mastering anxiety dpac meeting feb 28 2013 final

Mastery and ConfidenceRecognizing our children’s anxiety and helping them overcome their fears

Kootenay Lake School District #8Nelson, British ColumbiaDPAC Meeting – School Board OfficeFebruary 28, 2013Todd Kettner, Ph.D. , Registered Psychologist

We want our children to:

Learn wellBe socially competentBe successful in lifeOther wishes for our children?

Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

Anxiety gets in the way of…

Learning

The Prevalence of Anxiety Among Middle and Secondary School Students in Canada L.Tramonte & D. Willms. Canadian Journal of Public Health 2010;101(Suppl. 3):S19-S22.

Females had a higher prevalence of anxiety than males in both middle and secondary schools in a nationally representative sample. The prevalence of anxiety did not vary substantially among schools for either middle or secondary schools. Less than one half of Canadian students can be considered “in flow.” That is, > 50% of students feel confident in their skills and challenged in their classes. Students who lacked confidence in their skills were nearly twice as likely to experience anxiety.

Social Competence

5.5% of 13 to 18 year olds will have Social Anxiety (a subtype of anxiety) during their teens.

Merkingas, Burstein, Swanson, et. al. Journal of the American Academy of Child & Adolescent Psychiatry. 2-1 Oct:49 (10):980-989.

Lifelong Success

The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Pine DS, Cohen P, Gurley D, Brook J, Ma Y. Archives of General Psychiatry. 1998 Jan;55(1):56-64.

“An epidemiologically selected sample of 776 young people living in upstate New York received DSM-based psychiatric assessments in 1983, 1985, and 1992 using structured interviews… In simple logistic models, adolescent anxiety or depressive disorders predicted an approximate 2 to 3 fold increased risk for adulthood anxiety or depressive disorders.”

DuPont, R. L., DuPont, C. M. & Rice, D. P. (2002). Economic costs of anxiety disorders. In D. J. Stein & E. Hollander (Eds.). Textbook of Anxiety Disorders. American Psychiatric Publishing: Washington, D.C.

The Anxiety Disorders Association of Canada/Association Canadienne des Troubles Anxieux presented to the Committee on Social Affairs, Science and Technology in June 2003. They extrapolated the annual cost of anxiety disorders in Canada to be $65 Billion (direct and indirect). http://www.anxietycanada.ca/english/pdf/kirby.pdf

This submission also stated that anxiety disorders are the most common mental health problem among Canadians with a 12% one-year prevalence and >25% lifetime prevalence.

UNDERSTANDING ANXIETY

Approximately 40% of most psychological characteristics (anxious/easygoing, optimistic/pessimistic) are genetically related. This makes sense when we think of the heritability of height, set-point for body weight, propensity towards heart disease, risk of cancer and chance of alcohol misuse.

Once we consider the genetic factors, this leaves a huge amount of variance left for modeling, socialization, and learning.

Neuroanatomy of Anxiety

Prevalence of anxiety disorders in children and adolescents

10% to 20%

Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-V. Besdoo, Knappe, and Pine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018839/ Psychiatry in Clinical Practice North America. 2009 September: 32(3); 483-524. Prevalence was found to be 15 to 20%. Note: Other studies have shown somewhat lower prevalence rates.

Actions

Thoughts

Emotions

Managing our anxiety and depression AND improving our physical health outcomes

Anxiety

Some Examples

http://www.youtube.com/watch?list=PLZ5g0wGR8ABl0_vAQSBx4gQ95pMEXzWcn&v=8wOz6ES29TY&feature=player_detailpage

http://www.youtube.com/watch?list=PLZ5g0wGR8ABl0_vAQSBx4gQ95pMEXzWcn&v=8wOz6ES29TY&feature=player_detailpage

Main Types of Anxiety Disorders

Panic DisorderAgoraphobiaSpecific PhobiaSocial Phobia (Social Anxiety)Obsessive Compulsive DisorderPosttraumatic Stress DisorderGeneralized Anxiety Disorder


RECOGNIZING WORRY AND ANXIETY IN CHILDREN AND TEENS

Physical Symptoms

Physical Symptoms

Crying Muscle tension HeadachesStomach aches Nail biting Picking at skin

Fidgetiness Increased heart rate Sweating

Shallow breathing Dizziness Fatigue

Disrupted sleep Feeling of choking Feeling nauseasTightness in chest Trembling Numbness

