What Is Separation Anxiety? 9 Worksheets to Use in Therapy

Separation anxiety is characterized by excessive anxiety upon being separated from major attachment figures such as parents.

Despite its origins in childhood, separation anxiety can also persist into adolescence and adulthood and is a risk factor for developing more severe anxiety-related symptoms such as panic attacks and agoraphobia (Lewinsohn, Holm-Denoma, Small, Seeley, & Joiner, 2008).

These behaviors can be distressing for parents and caregivers to witness. Therefore, knowing the theory behind this behavior and interventions is essential in helping prevent the anxiety from escalating.

This post will explore the origins of separation anxiety across the lifespan and provide strategies for dealing with separation anxiety in children and adults. We will also provide exercises for therapists to integrate into their sessions with patients experiencing separation anxiety.

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Separation Anxiety in Psychology: Bowlby’s Theory

Bowlby’s (1958) evolutionary theory of attachment states that children are biologically predisposed to form attachments.

Babies are born with the tendency to display certain innate behaviors called social releasers, which help ensure meaningful contact with the attachment figure (McLeod, 2017).

Examples of these behaviors include:

• Crying
• Cooing
• Babbling
• Smiling
• Crawling
• Walking

These behaviors, also called proximity seeking behaviors, help to develop a secure attachment with their primary caregivers and lead to attachment behaviors such as seeking the primary caregiver when the child is upset or distressed.

For more reading regarding attachment, this article about Harlow’s Monkey Experiments is quite insightful.

If the child cannot engage in proximity seeking behaviors or find the caregiver when they are in distress, then the separation response – crying – is evoked.

The term ‘stranger danger’ is a common term used to describe the response babies and young children have toward a stranger. To test this theory, Mary Ainsworth developed an exercise called the ‘Strange Situation’ (Ainsworth, Blehar, Waters, & Wall, 1978), where children between 12 and 18 months were put in a room full of toys with their mother.

A stranger came in, talked to the mother for a few minutes, and then the mother would sneak away while the child interacted with the stranger. The mother then re-entered the room and greeted the child (Ainsworth et al., 1978).

If the child is happy to see the parent upon their return, but still explores, it shows that the child is confident that their parent will eventually come back. However, if the child appears confused or does not show any preference over their parent compared to the stranger, then it may suggest a lack of emotional connection and limited interaction between the child and parent, leading to distress and anxiety.

What Causes It in Babies, Toddlers, and Children?

It is considered normal for babies between the ages of 6 and 18 months t0 display signs of separation anxiety.

Around six or seven months, the concept of object permanence begins to develop.

Object permanence is the understanding that objects – in this case, the primary caregiver – continue to exist, even when they leave the room (Bowlby, 1958). As babies grow into toddlers (around 12–18 months), the anxiety surrounding separation may become more pronounced, as toddlers’ speech starts developing and they start being able to express how they are feeling.

A good general rule to determine if a baby’s crying is because of separation anxiety is to see if they stop upon being held by the primary caregiver. If the baby stops crying and fussing, ruling out being hungry, tired, or needing a change, it is more than likely that their distress is a result of developing object permanence.

Having a strong relationship with a secondary caregiver and a predictable routine are also important tenets for children experiencing separation anxiety.

It is not abnormal for separation anxiety to continue intermittently until ages four or five, as children may still be hesitant to separate from their caregivers and struggle with transitions (Yeary, 2020).

Therefore, it is important for all the child’s caregivers to continue to work together and establish a strong routine to support the child in feeling safe and secure, no matter what environment they are in.

Dealing With Parental Separation Anxiety

When parents are separated from their children, they can often experience negative emotions such as worry and anxiety. A little bit of anxiety surrounding separation is also considered developmentally normal, as it prompts parents to continue the secure attachment bond that has been formed from early infancy.

As children progress into adolescence, they become more independent and naturally spend more time with their peers and away from parents. Adolescents are working toward becoming more independent in their everyday lives, engaging in a process called separation individuation.

Separation individuation is not focused on breaking the bonds with one’s parents, but focuses on maintaining a balance between staying connected to one’s family and also becoming more of an individual. Parents’ feelings of separation anxiety are related to problems in identity development and to lower general wellbeing in adolescents (Kins, Soenens, & Beyers, 2011).

Parents often need support to help work through their emotions when separating from their children. Identifying the root cause of their apprehensions surrounding separating from their children is key in helping to ease the anxiety.

