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ANXIETY DISORDERS

What is Normal Anxiety?

Anxiety is a normal feeling that all children and adolescents will experience at sometime. It may be experienced in the form of worry, fear, apprehension, or distress. Anxiety is a natural response that helps us avoid dangerous situations and motivate us to take action in solving everyday problems. It is adaptive in helping us to survive! Occasional nervousness and fleeting anxieties occur when a child or youth is first faced with an unfamiliar or especially stressful situation. This can serve as an important protection or signal for caution in certain situations. Life's challenges may be met with a temporary retreat from a situation, a greater reliance on parents for reassurance, a reluctance to take chances, and a wavering confidence. Children/youth may also experience some physical symptoms, but their anxious feeling will be appropriate for the situation and be time limited. Typically these concerns will resolve when the child learns to master the situation or the situation changes. The fears will then dissipate and have no lasting ill effects. Anxiety will look different depending on the stages of development:

 

Early Childhood

Normal anxiety in this period of development may be exhibited as the following:

  • Separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year and declines over the next 3 years, resolving in most children by the end of kindergarten
  • Fear of new and unfamiliar situations, real and imagined dangers from big dogs, to spiders, to monsters
  • Apprehension with costumed characters, ghosts, and supernatural beings
  • May struggle with the dark, the basement, closets, and under the bed

 

School Age & Adolescence

  • Begin to fear real world dangers-fire drills, burglars, storms, illness, or drugs. With experience, they learn that these risks can exist as remote, rather than imminent dangers.
  • Social comparisons and worries about social acceptance
  • Concerns about academic and athletic performance
  • Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identity
  • Concerns about the larger world, moral issues and their future successes are common in later adolescence

 

When should be we concerned?

An anxiety disorder differs from normal anxiety in the following ways:

  • It is more severe, intense, longer-lasting in duration, with significant distress
  • It negatively interferes with child or youth’s ability to function or participate in typical activities of daily life or from what they want to do (i.e., school, relationships, emotional state)  
  • Occurs in the absence of or out of proportion to a threat or danger
  • Associated with worrying about past and future
  • Avoidance and escape become a child’s/youth’s automatic coping response
  • Often accompanied by physical complaints (i.e., stomach aches, headaches, nausea)
  • Can be maladaptive or unnecessary

 

Anxiety disorders are the most common mental illness among children and adolescents. However, as a result of stigma the majority will not seek professional help. Young women aged 15 to 24 are twice as likely to have anxiety disorders as young men (8.9% to 4.3% respectively). This disorder affects how one feels, thinks, behaves, and if left untreated can lead to depression, substance abuse, suicide or other mental health problems.  

 

Warning signs of Anxiety Disorders:

  • Excessive, inappropriate anticipatory worry

  • Physical complaints (i.e., headaches, stomach aches, nausea, vomiting, heart palpitations, shortness of breath)  

  • Demonstrating excessive distress out of proportion or in absence of the situation

  • Attention to threat, hyper-vigilance

  • Fast and sustained physiological arousal

  • Decreased attention or concentration, difficulty relaxing and sleeping

  • Easily distracted, irritable, speeding or slowing thoughts

  • Reluctance to go to school or other places, clinginess

  • Catastrophic, pessimistic thinking, trouble making decisions

  • Perfectionism, self-critical, very high standards that make nothing good enough

  • Demonstrating excessive avoidance, refuses to participate in expected activities, refusal to attend school

  • Seeks excessive reassurance (e.g., many ‘what if’ questions) 

 

What causes Anxiety Disorders:

There is no one cause for an anxiety disorder. Genetics does play a critical role, as does exposure to a stressful environment. It is best to understand the causes of anxiety as resulting from a combination of an increased vulnerability to anxiety-- because of genetic or physiological makeup and exposure to a specific trauma or acute or ongoing stressor. Additionally, modelling and inadvertent reinforcement from adults (i.e., parents, teachers) can also increase vulnerability to an anxiety disorder. Research has shown that some parents of anxious children, especially if they are anxious themselves, have an anxious interpretation of the world, or view it as frightening. When parents hold this view of the world as threatening, they likely will suggest that their children avoid situations rather than approach them. Many adults want to protect child/youth from anxiety, but then they don't have opportunities to learn new skills or practice them.

