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BRIDGES Program Stephanie Mealey MSW, RSW Karen Mackey OT (R) NL

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1 BRIDGES Program Stephanie Mealey MSW, RSW Karen Mackey OT (R) NL
Anxiety Session You are here because you have a teenager who is experiencing anxiety and participating in our group or who is being seen here on an individual basis. Our goals are to Educate you about anxiety Explain what your teen will learn in group Provide suggestions on how to be helpful BRIDGES Program Stephanie Mealey MSW, RSW Karen Mackey OT (R) NL

2 Anxiety Statistics Vary….
Anxiety disorders are the most common of all mental health problems, affecting approximately 1 in 10 people. (Canadian Mental Health Association) Most common, chronic costly emotional disorder in the US (NIMH) and in countries (WHO) Practice evidence-BY FAR the most common mental health referral to Central Intake Highlight that there is a big increase in referrals Very common, you are not alone We see lots of youth with anxiety , most of our referral s are anxiety related.

3 Why the increase???? Increased awareness about anxiety
Lifestyles “bigger…better…faster…smarter…” Lack of skill building (modeling, integrating, naturally occurring) World Messages Economy, illness, threats Pathologizing normal stress Awareness-we know more about it. “Household word” years ago no one talked about anxiety. We know more therefore we see more. Living in a faster paced world “Like we are on high speed on the treadmill of life . Pressure both self imposed and society based to be better people, parents, and employees. We take on more because we feel we have too “Lots of pressure.” This type of lifestyle will make anyone feel more anxious. Ex: Farmers Meatballs. “Do Best that you could” Sister loot bags. “You can and should do better” Less protective factors more risk factor. Lack skills as kids aren’t learning the skills they need to cope with life or “treadmill.” Modeling – Don’t have time, too guilty, when the kids are in bed Integrating – Not happening in activities, schools etc- There is no allstar yoga team Not Naturally occurring– because parent feel pressure to be best parent, sometime they rescue kids from pain, failure, “I’m bored” Bruce Perry – “Improvise social experience” - Build emotional muscle - Car ride across the island -Break-up We are living in a post 911, post Y2K world. Kids are exposed to much more of what is happening in the world. Very graphic, mixed messages “you're safe you’re not safe.” We are pathologzing normal experiences. We don’t want our children to experience pain or perhaps we feel pressure to make sure that we don’t miss something (anxiety disorder) and have the child suffer unnecessarily.

4 Anxiety IS NORMAL Anxiety is normal and needed.
It serves as a natural alarm system that tells us there is danger. Some people have sensitive alarm systems. It helps us survive! Normal and need! Our goal is not to eliminate but to help a child get in charge. Tell parents we need anxiety, it keeps us safe. Without anxiety, we tend to be careless with our words/ actions. Ex. Dark alley with stranger; take pulls off the table at a party. Natural alarm system. Survival mechanism. Kept us alive back in the cave days. Through evolution we have not needed that alarm system…we have safe guards; like laws, reports about pending weather threats, dangerous animals are locked up etc. Now we can use logic and reason to evaluate threats. Some kids/ people have more sensitive alarm systems—they just go off more easily. Just alike a sensitive smoke alarm/ toast. Or Car alarm /rub by it - Our goals is to help parents and teens understand the nature of their sensitive alarm system, encourage and teach them the skills to slow down, relax, and re-evaluate threats.

5 Important to point out that many famous people have anxiety.
Discuss the powerful brain and how many successful people use that brain to think up great stories, inventions or ideas. Its that same powerful brain that can create scary ideas and ruminate about what might happen ….What if this happens…what if that happens…our goal is to help teens understand that powerful brain and make it work for them. Example George Lucas A client who has shame associated with talking about his OCD was prompted to go home and research other famous people with OCD. This shifted therapy because the next session he told the therapist that he learned that his idol “George Lucas “ creator of star wars has come up in Google search of famous people with OCD. He was able to make the connection about how Mr. Lucas used his powerful brain and it would have been a benefit to helping him develop the characters, plots etc.

