Working with Anxious Children. Mary E Eason, PhD

Transcription

1 Working with Anxious Children Mary E Eason, PhD 1

2 Training Objectives 1. You will develop an understanding of the origins of anxiety in children 2. You will be able to put this understanding into practice on a daily basis to benefit your students 3. You will learn interventions to assist you in managing anxiety in school-age children 2

3 Organization 1. Understanding how anxiety develops 2. Helping your students overcome anxiety in the moment 3. The impact on you as an nurse/educator 3

4 The Adverse Childhood Experiences (ACE) Studies Origins in 1980 s Dr. Felitti s Obesity Clinic at Kaiser in San Diego Childhood sexual abuse and obesity 1990 s Centers for Disease Control became involved Relationship between a variety of adverse early experiences and physical health, mental health and quality of life 4

5 Adverse Childhood Experiences Abuse: emotional, physical, sexual Neglect: emotional, physical Household dysfunction: domestic violence, substance abuse, mental illness, parental separation, incarcerated household member 5

6 How common are ACEs? Population frequency In a classroom of 30 2/3 1 or more 20 students 2/9 3 or more 6 or 7 students 1/8 4 or more 3 or 4 students 6

7 ACEs are Related to Life Outcomes Mental Health and Substance Abuse: Depression Suicide attempts Alcoholism and alcohol abuse, Illicit drug use, Smoking Physical Health: Ischemic heart disease Liver disease Obesity Sexually transmitted diseases Early death Quality of Life: Poor academic achievement Adolescent pregnancy Poor work performance Financial stress Risk for intimate partner violence Unintended pregnancies 7

8 ACE Study

9 Adversity Impacts the Developing Brain Cortex Limbic System Brain Stem 9 QfcJ3o5-4FbCLilINL2d1DahNNNw91LGhfyuQ15bIcc=s580

10 Adversity Impacts the Developing Brain The quality of caregiving relationships Exposure to toxic levels of stress Trauma exposure Nervous system regulation Emotion regulation skills 10

11 The Brain Develops from the Bottom Up The Cerebral Cortex or Thinking Brain The Limbic System or Emotional Brain The Brain Stem or Survival Brain 11

12 The Brain Stem: The Survival Brain Controls the rhythms of life: heartbeat, waking, sleeping, breathing, cyclical release of hormones Arousal systems Reaction to threat: fight, flight or freeze. 12

13 The Impact of Adversity on Brain Stem / Survival Brain What does it look like in the classroom? Dysregulation of nervous system: Jitteriness, can t sit still, can t focus Tired, lethargic, can t focus Goes from 0 to 100 in 2 seconds Jumpy, easily startled Physical symptoms: stomach aches, headaches 13

14 INTERVENTIONS: Soothing the Survival Brain: Regulating the nervous system Use of music, dance, drumming Opportunities for movement Movement breaks Sensory experiences Calming centers in the classroom Lessons on breathing, meditation and relaxation skills 14

15 The Limbic System The Emotional Brain Attaches an emotional meaning to experiences Based on reward vs. threat Stores emotional memories and uses them to signal the Survival Brain Quality of caregiving relationships are critical 15

16 The Impact of Adversity on the Limbic System / Emotional Brain What does it look like in the classroom? Misperceiving danger Misperceiving social cues Trouble forming trusting relationships Reluctant to ask for help Depressed or anxious mood 16

17 INTERVENTIONS: Reaching the Survival Brain through the Emotional Brain: Building a Sense of Safety Understand what helps each child feel safe Talk about safety often Create a safe school environment Predictable routines and expectations Understand and minimize trauma reminders 17

18 INTERVENTIONS: Reaching the Emotional Brain: Positive Emotion & Creativity Make positive reinforcement the primary tool for intervention Limit punitive interventions and other exposure to negative emotion 5-1 Ratio of positive interaction to corrective interaction Attention to your own non-verbal body language and facial cues Increase opportunities for fun Creative self expression helps children process difficult emotions & 18

19 The Cerebral Cortex: The Thinking Brain Label emotions Evaluate emotions in a more sophisticated manner Impulse control, planning, organization Making sense of experience 19

20 The Impact of Adversity on the Cerebral Cortex / Thinking Brain. What does it look like in the classroom? Discrepancies in performance Difficulty organizing work, remembering to bring homework, working toward goals Difficulty articulating thoughts and feelings Deficits in critical thinking / problem solving Negative perspective on self, others, the world 24

21 INTERVENTIONS: Strengthening the Thinking Brain: Planning, Organization, Goal Setting Break down assignments and directions Have the student repeat directions back Use planners/color coded folders Help student formulate goals Help to break goals down into successive steps 21 &

22 INTERVENTIONS: Strengthening the Thinking Brain: Social-Emotional Skills and Behavioral Self-control Lessons on breathing, meditation and relaxation skills teach awareness and control of the nervous system Teaching children about the impact of ACEs normalizes their experience. Teach coping skills 22

