Examining Anxiety and Depression

By: Mark Neves (#6724026) Nicole Elias (#6504111) Rochelle Reynolds (#6723665)

We are seeing more and more youth that are being diagnosed with or exhibiting signs of

depression and anxiety. As the youth spend much of their day in school, it is essential

that teachers and other staff learn to recognize the characteristics and treatment

options in order to help them.

Why Are These Conditions Important?

Research has shown that social anxiety and depression regularly co-occur (Ingram et al. 2001). In children, many reviews have found correlations between depression and anxiety.

Genetics

Life Events

Personality (worriers and perfectionists are especially prone)

Hormones

Chemical imbalances

What Causes Anxiety and Depression?

Depression is a persistent sadness or loss of interest in activities for more than 2 weeks in absence of external precipitants. It requires a distinct change in mood accompanied by several physiological changes (R.H. Belmaker, M.D., and Galila Agam, Ph.D-New England Journal of Medicine)

The Clinical Definition of Depression

Types of Depression

This is not depression in the deepest sense of the word. It is like a sky that is always filled with gray clouds. The child may not feel deeply depressed but they may not feel good either.

Dysthmia

This is a reaction as a direct result to an event that occurs in one's life. This is often due to a loss of some kind (like a death). We commonly know this as grief and it is a normal form of reactive depression.

Reactive Depression

  This occurs when the person enjoys normal

moods some of the time. During times of depression though, the person may appear manic. During the manic phase, they typically will exhibit:

-increased energy -aggressive responses-decreased need for sleep-increased risk-taking -feelings of mood elevation

Bipolar Illnesss

This is the most common form of depression. This occurs when the child feels low but has no actual stressor in his or her environment. They have normal moods much of the time but end up having a number of depressive episodes during their life. There isn’t necessarily one specific trigger.

Recurring Unipolar Depression

Seasonal Affective Disorder (SAD)-This is the scientific term for what is frequently known as the “winter blahs.” A despair will set in with the disappearance of the shortened daylight hours and will persist as long as the cold winter and lack of sun remain present. As spring returns though, many children will feel their energy return.

Seasonal Affective Disorder (SAD)

The Symptoms or Traits of Depression

Stomach or body aches Tense face Trembling Sweating Nausea Difficulty sleeping

Physical Symptoms

Always sees the bad or negative side of things

“All or Nothing” type of thinking

Difficulty concentrating

May think of hurting themselves

Mental Symptoms

Sad

Irritable or grumpy

Feels hopeless or worthless

Loss of interest in things they once enjoyed

Feelings

Trouble with family and friends

Drop in grades or work ethic

Avoid people

Lack of energy

Behaviour

Only medical doctors can diagnose depression.

Diagnosis

The most common resources would be counseling through school or a health professional (family doctor, psychiatrist etc) and medication (anti-depressants).

For mild depression in adolescents, the answer does not lie in medication. Research has shown that while they may be helpful in adults, they are not as effective with young people. Medications need to be used with other treatments and strategies.

  For those with major depression, cognitive behavioural

therapy (CBT) may be used. CBT is a talking therapy that teaches new skills for thinking and acting more effectively.

How Depression is Treated

Strategies for Helping

Research shows that exercise is a very effective way to help treat depression!

Encourage the student to participate in class activities but understand they have low energy

student should be reassured that the teacher is there to help when needed

education priorities should ensure the child does not fall behind in academics to protect self-esteem

avoid punitive approaches Incorporate exercise into the day focus on specific strengths (“I like the colors you have

chosen for the flowers.” instead of “You are a great artist.”)

Refer to student support services

How Teachers Can Help

Have fun with the child! Encourage exercise and physical activity Don’t tell the child to “snap out of it” Be positive and use non-punitive discipline Don’t compare the child to his or her

siblings Don’t overprotect and overdirect Learn as much as possible about this

condition Communicate well with the school

How Parents Can Help

Watch for signs (crying, negative comments, loss of interest)

Listen and reassure (do not judge or tell them they shouldn’t feel that way)

Help them get help (see a counselor)

How Peers Can Help

Common Misconceptions Regarding Depression

Myth: Depression is not a real medical illness. Clinical depression is a serious medical condition that affects not only an

individual’s mood and thoughts, but also the individual’s body. Research has shown that depression has genetic and biological causes. Individuals coping with depression have a higher level of stress hormones present in their bodies, and the brain scans of depression patients show decreased activity in some areas of the brain.