Tingling sensations

Extreme anxiety can lead to hair loss, trichotillomania, rashes

Cognitive Symptoms

Cognitive Symptoms

Difficulty concentratingFear of illness – “I must be having a heart attack”Fear of losing it – “I’m going crazy”Fear of abandonment – “My girlfriend might leave me”Fear of failure – “I’m going to flunk the exam”Fear of rejection – “Nobody will like me at Trafalgar”Fear of fear – “I know I’ll have a panic attack if I go the Bombers basketball game”Fear of criticism – “My teacher won’t like the story I wrote.” “My parents will think the money they spent on my new hockey equipment was a complete waste”Fear of success – “I don’t want to try out for choir because my friends think I have a good voice and if I made it, then I’d have to be on stage”Fear of death Fear of lossFear of catastrophe if something isn’t in the right order or sequence

Behavioural Symptoms

Behavioural Symptoms

Avoidance School refusalSkipping classDropping out of sportsAlcohol, pot, other drugs to avoid anxiety or other challenging emotions“Losing homework”Not wanting friends overRefusal of overnights at friends, relatives, school trips, summer campsTantrumsYellingSometimes even physical aggression – “had to drag him kicking and screaming”


Emotional Contagion

Laughter

Emotional Contagion (Studies in Emotion and Social Interaction). Hatfield, Cacioppo & Rapson. 1993. Popularized in Malcolm Gladwell’s 2002 Bestseller “The Tipping Point.”

Examples: EMTs and ER nurses who calm their patients by talking calmly. Parents and teachers who talk quieter in order to “infect” their loud and boisterous children with their subdued volume.

http://www.gigglers.tv/

Emotional Contagion

Anxiety and Stress

parents

educators

Helping our students gain mastery

Classroom Strategies

Yerkes Dodson Law



Teacher and peer modeling


Relaxation Exercises


Graduated Mastery


Structure andPredictability


Gentle Logic


Tests

Help Outside

the Classroo

m

Parental Supports

Sleep hygieneExerciseInformationResolve real issuesReferral for support


School Supports

Learning Support TeacherSchool CounselorPsychologist

Community Supports

Nelson Community ServicesChild and Youth Mental HealthPrivate counselorsFamily physician Referral from family physician to pediatrician

1. Anxious Teen by Holly2. Learning by woodleywonderworks3. Social Competence by Purhoor Photograpy4. Lifelong Success by Jorge Franganillo 5. Amygdala - unknown6. Spider by Dincordero7. Spider on eye blog.ericlamb.net8. Beach by Zanzibar9. Yerkes Dodson – secretgeek.net10.Scared Child by Espon Faugstad11.Distressed Teen in Car by PLCjr12.Peers by teapics13.Parents by phub.com.au14.Educators – apa.org15.Classroom by horizontal.ingegration16.Counselor in chair by Parker Knight17.Staircase by Gwenael Piaser

Photos credits (mostly from Flickr)

Anxiety BC’s Excellent Website Resources. Results. Relief.

Information for Children, Teens, Parents, and Adults

http://www.anxietybc.com/

http://www.anxietybc.com/

Resources for Teachers:Fostering Resilience in Students with

Mental Health Issues

http://keltymentalhealth.ca/education



Handouts for:Relaxed Breathing

Building Social ConfidenceOvercoming Fears

Progressive Muscle Relaxation

http://youth.anxietybc.com/resources



Empirically Validated Quick Screening Measures for:Depression

AnxietyStress

Alcohol UseSocial Anxiety

Drug Use

http://www.mindcheck.ca/mood-stress



QUIZ1. What three main things did we discuss that anxiety gets in

the way of for our students? (must name all 3 for 2 points)2. True or false. A recent student published in the Canadian

Journal of Public Health showed anxiety is more prevalent among female than male students. (1 point)

3. One studied showed adolescent anxiety or depressive disorders predicted a ____ risk of adult anxiety or depressive disorders. a) 50% b) 100% c) >200% (1 point)

4. Explain emotional contagion and the role it plays in the maintenance of anxiety in students. (3 points)

5. Which two of the classroom strategies discussed do you feel is most important or relevant to your students? Why? (2 points)


mastering anxiety dpac meeting feb 28 2013 final

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