Helping patients to overcome fears and phobias

All of us experience fears and worries in our lives, and it can be particularly difficult for children who are coming to hospital for life-changing treatments. At Great Ormond Street Hospital (GOSH), a team of psychologists help patients to overcome anxieties they may experience.

For this year’s World Mental Health Day, we spoke to Dr Mandy Bryon, Head of Psychology, and Dr Eve McAllister, Clinical Psychologist in the Department of Child and Adolescent Mental Health at GOSH.

Fears or worries

Many of the children whom Mandy and the other psychologists within Great Ormond Street Hospital meet are worried about the medical procedures that they need to have within the hospital.

“For example, a child might have previously come to the hospital and had their blood taken, says Mandy. “Even though the team have done their best to make the experience as comfortable as possible, the child might have had a different interpretation. The nurses might not have been able to find a vein, or there were lots of people around, and the child may have become anxious and cried. The next time that child comes to hospital, they already have a fear response.” 

This fear response, which is often called ‘anticipatory anxiety’, occurs when a child experiences increased levels of anxiety when thinking about an event or situation in the future.

For example, children might get anxious about having a wound dressed because they associate it with discomfort. The child’s fear response may involve them saying that they don’t want to go to their hospital appointment, them becoming tense or feeling butterflies in their tummy. “This is a relatively normal reaction to mildly unpleasant procedures, such as having injections,” says Mandy.

Children can be supported with these mild anxieties by their parents and other professionals within the hospital, such as clinical psychologists. “Anticipatory anxiety is often relatively simple to treat,” says Mandy. “This can involve explaining anxiety and the upcoming medical procedure to the child and their parents, so they know what’s going on and then taking gentle steps towards their desired goal. This is so the child feels able to undergo their treatment and experience a sense of success.

“As a first step, it might be that the clinical psychologist and child just walk around the clinic and have a look into the treatment room and think: ‘Fantastic – that’s all we’re going to do today.’

“Then you might ask parents to practise handling equipment at home to build up familiarity and confidence with the equipment related to their feared situation with their child (for example, practise using antiseptic wipes and looking at dressings at home). We also use distraction techniques with the hospital’s play specialists.”

Distraction therapy is a way of helping a child cope with a painful or difficult procedure. It works by trying to take the child’s mind off the procedure by concentrating on something else that is happening. Books, games, puzzles, music and controlled breathing exercises can all be used in distraction therapy.

Using cognitive behaviour therapy

Eve says that sometimes children can develop a severe fear reaction, which appears greater than you would expect, or is irrational – a phobia. “This mental health condition requires an evidence-based psychological treatment and is usually delivered by a clinical psychologist,” says Eve

“Treating phobias is about identifying what the young person and family want to achieve, and why the child needs to and wants to face their fear. For example, if a child had a phobia of blood, you would identify why it was important for them to overcome this phobia. 

“It’s part of my role to design a programme, in collaboration with the child and their family, where the child gradually learns to face their fear, and practises doing this with their psychologist during sessions within the hospital and at home too. They build in confidence through each step, to enable them to eventually have their own blood taken if this is their goal.

“We may also use small rewards and a lot of praise to motivate younger children to complete each step and build their confidence. We aim to enable each child and family to reach their goal, such as having useful blood tests and other medical procedures within GOSH.” 

It’s very important that children receive psychological treatment for phobias that prevent them from engaging with their medical treatment. Providing this treatment is one of the many roles that GOSH’s clinical psychologists carry out. The team also provide treatment to children with a wide range of difficulties, including other forms of anxiety, pain, behavioural difficulties, and teaching children how to manage their health conditions more effectively.

The good news

The good news, says Mandy, is that most children feel positive about coming to GOSH. “There aren’t many children who get frightened of GOSH as a building, because there are lots of smiley faces and there are lots of things to do. Generally, people work very, very hard to make GOSH a nice place to be, with nice smells, bright colours and toys.”

And, most important of all the hospital has a dedicated psychosocial and child and adolescent mental health service as well as a play team to support patients and families through the challenges of spending time in hospital.