Myth: Even if depression is a medical illness, there’s nothing that can be done about it.

Fact: Depression is treatable, and more than 80 percent of individuals with depressive disorders improve with treatment. As new medications and treatments are discovered, the number should continue to rise.

The first step to finding effective treatment is to get a physical examination by a doctor to rule out other causes for your symptoms, such as thyroid problems. Once you’ve been diagnosed with depression, you and your doctor will decide on a course of treatment, which will include medication, psychotherapy or a combination of both.

Myth: Depression will go away by itself. Fact: For extremely fortunate individuals, depression may go away by

itself. But for the rest of us, depression can hang on for months, years or indefinitely. Depression can go away on its own, only to return in the future; once an individual has one episode of depression, they are predisposed to have more. Clinical depression is a potentially fatal disease – and suicide could be the end result of waiting for it to go away without any help.

Myth: Depression is a normal part of getting older. Fact: Depression is not a normal part of aging, but seniors do generally

experience more of the events that can trigger depression: loss of family and friends, ill health, isolation and financial worries. Furthermore, people over the age of 60 grew up in an era in which mental illness was not discussed, and they may feel more shame about asking for help than someone from a subsequent generation.

The highest rate of suicide of any age group occurs in that of people 65 and older, with men being more vulnerable than women. It’s imperative that seniors with depression seek help.

Myth: Depression only affects women. Fact: Although women report being affected by depression twice as

much as men, depression certainly affects men as well. Often, clinical depression is underreported in men, particularly in cultures that discourage them from asking for help or showing any weakness. Furthermore, men have a higher rate of successful suicide attempts than women, so it is crucial that men seek help for their symptoms.

Myth: Depression does not affect children or teenagers — their problems are just a part of growing up.

Fact: We’d like to believe that all children experience a happy, carefree childhood, but that’s simply not the case. According to the National Institute of Mental Health, studies show that 1 in 33 children and 1 in 8 adolescents are depressed in any given year. Children are not as practiced at articulating their feelings as adults, so adults must take the initiative to look for and notice symptoms of depression in children.

http://www.depressioncenter.net/wbdat/default.aspx

Online Depression Assessment

It is clinically significant distress and impairment in functionning. It is related to the « fight or flight » response

Anxiety is a normal emotion and we all have it.

Distress and dysfunction are the two major signs that indicate a person has cross over from normal anxiety to clinical anxiety. The third is inflexibility (that is, reacting in a maladaptive way to anxiety-provoking situations).

The Clinical Definition of Anxiety

Types of Anxiety

This is excessive anxiety and worry that occurs more days than not for a period of six months. The anxiety is focused on a number of different events or activities. Three of the following symptoms must occur:

-Restlessness or edginess-Tiring Easily-Difficulty Concentrating or the mind going blank-Irritability-Muscle Tension-Insomnia

Generalized Anxiety Disorder

A marked fear in social situations. There is some similarity to shyness but these symptoms are much more extreme and disabling

This is a type of anxiety that usually starts in early adolescense

Social Anxiety

This type of anxiety is closely related to social anxiety. Performance anxiety involves having to do something. An example would be having to write an answer on the board.

Performance Anxiety

What Do Children Worry About The Most?

Performance Speaking in front of the

class Volunteering answers Getting called upon Making a mistake Getting in trouble Not knowing what to do Asking for help

Social Fear of humiliation Fear of separation to

those who are familiar Picking a partner or

group work Going out at recess

and lunch Phys. Ed class

The presence of uncontrollable obsessions or compulsions. These are recurrent thoughts that are intrusive and provoke distress. Compulsions are repetitive behavioural or mental acts that a person feels driven to perform. These compulsions are aimed at preventing or reducing distress (even though there may be no actual connection between the action and the feared situation). *As many as 1% of youth may have this disorder

Obsessive-Compulsive Disorder

Trichotillomania-Feeling the need to pull out one’s hair, leading to noticeable hair loss

Body Dysmorphic Disorder-Becoming consumed by an imaginary defect in one’s appearance that it causes significant distress

Anorexia Nervosa and Bulimia Nervosa

Conditions Associated With Obsessive-Compulsive Disorder

This is the only anxiety disorder that requires an event that precedes it. This is when a person feels intense feelings of fear, helplessness or horror (examples: witnessing a murder, a car accident). It is viewed as a physical danger to oneself. The person will relive the trauma over and over through flashbacks or nightmares.

