Positive Parenting Strategies to Help Manage Anxiety

Transcription

1 Positive Parenting Strategies to Help Manage Anxiety Trinity High School August 23 rd, 2018 K a t h e r i n e D a h l s g a a r d, P h D, A B P P C l i n i c a l D i r e c t o r A B C : T h e A n x i e t y B e h a v i o r s C l i n i c T h e P i c k y E a t e r s C l i n i c D e p a r t m e n t o f C h i l d & A d o l e s c e n t P s y c h i a t r y & B e h a v i o r a l S c i e n c e s C h i l d r e n s H o s p i t a l o f P h i l a d e l p h i a Katherine K. Dahlsgaard, Ph.D.

2 Conflicts of Interest/Disclosures The content represents the presenter s personal opinions and does not necessarily represents the position of the presenter s employer or previous training sites. Paid contributer to: Philadelphia Inquirer Any case examples given in this presentation have had potentially identifying information altered or deleted. Katherine K. Dahlsgaard, Ph.D.

3 Please take a quick survey about this presentation. iphone: Go to your camera-- Center the image-- The survey will pop up. Android: Download any QR code reader app from Play Store. Go to your camera-- Center the image-- The survey will pop up. Or go to one of these links: ons eys/?s=y8lmpmyhcy (Updated )

4 Parents, why are you here??? It seems that our children are under siege. I would argue that it is parents who are also under siege. Tonight s theme will be parental empowerment.

5 Positive Parenting Strategy #1 REALLY appreciate the difference between fear & anxiety. because your kids do not.

6 The (literally) life-changing difference between FEAR and ANXIETY FEAR ANXIETY FIGHT OR FLIGHT revs up your body FIGHT OR FLIGHT revs up your body Thoughts are RIGID & CATASTROPHIC: I ll never get out of here! I m gonna die! Thoughts are RIGID & CATASTROPHIC: I ll ruin my whole grade! I ll never get into college! Possible outcome? Burns & death Possible outcome? CERTAINLY NOT DEATH

7 Positive Parenting Strategy #2: Trust that the vast majority of the anxiety and distress that your kid experiences will be normal. And temporary.

8 Point Prevalence of Child Anxiety Disorders from a Variety of High Quality Published Studies Using Community Samples Source: Merikangas et al., 2009, Dialogues in Clinical Neuroscience

9 Normal Anxiety All youth experience worries & anxiety These represent emerging abilities and are usually adaptive Fluctuate in response to stress that is, increase during a stressor and abate when stressor is conquered or simply passes. Distress, in and of itself, represents an inadequate criterion for distinguishing among normal and pathological anxiety states in children (Beesdo et al., 2009, p. 484). What teens said they feel most anxious about college admissions friendships excelling in school homework athletics social media Katherine Dahlsgaard, PhD, ABPP

10 Normal Parental Anxiety What you, their parents, worry about That they will worry about these things. That they won t get what they want. That they ll feel upset, disappointed, or in pain when things go badly. That they will get angry at you or lose their attachment to you if you don t prevent or fix their worries. In other words, YOU are worried about their worries!

11 Problematic Anxiety = Problematic Coping Skills The emotion of anxiety including the INTENSITY!!!! of the emotion is not what determines problematicness. Rather, the defining feature of PROBLEMATIC anxiety is over-reliance on avoidance and escape behavior that is pervasive, persistent, and moderately-to-severely impairing. That is, avoidance and escape of things or situations that are either: a) safe and healthy b) extremely unlikely to happen c) temporary & bearable

12 How problematic anxiety is maintained: The (vicious) circle of Negative Reinforcement Anxietyprovoking situation But then Person gets anxious Anxiety is lowered in the short term person feels RELIEF! Person avoids or escapes

13 Example: Problematic Social Anxiety - Adult The (vicious) circle of Negative Reinforcement Anxiety-provoking situation: I will have to give a public speeches if I take that promotion. But then Anxiety: I feel sick just thinking about it. I ll stutter and get red in the face. Phew! I ll just turn down that promotion.

14 How problematic anxiety is maintained in children The (vicious) circle of Negative Reinforcement, X 2 Anxietyprovoking situation But then Child gets anxious; SO DO CAREGIVERS Anxiety is lowered for both in the short term: child and CAREGIVER feel RELIEF! Child avoids or escapes OR CAREGIVER RESCUES

15 How problematic anxiety is maintained in children The (vicious) circle of Negative Reinforcement X 2 Kid has an oral presentation. But then I m sick. No school for me. He s so upset. He might go to school and embarrass himself. He ll be furious at me if I make him go. Phew! (kid) Phew! (parent) Child refuses to get out of bed; parent gives in.

16 Problematic Anxiety < Active PARENTAL Coping Skills You are well within your right as a parent to insist that your teen NOT regularly avoid situations that are a) Safe and healthy -- vaccinations/medical procedures; temporary separations from parents; attending after-school activities; working out a conflict with a peer; working out a conflict with a teacher; MAKING A MISTAKE AND LEARNING FROM THE CONSEQUENCES; doing poorly on a test; going to school without their homework finished or perfect; losing; breaking up with a sweetheart; attending school; arriving on time at school; staying at school the whole day. b) Extremely unlikely to happen dying during a thunderstorm; fainting because they feel hot; vomiting at school; failing a test and therefore failing at everything in life, forever. c) Temporary & bearable feeling (extremely) anxious and functioning anyway; losing at something; mild-to-moderate conflict with friends, teachers, & parents; uncertainty; things not being fair; things not being easy; things not being okay; MAKING A MISTAKE AND LIVING WITH THE CONSEQUENCES.

17 Positive Parenting Strategy #3: With regard to anxiety, understand that your job as a parent is more coach than helicopter pilot.

