Download Handout - Washington School Counselor Association

ANXIETY AND
DEPRESSION:
HELPING STUDENTS
BE SUCCESSFUL
WSCA 2017
DR. MARY AMANDA GRAHAM
SEATTLE UNIVERSITY
[email protected]
AGENDA
• Brain Storming
• Anxiety/School Refusal
• Depression
• Strategies and Solutions
• Planning
ISSUES
What are your experiences with
students who have anxiety and
depression?
ACTIVITY
Activity and Debrief
STATS
• Anxiety disorders are among the most common mental, emotional,
and behavioral problems to occur
• About 13 of every 100 children and adolescents ages 9 to 17
experience some kind of anxiety disorder
• Girls are affected more than boys. About 50% of children and
adolescents with anxiety disorders have a 2nd anxiety disorder or
other mental/behavioral disorder
• Anxiety disorders may coexist with physical health conditions
WHAT IS IT?
• Anxiety is a general feeling of apprehension or worry and
is a normal reaction to stressful situations
• Problematic when the feelings become excessive,
thoughts become irrational and everyday functioning is
debilitated
• Anxiety disorders are characterized by excessive feelings
of panic, fear, or irrational discomfort in everyday
situations
TYPICAL TYPES
• GAD
• PTSD
• Panic Disorders
• Specific Phobias
• Social Anxiety
• Separation Anxiety and School Refusal
• OCD
GAD
• Generalized Anxiety Disorder
GAD results in students experiencing six
months or more of persistent, irrational and
extreme worry, causing insomnia, headaches,
and irritability.
PTSD
• Post-Traumatic Stress Disorder (PTSD)
PTSD can follow an exposure to a traumatic
event such as natural disasters, sexual or
physical assaults, or the death of a loved one.
Three main symptoms: reliving of the
traumatic event, avoidance behaviors and
emotional numbing, and physiological arousal
such as difficulty sleeping, irritability or poor
concentration.
PANIC DISORDERS
• Panic Disorders
Characterized by unpredictable panic attacks,
which are episodes of intense fear,
physiological arousal, and escape behaviors.
Common symptoms: heart palpitations,
shortness of breath, dizziness and anxiety and
these symptoms are often confused with those
of a heart attack.
SPECIFIC PHOBIAS
• Specific Phobias
Intense fear reaction to a specific object or
situation (such as spiders, dogs, or heights)
which often leads to avoidance behavior. The
level of fear is usually inappropriate to the
situation and is recognized by the sufferer as
being irrational
SOCIAL PHOBIA/ANXIETY
• Social Phobia
Extreme anxiety about being judged by others
or behaving in a way that might cause
embarrassment or ridicule and may lead to
avoidance behavior.
SEPARATION ANXIETY
• Separation Anxiety Disorder
Intense anxiety associated with being away
from caregivers, results in youths clinging to
parents or refusing to do daily activities such
as going to school.
OCD
Obsessive-Compulsive Disorder (OCD)
Students may be plagued by persistent,
recurring thoughts (obsessions) and engage in
compulsive ritualistic behaviors in order to
reduce the anxiety associated with these
obsessions (e.g. constant hand washing).
SCHOOL REFUSAL
• Manifestation of the anxiety
• School refusal is higher post vacations,
weekends, or at the beginning and end of the
school year.
• Death of a loved one, a prolonged illness,
moving or changing schools, kindergarten,
and the transition from elementary to middle
school.
CAUSES
The causes of anxiety disorders are unknown but
experiences such as traumatic events appear to trigger
anxiety disorders in people who are already prone to
anxiety.
Genetics
RISKS
Trauma
Illness
Stress
Personality
Mental Health
Family History
Drugs and Alcohol
TRAUMA
Children who endured abuse or trauma or
witnessed traumatic events are at higher risk of
developing an anxiety disorder at some point in life.
ILLNESS
Having a health condition or serious illness can
cause significant worry about issues such as
your treatment and your future
STRESS BUILD-UP
A big event or a buildup of smaller stressful life
situations may trigger excessive anxiety —
death, college choices, expectations, role
changes, life circumstances, etc…
PERSONALITY
People with certain personality types can be more
prone to anxiety disorders
GENETICS
Can play a role for pre-disposition
DRUG AND ALCOHOL
Drug or alcohol use or abuse or withdrawal can
cause or worsen anxiety
MENTAL HEALTH
Students with other mental health disorders,
such as depression may experience anxiety.
