Download understanding and managing anxiety 2016

UNDERSTANDING AND MANAGING ANXIETY:
Generalized, Performance, Test
Mary Katherine Boncher, Ph.D., Lower Lab, PTA Psychologist
I. What is Anxiety?
 Anxiety is a feeling of nervousness, apprehension, fear, or worry.
 Fears and worries are normal and expected, such as worry about a loved
one or in anticipation of taking a test.
o In fact, anxiety is necessary for optimal functioning - without anxiety
we would probably never do things we did not want to do.
 Anxiety becomes a problem when it interferes with the ability to function.
 Anxiety disorders are the most common type of psychological problem
found in children and adolescents.
II. Types of Anxiety Disorders: (based on DSM-5)
 Agoraphobia is anxiety about being in places or situations from which
escape might be difficult (or embarrassing) or in which help may
not be available.
 Generalized anxiety disorder: Those who endure this condition
experience numerous worries that are more often on the mind
of the sufferer than not. Those worries interfere with the person's
ability to sleep or otherwise function.  Panic Disorder is characterized by a discrete period of intense fear or
discomfort with at least four of the following symptoms: accelerated
heart rate or palpitations, sweating, trembling or shaking,
sensations of shortness of breath, feeling of choking, chest pain or
discomfort, nausea or abdominal distress, feeling dizzy, unsteady,
or lightheaded, feeling of unreality, fear of losing control, fear of
dying, numbness, chills or hot flashes. These same symptoms also
can be caused by caffeine consumption, amphetamines an
overactive thyroid, abnormal heart rhythms, and other heart
abnormalities.
 Separation anxiety disorder: Developmentally inappropriate and
excessive fear or anxiety concerning separation from those to
whom the individual is attached. Manifestations include: recurrent
and excessive distress when anticipating or experiencing
separation, worry about losing major attachment figures, worry
about experiencing and untoward event (getting lost), persistent
reluctance or refusal to go out or sleep alone, fear of being alone,
repeated nightmares involving theme of separation, repeated
complaints of physical symptoms when separation from attachment
figure occurs or is anticipated.
 Selective Mutism: Consistent failure to speak in specific social situations
that interferes with educational or occupational achievement or with
social communication and failure to speak is not attributable to lack
of knowledge or ability.
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Social Anxiety. Marked fear or anxiety about one or more social
situations in which the individual is exposed to possible scrutiny by others,
Specific Phobia: People with phobias experience irrational fear that may
rise to the level of panic attacks in response to a specific thing or situation.
Examples of phobias include fears of spiders, insects in general, open
spaces, closed-in spaces, air travel, heights, and social
anxiety. If
severe,
Test Anxiety may be a Specific Phobia but many children suffer
from test anxiety that is less severe and would not be classified as
a disorder.
III. Symptoms of Anxiety:
 Physical: rapid heart rate, muscle tension, increased breathing, sweating,
and nausea. It is not unusual for a child to complain of stomachaches,
headaches, vomiting, diarrhea, or tiredness.
 Emotional: fear or worry. There may also be confusion, irritability, and/or
denial.
 Cognitive: thoughts focused on physical, emotional, or social danger to
self or others and the inability to handle the real or assumed threat. Mind
may also go blank.
 Behavioral: fidgeting, pacing, crying, clinging, or shaking. Problems falling
to sleep or staying asleep
 Anxiety can involve avoidance and can manifest as dissociation.
IV. Causes of Anxiety: Anxiety may be caused by an individual or combination
of factors.
 Environmental factors: Anxiety may stem from stress, pressures, difficult
experiences
 Anxiety can be a learned behavior via modeling or reinforcement.
 Research indicates that there is a genetic link with anxiety.
 Anxiety appears to be related to individual differences in the amount of
GABA (gamma amino butyric acid), a neurotransmitter that inhibits the
activity of the nervous system in the brain.
O GABA counteracts the excitatory effects of some of the other
neurotransmitters, dampens emotional arousal, and prevents
frenzied disorganized responses to stimuli. Low levels of GABA are
linked to anxiety
V. Parent’s May Model Anxious Responding or Intensify Stress on Child.


