Examining Anxiety and Depression

1. Examining Anxiety and Depression By: Mark Neves (#6724026) Nicole Elias (#6504111) Rochelle Reynolds (#6723665)

2. Why Are These Conditions Important? We are seeing more and more youththat are beingdiagnosedwith or exhibitingsigns of depression and anxiety. As the youthspendmuch of theirday in school, itis essential thatteachers and other staff learn to recognize the characteristics and treatment options in order to help them.

3. Research has shown that social anxiety and depression regularly co-occur (Ingram et al. 2001). In children, many reviews have found correlations between depression and anxiety.

4. What Causes Anxiety and Depression? • Genetics • Life Events • Personality (worriers and perfectionists are especiallyprone) • Hormones • Chemicalimbalances

5. The ClinicalDefinition of Depression • Depression is a persistent sadness or loss of interest in activities for more than 2 weeks in absence of external precipitants. It requires a distinct change in mood accompanied by several physiological changes (R.H. Belmaker, M.D., and GalilaAgam, Ph.D-New England Journal of Medicine)

6. Types of Depression

7. Dysthmia • This is not depression in the deepest sense of the word. It is like a sky that is always filled with gray clouds. The child may not feel deeply depressed but they may not feel good either.

8. Reactive Depression • This is a reaction as a direct result to an event that occurs in one's life. This is often due to a loss of some kind (like a death). We commonly know this as grief and it is a normal form of reactive depression.

9. Bipolar Illnesss • This occurs when the person enjoys normal moods some of the time. During times of depression though, the person may appear manic. During the manic phase, they typically will exhibit: -increased energy -aggressive responses -decreased need for sleep -increased risk-taking -feelings of mood elevation

10. Recurring Unipolar Depression • This is the most common form of depression. This occurs when the child feels low but has no actual stressor in his or her environment. They have normal moods much of the time but end up having a number of depressive episodes during their life. There isn’t necessarily one specific trigger.

11. Seasonal Affective Disorder (SAD) • Seasonal Affective Disorder (SAD)-This is the scientific term for what is frequently known as the “winter blahs.” A despair will set in with the disappearance of the shortened daylight hours and will persist as long as the cold winter and lack of sun remain present. As spring returns though, many children will feel their energy return.

12. The Symptoms or Traits of Depression

13. PhysicalSymptoms • Stomach or body aches • Tense face • Trembling • Sweating • Nausea • Difficulty sleeping

14. Mental Symptoms • Always sees the bad or negative side of things • “All or Nothing” type of thinking • Difficulty concentrating • May think of hurting themselves

15. Feelings • Sad • Irritable or grumpy • Feels hopeless or worthless • Loss of interest in things they once enjoyed

16. Behaviour • Trouble with family and friends • Drop in grades or work ethic • Avoid people • Lack of energy

17. Diagnosis • Only medical doctors can diagnose depression.

18. How DepressionisTreated • The most common resources would be counseling through school or a health professional (family doctor, psychiatrist etc) and medication (anti-depressants). • For mild depression in adolescents, the answer does not lie in medication. Research has shown that while they may be helpful in adults, they are not as effective with young people. Medications need to be used with other treatments and strategies. • For those with major depression, cognitive behavioural therapy (CBT) may be used. CBT is a talking therapy that teaches new skills for thinking and acting more effectively.

19. Strategies for Helping

20. Research shows thatexerciseis a very effective way to help treatdepression!

21. How Teachers Can Help • Encourage the student to participate in class activities but understand they have low energy • student should be reassured that the teacher is there to help when needed • education priorities should ensure the child does not fall behind in academics to protect self-esteem • avoid punitive approaches • Incorporate exercise into the day • focus on specific strengths (“I like the colors you have chosen for the flowers.” instead of “You are a great artist.”) • Refer to student support services

22. How Parents Can Help • Have fun with the child! • Encourage exercise and physical activity • Don’t tell the child to “snap out of it” • Be positive and use non-punitive discipline • Don’t compare the child to his or her siblings • Don’t overprotect and overdirect • Learn as much as possible about this condition • Communicate well with the school

