Moving from Anxiety to Op2mal Wellness L. Read Sulik, MD, FAAP, DFAACAP
Disclosures None
Objec2ves Iden2fy the emo2onal, physiological and cogni2ve changes in anxiety and recognize the interpersonal problems, performance and func2oning problems and behavior problems that develop as a result. Develop an approach to understand what individuals are experiencing as a result of anxiety and apply a framework for a process of change that can lead to calming of sustained physiological arousal associated with chronic stress, trauma and anxiety.
Anxiety
Anxiety Disorders Specific Phobia Separa2on Anxiety Disorder Generalized Anxiety Disorder Social Anxiety Disorder Selec2ve Mu2sm Acute Stress Disorder Post Trauma2c Stress Disorder Panic Disorder
Pediatric Age of Onset Au2sm Spectrum Disorders: 0 3 years or later for mild ADHD: 4 7 years ANXIETY: 6 12 years Depression: 13 16 years Bipolar and psychosis: 17 years +
Epidemiology VERY COMMON Incidence 2 to 4 % 6 12 month prevalence 10 12 % Life2me prevalence 14 27% UNDERDIAGNOSED and UNDERTREATED We must LOOK FOR IT!!!
in order to look for anxiety we must really understand anxiety in order to really understand anxiety, we have to really understand AROUSAL
ñ Arousal = ñ Arousal
3 Gi?s / 3 Curses Sensi2ve Intense Persistent
Arousal
3 Areas of Changes
I am not my thoughts
My anxiety causes me to have thoughts
hot burner thoughts
Which worsen my anxiety
hot burner thoughts - RuminaJve - AnJcipatory Worries - Intrusive Memories - Catastrophic filling in the gaps
So...
Change the thoughts
and
Calm the Arousal
Depression Anxiety ADHD Suffering 10 9 8 7 6 5 4 3 2 1 0 Self Assessment Prac2ce What is your Current State (on a scale of 0 to 10) when 0 is your Ideal State of Thriving at the bottom of the scale, and 10 is the worst it could every be or has ever been for you at the top of the scale? 10 9 8 7 6 5 4 3 2 1 0 Ideal State 10 9 8 7 6 5 4 3 2 1 0 10 9 8 7 6 5 4 3 2 1 0
Healing
Photograph by Aaron Huey, Na2onal Geographic
you really need to know the difference between TREATMENT... and HEALING Rick Two Dogs, Lakota Medicine Man
Treatment is what you do to us... Healing is the WORK we each need to do Rick Two Dogs, Lakota Medicine Man
If Healing is the WORK, And to do the WORK is to Change, then We must understand what to change and why the change is needed; prepare effec7vely for the change; and receive the right support within the right structure to change.
Technical vs. Adap2ve Challenges Technical Challenge You know what the solu2on is and have the right tools to apply to solve the problem Response is to Act AdapJve Challenge You don t know what the solu2on is and you have likely tried numerous technical fixes which haven t worked Response is to Observe, Ques2on, Listen (with the willingness to be influenced) and Experiment
Perhaps one of the greatest mistakes we make in healthcare is con2nuing to apply technical fixes to our pa2ent s adap2ve challenges... We must lead our pa2ents in a way that support them through the adap2ve changes needed to undergo healing and personal health transforma2on. The greatest mistake a leader can make is to apply a technical fix to an adap2ve challenge - Cambridge Leadership Associates
To EffecJvely Change CondiJoned Human PaVerns of Behavior is a COMPLEX ADAPTIVE CHALLENGE
Preparing to Change The Four Pillars
Insight
IntenJon
Structure
PracJce
healing...
