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Exposure and Parental Involvement as a Key to Meaningful Progress for Student Anxiety
Megan M. Urbassik, Ph.D.
School Psychologist
Loudoun County Public Schools
Overview
– The session will include a description of a case study dealing with severe anxiety in a female elementary school student. Specifically, the success of using a scientifically informed school- and family-based cognitive-behavioral approach (i.e., the Cool Kids Program®) with a strong exposure component will be described. The criticality of parental involvement as an irreplaceable key to treatment success will be included.
Anxiety 101
Definitions
– Excessive fear about real or imaginary circumstances
– Symptoms can be either physical, behavioral, or cognitive
– Generally, anxiety is normal and adaptive– Huberty (2004)
– Anxiety disorders are the most common disorders among school-age children
– Fortunately, they are also the most treatable set of disorders
Symptoms of Anxiety
– Cognitive/Thoughts
– Difficulty concentrating, worrying, hypervigilance
– Behavioral
– Withdrawal, need for reassurance, habitual behaviors, crying
– Physical
– Heart rate, trembling, shortness of breath
Prevalence Rates
– Lifetime prevalence rate of any anxiety is over 15%
– For children, over 25% for general anxiety and over 8% for severe anxiety
– (Kessler et al., 2009; National Institute of Health, n.d.)
– 70-80% children who receive mental health services receive them in schools given the inadequacy or unavailability of outside mental health services
Thoughts
ActionsFeelings
Treatments
– Well-established treatments for anxiety – Cognitive Behavioral Therapy (CBT)
– Exposure
– Modeling
– Education
– CBT with parents
– CBT plus medication
– (Higa-McMillan et al., 2016; Sadock & Sadock, 2007)
School-Based Treatment
Overview
– Schools are often willing to help, but may not have the resources needed for students to make meaningful progress
– Schools are becoming de facto mental health providers – Providers often do things that are counterproductive to progress – Schools provide support that varies by school, and skillsets vary; however, the
support offered can be productive and help provide meaningful change – There are a variety of strategies, tools, and programs available to trained staff that
can assist in the treatment of students with anxiety in the school setting
– Meaningful growth is RARELY made without joint efforts from the professional and the parents (Dowell & Ogles, 2010)
Cool Kids® Program
– Based on the Coping Kids Program, Coping Koala, and Coping Cat– Research based intervention
– 80% of children who completed the program were diagnosis free or showed marked improvement
– Symptom reduction maintained for up to 6 years
– Better outcomes shown with parental involvement, especially in younger children
– Designed for children age 6 to 12 (a separate program is available for 13-17)
– Can be done in individual or group counseling
– (Lyneham, Abbott, Wignall, & Rapee, 2003)
Session Goals
– Learning about anxiety
– Thinking realistically – Detective Thinking
– Self-rewards and monitoring
– Fight fear by facing fear, fear hierarchy
– Exposure and Worry Surfing
– Skill building
– Maintaining the good and dealing with the bad
Case Study
Anna
Anna
– 7 year old, second grader
– Lives with mom, dad, and two sisters
– Types of fears she exhibited
– Illness, self and others
– Parental, especially dad, separation
– Trying new things (e.g., school work, pool, guitar)
– Special circumstances (e.g., St. Patrick’s Day, ear piercing)
Parent Intake Interview
– Gather pertinent background information
– Lay out treatment plan
– Parents sign agreement
Session Goals
– Learning about anxiety
– Thinking realistically – Detective Thinking
– Self-rewards and monitoring
– Fight fear by facing fear, fear hierarchy
– Exposure and Worry Surfing
– Skill building
– Maintaining the good and dealing with the bad
Session Structure
– High points since last meeting, snack (10 minutes)
– Review homework and talk about low points (10 minutes)
– Lesson (25 minutes)
– Assign homework (5 minutes)
– Parent check in (in person or by phone; 5-20 minutes)
Learning about Anxiety
– What is anxiety?
– Who gets anxious? Why me?
– Three components of anxiety: your body, your thoughts, your actions
– Identifying triggers
– Worry scale
(Lyneham, Abbott, Wignall, & Rapee, 2003)
Detective Thinking
– Pretend you are a detective and look for evidence why bad things will not happen
– Start with self-talk: situation, two thoughts
– Steps– 1) What is the event
– 2) What is the thought behind my feelings
– 3) Look for evidence
– 4) List alternatives
– 5) What is a realistic thought
Fight Fear by Facing Fear(Exposure)– First work on positive self-talk and
rewarding yourself*
– Make a worry list: really hard, sort of hard, a little hard
– Pick a goal
– List all of the steps to get to your goal
– Give each step a worry rating
– Identify a reward for each step
(Lyneham, Abbott, Wignall, & Rapee, 2003)
Worry Surfing
– You will feel anxious! There is no need to fight it – surf it!
– Steps:
– 1) Notice the worry, look for clues that you are getting anxious
– 2) Paddle to the top of your worry wave and choose
– What should you be doing now, and focus on that
– 3) Keep concentrating until your worry fades away
– 4) Then, reward yourself!
– Practice, practice, practice
Parent Check-Ins
– How did homework actually go?
– Give mom assignments and the strategies we were working on
– Letting me know of the events coming up
– Discuss unexpected needs
– Bedtime: http://keltymentalhealth.ca/healthy-living/bedtime-routine
– Positive parent techniques
Where is Anna now?
– Did go to private provider
– I switched schools and the provider that took my place did some of those things that were counterproductive
Questions
References
– Dowell, K. A. & Ogles, B. M. (2010). The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 39, 151-162. doi: 10.1080/15374410903532585
– Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45, 91-113. doi: 10.1080/15374416.2015.1046177
– Huberty, T. J. (2004). Anxiety and anxiety disorders in children: Information for parents. Helping Children at Home and School II: Handouts for Families and Educators.
– Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., Ustün, T. B., Wang, P. S. (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys. Epidemiological Psychiatric Society, 18, 23–33.
– Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The Cool Kids Program – Children’s Workbook. MUARU: Macquarie University, Sydney.
– Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The Cool Kids Program – Therapist Manual. MUARU: Macquarie University, Sydney.
– National Institute of Health (n.d.). Any Anxiety Disorder Among Children. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-children.shtml
– Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.