18 Congratulations on your promotion to Head Coach for Team Resilience!!! Your role as Coach Mom or Coach Dad: Is not to rescue your teen from feeling anxiety Is not to prevent your teen from feeling anxiety Rather, your job is to model, teach, and support your teen mastering active coping skills Just as with any other skills, these will require practice and some discomfort. For both of you. Katherine K. Dahlsgaard, Ph.D.

19 Which kind of coach do you want to be? Katherine K. Dahlsgaard, Ph.D.

20 Positive Parenting Strategy #4: Successful experiences with anxiety equal vitamins for your child s soul. And yours.

21 Evidence-Based Treatments: Child/Adolescent Anxiety Disorders Substantial evidence that SSRIs are also safe and efficacious for anxiety disorders (JAMA Pediatrics, 2017; JAMA Psychiatry, 2017; Rynn et al., 2015) Cognitive-Behavioral Therapy (CBT) designated as the scientifically well-established and first-line treatment for anxious youth with over 30 methodologically robust or fairly rigorous studies conducted (Higa- McMillan et al., 2016; see also Cochrane Review, 2015 & Wang et al., 2017) Exposure is deemed the primary active ingredient within CBT for all kinds of anxiety (American Psychiatric Association, 2009; Deacon & Abramowitz, 2004; National Institute for Child Excellence, 2011) Katherine K. Dahlsgaard, Ph.D.

22 EXPOSURE (i.e., bravery practice) works for any kind of anxiety! Exposure / approach of anxietyeliciting stimuli or situations Prevention of avoidant & escape behaviors Gradual habituation to symptoms over time via repeated practice Accumulated experiential proof that anxiety is merely an emotion that the kid can handle Foster adaptive coping and processing of new learning/corrective information From Dugas & Robichaud (2007)

23 Positive Parenting Strategy #5 One of the most powerful, concrete, and positive changes you can make in your parenting is to SPEND LESS TIME WORRYING ABOUT YOUR KIDS.

24 Brain Worry: The Big Sick on Fire Worry s job is to get you to OVER- ESTIMATE a negative outcome and UNDER-ESTIMATE your ability to cope if something goes horribly wrong.

25 Some brief examples of perfectly understandable parental worries 1. Will s son has never been good at separation, and this weekend is his first weekend away with his 9 th grade class. Will can t stop worrying that his son will be upset, cry in front of other kids, and need to come home. He canceled plans with his buddies for that night just so he can be ready to go and get his kid. 2. Tom & Alex s daughter has always been an excellent student, but she s having some trouble in AP Calculus and seems nightly to be falling apart, crying and calling herself a failure. This is coinciding with applications to college which she is avoiding. Parents are so overwhelmed that they only talk about her problems and their worry fills their days (and nights). 3. Michael s teenage son has extremely severe social anxiety disorder and depression on top of that. The boy is functioning relatively well goes to and excels in school, holds down a job in the summer but is really miserable. Michael is doing all the right things: He has taken his son to a good psychiatrist for medication and is tracking down a therapist specializing in CBT. Michael is doing everything he can for his child. And he is very, very worried about him. Katherine K. Dahlsgaard, Ph.D.

26 So, what s the dominant theory about worry? In general, worry must somehow be reinforcing, because worry maintains itself over time. Current theory is that by worrying ahead of time, we think we are averting catastrophe ( covering all the bases ) Because the worst RARELY HAPPENS, worry begins to be associated with nothing happening = RELIEF. Ta-da! Worry works! relief and negative reinforcement. For the nerds, this is part Pavlovian & part Skinnerian. Let s examine a visual of this concept

27 How is worry maintained? The (vicious) circle of Negative Reinforcement! My kid is now DRIVING. But then What if a driver is careless? What if my kid is careless?! What if my kid ends up being in an accident? What if what if what if?? That s 200 days my kid hasn t been in an accident! Relief! Mom continues to let her kid drive anyway. With appropriate reminders to be careful. BUT THE WORRY IS DAILY.

28 Positive Parenting Strategy #6 There are two beliefs in particular regarding worrying about your children that you need to give up.

29 Unhelpful Beliefs About Worry 1. If I don t worry about my children, it means I don t care about them. a) You already care about your children. Show that love, care, and concern in ways that are more helpful to them and less painful for you. 2. Worry Has Something Important To Tell Me about My Child. a) Actually, worry is a seductive and unhelpful avoidance strategy. There are MUCH BETTER parenting strategies (think Coaching metaphor). Katherine K. Dahlsgaard, Ph.D.

30 Positive Parenting Strategy #7 Save it for worry time.

31 Save It For Worry Time Use the magic of containment as your top parenting strategy to combat excessive worry Worry is a waste of time So, how much time do you want to worry each day about your children? An hour? Or 5 minutes? Avoid Allowing your worry about your kid unlimited time to intrude on your life. Instead. a. Pick a guaranteed 5-minute time you can worry each day. b. Otherwise, save it for worry time! c. Tell your brain to get busy doing something else in the meantime. Repeat. d. P.s. Worry time works with your kids, too. Adapted from Dawn Huebner What do when you worry too much

32 Please take a quick survey about this presentation. iphone: Go to your camera-- Center the image-- The survey will pop up. Android: Download any QR code reader app from Play Store. Go to your camera-- Center the image-- The survey will pop up. Or go to one of these links: ons eys/?s=y8lmpmyhcy (Updated )

33 QUESTIONS? Two great books to read are: Steinberg, L. (2014). Age of Opportunity: Lessons from the New Science of Adolescence. Jensen, F. (2015). The teenage brain: A neuroscientist s survival guide to raising teenagers and young adults. Katherine K. Dahlsgaard, Ph.D., ABPP