6 Anxiety – Not all Bad! Liabilities Assets Higher levels of stress
Personalizes Easily exploited Difficulty setting limits/saying no Excessive time spent doing or thinking about tasks Consumed by things Assets Cooperative Motivated/driven Thoughtful/reflective Organized Sensitive/Intuitive Loyal Creative We tend to often focus on all the liabilities and as caregivers when we do that we indirectly give the liabilities power. We can’t stress enough the importance of remembering and reminding your teen about the assets to being anxious. It these people who are less likely to bully, are more caring and concerned, creative and driven. Its about finding balance and learning to make that powerful brain work for you. Anxious people can make some of the best employee or friends. Create some discussion Ask yourself is my teen creative? Is my teen thoughtful? Is my teen reflective?

7 Development of Anxiety
Predisposition Biological sensitivity Personality Temperament Stress (good or bad) Learned Anxiety Lack of stress skills “Treadmill of life” Stable factors that cause anxiety. These are factors that remain stable across your life. You can’t change these factors. You can learn to adapt or master these factors. Predisposition- some of you are born into families where lots of people with anxiety. You come by it naturally. Just like some families have lots of red heads or people with diabetes; some people have families with anxiety. Biological sensitivity- Inherit a general tendency to be sensitive, emotional, more tearful, high strung and highly reactive. “Emotional Sun Burned” A researcher by the name of Dr.Kegan- Harvard University studied children (Twins) in the hospital nurseries and throughout their life. He noticed that some children are born with more highly sensitive states. Inhibited and uninhibited children. Temperament (personality) Research tells us that we are born with certain personality traits. Some personality traits are linked more with anxiety.  Environmental Factors that cause anxiety- these factors can change daily and we can have some influence over these factors. Stress- Stress (good or bad) will affect the level of your anxiety. For most people there is a correlation between stress and anxiety. Even the day to day business of life can cause our anxiety to be higher. Examples morning routine, going on a trip. Experience and learning- we are all shaped by our own personal experiences. When we have an experience that makes us anxious we learn to develop fear. For example if you have been bitten by a dog you may fear dogs. If you have been bullied at school at lunchtime you may have anxiety at lunchtimes. We have watch other people in our lives (Mom, Dad, Nan etc) react to stress in an anxious way and in watching them we may have picked up some of their worrying habits. Santa Example- Christmas eve many people think they hear or see santa…stress factors ANXIETY!!

8 Continuum of Anxiety Normal Anxiety Severe impairment No Anxiety
due to Anxiety No Anxiety Anxiety sits on continuing from no anxiety to some immobilized by anxiety. Our goal is not to eliminate but to help a child get in charge. We also need to be aware that anxiety will move up and down the continuum with stress (good/bad). We encourage teen to play detective and try to see patterns and understand what influences anxiety. They may already have some great tools that they use that help with anxiety. Further more in playing detective we can be proactive and undercover times when the anxiety is worse and encourage the use of skills during those times. As a family you may discover times of the day or week when anxiety is higher and as a family try to prepare for same, for example if Monday morning seems to be a high anxiety times ask yourself are there things that can be done Sunday to reduce the stress.

9 Common Anxieties 5 years - separation, dark, animals, “bad people”
6 years - separation, harsh weather, ghosts, dark, sleeping alone, bodily injury (all ages) 7-8 years - ghosts, dark, fears based on TV viewing, staying alone 9-12 years - tests, school performance, start of physical appearance, death 13-15 years - family and home issues, world concerns, preparation for the future, personal appearance, social relations Older - fear of isolation, natural events, sexual issues, economic issues, morality Review and discuss. Stress the importance of not pathologizing normal anxiety. Taken from “The Worried Child.”

10 Disruptive or pressured behavior/fight
Effects of Anxiety Physical Feelings (Body) Muscle tension Racing heart Belly pain Nausea Head ache Sweating Behavior Avoid/Escape/Flight Disruptive or pressured behavior/fight Freeze Seeking reassurance Thoughts (Brain) What if…? Thinking the worst Review the slide. Highlight the three different areas and the impacts on an individual. Explain how its important to play detective and try to see how anxiety impacts the teen.

11 Anxiety Reactions Flight Fight Freeze Avoidance Behavior Indecision
Tummy aches & pains Quitting Lying Fight Behavior Refusal Extreme persistence Perfectionism Self-imposed pressure Freeze Indecision Inaction Review the chart

12 When does it become a disorder...
Distress or interference is much greater than anxiety experienced by other children of the same age When it interferes with daily functioning/causes impairment When it is persistent When accommodations are always necessary Regardless of the extent of the anxiety …the development of skills will help anyone. May want to mention that if a clients is dx with an anxiety disorder and given medication that the meds will only turn the volume down and that the skills still needed. When a kid just can’t be a kid!!!!

