ANXIETY AND DEPRESSION Thinking SEEDS feeling SEEDS doing SEEDS

ANXIETY AND DEPRESSION

THINKING SEEDS

FEELING SEEDS

DOING SEEDS

Bob Schuppel, M.Ed., LPCC-S17800 Chillicothe Road, Ste. 230

(440) [email protected]

bobschuppel.com

mailto:[email protected]

2WHAT ARE SEEDS?

3…OF LIFE?

4WHAT ARE SEEDS?

5WHAT ARE THE SEEDS?

A Buddhist said the following…

MIND IS A FIELDIN WHICH EVERY KINDOF SEED IS SOWN


IN US ARE INFINITE

VARIETIES OF SEEDS


MANY SEEDS ARE INNATE HANDED DOWN BY ANCESTORS

8WHAT ARE SEEDS?

…handed down byancestors…


SOME SEEDS SOWN WHILEIN THE WOMB


OTHERS WERESOWN WHENWE WERE CHILDREN


SEEDS FROMPARENTS AND

FAMILY MEMBERS


SEEDS FROM SOCIETY AND

RELIGIONRIGHT and WRONG


SEEDS THAT WERE THRUST UPON US

16

COGNITIVE DEVELOPMENTTHOUGHTS, EMOTIONS AND ACTIONS

17THE BRAIN

relay impulses and especially sensory impulses to and from the cerebral cortex

18THE BRAIN

The cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness.

http://en.wikipedia.org/wiki/Memory

http://en.wikipedia.org/wiki/Attention

http://en.wikipedia.org/wiki/Perception

http://en.wikipedia.org/wiki/Awareness

http://en.wikipedia.org/wiki/Thought

http://en.wikipedia.org/wiki/Language

http://en.wikipedia.org/wiki/Consciousness

19THE BRAIN

Selective Attention

20THE BRAIN

perform primary roles in the formation and storage of memories associated with emotional events

21THE BRAIN

Brain has two memory systems, one for ordinary facts and one for emotionally charged one

The stronger the amygdala arousal, the stronger the imprint

Emotional memories can be faulty guides to the present – out of date

22THE BRAIN

Amygdala is a repository for emotional memory – scans experiences comparing what is happening now and what happed in the past

One element appears similar to past? MATCH! Commands us to react to the present in ways

we were imprinted long ago – with thoughts, emotions, and reacts in response to situations ONLY DIMLY SIMILAR, but close enough

23THE BRAIN

24THE BRAIN

25THE BRAIN

26

SCHOOL-AGED ANXIETY

Generalized Anxiety Disorder

Panic Attacks

Agoraphobia

OCD

27

GENERALIZED ANXIETY DISORDER

G.A.D.

Worries significantly disrupt school, social activities, family

Worry is uncontrollable

Worries are extremely upsetting and stressful

Worry is about all sorts of things, tend to expect the worst

Worry almost every day and at least for six months

Typical Worries

Worrying doesn’t get in the way of everyday activities & responsibilities

Able to control worries

Worries are unpleasant but don’t cause significant distress

Worries limited to a specific, small number of realistic concerns

Bouts of worry last a short period of time

28PHYSICAL SYMPTOMS OF GAD

Jumpiness or unsteadiness

Edginess or restlessness

Tiring easily

Muscle tension, aches or soreness

Trouble falling asleep or staying asleep

Stomach problems, nausea, or diarrhea

29

PSYCHOLOGICAL SYMPTOMS OF GAD

Inability to relax

Difficulty concentrating

Fear of losing control or being rejected

Irritability

Feelings of dread

Inability to control anxious thoughts

30CHILDREN AND GAD

“What if” worries about situation in the future

Perfectionism, excessive self-criticism, and fear of making mistakes

Feeling source of blame for disaster (maturational crisis) and their anxious worries will keep tragedy from occurring

Misfortune is contagious and will happen

Need frequent reassurance and approval

31PANIC ATTACK

Must include a discrete period of intense fear or discomfort, in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes:Shivers Pounding heart SweatingTrembling Smothering ChokingChest pain Dizzy LightheadedFear dying Chills Hot flashes

Abdominal distress Shortness of breath

32

SYMPTOMS OF AGORAPHOBIA

I don’t care if it IS Tweety, I ain’t going out there!

33

SYMPTOMS OF AGORAPHOBIA

Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available

34CDO!!

35

OBSESSIVE-COMPULSIVE DISORDER

Obsessions are recurrent and persistent thoughts, impulses, or images

They are unwanted and cause marked anxiety ordistress

Frequently, they are unrealistic or irrational

They are not simply excessive worries about real-life problems or preoccupations

36

OBSESSIVE-COMPULSIVE DISORDER

Compulsions are repetitive behaviors or rituals

Appears in behaviors like hand washing, hoarding, keeping things in order, checking something over and over

“Appears” in mental acts like counting, repeating words silently, avoiding, tally marks

37OBSESSIONS

Fear of contamination or dirt

Having things orderly and symmetrical

Aggressive or horrific impulses

Making a Mistake

38COMPULSIONS

Washing and cleaning

Counting

Checking

Demanding reassurances

Performing the same action repeatedly

Orderliness

39WHAT DO WE DO?

