Anxiety Session Anxiety Session

BRIDGES ProgramBRIDGES Program

Stephanie Mealey MSW, RSWStephanie Mealey MSW, RSW

Karen Mackey OT (R) NLKaren Mackey OT (R) NL

Anxiety Anxiety

Statistics Vary….Statistics Vary…. Anxiety disorders are the most common of all mental Anxiety disorders are the most common of all mental

health problems, affecting approximately 1 in 10 health problems, affecting approximately 1 in 10 people. (Canadian Mental Health Association)people. (Canadian Mental Health Association)

Most common, chronic costly emotional disorder in Most common, chronic costly emotional disorder in the US (NIMH) and in 10 -17 countries (WHO)the US (NIMH) and in 10 -17 countries (WHO)

Practice evidence-BY FAR the most common mental Practice evidence-BY FAR the most common mental health referral to Central Intakehealth referral to Central Intake

Why the increase????Why the increase????

Increased awareness about anxietyIncreased awareness about anxiety

Lifestyles “bigger…better…faster…Lifestyles “bigger…better…faster…smarter…”smarter…”

Lack of skill buildingLack of skill building (modeling, integrating, naturally occurring)(modeling, integrating, naturally occurring)

World MessagesWorld Messages Economy, illness, threatsEconomy, illness, threats

Pathologizing normal stressPathologizing normal stress

Anxiety IS NORMAL Anxiety IS NORMAL Anxiety is normal and needed. Anxiety is normal and needed.

It serves as a natural alarm system that tells us there is It serves as a natural alarm system that tells us there is danger. danger.

Some people have sensitive alarm systems.Some people have sensitive alarm systems.

It helps us survive!It helps us survive!

Anxiety – Not all Bad!Anxiety – Not all Bad!

LiabilitiesLiabilities Higher levels of stressHigher levels of stress Personalizes Personalizes Easily exploited Easily exploited Difficulty setting Difficulty setting

limits/saying nolimits/saying no Excessive time spent Excessive time spent

doing or thinking about doing or thinking about taskstasks

Consumed by thingsConsumed by things

AssetsAssets CooperativeCooperative Motivated/drivenMotivated/driven Thoughtful/reflectiveThoughtful/reflective OrganizedOrganized Sensitive/IntuitiveSensitive/Intuitive LoyalLoyal CreativeCreative

Development of AnxietyDevelopment of Anxiety

PredispositionBiological sensitivity

PersonalityTemperament

Stress (good or bad)

Learned Anxiety Lack of stress skills

“Treadmill of life”

ANXIETY!!

Continuum of AnxietyContinuum of Anxiety

Common Anxieties Common Anxieties 5 years - separation, dark, animals, “bad people”5 years - separation, dark, animals, “bad people” 6 years - separation, harsh weather, ghosts, dark, 6 years - separation, harsh weather, ghosts, dark,

sleeping alone, bodily injury (all ages)sleeping alone, bodily injury (all ages) 7-8 years - ghosts, dark, fears based on TV viewing, 7-8 years - ghosts, dark, fears based on TV viewing,

staying alone staying alone 9-12 years - tests, school performance, start of physical 9-12 years - tests, school performance, start of physical

appearance, deathappearance, death 13-15 years - family and home issues, world concerns, 13-15 years - family and home issues, world concerns,

preparation for the future, personal appearance, social preparation for the future, personal appearance, social relationsrelations

Older - fear of isolation, natural events, sexual issues, Older - fear of isolation, natural events, sexual issues, economic issues, morality economic issues, morality

Taken from “The Worried Child.”

Effects of Anxiety Effects of Anxiety Physical Feelings

(Body)Muscle tensionRacing heart

Belly painNausea

Head ache Sweating

BehaviorAvoid/Escape/Flight

Disruptive or pressured behavior/fightFreeze

Seeking reassurance

Thoughts(Brain)What if…?

Thinking the worst

Anxiety ReactionsAnxiety Reactions

FlightFlight

AvoidanceAvoidance Tummy aches & Tummy aches &

painspains QuittingQuitting

LyingLying

FightFight

BehaviorBehavior Refusal Refusal Extreme Extreme

persistencepersistence PerfectionismPerfectionism Self-imposed Self-imposed

pressurepressure

FreezeFreeze

IndecisionIndecision

InactionInaction

When does it become a disorder...When does it become a disorder...