One strategy that might be useful is to start a thought diary. This article on using a thought diary in Cognitive-Behavioral Therapy helps break down how a thought diary can be helpful in addressing intrusive thoughts and feelings that cause anxiety.

Coping With Separation Anxiety at School

In early childhood, school is one of the first places where separation anxiety and related anxious behaviors may manifest, as it represents a change in routine for both children and parents.

A key component of separation anxiety is avoidance, where the most common manifestation is refusing to go to school. Behavioral symptoms of separation anxiety typically manifest in the child completely refusing to go to school but can also be characterized by irregular attendance (i.e., arriving late and leaving early) or throwing a tantrum upon arriving at school.

Children can also experience a high degree of distress as the day goes on and even start having physical symptoms of anxiety.

Some specific techniques that may help build structure for a child experiencing separation anxiety about going to school include:

• Keeping goodbyes short and sweet
• Having a special handshake or goodbye “routine” upon separating
• If possible, having gradual exposure to a new school or situation by visiting the school a few weeks prior to starting and rehearsing the drop-off routine (i.e., driving the child to the spot where they will enter their class, meeting the teacher ahead of time)
• Having the child “act out” scenarios where they are being dropped off or simulate activities they may do at school using their toys or siblings/family members

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Do Teenagers and Adults Experience It?

Since separation anxiety is mainly discussed in the context of childhood, not as much attention has been paid to the prevalence of separation anxiety in adults. However, the Diagnostic and Statistical Manual of Mental Disorders has amended the diagnostic criteria for separation anxiety, stating that the age of onset could be after 18 (Silove & Marnane, 2013).

Teenage and adult separation anxiety are both characterized by fearfulness when exposed to specific situations, such as leaving home. It can also be characterized by an individual’s refusal to be drawn into independent activity.

Around the teenage years, separation anxiety can further manifest into panic disorder, often persisting into adulthood. Panic disorder is characterized by episodes of severe anxiety manifesting from a specific situation that the individual is fearful of.

These episodes of severe anxiety are accompanied by various physical symptoms (i.e., shaking, nausea, difficulty breathing) and emotional symptoms (i.e., crying, intense fear or discomfort; Eisen & Schaefer, 2005).

Therefore, it is important to provide strategies and interventions for adults and teenagers who are experiencing separation anxiety or panic disorder. This can be done through early intervention and identification of elevated anxiety in childhood, as the earlier the anxiety is identified, the sooner options can be provided for treatment.

Understanding one’s options for treatment is vital in providing early intervention. Here is an article for further reading on how to cope with anxiety.

Treating Separation Anxiety in Therapy

Treatment for separation anxiety revolves around identifying the client’s fears by modifying the client’s approach toward uncomfortable situations.

The most widely used therapeutic approach for separation anxiety or other anxiety-related disorders is Cognitive-Behavioral Therapy (CBT), specifically focused on exposure therapy.

Exposure therapy focuses on simulating the situation the individual is fearful of or the symptoms they are experiencing (i.e., dizziness) in a safe environment, while giving them specific tools to help them work through, rather than avoid, fearful sensations or feelings.

11 Worksheets & Toys for Your Sessions

Below, we have provided worksheets that can help individuals of all ages combat separation anxiety and help face the worries that lead to feelings of anxiety or avoidance of specific situations.

Children

• My Body and My Worries: This worksheet gives children the opportunity to draw the sensations that their body experiences when they face anxiety or worry.
• Labeling Your Feelings: This activity gives children the opportunity to write down or draw out their worries about a specific situation that is scaring them.
• Best and Worst: This exercise is aimed at giving children a chance to identify the pros and cons of a frightening situation. Drawing, writing, or a combination of both can be used to help them complete this worksheet.
• When I’m Scared: A worksheet that children can work through with a grown-up they trust to help explore their fears.

Teenagers and adults

• Drawing Your Fears: This activity gives teenagers the opportunity to map out the best, most likely, and worst-case scenarios by drawing out how they visualize each situation.
• Cognitive Restructuring Worksheet: An exercise that is central to Cognitive-Behavioral Therapy. This worksheet allows individuals to analyze their thoughts, documenting facts supporting and contradicting their thoughts. It also provides a series of questions to consider regarding the validity and origin of the thought to help individuals debunk it if it is not productive.
• Worry Bank: An activity that charts your worries over five days and helps you develop a “worry time,” preventing you from spending a lot of time on the little things.
• A Mountain of Worries: A worksheet that allows individuals to rate their worries and list them from highest to lowest.
• My Worry Journey: A worksheet that allows individuals to map out their worries and anticipate the most likely scenarios.

