Presentation on theme: "“We have nothing to fear but fear itself”"— Presentation transcript:
1 “We have nothing to fear but fear itself” Anxiety and Kids:“We have nothing to fearbut fear itself”Touchstone Academy – Live and Learn Series, Oct. 23, 2014“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance” …FDR’s first inaugural addressTreating anxiety is like that. Treating this very treatable symptom and group of psychiatric illnesses is like that. Much of the what makes an anxiety problem so disabliing is the fear of the fear…the anxiety about the anxiety. A fire starts to burn and the flames get fanned.But just like a fire can get put out so can anxiety problems/symptoms get treatedGive own HxThe reason I like working with this “bread and butter’ of psychiatry is that they are so trreatable/ curableEdward S. Yuzda, MD, MSc, FRCPCDr. Jean Craven, Clinical PsychologistDr. JoAnne Burt ,School Psychologist, ASD---SMs. Anita Hofmann, Occupational Therapist
2 As a child of the 80’s I can’t resist the simple wisdom of Calvin and Hobbes I think one of the hardest things for me to remember when I’m talking with my kids about the trials and tribulations is that what seems like little/trivial problems to me are huge problems to themThis cartoon was especially useful to remind me to keep my perspective for my son’s sleep problemsAnd also reminding me of my own sleep issues when I was a kid which was a great way to normalize his difficulties (but has also become a constant source of amusement to my kids as I am reminded of them…so be careful what you ask for!)
3 Anxiety is the hand-maiden of creativity TS ElliotFirstly, when speaking of anxiety, we must remember that anxiety (like all emotions) is crucial for our survival as a species.As an example, the way I contextualize sleep difficulties, is by looking at our past…Cavebear exampleAnxiety drives us/compels us/motivates us…as for this talkIt is truly as the other of ‘The Love Song of J Alfred Pruffrock’ wrote, the hand-maiden of creativity
4 Anxiety - A Very Common Problem Society’s Most Common (yet Curable) Mental Health ProblemAnxiety - A Very Common ProblemMental Disorder1 Year Prevalence (%)Age = yearsAny Anxiety Disorder16.4Any Mood Disorder7.1Major Depressive Disorder5.3Bipolar Disorder1.1Schizophrenia1.3Any Disorder21I would remind you that these figures are based on diagnosed anxiety disorders (in addition to other mental illlnesses)…it doesn’t include simply anxious symptoms that do not fully manifest as a diagnosable conditionSo the number of people that anxiety impacts really is staggerring and we begin to get a scope of the magnitude of the problemDespite how common these conditions are, they are often woefully mismanaged in clinical situations
5 EPIDEMIOLOGY – all anxiety disorders WHO studyAnnual prevalence – 17.7 %Lifetime prevalenceWomen – 30.5%Men – 19.2%
6 Most Common Mental Health Issue in Children and adolescents Overall Prevalance - 10%Separation Anxiety Disorder – %Selective Mutism – 0.7%Obsessive Compulsive Disorder – 1.2%Social Anxiety Disorder – 7%Specific Phobia – 10%Panic Disorder – 2-3%Agoraphobia – 3-4%Post Traumatic Stress Disorder – 2-3%About 40% of adults with Panic Disorder indicated that their symptoms began in their childhood
7 “The child is the father of the Man” William Wordsworth ( )
8 Tell me about youR childhood Childhood experiences heavily influence usAttitudes, rules beliefs and assumptions, maladaptive or not, govern our behavior as adults‘And once a boy has suffered rejection, he will find rejection, even where it does not exist…or worse, will draw it forth from people simply by expecting it’East of Eden…John Steinbeck
