When Anxiety Becomes a Problem

Transcription

1 ADHD Association of Great Edmonton January 16, 2013 When Anxiety Becomes a Problem Dr. Greg Schoepp, Registered Psychologist Division of Clinical Psychology, University of Alberta Hospital Greg.Schoepp@albertahealthservices.ca

2 Presentation Outline Introduction Components of Anxiety Normal vs. Problem Anxiety Causes of Anxiety Types of Anxiety Treatment for Problem Anxiety Where to Seek Help Question and Answer time

3 Anxiety Component Cycle (Craske & Barlow, 2006) Anxious thoughts about future negative events Physical arousal and symptoms of tension Anxious behaviors and attempts to prevent negative events

4 Anxiety Facts Normal Adaptive Is not dangerous Does not last forever Is mostly anonymous

5 When Does Anxiety Become a Problem When our minds and body react as if there is danger when there is no real danger Anxiety problems are common. One in four adults will have an anxiety issue in their lifetime. Anxiety BC

6 Normal vs Problem Anxiety Normal Anxiety Reasonable Productive Manageable Mobilizing Specific Time-limited Age-matched Problem Anxiety Excessive Detrimental Difficult to control Paralyzing Pervasive Chronic Age-mismatched

7 Can Occur With Anxiety connection with major depression, substance dependance, suicidal behavior Coping with substances Disruptive behavior (ADHD, defiance, serious rule breaking behavior); Tourettes/tics; learning issues; pervasive developmental issues; other anxiety issues

8 ANXIETY TYPES Selective Mutism Separation Anxiety Disorder Specific Phobia Generalized Anxiety Social Phobia Panic Disorder Obsessive-compulsive Disorder Acute Stress & Post-traumatic Stress Disorder Anxiety Disorder N.O.S.

9 Selective Mutism Persistent inability to speak in select social settings Normal talk in comfortable, secure, relaxed settings Up to 2% primary grade children Mutism is attempt to manage fear of speaking Specific fear or phobia of being heard or seen speaking in certain circumstances Cautious in unfamiliar settings perceived as threatening Specific SM vs. generalized SM Positive relations with peers, academic progress OK

10 Separation Anxiety She won t be there after school Distress about separation or even threat of separation Crying, clinging, pleading, tantrums, somatic complaints Nightmares involving themes of death and loss, associated sleep difficulties Avoid school, sleepovers, birthday parties Frustrated parents

11 Specific Phobia The needle will really hurt Persistent, marked fear of circumstances or situations, i.e., heights, insects, animals, needles or blood, storms, dark, vomiting Individual believes dire outcome from contact with object, i.e., contracting illness from injection Avoidance, anxious anticipation, or distress in situation interferes in daily routine Child may react with crying, tantrums, freezing, or clinging, not always aware fear is unreasonable

12 Generalized Anxiety What if Excessive worries take over thinking Excessive worry about multiple topics (work or school performance, friends or family, health, punctuality, catastrophic events; 2) difficulty regulating worry Persistent negative predictions and worst case scenario outlook (3/6 symptoms) Poor concentration, irritability, restlessness, fatigue, sleep disturbance, somatic symptoms (headaches, stomach aches), muscle tension Seek reassurance, avoid or procrastinate, list making, information seeking, refuse to delegate, self-imposed high standards, fear of failure Lacks situational specificity

13 Social Phobia Everyone will laugh at me Intense anxiety and distress in social or performance situations where they face unfamiliar people or possible evaluation. Fears of looking foolish, fear negative evaluation from others, humiliation or embarrassment. Performance situations public speaking, eating in front of others Interpersonal situations attend party, phone use Physical symptoms racing heart, blushing

14 Social Phobia Avoidance and playing it safe Anxious thoughts about others, They ll think I m weird. Anxious personal thoughts, I ll have nothing to say. Focus attention on yourself during social situations. Focus on your performance and how anxious you feel and look.

15 Panic Attack Short burst of severe fear that involves sweating, trembling, shortness of breath, dizziness, heart palpitations Peaks within 5 10 minutes then subsides Children who panic are fearful of the bodily changes As child ages, may connect symptoms with thoughts of dying or going crazy

16 Agorophobia Anxiety about being places or situations where escape is difficult or embarrassing Anxiety about help not available in event of panic attack Avoidance or significant distress in situations Alone, away from home, public places, driving, open places

17 Panic Disorder I m going to die Misinterpretation of physical symptoms that something wrong or feeling of loss of control With or without agorophobia Avoid physical activities, avoid certain food or beverages, travel with companion, sit near doors or exits Not common until late adolescence (1% general population), very rare before puberty Often incorrectly diagnosed in children

18 Obsessive-Compulsive Disorder I ll get germs and be sick... Obsessions - recurrent, persistent, ideas, thoughts, images that are intrusive, regarded as senseless or repugnant Dirt and infection, fear something terrible will happen, disease, death, symmetry or exactness, repugnant (sexual, religious thoughts, harming oneself or others) Compulsions relieves distress, repetitive, seemingly purposeful actions performed according to rules, to produce or prevent some further event or situation, mental or observed

