to a child they don’t know very well at preschool about what happened on the weekend.
9. They visit a new group or class and say hello and goodbye to a child in the class.
10. They visit the new group or class and talk with a child in the class.
11. They visit the new group or class and talk with 2 children in the class.

Stepladder approach for a 7-year-old with separation anxiety

Here’s a stepladder for a child with separation anxiety who’s afraid of leaving their mother, even for a short time. At the start of the stepladder, this child can’t sleep alone and sleeps in their parents’ bed.

1. They stay inside and play while Mum puts the washing on the line.
2. They stay in their bedroom and play for 30 minutes while Mum is in a different room.
3. They stay at home with Dad while Mum visits the neighbour for 10 minutes.
4. They sleep on a mattress on the floor, next to Mum and Dad’s bed.
5. They stay at home with Dad while Mum goes shopping for 30 minutes.
6. They stay at home with Dad while Mum goes out to lunch.
7. They sleep on the mattress on the floor but move it closer to the door, away from Mum and Dad’s bed.
8. They stay at home with another trusted adult while Mum and Dad go out for lunch.
9. They stay at home with Dad while Mum goes out for the evening.
10. They stay at home with another trusted adult while Mum and Dad go out for the evening.
11. They sleep in their own bedroom.
12. They stay at home with another trusted adult and sleep in their own bedroom while Mum and Dad go out for the evening.

Stepladder approach for an 8-year-old with generalised anxiety

Here’s a stepladder for a child with generalised anxiety who fears being late, especially for school. They like to arrive early instead. They also constantly ask questions like ‘What’s the time?’, ‘Are we going to be late?’ and ‘What will happen if I’m late?’

1. They ask no more than 2 questions about being late to soccer training and arrive no more than 5 minutes early.
2. They ask no more than 2 questions about being late to a friend’s house and arrive on time.
3. They ask no more than 2 questions about being late to a friend’s house and arrive 5 minutes late.
4. They ask no more than one question about being late to school and arrive at school 5 minutes before the bell goes.
5. They ask no more than one question about being late to soccer practice and arrive one minute late.
6. They ask no more than one question about being late to school and arrive at school one minute before the bell goes.
7. They ask no questions about being late to a friend’s house and arrive 15 minutes late.
8. They ask no questions about being late to school and arrive at school as the bell goes.
9. They ask no questions about being late to soccer practice and arrive 5 minutes late.
10. They ask no questions about being late to school and arrive 10 minutes after the bell goes (after their parents check that this is OK with the school).

Stepladder approach for a 14-year-old with social anxiety

Here’s a stepladder for a child with social anxiety who’s afraid of asking questions and talking in class, even when they’re comfortable with the topic:

1. They ask the librarian a question at the school library.
2. They choose a teacher they feel comfortable with and ask that teacher a question at the end of class.
3. They choose a class they feel comfortable in and share an idea during a small group discussion in that class.
4. They choose a class they feel comfortable in and share an idea during a large group discussion in that class.
5. They choose a teacher they feel less comfortable with and ask that teacher a question at the end of class.
6. They choose a class they don’t feel very comfortable in and share an idea during a small group discussion in that class.
7. They choose a class they don’t feel very comfortable in and share an idea during a large group discussion in that class.

Children learn how to cope with difficult situations by watching their role models and listening to what those people say. So think about how you act and what you say in situations that you find stressful. For example, if you see a spider you might calmly say, ‘It’s a spider. What do you know about spiders? Do you know how to spot one that might be dangerous?’