Worrybusters Complete Anxiety Program

Worrybusters is a series of books and resources written by Dr Marilyn Campbell to help prevent and manage anxiety in children.

The Worry Busters program is designed to tackle anxiety in primary school-aged children aged five to twelve years. It comprises parent and teacher guides for managing children’s anxiety and a series of seven books for children, each of which focuses on a character with a different type of anxiety condition. The conditions include social phobia (Anthony the Shy Alien), generalised anxiety disorder or worry (Jali the Nervous New Boy), separation anxiety disorder (Cilla the Worried Gorilla), physical phobias (Danny the Frightened Dinosaur), obsessive compulsive disorder (Dig the Fearful Pig), post-traumatic stress disorder (Carla the Terrified Koala) as well as aggressiveness (Beulah the Anxious Bully).

Collectively, anxiety conditions are the most common mental disorders in children. Moreover, they often persist throughout life, causing significant distress and interfering significantly with social life and achievement both during the child’s formative years and later in adulthood. Early intervention to prevent or treat anxiety in childhood has the potential to avert some of these debilitating consequences. Campbell’s program is intended to provide strategies and information to assist parents, teachers and children to do this.

The parent’s guide provides, in readable form, information about how to recognise the behaviours, thoughts and physical reactions associated with anxiety conditions. It also gives practical day-to-day strategies a parent can use to assist a child with anxiety. These include ideas about communication and modeling, and brief descriptions of evidence-based strategies such as graded exposure, cognitive restructuring (coping self-talk) and behavioural techniques. These strategies are likely to be of use both in a self-help context and also as a resource for parents whose children are receiving professional help. The teacher’s guide is more technical and is designed to provide the teachers with classroom strategies for managing children with anxiety, to use the children’s Worry Buster book series in class to teach children to label feelings of anxiety, develop coping behaviours and seek help. It incorporates suggested exercises to accompany the children’s books and resources which can be photocopied for this purpose.

The seven extensively illustrated children’s books each centre around a different character whose behaviour and responses are typical of a child with an anxiety disorder. These stories are designed to assist children to better understand their own or other childrens’ anxiety problems and, in the case of the child who has an anxiety condition, to learn they are not alone in experiencing these difficulties. The narratives also include some strategies for coping (eg graded exposure) and all stories model a help seeking approach. There is an appropriate gender mix among the characters and the type of helper varies across books (eg teacher, counsellor). One of the key characters, Jali, is a young boy of Aboriginal background.

The series is likely to be a useful resource for parents, teachers and children to better understand childhood anxiety. Its strength lies in providing a coherent program which targets the child, the family and the school, thus ensuring an integrated approach to addressing the anxiety problem. In addition, the suggested, whole-of-classroom approach, maximises the chances of the program contributing to primary prevention, since it involves children who have no symptoms of anxiety as well as those with an anxiety disorder. Although it contains some evidence-based strategies for coping with anxiety, it is primarily an informational rather than a structured self-help manual. Consequently it may be most useful as a resource to increase anxiety literacy, appropriate help-seeking and parental and teacher support rather than providing specific ‘worry-busting’ self-help tools.

The program originates in a university. However, no evidence is provided in the material supplied as to its acceptability or efficacy either in improving anxiety outcomes or in increasing knowledge about anxiety in any of the target groups. The book explicitly states that it targets five to twelve year olds. The appropriateness of the format and the text for such a diverse age range is unclear. Older children may benefit from separately developed material, possibly including more explicit self-help exercises. Although the illustrations are striking and likely to appeal to many readers, some children may find some of the darker illustrations and strong graphical style anxiety provoking. Finally, the children’s books contain notes at the end for teachers and parents. While this is likely to be helpful to adults, there is no explicit labeling of the anxiety conditions in the text for children. In the absence of an explanation from any other source, some older children may be concerned after reading the information targeted to parents and teachers. Finally, there is a tendency in the teacher and parent guides to use phrases such as ‘the anxious child’ and ‘naughty children’ rather than ‘the child with anxiety’ and ‘children who have been naughty. The children’s books are labeled similarly (eg the ‘anxious bully’, ‘the terrified Koala’). Parsimony, particularly in choosing titles for children’s books is important, but this must be balanced against the desirability of modelling appropriate language for children, parents and teachers.

Despite the above limitations, this is a creative series of books which is likely to be of significant utility in a neglected area of health. The series will be of interest to teachers, parents and appropriate-age children. As a treatment program, its greatest utility may be as an adjunct to interventions delivered by professionals who have specific expertise in evidence-based interventions for anxiety. In addition, it may serve as a useful primary preventive resource and as a program for modifying negative attitudes among teachers, parents and children.