23. How Peers Can Help • Watch for signs (crying, negative comments, loss of interest) • Listen and reassure (do not judge or tell them they shouldn’t feel that way) • Help them get help (see a counselor)

24. Common Misconceptions Regarding Depression

25. Myth:Depression is not a real medical illness. Clinical depression is a serious medical condition that affects not only an individual’s mood and thoughts, but also the individual’s body. Research has shown that depression has genetic and biological causes. Individuals coping with depression have a higher level of stress hormones present in their bodies, and the brain scans of depression patients show decreased activity in some areas of the brain. Myth:Even if depression is a medical illness, there’s nothing that can be done about it. Fact: Depression is treatable, and more than 80 percent of individuals with depressive disorders improve with treatment. As new medications and treatments are discovered, the number should continue to rise. The first step to finding effective treatment is to get a physical examination by a doctor to rule out other causes for your symptoms, such as thyroid problems. Once you’ve been diagnosed with depression, you and your doctor will decide on a course of treatment, which will include medication, psychotherapy or a combination of both.

26. Myth: Depression will go away by itself. Fact: For extremely fortunate individuals, depression may go away by itself. But for the rest of us, depression can hang on for months, years or indefinitely. Depression can go away on its own, only to return in the future; once an individual has one episode of depression, they are predisposed to have more. Clinical depression is a potentially fatal disease – and suicide could be the end result of waiting for it to go away without any help. Myth: Depression is a normal part of getting older. Fact: Depression is not a normal part of aging, but seniors do generally experience more of the events that can trigger depression: loss of family and friends, ill health, isolation and financial worries. Furthermore, people over the age of 60 grew up in an era in which mental illness was not discussed, and they may feel more shame about asking for help than someone from a subsequent generation. The highest rate of suicide of any age group occurs in that of people 65 and older, with men being more vulnerable than women. It’s imperative that seniors with depression seek help.

27. Myth: Depression only affects women. • Fact: Although women report being affected by depression twice as much as men, depression certainly affects men as well. Often, clinical depression is underreported in men, particularly in cultures that discourage them from asking for help or showing any weakness. Furthermore, men have a higher rate of successful suicide attempts than women, so it is crucial that men seek help for their symptoms. • Myth: Depression does not affect children or teenagers — their problems are just a part of growing up. • Fact: We’d like to believe that all children experience a happy, carefree childhood, but that’s simply not the case. According to the National Institute of Mental Health, studies show that 1 in 33 children and 1 in 8 adolescents are depressed in any given year. Children are not as practiced at articulating their feelings as adults, so adults must take the initiative to look for and notice symptoms of depression in children.

28. Online Depression Assessment • http://www.depressioncenter.net/wbdat/default.aspx

29. The ClinicalDefinition of Anxiety • It isclinicallysignificantdistress and impairment in functionning. It isrelated to the « fight or flight » response • Anxietyis a normal emotion and we all have it. • Distress and dysfunction are the two major signsthatindicate a person has cross over from normal anxiety to clinicalanxiety. The thirdisinflexibility (thatis, reacting in a maladaptiveway to anxiety-provoking situations).

30. Types of Anxiety

31. GeneralizedAnxietyDisorder • This is excessive anxiety and worrythatoccurs more daysthan not for a period of six months. The anxietyisfocused on a number of differentevents or activities. Three of the followingsymptoms must occur: -Restlessness or edginess -TiringEasily -DifficultyConcentrating or the mindgoingblank -Irritability -Muscle Tension -Insomnia

32. Social Anxiety • A markedfear in social situations. There issomesimilarity to shyness but thesesymptoms are much more extreme and disabling • This is a type of anxietythatusuallystarts in earlyadolescense

33. Performance Anxiety • This type of anxiety is closely related to social anxiety. Performance anxiety involves having to do something. An example would be having to write an answer on the board.

