Anxiety Disorders! The Anxiety Disorders! 3/25/13. Strategies for Managing Anxiety in a School Setting. Importance of Treating Anxiety in Children!
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1 Strategies for Managing Anxiety in a School Setting Importance of Treating Anxiety in Children Prevalence Presented by Lynn Lyons, LICSW lynnlyonsnh.com Chronicity Co-Morbidity By conservative estimates, 10% of children and teens currently have an anxiety disorder. When left untreated, anxiety generally becomes chronic, and correlates with: increased rates of depression into adulthood attention and concentration problems impaired peer relationships and social skills conduct problems increased use of medical and psychiatric services an almost 50% retention of the diagnosis 8 years after the initial onset (Keller, et al., 1992) delay in the onset of independent living Anxiety Disorders 25 % of year olds 6% of these are classified as severe Girls 30% Boys 20% 11 years old is average age of onset Women are 60% more likely over lifetime McLoone, Hudson, & Rapee, Education and Treatment of Children, 2006; 29(2): The Anxiety Disorders Generalized Anxiety Disorder Social Anxiety Separation Anxiety Obsessive Compulsive Disorder Post Traumatic Stress Disorder Panic Disorder (not in the DSM for children) Phobias Predictors of Anxiety in Children Temperament Parents/Family Cognitive and Emotional Management 1
2 How do anxious children (and often their parents) experience and interpret their world? Anxious children... Catastrophize: focus on the worst possible scenario or outcome Overgeneralize/Globalize: allow a single negative experience or outcome to predict the same outcome for all future, similar events Personalize: attribute negative outcomes to self, and internalize causes of outcomes So what does that mean? Children are more likely to perceive ambiguous situations as more threatening or dangerous have lower estimates of their own competency to cope with such situations engage in all or nothing thinking (perfectionistic) become masters of negative expectancy Anxiety is a disorder of Children are more likely to have more somatic complaints be fearful of physical symptoms have higher levels of anxiety sensitivity Barrett, Rapee, Dadds, & Ryan, 1996; Bogels & Zigterman, 2000; Weems, et al., 2001 Anticipation Expectations Reactions Perception Anxiety Demands TWO Things: Certainty: I have to know what s going to happen next and I want to control it Trigger Worried Amygdala Activated Response Comfort: I want to feel safe and comfortable or else I want out Intensified Reactions More Worried 2
3 Fight or Flight Avoidance Avoidance of: social contact new experiences possible failures negative affect physical arousal Avoidance Happens... in a desperate effort to get and stay comfortable. So what s wrong with getting comfortable? Child Worries Seeks Immediate Comfort through Avoidance Cycle of Avoidant Worry Feels Uncomfortable with Uncertainty Feels relief And sometimes, schools and parents help 3
4 Accommodation Anything done in service to the avoidance, without any teaching or skill building adjusting family and school routines or schedules school accommodations with no weaning plan allowing unacceptable behavior and referring to it as anxiety medication with no therapy/skill building Handling Discomfort Means Movement... Child Worries Learns Skills to Manage Uncertainty Cycle of Normal Worry Feels Uncomfortable with Uncertainty Moves Forward Using Skills Anxious kids must learn how to: handle discomfort and uncertainty manage emotions demonstrate flexibility make mistakes and manage failure So let s talk about HOW The skills we teach must target two areas: Physiological (those uncomfortable bodily reactions) Cognitive (those worried thoughts) The Importance of Experiential Learning Talking (alone) does not change neural pathways Need experience to impact brain s alarm system Experiential learning is more memorable, and needed to create powerful reference experiences More work and creativity is required, but engagement is greater and progress much quicker 4
