anxiety and selective mutism in youth workshop

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Anxiety and Selective Mutism in Youth Workshop. Dr. Alissa Pencer Registered Psychologist. Outline. Part I: Anxiety Disorders in Youth Part II: Selective Mutism Part I: Anxiety Disorders in Youth When is anxiety a problem? Prevalence and course Common Anxiety Disorders Causes - PowerPoint PPT Presentation

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  • Anxiety and Selective Mutism in Youth Workshop Dr. Alissa PencerRegistered Psychologist

    A. Pencer October 2012

  • OutlinePart I: Anxiety Disorders in YouthPart II: Selective Mutism

    Part I: Anxiety Disorders in YouthWhen is anxiety a problem?Prevalence and courseCommon Anxiety DisordersCausesCognitive Behaviour Therapy for Anxiety DisordersRealistic ThinkingExposureCase Examples and Group Exercises

    A. Pencer October 2012

  • Fear, Anxiety, and WorryEveryone worries, everyone gets anxious and everyone is afraid of something. Very young children are often fearful of strangers, the dark, animals and insects.Older children and adolescents are often fearful of peer rejection and are more self-conscious and strive to fit in with their peers. Adults often worry about public speaking.

    A. Pencer October 2012

  • A. Pencer October 2012

  • When is Anxiety A Problem?Most children, adolescents and adults use anxiety to help them make good decisions, e.g., looking both ways before you cross the street, putting on your seatbelt, setting your alarm so you arent late, studying for tests, budgeting time to complete assignments. Anxiety becomes a problem when it makes the decisions for you, interferes with your life and/or causes significant distress.

    A. Pencer October 2012

  • Inverted U-Shaped Relationship Between Arousal and PerformanceHebb, D. O. (1955). Psychological Review, 62, 243-254

    A. Pencer October 2012

  • ExamplesNot being able to join extracurricular activities.Not being able to speak in front of the class.Not handing an assignment in because not perfect.Not being able to go to school because overwhelming.Washing your hands 30 times a day.

    A. Pencer October 2012

  • How Common are Anxiety Disorders?Anxiety disorders are the most common psychological problem found in children and adolescents.Approximately 1 in 10 youth meets the criteria for an anxiety disorder.Despite this, often mental health centres see more children with aggressive difficulties, attentional problems, eating disorders, or suicidal tendencies.

    A. Pencer October 2012

  • 6 Month Prevalence Rates of Mental or Addictive Disorders in Children 4-17 %Anxiety Disorders7ADHD5Conduct Disorder4Mood Disorders 4Substance Use Disorders1Any Disorder 14Waddell et al, Can J Psychiatry, 2002

    A. Pencer October 2012

  • How Does Anxiety Effect Youth?Anxious youth tend to have: Fewer friendsDifficulty meeting new people, joining clubs and groupsAcademic problems because they avoid homework, dont make full use of the resources, and have difficulties concentrating because they worrySchool avoidance

    A. Pencer October 2012

  • Long termIn the long term, anxious without treatment have: Restricted choices in terms of opportunities for careersLower self esteemIncreased likelihood of becoming an anxious and/or depressed adult

    A. Pencer October 2012

  • What Does Anxiety in Youth Look Like?No two anxious youth will behave exactly the same way, nor will they worry about the exact same things.However, there are common anxiety patterns which roughly translate into the anxiety disorders.

    A. Pencer October 2012

  • What is an Anxiety Disorder?Interfering with daily activitiesCausing significant distressReaction is too extreme for the situationTrigger is not an actual threat

    A. Pencer October 2012

  • Anxiety DisordersSeparation Anxiety Disorder: separation from caregivers and concern bad things will happen to themGeneralized Anxiety Disorder: worry excessively about many areas of life functioning (e.g., school work, family, friends, health)Social Phobia: fearful of social or performance situations

    A. Pencer October 2012

  • Anxiety Disorders contdSpecific Phobia: fear of particular objects or situationsPanic Disorder: misinterpret bodily changes and have a fear of losing controlObsessive Compulsive Disorder: the presence of intrusive repetitive thoughts or behaviors

    A. Pencer October 2012

  • Causes & Treatment

    A. Pencer October 2012

  • What Causes Anxiety Disorders?GeneticsAnxiety runs in familiesCommon for at least one parent to be somewhat anxious Research has shown that what is passed on from parent to child is not a specific tendency to be shy or worry but a general personality to be more emotionally sensitive than other people.