19 OBSESSION RELIEF DISTRESS COMPULSION

20 Acute & Post Traumatic Stress set of symptoms that develop following exposure to traumatic, physically threatening event, witnessed or experienced Individual reacted with intense fear, helplessness, or horror re-experience trauma; avoidance; and hyperarousal Relive or re-experience nightmares, upsetting memories, act as if trauma happening again, anxiety when reminded of trauma Acute < 3 months; Post > 3 months

21 Viewing The World as Dangerous thinking biases - more threatening interpretations of ambiguous situations overestimate likelihood of experiencing threatening events in future, overestimating risk thinking the worst, catastrophizing (children) magical feelings or thoughts assuming something will happen based on emotions or thoughts

22 The Anxiety Formula (Chansky, 2004) Overestimation of threat + Underestimation of ability to cope = ANXIOUS RESPONSE

23 Treatment Components for Anxiety My Body Relaxation training/mindfulness My Actions Alternate coping methods What happened? Recognize Anticipate Modify My Emotions Exposure My Thoughts Address anxious thoughts & beliefs

24 Six Families of Deep Relaxation Smith (2005) Physical Yoga stretching Progressive Muscle Relaxation (PMR) Breathing exercises Mental Autogenic suggestion Imagery or visualization & relaxing self-talk Mindfulness

25 Realistic Thinking looking at all aspects of a situation (the positive, the negative, and the neutral) before making conclusions Ask yourself What am I thinking right now? What is making me feel anxious? What am I worried will happen? What bad thing do I expect to happen?

26 Examples of Anxious Thoughts What if I can t do it? I m going to die of a heart attack! People are going to laugh at me if I mess up during the presentation. I m going to go crazy if I can t stop feeling so anxious. What if something bad happens to my child?

27 Questions to Help with Realistic Thoughts 1. Am I falling into a thinking trap (e.g., thinking worst or overestimating danger)? 2. What is the evidence that this thought is true? What is the evidence that this thought is not true? 3. Have I confused a thought with a fact? 4. What would I tell a friend if he/she had the same thought? 5. What would a friend say about my thought? 6. Am I 100% sure that will happen? 7. How many times has happened before?

28 Questions to Help with Realistic Thoughts cont d 8. Is so important that my future depends on it? 9. What is the worst that could happen? 10. If it did happen, what can I do to cope with or handle it? 11. Is my judgment based on the way I feel instead of facts? 12. Am I confusing possibility with certainty? It may be possible, but is it likely? 13. Is this a hassle or truly a horrendous problem? 14. Is there a more rational way of looking at this situation?

29 Create and Use Coping or Realistic Statements People cannot tell when I am feeling anxious, This has happened before and I know how to handle it. There is a chance that I might not do well in tomorrow s interview, but not performing perfectly on a job interview doesn t mean I won t get the job. Even if I don t get this job, it doesn t mean I will never get a job. I have always been able to find work.

30 Realistic Thinking Example Anxious thought (just after a conversation with an attractive looking person) He or she didn t like me. I didn t know what to talk about. I m such a loser. A second look

31 The Arousal Curve Anxiety event Time

32 Exposure Strategies fears faced gradually, slightly difficult to most difficult anxiety exposure encourage coping strategies to prolong remaining in situation practice and repetition critical Individual learns situation is not threatening parental involvement critical for children specific skills needed to design exposures for target anxiety (e.g. OCD, Social Phobia)

33 Brenda s Exposure Hierarchy to feel more comfortable eating in public Coffee with co-worker on break Go for coffee after movie with girlfriends Eat lunch at A&W with friends Eat dinner with date at casual restaurant Eat dinner at staff Christmas party Attend friend s wedding reception Eat dinner at nice restaurant with date

34 Parent Responses Hirschfield-Becker, D. (2006). Being Brave Program Unhelpful Oh-no reaction Tensing Reaction Escape or avoidance Reassurance seeking Helpful Ho-hum response Relaxation Practice staying in situation Active coping

35 Parental Involvement Principles 1. Basic anxiety management skills 2. Helpful vs. unhelpful approaches 3. Gradual exposure ideas 4. Optimistic, coping attitude 5. Relapse prevention ideas I m a coping coach!

36 Seeking Appropriate Help Self-help books; websites 211 community resource number, (780) outside Edmonton Mental health East Edmonton (780) Northgate Clinic (780) Northeast Health Centre (780) Leduc, Sherwood Park, St. Albert, Spruce Grove

37 Online Resources Comprehensive website about anxiety information, self-help ideas, and when to seek help for adults, parents, and teens Anxiety Disorders of America for information and treatment of child, adolescent, and adult anxiety issues

38 Seeking Appropriate Help Family Physicians Psychiatrists Private Psychologists - Psychologists Association of Alberta online referral search Community Agencies - The Family Centre - Cornerstone Counselling - Catholic Social Services

39 Further Reading Discussion Thank you