34. What Do Children Worry About The Most? Performance • Speaking in front of the class • Volunteering answers • Getting called upon • Making a mistake • Getting in trouble • Not knowing what to do • Asking for help Social • Fear of humiliation • Fear of separation to those who are familiar • Picking a partner or group work • Going out at recess and lunch • Phys. Ed class

35. Obsessive-Compulsive Disorder • The presence of uncontrollable obsessions or compulsions. These are recurrent thoughts that are intrusive and provoke distress. Compulsions are repetitive behavioural or mental acts that a person feels driven to perform. These compulsions are aimed at preventing or reducing distress (even though there may be no actual connection between the action and the feared situation). *As many as 1% of youth may have this disorder

36. Conditions AssociatedWith Obsessive-Compulsive Disorder • Trichotillomania-Feeling the need to pull out one’s hair, leading to noticeable hair loss • Body Dysmorphic Disorder-Becoming consumed by an imaginary defect in one’s appearance that it causes significant distress • Anorexia Nervosa and Bulimia Nervosa

37. Post-Tramatic Stress Disorder • This is the only anxiety disorder that requires an event that precedes it. This is when a person feels intense feelings of fear, helplessness or horror (examples: witnessing a murder, a car accident). It is viewed as a physical danger to oneself. The person will relive the trauma over and over through flashbacks or nightmares.

38. SeparationAnxietyDisorder • This disorder is found primarily in younger children. It involves excessive anxiety about being separated from the parent or home. As many as 4% of children and young adolescents may suffer from this disorder. • Incessant worry about harm coming to a parent or about an event that involves separation (like being kidnapped) occurs. In extreme forms, these children may be afraid of going to school.

39. Panic Disorder • This occurs when the person experiences spontaneous panic attacks. These are sudden and intense waves of intense fears and panic. There are physical symptoms involving shortness of breath, choking sensations, sweating and rapid heart rate. It is essentially a fear of being in places or situations from which escape might be difficult or impossible. It tends to get worse with age and develops into a full blown panic disorder.

40. SpecificPhobias • An intense fear that is out of proportion to any real threat and focused on a specific object, activity, situation or animal • Panic attacks can occur but they have very specific triggers *Most people have one or two irrational fears (airplanes, heights, dogs are some examples)

41. Diagnosis Checklists • Liebowitz Social Anxiety Scale Test • Social Phobia Inventory (SPIN) • Only medical doctors can diagnose anxiety

42. The Symptoms or Traits of Anxiety

43. Mental State • Excessive worry • Perfectionism • Frequent questioning of situations • Difficulty concentrating

44. Feelings and Emotions • Overly sensitive to criticism • Socially withdrawn • Easily embarrassed • Excessive worry about multiple topics • Easily agitated

45. Behaviour • Avoidance of evaluations • Reluctant to answer questions • Reluctance to join social situations (avoidance and withdrawal) • Difficulty concentrating/remembering • Irritability • Disorganized

46. PhysicalSymptoms • Weight loss • Change in eating habits • Difficulty sleeping • Stomach aches or headaches • Cries often

47. Strategies for Helping

48. UnhelpfulStrategies • Excessively reassuring the child • Being too directive • Permitting or encouraging avoidance • Becoming impatient with the child

49. HelpfulStrategies • Prevent avoidance • Communicate your empathy effectively • Prompt the child to cope constructively • Model brave, non-anxious behaviour • Provide consistent discipline • Symbolic play • Teach self-talk • Develop a list of strategies to use when unpleasant feelings/thoughts arise

50. How the Parent Can Help • Pay attention to your child’s feelings. • Stay calm when your child becomes anxious about a situation or event. • Maintain a healthy lifestyle and encourage exercise • Reward brave behaviour • Don’t permit avoidance • Recognize and praise small accomplishments. • Don’t punish mistakes or lack of progress. • Be flexible and try to maintain a normal routine. • Modify expectations during stressful periods. • Plan for transitions • Communicate well with the school