Depression and anxiety are cousins.
25
DEPRESSION
• Major Depressive
Disorder (MDD)
26
DEPRESSION: SYMPTOMS
• Decreased interest in
activities;
• Hopelessness
• Persistent boredom/low
energy
• Social isolation, poor
communication
• Low self-esteem and guilt
• Extreme sensitivity to
rejection or failure
• Increased irritability, anger, or
hostility
• Difficulty with relationships
• Frequent complaints of illness
• Frequent
absences/academics
• Poor concentration
• A major change in
eating/sleeping
• Thoughts or expressions of
suicide or self-destructive
behavior
27
DEPRESSION: WHAT A
STUDENT SAYS
• https://www.youtube.com
/watch?v=txJGm6zhiBA
28
DEPRESSION: PREVALENCE AND
RISK
• Major depression strikes 8 percent of youth ages 12
and older
• More girls than boys in adolescence; equal rates in
childhood
• Three risk factors
• Temperament (negative affectivity)
• Environmental (adverse childhood experiences, particularly
multiple experiences)
• Genetic (two to four higher likelihood if first degree relative has
depression)
29
DEPRESSION: ASSESSMENT
AND TREATMENT
• Psychological and/or psychiatric evaluation needed
• Screening tools
• Child Behavior Checklist
• Beck Inventory
• Comprehensive treatment often includes both individual, family therapy, and medication
• Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of
individual therapy
• Medication side effects
• Medication dosage must be tapered off to avoid negative effects of abruptly stopping the
medication
30
WARNING SIGNS FOR SUICIDE
• Talking about suicide
• Getting the means to commit
suicide
• Withdrawing from social
contact
• Having mood swings
• Preoccupation with death,
dying or violence
• Feeling trapped or hopeless
about a situation
• Increased use of alcohol or
drugs
• Changes in eating or sleeping
patterns
• Risky or self-destructive
behaviors
• Giving away belongings
• Saying goodbye to people as
if they won't be seen again
KEY POINTS TO REMEMBER
Anxiety levels fluctuate
Depression is silent
Variables
Erratic
Often missed
MUST FOCUS ON THE ROOT!!
COOCCURRING
• Co- occurring diagnoses of depressive disorders, ADHD, and other
anxiety disorders are common in anxiety patients.
• Symptoms that may appear to be ADHD:
• Restlessness, feeling keyed up or on edge
• Difficulty concentrating, mind going blank
• Irritability
• Clinically significant distress or
impairment in social or academic areas
CO OCCURRING CONTINUED…..
• Adolescents with substance use disorders (SUD)
especially exhibit a high prevalence of mental health
problems compared to the general population
• Many teens believe that drugs and alcohol may alleviate
anxiety and stress
GENERAL SYMPTOMS
• Feeling nervous, restless or tense
• Having a sense of impending danger, panic
or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
GENERAL SYMPTOMS
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than
the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety
• School Refusal
EFFECTS OF ANXIETY AND
DEPRESSION
• School failure
• Absenteeism/Refusal
• Classroom disruption/Teacher
• The inability to complete basic tasks
• Suicide/Self-harm
• Family stress
• Impaired social relationships
BEHAVIORS MISSED OR
LABELED
When a student acts out — throws a book,
yells, storms out of the room — or has difficulty
learning to read or grasping new math
concepts, teachers often don’t suspect anxiety
as the underlying cause, which means the
problems may persist or worsen.
WHY WE MISS IT
• Not predictable
• Out of the blue
• Coming from left field
PRE-SCHOOL AND
ELEMENTARY
Show reluctance to:
• Work in groups
• Participate in group discussions
• Write on the blackboard
• Perform in musical or physical activities
• Read aloud or answer questions
CONTINUED
• May also have difficulties with:
Handing in work, due to a fear that it is not good
enough
• Accepting criticism
• Concentrating
• Sleeping (often tired in class)
• Regulating emotions (easily irritated, frustrated)
ADOLESCENTS
As well as the other symptoms, students also are prone to:
Skipping school
• Taking up substance abuse (drugs or alcohol)
• Fear of public speaking
• Difficulty in maintaining relationships or employment
• Fears of using public restrooms
FOCUS ON ANXIETY
•SYSTEMIC
ALL ON BOARD
• School Counselor
• Teachers
• Parents
• Friends
• Family
• Administrators
EFFECTIVE WAYS TO TREAT ANXIETY
• Cognitive-behavioral/ACT/Resilience
• Relaxation/Mindfulness
• Family therapy/Individual Therapy/School Counselor
• Parent training
• Teacher Training
• Focus on the CAUSE not the symptom
• Individual and possible medication
STRATEGIES FOR DEALING WITH
ANXIOUS STUDENTS
•
•
•
•
Transitions and separation
Not Intentional and Not Oppositional
Safe space
Systemic approach. All speaking the same language
STRATEGIES CONTINUED…..