13 Why my child? It’s hard to be the parent of the anxious child. You may often feel sad, heart broken, frustrated, and helpless to fix the situation. Most parents struggle with “Why my child” They are likely at work, riding their own “treadmill of life” and praying that the school doesn’t call again today. The next slide will present some theories which may shed light on the development of anxiety but again regardless of the cause the acquisition of skills is helpful.

14 Adolescent Stress Factors
The Perfect Storm The Teenage Brain Frontal lobe restructured self-control, judgment, emotional regulation Anxiety Predisposition, Temperament Biological Sensitivity The Perfect Storm Adolescent Stress Factors Drugs Social appraisal Belonging to a group Getting good grades Review and highlight special considerations for teens.

15 Brain Review and encourage parents to watch the video for extra information.

16 Learning skills to mastery symptoms Getting to know Anxiety
Treatment Skill Building Learning skills to mastery symptoms Insight and Awareness Getting to know Anxiety Practice Facing Fears & Using skills There is no magic cure for anxiety. Our approach: Insight and awareness- getting to know your anxiety, assets, factors effecting your anxiety, that it is normal and needed etc Skills- we teach client skills to manage symptoms that impact thinking, the body symptoms and their behavior (actions) Finally we encourage practice. Practice using skills and practice facing the feared situation and building emotional muscle.

17 Language we use… Mastering anxiety Getting in charge
Turning the volume down Riding the wave Building emotional muscle Don’t Pathologize!

18 BRAIN-Targets Beliefs about anxiety
Racing thoughts “can’t turn the brain off” Negative self-talk Recurring thoughts or images Review

19 Brain-Strategies Education about anxiety
Awareness of factors influencing anxiety Highlight assets (powerful thinker) Awareness of Attention Examine & challenge thoughts Replace with more positive/realistic or less anxious self-talk The goal is to shift from being an anxious thinker to a more realistic thinker

20 This is a tool use to help teens concretely think about their anxiety .
To think about how intense they perceive things. To try to quantify the level of anxiety. Many times we just flatly say I have anxiety but anxiety is normal so we need to be more specific. This also helps as a tool with clients to ask when is anxiety better? Helps us track patterns, For example if measured three times a day did we see any patterns, was anxiety worse in the morning? If we find patterns we can look further to see if there is a way to influence or reduce the anxiety.

21 This again helps us to looks for clues as to when the anxiety is greater or smaller.
It helps us see triggers that bring anxiety up. It helps us identify resources to bring anxiety down.

22 Brain- Awareness Power of Attention Direction of Attention
Our brains are powerful What we choose to focus on will influence how we feel By being focused on our worries, we may miss things Direction of Attention Biologically we are velcro for negative thoughts; teflon for positive Learning to direct our attention Awareness test Refer to the “what do you see power point”

23 We Blame Events FEELINGS EVENTS Anxiety Trying out for a team Stressed
Speaking in public Going to School FEELINGS Anxiety Stressed Nervous Teens will often tell us that events cause their anxiety…”School makes me anxious” “being in crowds makes me anxious.” We need to highlight for teens that it is not the event that is causing the anxiety but the thoughts around the event. If it was the event alone, all people facing that event would have the same feeling.

24 Thought Investigation and Challenge
Our job is to highlight the thought feeling connection. To explain to clients that it isn’t the event that is causing their anxiety but their interpretation of the events. For example you may hear a bang outside your house on a windy night. One person thinks its windy and things are blowing around and the garbage bin blew over- if they think this way they feel assured and go back to sleep. The second person with the anxious powerful brain thinks “what's that noise?” I bet it is a robber and they are lurking outside and as they tried to peep in the window they banged into the garbage bin. When we cover this with clients we want to highlight how quickly thoughts race through the brain. Stats tell us we have about thoughts a day. That’s why its important to slow our thoughts and examine them. The thought investigation would involve us slowing the think feel do cycle and having clients evaluate their thoughts.