is the work that we each need to do
What Work actually Works? EducaJon / Insight Changing the paperns of misunderstanding, misinterpre2ng and misperceiving CogniJve Behavioral Therapy Changing the thinking paperns Changing the behavioral paperns Interpersonal Therapy Changing the paperns of rela2ng to others Physical AcJvity and Exercise Changing the paperns that perpetuate the fa2gue and energy craving cycle Improve modula2on of arousal Breathing / RelaxaJon Exercise Changing the paperns of short, fast, shallow breaths MeditaJon / Mindfulness Changing the paperns of hot burner thoughts by prac2cing discipline of presence Improved NutriJon Changing paperns of carbohydrate craving AnJdepressant MedicaJons Changing the paperns of neurotransmiper func2oning Calming the sustained heightened state of arousal Decreasing obsessiveness
Spiritual World Seek Breathe Internal World Build Think Tend Rest The Work Connect Hydrate Behave Nourish External World Express Move Physical World 2015 L. Read Sulik, MD
CogniJve Behavioral Therapy Spiritual World Seek Breathe Internal World Build Think Tend Rest The Work Connect Hydrate Behave Nourish External World Express Move Physical World 2015 L. Read Sulik, MD
Interpersonal Therapy Spiritual World Seek Breathe Internal World Build Think Tend Rest The Work Connect Hydrate Behave Nourish External World Express Move Physical World 2015 L. Read Sulik, MD
Substance Abuse Therapy Spiritual World Seek Breathe Internal World Build Think Tend Rest The Work Connect Hydrate Behave Nourish External World Express Move Physical World 2015 L. Read Sulik, MD
Weight Loss Approaches Spiritual World Seek Breathe Internal World Build Think Tend Rest The Work Connect Hydrate Behave Nourish External World Express Move Physical World 2015 L. Read Sulik, MD
Individual Exercise What is your Current State (on a scale of 0 to 5) when 0 is the Ideal State in the center of the diagram and your score on each domain is how much change you must make to move from your Current State to your Ideal State Spiritual World Build Seek Breathe Think Internal World 5 4 Tend Rest 3 Connect The Work Hydrate 2 Behave Nourish 1 External World Express Move Physical World 0 Ideal State
The Work applies regardless of the condi2on... Ideal State Severe Anxiety
Breathe Current State Change Process Ideal State (Symptom / Problem) Stressed State Hyperven2la2ng Short, Fast, Shallow Breaths Prac2ce Ritual of Breathing in through the nose to the count of 2 and out through the mouth to the count of 4 for 10 breaths at a 2me. Develop deep breathing prac2ces Ability to use the breath as a tool and a gateway to all self- soothing prac2ces to achieve a calm, relaxed state when the feeling stressed, anxious, depressed or hyperaroused
Think Current State Change Process Ideal State (Symptom / Problem) Internally distracted Rumina2ve Thoughts Hopeless and Suicidal Thoughts hot burner thoughts Cogni2ve Distor2ons Catastrophic filling in the gaps Prac2ce Ritual of Embracing thoughts of deep gra2tude and holding these thoughts in the mind to replace Calm internal state of thinking with the ability to recognize intrusive rumina2ve thoughts and use the developed skills of changing thoughts to achieve calmer state
Rest Current State Change Process Ideal State (Symptom / Problem) Delay in Onset Disrupted Sleep Bed2me Avoidance Nightly Ritual to Prepare to Transi2on from Wakefulness to Sleep Morning Ritual to Prepare to Transi2on from Sleep to Wakefulness Ressul Sleep that leads to alert, energized calm wakefulness
What Parents Must Do! Develop a DEEP Understanding of Anxiety Modify Expecta2ons Provide Uncondi2onal Support Create Structure for Change Create Opportuni2es for Success Model Own Self- Care and Live the Work Breath, Think, Rest, Hydrate, Nourish, Move, Express, Behave, Connect, Build, Tend, Seek!
L. Read Sulik, MD, FAAP, DFAACAP Chief Integra2on Officer, PrairieCare Execu2ve Director, PrairieCare Ins2tute Associate Professor, University of Minnesota Department of Psychiatry Child & Adolescent & Adult Psychiatrist 1934 Hennepin Avenue South, Suite 300 Minneapolis, MN 55403 952.826.8378 Execu2ve Assistant 952.903.1362 Nurse 952.826.8429 Office 320.492.2232 Cell