Giulia Cacciatore has personality, the kind that
makes you want to be 13 again.
An honor roll student, she peppers her
conversations with superlatives and wears her long
blonde hair in a pony tail that sways when she
moves. Giulia loves mashed potatoes, music —
Coldplay, Bruno Mars and One Direction — and
riding horses is her “favorite thing in the whole
wide world.”
Listening to her, one would never imagine that just
two years ago, she suffered from debilitating
anxiety. Her fear of vomit and of becoming ill had
resulted in extreme weight loss and weeks of
missed school days. Her behaviors — including
excessive hand washing that left her hands
cracked and bleeding, refusing to eat food without
checking an expiration date and hours of distress
after the sight of vomit — frightened her parents.
Her mother, Micheline Cacciatore, had sought help
from a psychologist with little change in Giulia’s
behavior. Desperate, she did some research, and
found the Child and Adolescent Mood and Anxiety
Treatment (CAMAT) program, part of the University
of Miami’s Department of Psychology. Against the
advice of the psychologist who thought the
program was too aggressive, she pursued
treatment for Giulia.
The program, which focuses on groundbreaking
research and treatment of anxiety and depression
disorders in children and adolescents, uses
intensive cognitive behavioral therapy (CBT), in
which patients are gradually exposed to what they
fear and overcome the fear in the process.
“Their whole lives are changed by being in contact
with something they’ve been afraid of, and we’ve
seen that repeatedly,’’ said Jill Ehrenreich May,
Ph.D., director of CAMAT.
Like many parents who deal with a child’s anxiety,
Cacciatore and her husband, Fabrizio, felt alone.
They struggled to help Giulia, maintain a family life
and raise their other child, son Luca, now 5.
“It sounds silly when you tell somebody, ‘My kid’s
afraid of vomit and my life is completely upside
down because of it.’ It sounds ridiculous, but it’s
really real,” Micheline Cacciatore said.
While Giulia’s case was extreme, anxiety disorders
are not only real, they are common, Ehrenreich
May said.
“Anxiety disorders are pretty much the common
cold of childhood mental illness,” she said. “They
don’t get as much press as things like ADHD or
autism, but they’re more common if you consider
all anxiety disorders as a group.’’
Fear and anxiety are normal and instinctual in
everyone, allowing us to protect ourselves from
threats, she said. However, some children,
including Giulia, are more prone to anxiety and
anxiety disorders. Anxiety can turn into depression
if left untreated, she said. In addition, compared
with previous generations, Ehrenreich May said,
“threat information” now follows kids everywhere,
from computers and social media to cellphones
and television.
“You have easy access to the idea that bad things
can happen,” she said.
According to the National Institutes of Mental
Health, a large national survey of adolescent health
found that about 8 percent of teens 13-18 have an
anxiety disorder, with symptoms appearing at
around 6 years old. Of these teens, only 18
percent received mental health care. Brain imaging
shows that children with anxiety disorders have
atypical activity in specific areas of the brain,
compared with people without the disorder.
Nevertheless, Ehrenreich May said, the types of
anxiety therapists see hasn’t changed much.
The most common type of anxiety seen at CAMAT
is generalized anxiety disorder — a high level of
worry about specific issues — school, the future,
performance, hurricanes, the state of the world and
illness, among them. The second most common
disorder therapists see is social anxiety disorder,
which is often seen in children with ADHD,
Asperger’s Syndrome and high-functioning autism.
“Kids who have ADHD … oftentimes get negative
feedback from their social and academic
environment and over time they become overly
vigilant as a way of coping,” she said.
Many children with ADHD also have poor
frustration tolerance, which can result in avoidance
of situations, activities, anything that causes them
anxiety, she said. Children on the autism spectrum
are also prone to generalized anxiety and
particularly social anxiety.
“They feel like they’re getting negative feedback,
and they don’t understand why.”
While parents may first opt for traditional
psychotherapy, experts including those from the
National Institutes of Mental Health, say that in
order to decrease symptoms, parents should seek
treatment from psychotherapists trained in
cognitive behavior therapy, who can also prescribe
medication.
Cognitive behavioral therapy differs from traditional
psychotherapy or “talk therapy’’ in that the focus is
on the present, and is action-oriented in educating
patients and parents about the disorder and
ultimately exposing patients to what they fear.