Distress or interference is much Distress or interference is much greater than anxiety experienced greater than anxiety experienced by other children of the same by other children of the same age age

When it interferes with daily When it interferes with daily functioning/causes impairmentfunctioning/causes impairment

When it is persistent When it is persistent When accommodations are When accommodations are

always necessaryalways necessary

When a kid just can’t be a kid!!!!

Why my child? Why my child?

The Perfect Storm

The TeenageBrain

Frontal lobe restructuredself-control, judgment, emotional regulation

AnxietyPredisposition, Temperament

Biological Sensitivity

Adolescent Stress Factors

DrugsSocial appraisal Belonging to a groupGetting good grades

The PerfectStorm

The PerfectStorm

Brain Brain

http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/view/

TreatmentTreatment

Insight and AwarenessGetting to know Anxiety

Insight and AwarenessGetting to know Anxiety

Skill Building Learning skills to mastery

symptoms

Skill Building Learning skills to mastery

symptoms

PracticeFacing Fears & Using skills

Language we use…Language we use…

Mastering anxietyMastering anxiety

Getting in charge Getting in charge

Turning the volume down Turning the volume down

Riding the waveRiding the wave

Building emotional muscle Building emotional muscle

Don’t Pathologize! Don’t Pathologize!

BRAIN-TargetsBRAIN-Targets

Beliefs about anxietyBeliefs about anxiety

Racing thoughts Racing thoughts “can’t turn the brain off”“can’t turn the brain off”

Negative self-talkNegative self-talk

Recurring thoughts or imagesRecurring thoughts or images

Brain-StrategiesBrain-Strategies

Education about anxietyEducation about anxiety

Awareness of factors influencing anxietyAwareness of factors influencing anxiety

Highlight assets (powerful thinker)Highlight assets (powerful thinker)

Awareness of Attention Awareness of Attention

Examine & challenge thoughtsExamine & challenge thoughts

Replace with more positive/realistic or less Replace with more positive/realistic or less anxious self-talkanxious self-talk

Scale Your Anxiety

1 2 3 4 5 6 7 8 9 10

Things that make my anxiety go

up the scale……

Things that make my anxiety

go down the scale……

I nvestigate what things influence your anxiety positively

or negatively……

Brain- Awareness Brain- Awareness

• Power of AttentionPower of Attention Our brains are powerfulOur brains are powerful What we choose to focus What we choose to focus

on will influence how we on will influence how we feelfeel

By being focused on our By being focused on our worries, we may miss worries, we may miss thingsthings

• Direction of AttentionDirection of Attention

• Biologically we are velcro for Biologically we are velcro for negative thoughts; teflon for negative thoughts; teflon for positivepositive

• Learning to direct our Learning to direct our attentionattention

We Blame Events We Blame Events

EVENTSTrying out for a team

Speaking in publicGoing to School

EVENTSTrying out for a team

Speaking in publicGoing to School

FEELINGSAnxiety Stressed Nervous

FEELINGSAnxiety Stressed Nervous

Thought Investigation and Thought Investigation and ChallengeChallenge

Ideas for helping…Ideas for helping…

Model positive/realistic ThinkingModel positive/realistic Thinking

Highlight the strengths of being an Highlight the strengths of being an powerful thinkerpowerful thinker

Help them use skills Help them use skills scaling scaling highlight positive/more realistic thinking highlight positive/more realistic thinking Help them scrutinize their thoughtsHelp them scrutinize their thoughts

Body Body

How your body reacts…How your body reacts…

Body - TargetsBody - Targets

The Basic (Sleep, Diet & Exercise)The Basic (Sleep, Diet & Exercise)

Body sensations Body sensations Muscle tensionMuscle tension Heart palpitations, SOB, dizziness, nausea, Heart palpitations, SOB, dizziness, nausea,

vomiting vomiting Inability to relax Inability to relax

Body Strategies Body Strategies

Create awareness of body stressCreate awareness of body stress

Learn relaxation skillsLearn relaxation skills

Highlight things that help you to relax Highlight things that help you to relax

Encourage proper care of the body Encourage proper care of the body (sleep, diet, exercise) (sleep, diet, exercise)

Body- The BasicsBody- The Basics

Back to the Basics

Fueling your Body

Eating right will help arm you to deal with any

stress or anxiety.

Are you giving your body what it needs?