Gadgets and toys

Certain toys and gadgets are helpful for distracting and refocusing young children who are struggling with separation anxiety.

One of these is Pop-Its, a silicone toy structured like bubble wrap that is designed to reduce anxiety and refocus attention.

This toy gives them a repetitive activity to help reduce the presence of their anxiety and fears. They are available in many colors and shapes so you can personalize them based on your child’s preferences. Adults enjoy and can use them too.

Weighted blankets can be helpful tools to help adults and children feel more secure while they are sleeping. In particular, if children are having separation anxiety surrounding sleeping away from their parents, a weighted blanket helps to provide them with more security to help reduce their anxiety. For adults, it provides extra weight, helping to calm their heart rate and breathing so the body can get the rest it needs.

3 Books on the Topic

Several books are available to help increase your understanding of separation anxiety and obtain tips and techniques to cope with it.

1. Helping Your Child Overcome Separation Anxiety or School Refusal (A Step-by-Step Guide for Parents) – Andrew R. Eisen, Linda B. Engler, and Joshua Sparrow

The authors provide an overview of school refusal and the specific challenges that come with separation anxiety surrounding attending school. The book contains real-life examples of children who have experienced school refusal and separation anxiety.

It also has resources to assist parents in establishing a plan to help their children overcome anxiety surrounding attending school and templates for plans to help parents and teachers work together to combat these issues.

Available on Amazon.

2. A Kissing Hand for Chester Raccoon (The Kissing Hand Series) – Audrey Penn and Barbara Gibson

This is a picture book for children and parents facing separation. It is geared toward younger children (toddlers and preschoolers).

The story is about a little raccoon named Chester who does not want to go to school. His mom shares a family secret about ‘the kissing hand’ where his mother kisses his hand upon leaving him.

This way, every time Chester misses his mother, he can hold his hand to his face and feel the warmth of her kiss whenever he needs a reminder that his mother is always with him.

Kindergarten teachers often read this book on the first day of school to help children cope with the separation. The book comes with a CD of the story being read and a recording of ‘Chester’s Song,’ written by the author.

Available on Amazon.

3. The Anxiety Workbook for Teens: Activities to Help You Deal With Anxiety and Worry – Lisa M. Schab, LCSW

This book is geared toward teenagers who are experiencing anxiety. It is structured like a journal, explaining the sensations that cause a teen to feel anxious. Following each explanation, there is an activity in a journal format, where teenagers are invited to draw or write about their feelings.

One activity that would be good for teenagers specifically experiencing separation anxiety is in Chapter 2: The Chemistry of Anxiety. If teenagers are experiencing separation anxiety about going to school or completing other activities independently (i.e., driving), this may be a good therapeutic exercise for them.

Available on Amazon.

PositivePsychology.com’s Helpful Resources

The Emotional Intelligence Masterclass© is a tool for practitioners looking to engage their clients in activities to help develop emotional intelligence and for individuals looking to improve their own emotional intelligence.

The six-module course aims to educate individuals on the six pillars of emotional intelligence and ultimately increase individuals’ awareness of their emotional responses to specific situations. Gaining an understanding of one’s emotions and the situations that bring on different responses is key in combating difficult emotions such as separation anxiety.

The Realizing Resilience Masterclass© also aims to help individuals develop resilience to cope with difficult situations. This six-module course provides tools for practitioners to educate their clients about resilience with the goal of applying resilient behavior to overcome situations they are afraid of. All the science-based techniques are backed up by research and references.

Developing resilience is an excellent way to help individuals approach situations they are afraid of and can provide an excellent accompaniment to exposure and CBT approaches.

A Take-Home Message

Although separation anxiety may be predominantly known as a condition that young children or infants experience, this article has demonstrated that separation-related anxiety can prevail through adolescence and adulthood.

Coping with separation anxiety in individuals of all ages can be a difficult and trying experience.

However, it is important to exercise patience and persistence when treating this condition, whether you are a parent, practitioner, or individual who is addressing these issues.

As in all anxiety-related conditions, a vital step is understanding the origins of the anxiety in order to deal sufficiently with the symptoms that are causing distress.

Once you understand the origin of the anxiety, putting together a treatment plan and establishing structure surrounding the distressing event will be key in helping ease the anxiety.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free.