40

Neurotransmitter

41

NEW ENGLAND JOURNAL OF MEDICINECOGNITIVE BEHAVIORAL THERAPY, SERTRALINE, OR A COMBINATION IN CHILDHOOD ANXIETYOCTOBER, 2008

80.7% rated ‘very much’ or ‘much improved’ for combination therapy: c.t. & sertraline (Zoloft)

59.7% for cognitive therapy

54.9% for sertraline (Zoloft)

23.7% placebo

Anxiety disorders are common in children and adolescents and cause significant impairment in school, in family relationships, and in social functioning

High prevalence (10-20%) and substantial morbidity, anxiety disorders in children and adolescents remain underrecognized and undertreated

42

WHAT IS NEUROPLASTICITY?

The human brain is incredibly adaptive. The brain’s ability to act and react in ever-changing ways is known, in the scientific community, as “neuroplasticity” - 100 billion nerve cells, constantly laying down new pathways for neural communication and to rearrange existing ones throughout life

Aids the processes of learning, memory, and adaptation through experience

Because of the brain’s neuroplasticity, old dogs, so to speak, regularly learn new tricks of every conceivable kind

43COGNITIVE THERAPY

Creatures of Habits

ThinkingFeelingBehaving

44

MINI FORMULATIONS OF ANXIETY-INDUCED PROBLEMS

1. What happen?

2. What did I think?

3. How did I feel?

4. What did I do? or How did it change my body?

45

PREPARATION FOR DEALING WITHANXIETY CAUSING PROBLEMS

1. Where might it happen?

2. What is the best thought I can think?

3. What might I feel?

4. What can I do?

46

MEASURINGTHEANXIETY

Out of Control

Feeling Worried

Doing Alright

Calm & Cool

47

INTERVENTIONS FOR SCHOOL & HOME

PROACTIVE

There are many ways that schools can help a child with anxiety disorders

Meetings between parents, school staff, such as teachers, guidance counselors, or nurses, AND community-based counselors / therapists will allow for collaborative process to develop helpful school structure for the child

The child may need particular changes (accommodations and modifications) within a classroom and home

48


PROACTIVE

Schedule check-ins on arrival and throughout the day to reduce the child's anxiety and facilitate transition during school, even at home

Accommodate late arrival due to difficulty separating, getting to school

49


PROACTIVE

Identify a safe place where the child may go to reduce anxiety during stressful periods. Developing guidelines for appropriate use of the safe place will help both the child and staff or parents

Develop relaxation techniques to help reduce anxiety at school. The same techniques that are useful at home can often be implemented at school as well. Gym time, run time, etc.

50


PROACTIVE

Provide times for the child to convey messages to family. Brief (a minute or so) contact with family may substantially reduce anxiety and may help younger children recognize that their connection to their parents is intact. (In some children, this strategy may instead heighten awareness of the separation.) In preparation for possible times when the parent is not available, identify additional people for the child to contact

51


PROACTIVE

Ask the parent to send short notes for the child to read as a reward for staying in school. These can be placed in the child's lunchbox or locker, so that they can be obtained after the child has succeeded in class for a period of time. Could also be a problem!

52


PROACTIVE

If the child is avoiding school, address the cause(s) and initiate an immediate plan for him or her to return. The child may require gradual reintroduction to school and may readjust more quickly if allowed to attend for partial days at first

53


PROACTIVE

Encourage the child to help develop interventions. Enlisting the child's ideas in the task will lead to more successful strategies and will foster the child's ability to problem-solve. However, sometimes children will try to negotiate a "date" to attempt to return to school or go to some other activity. In most cases this strategy is not successful, and it can increase conflict ("You promised you'd go today")

54


PROACTIVE

Provide assistance to the child during interactions with peers. An adult's help may be very beneficial for both the child and his or her peers. Small, initially supervised, group activities. Pair-up

55


PROACTIVE

Be aware that transitions may be difficult for the child. When a child with separation anxiety refuses to follow directions, for example, the reason may be anxiety rather than intentional oppositionality

56


PROACTIVE

Reward a child's efforts. Every good effort, or step in the desired direction, deserves to be praised!

57


PROACTIVE

“A child reaps the benefits of affirming words for a

lifetime!”The 5 Love Languages of Children

by Gary Chapman & Ross Campbell

58


PROACTIVE

Discuss anxiety symptoms privately with the child. Never single out a child or call attention to their anxiety in front of the class or siblings at home. This can cause humiliation or embarrassment and increase anxiety symptoms.