Ehrenreich May said that whether medication or
CBT is used, an essential part of treating anxiety is
to stop the avoidance. Without addressing
avoidance, a behavior may lessen or go away only
to morph into other anxiety behaviors. Cognitive
behavioral therapy helps kids develop coping skills
that transfer later on, she said.
Despite the need for treating children, she said, a
relatively small number of programs exist
nationwide, primarily as part of research programs
on college campuses. CAMAT, which opened in
2008, conducts research, and every child who
receives treatment becomes part of that research,
Ehrenreich May said.
There are also clinics at Florida International
University, University of South Florida and
University of Central Florida.
Micheline Cacciatore said she was fortunate to find
help, and she and Giulia hope they can help others
by sharing their story.
“Without them [CAMAT], I have no idea where we
would be now,’’ Cacciatore said. “Not only did they
give me back my daughter, but the parenting skills
that I learned also helped us get our whole family
back on track.’’
Giulia was always an anxious child, her mother
said. Add to that a move to Miami from
Massachusetts, bullying at a school she eventually
left and food poisoning at a restaurant, and Giulia’s
anxiety increased.
Her therapist at CAMAT, Erin Girio-Herrera, Ph.D,
said Giulia’s case was tough, not just because of
the particular phobia, but because she had become
“highly avoidant,’’ vehemently refusing and
resisting treatment.
“Initially when they told me what the treatment was
going to be, I just felt like I was throwing her in a
lion’s cage and she was either going to get eaten
alive or come out of it. I knew we had to do it
because nothing else was working,” Micheline
Cacciatore said. “She was losing weight daily, and
it was becoming dangerous.”
At 11, Giulia weighed 56 pounds. According to the
Centers for Disease Control and Prevention, the
median weight for an 11-year-old girl is 108
pounds. Now she weighs 85 pounds, a healthy
weight for her height and size.
Micheline Cacciatore said Giulia’s previous
psychologist had also used cognitive behavioral
therapy. However, “she wasn’t doing it to the
extent they do it at UM. They have patients every
hour. They don’t have time for that. The symptoms
never went away.”
Still, she said, “It was really hard to put all my
trust in them, and we did almost drop out a couple
of times.” Giulia’s pained reactions, crying for
hours, were hard to bear. Some therapy sessions
lasted all day.
“A lot of the parents of kids we work with are
exhausted because they’re providing reassurance
24 hours a day,” Ehrenreich May said.
Micheline Cacciatore said she was one of them. “It
was the only way we could get her out of the
house or get to sleep. She would make us
promise her over and over that she wouldn’t get
sick.
“It was the hardest promise to make, because we
knew it was an empty promise if she got sick. We
learned the second day of therapy from Dr. Girio.
No more [promises that she would not get sick].”
“What kids get a lot of is, ‘It's OK, you don’t need
to worry. That’s never going to happen.’ If that
was curative, I wouldn’t have a job,’’ Ehrenreich
May said.
Girio-Herrera said the process begins relatively
slowly, with psycho education “so she had some
understanding of what’s happening in her body.”
Then she began to trigger Giulia’s reactions.
Girio-Herrera had a staff person cough outside the
door to the office. She “choked” on a sip of water,
and coughed, then rolled a colorful pen across the
table. Giulia caught it without thinking. Giulia had
to touch surfaces in the bathrooms at CAMAT. She
saw pictures and video of people gagging and
vomiting.
Finally came exposure to the smelly vomitous
mass. She and Girio-Herrera ultimately came up
with a name for the object of her fear — Voldemort.
“At times when it was hard for her, I would say
things like, ‘So are you going to let Voldemort
win?’ ’’ Girio-Herrera said. “ ‘Can you be stronger
and braver than Voldemort right now?’ Those kinds
of things were helpful to her.”
“I remember the day I killed Voldemort. It was
good,” said Giulia, now enjoying being a seventh-
grader at Riviera School. She is considering
becoming a therapist like Girio-Herrera.
“I keep telling her ‘You saved me,’ ” Giulia said of
Girio-Herrera, “and she says ‘No, you did it.’ ”
No comments:
Post a Comment