5 The Worry Stance: I (my child) have to know, or I (my child) can t move forward. This is uncomfortable, so I m going to avoid/prevent it. I (my child) have to be comfortable. I (my child) can t handle this. What we re going for: I (my child) can t know everything, but I (my child) can move forward anyway. This is uncomfortable, but I (my child) can handle it. Moving through discomfort is necessary to learn and grow. I (my child) can handle this. Trigger Worried Amygdala Activated Response But Intensified Reactions More Worried those physical symptoms really get everyone s attention How you respond to physical symptoms will have a BIG impact on the length and intensity of anxiety symptoms. Kids need to understand The physical symptoms are real (they re not faking, you believe they feel badly ) What they think and imagine has an impact on what their body does The cycle of anxiety and avoidance They can learn things that will put them in charge of getting through the school day 5
6 How I explain worry to kids, and why worry makes their bodies feel funky Trigger Worried Intensified Reactions Amygdala Activated More Worried Response Heavy Hands The message is NOT that we are eliminating or avoiding the physical symptoms, but that they can be managed and perceived through a different lens. Nose Breathing Face Soggy Heavy Hands Two Critical Skills: Trigger Worried Amygdala Activated I can handle (and understand) what my body does Response I can tolerate discomfort Intensified Reactions More Worried 6
7 Critical Cognitive Skills:" I can handle the uncertainty of life be more flexible (malleability) problem solve (vs ruminate) tolerate (and normalize) discomfort react differently to my thoughts What you can teach Physiological calming and informing Externalizing and personifying Worry Parts Normalizing initial cognitive, physical, and emotional responses Dissociating from or dismissing negative worried thoughts learn by doing, failing, & succeeding Expect Externalize Experiment Lynn s Cheat Sheet" I can Body Brain Bravery Bridge Lynn s Cheat Sheet" (Kid Version) Beware the CONTENT TRAP 7
8 The Content Trap Working with Parents Content Focus on the source of the problem, and then talk about how to fix THAT SPECIFIC problem Reassure about that SPECIFIC problem Give data, stats, rational information Go over plans and specifics repeatedly Process Focus on HOW worry operates and what it s up to Cue worry-managing strategies Be general: That sounds like worry to me Prompt independent, internal reassurance and problem solving What percent of children living with an anxious parent meet the criteria for an anxiety disorder? Lead researcher Golda Ginsburg reports data showing that the children of parents diagnosed with an anxiety disorder are up to seven times more likely to develop an anxiety disorder themselves, and up to 65 percent of children living with an anxious parent meet criteria for an anxiety disorder. Ginsburg, et al., The Child Anxiety Prevention Study: Intervention Model and Primary Outcomes. Journal of Consulting and Clinical Psychology, 77(3), June 2009, Working with parents Must have an agreed upon goal Parents benefit greatly from psycho-education Parents dealing with anxious children are most likely anxious, or worn out, or both. They are learning the same skills that their child is learning 504 Plans Is this plan accommodating the anxiety? Does this plan address the teaching of skills that reduce anxiety? Is there a weaning-off component to the plan? What role will visits to the nurse have? What is the role of the nurse in the plan? Does the plan specifically address physical symptoms? 8
9 The Worry Stance: I (my child) have to know, or I (my child) can t move forward. This is uncomfortable, so I m going to avoid/prevent it. I (my child) have to be comfortable. I (my child) can t handle this. What we re going for: I (my child) can t know everything, but I (my child) can move forward anyway. This is uncomfortable, but I (my child) can handle it. Moving through discomfort is necessary to learn and grow. I (my child) can handle this. Information Stuff me lynn@lynnlyonsnh.com for pdf of these slides Facebook: Lynn Lyons, Psychotherapist, Anxiety and Children Sign up for my NEWSLETTER on FB or me My DVD is available on my website Decreasing Anxiety: How to Talk to Your Anxious Child PROMO CODE school2013 for 50% discount 9
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DSM-5 to ICD-9 Crosswalk for Psychiatric s The crosswalk found on the pages below contains codes or descriptions that have changed in the DSM-5 from the DSM-IV TR. DSM-5 to ICD-9 crosswalk is available
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