Supporting Students with Anxiety: Supporting Students with Anxiety: Solution Focused Strategies for the Solution Focused Strategies for the

Busy School CounselorBusy School Counselor

LACA Fall WorkshopOctober 29, 2013

Rick Auger, PhD Jackie Brand, LSC

Minnesota State University, Mankato

Session GoalsSession Goals

Provide basic information about childhood anxiety—what it is and how it works

Present a number of interventions for anxiety that are appropriate for use by school

counselors (and try a few out)

Discuss special considerations for young children

Have everyone leave with at least two important ideas related to childhood anxiety that can be applied in schools immediately

Anxiety is….

What happens when you focus on perceived future threats…

Believing the challenges facing you exceed your ability to meet those challenges…

A combination of physiological, cognitive, and behavioral reactions...

Fueled by self-doubt…

What you should target in your intervention (rather than targeting the object of the anxiety)

Anxiety as a spectrum…Anxiety as a spectrum…

Minimal Symptoms

Troubling Symptoms

Anxiety Disorder

10% - 20%

2010 Minnesota Student Survey

During the past 30 days, have you felt nervous, worried, or upset?

Grade 6 boys

Grade 6girls

Grade 9 boys

Grade 9girls

Grade 12 boys

Grade 12 girls

All of the Time

3% 4% 4% 5% 4% 4%

Most of the Time

7% 9% 6% 12% 7% 12%

Percentage of students in your building Percentage of students in your building who experience significant anxiety:who experience significant anxiety:

1% – 5%

6% – 10%

11% - 20%

21% - 30%

More than 30%

Emotional response to perceived threats

Types of anxiety disorders• Separation anxiety disorder• Selective mutism• Specific phobia• Social anxiety disorder (social phobia)• Panic disorder• Agoraphobia• Generalized anxiety disorder• Separate disorders in DSM-5 but sometimes grouped with

anxiety disorders:• Obsessive-compulsive disorder• PTSD• Acute stress disorder• Adjustment disorder with anxiety

Neurobiology of Anxiety

The neurobiology of anxietyRettew (2012)

• Adolescents’ two brain-related problems: too much accelerator and not enough brake

• Individual differences in behavioral inhibition

• The link between temperament/personality and anxiety

• Anxiety is real and in moderation is adaptive

Interventions for Anxiety

There is just one of you

And there are many of them

Relaxation: The go-to anxiety intervention

Relaxation strategies

• Progressive muscle relaxation

• Guided imagery

• Deep breathing

Progressive muscle relaxationProgressive muscle relaxation

http://www.youtube.com/watch?v=HFwCKKa--18

http://visuals.autism.net/

Exposure strategies

• Help students face their fears—GRADUALLY

• Involves gently exposing students to their fears, and then helping them relax away the fear

• Start with visualization, then move to in vivo

Steps for Gradual Exposure:

Relaxation training

Create anxiety hierarchy

Anxiety arousal (via imagery)

Relaxationcoping

Homework,practice

Recognition ofanxiety cues

Cognitive strategies

• Slogans

• Reframing

• Developing coping strategies for the possibility that things might go wrong

• Teach and model going with the flow

Cognitive strategies

Reframing

Student: “I’m always so stressed about my assignments!”

Counselor: “I wonder if that stress is really just energy that you could use to keep yourself working hard?

Cognitive strategies

Reassurance therapy: “It seems like you’re catastrophizing again. I’m sure your mind won’t go completely blank during your speech. You’ll do fine.”

Developing coping strategies:“Well, I think it is very unlikely that your mind will go completely blank, but just in case let’s talk about what you can do if that does happen. How could you cope with that?”