Post-Tramatic Stress Disorder

This disorder is found primarily in younger children. It involves excessive anxiety about being separated from the parent or home. As many as 4% of children and young adolescents may suffer from this disorder.

Incessant worry about harm coming to a parent or about an event that involves separation (like being kidnapped) occurs. In extreme forms, these children may be afraid of going to school.

Separation Anxiety Disorder

This occurs when the person experiences spontaneous panic attacks. These are sudden and intense waves of intense fears and panic. There are physical symptoms involving shortness of breath, choking sensations, sweating and rapid heart rate. It is essentially a fear of being in places or situations from which escape might be difficult or impossible. It tends to get worse with age and develops into a full blown panic disorder.

Panic Disorder

An intense fear that is out of proportion to any real threat and focused on a specific object, activity, situation or animal

Panic attacks can occur but they have very specific triggers

*Most people have one or two irrational fears (airplanes, heights, dogs are some examples)

Specific Phobias

Liebowitz Social Anxiety Scale Test

Social Phobia Inventory (SPIN)

Only medical doctors can diagnose anxiety

Diagnosis Checklists

The Symptoms or Traits of Anxiety

Excessive worry

Perfectionism

Frequent questioning of situations

Difficulty concentrating

Mental State

Overly sensitive to criticism

Socially withdrawn

Easily embarrassed

Excessive worry about multiple topics

Easily agitated

Feelings and Emotions

Avoidance of evaluations Reluctant to answer questions Reluctance to join social situations

(avoidance and withdrawal) Difficulty concentrating/remembering Irritability Disorganized

Behaviour

Weight loss

Change in eating habits

Difficulty sleeping

Stomach aches or headaches Cries often

Physical Symptoms

Strategies for Helping

Excessively reassuring the child

Being too directive

Permitting or encouraging avoidance

Becoming impatient with the child

Unhelpful Strategies

Prevent avoidance Communicate your empathy effectively Prompt the child to cope constructively Model brave, non-anxious behaviour Provide consistent discipline Symbolic play Teach self-talk Develop a list of strategies to use when

unpleasant feelings/thoughts arise

Helpful Strategies

Pay attention to your child’s feelings. Stay calm when your child becomes anxious about a

situation or event. Maintain a healthy lifestyle and encourage exercise Reward brave behaviour Don’t permit avoidance Recognize and praise small accomplishments. Don’t punish mistakes or lack of progress. Be flexible and try to maintain a normal routine. Modify expectations during stressful periods. Plan for transitions Communicate well with the school

How the Parent Can Help

Keep an anxiety log Incorporate exercise into the day Prevent avoidance Music therapy Visual imagery Circle breathing Allow for open-ended assignments and choices Chunk work Have the student set realistic goals Provide a lot of structure and predictability Model mistake-making Plan for Transitions Be flexible-allow for re-do’s and re-write’s Provide fidget tools (such as a squeeze ball) Incorporate self-reflection activities (journaling, poetry, etc) Try the “5 Point Scale” Teach the student that drugs/alcohol will not help the problem

How the Teacher Can Help

Watch for signs (overly jumpy or worried, panic attacks, avoids situations)

Listen and reassure (do not judge, tell them they may have anxiety)

Help them to get help (counseling)

How Peers Can Help

Common Misconceptions Regarding Anxiety

Myth: Panic Attacks are deadly. No. It may seem like that for someone having an attack but it's just

the body's natural defensive reaction to (an exaggerated) perception of threat or danger. Being a natural body response, these attacks cannot kill.

Myth: A Panic Anxiety Attack can happen to anyone, at anytime, anywhere.

True. However, those suffering from some other forms of Anxiety Disorder (e.g. General Anxiety Disorder or GAD) are at a bigger risk of having one. Cumulative stress, heavy emotional disturbance, major life changes and negative thinking can all cause panic attacks.

Myth : A Panic Anxiety Attack is not really an illness" Fact: The National Institute of Mental Health begs to differ. Panic

disorder is a real and serious illness, afflicting 6.8 million Americans today. If left untreated, this can seriously debilitate and affect someone's life.

Myth: If your parents and grandparents had Panic Disorder, you will too. Fact Genetics has been linked to causing panic disorders that can span

generations. However, this is just one of its many known causes and is not the sole basis for diagnosing this disorder.

Myth: In real sense, anxiety disorders are not true illnesses or diseases. Fact: Just like diabetes, anxiety disorders are true, severe medical conditions that

may have emerged from various reasons and factors like your genes, upsetting events and even ones that makeup your brain.