 

Types of Anxiety Disorders:

  • Separation anxiety

  • General anxiety

  • Specific phobias

  • Social anxiety

  • Obsessive Compulsive Disorder

  • Panic Disorder

  • Post Traumatic Stress Disorder

 

What fuels Anxiety:

Anxiety is fuelled and maintained by the interconnections of three areas and can be best understood as a triad:

  1. Thoughts

  2. Physical arousal

  3. Behaviours

Understanding the anxiety triad is extremely important when providing treatment and classroom/school adaptations. It is important to remember that anxiety is treatable! The main type of psychological treatment used to treat Anxiety Disorders is children/youth is called Cognitive Behaviour Therapy (CBT). This evidenced-based treatment has been validated by research to provide successful results among children/youth. This form of treatment should always be delivered by trained mental health professionals.

For more information on the specifics of what fuels anxiety, click here.

 

Cognitive Behavior Therapy (CBT):

CBT teaches children/youth that rather than accepting anxious thoughts as truth, to generate more realistic versions of situations and their ability to cope with them. Children/youth then gradually face their fearful situations breaking the challenges down into small, manageable steps. They are then able to more quickly make into non-anxious interpretations of situations, and understand that avoidance of feared situations only makes matters worse. They learn instead that the only way to get past anxiety is to face it head on and approach situations until they become used to them.

CBT for most anxiety disorders addresses four main areas of interventions: 

1. Psychoeducation:

  • Focuses on an explanation for how anxiety is triggered and maintained

  • Anxiety results from the brain misperceiving and exaggerating the risk in a situation and making them feel they need to avoid in order to survive

2. Cognitive Restructuring:

  • Guided to generate and evaluate the accuracy of self-talk; their internal dialogue or appraisal of a situation and identify thinking errors

  • Taught to "think twice" and identify the most likely thing that would happen in the situation, or the "what else's"; alternative thoughts

3. Breathing and relaxation techniques:

  • Aims to decrease the physical arousal often felt by children/youth

4. Exposure:

  • Challenging children/youth to face the situations and sensations and thoughts, which they may have come to avoid out of fear of feeling anxious

  • Done in small, manageable steps

  • Through exposing them in small steps they learn that they can feel anxious in a particular situation and still be okay

 

In the Classroom

Although most children/youth with anxiety disorders often benefit from specialized treatment, there are a variety of classroom and school-based adaptations that are useful:

 

  1. Help students identify worrisome thoughts:
    When anxious, our thoughts tend to focus on all the bad things that might happen. Then we imagine the worst and worry! Often these anxious thoughts just paralyze and make us want to run away or hide. To help students identify their worrisome thoughts, suggest that they ask themselves:
    • What am I thinking right now?
    • What am I worried will happen?
    • What bad things do I expect to happen?

 

  1. Encourage students to pay attention to their Automatic Thoughts:
    Automatic thoughts are very short, quick thoughts or images that enter our mind almost automatically. They are part of our self-talk and we are often not aware of them. They set off our anxiety alarm. Worry Diary/box exercise: For two weeks, ask the student to write down their worries as they pop up. By writing them down, they don’t have to “keep track” of their worries in their head anymore. The student might find that a lot of worries don’t seem so powerful a few hours later, and especially after a good night’s sleep.

 

  1. Alternatives to Negative Self-Talk or Coping Statements:
    Encourage students to replace their negative thoughts with some of these possible alternatives or coping statements:
    • I am in charge, not my negative thoughts
    • The world is a pretty safe place
    • I can cope with most things
    • I can feel anxious and still do it
    • It’s just anxiety, it’s not dangerous, and it’s just temporarily uncomfortable
    • These are just my anxious thoughts. I don’t have to believe them, I can just let them go

 

  1. Breaking down situations into small manageable steps:
    For Example: A student is anxious about doing a presentation in front of the class. This can be broken up into a number of steps:
    • Doing a short presentation in front of a friend
    • Doing a short presentation in front of the teacher
    • Doing a short presentation in front of the teacher and a few friends

 

  1. Being uncomfortable with uncertainty:
    Help students become comfortable with uncertainty. This builds tolerance of it and helps to face the fear of not knowing. Examples of this strategy might be:
    • Ordering something completely new at a restaurant
    • Delegating an important part of a group school project to someone else
    • Not asking a friend if he or she likes something new that you bought
    • Telling yourself you’ll just have to see what happens at the party, rather than mentally rehearsing all your actions and conversations beforehand

 

  1. Helping students bring down the temperature:
    • Relaxing activities
    • Calm breathing exercises
    • Muscle relaxation: tense and release
    • Mindfulness breathing: 4-7-8; an example can be found here
    • Visualizations and imagery

 

  1. Develop Healthy Habits:
    • Increase sleep
    • Increase exercise
    • Healthy eating
    • Decrease drug/alcohol use

 

Links

 

 

 

Resources

 

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For more information on borrowing a resource, contact Silvia Venturino at sventurino@lbpsb.qc.ca.