Weather Anxiety

In any part of our country, most times of the year, severe weather threatens the homes and lives of families. Families survive hurricanes, mudslides, flooding, tornadoes and other forms of violent weather. In addition to real life experiences, media images from all over the world bring the realities of violent weather into our homes every day.

It is difficult to estimate the number of children with weather anxieties, partially due to the fact that they may not present for treatment at their primary provider and many parents would rather live with the problem than see a mental health professional. Indeed many children have passing worries about the weather and need only minimal reassurance that their parents are well prepared for a weather event.

Weather-related anxieties can reach problematic levels, however, impacting the child’s ability to attend school or extracurricular activities, sleep alone, or meet other developmentally appropriate expectations.

For some children, a weather anxiety may turn into a Specific Phobia related to weather. The criteria for a Specific Phobia (American Psychiatric Association, 1994) and examples of how each criterion applies to a phobia of weather is provided in Table 1.

Some children have been directly victimized by violent weather and may be experiencing symptoms of Post Traumatic Stress Syndrome such as flashbacks of the event, nightmares, sleep disturbance, and hypervigilance that cause them significant impairment in their daily lives. These children should be referred for mental health assistance as soon as possible.

Table 1. Diagnostic Criteria for Specific Phobia and Weather examples

Diagnostic Criteria for Specific Phobia	Examples for phobia related to weather
A. Persistent and excessive fear elicited by the presence or anticipation of a specific thing or situation.	Overwhelming feeling of fear or dread present when a few clouds are in the sky and there is only a slight chance of rain in the forecast.
B. When exposed to the thing or situation, anxiety is the immediate response.	Child may cry, cling to caregivers, freeze, report trouble breathing, and become irrational at the sound of thunder or the request to go out to recess when the sky is overcast.
C. The fear that is felt is known to be unreasonable. Children do not have to meet this criterion.	No matter how much a parent explains that the child is safe, child still has excessive fear of the pending storm.
D. The fearful thing or situation is avoided or endured with significant distress.	Child may try to get out of recess, going to ball practice. If child must go, may cry and protest or stay close to an adult and be hypervigilant of the sky or forecast.
E. The person’s response to the thing or situation (avoidance, distress) significantly interferes with that person’s normal functioning, or the person is significantly distressed about having the problem.	Child may refuse to go to school or extracurricular events on a cloudy day; child may refuse to sleep alone.
F. The problem must have duration of at least 6 months in persons under 18 years old.
G. The person’s anxiety or avoidance is not better explained by another mental health disorder (Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Separation Anxiety Disorder, Social Phobia, or Panic Disorder with or without Agoraphobia.	If the child was exposed to a violent weather event, PTSD may need to be ruled out. If the child also presents with many other anxieties, other disorders may better account for the weather anxiety, or a specific phobia could be co-morbid.

Treatment Options

Preventing Weather Anxiety

Advising parents about how to deal with weather and weather related issues before they become a problem is an important area for healthcare providers to cover, especially during regional stormy seasons. The important thing to keep in mind is that children are learning about how to deal with weather regardless of whether the parents intend it or not.

When a parent expresses concern about the weather, perhaps taking the children to the basement of their home during severe weather, the way that they do this can impact the children. For example, if the parent has previously prepared for such an event, as is the case in many parts of the Midwest and the Southeast, this can go a long way toward reassuring the child.

The parent who has an area set up in the basement in which there is a radio, flashlights, and a small table for homework, is getting the message that you have to prepare for storms but you also have to get your homework done. Conversely, the family that is huddled together listening to a weather radio with parents obviously anxious and upset is also getting a message across to their children, but the message is one of fear and lack of control. Similarly, the parent who acts nervous but "talks a good game" will inevitably find out that their child learned from the parent’s behavior infinitely more than he or she learned from what they said.

In the interest of preventing unnecessary anxiety over storms, we have routinely recommended that parents take their children out into a gentle rain (during a non-electrical storm). This can start when the child is an infant. The parents can stand under the cover of their garage, carport or front entryway, holding the infant. They extend their hand out into the rain and return it so that the infant can feel the wet rain. After doing this several times, they can encourage their infant to extend her hand out into the rain.

Similarly, the parent can walk out into the rain with an umbrella, with an infant or a toddler, in order to give the child an opportunity to appreciate the cleanliness of the rain as well as the smell of the fresh air. Over the generations, many families have passed on dialogues that can be calming to their children as well, including such comments as, "the rain is God's way of cleaning the grass and the ground." In this way, the parents are offering reassurance to their child in both action and word.

General Reassurance and Parental Behavior

The above suggestions on preventing weather anxiety focus on parental behavior. If a child starts to demonstrate some disturbance related to weather, such as wanting to sleep with parents on stormy nights or focusing on the weather forecast when tornados are predicted, parents must remember the impact of their response on the child’s response.

For many children, some reassurance to the child that the parent is prepared may be helpful but care must be taken to not go overboard. Too much reassurance can be as anxiety provoking for children as too little. Brief, matter-of-fact explanations that the family is safe and that parents are monitoring the weather situation are usually sufficient. Weather monitoring should be kept to a safe minimum.

Parents can be directed to www.fema.org, which has an excellent booklet on preparedness that can be downloaded for free or read online (“Are You Ready” guide) to make sure they are, indeed, prepared adequately. As mentioned above with the homework example, parents should also be advised to keep behavioral expectations the same as when the weather is clear and to monitor their own anxiety responses. For example, the child should be encouraged to sleep in her own room and to go to bed at the usual time.

