anxiety. Strategies for helping children to understand and manage their Maria Ivanka Milić

Transcription

1 Strategies for helping children to understand and manage their anxiety. Maria Ivanka Milić Clinical Psychologists Psychstuff4kids Westmead + Chatswood Ph:

2 ANXIETY What is anxiety? What does it looks like? Strategies: psychoeducation/understanding structural, behavioural & cognitive tools. 2

3 What is anxiety? Normal emotion which is adaptive and important to our lives. Triggered by threat. Everyone gets anxious. Real and perceived threat. Three aspects to anxiety : physiological, cognitive, & behavioural. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 3

4 ANXIETY: When is it helpful? PERFORMANCE Very good Average Very poor Very calm aroused panic ANXIETY LEVEL 4

5 ANXIETY: The Psychological model Trigger situation thought bodily sensation Words in my mind. If I..then What if.. F e e l i n g s Bo dy cl ue s Actions: Avoidance of feared trigger Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 5

6 What may trigger anxiety feelings? Everyday events. Temperament. Normal fears and anxieties at a particular developmental stage. Expected and unexpected changes. Acute and/or ongoing stresses for child, family, community. Individual life challenges (eg. learning, friendships). Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 6

7 Flight - fight response The body reacts to real and perceived threats in the same way. The body prepares to run, freeze or fight the threat. Perceived threats are not the sorts of threats that you can easily run, freeze or fight so there is no corrective response that would remove the FFF symptoms. Over-breathing (and possibly hyperventilation) causes the carbon dioxide levels to change and any of the following bodily changes: light headedness - difficulties concentrating dizziness - tingling sensations in hands weakness in the legs - pain in the chest increased heart beat - irregular heart beat tightness in the chest feeling you cannot breathe CONCLUSION: the physical symptoms are real, not imagined Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids

8 Primary Anxiety My primary anxiety(ies) Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 8

9 Primary + Secondary Anxiety Anxiety about my anxiety My primary anxiety(ies) Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 9

10 Levels of anxiety. My primary anxiety(ies) Anxiety about my anxiety Anxiety about how you will respond to my anxious behaviour Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 10

11 ANXIETY: What does it look like? Different for different children: slower in starting & completing tasks avoidant ( stubborn & defiant ) irritable and snappy out the door confused quiet, reserved over plan/organise meltdowns/tears very compliant very very helpful Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 11

12 Impact of anxiety: Executive functioning skills. Cognitive tiredness. Missed opportunities for learning classwork, I can do it! can cope with the feeling and it does go away, anxiety bigger than it needs to be, new skills Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 12

13 Executive Functioning Cooper-Kahn & Laurie Dietzel (2008). Late Lost and Unprepared: A Parent s Guide to Helping Children with Executive Functioning. List of executive functions: 1. Inhibition: Stopping myself! 2. Shift: Can I move my thinking around? 3. Emotional Control: Stop and think when feeling. 4. Initiation: getting started and thinking about how to start 5. Working Memory: how much can I hold in my thinking my RAM 6. Planning/Organisation: of what I have to do now and in the future 7. Organisation of Materials: where are my things 8. Self-Monitoring: how am I going? 13

14 When is anxiety clinical? Children who met criteria for a diagnosis of anxiety disorder become anxious more easily, more often, and more intensely. The anxiety significantly interfers with functioning : school, social, family. Disproportionate anxiety present for 6 months of more. These children are not different. Most common disorder occurring in children and adolescence. Under diagnosed and yery treatable. If Anxiety in children and adolescence is left untreated -> increased risk of depression, adult mental health disorder. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 14

15 Clinical Anxiety Diagnoses DSM-V anxiety disorders in children and adolescents : Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia Generalised Anxiety Disorder Unspecified Anxiety Disorder 15

16 Anxiety Management : Practical Strategies Adult and situation considerations. Talking feelings. Educating children about anxiety. Helping children manage physical symptoms Detective thinking Fighting Fears by Facing Fears (exposure) Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 16

