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Tips for Dealing with Student Anxiety

Helping Anxious Kids: Powerful Approaches for Breaking the Worry Cycle

Recorded 3-day workshop sponsored by PESI, Inc.

Lynn Lyons, LICSW

● Internationally recognized psychotherapist, author and speaker

● Special interest is in helping families break generational patterns of worry

● She teaches families how anxiety works

● She uses a playful approach and humor to help children and families learn skills to help deal with their anxieties

Learning Outcomes

1. Determine how related service providers can provide valuable contributions in working with students experiencing anxiety

2. Collaborate with the educational team to create accommodation plans that focus on building skills needed to address anxiety

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Agenda ● 10 minutes: What is anxiety?● 10 minutes: Anxiety surrounding

return to school following COVID-19 pandemic

● 20 minutes: Steps related service providers can take to address anxiety in students

● 10 minutes: Review of resources for children, parents and therapists

● 5 minutes: Course test

What is Anxiety?https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

Five major types of anxiety disorders

● Generalized Anxiety Disorder● Obsessive-Compulsive Disorder (OCD) ● Panic Disorder● Post-Traumatic Stress Disorder (PTSD)● Social Phobia (or Social Anxiety Disorder)

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What does anxiety look like?

https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_GeneralizedAnxietyDisorder.pdf

Generalized Anxiety Disorder

• Excessive worry more days than not during a

6-month or more period of time

• Child finds the worry difficult to control

• Worry causes clinically significant distress

• Worry is not attributed to an effect of a medical

condition or use of a medication

• Not better explained by another medical

disorder

Obsessive-Compulsive Disorder

Indicators of OCD that may be observed in the school environment:

• Repeated trips to the bathroom or excessive time

spent in bathroom

• Rough, red or cracked skin resulting from

excessive washing

• Avoidance of certain places in school

• Excessive time to complete schoolwork

• Turning in work with multiple erasures

• Excessive fidgeting with clothing or items in desk

• Repeating a behavior over and over

• Restarting of a task if interrupted

• Repeated asking of the same question

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Panic Disorder

Regular and unexpected panic attacks

One or more attack has been followed by a month or more of the following:

• Persistent concern about more attacks• Significant change in negative behavior related to

the attacks

https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/

• Pounding hear, palpitations, racing heartbeat

• Sweating• Trembling/shaking• Short of breath• Feeling of choking

• Chest pain or discomfort• Nausea or abdominal

distress• Dizzy, unsteady, faint• Feeling of being detached

from reality

• Fear of losing control• Fear of “going crazy”• Fear of dying• Numbness or tingling• Chills or heat

sensation

Post-Traumatic-Stress Disorder (PTSD)

• Somatic Reactions

• Cognitive Reactions

• Emotional Reactions

• Behavioral Reactions

Social Phobia (Social Anxiety Disorder)

• Marked fear or anxiety about one or more social situations• The social situations almost always provoke fear or anxiety

(may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations)

• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

• The social situations are either avoided or endured with intense fear or anxiety.

• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The fear, anxiety, or avoidance is persistent (lasting for 6 months or more)• The fear, anxiety, or avoidance is not attributable to the physiological

effects of a medication• The fear, anxiety, or avoidance is not better explained by the symptoms of

another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder

Https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t12/#:~:text=A.,will%20be%20humiliating%20or%20embarrassing.

Table 16DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison Retrieved at:

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What Do Kids Tend to Worry About?

School Age kids tend to worry about

● “Bad people”● Ghosts● Being left alone● The dark● School performance● What others think of them

http://macnamara.ca/portfolio/what-kids-worry-and-fear-at-different-ages/

Anxiety and Depression together is typical

Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children

https://www.nimh.nih.gov/health/topics/depression/index.shtml

What happens in the brain?

Fight or Flight

Rational problem solving!!

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What happens in the body?