Myth: Anxiety disorder is only of one type. Fact: There are indeed many types of anxiety disorders: generalized anxiety

disorder, social anxiety disorder, obsessive-compulsive disorder, and panic disorder.

Myth: Men and women are affected by all types of anxiety disorders equally.Fact: Women are normally twice as likely to be affected as men for four out of the many anxiety disorders: post-traumatic stress disorder generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder.

Online Anxiety Assessment http://cl1.psychtests.com/bin/transfer?

req=NDF8Mjk3OXwxMjE3NzE1fDB8MQ==&refempt=

http://www.socialanxietysupport.com/disorder/liebowitz/

Important Statistics and Facts Regarding Anxiety and Depression

Depression and anxiety often co-exist together Anxiety is the most common mental disorder Up to 5% of children and adolescents have an

anxiety disorder on any given day. Girls are more likely than boys to have an anxiety

disorder (the hormone Estrogen in females may play a role in how it interacts with serotonin).

Anxiety can also co-exist Substance Abuse and Tic Disorders

If anxiety is caught before the age of 12, it becomes highly treatable!

There is a high correlation between aggressive destructive behaviours in preschool years with anxiety disorders. (Tyson, 2005).

It was also determined that children with anxiety issues may have grown up with chronic stress, disturbed attachment and maladaptive parent-child interactions in their environment as young children.

2% of children experience clinical depression but 3-5% of adolescents will experience it

Depression is higher in females of all ages If anxiety is caught before the age of 12, it

becomes highly treatable! Depression occurs in persons of all genders,

ages, and backgrounds

Only 25% of children and adolescents have depression alone. 75% have at least one other (co-morbid) condition. This could include:

-ADHD -Conduct Disorder -Learning Disabilities -Delinquincy -Anxiety Disorders -Eating Disorders -Substance Abuse

What Are The Dangers of NOT Treating Anxiety and Depression?

School refusal Social isolation Depression Substance abuse Physical illness (such as irritable bowel

syndrome, pneumonia, thyroid disorders) Basically, a person who continues to live with

anxiety will have a diminished quality of life.

For Anxiety:

**Besides not living one’s life to its fullest potential, the greatest danger is suicide**

For Depression:

Paul Foxman is currently one of the leading world experts on anxiety. Good professional books are The Worried Child and Dancing with Fear.

Stories for Youth:

David and the Worry Beast: Helping Children Cope with Anxiety By: Anne Marie Guancy

When My Worries Get Too Big: A Relaxation Book for Children Who Live with Anxiety By: Kari D. Buron

Resources For Teachers

Anxiety:

http://www.worrywisekids.org/ http://www.adaa.org http://www.anxietycanada.ca http://www.adam.mb.ca/helpful.asp http://www.socialanxietysupport.com/d

isorder/liebowitz/

Anxiety Websites

Depression:

http://www.depression.mb.ca/ http://www.afm.mb.ca/ http://www.manitoba.cmha.ca/bins/site2.asp

?cid=284-683&lang=1 http://www.cmhawpg.mb.ca/ http://www.mentalhealthworks.ca/ http://www.depressioncentre.net/

Depression Websites

Websites:

http://www.anxietybc.com/http://www.who.int/en/http://www.worrywisekids.org/http://www.adaa.orghttp://www.anxietycanada.cahttp://www.adam.mb.ca/helpful.asphttp://www.socialanxietysupport.com/disorder/liebowitz/http://www.depression.mb.ca/http://www.afm.mb.ca/http://www.manitoba.cmha.ca/bins/site2.asp?cid=284-683&lang=1http://www.cmhawpg.mb.ca/http://www.mentalhealthworks.ca/http://www.depressioncentre.net/http://www.healthcentral.com/depression/just-diagnosed-822-143.htmlhttp://www.medicinenet.com/script/main/art.asp?articlekey=22653http://myanxietyattacks.com/anxiety-disorders/anxiety-disorders-facts-myths

References

Books:

Carlson, Trudy (1998). Depression in the Young-What We Can Do To Help Them. Duluth: Benline Press

Foa, Edna B. & Wasmer Andrews, Linda (2006). If Your Adolescent Has An Anxiety Disorder. New York: Oxford University Press.

Foxman, Paul (2004). The Worried Child. Almeda: Hunter House.

Randall, Kaye & Strom, Donna & Bowman, Susan (2007). 102 Creative Strategies for Working With Depressed Children and Adolescents. Youth Light Inc: Chapin.

References