Download Anxiety

Supporting Students with Anxiety: Solution Focused
Strategies for the Busy School Counselor
LACA Fall Workshop
October 29, 2013
Rick Auger, PhD
Jackie Brand, LSC
Minnesota State University, Mankato
Session Goals
Provide basic information about childhood anxiety—what it is
and how it works
Present a number of interventions for anxiety that are
appropriate for use by school counselors (and try a few out)
Discuss special considerations for young children
Have everyone leave with at least two important ideas related
to childhood anxiety that can be applied in schools
immediately
Anxiety is….
What happens when you focus on perceived future
threats…
Believing the challenges facing you exceed your ability to
meet those challenges…
A combination of physiological, cognitive, and behavioral
reactions...
Fueled by self-doubt…
What you should target in your intervention (rather than
targeting the object of the anxiety)
Anxiety as a spectrum…
Minimal Symptoms
Troubling Symptoms
Anxiety
Disorder
10% - 20%
2010 Minnesota Student Survey
During the past 30 days, have you felt
nervous, worried, or upset?
Grade 6
boys
Grade 6
girls
Grade 9
boys
Grade 9
girls
Grade 12 Grade 12
boys
girls
All of the Time
3%
4%
4%
5%
4%
4%
7%
12%
Most of the Time
7%
9%
6%
12%
Percentage of students in your building who
experience significant anxiety:
1% – 5%
6% – 10%
11% - 20%
21% - 30%
More than 30%
Emotional response to perceived threats
Past
Depression;
shame; PTSD
Present
Fear
Future
Anxiety
Types of anxiety disorders
•
•
•
•
•
•
•
•
Separation anxiety disorder
Selective mutism
Specific phobia
Social anxiety disorder (social phobia)
Panic disorder
Agoraphobia
Generalized anxiety disorder
Separate disorders in DSM-5 but sometimes grouped with
anxiety disorders:
•
•
•
•
Obsessive-compulsive disorder
PTSD
Acute stress disorder
Adjustment disorder with anxiety
Neurobiology of Anxiety
The neurobiology of anxiety
Rettew (2012)
• Adolescents’ two brain-related problems: too much
accelerator and not enough brake
• Individual differences in behavioral inhibition
• The link between temperament/personality and anxiety
• Anxiety is real and in moderation is adaptive
Interventions for Anxiety
There is just one of you
And there are many of them
Relaxation: The go-to anxiety intervention
Relaxation strategies
• Progressive muscle relaxation
• Guided imagery
• Deep breathing
Progressive muscle relaxation
Tension
5’
Relaxation
Relaxation
15’
15’
Tension
5’
http://www.youtube.com/watch?v=HFwCKKa--18
http://visuals.autism.net/
Exposure strategies
• Help students face their fears—GRADUALLY
• Involves gently exposing students to their fears, and then
helping them relax away the fear
• Start with visualization, then move to in vivo
Steps for Gradual Exposure:
Relaxation
training
Create anxiety
hierarchy
Anxiety arousal
(via imagery)
Recognition of
anxiety cues
Relaxation
coping
Homework,
practice
Cognitive strategies
• Slogans
• Reframing
• Developing coping strategies for the possibility that
things might go wrong
• Teach and model going with the flow
Cognitive strategies
Reframing
Student: “I’m always so stressed about my assignments!”
Counselor: “I wonder if that stress is really just energy that
you could use to keep yourself working hard?
Cognitive strategies
Reassurance therapy:
“It seems like you’re catastrophizing again. I’m sure your mind
won’t go completely blank during your speech. You’ll do fine.”
Developing coping strategies:
“Well, I think it is very unlikely that your mind will go completely
blank, but just in case let’s talk about what you can do if that
does happen. How could you cope with that?”