9 Normal Anxiety Anxiety is essential to life A desire to reduce anxiety keeps us fed, keeps us procreating, keeps us sitting through a dead boring lectureIt compels us to carry out certain acts that forestall or prevent danger
10 PATHOLOGICAL ANXIETY Too much of a good thing Uncontrollable Chronic & PersistentExaggeratedImpairs functioning (at home, in relationships)i.e. obsessionality
12 Prepared to Fight or Flee for Safety & Protection What is signaling?Brain RegistersDANGER!DANGER!Prepared to Fight or Flee for Safety & ProtectionInitiationof Physiologic Cascade Heart Rate Tension Alertness PerceptionSensory Perception(Ears, Eyes, Nose, Touch, Taste)Signaling:Our hard-wired danger response mechanism. Every organism on the planet from an ant to a human being has a Signaling Mechanism. Without it we and all other creatures on the planet would die!Our signaling mechanism is what allows us to jump out of the way of oncoming traffic; sharpen our senses to the slightest change in our environment when we are afraid; gets us ready to run to escape from danger or prepares us to fight to protect ourselves. It also helps us focus when we have to study to pass an exam or drive a vehicle safely during a bad storm.When the brain senses danger from signals received from the environment through our 5 senses it reacts before we have time to THINK about it… this is an automatic ‘reflex’!... If the brain waited for us to think before we acted in danger situations we would most likely never live to know about it!!As soon as the brain senses danger it turns an our ‘adrenaline tap’... This activates a whole cascade of reactions that results in our bodies being prepared to react and protect itself.The Signaling Physiologic cascade is hardwired for survivalResult of the Physiologic cascade:Increased heart rateSweatingTensionIncreased delivery of blood to the musclesSharpened sight and hearingInhibition of digestionExtreme alertnessInternal Signals(Thoughts, Emotions, Physical)
13 Signaling = “fight or flight” This danger signaling mechanism is also called the ‘Fight or Flight’ response, and is initiated by the brain when it perceives danger from any of the five senses.The brain then initiates a ‘physiological cascade’ in response to the perceived danger. This results in in a state of readiness characterized by ‘autonomic hyperarousal’.This process:Shunts blood from body organs that don’t need blood in times of stress (like the digestive tract) to our muscles, lungs, and heartSharpens our five sensesSuper-focuses our attention away from unnecessary environmental noise to important safety and danger cues, andAllows us to take immediate action to protect ourselves.
14 of Physiologic Cascade What is anxiety?No DangerBrain RegistersDANGER!AnxietyInitiationof Physiologic Cascade Heart Rate Tension Alertness PerceptionSensory Perception(Ears, Eyes, Nose, Touch, Taste)Dysfunction of the danger signaling mechanism can lead to triggering of the ‘physiologic cascade’ in the absence of real danger:This is called ‘Anxiety’Internal Signals(Thoughts, Emotions, Physical)
15 Everyone experiences anxiety from time to time. Normal anxiety is an expected response to stressful or dangerous situation.But anxiety which is abnormal occurs in the absence of danger and is excessive or inappropriate to the situation.