17 In the classroom: Use strategies to compliment executive functioning/learning eg. break down tasks into stages, regular breaks. Model coping talk out loud in class. Allow and coach flexibility in tasks. Make things predictable and familiar when eg. Changing activities Starting a new activities Doing an unfamiliar activity Giving a more complex task Make clear expectations of how you want the task completed When disciplining the class, be aware of who you are disciplining. Watch for tiredness and overload. 17 Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood

18 Can I detect and talk feelings? The child: Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 18

19 How do I talk about and to anxiety? It is OK to feel anxious. Eliminating or avoiding anxiety is not the solution. One builds resilience by learning I can feel anxious and I can manage this feeling. I am OK. I can ask for help if I need to. Be aware of one s own emotional response (eg. your tone of voice, body language, words). Your role is to support not to take away the child s anxiety. Modelling a positive way of talking about your own feelings helps. Think about the now for a few minutes. Once acknowledged, think about what they can do now to return to task. Plan for how the anxiety can be managed in more detail later (Who? When? Where?). Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 19

20 Can I detect and talk feelings? Labeling emotions Younger children (e.g., under 6) may need to do this for them looks like you might be feeling anxious right now, I can tell because you are tensing your face and looking scared Older children (e.g., > 6 years) ask how are you feeling right now? May still need to guess and label emotion for them Psychstuff4kids Westmead and Chatswood 20

21 How BIG are my feelings of anxiety? Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 21

22 Ways to decrease the physical symptoms Explain physical symptoms ( psychoeducation ) about the flightfight response. Help them to monitor their own body and learn which symptoms they get. Strategies: Slow breathing exercise. Relaxation/mindfulness techniques. Distraction techniques. Exercise Repetition is critical. Progress is not smooth. Adults in the environment need to remain calm. Reward the child for their efforts. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 22

23 Thinking Anxiety makes us think: -Something bad will happen, -Overestimate likelihood, -Overestimate how bad it will be, -Underestimate our ability to cope. Like a detective, look for the evidence. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 23

24 Like a detective ask questions: Acknowledge the fear though then wonder with the child aloud: - Has it ever happened? What happened? How often? - Has it ever happened to their friend or classmate? What happened? How often? - If it has happened or less happened, what have they noticed actually happened? - Is Mr Worry playing tricks and telling you lies? - Is it only a little problem or not a problem, and Mrs Naughty is making it sound really really big and bad? Chat out loud, your own unhelpful thoughts and helpful coping thoughts in a situation you were scared. Reflect on what you have learnt about anxiety - Mr Scared shrinks if I ignore his words and keep trying. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 24

25 Facing the fear - Graded Exposure Fears are faced gradually, working from lesser fears through to greater fears. The child should stay in the feared situation long enough for their anxiety/fear to drop so that they learn nothing bad will happen. So, the longer they stay the better. Repetition is critical. Progress is not smooth. Monitor for subtle avoidance and distraction. Excessive reassurance must be avoided. Adults in the environment present as calm. Reward the child for their efforts. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 25

26 As the support person it is important to: Encourage and support the child to practice facing their fears. When the child is facing their fears: Ask the child to rate their level of anxiety before the exposure. Monitor for subtle avoidance and distraction, and if you notice any, remind them they need to focus back on the task. Avoid giving (excessive) reassurance. Ok to give them some helpful selftalk if they are young If the child refuses to do the task, physically forcing them to do so is not effective and could be detrimental. Reward the child for their efforts. Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 26

27 Some helpful resources: Rapee, Wignall, Spence, Cobham, Lyneham (2008) Helping Your Anxious Child: A Step-by-Step Guide for Parents (2 nd Edition) Gottman (1997) Raising and Emotionally Intelligent Child: The Heart of Parenting. For the parent or teacher to read with the child: Morgan & Cartlidge (2004) Brave Mouse Zelinger & Zelinger (2011) Please Explain Anxiety to Me! Simple Biology and Solutions for Children and Parents. Ironside (2011) The Huge Bag of Worries. Cook (2012) Wilma Jean the Worry Machine Al-Ghani (2013) The Panicosaurus: Managing Anxiety in Children Including Those with Asperger s Syndrome. Huebner (2006) What to Do When You Worry Too Much: A Kid s Guide to Overcoming Anxiety Maria Ivanka Milic, Clinical Psychologist, Psychstuff4kids Westmead 27