Coping with a Specific Weather Phobia

If, as a healthcare provider, you determine the child you are treating may indeed have a specific phobia related to weather, evidence based, empirically supported, strategies are available to help such children and families cope with their anxiety. Although we could not locate outcome studies that address Specific Phobia related to weather in particular, there are a number of studies that have documented the efficacy of cognitive-behavioral treatment for Specific Phobias and anxiety disorders that can be applied to weather-related anxieties (Pina, Silverman, Fuentes, Kurtines, & Weems, 2003), and for anxiety and depressive disorders (Compton et al., 2004).

Perhaps one of the most prolific researchers in the area of childhood anxiety is Kendall. He has published several empirical studies on anxiety disorders as well as treatment and therapist manuals for use by the trained clinician (e.g., Kendall, & Southam-Gerow, 1996). The basic tenets of empirically supported treatments for phobias are typically behavioral or cognitive-behavioral in nature, with both educational and experiential components.

A brief description of treatment is provided below so that you may help the parent know what to look for in the treatment offered by a mental health provider.

To address phobias and other anxiety disorders, children are educated about the anxiety response and learn how to recognize their own symptoms (e.g., upset stomach, tense muscles). They are then taught relaxation strategies including visual imagery of relaxing events, muscle relaxation, and controlled breathing to use when they feel anxious about storms or related events. The child then assists the therapist in developing a hierarchy of storm experiences that feel more and more threatening with the understanding that no step on the hierarchy will be taken without the child’s permission.

The therapist then begins to introduce each step, exposing the child to the feared situation, and helping prevent the anxiety response by using his or her relaxation strategies. Every time that the child experiences anxious feelings and is able to keep himself from getting any more anxious, he is closer to learning that he actually has control over his thoughts and feelings. The child with weather anxieties who is treated successfully learns that he can stop his uncomfortable thoughts and feelings when it comes to storms. The brief case study below highlights some of these treatment steps:

Case Study

A nine-year-old girl presented with a multiyear history of fear of thunderstorms. Whenever there were storms, she would insist upon sleeping in her parent’s bed. Her parents, with the best of intentions, welcomed her into their bed on the assumption that they needed their sleep as well.

She had also started to limit her attendance at activities if stormy weather was predicted. For example, she would refuse to go to her dance lessons, go to a friend’s house, or sleep over at her grandmother’s home if she thought it was going to storm. Treatment began with helping her and her parents recognize her signs of anxiety, which included stomachaches, increased irritability and oppositional behavior, and eventually shortness of breath.

After recognizing these signs, we practiced the use of visual imagery and relaxation procedures in the office and it was recommended that the family purchase a CD of thunderstorms so that she could practice her new coping strategies while listening to the sounds of storms. She was encouraged to listen to the thunderstorm CD daily at a very low volume and to increase the volume every day or two.

Later, when she had learned not only to relax while listening to the CD, but also to do her homework, we encouraged her to start falling to sleep with the CD on. Within a few weeks of this “desensitization” procedure, accompanied by her use of relaxation skills, she was able to fall asleep in her own bed during a storm, to get back to sleep during a storm, and to attend her preferred social events once again.

Medications

In a review of treatment options for anxiety disorders in general, Christophersen and Mortweet (2001) found that most guidelines suggest that medications, if used, should be used in combination with nonpharmacological treatments. For example, the practice guidelines of the American Academy of Child and Adolescent Psychiatry (1997) acknowledge the limitations in the state of pharmacological treatment of anxiety in children and suggest that it be used as an adjunctive intervention to nonpharmacological treatments.

Similarly, Velosa and Riddle (2000) suggested that medication interventions should also include illness education, support, behavioral components such as relaxation training for the child, and behavioral management training for the parents. Given the growing potential of medications for treating anxiety disorders, however, continued investigation of this treatment option is warranted. Some evidence is all ready available for the medical treatment of anxiety in adults, especially in the area of social anxiety disorder (Blanco, Raza, Schneier, & Liebowity, 2003; McClellan and Werry, 2003).

References

Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, R. & Curry, J. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 930-959. [283]
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. [225]
McCellan, J .M., & Werry, J. S. (2003). Evidence-based treatments in child and adolescent psychiatry: An inventory. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12): 1388-1400. [298]
Pina, A.A., Silverman, W.K., Fuentes, R. M., Kurtines, W. M., & Weems, C.F. (2003). Exposure-based cognitive-behavioral treatment for phobic and anxiety disorders: Treatment effects and maintenance for Hispanic/Latino relative to European-American youths. Journal of the American Academy of Child & Adolescent Psychiatry, 42(10): 1179-1187. [297]
Kendall, P. C., & Southam-Gerow, M. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64, 724-730. [299]
Velosa, J. F. & Riddle, M. A. (2000). Pharmacologic treatment of anxiety disorders in children and adolescents. Child and Adolescent Clinics of North America, 9, 119-133. [296]
Blanco, C, Raza, M. S., Schneier, F. R., & Liebowity, M. R. (2003). The evidence-based pharmacological treatment of social anxiety disorder. International Journal of Neuropsychopharmacology, Dec; 6(4), 427-442. [301]
Christophersen ER, Mortweet SL. Treatments that Work with Children: Empirically Supported Strategies for Managing Childhood Problems. Washington, D.C.: APA Books, 2001. [46]