Play therapy interventions for anxiety are the most effective way to help children. Did you know that childhood anxiety disorders are the most common type of psychiatric problem seen in children? (Costello E.J., Angold, A., 1995). As a play therapist, chances are you have- or will- come across a child with anxiety.

Anxiety is something all people experience and there are normal levels of anxiety for children at various stages of development such as separation anxiety when a child is between the ages of 18 months to 3 years. It is when the anxiety occurs beyond the normal developmental stages persistently in such a way as to interfere with a child’s functioning that it needs to be addressed with professional intervention and support.

In my 3 hour APT and NBCC approved play therapy training called 40 Play Therapy Techniques for the Anxious Child Ages 4-11you will find a treasure trove of valuable interventions gathered from many years of my own experience working with children suffering with anxiety. In this article, I will give you a sneak peek into what you will learn in that workshop.

(There may be affiliate links in this article which will pay a small commission with me if any purchase is made through those links).

We use play therapy interventions for anxiety disorders such as:

• Generalized Anxiety Disorder
• Obsessive Compulsive Disorder
• Panic Disorder
• Phenomenon of School Refusal
• Posttraumatic Stress Disorder
• Selective Mutism
• Separation Anxiety Disorder
• Social Anxiety Disorder
• Trichotillamania

Child-centered play therapy with childhood anxiety can be very supportive and effective and should be the foundation of all and any play therapy provided. Sometimes it is clinically appropriate to provide facilitative and directive play therapy interventions after establishing rapport and observing a child’s free play.

A prescriptive play therapy approach is one I utilize and I teach in my play therapy training because I firmly believe we need to assess where a child is in their development and circumstances to determine the best way to help that individual child. Child-centered play therapy is the foundation of all play therapy in that we must allow the child to explore, express and experience her feelings, perceptions and thoughts through her play and we are able to see and understand better what that child is experiencing. But, it is very possible to use directive and structured play therapy interventions for anxiety while still incorporating the essence and tenets of a child centered approach. As we  build that essential rapport through tracking and reflecting and holding space in a child-centered way (even with and through more directive interventions), it is helpful to bridge into facilitative and directive play therapy techniques based in cognitive-behavioral theory when:

• A child is older and needs developmentally appropriate play
• The time frame for treatment or number of sessions is limited, or
• A child is in “battle zone” of divorce or abuse
• A child appears to be stuck in particular themes of play

6 reasons for directiv play therapy with highly anxious children:

1. Rapport Building – Though not included in the above-mentioned training I have added this very important reason to use structured or directive play therapy with highly anxious children because a pure child centered approach can overwhelm a child new to the play room. 
2. Assessing, Awareness, and Containing– These interventions help children measure, assess, and even quantify the level of their worry.
3. Turning Thoughts Around (Cognitive Restructuring)– This involves helping children through playful activities to identify the anxious thoughts and beliefs and feel empowered to overcome, shift, and change those thoughts.
4. Self-Soothing/ Finding Calm– These teach a child how to find their way back to calm.
5. Choosing a Different Focus and Direction (Distraction)– These help the child make a choice to direct their thinking in a different way.
6. Becoming the Boss (Empowerment)– These help the child experience a sense of mastery.

Here is a sneak peek at a few of the 40+ interventions I share in my 3 hour recorded training that will help you develop a wide variety of techniques for using play therapy with childhood anxiety called  40 Play Therapy Techniques with the Anxious Child PLUS a bonus extra on rapport building not included in the training!

Some play therapy interventions for anxiety:

Rapport Building

• DIY Would you Rather do/have This? or That? Game: No reason to buy the game at the store plus you can adapt the game for individual clients by creating your own. All you need is popsicle sticks and coffee can, jar or small oatmeal container and a fine tip Sharpie. You can cover the container with colored paper, string or paint. On the sticks write choice options on either side that correlate and the sillier they are the more fun the game. (i.e. wear ballerina slippers to school/wear roller skates to school; or eat ice cream in an igloo or drink hot chocolate at the beach).

Assessment

• Macaroni Worry Cards: cut an 8×11 sheet of paper in half. Together, create a list of things/ topics the child is worried about. Write each one down on a card/paper. Then, lay out all the cards on the floor and give the child a bowl of dried macaroni noodles. Tell him/her they can use as many or few as they wish but the more macaroni noodles they play on each card, the bigger that worry is. Go through each worry and have him/her place noodles on the cards and REFLECT how big or small that worry is as you go. The child will feel heard and will have a greater awareness of the size of their worries. (adapted from Techniques, Techniques, Techniques by Sueann Kenney-Noziska. )

Cognitive Restructuring

• Paper Fortune Cookies: Make paper fortune cookies and insert positive affirmation statements in them. Give the child one each time s/he leaves your office and the fortune inside will be his/her positive statement to work with for the week. An alternative is for you and your client to make the fortune cookies together and have him/her write the positive statements on the slips and insert them. Learn how to make fortune cookies here!
• Boss Back Brain: Paris Goodyear-Brown’s book The Worry Wars is one of my all time favorites for relatable stories for children along with highly effective play-based interventions that assist children in learning to develop “boss back thoughts” to redirect the fearful thoughts that fill children’s minds.

Self-Soothing

• Feather Blowing: Using a very light weight feather (with a small vein) have the child keep the feather floating in the air with his breath alone. You can make a game of it where you and the child each blow your own feathers in the air without touching the feather to see who can keep the feather up longer. This teaches the child mastery of the breath, inhaling deeply and sustaining the exhale. Learning to work with the breath can be a powerful self-soothing skill.
• Wet Noodle-Dry Noodle: Using the example of cooked vs. uncooked noodles we allow our bodies to be alternately stiff and loose helping children have the experience of what it is to be tense vs. relaxed. Not only does this increate somatic awareness but it teaches the child to consciously direct the body to soften and relax.
• Teaching Children Mindfulness: In this training, play therapists will learn not only how to practice more mindfulness themselves in order to be fully present for clients, but will also be able to introduce mindfulness to children through play therapy techniques.

Want to read more about the 3 hour training that contains over 40 play therapy techniques you can use with children who have anxiety disorders? Check out the course description and learning objectives here. 

Below are 2 articles I’ve written previously that provide a variety of some of my other favorite resources for helping children with anxiety:

• Resources for Parents of Children with Anxiety
• Resources for Helping Children with Anxiety in Play Therapy

Need consultation or coaching on how to work with a child with anxiety? I offer both contact and non-contact play therapy  training as well as consultation for therapists and coaching for parents. Contact me  here to schedule a consultation.