Helping Adolescents Cope with Anxiety and Stress During High School

1. Helping Adolescents Cope with Anxiety and Stress During High School January 7, 2014 Jonathan Dalton, Ph.D. Center for Anxiety and Behavioral Change

2. Children and Adolescents Why 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

3. 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

4. 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)

5. When Does Anxiety Become Disordered? • Distress • Avoidance • Interference • Functional Impairment

6. 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

7. Three Pillars of Anxiety • Uncertainty • Lack of control • Perception of danger

8. Anxiety Reduction • Education • Cognitive Reframing • Behavior Change

9. Basic Template for the Treatment of Anxiety Disorders in Teens • Assessment • Psychoeducation • Cognitive Reappraisal Strategies • Exposure • Parent Training • Relapse Prevention

10. 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

11. Cognitive Strategies“Why don’t the palm trees care when the wind blows?” • Coping cards • Mindfulness training • Problem-solving skills training • Cognitive flexibility exercises

12. 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

13. Decreasing Avoidance“Urges do not dictate actions.” • Metacognitive awareness of urge to avoid or escape • “Swatting butterflies” • Rehearsal of self-instruction • Building distress tolerance

14. 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.)

15. Three Critical Variables for Habituation to Occur (Successful Exposure) • Frequency • Intensity • Duration

16. Psychoeducation for Parents“Fear and Avoidance are Teammates” • Parent-training is paramount! • Begin with education regarding the negative reinforcement of anxious behavior • “Protection Trap”

17. Parent Training“Water the seeds, not the weeds.” Essential for treatment • Focus on “loving firmness” (kite metaphor) • Metaphor of flight attendant during turbulence

18. 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

19. scene from Ray

20. 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

21. Jonathan Dalton, Ph.D.Center for Anxiety and Behavioral Changedrjdalton@gmail.com301-610-7850