Helping Adolescents Cope with Anxiety and Stress During High School January 7, 2014

Helping Adolescents Cope with
Anxiety and Stress During High
School
January 7, 2014
Jonathan Dalton, Ph.D.
Center for Anxiety and Behavioral Change
Why this is so important
Children and Adolescents
 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
Adults
 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 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?
 Distress
 Avoidance
 Interference
 Functional Impairment
Fear, 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
Three Pillars of Anxiety
 Uncertainty
 Lack of control
 Perception of danger
Anxiety Reduction
 Education
 Cognitive Reframing
 Behavior Change
Basic Template for the Treatment
of Anxiety Disorders in Teens
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Assessment
Psychoeducation
Cognitive Reappraisal Strategies
Exposure
Parent Training
Relapse Prevention
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
Cognitive Strategies
“Why don’t the palm trees care when the wind
blows?”
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Coping cards
Mindfulness training
Problem-solving skills training
Cognitive flexibility exercises
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
 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.”
 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”
 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)
 Frequency
 Intensity
 Duration
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
“Water the seeds, not the weeds.”
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”
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Functional analysis
Positive reinforcement
Negative reinforcement
Coercive behavior cycle
Extinction
Extinction Burst
Habituation
scene from Ray
Relapse 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
Jonathan Dalton, Ph.D.
Center for Anxiety and
Behavioral Change
[email protected]
301-610-7850