Consider what you may model
 How do you manifest stress/anxiety?
 How do you handle it?
 In what ways does your child handle stress in a similar
fashion to you?
Consider how you may intensify your child’s stress
 By being overly critical and undermining child’s self
confidence
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By being overly protective, rescuing child from learning from
his/her mistakes and thus undermining the ability to develop
competence.
By being overly punitive or irritable.
What pressures, stressors do you put on your children?
VI. Child Management Skills: Lessen Stress and Sources of Anxiety



Understand why a child is anxious to better handle reactions to child’s
anxiety
Work on admiring the effort put in
Allow child to make decisions, make mistakes, and learn from mistakes.
o Re-conceive mistakes as sources of information
o Teach that making mistakes is an important part of learning how
to solve problems.
o Intervene after child bottoms out or loses self-control by helping
child focus on what they did to calm down.
o Teach so child learns from the experience
o Teach by example
What do you do as a family to decrease and alleviate stress?
VII. Emotional, Cognitive, Physical, Behavioral Interventions


Physical
Awareness
Develop awareness of where in the body the anxiety or fear
manifests, where it is held physically
Relaxation
 
Breathing and relaxation help relief stress and quiet anxiety.
Teach and practice relaxation with your child
(See Attached: four step breathing, tense-relax, and hook)
Imagery
Think of an image that is soothing and bring the picture up
in your mind
Mindfulness
Practice being in the moment – anxiety can be related to
worries about the past or future so practice being in the
moment can be helpful
Activity
Do an activity that burns off some of the extra anxious
energy: run, play ball,
Emotional
Put feelings into words
Some feeling words for anxious
- Concerned, nervous, worried, stressed, anxious, scared, fearful.
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Teach child to be aware and the movement of his/her level of worry
on continuum
0
1
Not worried
2
3
4
5
6
Anxious
7
8
9
10
Really afraid

Cognitive
Realistic Thinking
Talk with child about his/her fears.
Allow child to express thoughts related to his/her fears.
With child discuss how realistic and/or how helpful the
anxious thoughts are.
Help child begin to challenge the irrational or unhelpful
thoughts.
Help child with something to stop the irrational or unhelpful
thought (see attached on “thought stopping”)
Help child come up with more realistic or helpful thoughts
(see attachment thought substitution)
Practice “thought stopping” and/or “thought substitution”
with child
Remember that practice should initially occur in nonanxious situation.

Behavioral
Spend less time on worries
Allow only 15 minute a day worry time
Write down worries and put in a worry box
Talk about worries during worry time
If eventually there are no worries to talk about – talk about
fun things.
Do other things
Get involved in activities that keep you busy and not
worrying