23 Anxiety and the Difficulty Regulating Emotions 23

24 Adversity impacts the development of Emotion Regulation Skills Tolerate distressful emotions Self sooth / Calm oneself down Form supportive relationships Use social support to manage distress Understand, label and talk about emotions Delay gratification Problem solve Plan ahead & work toward goals 24

25 The Hyper-arousal Continuum adapted from: Bruce Perry, Parts of the brain being used Thinking brain Thinking and Emotional brain Emotional brain Emotional and Survival brain Survival brain Thinking style Abstract, sophisticated, reflective Concrete Emotional Reactive Reflexive Internal state CALM AROUSED ALARM FEAR TERROR 25

26 INTERVENTIONS Align Your Action With Where The Child is On the Hyper-arousal Continuum Calm - the learning moment. The time to teach skills Aroused coach child to utilize previously learned coping skills Alarm stay calm, do very little. Goal is to let the episode pass Fear and Terror stay in your thinking brain and alert for safety concerns. 26

27 INTERVENTIONS: Minimizing common non-verbal cues that may act as anxiety triggers Loud noises An adult coming up quickly behind a student Sudden movements Unexplained changes in routine Facial expressions Peer conflict 27

28 What can you do to help? Relaxation Breathing Distraction Mindfulness Exercises Grounding Exercises Safe/Calm Place Positive Goal/Positive State 28

29 Relaxation Breathing Put one hand just above your belt line Put the other hand right over the breast bone Open your mouth to gently sigh, notice the relaxation in the shoulders Close your mouth slowly and keep it closed Inhale slowly through your nose by pushing your belly out Pause Open your mouth and slowly exhale by pulling your belly in Pause Start over 29

30 Belly Breathing with Elmo 30

31 Breathing Tools Can be done lying down or sitting Younger kids can use a stuffed animal on the belly Imagine your belly like a balloon blowing up and letting air out 31

32 Distraction Wiggle your fingers and toes Use your voice (read a book out loud) Look in a mirror, smile, what do you feel? Go outside, count the trees and birds and bushes Take a walk Hold on to a stuffed animal or blanket List 5 positive things in your life Count backwards Think of all the animals that start with each letter of the alphabet Listen to music, watch a video Eat a hard candy 32

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34 Mediation v. Suspensions 34

35 Mindfulness Strategies Place hands over your heart Take a few deep breaths Acknowledge that life is hard right now Acknowledge that this is suffering this is really painful Acknowledge that suffering is part of being human Focus on positive affirmation such as: May I hold myself with compassion May I experience peace May I treat myself with love and kindness May I love and accept myself just as I am May I open to my experience just as it is 35

36 Grounding Exercises KEEP THE CHILD IN THE PRESENT Notice how your body feels What part of you is touching the floor? Chair? Wall? What does that feel like? What do you notice on the walls? What colors do you notice> Name all the colors you notice? What do you smell? Find the things in the room that start with the letter? Focus on my voice, breath in and out Get out and go for a walk 36

37 Safe/Calm Place Ask the child to imagine a place where they feel calm and safe Have the child do relaxation breathing while imagining themselves in their safe/calm place Have them tell you in as much detail about their safe/calm place Speak in soft tones with reassurance as they describe their place If it works to calm them, have them use this imagery to calm themselves at home or in the classroom Use in conjunction with other interventions 37

38 Positive Goal and Positive State This is best developed when the child is in a calm place using their thinking brain. Have the child list a positive goal for their future Have them imagine the goal in detail Have the child identify the positive feelings they imagine when they achieve their goal or how it feels to just experience thinking about the goal. I want to get along with peers I want to stay in class all day long 38

39 Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. - Leo Buscagilia 39

40 Physical Diet, exercise, healthcare Sleep, rest, relaxation, stress management Emotional Self monitoring, Pleasurable activities Self expression, Affirmations Taking Care of yourself outside of the nursing office Spiritual Finding inspiration, Time in nature, Faith Community Social Peer Support Time with loved ones 40

41 Questions? Give me a call or send an Mary E. Eason, Ph.D. Consultant Psychologist, Trainer, Meason@ochca.com

42 Mindfulness Resources Websites UCLA Mindful Awareness Research Center Jon Kabat-Zinn Tara Brach Jack Kornfield Deepak Chopra Apps Stop Breathe Think Calm The Mindfulness Appp: Meditation for Everyone Headspace Simple Habit Aura Daylio (mood tracker) Resources/Referrals Susan Samueli Center for Integrative Medicine, Irvine CA TEDxtalk: How mindfulness meditation redefines pain, happiness and satisfaction. Dr. Kasim Al-Mashat 42 The Power of Mindfulness. Shauna Shapiro