Cognitive strategies
Example: Keep a thought record
SITUATION
AUTOMATIC
THOUGHT
EVIDENCE
RATIONAL
THOUGHT
Solution focused strategies
Students with anxiety have ways of thinking that are
naturally problem-focused:
•Unrealistic worry:
“It will be awful if I fail”
•Exaggerating the risks and dangers of life:
“I’ll definitely fail if I take Advanced English”
•Excessive self-consciousness:
“Everyone noticed when I tripped walking up the steps, and now they
all think I’m a dork”
Assumptions of Solution-Focused Counseling
• Concentration on solutions can better facilitate positive
change
• Every problem has exceptions and contains seeds of a
solution
• Small improvements can lead to bigger improvements
• All students have untapped strengths and resources and
the ability to solve/manage their own problems
Assumptions of Solution-Focused Counseling
• Focusing on positive goals facilitates change
• There is no single right way to look at problems and
issues
• Insight into the cause of a behavior is not necessary to
change the behavior
• It is not necessary to know a great deal about the
problem in order to be helpful
Solution-Focused Guidelines
Looking at problems differently can
encourage their resolution
Example: From “I have high anxiety” to “I haven’t figured out
the right strategies to manage my anxiety”
Solution-Focused Guidelines
Engage in solution talk rather than problem talk
Problem talk:
“How was your anxiety this week?”
Solution talk:
“Tell me about the times this week when you
felt comfortable and relaxed”
Solution-Focused Guidelines
Look for exceptions – times when students are
effectively managing their lives and issues
Example: Tell me about a time you did not feel anxious?
What were you doing?
Solution-Focused Guidelines
Focus on small and reasonable changes rather
than dramatic wide ranging changes
Example: Setting a goal of moving from 2 to 3 instead of
2 to 10
Solution-Focused Guidelines
Externalize the problem
Examples:
What name could you give to what we are talking about here?
Tell me times when you have beat worry and have felt at ease?
Anxiety is sure bullying you around! What can you tell anxiety to
get it off your back?
Solution-Focused Guidelines
Compliment students on past and current
accomplishments and positive changes
Example: “You were really able to tackle that anxiety
and get through that test!”
Solution-Focused Guidelines
Don’t ask students to do something new –
rather, ask them to do a variation of what they
have already had success with.
Example: “You’ve done such a nice job of turning around
your relationship with Mr. Green. I wonder if you could
do some of that same work to get along better with Ms.
Brown?
Solution-Focused Guidelines
Help form goals that are in positive terms and
that are concrete, specific, and measurable
Examples:
Be on time for school three or more days this week
Participate in two social events weekly with peers
Solution-Focused Guidelines
Flag the minefield
Examples:
“What has gotten in your way of achieving this goal in the
past? What can you do to make sure that doesn’t
happen this time?”
“Last week you got pulled away from your goal of paying
attention in class by your friends. How will you
overcome that this week?”
A counseling dialogue…
Student:
“I get so worried about big tests. My mind just goes
blank. I can feel myself blowing it. I hate it…”
A support-oriented school counselor might say:
“I can hear the discouragement in your voice. That must
be hard—to know that you can do better, but to have
your anxiety interfere so much.”
A counseling dialogue…
Student:
“I get so worried about big tests. My mind just goes
blank. I can feel myself blowing it. I hate it…”
A cognitive-oriented school counselor might say:
“That sounds really discouraging. I wonder if your mind
really goes blank or if you just haven’t really listened to
the thoughts you have. Let’s try to figure out what
thoughts you have during tests, and whether those
thoughts help you or hurt you.”
A counseling dialogue…
Student:
“I get so worried about big tests. My mind just goes
blank. I can feel myself blowing it. I hate it…”
A solution-focused school counselor might say:
“That sounds really discouraging. But I see from your
transcript that you are still getting solid grades. There
must be times when you are able to contain your anxiety
enough to let your knowledge shine through. When is
the last time that happened, even a little? Let’s talk
about that…”
Mindfulness strategies
• Mindfulness: Bringing one’s complete attention to the
present experience on a moment-by-moment basis
• Exercise: Focus on doing one thing at a time (the
opposite of multitasking) for a day
• Exercise: Use self-message to narrate your activity
• Exercise: Practice bringing one’s attention back to the
present with self-message “Come back to the present”
Anxiety management apps…
AnxietyCoach (Mayo clinic)
Anti-Stress Quotes
Calming Breath
Optimism
ZenView
Time management for anxiety
•Help student do a “time study” for a week.
