Helping Adolescents Cope with Anxiety and Stress During High School January 7, 2014 Jonathan Dalton, Ph.D.

Center for Anxiety and Behavioral Change

Why this is so important Children and Adolescents    Median age of onset 11 – earliest of all forms of psychopathology  8 % of children between ages 13 and 18 currently have an anxiety disorder  25% will have an anxiety disorder between the ages of 13 and 18 5.9% will have “ severe ” anxiety disorder Only 18 % of these teens receive treatment

Adults   28.8 percent lifetime prevalence Most common category of mental health disorders  18 % of adults currently have an anxiety disorder (40 million)  $42 billion in annual health costs

Treatment Works!

“ Ultimately we know deeply that on the other side of every fear is freedom ” – Marilyn Ferguson  Treatment success rates for anxiety disorders with CBT (exposure therapy) range from 60% to 90%  Tragically low utilization rates (18% compared with 79% for ADHD)

When Does Anxiety Become Disordered?

 Distress  Avoidance  Interference  Functional Impairment

Fear, Anxiety, and Stress  Anxiety: Future-oriented “ diffuse apprehension ”  Fear: Present-oriented defensive response to observable threat  Stress: Perceived environmental demands exceed one’s perceived ability to meet them

Three Pillars of Anxiety  Uncertainty  Lack of control  Perception of danger

Anxiety Reduction  Education  Cognitive Reframing  Behavior Change

Basic Template for the Treatment of Anxiety Disorders in Teens       Assessment Psychoeducation Cognitive Reappraisal Strategies Exposure Parent Training Relapse Prevention

Cognitive Reappraisal of Anxious Arousal “ Don ’ t believe everything you think!

”     Body is doing the right thing at the wrong time Perspective of “ curious observer ” “ In this moment… ” Metaphor of fire alarm

Cognitive Strategies “ Why don ’ t the palm trees care when the wind blows?

”     Coping cards Mindfulness training Problem-solving skills training Cognitive flexibility exercises

Coping Cards “ Just because I ’ m scared… ”  I am stronger than my fear  Scary thoughts can never hurt me  I know I can do this because…  The presence of a thought is not evidence to support it     Just because I ’ m scared doesn ’ t mean I can ’ t do it It ’ s ok to be scared Just do it anyway Anxiety is temporary and harmless

Decreasing Avoidance “ Urges do not dictate actions.

”     Metacognitive awareness of urge to avoid or escape “ Swatting butterflies ” Rehearsal of self-instruction Building distress tolerance

Fear Reduction Through Behavior Change “ Courage is what you do, not what you feel ”  Exposure to the feared situation in the absence of the feared consequence produces fear reduction  Exposure can be conducted in a variety of manners, but exposure always remains the “ active ingredient ” (e.g., acetaminophen comes in tablets, caplets, gelcaps, etc.)

Three Critical Variables for Habituation to Occur (Successful Exposure)  Frequency  Intensity  Duration

Psychoeducation for Parents “ Fear and Avoidance are Teammates ”  Parent-training is paramount!

 Begin with education regarding the negative reinforcement of anxious behavior  “ Protection Trap ”

Parent Training “ Water the seeds, not the weeds.

” Essential for treatment  Focus on “ loving firmness ” (kite metaphor)  Metaphor of flight attendant during turbulence

Nuts and Bolts “ Your attention is your child ’ s paycheck, so be exceptionally careful what you pay him/her for ”        Functional analysis Positive reinforcement Negative reinforcement Coercive behavior cycle Extinction Extinction Burst Habituation

scene from Ray

Relapse Prevention    Problem-solving skills training Increase perceived social support Emphasis on continued self- directed exposure   Relaxation training Reframe potential recurrence of symptoms as opportunity for future learning  Increase self-efficacy to deal with future fears

Jonathan Dalton, Ph.D.

Center for Anxiety and Behavioral Change [email protected]

301-610-7850