Cognitive strategiesCognitive strategies

Example: Keep a thought record

SITUATION AUTOMATIC THOUGHT EVIDENCE RATIONAL

THOUGHT

Solution focused strategies

Students with anxiety have ways of thinking that are naturally problem-focused:

•Unrealistic worry:

“It will be awful if I fail”

•Exaggerating the risks and dangers of life:

“I’ll definitely fail if I take Advanced English”

•Excessive self-consciousness:

“Everyone noticed when I tripped walking up the steps, and now they all think I’m a dork”

Assumptions of Solution-Focused Assumptions of Solution-Focused CounselingCounseling

• Concentration on solutions can better facilitate positive change

• Every problem has exceptions and contains seeds of a solution

• Small improvements can lead to bigger improvements

• All students have untapped strengths and resources and the ability to solve/manage their own problems

Assumptions of Solution-Focused Assumptions of Solution-Focused CounselingCounseling

• Focusing on positive goals facilitates change

• There is no single right way to look at problems and issues

• Insight into the cause of a behavior is not necessary to change the behavior

• It is not necessary to know a great deal about the problem in order to be helpful

Solution-Focused GuidelinesSolution-Focused Guidelines

Looking at problems differently can encourage their resolution

Example: From “I have high anxiety” to “I haven’t figured out the right strategies to

manage my anxiety”

Solution-Focused GuidelinesSolution-Focused Guidelines

Engage in solution talk rather than problem talk

Problem talk: “How was your anxiety this week?”

Solution talk: “Tell me about the times this week when you

felt comfortable and relaxed”

Solution-Focused GuidelinesSolution-Focused Guidelines

Look for exceptions – times when students are effectively managing

their lives and issues

Example: Tell me about a time you did not feel anxious?

What were you doing?

Solution-Focused GuidelinesSolution-Focused Guidelines

Focus on small and reasonable changes rather than dramatic wide

ranging changes

Example: Setting a goal of moving from 2 to 3 instead of 2 to 10

Solution-Focused GuidelinesSolution-Focused Guidelines

Externalize the problem

Examples:What name could you give to what we are talking

about here?

Tell me times when you have beat worry and have felt at ease?

Anxiety is sure bullying you around! What can you tell anxiety to get it off your back?

Solution-Focused GuidelinesSolution-Focused Guidelines

Compliment students on past and current accomplishments and

positive changes

Example: “You were really able to tackle that anxiety and get through that test!”

Solution-Focused GuidelinesSolution-Focused Guidelines

Don’t ask students to do something new – rather, ask them to do a

variation of what they have already had success with.

Example: “You’ve done such a nice job of turning around your relationship with Mr.

Green. I wonder if you could do some of that same work to get along better with Ms.

Brown?

Solution-Focused GuidelinesSolution-Focused Guidelines

Help form goals that are in positive terms and that are concrete,

specific, and measurable

Examples: Be on time for school three or more days this

week Participate in two social events weekly with

peers

Solution-Focused GuidelinesSolution-Focused Guidelines

Flag the minefield

Examples:

“What has gotten in your way of achieving this goal in the past? What can you do to make

sure that doesn’t happen this time?”  

“Last week you got pulled away from your goal of paying attention in class by your friends.

How will you overcome that this week?”

A counseling dialogue…

Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…”

A support-oriented school counselor might say:“I can hear the discouragement in your voice. That must be hard—to know that you can do better, but to have your anxiety interfere so much.”

A counseling dialogue…

Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…”

A cognitive-oriented school counselor might say:“That sounds really discouraging. I wonder if your mind really goes blank or if you just haven’t really listened to the thoughts you have. Let’s try to figure out what thoughts you have during tests, and whether those thoughts help you or hurt you.”

A counseling dialogue…

Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…”

A solution-focused school counselor might say:“That sounds really discouraging. But I see from your transcript that you are still getting solid grades. There must be times when you are able to contain your anxiety enough to let your knowledge shine through. When is the last time that happened, even a little? Let’s talk about that…”

Mindfulness strategies

• Mindfulness: Bringing one’s complete attention to the present experience on a moment-by-moment basis

• Exercise: Focus on doing one thing at a time (the opposite of multitasking) for a day

• Exercise: Use self-message to narrate your activity

• Exercise: Practice bringing one’s attention back to the present with self-message “Come back to the present”

Anxiety management apps…

AnxietyCoach (Mayo clinic)

Anti-Stress Quotes

Calming Breath

Optimism

ZenView

Time management for Time management for anxietyanxiety

•Help student do a “time study” for a week. How many hours studying? Overcommitted?

