helping your children learn to handle their own anxiety - parent child … · 2016-08-14 · harold...
TRANSCRIPT
![Page 1: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/1.jpg)
Helping Your Children Learn to
Handle Their Own Anxiety
Daniel G. Shapiro, M.D.
Developmental and Behavioral Pediatrics
www.parentchildjourney.com
![Page 2: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/2.jpg)
Aristotle and the “Golden Mean” Not too little anxiety
Not too much anxiety
![Page 3: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/3.jpg)
Anxiety in childhood and adolescence:
Common, under-recognized, under-treated
8-10%
![Page 4: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/4.jpg)
“Anxiety” A.K.A.
Home sick Worry wart Self-conscious Shy Over-sensitive Fearful Apprehensive Dreadful Worried Stressed
![Page 5: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/5.jpg)
Common thoughts and behaviors
Hypervigilant/ “on-guard”
Narrow comfort zone
Withdrawal/ negative initial reaction to novel stimuli
Feels threatened
Avoids
Catastrophizes
Excessive need for reassurance
Accommodation by parents
![Page 6: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/6.jpg)
Chicken and Egg causation:interacting factors
genetics ↔ environment
child ↔ parent
![Page 7: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/7.jpg)
“Chicken-egg” Diagnosis
• Primary anxiety with secondary
symptoms• Anxiety causing other stuff
• Hidden primary condition with
secondary anxiety• Other stuff causing anxiety
![Page 8: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/8.jpg)
Primary Anxiety Disorders• Separation Anxiety• Generalized Anxiety• Specific Fears and Phobias• Selective Mutism• Obsessive-Compulsive Disorders• Perfectionism• Social Anxiety• Situational Anxiety• Acute/ Post-Traumatic Stress Disorder• Panic Attack / Panic Disorder• Agoraphobia
![Page 9: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/9.jpg)
Anxiety causing other stuff
Physical (“midline”) symptoms
◦ Headaches/ Dizziness
◦ Chest pain/ shortness of
breath/ hyperventilating,
palpitations
◦ Lump in throat, swallowing
difficulties, vomiting
◦ Eating too much or too little
◦ Stomachaches
◦ Bowel/ bladder urgency/
frequency/ “accidents”
![Page 10: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/10.jpg)
Anxiety causing other stuff
• Attention, executive and learning problems (poor school performance)
• Aggressiveness/ explosive outbursts• Sensory Reactivity /“Processing
Disorder”• Sleep problems (initiation and
maintenance)
![Page 11: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/11.jpg)
Other stuff causing anxiety
ADHD/ Executive Dysfunction
Learning disability/ weaknesses
Motor coordination deficits
Sensory differences
Autism Spectrum Disorder/Asperger’s
Syndrome/ Social skills deficits
![Page 12: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/12.jpg)
Other stuff causing anxiety
Tourette’s Syndrome/tic disorders
Bipolar illness
Medication side effect
• stimulants for ADHD
• steroids for asthma
Substance-induced
Environmental stresses
Parent (or other-adult) anxiety
![Page 13: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/13.jpg)
Adult anxiety (parent, relative,
teacher, doctor, etc.)
causing child anxiety
Normal adult worry
Unrealistic adult demands and expectations
Adult worry about current medical problem
Adult worry about past problem
◦ “Vulnerable Child Syndrome”
Primary adult Anxiety Disorder
![Page 14: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/14.jpg)
For the sake of further
discussion, let’s assume…
• Other stuff has been minimized
• Anxiety is out of proportion to life
situation
• Child’s anxiety (not the parent’s) is
the main problem
![Page 15: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/15.jpg)
General management principles
• Do not “feed” the anxiety
• “Feed” bravery and independence
• Respect the anxiety
![Page 16: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/16.jpg)
Do not “feed” the anxiety
Accept anxiety as a normal emotion
Beware: anxiety is contagious
Do not reinforce anxiety with attention
Do not allow avoidance behaviors
![Page 17: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/17.jpg)
“Feed” bravery and independence
Shift problem-solving from parent to
child
Believe in your child’s abilities and
resilience
Praise self-help
Role models of bravery
![Page 18: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/18.jpg)
Respect the anxiety
• Be reassuring and patient
• Teach why anxiety can be a problem
• Teach how to control anxiety
• Set realistic/ achievable goals
![Page 19: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/19.jpg)
CBT: Cognitive-behavioral
therapy
“Cognitive” because it challenges
distorted/ irrational thoughts
“Behavioral” because it changes
avoidance behaviors
◦ Note: the right balance of “C” and “B”
depends upon the child’s developmental
age and motivation
![Page 20: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/20.jpg)
Scared?