How many hours studying? Overcommitted?
•Create a month-long calendar.
Insert study times, major projects, etc.
•Work the calendar a day at a time.
Anxiety in Young Children
Types of Anxiety in Young Children
• Separation Anxiety
• Phobias
• Generalized Anxiety
General Information:
Anxiety in Young Children
• Early intervention
• Co-occurring disorders
• Anxiety in young children often stems from
• Child’s temperament & genetic risk
• Parental anxiety (role modeling)
• Adult response
• Previous experiences
General Information:
Anxiety in Young Children
In all types of anxiety, remember:
• Acknowledgement of anxiety
• Don’t advise avoidance
• Incremental Plan
• Proper sleep, nutrition, activity
• Give them the tools
Separation Anxiety: Symptoms
• constant thoughts and intense fears about the safety
of parents and caretakers
• refusing to go to school
• frequent stomachaches and other physical
complaints
• extreme worries about sleeping away from home
• being overly clingy
• panic or tantrums at times of separation from
parents
• trouble sleeping or nightmares
Separation Anxiety: Brief Interventions
• Preparation
• Educating and supporting
parents
• Drop off and pick up
• Overly protective parent
Specific Fears or Phobias in Young Children
• Age appropriateness
• From fear to disorder
• Brief counseling
Specific Fears or Phobias: Brief Interventions
• Get the details
• Previous experience
• Child’s perspective
• Object of his fears
• Desensitization
• Art & Objects
Generalized Anxiety in Young Children:
Brief Interventions
• Regular routines
• Sufficient sleep
• Prepare for changes in routine
• Intervening with parents
• Educating parents and teachers
• Positive self-talk & Visual imagery
• Relaxation (www.consciousdiscipline.com)
Children’s Books
When To Refer
Mental health referrals for children with anxiety are
appropriate if:
• the student has moderate to severe anxiety that is interfering
with function (isolation, chronic absenteeism, self-harm, failing
classes)
• the school counselor is not comfortable managing the student’s
anxiety (or does not have sufficient time for even brief
interventions)
• the child or family request a referral
• the student is not responding to brief school-based
interventions.
Where To Refer
Child Anxiety Center
821 Raymond Ave., Suite 270
St. Paul, MN 55114
Phone: (651) 645-5558
Anxiety Treatment Resources
Edinborough Corporate Center Suite 650
3300 Edinborough Way
Edina, MN 55435
Phone: 952-854-2622
University of Minnesota Amplatz Children's
Hospital
2450 Riverside Ave.
Minneapolis, MN 55454
800-233-7503 (Toll-Free)
University of Minnesota Medical Center,
Fairview
West Bank Emergency Department
2312 S. 6th St.
Minneapolis, MN 55454
National Alliance on Mental Illness
http://www.namihelps.org/support/young-adult-namiconnection.html
FACTS
1385 Mendota Heights Rd Station
Mendota Heights, MN 55120
(651) 379-9800
Hennepin County:
http://hennepin.us/portal/site/HennepinUS/menuitem.
b1ab75471750e40fa01dfb47ccf06498/?vgnextoid=49e2
e5d0820a3210VgnVCM10000049114689RCRD
Ramsey County:
http://www.health.state.mn.us/divs/idepc/refugee/rgra
msey.pdf
Dakota County:
http://www.co.dakota.mn.us/healthfamily/mentalhealt
h/lowcostservices/pages/default.aspx
Resources for adolescents
• The Anxiety & Phobia Workbook, 3rd Ed.
Edmund Bourne
New Harbinger Publications
• The Anxiety Workbook for Teens
Lisa Schab
New Harbinger Publications
• Helping Students Overcome Depression and Anxiety, 2nd Ed.
Ken Merrell
Guilford Press
TED talks
• Andy Puddincomb: All it takes is 10 mindful minutes
• Kelly McGonigal: How to make stress your friend
• Matt Killingsworth: Want to be happier?
• Thandie Newton: Embracing otherness, embracing myself
** Go to www.ted.com/talks/ and search under the presenter’s
name
Thank you!
Thank you for inviting us to share
the morning with you!
Send us questions or comments:
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