•Create a month-long calendar.Insert study times, major projects, etc.

•Work the calendar a day at a time.

Anxiety in Young Children

Types of Anxiety in Young Children

• Separation Anxiety• Phobias• Generalized Anxiety

General Information:Anxiety in Young Children

• Early intervention

• Co-occurring disorders

• Anxiety in young children often stems from• Child’s temperament & genetic risk• Parental anxiety (role modeling)• Adult response• Previous experiences

General Information:Anxiety in Young Children

In all types of anxiety, remember:

• Acknowledgement of anxiety

• Don’t advise avoidance

• Incremental Plan

• Proper sleep, nutrition, activity

• Give them the tools

Separation Anxiety: Symptoms

• constant thoughts and intense fears about the safety of parents and caretakers

• refusing to go to school • frequent stomachaches and other physical

complaints • extreme worries about sleeping away from home • being overly clingy • panic or tantrums at times of separation from

parents • trouble sleeping or nightmares

Separation Anxiety: Brief Interventions

• Preparation

• Educating and supporting parents

• Drop off and pick up

• Overly protective parent

Specific Fears or Phobias in Young Children

• Age appropriateness

• From fear to disorder

• Brief counseling

Specific Fears or Phobias: Brief Interventions

• Get the details

• Previous experience

• Child’s perspective

• Object of his fears

• Desensitization

• Art & Objects

Generalized Anxiety in Young Children:Brief Interventions

• Regular routines

• Sufficient sleep

• Prepare for changes in routine

• Intervening with parents

• Educating parents and teachers

• Positive self-talk & Visual imagery

• Relaxation (www.consciousdiscipline.com)

Children’s Books

When To Refer

Mental health referrals for children with anxiety are appropriate if:

• the student has moderate to severe anxiety that is interfering with function (isolation, chronic absenteeism, self-harm, failing classes)

• the school counselor is not comfortable managing the student’s anxiety (or does not have sufficient time for even brief interventions)

• the child or family request a referral

• the student is not responding to brief school-based interventions.

Where To ReferChild Anxiety Center821 Raymond Ave., Suite 270 St. Paul, MN 55114Phone: (651) 645-5558

Anxiety Treatment ResourcesEdinborough Corporate Center Suite 6503300 Edinborough WayEdina, MN 55435 Phone: 952-854-2622

University of Minnesota Amplatz Children's Hospital2450 Riverside Ave.Minneapolis, MN 55454800-233-7503 (Toll-Free)

University of Minnesota Medical Center, Fairview West Bank Emergency Department2312 S. 6th St.Minneapolis, MN 55454

National Alliance on Mental Illnesshttp://www.namihelps.org/support/young-adult-nami-connection.html

FACTS1385 Mendota Heights Rd StationMendota Heights, MN 55120 (651) 379-9800

Hennepin County: http://hennepin.us/portal/site/HennepinUS/menuitem.b1ab75471750e40fa01dfb47ccf06498/?vgnextoid=49e2e5d0820a3210VgnVCM10000049114689RCRD

Ramsey County: http://www.health.state.mn.us/divs/idepc/refugee/rgramsey.pdf

Dakota County: http://www.co.dakota.mn.us/healthfamily/mentalhealth/lowcostservices/pages/default.aspx

Resources for adolescents• The Anxiety & Phobia Workbook, 3rd Ed.

Edmund BourneNew Harbinger Publications

• The Anxiety Workbook for TeensLisa SchabNew Harbinger Publications

• Helping Students Overcome Depression and Anxiety, 2nd Ed.Ken MerrellGuilford Press

TED talks

• Andy Puddincomb: All it takes is 10 mindful minutes

• Kelly McGonigal: How to make stress your friend

• Matt Killingsworth: Want to be happier?

• Thandie Newton: Embracing otherness, embracing myself

** Go to www.ted.com/talks/ and search under the presenter’s name

Thank you!Thank you!

Thank you for inviting us to share the morning with you!

Send us questions or comments:richard.auger@mnsu.edujacelyn.brand@mnsu.edu