Helping Children with Selective Mutism: Breathing and Muscle Relaxation

Christopher A. Kearney is a Professor of Psychology and Director of UNLV Child School Refusal and Anxiety Disorders Clinic, University of Nevada, Las Vegas. His new book, Helping Children with Selective Mutism and their Parents, provides information that can help readers better understand and combat selective mutism. In the excerpt below, Kearney provides some techniques to help children cope with their anxiety about speaking.

Breathing

A simple way to help children reduce physical feelings of distress is to teach them to breathe correctly.  Many children experience shortness of breath, breathe shallowly, or hyperventilate when upset.  Doing so actually makes the feeling of anxiety worse, so helping a child regulate breathing is important.  Have the child sit before you in a comfortable position.  Then ask the child to breathe in slowly through the nose (with mouth closed) and breathe out slowly though the mouth. As the child does so, encourage him to breathe deeply into the diaphragm (between the abdomen and chest and just below the rib cage.)  The child may need to push two fingers into the diaphragm to experience the sensation of a full, deep breathe.  The child can then breathe slowly out of his mouth.  Parents may even join the process to help their child practice at home.

For younger children such as Austin[age 6], you may wish to create an image during the breathing technique.  Austin could imagine blowing up a tire or pretend he is a large, floating balloon.  As Austin breathes in, he can imagine filling up with fuel and energy.  As he breathes out, he can imagine losing fuel and energy (or tension).  The child must come to understand the difference between feeling tense when the lungs are full of air and feeling more relaxed after breathing out.  The following breathing script adapted from Kearney and Albano (2007) may be helpful:

Pretend you are a hot air balloon.  When you breathe in, you are filling the balloon with air so it can go anywhere you want.  Breathe in through your nose like this (show for your child).  Breathe slowly and deeply – try to breathe in a lot of air!  Now breathe out slowly through your mouth like air leaving a balloon.  Count slowly in your head as you breathe out…1…2…3…4…5.  Let’s try this again (practice at least three times).

Key advantages of the breathing method are its ease, brevity, and portability.  The child can use this method in different stressful situations and usually without drawing the attention of others.  I recommend that a child practice this breathing method at least three times per day for a few minutes at a time.  In addition, the child should practice in the morning before school and during particularly stressful times at school.  Some children benefit as well by practicing this technique whenever they are around other people and an expectation for potentially speaking is present.  For example, a child could use the breathing technique prior to and during a church service.

Muscle Relaxation

Another method of helping a child reduce physical feelings of anxiety is progressive muscle relation (PMR).  Youths such as Austin are usually quite tense in different areas of their body, especially in the shoulders, face, and stomach.  Different methods of muscle relation are available, but a preferred one is a tension-release method in which a child physically tenses, holds, and then releases a specific muscle group.  For example, a child may ball his hand into a fist, squeeze as tightly as possible and hold the tension for 10 seconds, and then suddenly release the grip (try it).  When this is done two or three times in a row, people generally report feelings of warmth in the muscle as well as relaxation.

Muscle relaxation via tension-release can be done in different ways.  When I work with children, I use a relation script that covers most areas of the body.  I first ask the child to sit in a comfortable position and close her eyes.  I then read the script slowly and ask the child to participate.  You may wish to use the following script adapted from Ollendick and Cerny (1981) with a child:

(Speaking slowly and in a low voice) Okay, sit down, try to relax, and close your eyes.  Try to make your body droopy and floppy, as if you are a wet towel.  Take your right hand and squeeze it as hard as you can.  Hold it tight! (Wait 5 to 10 seconds.) Now let go quickly.  Good job.  Let’s do that again.  Take your right hand and squeeze it as hard as you can.  Hold it. (Wait 5 to 10 seconds.)  Now let go quickly.  See how that feels.  Nice and warm and loose.  Now take your left hand and squeeze it as hard as you can.  Hold it tight! (Wait 5 to 10 seconds.) Now let go quickly.  Good job.  Let’s do that again…

Now shrug your shoulders hard and push them up to your ears.  Make your shoulders really tight.  Hold them there.  (Wait 5 to 10 seconds.)  Now let go quickly.  Great.  Let’s do that again…

Now scrunch up your face as much as you can.  Make your face seem really small and tight.  Now hold it there.  (Wait 5 to 10 seconds.)  Now let your face go droopy.  Good.  Let’s do that again…

Now I want you to bite down real hard with your teeth.  Make your jaw really tight. Hold it there.  (Wait 5 to 10 seconds.)  Now open your jaw.  How does that feel?  Good.  Let’s try that again…

Let’s go to your stomach now.  Bring in your stomach as much as you can – make it real tight!  Press it against your backbone.  Now hold it there.  (Wait 5 to 10 seconds.)  Now let go quickly.  That feels betters.  Let’s try that again…

Okay, one more. Push your feet onto the floor real hard so your legs feel really tight.  Push hard! Now hold it.  (Wait 5 to 10 seconds.)  Now relax your legs.  Shake them a little.  Let’s try that again…

…I recommend that a child practice this script at least twice per day in the beginning of your intervention and then once or twice per day as he becomes more adept and independent.  In addition, the child could practice the method during times of the day when she feels most distressed…The idea is to replace anxious feelings with more relaxed ones so the child may feel more comfortable speaking.