59


PROACTIVE

Teach positive self-talk to the entire class or family. Helping children to be aware of the negative way they talk to themselves, such as the use of “I can’t” and help them to develop a more positive way of talking to themselves.

60


PROACTIVE

Post the daily routine in the classroom and at home and let children know in advance any changes in the schedule.

61

DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONS

62

DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING

Respond calmly to the child’s crisis (maturational or actual), anger and outbursts. At the same time make it clear, both verbally and nonverbally, that you are taking their crisis seriously.

63


Be sure that you do not inadvertently reinforce the intense expressions of affect. Avoid defensive or confrontational words. Be mindful of body posture.

64


Notice what behavior on your part may have triggered intense reactions. Monitor your own behaviors (behavior include thoughts, words spoken, emotions expressed and physical movements).

65


Work collaboratively with the child to maintain a moderate level of intensity. Solicit feedback/expression of emotion (moderately) from the child and take it seriously.

66


Once the child is calm, highlight the disadvantages of intense reactions, the ways in which they interfere with achieving the child’s goals. Then collaboratively work to identify more adaptive alternatives (such as dealing with situations and emotions before the reactions become too intense)

67


Encourage recognition and acceptance of moderate levels of affect. Encourage and reinforce moderate expressions of affect. When affect is expressed in more adaptive ways, make a point to recognize it, validating the child’s reactions, trying to understand and respect the responses

68


Identify and address the child’s fears regarding expression of affect. Address dichotomous (polar, extreme) thinking (i.e. use of always; never; should; must; need, etc.).

69BREAKIN’ HABITS

70

NONVIOLENT COMMUNICATIONMARSHALL B. ROSENBERG, PH.D.

NVC Process: Compassion Based

The concrete actions we observe that affect our well-being

How we feel in relation to what we observe

The needs, values, desires that create our feelings

The concrete actions we request in order to enrich our lives… WANTS not NEEDS or HAVE TOs!

71


Positive Feeling Words

Astonished Calm Eager ExcitedGrateful HappyHopeful LovingPeaceful Powerful RelaxedRelievedSatisfied Sensitive SurprisedThankfulTrusting Understood Warm

72


Negative Feeling Words

AfraidAggravated Agitated AnnoyedAnxious Bored Confused DepressedDisappointed DiscouragedEmbarrassed FearfulFurious Guilty Helpless HopelessJealous Miserable Numb Sad

Scared Sorry

74SUPER-PARENTS!

75STRATEGIES THAT WORK!

RelaxationLetting go of random and focusing on automatic (i.e. breathing)

Acceptance of AnxietyDo not fight or try to control anxiety, then control

Agreeing to other’s requestsLetting others be in control puts you in control

Accepting othersTrying to control others leads to feeling out of control

76

INTERVENTIONS FOR SCHOOLA.W.A.R.E.

A: Accept the anxiety. Welcome it. Don’t fight it

W: Watch your anxiety. Look at it without judgment

A: Act with the anxiety. Act as if you aren’t anxious

R: Repeat the steps. Accept, watch, and act with it

E: Expect the best. What you fear the most rarely happens

77

THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.

Be dispassionate! Be Cool!

Listen, even as you are being shouted at

78


Never, ever shout! Speak wisely

Add 15 minutes to every interaction involving a teen

79


Check your ego and pride, it’s not about YOU!

Never, ever harm or injure

80


Apologize at every opportunity

Acknowledge and respect the child’s identity

81


Be your true self

Know that “This Too Shall Pass”

82

References

Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of

depression. New York: The Guildford Press.

Bradley, M.J. (2003). Yes, your teen is crazy! Loving your kid without losing your mind.

Gig Harbor, WA: Harbor Press

Freeman, A., Pretzer, J., Fleming, B., & Simon, K.M. (2004). Clinical applications of

cognitive therapy (2nd ed.). New York: Springer.

Goldstein, A.P. & Glick, B. (1987). Aggression replacement training. Champaign, Il:

Research Press.

Greenberger, D. & Padesky, C.A. (1995). Mind over mood, change how you feel by

changing the way you think. New York: The Guildford Press.

Greenberger, D. & Padesky, C.A. (1995). The clinician’s guide to mind over mood. New

York: The Guildford Press.

McKay, M. & Fanning, P. (1992). Self-esteem (2nd ed.). Oakland, CA: New Harbinger

Publications, Inc.

Reineke, M.A., Dattilio, F.M., & Freeman, A. (1996). Cognitive therapy with children

and adolescents, a casebook for clinical practice. New York: The Guildford

Press.

Rosenberg, M.B. (2003). Nonviolent communication, a language of life. Encinitas, CA:

PuddleDancer Press.

ANXIETY AND DEPRESSION Thinking SEEDS feeling SEEDS doing SEEDS

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