Transcript Supporting Students with Anxiety Disorders

SUPPORTING STUDENTS
WITH ANXIETY DISORDERS
Myque Harris, MS, LCPC
Tennessee State University
Loyola University, 2005
Licensed Clinical Psychotherapist, 2007
Psychiatry Clinic, Private practice,
School based mental health
VIDEO: IN THEIR OWN WORDS...
 http://www.youtube.com/watch?v=4VbxjsO9IYI&feature=colike
 http://youtu.be/Rcy2jF1EXjk
 Cleansing Breath
 Today we will talk about Anxiety and ADHD with a primary focus on
anxiety.
 Discuss inattention/impulsivity and acknowledge possible root in anxiety or
ADHD
ANXIETY
 Anxiety is the most common, chronic, costly emotional disorder in the
U.S. (NIHM) for both Children and Adults
 25% of Adults
 Children age 8 (25.7%); Age 17 (21.4%)
•
Women vs. Men
 More likely to affect females (Social Anxiety is equal)
 Comorbid with Depression and ADHD
 GAD and depression more common
 Why? BOTH Nature (40%) AND Nurture (60%) play a part – 3 main
ingredients
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3 INGREDIENTS IN ANXIETY
 Biological Sensitivity
 Research in infants shows biological sensitivity from birth; Over
sensitive to stimuli (sounds, odor, touch)
 Temperament can be ID as early as 4 months to show which
babies will be more likely to have anxiety
 Stress Overload
 Correlation between Stress and Anxiety
 School months verses summer months
 Personality Traits
 People with Anxiety have similar traits – Further look…Next slide...
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ANXIETY DISORDERS – DSM-IV
 General Anxiety Disorder
 Separation Anxiety
 Obsessive Compulsive Disorder
 Obsession: intrusive thoughts or images, associated with negative feelings
 Compulsion: Ritualized behavior, checking, counting, hoarding
 Panic Disorder
 Overanxious Disorder
 Social Anxiety Disorder
 Phobias
 Post Traumatic Stress Disorder (PTSD)
 Anxiety due to medical issues (allergies, Crohn’s)
 Obsessive Personality Disorder (Personality Disorder vs. an Anxiety disorder)
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WHAT IS ADHD?
 The inability to maintain focus and
manage internal (thoughts) and
external (noise) distractions;
organize, sequence and make
things happen, inhibit impulses and
issues in some memory function.
 Types of ADHD
 Predominately Inattentive (ADD)
 Predominately Hyperactive-
Impulsive
 Combined type
 ADHD NOS
 6 symptoms, 6 months, 2 or
more settings
 Before the age of 7 years
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• There is a breakdown in the area of attention
• This
breakdown prevents complete and
accurate
processing
of
information,
comprehension, and recall
Attention
Processing
Comprehension
Memory
Barrie Morganstein, Ph.D. & Trey Ishee, Psy.D.
DIFFERENTIAL DIAGNOSES
Anxiety –
• Stress and worry can also cause poor attention and distractibility prevents
information from accurately and completely entering the brain.
• Anxiety and low self-esteem can also cause children to hesitate in
responding which can look like comprehension difficulties or verbal apraxia.
ANXIETY
• Anxiety can also cause breakdowns in the areas of
attention and processing, but can also cause
breakdowns further along the process and disrupt
communication in a variety of ways
Attention
Processing
Comprehension
Memory
BRAIN PARTS AND FUNCTIONS
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BRAIN STRUCTURES
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YOUR BRAIN ON ANXIETY
Model of the brain
Functions
 Brainstem:


Connects to the spinal chord

Heart rate, breathing, sleeping, eating
Cortex:



Pre frontal lobes:

Logic, fore thought, planning, mindful choices

Fully develops in our 20s
Limbic Region:


Multi-layered, complex
Emotion, behavior, motivation, long term memory,
olfaction
Amygdala:

Part of the limbic system

Processes strong emotional, such as fear, anger, anxiety

Acts as a smoke alarm

MYQUE HARRIS, MS, LCPC
Alarm System – Next slide for visual
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EMOTIONAL HIJACKING!
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NEURAL STATIC AND IMPRINTING
 Neural Static
 Brainstem and limbic system hijack the brain and body (fight, flight
or freeze) and temporarily create “static” in the brain that inhibits
the brain from functioning
 We are not (literally) thinking clearly and using all of our resources
 Imprint neural firing patterns
 Similar situations, “Alarm systems” warns us, but makes errors –
Values speed over accuracy
 Hebbs’s axiom: Neurons that fire together wire together
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EXPLICIT AND IMPLICIT MEMORY
 Explicit (Aware) and Implicit (Unaware) Memory
 These memories affect and influence future experiences
 WOMEN’S BUG STORY
 Fearful memories are attached to an/a:
1.
Informational component (“Nobody likes me!”; “I’m not smart
enough to do math!”)
2.
Energy/Emotional component (Helplessness, sadness, confusion)
3.
Negative conclusion or message about self (“I’ll never have
friends; I will fail math and there is nothing I can do about it.”)
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THE “ALARM SYSTEM”
 Jobs:
 Imprints experiences in which we have felt at risk so we
can be alerted to similar experiences in the future.
*Note: Usually in childhood these experiences are perceived as very
intense because of the vulnerability, naivety and lack of experience of
children.
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PERSONALITY TRAITS
COMMON TO ANXIOUS STUDENTS
 Looks like a model student?
 Positive
 Responsible
 Cooperative
 Prefers structure
 Motivated Student
 Likes to please
 Avoids conflict
 Perfectionism
 Worry
 Difficulty relaxing
 Low assertiveness
MYQUE HARRIS, MS, LCPC
 Thoughtful/Reflective
 Negative
 Higher Stress/Anxiety levels
 Personalizes – makes things about
them
 Easily exploited
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TYPICAL WORRIES, AGES 7-15
 School performance
 Appearance
 Social Acceptance
 Peer relationships
 Death of a parent
 Global/Societal Issues
 Violence, hunger, poverty,
economy
 Refer to Developmental
handout
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HOME
 Major transitions (i.e. moving)
 Divorce of parents
 Parents Illness
 Unstable Parent (Mood, lack of presence, etc.)
 Inconsistent home structure
 Families create anxiety in children
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SCHOOL RELATED ANXIETIES
 Text Anxiety – a specific phobia (Handout)
 Symptoms
 Excessive or unusual fear, tension, apprehension, somatic
arousal.
 Can occur before, during or after exam
 Concentration, problem solving and creative thinking are
affected.
 Associated with some major concern about performance
 Fear of Anxiety symptoms
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FEAR OF ANXIETY SYMPTOMS
 Students can have anxiety
about have anxiety
 Fear of embarrassment
 Fear of losing control
 “I don’t know what’s
wrong!”
 Teary; embarrassed
 Cycle created
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Somatization
Internalizing Anxiety
These issues can be real or
imagined. Many anxious students
develop real health issues
because of how they internalize
their anxiety.
MYQUE HARRIS, MS, LCPC
 Gastrointestinal (GI) Issues
 Headaches
 Aches and Pains
 Wrist and knee braces
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Supporting children and
families dealing with
anxiety…
WE CAN HELP!!!
Children can…
• Learn new patterns
• Develop new coping skills
• Understand new concepts
• Change patterns in thinking
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THERAPY: STUDENTS AND FAMILIES
Sales
Client 40%
Therapist's Expectation 15%
15%
15%
Relationship 30%
Therapist's Technique 15%
40%
30%
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COUNSELING TECHNIQUES
Counseling
 Cognitive Behavior Therapy






(CBT)
Rational Emotive Behavior
Therapy (REBT)
Talk Therapy
Play Therapy
Art Therapy
In-Vivo (exposure) Therapy
Mindfulness
MYQUE HARRIS, MS, LCPC
Other
 Medication
 Food restrictions
 Reducing caffeine
 Supplements
 Relaxation and Breathing
Techniques
 Sleep hygiene
 Nutrition
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HOW PARENTS/TEACHERS CAN HELP…
 Recognize signs of a possibly anxious child/student
 Equip that child/student with skills they can use at home or in the classroom
or in social situations (Stop-Think- Reflect-Choose)
 Make accommodations when needed (Tell child/students what will happen
on a trip, the morning of the outing…)
 Communicate with teachers/parents about observations
 Help students understand how to recognize a different perspective
 Integrate specific techniques into your home or classroom routine
(Breathing, reflecting, relaxation)
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HOW PARENTS/TEACHERS CAN HELP…
Parents/Teachers can…
FEAR THERMOMETER
 Listen to the students
9 – I can’t take it!
7 – I’m very uneasy
5 – I’m a little uneasy


1- I’m “A” Ok!



MYQUE HARRIS, MS, LCPC
perspective or send them to an
adult who has the time to listen
MO – rate their feeling, ask why
5?
Catch it early: Use techniques to
calm kids before they cross over
Feeling vocabulary
Help kids understand where they
feel their feelings in their bodies
Talk therapy can be free!!!! Use it
at home or in school!!!
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TECHNIQUES
 3’s – Signals, Source, Solutions/Skills
 Stop-Breath-Reflect-Choose
 Worry Box
 Worry Time
 Breathing
 In and out through nose (Para sympathetic nervous system)
 Managing Test Anxiety (or specific subject, Math)
 Relaxation Techniques (Progressive muscle relaxation)
 Redirect thinking – Mini CBT
 FAFL – Face, Accept, Float, Let time pass…
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RELAXATION TECHNIQUES
 Music
 Breathing
 Nostril breathing
 Belly breathing
 Stillness
 Practice being still, increase time
 Meditation, Chanting
 Physical practice
 Yoga
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PROGRAMS
 Life Skills Program for Anxiety in Kids
 Reduce stress (adjust schedules, Time management Skills
 Adjusting parenting and home structure
 Sleep Hygiene
 Feelings support work
 Having reasonable goals (At School and Home)
 Relaxation Techniques
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YAY! PROGRESS
More Relaxed
Less worry
Increased positive outlook
Higher self esteem
Risk tolerance is higher
Better social skills
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QUESTIONS
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REFERENCES
 Foxman, P. The Worried Child: Recognizing Anxiety in Children
and Helping Them Heal, 2007
 Fralich, Terry, Cultivating Lasting Happiness: A 7-Step Guide to
Mindfulness, 2007
 Diagnostic and Statistical Manual of Mental Health Disorders,
Fourth Edition
 National Inst. Of Mental Health
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