Remember practice initially and frequently in non-anxious situations

Other techniques
Managed Exposure imagined or in-vivo
Assertiveness
Problem Solving
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REFERENCES
Books
Huebner, D. (2006). What to do when you worry too much: A kid’s guide to
overcoming anxiety. Washington DC: Magination Press
Mayers, Diane Peters. (2008). Overcoming school anxiety: How to help your
child deal with separation, test, homework, bullies, math phobia, and
other worries. New York: AMACOM.
Rapee, Ronald M.; Spence, Susan H.; Cobham, Vanessa; Wignall, Ann. (2000).
Helping your anxious child: A step-by-step guide for parents. Oakland,
Ca: New Harbinger Publications.
Zucker, B. (2009). Anxiety – Free Kids’: An Interactive Guide for Parents and
Children. Waco Tx: Product Press, Inc.
CD Guided Imagery
"Airy Melody's Relaxation/Healing Series: Rainbows and Sunshine."
Guided Imagery Scripts
http://www.innerhealthstudio.com/relaxation-scripts.html
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FOUR STEP BREATHING
RELAXATION TECHNIQUE
Breathe in, fill stomach with air while pushing
stomach out
Breathe out, relax stomach
Breathe in, suck stomach in – more – more
Breathe out, relax stomach
Do cycle three times or more if needed
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TENSE / RELEASE
RELAXATION TECHNIQUE
Tense / Release, like The Hook is a particularly useful
strategy when someone is tense and is having a very
hard time relaxing and letting go.
In essence you ask the person to intensify their physical
tension (gaining control through the act of
intensification) in order to then let it go.
Begin by tensing and relaxing your muscles.
Squeeze your fists.
Make your legs stiff like boards.
Scrunch up your face.
Keep your body tight while you
Count to 5 in your head.
Then relax your whole body by
Letting your muscles go loose.
Next think about your breathing. Breathe in through
your nose and out through you mouth.
With each breath, picture the air going in through your
nose and traveling all the way down toward your belly.
As you breathe in,
Feel the calm, cool air filling your body.
As you breathe out,
Feel the tense, hot air leaving your body.
Breathe in …. And out
Five times altogether
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THE HOOK
RELAXATION TECHNIQUE
The Hook is a particularly useful strategy when
someone is tense and is having a very hard time
relaxing and letting go.
In essence you ask the person to intensify their physical
tension (gaining control through the act of
intensification) in order to then let it go.
Put right wrist over left with palms facing each other.
Thread fingers and clasp palms.
Move hands toward your body, through your arms, and
rotate them upward.
Tighten and squeeze hands together creating as much
tension as possible.
At the same time:
While standing or sitting, cross left leg over the right leg
at the knee
Wrap right foot behind left calf.
Tighten and squeeze your legs together creating as
much tension as possible.
Hold to count of three squeezing tightly.
Let out your breath, relax arms and legs.
Let go and relax.
Repeat three times or more if needed.
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THOUGHT STOPPING
A COGNITIVE COPING STRATEGY
The overall concept behind thought stopping and
thought substitution is that what we think and say in our
heads impacts what we feel and how we behave.
Changing thoughts, therefore, changes feelings and
behaviors and offers an excellent coping strategy.
Person using this technique must be calm enough to
engage in some level of rational thought.
Help person identify the irrational or negative thought(s)
that are going through his/he head.
Help person see that the irrational and/or negative
thought is not helpful and is actually in the way of
solving the problem.
Explain that the task is to stop the irrational or negative
thought by telling yourself to stop the thought.
Do thought stopping by saying stop, stop, stop every
time you have the irrational or negative thought.
Alternatively, you could say to yourself I don’t have to
think that, I don’t have to think that, I don’t have to think
that.
Thought stopping needs to be practiced when not upset
in order to be a useful coping strategy when upset.
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THOUGHT SUBSTITUTION
A COGNITIVE COPING STRATEGY
The overall concept behind thought stopping and
thought substitution is that what we think and say in our
heads impacts what we feel and how we behave.
Changing thoughts therefore, changes feelings and
behaviors and offers an excellent coping strategy.
Person using this technique must be calm enough to
engage in some level of rational thought.
Help person identify the irrational or negative thought(s)
that are going through his/he head.
Explain that the task of thought substitution is to
substitute a more rational and positive thought for the
irrational or negative thought. That doing such will
change how one feels and behaves.
Help person come up with more rational and positive
thought. For example if person is thinking, “I will fail
going from 2nd to 3rd grade. It will be awful.” The thought
substitute might be “I can handle it. I did ok from 1st to
2nd grade and I can do ok again.”
Do thought substitution.
Thought substitution needs to be practiced when not
upset in order to be a useful coping strategy when
upset.
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ANXIETY WARNING SIGNS
TRIGGERS for ANXIETY
Outside/External Triggers – things/events that make me feel
anxious:
1.
2.
3.
Inside/Internal Triggers – things I say to myself when I feel
anxious:
1.
2.
3.
CUES when Anxious – where/how do I feel anxiety in my
body?
1.
2.
3.
WHAT CAN I DO WHEN I FEEL TRIGGERS AND CUES
OF ANXIETY?
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