    A. Pencer October 2012

  • What causes anxiety disorders?Parent ReactionParent reactions or the way they handle their child or teens anxious behaviour might also play a role (e.g., being over-protective).ModelingChildren and adolescents copy their parents coping strategies (e.g., avoiding fearful situations).StressorsBit by a dog, death of a loved one, being bullied, getting sick

    A. Pencer October 2012

  • Interventions that HelpPsycho educationTreatment:Group CBT for youth and parentsIndividual CBTMedication

    A. Pencer October 2012

  • Evidence for CBT in Anxiety Disorder TreatmentIndividual CBT (Kendall,1994 and 1997)Study 1: 64% of treatment group no longer with dxStudy 2: 71% of treatment group no longer with dxResults in both studies maintained at 1 yearAt 7 years post-treatment, anxiety disorder no longer primary in 92% of youth

    Up to 84% no longer have dx if parent component added (Barrett et al., 1996)

    Individual vs. Group CBT(Manassis et al, 2002; Rapee, 2000)Group CBT as effective as Individual CBT

    A. Pencer October 2012

  • Three Components of AnxietyFeeling (Physiological)Cognitive (Thoughts)Doing (Behaviors)

    A. Pencer October 2012

  • Physiological Component

    A. Pencer October 2012

  • A. Pencer October 2012

  • Anxiety and the BrainLimbic System-scans all sensory input, flight/fightresponse, integrates memory, emotionPrefrontal Cortex - decision making, planning, emotion regulationLocus coeruleusAlarm system:sympathetic nervous system activation

    A. Pencer October 2012

  • Fight-Flight ResponseIn fearful situations teens become pumped up or aroused. This is the fight-flight response.Immediate or short-term anxiety is named the fight-flight response. Its the bodys way of protecting you from danger.The fight-flight response causes you to sweat, increase heart rate, tense muscles, make you breath faster, feel hot or cold, dry mouth, and feel lightheaded or dizzy.

    A. Pencer October 2012

  • Fight Or Flight?

    A. Pencer October 2012

  • In youth with anxiety disorders, the fight-flight response occurs when there is no immediate danger, but instead a perceived danger. Being in a classroom filled with other studentsUsing a restroom at schoolGoing to the cafeteria Doing a presentationHaving your heart raceParagraph you just wrote is just not right

    A. Pencer October 2012

  • Cognitive Component

    A. Pencer October 2012

  • Examples (Cognitive)Anxious children and teens have thoughts that center around harm or threat.I cant leave to go to school and be away from my mom or something bad will happen to her. (Separation)I cant do this presentation because my classmates will think Im dumb. (Social)If I dont check the back door lock, someone will break in. (OCD/GAD)

    A. Pencer October 2012

  • Behavioral Component

    A. Pencer October 2012

  • Anxious behavioursAnxious children and teens often behave differently:They pace, fidget, cry, cling, shake.They avoid.Refusing to go somewhere aloneRefusing to go to schoolThey seek reassurance.Am I going to die?Am I going to fail?Is everyone going to laugh at me?

    A. Pencer October 2012

  • Core Components of CBT

    Realistic Thinking/Cognitive RestructuringExposure **Skills Training (e.g., deep breathing and relaxation, problem solving, social skills, assertiveness, stress management)

    A. Pencer October 2012

  • Thinking ErrorsAnxious children overestimate how likely it is that an unpleasant event will happen.They overestimate how bad the consequences will be if the event does happen. They underestimate their ability to cope with the anxiety and the unpleasant event

    A. Pencer October 2012

  • Realistic ThinkingEventThought/Belief EmotionParent is latethere has been a crashworry,anxietyParent is latestuck in trafficannoyanceParent is latestopped to get pizzahappy

    A. Pencer October 2012

  • Steps in Realistic/Detective Thinking1) Identify the situation that is making you worried2) Identify the worried thought3) Look for Realistic Evidence to challenge your worried thought4) Look for alternative outcomes5) Identify a more realistic thought

    A. Pencer October 2012

  • Questions for collecting evidenceWhat is the evidence that this thought is true? What is the evidence that this thought is not true?What would I tell a friend if he/she had the same thought?Am I 100% sure that ___________will happen?How many times has __________happened before? What was the outcome?What is the worst that could happen? What is likely to happen?If it did happen, what can I do to cope with or handle it?Am I confusing possibility with certainty? It may be possible, but is it likely?

    A. Pencer October 2012

  • A. Pencer October 2012

  • ExposureBy avoiding, children minimize direct and prolonged contact with feared situations.Anxious children have no opportunity to learn that the situation is harmless.

    A. Pencer October 2012

  • ABTimeHighLowAnxietyFirst timeSecond time if removed at point B Second time if taken out of situation

    A. Pencer October 2012

  • Fighting Fear by Facing Fear

    The Keys to Stepladders: gradual (start low on anxiety thermometer)stay in step lo

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