Exposure and Parental Involvement as a Key to Meaningful Progress for Student Anxiety Megan M. Urbassik, Ph.D. School Psychologist Loudoun County Public Schools
Overview The session will include a description of a case study dealing with severe anxiety in a female elementary school student. Specifically, the success of using a scientifically informed school- and family-based cognitive-behavioral approach (i.e., the Cool Kids Program ) with a strong exposure component will be described. The criticality of parental involvement as an irreplaceable key to treatment success will be included.
Anxiety 101
Definitions Excessive fear about real or imaginary circumstances Symptoms can be either physical, behavioral, or cognitive Generally, anxiety is normal and adaptive Huberty (2004) Anxiety disorders are the most common disorders among school-age children Fortunately, they are also the most treatable set of disorders
Symptoms of Anxiety Cognitive/Thoughts Difficulty concentrating, worrying, hypervigilance Behavioral Withdrawal, need for reassurance, habitual behaviors, crying Physical Heart rate, trembling, shortness of breath
Prevalence Rates Lifetime prevalence rate of any anxiety is over 15% For children, over 25% for general anxiety and over 8% for severe anxiety (Kessler et al., 2009; National Institute of Health, n.d.) 70-80% children who receive mental health services receive them in schools given the inadequacy or unavailability of outside mental health services
Thoughts Feelings Actions
Treatments Well-established treatments for anxiety Cognitive Behavioral Therapy (CBT) Exposure Modeling Education CBT with parents CBT plus medication (Higa-McMillan et al., 2016; Sadock & Sadock, 2007)
School-Based Treatment
Overview Schools are often willing to help, but may not have the resources needed for students to make meaningful progress Schools are becoming de facto mental health providers Providers often do things that are counterproductive to progress Schools provide support that varies by school, and skillsets vary; however, the support offered can be productive and help provide meaningful change There are a variety of strategies, tools, and programs available to trained staff that can assist in the treatment of students with anxiety in the school setting Meaningful growth is RARELY made without joint efforts from the professional and the parents (Dowell & Ogles, 2010)
Cool Kids Program Based on the Coping Kids Program, Coping Koala, and Coping Cat Research based intervention 80% of children who completed the program were diagnosis free or showed marked improvement Symptom reduction maintained for up to 6 years Better outcomes shown with parental involvement, especially in younger children Designed for children age 6 to 12 (a separate program is available for 13-17) Can be done in individual or group counseling (Lyneham, Abbott, Wignall, & Rapee, 2003)
Session Goals Learning about anxiety Thinking realistically Detective Thinking Self-rewards and monitoring Fight fear by facing fear, fear hierarchy Exposure and Worry Surfing Skill building Maintaining the good and dealing with the bad
Case Study Anna
Anna 7 year old, second grader Lives with mom, dad, and two sisters Types of fears she exhibited Illness, self and others Parental, especially dad, separation Trying new things (e.g., school work, pool, guitar) Special circumstances (e.g., St. Patrick s Day, ear piercing)
Parent Intake Interview Gather pertinent background information Lay out treatment plan Parents sign agreement
Session Goals Learning about anxiety Thinking realistically Detective Thinking Self-rewards and monitoring Fight fear by facing fear, fear hierarchy Exposure and Worry Surfing Skill building Maintaining the good and dealing with the bad
Session Structure High points since last meeting, snack (10 minutes) Review homework and talk about low points (10 minutes) Lesson (25 minutes) Assign homework (5 minutes) Parent check in (in person or by phone; 5-20 minutes)
Learning about Anxiety What is anxiety? Who gets anxious? Why me? Three components of anxiety: your body, your thoughts, your actions Identifying triggers Worry scale (Lyneham, Abbott, Wignall, & Rapee, 2003)
Detective Thinking Pretend you are a detective and look for evidence why bad things will not happen Start with self-talk: situation, two thoughts Steps 1) What is the event 2) What is the thought behind my feelings 3) Look for evidence 4) List alternatives 5) What is a realistic thought
Fight Fear by Facing Fear (Exposure) First work on positive self-talk and rewarding yourself* Make a worry list: really hard, sort of hard, a little hard Pick a goal List all of the steps to get to your goal Give each step a worry rating Identify a reward for each step (Lyneham, Abbott, Wignall, & Rapee, 2003)
Worry Surfing You will feel anxious! There is no need to fight it surf it! Steps: 1) Notice the worry, look for clues that you are getting anxious 2) Paddle to the top of your worry wave and choose What should you be doing now, and focus on that 3) Keep concentrating until your worry fades away 4) Then, reward yourself! Practice, practice, practice
Parent Check-Ins How did homework actually go? Give mom assignments and the strategies we were working on Letting me know of the events coming up Discuss unexpected needs Bedtime: http://keltymentalhealth.ca/healthy-living/bedtime-routine Positive parent techniques
Where is Anna now? Did go to private provider I switched schools and the provider that took my place did some of those things that were counterproductive
Questions Megan.Urbassik@lcps.org
References Dowell, K. A. & Ogles, B. M. (2010). The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 39, 151-162. doi: 10.1080/15374410903532585 Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45, 91-113. doi: 10.1080/15374416.2015.1046177 Huberty, T. J. (2004). Anxiety and anxiety disorders in children: Information for parents. Helping Children at Home and School II: Handouts for Families and Educators. Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., Ustün, T. B., Wang, P. S. (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys. Epidemiological Psychiatric Society, 18, 23 33. Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The Cool Kids Program Children s Workbook. MUARU: Macquarie University, Sydney. Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The Cool Kids Program Therapist Manual. MUARU: Macquarie University, Sydney. National Institute of Health (n.d.). Any Anxiety Disorder Among Children. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-children.shtml Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.