• Work with a child regarding class participation and answering
questions on the board, understanding that many anxious youth fear
answering incorrectly.
• Encourage small group interactions and provide assistance in
increasing competency and developing peer relationships.
• Acknowledge success by exploring with student
AND MORE…
• Organized, calming, and supportive
• Ask for feedback from youths about any interventions
• It is important for behaviors to be reinforced at home as
well as in school therefore parents should be involved
WHAT TO TELL PARENTS
• Your anxiety impacts your child
• Stop reassuring your child
• Deep Breathing
• Empathize
• Allow it and teach acceptance
• Strategize
• Seek Help
P.S.
• You are not a bad parent
ACCEPTANCE AND
COMMITMENT THERAPY
DEFINITION
Acceptance and Commitment Therapy (ACT) is a type of therapy that
helps you accept the difficulties that come with life. ACT is a form of
mindfulness: wellness can be attained by overcoming negative
thoughts and feelings.
Essentially, ACT looks at your character traits and behaviors to assist
you in reducing avoidant coping styles. ACT also addresses making
changes, and what to do about it when you get stuck
THE WHEELS ON THE BUS
• https://www.youtube.com/watch?v=Z29ptSuoWRc
ACT
Accept your reactions and be present
Choose a valued direction
Take action
FRAMEWORK
• Imagining and understanding
• Accepting
• Planning
• Options
• Looking at consequences
• Chose
• Reflect
WHAT HELPS
• https://www.youtube.com/watch?v=jrmKtaMqOh4
THOUGHTS AND LANGUAGE
• The ability to create and solve
TRAPPED IN A ROOM
• Imagining and understanding
• Accepting
• Planning
• Options
• Looking at consequences
• Chose
• Reflect
Trapped in intense Anxiety
 Imagine that instead of being trapped inside a room, that you are instead
trapped inside of intense anxiety or depression
 What do students do to get out of it?
Experiential Avoidance
ACT is based on the principle of Experiential Avoidance
(EA).
The more students try to get away from or solve
psychological issues, the less you solve and the worse
things get.
The more they try to avoid feeling these ways, the more our
lives generally constrict.
THE FOCUS
• ACT aims to enable students to have the psychological
flexibility to experience both good and bad feelings, and
control our behaviour to create meaningful and rich lives
Acceptance Commitment Therapy
Contact with the
Present Moment
Acceptance
Values
Essential
Components
of ACT
Defusion
Committed
Action
Self-As-Context
ACCEPTANCE
 Willingness note resignation
 Embracing all (both painful and joyful) without attempting to alter
 The idea is to let students let go of their struggle
 This is directly opposite to Experiential avoidance where attempts are
made at altering both form and frequency of unwanted thoughts
 Importantly, acceptance is used in ACT to foster values based action that
may previously had been avoided
DEFUSION
• The core theoretical posture behind mainstream CBT is that clients
need to rid themselves of negative unwanted content to facilitate
behaviour change
• ACT is opposite
• ACT suggests that people can live and behave in a value consistent
manner in the face of challenging thoughts
• To help them do this ‘defusion’ aims to create distance and
disengagement between the student and their thoughts
DEFUSION
• Students in general tend to be fused with thoughts
• Many times these are not helpful
• Defusion techniques aim to reduce the impact of thoughts
by altering their believability
BEING PRESENT
 Past and future
 Lose contact
 ACT promotes on-going non judgemental contact with psychological and
environmental events as they occur
 When in the present moment, people are flexible, responsive and aware of
the possibilities afforded by the context
 Mindfulness
 The ability to control our attention in a flexible manner
SELF AS CONTEXT
Students tend to create an attachment to the
conceptualized self i.e. over the course of time we build a
story of ‘who we are’.
However, sometimes this attachment to ‘who we are’ (the
conceptualized self) make students inflexible and rigid in
behaviour
SELF AS CONTEXT
 ACT aims to gets students aligned with self as a context.