Physiological occurrences:

● Different for each individual

● Response may be different if panic attack occurs

Pounding heart

Upset tummy

headache

Sweaty palms

Extreme fatigue

Aches and pains

Adrenaline rush

Rapid, shallow breathing

lightheadedness

How to explain anxiety to children – sample video

Returning to School following the COVID-19 pandemicHere are some of the things kids may feel anxious about:

● Difficulty catching up with school work● Trying to “fit in” after not seeing peers for an extended time● Following safety rules (or other kids not following them)● Getting sick or bring the virus home to family members● Uncertainty - not knowing what will happen next - changing schedules, new rules● Facing having to talk about things that have happened in their family ( illness, death, or the loss of a

job)

https://www.understood.org/en/school-learning/choosing-starting-school/back-to-school/managing-back-to-school-anxiety?utm_medium=email&utm_source=newsletter-en&utm_campaign=evergreen-july20-fm&utm_content=send

SIX FEET

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Continued Remote Learning Can Increase Worry Too

● Different sleep routine● Lack of structure● Isolated from peers● Decreased access to regular meals● Too much screen time● Decreased access to classroom aide● Decreased motivation

Teens● Adolescents tend to use extreme

language ○ Freaking out

○ Depressed○ Panic attack

● Help them see the range:○ What is the difference between “upset” and

“freaking out”○ What is the difference between “sad” and

“depressed”

○ What is the difference between “nervous” and having a “panic attack”

● Bridge back to successes○ Review a successful event - ask question “How

did you do that?”

What can we do as related service providers?

● Be aware of signs of anxiety○ Often mistaken for ADHD/ADD○ May “fly under the radar”

● Collaborate with guidance counselor/psychologist/IEP team/outside providers

● Connect with parents and teachers● Assist with accommodations in 504 plans● Model flexibility/dealing with challenges

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Content vs. Process

Focus on how to “handle the anxiety” vs trying to get rid of the anxiety

Help normalize the feelings of worry (brain and body)

Don’t use words that indicate that worry can be eliminated -only that worry can be handled

➢ Expect➢ Externalize➢ Experiment

Ability to tolerate the unknown (uncertainty)

Promote Flexibility● Model flexibility● Point out flexibility in others● Praise flexibility

● Uncooked spaghetti - rigid and fragile

● Cooked spaghetti - flexible and strong

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Other Strategies….

● Connect to successes

● Normalize the ups and downs of being able to get past it

● Have kids notice coping mechanisms in other kids, adults

● Monitor screen time (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214874/)

Use of rewards

● Can be used as a short-term strategy

● Don’t make it excessive

● Reward child when they take a measure to

“try” something they are anxious about

● Make it interactive (especially for children)

○ We will order pizza and you pick toppings

○ We will play miniature golf

● Be clear on why you are rewarding them

● Don’t use “if you ….. X times in a row”

○ just builds anxiety as they get towards the goal

Expose (with assistance) vs. Avoid

Exposure Therapy

● Form of Cognitive Behavioral Therapy (CBT)● Client is gradually exposed to situation they are

anxious about/fearful of, learning to be less sensitive to it over time

Peris et al article:

● The more time spent on challenging exposure tasks, the better the outcome

● Importance of collaboration to ensure client compliance and mastery

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Accommodation plans

● If you give an escape hatch - they are going to use it● Pay attention to the message you are giving● Is the plan avoidance-based or skills-based??● When and if the child leaves the classroom, there needs to be a very specific

plan in place for where they go, and what happens next in detail….(careful of comfy couch in the guidance office where there is a bowl of candy…. For example)

● There needs to be a weaning off plan● Schedules and warnings of changes throughout the day do not help the child

obtain skills

What Not To Do - “Doing the Disorder”● Provide certainty● Overvalue routine● Model rigidity● Be overly critical● Be overprotective

*with autism - need to teach flexibility slowly

Have a planGive your brain something to “chew on” so that body can calm down

Example:

ABC Animal game - A alligator, B bear, C cat, D dog, E elephant, F flying squirrel…

(Can do with desserts, names, flowers, etc.)