Are you eating right?

Are you eating regularly?

Sleep Habits- Good or Bad?

Do you go to sleep at the same time most nights?

I s your sleep space reserved for sleeping only or is it

where you hang out all day?

Do you have a routine way to prepare f or bed?

Do you power down all the electronics (TV, cell phone,

gaming systems, lap top) an hour before bed?

Are you Keeping Active?

Do you take time daily to work out or are you more

of a couch potato?

I s most of your day spent doing non-physical

activities?

I s staying active important to you?

1…2...3...4...5...6...7...8...9...10

1…2...3...4...5...6...7...8...9...10

1…2...3...4...5...6...7...8...9...10

BRIDGES Program, Eastern Health 2013

Body Mapping Body Mapping

Body – Relaxation Body – Relaxation

Back to the Basics (Sleep, Diet, Exercise)Back to the Basics (Sleep, Diet, Exercise)

Play Detective- what already works Play Detective- what already works

Relaxation SkillsRelaxation SkillsVisualization, progressive muscle relaxation, deep Visualization, progressive muscle relaxation, deep breathing etc. breathing etc.

Ideas for helping…Ideas for helping…

Model Positive Self CareModel Positive Self Care

Encourage care of the basicsEncourage care of the basics

Help them use skills Help them use skills Remind them of their skills to relax Remind them of their skills to relax Provide an opportunity for them to practiceProvide an opportunity for them to practice Promote a relaxing environment at homePromote a relaxing environment at home

Behavior Behavior

What we do …What we do …

How we respond….How we respond….

Behavior Targets Behavior Targets

AvoidanceAvoidance

Emotional Outbursts Emotional Outbursts

Excessively Seeking Reassurance Excessively Seeking Reassurance

Behaviors Strategies Behaviors Strategies

Build Emotional MuscleBuild Emotional Muscle

Exposure & Habituation Exposure & Habituation

Additional Coping SkillsAdditional Coping SkillsAssertivenessAssertiveness

Time ManagementTime Management

Social SkillsSocial Skills

Problem Solving etc. Problem Solving etc.

Let’s ride the wave of anxiety& Build emotional Muscle

PRACTICE!!!!!!!!!!!PRACTICE!!!!!!!!!!!

Ideas for helping…Ideas for helping…

Model brave behavior Model brave behavior

Encourage approach behaviorsEncourage approach behaviors

Help develop exposure plansHelp develop exposure plans

Make exposure part of learning Make exposure part of learning

Tips for SupportersTips for Supporters

Listen to the teen & don’t minimizeListen to the teen & don’t minimize

Reduce stress Reduce stress

Have routines Have routines

Normalize anxiety & use age appropriate Normalize anxiety & use age appropriate language language

Model brave behavior Model brave behavior

Model problem solving skills, stress Model problem solving skills, stress management & relaxation management & relaxation

Tips for SupportersTips for Supporters

Avoid excessive reassurance Avoid excessive reassurance

Be mindful of your own reactions Be mindful of your own reactions

Realistic expectations, small stepsRealistic expectations, small steps

Give appropriate consequences Give appropriate consequences

Build self-confidenceBuild self-confidence

Encourage independenceEncourage independence

PRAISE!!!!PRAISE!!!!

You are helping them build skills to master their anxiety!

ResourcesResourcesThe The Responsive ClassroomResponsive Classroom approach is a widely used, research-approach is a widely used, research-backed approach to elementary education that increases academic backed approach to elementary education that increases academic achievement, decreases problem behaviors, improves social skills, achievement, decreases problem behaviors, improves social skills, and leads to more high-quality instruction. and leads to more high-quality instruction. (responsiveclassroom.org)(responsiveclassroom.org)

The FRIENDS program is a school-based anxiety prevention and The FRIENDS program is a school-based anxiety prevention and resiliency skill-building program. BC sponsored by the Ministry of resiliency skill-building program. BC sponsored by the Ministry of Children and Family Development (friendsinfo.net)Children and Family Development (friendsinfo.net)

MindMasters, Mini Mindmasters- Eastern OntarioMindMasters, Mini Mindmasters- Eastern Ontario

BC Anxiety WebsiteBC Anxiety Website

Skills for Life Skills for Life

Referral to Central Intake (local mental services) Referral to Central Intake (local mental services)

QUESTIONS????QUESTIONS????