 I from which events are experienced is distinct from those
events
 The point is to help students develop a sense of self as
observers, independent of the particular experience
being had at that moment
DEFINING VALUED DIRECTIONS
Explore with students
 What are the things that are most important to you?
 What are the things you care about most?
 In many areas students lose touch with the things important to
 Family
 Friends
 School
 The environment
 Religion
 Health
 ACT aims to enable clients to fully contact their values
COMMITTED ACTION
• Finally, ACT encourages the development of larger and larger
patterns of behaviour linked to the clients values
• Set achievable goals with students (other techniques CTB etc)
• And then they will look at the possible barriers to achieving their
goals and underlying values
ACT
• Psychological flexibility
EMOTIONAL REGULATION
1)
Determine what is happening in the environment
2)
Identify and describe your emotions and feelings
3)
Be grounded in your body. Notice how you experience your emotions
physically
4)
Pay attention to your thoughts
5)
Evaluate you behavior. Figure out how emotions and feelings influence
behavior. Is your behavior effective?
6)
Think about potential aftermath
THE HERE AND NOW
72
You are not the emotion
Observe
You don’t have to act on the emotion
Step Away
Unhook
Think of alternative emotions
Love the emotion
No Judging
Be Willing
Radical Acceptance
ACTING OPPOSITE
• Fear
• Sadness
• Guilt Shame-True/False Repair-CommittAccept-Let Go
• Anger
RIDING THE WAVE
MINDFULNESS
• Mindfulness is the awareness that emerges through paying
attention on purpose, in the present moment, and non
judgementally to things as they are. This means paying
attention to things are they really are in any given moment
not what we want them to be.
BREAKING IT DOWN
•
•
•
•
•
Paying attention
Present Moment
Non reactively: Reaction vs Response
Non judging
Accepting
HOW DOES IT HELP
• It is the exact opposite of “ruminative thinking” (the
tendency to dwell on the same thought or theme)
which creates low moods to persist and return.
• Teaches to attach labels to thoughts, to detach from
emotions. You are experiencing an event/emotion –
you are not that event/emotion.
• Teaches that thoughts are thoughts, not facts.
• Teaches to just be aware instead of judging.
• Teaches self compassion as well as compassion to
experience and others.
WHAT TYPES OF
MINDFULNESS ARE THERE?
• Mindful Breathing
• Mindful Walking
• Body Scan
• Mindful Eating
• Mindful Yoga
THE 3 MINUTE BREATHING
SPACE
Use the three-minute breathing space in moments of stress, when you are troubled in thoughts or feelings. You can
use it to step out of automatic pilot; to reconnect with the present moment and your own inner wisdom.
1: Acknowledging
•
Bring yourself into the present moment by deliberately adopting a straight posture. Then ask: ‘What’s going on
with me at this moment? What thoughts, feelings and body sensations am I experiencing right now?
•
You could put your inner experience into words, for example, say in your mind, ‘A feeling of anger is arising’ or
‘self-critical thoughts are here’ or ‘my stomach is clenched and tense.’
2: Gathering
•
Gently bring your full attention to the breathing. Experience fully each in-breath and each out-breath as they follow
one after the other. It may help to note at the back of your mind ‘breathing in…breathing out’, or to count the
breaths. Let the breath function as an anchor to bring you into the present and to help you tune into a state of
awareness and stillness.
3: Expanding
•
Expand your awareness around the breathing to the whole body, and the space it takes up, as if your whole body
is breathing. Especially take the breath to any discomfort, tension or resistance you experience, ‘breathing in’ to
the sensations. While breathing out, allow a sense of softening, opening, letting go. You can also say to yourself
‘it’s ok to feel whatever I’m feeling.’ Include a sense of the space around you too. Hold everything in awareness. As
best you can, bring this expanded awareness into the next moments of your day.
TEACHING AND BUILDING
RESILIENCE
• Talking: open and honest and age appropriate
• Home and school emotionally safe
• Limited Exposure to the news
• Acknowledge Anxiety
• Establish Structure
CONTINUED
• Strategize
• Teach Acceptance and Expression
• Responsibility
• Perspective
• Self-Care
CREATIVE IDEAS
AND SYSTEMICALLY
• Teach it
• Practice it
• Review
• Remind
• Repeat
• Repeat
• Repeat
PLANNING
SELF CARE
QUESTIONS AND COMMENTS
• Thanks you
[email protected]
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