Numbers - count by 4s

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Resources - books for therapists● The Brain That Changes Itself - Norman Doidge - talks about neuroplasticity

and powers of positive thinking

● Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts - by Sally M. Winston PsyD (Author), Martin N. Seif PhD (Author)

● The Discriminating Therapist: Asking “How” Questions, Making Distinctions, and Finding Direction in Therapy - by Michael Yapko

● Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician’s Guide

Resources - books for parents● Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise

Courageous and Independent Children - by Reid Wilson and Lynn Lyons LICSW

● Curriculum of Positive Psychology - by Dr. Martin Seligman - shifting kids to positive mindset

● Parenting the New Teen in the Age of Anxiety - by Dr. John Duffy - provides insights for parents regarding their teens growing up with the pressure of social media

● Helping Your Anxious Teen: Positive Parenting Strategies to Help Your

Teen Beat Anxiety, Stress, and Worry - by Dr. Sheila Achar Josephs - guidebook for parents

Resources - children’s books● The Owl Who Was Afraid of the Dark -by Jill Tomlinson - teaches kids flexibility,

shifts in perspective, experience is malleable

● A Friend Like Ed - by Karen Wagner and Janet Pedersen - social skills - teaches kids accepting difference, loyalty, flexibility, the importance and possibility of connection and friendship

● Wanda’s Monster - by Eileen Spinelli - teaches kids that worries and fears are manageable and malleable, shifting perspectives, creativity and access resources

● Ming Lo Moves the Mountain - by Arnold Lobel - teaches kids flexibility, creativity, problem solving

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Resources - Children’s books (cont’d)● The Opposite - by Tom MacRae and Elena Odriozola - teaches kids the concept of

confronting anxiety and fear instead of avoiding

● Something Might Happen - by Helen Lester - teaches kids how to manage the unknown, experimentation, and accessing resources

● Once Upon An Ordinary School Day - by Colin McNaughton - teaches kids imagination, possibilities, thinking outside the box, positive expectancy

● Playing with Anxiety: Casey’s Guide for Teens and Kids - by Reid Wilson (Lynn Lyons - contributor)

Some Helpful Websites

● Anxiety and Depression Association of America (adaa.org) - non-profit organization - provides resources on anxiety and depression

● Understood for All (Understood.org) - an organization that has programs for families, teachers and young adults, focusing on people who learn and think differently

● National Institution of Mental Health (https://www.nimh.nih) - lead federal agency on research for mental disorders - information and resources on children and mental health (including anxiety)

● Center for Disease Control (https://www.cdc.gov/childrensmentalhealth/depression.html) - Information on anxiety and depression in their section on Children’s Mental Health

References● Carrion, Victor. (2018) Assessing and Treating Youth Exposed to Traumatic Stress. American Psychiatric Association Publishing:

W ashington, DC.

● Lewin, A. & Storch, E. (editors) 2017. Understanding OCD: A Guide for Prents and Professionals. Jessica Kingsley Publishers,

Philadelphia, PA.

● Lyons, L. Helping Anxious Kids: Powerful Approaches for Breaking the W orry Cycle. 3-Day Intensive W orkshop . PESI, Inc. 3-day

workshop .

● Peris, T. S., Caporino, N. E., O ’Rourke, S., Kendall, P. C., W alkup, J. T., Albano, A. M ., … Compton, S. N. (2017). Therapist-Reported Features of Exposure Tasks That Predict D ifferential Treatment Outcomes for Youth W ith Anxiety. Journal of the American

Academy of Child & Adolescent Psychiatry , 56(12), 1043–1052. https://doi.org/10.1016/j.jaac.2017.10.001

● Stefanakos, V. S. (2020, April 17). W hat to Do W hen Your Teen Resists Your Help . Teen Resists Help | Teen Homework Help | Peer and Teacher Support. Retrieved at: https://www.understood.org/en/friends-feelings/teens-tweens/talking-openly/what-to-do-when-your-teen-resists-your-help?utm_medium=email

● Yeager, D. S., Lee, H. Y., & Jamieson, J. P. (2016). How to Improve Adolescent Stress Responses. Psychological Science , 27(8), 1078–1091. https://doi.org/10.1177/0956797616649604