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Helping Adolescents Cope with Anxiety and Stress During High School. January 7, 2014 Jonathan Dalton, Ph.D. Center for Anxiety and Behavioral Change. Children and Adolescents. Why this is so important. Median age of onset 11 – earliest of all forms of psychopathology - PowerPoint PPT Presentation
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Helping Adolescents Cope with Anxiety and Stress During High
School
Helping Adolescents Cope with Anxiety and Stress During High
School
January 7, 2014
Jonathan Dalton, Ph.D.
Center for Anxiety and Behavioral Change
January 7, 2014
Jonathan Dalton, Ph.D.
Center for Anxiety and Behavioral Change
Why this is so importantWhy this is so important
Median age of onset 11 – earliest of all forms of psychopathology
8 % of children between ages 13 and 18 currently have an anxiety disorder
25% will have an anxiety disorder between the ages of 13 and 18
5.9% will have “severe” anxiety disorder Only 18 % of these teens receive treatment
Median age of onset 11 – earliest of all forms of psychopathology
8 % of children between ages 13 and 18 currently have an anxiety disorder
25% will have an anxiety disorder between the ages of 13 and 18
5.9% will have “severe” anxiety disorder Only 18 % of these teens receive treatment
Children and AdolescentsChildren and Adolescents
AdultsAdults
28.8 percent lifetime prevalence Most common category of mental health
disorders 18 % of adults currently have an anxiety
disorder (40 million) $42 billion in annual health costs
28.8 percent lifetime prevalence Most common category of mental health
disorders 18 % of adults currently have an anxiety
disorder (40 million) $42 billion in annual health costs
Treatment Works! “Ultimately we know deeply that on the other side
of every fear is freedom” – Marilyn Ferguson
Treatment Works! “Ultimately we know deeply that on the other side
of every fear is freedom” – Marilyn Ferguson
Treatment success rates for anxiety disorders with CBT (exposure therapy) range from 60% to 90%
Tragically low utilization rates
(18% compared with 79% for ADHD)
Treatment success rates for anxiety disorders with CBT (exposure therapy) range from 60% to 90%
Tragically low utilization rates
(18% compared with 79% for ADHD)
When Does Anxiety Become Disordered?
When Does Anxiety Become Disordered?
Distress
Avoidance
Interference
Functional Impairment
Distress
Avoidance
Interference
Functional Impairment
Fear, Anxiety, and StressFear, Anxiety, and Stress
Anxiety: Future-oriented “diffuse apprehension”
Fear: Present-oriented defensive response to observable threat
Stress: Perceived environmental demands exceed one’s perceived ability to meet them
Anxiety: Future-oriented “diffuse apprehension”
Fear: Present-oriented defensive response to observable threat
Stress: Perceived environmental demands exceed one’s perceived ability to meet them
Three Pillars of AnxietyThree Pillars of Anxiety
Uncertainty
Lack of control
Perception of danger
Uncertainty
Lack of control
Perception of danger
Anxiety ReductionAnxiety Reduction
Education
Cognitive Reframing
Behavior Change
Education
Cognitive Reframing
Behavior Change
Basic Template for the Treatment of Anxiety Disorders in Teens
Basic Template for the Treatment of Anxiety Disorders in Teens
Assessment Psychoeducation Cognitive Reappraisal Strategies Exposure Parent Training Relapse Prevention
Assessment Psychoeducation Cognitive Reappraisal Strategies Exposure Parent Training Relapse Prevention
Cognitive Reappraisal of Anxious Arousal
“Don’t believe everything you think!”
Cognitive Reappraisal of Anxious Arousal
“Don’t believe everything you think!”
Body is doing the right thing at the wrong time
Perspective of “curious observer” “In this moment…” Metaphor of fire alarm
Body is doing the right thing at the wrong time
Perspective of “curious observer” “In this moment…” Metaphor of fire alarm
Cognitive Strategies“Why don’t the palm trees care when the wind
blows?”