25 Ideas for helping… Model positive/realistic Thinking
Highlight the strengths of being an powerful thinker Help them use skills scaling highlight positive/more realistic thinking Help them scrutinize their thoughts Review

26 Body How your body reacts…

27 Body - Targets The Basic (Sleep, Diet & Exercise) Body sensations
Muscle tension Heart palpitations, SOB, dizziness, nausea, vomiting Inability to relax Review

28 Body Strategies Create awareness of body stress
Learn relaxation skills Highlight things that help you to relax Encourage proper care of the body (sleep, diet, exercise) If the symptoms of anxiety cause the body to be tense obviously the treatment intervention would be geared toward learning to relax. This sounds simple but many clients struggle with this one. As a society we don’t value relaxation and many of us neglect this area. Ask the parents in the room by a show of hands how many of them can concretely identify ways to relax. Ask if any of them regularly practice it. Stress the importance of modeling. If we are expecting teen to regularly use these skills then we need to be modeling it for them otherwise we are indirectly showing a lack of value for these skills.

29 Body- The Basics Many of us neglect the basics.
Research has shown that constant and regular care of the basics will improve mood.

30 Body Mapping We use this as a way of helping client again play detective and get to know their anxiety. If they learn that shortness of breath is a regular symptom then learning a skills to regulate breathing will be helpful .

31 Body – Relaxation Back to the Basics (Sleep, Diet, Exercise)
Play Detective- what already works Relaxation Skills Visualization, progressive muscle relaxation, deep breathing etc. Review

32 Ideas for helping… Model Positive Self Care
Encourage care of the basics Help them use skills Remind them of their skills to relax Provide an opportunity for them to practice Promote a relaxing environment at home Review

33 What we do … How we respond….
Behavior What we do … How we respond….

34 Behavior Targets Avoidance Emotional Outbursts
Excessively Seeking Reassurance Review

35 Behaviors Strategies Build Emotional Muscle Exposure & Habituation
Additional Coping Skills Assertiveness Time Management Social Skills Problem Solving etc. Review

36 Let’s ride the wave of anxiety & Build emotional Muscle
This is the cycle of avoidance , it’s important to share this notion with parents. We need parents to understand that in order to help them not be afraid , the teen needs to be exposed to the feared situation in order to “build emotional muscle.” Parents need to know exposure lowers anxiety and avoidance strengthens. Explain: Habituation- bodies natural way to adjust. Slowly exposing ourselves, rule of thumb is one notch above comfort level. Explain to parents that the children need to ride the wave—it builds emotional muscle. For parentis Validate it’s normal to want to rescue but when they do they inadvertently rob the child from having the chance to naturally build skills. And they are also sending the message “I’m not sure you can handle this.” We need to remember, these kids are always looking for clues “is this safe” and If mom or dad seem nervous then they will feel they need to be on super alert. Explain the Cycle of avoidance and the importance of riding the wave. Our bodies have a natural way of adjusting its called habituation. What that means is that as we expose ourselves to certain things and stay with the discomfort our bodies will adjust. Much like when you first put your toes in the cold pool. Initially it feels freezing but if you slowly start to lower yourself into the pool bit by bit your body adjust to the temperature.

37 PRACTICE!!!!!!!!!!! Regular Practice Integration of skills Learning
Anxiety Management Regular Practice Integration of skills & Reduction in anxiety Practice is so important Many times clients will try something once and say it didn’t work. It take 21 days to form a habit. We can’t stress enough the importance of practice. We are essential trying to change a very ingrained way of interacting with the world. It will be hard to change this pattern. Use the hand writing analogy.

38 Ideas for helping… Model brave behavior Encourage approach behaviors
Help develop exposure plans Make exposure part of learning Review

39 Tips for Supporters Listen to the teen & don’t minimize Reduce stress
Have routines Normalize anxiety & use age appropriate language Model brave behavior Model problem solving skills, stress management & relaxation Review

40 You are helping them build skills to master their anxiety!
Tips for Supporters Avoid excessive reassurance Be mindful of your own reactions Realistic expectations, small steps Give appropriate consequences Build self-confidence Encourage independence PRAISE!!!! Review You are helping them build skills to master their anxiety!

41 Resources The Responsive Classroom approach is a widely used, research-backed approach to elementary education that increases academic achievement, decreases problem behaviors, improves social skills, and leads to more high-quality instruction. ( The FRIENDS program is a school-based anxiety prevention and resiliency skill-building program. BC sponsored by the Ministry of Children and Family Development ( MindMasters, Mini Mindmasters- Eastern Ontario BC Anxiety Website Skills for Life Referral to Central Intake (local mental services)


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