Thinking about what?
Other things I can do or think to help
myself relax
Pat myself on the back for helping
myself calm down
![Page 21: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/21.jpg)
A change of attitude
Externalize the anxiety
You control it
It stops controlling you
![Page 22: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/22.jpg)
Bossing Back ANXIETY• How has ANXIETY bossed you around
this week?
• How does ANXIETY mess things up at
home? At school? With your friends?
• How have you said, “NO!” to ANXIETY?
• Please give an example of how you
“bossed back” ANXIETY this week.
• When you “bossed back” ANXIETY, how
did it feel? What did you say to yourself?
![Page 23: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/23.jpg)
Bossing Back ANXIETY
• Who helps you boss ANXIETY back?
• How would (name your hero) boss
ANXIETY around?
• Who do you most want to know about
your success in writing ANXIETY out
of your life story?
• What will your life without ANXIETY
look like?
![Page 24: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/24.jpg)
Before…
ANXIETY in control
Transition Zone
You
in control
![Page 25: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/25.jpg)
After…
Anxiety
in control
YOU in control
Transition Zone
![Page 26: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/26.jpg)
What needs to change?
• What am I anxious about? • Make a list
• How anxious am I? • The “Fear Thermometer”
![Page 27: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/27.jpg)
Fear Thermometer
1 2 3 4 5 6 7 8 9 10
no I’m a maybe I I don’t really NO
problem little can resist think so hard! WAY!
uneasy but I’m
not sure
![Page 28: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/28.jpg)
Anxiety Symptoms
Rank Symptom Temperature (1-10) Target Date
1
2
3
4
5
6
7
8
9
10
![Page 29: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/29.jpg)
How will I change it?
• Realistic thinking
• Relaxation
• Exposure
![Page 30: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/30.jpg)
Realistic thinking
Challenging irrational thinking
Challenging excessive anxiety
![Page 31: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/31.jpg)
Relaxation
Self-calming: “STOP”
Ordinary relaxation strategies
New relaxation techniques
Practice, practice, practice
![Page 32: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/32.jpg)
Ordinary relaxation strategies
Listening to/ playing music
Reading
Writing
Drawing
Exercise
Conversation
Going to a quiet room
Playing a game
![Page 33: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/33.jpg)
New relaxation techniques
Yoga
Meditation
Neuro-biofeedback
Self-hypnosis
Progressive muscle relaxation
Breathing awareness
Calming mental imagery
![Page 34: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/34.jpg)
Exposure
Deliberate exposure
Graduated exposure
Sufficient exposure
Sufficient reward
![Page 35: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/35.jpg)
Graduated exposure
Start with the smallest fears on child’s
rating scale
◦ “Low hanging fruit”
Slowly increase the degree of difficulty
Finally, the child challenges his or her
worst fears
![Page 36: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/36.jpg)
Facing My Fears: Step-by-StepFinal goal:
My reward:
Goal #5:
My reward:
Goal #4:
My reward:
Goal #3:
My reward:
Goal #2:
My reward:
Goal #1:
My reward:
![Page 37: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/37.jpg)
What if it’s too hard?
CBT with a psychologist
Medication with a Child Psychiatrist or
Developmental-Behavioral
Pediatrician
Referral for parent therapy
![Page 38: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/38.jpg)
Medication options
SSRIs (selective serotonin reuptake
inhibitors)
NRIs (norepinephrine reuptake
inhibitors)
Tricycles anti-depressants
Beta blockers
Benzodiazepines
![Page 39: Helping Your Children Learn to Handle Their Own Anxiety - Parent Child … · 2016-08-14 · Harold Rapee et. al, Helping Your Anxious Child Daniel Goleman, Emotional Intelligence](https://reader033.vdocuments.us/reader033/viewer/2022050116/5f4cfd9d4e914f6176314c47/html5/thumbnails/39.jpg)
References
Antony and Swinson, When Perfect Isn’t Good
Enough and The Shyness and Social Anxiety
Workbook
Harold Rapee et. al, Helping Your Anxious Child
Daniel Goleman, Emotional Intelligence and Social
Intelligence
E. Foa, Stop Obsessing
John March, Talking Back to OCD
Bonnie Zucker, Anxiety-Free Kids
Baker and Brightman, Steps to Independence
Mel Levine, A Mind at a Time