1. Anxiety DisordersWhat School Counselors Need to know! Dr. Iliana Garcia – Ortega Psychiatrist Research Associate Sun Life Financial in Adolescent Mental Health Dalhousie University & IWK Health Centre www.teenmentalhealth.org
2. Most people experience anxiety as… Feeling tense, edgy, frustrated, irritable or overwhelmed. Different degrees of physical symptoms such as: neck tension, headache, sweaty palms, shakiness, flushing, stomach sickness, restlessness. Although unpleasant, most people are able to tolerate it and have become so good at coping that other people often can’t even tell that they are anxious! Anxiety can be a good thing! It helps us focus and get things done and can even enhance our performance (ie., exam preparation for a student, performance for a concert pianist)
3. Anxiety associated with anxiety disorders is different… It is unreasonable, excessive or inappropriate to the situation It’s intensity exceeds the person’s capacity to endure it It may be persistent – continues despite the absence of an acute stressor or situation It prevents the person from doing what they need to do, achieving their goals, or being who they want to be – it causes functional impairment It leads to unhealthy coping strategies such as avoidance and withdrawal
4. What is Anxiety? Initiation of Physiologic Cascade Perceived Heart Rate Anxiety -danger in annormal situation Alertness Behaviour Perception Tension
5. What about the brain?
6. Anxiety Disorders• They are the most common of all the mental disorders and usually begin in childhood or adolescence - affect 8-10% .• Anxiety disorders run in families (anxious young people often have anxious parents)• Despite their high lifetime prevalence they remain poorly identified, diagnosed, and treated.• They lead to high utilization of health services (many un-necessary investigations)• Are frequently very amenable to treatment (psychotherapy; medications)
7. • Different anxiety disorders throughout life – Separation anxiety disorder = childhood – Social Anxiety Disorder; Panic Disorder = teen onset• Anxiety disorder can lead to: – Poor economic, vocational, interpersonal outcomes – Significant negative impact on family, social and school functioning – Increased morbidity: • comorbid anxiety disorders, major depressive disorder and alcohol and drug abuse• Chronic anxiety disorder can lead to: – Poorer physical health outcomes – Increased cardiovascular morbidity and mortality in mid-life
9. Diagnosis of Anxiety Disorders There are no biological tests that are diagnostic of any specific anxiety disorder. Diagnosis of anxiety disorders is reliant on a careful clinical assessment of the person’s presenting signs and symptoms and clinical history taking. The symptoms of the anxiety disorders cluster into 3 groups: 1. Physical Symptoms 2. Psychological Symptoms – Thinking/Cognition Symptoms 3. Behavioral Symptoms
10. What’s the difference between Mental distress and Mental disorders? Distress Disorder Caused by abnormal brain Caused by event or trigger of functioning brain driven activities May have environmental trigger Normal/usual Response Complex interaction between Temporary, ADAPTIVE genetic and environment No professional treatment Prolonged needed Usually needs professional Not associated with sustained treatment disability Associated with sustained Does not meet recognized disability diagnostic criteria for a mental Meets recognized diagnostic disorder criteria: DSM; ICD
11. Normal emotional response to distress: The Acute Stress ResponseThinking Emotion WORRY!! Panic WORRY!! Irritability WORRY!! Physical Loss of AppetitePerception Difficulty Sleeping Headaches Behavior Signaling Avoidance Physiologic Withdrawal Hyper-arousal
12. Thinking / Cognition Symptoms Excessive worry, obsessive ruminations, apprehension, difficulties making decisions, trouble focusing and concentration, etc. People with anxiety disorder often have dysfunctional thinking patterns – distorted ways of thinking about situations, themselves, and others.
13. Faulty logic is a dysfunctional pattern of thinking that is biased, based on personal assumptions.• All-or-nothing thinking• Catastrophizing• Discounting the positive• Emotion over logic• Magnification/Minimization• Mental Filter• Mind reading• Overgeneralization• Jumping to Conclusions
14. What does faulty logic look like?If you listen closely to a person who is anxious youwill find they tend to do the following: Expect the worst Worry about things before they happen Predict the future Underestimate their strengths Underestimate their ability to cope Unrealistic negative thinking
15. Examples of behavioral symptoms1. Social Withdrawal • Dropping out of recreational activities • Spending time alone • Avoiding social situations and events • Not speaking with or going out with friends2. Avoidance of stressful situations • School refusal • Staying home from school, work or from planned social activities • Refusing to ride in a car • Refusing to leave the house • Refusing to sleep alone or with the lights out
16. Behavior symptoms• People with anxiety disorders will do what they can to reduce their anxiety and they quickly learn that by avoiding the things that make then anxious they can prevent themselves from feeling worse. DO NOT SUPPORT AVOIDANT BEHAVIORS• In addition, self-soothing habits and rituals, repetitive reassuring behaviors and the may be using of substances such as drugs and alcohol may be used to reduce anxiety.