17 The Rogues Gallery of Anxiety Panic DisorderAgoraphobiaPost-Traumatic Stress DisorderSeparation Anxiety DisorderGeneralized Anxiety Disorder (adult)Social Anxiety DisorderSpecific PhobiasSelective Mutism
18 The Rogues Gallery of Obsessive-compulsive and related disorders Obsessive Compulsive DisorderBody Dysmorphic DisorderHoarding DisorderTrichotillomaniaExcoriation Disorder
19 The Rogues Gallery of Trauma- and Stressor-related disorders Reactive Attachment DisorderDisinhibited Social Engagement DisorderPost-Traumatic Stress DisorderAcute Stress DisorderAdjustment Disorder
21 Avoidance Anxiety AVOIDANCE – The Yang to Anxiety’s Ying Avoidance is the KEY functional symptom found in all Anxiety DisordersAvoidance behaviours INCREASE anxietyNot allowing Avoidance behaviours DECREASES anxietyAll successful therapeutic interventions in Anxiety Disorders MUST address Avoidance behavioursAvoidanceAnxiety
23 Anxiety’s Imposter -Somatization Most people with psychological problems go to their family doctor with a physical complaint rather than recognizing that they have a form of mental distress.Physical symptomsPsychiatric symptoms
24 Sorrow that has no vent in tears may make other organs weep SomatizationSorrow that has no vent in tears may make other organs weepHenry Maudsley ( )
25 General ManagementWhether mild, moderate or severe, parents/family must play a role in helping your childthere are general strategies that can help any child who is experiencing anxiety problemsAlthough there are different types of anxiety problems and specific strategies aimed at helping children cope with different types of fears,
26 General Management Listen - listen to your child's thoughts and feelingsNormalize - let your child know he/sheis not aloneEducate - anxiety is normal, harmless,and temporaryModel it - Model facing fears andencouragementPraise - Don't forget to praise your child forhis or her effortsHelpful Hints:Listen! Make sure you take the time to listen to your child's thoughts and feelings. Simply feeling heard can be very helpful to your child.Normalize! It is important to let your child know that he or she is not alone. Lots of children have problems with anxiety.Educate! Let your child know that anxiety is normal, harmless, and temporary.Model it! Model facing fears and provide support and encouragement. Motivate your child through supportive coaching. However, be careful not to push your child too far too fast. Let your child work at his or her own pace.Avoid Giving Excessive Reassurance! Resist giving excessive reassurance, instead encourage your child to use his or her coping strategies (for example, calm breathing or challenging scary thoughts)Praise! Don't forget to praise your child for his or her efforts! Remember, facing your fears is not easy!
27 Strategies at Home Reduce Stress Make a Routine Work Together Give ConsequencesBe SupportiveEncourage IndependenceAvoid Giving Excessive ReassuranceBuild Self-ConfidenceRealistic ExpectationsDealing with Your ReactionsTake RisksAvoid AvoidanceReduce Stress! Excessive stress and tension in your homeMake a Routine! Establish a routine by setting specific times for meals, homework, quiet time, and bedtimeWork Together! It is important that you and your partner work together to help your child manage his or her anxiety.ConsistencyGive Consequences! Although your child may have problems with anxiety, that does not give him or her the green light for inappropriate behaviorBe Supportive! Recognize that it is difficult for children to face their fears. It is important not to laugh at your child or minimize his or her fearsEncourage Independence! Although it is tempting to want to do things for your child, especially when he or she tends to be nervous and fearful, it is better to let kids do things for themselvesAvoid Giving Excessive Reassurance! It can be hard not to give your child reassurance, especially when he or she is scared or anxious; however, giving constant reassurance prevents your child from learning how to cope on his or her ownBuild Self-Confidence! It is important to praise your child for his or her accomplishments and for facing fearsRealistic Expectations! It is important to have expectations for your child and help him or her meet those expectations; however, understand that an anxious child will have some trouble doing things, and may need to go at a slower pace.Reactions! Although it is important to be understanding and caring, do not overreact or let anxiety trick you into thinking that something is too hard or impossible for your childDealing with Your Reactions! It can be very difficult dealing with an anxious child. Make sure you manage your own reactionsTake Risks! Anxious children need to try new things and take some risks, in order to build confidence and develop the necessary skills for dealing with the worldAvoid Avoidance! Anxious children tend to want to avoid things that cause them anxiety.
28 Healthy Habits for the Home Anxious children and teens prefer to have a sense of control in their livesThey feel calmer when:life is predictablethey know what is expected of themthey know what the consequences will beTherefore set limits, create routines, encouragephysical activity and good nutrition
29 Cognitive Behavioral Therapy Skill-based psychotherapy, teaching specific techniquesTargets maladaptive thoughts and behaviorsPsychoeducation about anxiety/anxiety is normal and adaptiveLearning to relax via Progressive Muscle Relaxation,Mindfulness or Calm BreathingChallenging anxiety inducing thoughtsExposure Therapy - facing fears
30 Very Useful WebsitesAnxietyBC.comTeenmentalhealth.org