Cognitive Strategies“Why don’t the palm trees care when the wind
blows?”
Coping cards Mindfulness training Problem-solving skills training Cognitive flexibility exercises
Coping cards Mindfulness training Problem-solving skills training Cognitive flexibility exercises
Coping Cards“Just because I’m scared…”
Coping Cards“Just because I’m scared…”
I am stronger than my fear
Scary thoughts can never hurt me
I know I can do this because…
The presence of a thought is not evidence to support it
I am stronger than my fear
Scary thoughts can never hurt me
I know I can do this because…
The presence of a thought is not evidence to support it
Just because I’m scared doesn’t mean I can’t do it
It’s ok to be scared Just do it anyway Anxiety is temporary
and harmless
Just because I’m scared doesn’t mean I can’t do it
It’s ok to be scared Just do it anyway Anxiety is temporary
and harmless
Decreasing Avoidance“Urges do not dictate actions.”
Decreasing Avoidance“Urges do not dictate actions.”
Metacognitive awareness of urge to avoid or escape
“Swatting butterflies” Rehearsal of self-instruction Building distress tolerance
Metacognitive awareness of urge to avoid or escape
“Swatting butterflies” Rehearsal of self-instruction Building distress tolerance
Fear Reduction Through Behavior Change“Courage is what you do, not what you feel”
Fear Reduction Through Behavior Change“Courage is what you do, not what you feel”
Exposure to the feared situation in the absence of the feared consequence produces fear reduction
Exposure can be conducted in a variety of manners, but exposure always remains the “active ingredient” (e.g., acetaminophen comes in tablets, caplets, gelcaps, etc.)
Exposure to the feared situation in the absence of the feared consequence produces fear reduction
Exposure can be conducted in a variety of manners, but exposure always remains the “active ingredient” (e.g., acetaminophen comes in tablets, caplets, gelcaps, etc.)
Three Critical Variables for Habituation to Occur (Successful Exposure)
Three Critical Variables for Habituation to Occur (Successful Exposure)
Frequency
Intensity
Duration
Frequency
Intensity
Duration
Psychoeducation for Parents
“Fear and Avoidance are Teammates”
Psychoeducation for Parents
“Fear and Avoidance are Teammates”
Parent-training is paramount!
Begin with education regarding the negative reinforcement of anxious behavior
“Protection Trap”
Parent-training is paramount!
Begin with education regarding the negative reinforcement of anxious behavior
“Protection Trap”
Parent Training“Water the seeds, not the weeds.”
Parent Training“Water the seeds, not the weeds.”
Essential for treatment
Focus on “loving firmness” (kite metaphor)
Metaphor of flight attendant during turbulence
Essential for treatment
Focus on “loving firmness” (kite metaphor)
Metaphor of flight attendant during turbulence
Nuts and Bolts“Your attention is your child’s paycheck, so be exceptionally careful what you pay him/her for”
Nuts and Bolts“Your attention is your child’s paycheck, so be exceptionally careful what you pay him/her for”
Functional analysis Positive reinforcement Negative reinforcement Coercive behavior cycle Extinction Extinction Burst Habituation
Functional analysis Positive reinforcement Negative reinforcement Coercive behavior cycle Extinction Extinction Burst Habituation
scene from Rayscene from Ray
Relapse PreventionRelapse Prevention
Problem-solving skills training Increase perceived social support Emphasis on continued self- directed exposure Relaxation training Reframe potential recurrence of symptoms as
opportunity for future learning Increase self-efficacy to deal with future fears
Problem-solving skills training Increase perceived social support Emphasis on continued self- directed exposure Relaxation training Reframe potential recurrence of symptoms as
opportunity for future learning Increase self-efficacy to deal with future fears
Jonathan Dalton, Ph.D.Center for Anxiety and
Behavioral [email protected]
301-610-7850
Jonathan Dalton, Ph.D.Center for Anxiety and
Behavioral [email protected]
301-610-7850
