student anxiety and depression...anxiety and depression are common cumulative lifetime prevalence of...
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Student Anxiety and Depression
Mona Potter, MD and Abigail Stark, M.S.
Lincoln Sudbury, March 11, 2019
Anxiety and Depression are Costly
Students and Families• Social, emotional, and identity
development
• Academic/school performance
• Secondary psychiatric problems and substance abuse
• Physical symptoms
• Family functioning
• Life satisfaction (e.g., marriage, employment)
Schools
• Classroom management
• School avoidance
• Teacher burnout – loss of confidence and “empathy fatigue”
• Financial and resource burden
They can lead to problems with…
Anxiety and Depression are Common
Cumulative Lifetime Prevalence of Childhood Psychiatric Disorders
J Am Acad Child Adolesc Psychiatry. 2010 Oct; 49(10): 980–989. n=10,123
Anxiety
• Anxiety is the most common childhood psychiatric disorder
• Almost 1/3 of youth will struggle with anxiety by age 18
Anxiety and Depression are Common
Past Year Prevalence Of Major Depressive Episode Among US Adolescents (2016)
Data Courtesy of SAMHSA
• Depression often presents with irritability, physical symptoms, and/or withdrawal in younger children
• Past year prevalence of depression in adolescents was 12.8% in 2016
Teenagers See Anxiety and Depression as a Major Problem
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Anxiety andDepression
Bullying Drug Addiction DrinkingAlcohol
Poverty TeenPregnancy
Gangs
The percentage of teens who perceive each of the following as a major problem among peers
Source: Pew Research Center Feb 2019 Report
Many Students Are Not Getting Help
Child Mind Institute 2015 Children’s Mental Health Report childmind.org/report
Who DOES NOT get treatment…
“How do I know if this is typical stress or something more?”
High AnxietyNo Anxiety
Biology and Environment Impact Depression and Anxiety
Biology and Environment Impact Depression and Anxiety
Temperament
NATURE
Biology and Environment Impact Depression and Anxiety
Temperament
NATURE NURTURE
Depressed Pediatric Brain Anxious Pediatric Brain
Fear sensitivity
McClure et. al, 2007
Attention bias to threat
Britton et al, 2012
Altered connections
Roy et. al, 2013
Miller et. al, 2015
Altered activation
Reduced Hippocampal volume
Chan et. Al, 2010
Anxious Brain: Fear Circuitry
The Young Brain is a Malleable Brain
Myelination
The Young Brain is a Malleable Brain
What brains are we building?
System of Support: Let’s Work Together
• Communication and collaboration across systems for early, integrated interventions using common language
• Understand what the child brings to the table, both strengths and deficits, and respond accordingly
• Be mindful of what environment we are fostering
pediatrician Family and community
school
Psychiatrist/Therapist
Treatment of Adolescents with Depression Study (TADS)
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CBT fluoxetine CBT +fluoxetine
placebo
Response Rate (%)
36-week (with one year follow-up), Randomized Control Trial (RCT) of 439 children ages 12-17 diagnosed with Major Depressive Disorder (MDD)
•Treatment groups:•Cognitive Behavioral Therapy (CBT) alone•Fluoxetine alone: 10-40mg/day•CBT + fluoxetine•Placebo
•Response Rate:•CBT alone: 43% •Fluoxetine alone: 61% •CBT + fluoxetine: 71% •Placebo: 35%
March et al., JAMA (2004), NIMH funded
Child/Adolescent Anxiety Multimodal Study (CAMS)
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CBT alone sertralinealone
CBT +sertraline
placebo
Response Rate (%)
12-week, randomized, controlled trial (RCT) of 488 children ages 7-17 (mean 11.8) diagnosed with separation anxiety disorder, generalized anxiety disorder, or social phobia.
•Treatment groups :•CBT alone: 14 sessions of CBT •Sertraline alone: up to 200mg/day, average dose 140mg/day•CBT + sertraline•Placebo
•Response Rate:•CBT alone: 60% •Sertraline alone: 55% •CBT + sertraline: 81% •Placebo: 24%
Walkup et al, 2008, NIMH funded
What Can We Do
Similar skills both within school and family systems
Mindful Awareness of Thoughts, Behaviors, and
Feelings
Validation: Connect before you redirect
• Gradual exposure to situations that create uncomfortable emotions• Acting Opposite to emotion urges• Challenging unhelpful thoughts
• Using coping skills when emotions are intense
Across systems,we can model targeting thoughts,
feelings and behaviors…
Making Emotions Understandable:The 3-Component Model
What you DO
What you THINK
What you FEEL
Environment
Environment
Foundational Skill: Mindfulness
“Mindfulness means paying attention on purpose, in the present moment, and non-judgmentally.” ~Jon Kabat-Zinn, PhD
Yurgelon-Todd 2006
Adolescent brain Adult brain
Foundational Skill: Validation
Why Validate?
• Shows we are listening and want to understand.
• We are nonjudgmental.
• We care about the relationship
• Helps regulate emotions
• Helps move towards problem solving
• Make eye contact.
• Look for a word that
describes the feeling, or say,
“I really want to understand
what you’re feeling.”
• Reflect the feeling back
without judgment.
• Start a sentence with: “It
sounds like you feel...” or “It
makes sense that you’re
feeling…”
• Stick the landing!
How to Validate
Addressing Behaviors Associated with Anxiety and
DepressionWhat
you DO
Exposure to
Emotions: Protect vs.
Push?
The Role of Avoidance
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The Role of Avoidance
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AVOIDANCE
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The Role of Avoidance
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The Role of Avoidance
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The Role of Avoidance
So what can you do about it?
Face your stressors
instead of avoiding them!
Approaching Stressful Situations
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APPROACH
APPROACH
APPROACH
Exposure Hierarchies
Opposite Action
• Taking opposite action to emotion
• Identify the action urge
• Choose an action opposite to the action urge
• Do it ALL THE WAY
Addressing Thoughts Associated with Anxiety and Depression
What you THINK
Connecting Thoughts and Feelings
• Catch an increase in uncomfortable feelings
• Check whether thoughts are helpful and true
• Identify a more helpful version of that thought
Catch, Check, and Change
Is it helpful?Is it true?
If not, develop a more helpful and true version of that thought.
Emotion Thought Is it helpful?Is it true?
What’s a more helpful thought?
Catch, Check, and Change
Addressing Emotions Associated with Anxiety and Depression
What you FEEL
Self-Soothe with the Six Senses:
• Sight
• Hearing
• Touch
• Taste
• Smell
• Movement
Build a Self Soothe Kit!
Not just for kids!...