Worry Activities for Kids: Worry Monster, Worry Box, Worry Time and a Brave-Steps Ladder

About this tool

Worry activities for kids are structured, mostly playful ways to help a child notice worry, treat it as something they have rather than something they are, contain it, and gradually approach the things it makes them avoid. The four that appear in nearly every evidence-based program for childhood anxiety are externalising the worry (the worry monster, giving the worry a name), the worry box, worry time, and a graded ladder of brave steps toward a feared situation. A fifth element is not an activity but changes everything: how the adult responds when the child asks, again, whether it will be okay. This page is for the parent, carer, teacher or clinician who will run them. The activities are optional and adult-led: a child who joins in draws a monster, posts a worry or tries a brave step, and nothing here is a test, a form or a score.

Before you start, one distinction the exercise depends on. These activities are for repetitive hypothetical worries, the ones that circle without resolving. They are not for real problems that need an adult to act. If a child raises bullying, being hurt, feeling unsafe, being ill, or anything you are not sure about, open the box then and there and deal with it. The rules below never override that, and a child who learns their real concerns get deferred will stop bringing them.

Worry itself is ordinary in children, and much of it is developmental: fears of the dark and of separation in early childhood, of injury and storms in the middle years, of social judgment and failure as adolescence approaches. Worry becomes a problem by its size and cost: when it is there most days, stops a child doing age-appropriate things such as sleeping alone or going to a party, and the family starts organising itself around it. Anxiety disorders are among the most common childhood mental health conditions, and cognitive behavioral therapy for them has strong trial support, back to Philip Kendall's Coping Cat program in the 1990s. The activities here are components of that kind of program, not the program itself.

Externalising the worry comes from narrative therapy, where Michael White and David Epston described separating the person from the problem so the family can unite against the problem rather than against the child. With children, the worry becomes a character. A worry monster, drawn or a soft toy, is the common version: the monster whispers that the sleepover will go wrong, and child and parent talk back to it. Older children may prefer the worry bully or my worry brain. The language shift is the active part. The child who says my worry is telling me the dog will bite has already stepped back from the child who says the dog will bite. Keep it light: the monster is a bit silly, never frightening, and the child is always in charge.

The worry box, or a worry jar or a monster that eats worries, gives the worry a place to go. The child writes, draws or dictates the worry and posts it in the box, which is closed. The box is not a way of pretending the worry is gone; it says this is parked until we deal with it. It pairs with worry time, adapted from adult treatment for generalized anxiety, where Thomas Borkovec and colleagues showed in 1983 that confining worry to a fixed daily slot reduced it. For a child, worry time is ten or fifteen minutes at the same time each day, never at bedtime, when the box is opened and each worry looked at with you. Some will have solved themselves, some need a plan, and a few need the brave-steps ladder. The child learns that worries can wait and will be heard, which removes the need to raise the same worry fifteen times.

Reassurance is where good parents go wrong, and it is also where every child is different. When a child asks is it going to be okay, a short, warm, honest answer that gives information they did not have is help. Repeated reassurance about the same hypothetical worry tends to work like a sedative with a short half-life: it calms for a minute, the worry returns and another dose is needed. Research on family accommodation, the ways parents change their behavior to relieve a child's anxiety in the moment, links heavy accommodation to worse anxiety over time. Eli Lebowitz's SPACE program, tested in a 2020 randomised trial, treated children's anxiety as effectively as child CBT by working only with parents to reduce accommodation and express confidence; it is a structured treatment delivered with a clinician, not a rule about how many times you may answer. How much reassurance is too much depends on the child, the worry and the day, and a clinician who knows your child can help you set the line. The response the program teaches has two halves and both matter: I can see this is really hard for you, and I know you can handle it. Validation without the rescue. A real question that needs real information still gets an answer.

The brave-steps ladder is the piece that actually shrinks a fear. It is a child-sized exposure hierarchy, the core of anxiety CBT: one specific feared situation broken into eight or ten steps from easy to hard, climbed one rung at a time, staying on each until it feels manageable. For a child frightened of dogs, the rungs might run from looking at photos, to watching a dog through a window, to standing near a calm dog on a lead, up to stroking one. The adult builds the ladder with the child, makes the first rung almost too easy, praises effort over outcome, and never pushes past the agreed rung. Learning that the feared thing is survivable, and that anxiety falls on its own if you stay, is what changes the worry; talking about the fear does not.

The evidence supports the whole more than the parts. Child CBT programs that combine psychoeducation, externalising language, graded exposure and parent work have good trial support, and a Cochrane review in 2020 found them effective compared with waiting lists. Parent-only approaches targeting accommodation have at least one strong trial. Taken alone, the worry box and the worry monster have little direct research; they are framing devices that make the harder work possible. Worry time has adult evidence and far less child evidence. Nothing here is proven for your particular child, and none of it replaces assessment when worry is severe.

Common mistakes: doing the activities only in a crisis, when a child is too flooded to learn; letting the worry monster become scary; using the worry box to avoid ever discussing the worry; scheduling worry time at bedtime; building a ladder with a huge first step; and, most of all, reassuring at every ask while running the activities. One more: treating the child's worry as the family's emergency. Children watch how adults respond to their fear, and calm, slightly bored confidence tells them more than any activity.

See a professional if worry has been present most days for several weeks, is stopping your child sleeping, attending school or seeing friends, or comes with stomach aches or headaches that have no medical cause. A child therapist trained in CBT for anxiety can run a full program and coach you through your part of it. Psychology.com's directory lets you search for child and adolescent therapists at no cost. Separately and urgently: if your child says they do not want to be here or alive, talks about ending their life, or tells you someone is hurting them, that is not a worry activity. Stay with them if their immediate safety is uncertain, start getting professional or crisis help now rather than watching to see if it lasts (in the US, call or text 988), and call your local emergency number if there is immediate danger or an urgent medical need.

Reviewed by Michael Callans, MSW
Checked that the page addresses the adult, that the reassurance and accommodation guidance matches the parent-based treatment literature, and that the ladder follows graded exposure principles.

References

1. Rapee RM, Wignall A, Spence SH, Cobham V, Lyneham H. Helping Your Anxious Child: A Step-by-Step Guide for Parents. 2nd ed. New Harbinger; 2008.
2. Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(3):362-372.
3. Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology. 1994;62(1):100-110.
4. Borkovec TD, Wilkinson L, Folensbee R, Lerman C. Stimulus control applications to the treatment of worry. Behaviour Research and Therapy. 1983;21(3):247-251.
5. White M, Epston D. Narrative Means to Therapeutic Ends. W. W. Norton; 1990.

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