17. Physical symptoms• Rapid heart rate or racing • Upset stomach: heart nausea, vomiting, indiges• Headache tion, heart-burn.• Muscle Tension • Diarrhea or loose stools• Chest pains • Shortness of breath or• Dizziness or faintness difficulty breathing• Sweating • Sleep trouble• Trembling or shakiness
18. Signs of Trouble - Warning signs• Marked changes in personality• Declining in school performance or failure to achieve expected levels of functioning• School refusal or avoidance of age appropriate social activities or dating• Inability to cope with usual problems and daily activities• Excessive / irrational fears, worries or anxiety• Abuse of alcohol, cigarette or other drugs• Significant changes in eating or sleeping patterns• In younger children: crying, tantrums, freezing, clinging, staying close to parents
19. …What others might notice• Consistent late arrivals or frequent absences at school or work• Low morale, low self-esteem• Social withdrawal• Difficulties in completing school work• Lack of cooperation or frequent altercations with others• Frequent complaints of unexplained aches and pains• Withdrawal from usual activities
20. …What teachers might notice• Problems concentrating, making decisions, or remembering things• Missed deadlines, delays in completing assignments, poor exam grades• Constant excuses for missed deadlines, or poor quality work• Decreased interest or involvement in class topics or academics in general Note: Such behavior could indicate the student is having a bad day or week. A pattern that continues for a long period of time, or repeats, may indicate an underlying serious mental health problem or mental illness.
21. Differential DiagnosisA variety of physical conditions can present with or beaccompanied by anxiety symptoms. The most common of theseare the endocrine/hormone disorders.Think of physical disorder as the cause of anxiety if: Physical findings on clinical examination No family history of anxiety or depression No avoidance behaviors or social withdrawal
22. Anxiety and other common mental disordersDepression vs. Anxiety ADHD vs. Anxiety –poor attention – Low mood, sadness –easily distracted – sleep disruption –forgetful – poor concentration –difficulty organizing –fidgety – fatigue/energy loss –restlessness – diminished interest –Impulsiveness –doesn’t wait turn
23. Medication that can Substances that can produce produce Anxiety symptoms Anxiety symptoms • Caffeine• Ephedrine • Cocaine• Pseudo-ephedrine • Abstinence from alcohol• Albuterol, Theophylline • Abstinence from• Thyroid medicines narcotics • Abstinence from sedatives
24. School Counselors Collaborate with Other Health Providers Students StudentTeachers School with Parents Counselor Mental Disorder Administrators Community
25. Anxiety Disorders are treated in two primary ways… and often used concurrently Two Pathways Biological Psychosocial Treatments TreatmentsMEDICATIONS/OTHERS COUNSELING/THERAPY
26. Treatment of Anxiety Disorders in Children and youth• 1st Line: Cognitive Behavioural Therapy (CBT)• 2nd Line: Medication plus CBT SSRI medication has strongest evidence: fluoxetine – prozac sertraline – zoloft citalopram – celexa
27. SSRIs and School Counselors• If GP choose to use one of the SSRIs. Predict side effects onset soon after treatment has started.• Patients with anxiety tend to be very sensitive to the side effects to medications , they may experience an initial increase in their anxiety symptoms on initiation of the SSRI.• Educate that clinical response may not be fully present for 4 – 12 weeks• Educate that maintenance treatment will be for 12 months or longer
28. What are the expectations of school counselors ?– Academic support – Individual student planning– Goal setting and decision-making – Individual and small-group– Career awareness counseling– Education on understanding self and – Individual/family/school crisis others intervention– Peer relationships, coping strategies and – Conflict resolution effective social skills – Consultation/collaboration– Communication, problem-solving and – Referrals conflict resolution– Substance abuse education– Multicultural/diversity awareness
29. How can you help?∙ Provide information about what you think the problem – Mental health education.∙ Provide supportive psychological assistance, give reassurance and help the person challenge the worrying thoughts∙ Help the family (others) understand what the problem is∙ Help the person find activities that can “get their mind off their worries”∙ Teach the person how use thinking skills to counter the symptoms and calm themselves∙ Teach the person how to focus on positive thoughts and feelings∙ Teach the patient how to deep breath∙ Monitor and refer if problems worsen or if other problems arise
30. What else?Help people learn more balanced ways of thinking!Learning more realistic ways of thinking about events, situations,themselves, and others is really hard to do! Remember thatusing faulty logic is a habit that people have practiced for MANY YEARS!Promote self-esteem by offering praise for small accomplishments andrewarding participation even if the student gives a wrong answer.If avoidance of social situations persists go with the patient to theselocations and help them face their worries thereIn your interactions with the student, speak softly and calmly.Help the student confront feared situations with gentle encouragement.