1. ANXIETY AND DEPRESSIONThinking SEEDS feeling SEEDS doing SEEDS Bob Schuppel, M.Ed., LPCC-S 17800 Chillicothe Road, Ste. 230 (440) 543-4771 bob@bobschuppel.com bobschuppel.com

2. What are seeds?

3. …OF LIFE?

4. What are seeds?

5. A Buddhist said the following… MIND IS A FIELD IN WHICH EVERY KIND OF SEED IS SOWN What Are the Seeds?

6. IN US ARE INFINITE VARIETIES OF SEEDS What Are the Seeds?

7. MANY SEEDS ARE INNATE HANDED DOWN BY ANCESTORS What Are the Seeds?

8. …handed down by ancestors… What are seeds?

9. SOME SEEDS SOWN WHILE IN THE WOMB What Are the Seeds?

10. OTHERS WERE SOWN WHEN WE WERE CHILDREN What Are the Seeds?

11. SEEDS FROM PARENTS AND FAMILY MEMBERS What Are the Seeds?

12. What Are the Seeds?

13. SEEDS FROM SOCIETY AND RELIGION RIGHTandWRONG What Are the Seeds?

14. SEEDS THAT WERE THRUST UPON US What Are the Seeds?

15. What Are the Seeds?

16. Cognitive DevelopmentThoughts, Emotions and Actions

17. relay impulses and especially sensory impulses to and from the cerebral cortex The brain

18. The cerebral cortex plays a key role in memory, attention, perceptualawareness, thought, language, and consciousness. The brain

19. Selective Attention The brain

20. perform primary roles in the formation and storage of memories associated with emotional events The brain

21. Brain has two memory systems, one for ordinary facts and one for emotionally charged one • The stronger the amygdala arousal, the stronger the imprint • Emotional memories can be faulty guides to the present – out of date The brain

22. Amygdala is a repository for emotional memory – scans experiences comparing what is happening now and what happed in the past • One element appears similar to past? MATCH! • Commands us to react to the present in ways we were imprinted long ago – with thoughts, emotions, and reacts in response to situations ONLY DIMLY SIMILAR, but close enough The brain

23. The brain

24. The brain

25. The brain

26. School-Aged Anxiety Generalized Anxiety Disorder Panic Attacks Agoraphobia OCD

27. G.A.D. Worries significantly disrupt school, social activities, family Worry is uncontrollable Worries are extremely upsetting and stressful Worry is about all sorts of things, tend to expect the worst Worry almost every day and at least for six months Typical Worries Worrying doesn’t get in the way of everyday activities & responsibilities Able to control worries Worries are unpleasant but don’t cause significant distress Worries limited to a specific, small number of realistic concerns Bouts of worry last a short period of time Generalized Anxiety Disorder

28. Jumpiness or unsteadiness Edginess or restlessness Tiring easily Muscle tension, aches or soreness Trouble falling asleep or staying asleep Stomach problems, nausea, or diarrhea Physical Symptoms of GAD

29. Inability to relax Difficulty concentrating Fear of losing control or being rejected Irritability Feelings of dread Inability to control anxious thoughts Psychological Symptoms of GAD

30. “What if” worries about situation in the future Perfectionism, excessive self-criticism, and fear of making mistakes Feeling source of blame for disaster (maturational crisis)and their anxious worries will keep tragedy from occurring Misfortune is contagious and will happen Need frequent reassurance and approval Children and GAD

31. Must include a discrete period ofintense fear or discomfort, in which four or moreof the following symptoms develop abruptly and reach a peak within 10 minutes: Shivers Pounding heart Sweating Trembling Smothering Choking Chest pain Dizzy Lightheaded Fear dying Chills Hot flashes Abdominal distress Shortness of breath Panic Attack

32. I don’t care if itIS Tweety, I ain’t going out there! Symptoms of Agoraphobia

33. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available Symptoms of Agoraphobia

34. CDO!!

35. Obsessions are recurrent and persistent thoughts, impulses, or images They are unwanted and cause marked anxiety or distress Frequently, they are unrealistic or irrational They are not simply excessive worries about real-life problems or preoccupations Obsessive-Compulsive Disorder

36. Compulsions are repetitive behaviors or rituals Appears in behaviors like hand washing, hoarding, keeping things in order, checking something over and over “Appears” in mental acts like counting, repeating words silently, avoiding, tally marks Obsessive-Compulsive Disorder

37. Fear of contamination or dirt Having things orderly and symmetrical Aggressive or horrific impulses Making a Mistake Obsessions

38. Washing and cleaning Counting Checking Demanding reassurances Performing the same action repeatedly Orderliness Compulsions

39. What Do We Do?

40. Neurotransmitter

41. 80.7% rated ‘very much’ or ‘much improved’ for combination therapy: c.t. & sertraline (Zoloft) 59.7% for cognitive therapy 54.9% for sertraline (Zoloft) 23.7% placebo Anxiety disorders are common in children and adolescents and cause significant impairment in school, in family relationships, and in social functioning High prevalence (10-20%) and substantial morbidity, anxiety disorders in children and adolescents remain underrecognized and undertreated New England Journal of MedicineCognitive Behavioral Therapy, Sertraline, or a Combination in Childhood AnxietyOctober, 2008

42. The human brain is incredibly adaptive. The brain’s ability to act and react in ever-changing ways is known, in the scientific community, as “neuroplasticity” - 100 billion nerve cells, constantly laying down new pathways for neural communication and to rearrange existing ones throughout life Aids the processes of learning, memory, and adaptation through experience Because of the brain’s neuroplasticity, old dogs, so to speak, regularly learn new tricks of every conceivable kind WHAT IS NEUROPLASTICITY?

43. Creatures of Habits Thinking Feeling Behaving COGNITIVE THERAPY

44. 1. What happen? 2. What did I think? 3. How did I feel? 4. What did I do? or How did it change my body? MINI FORMULATIONS OF ANXIETY-INDUCED PROBLEMS

45. 1. Where might it happen? 2. What is the best thought I can think? 3. What might I feel? 4. What can I do? Preparation for Dealing withAnxiety Causing Problems

46. MeasuringtheAnxiety Out of Control Feeling Worried Doing Alright Calm & Cool

47. There are many ways that schools can help a child with anxiety disorders Meetings between parents, school staff, such as teachers, guidance counselors, or nurses, AND community-based counselors / therapists will allow for collaborative process to develop helpful school structure for the child The child may need particular changes (accommodations and modifications) within a classroom and home Interventions for School & Home Proactive

48. Schedule check-ins on arrival and throughout the day to reduce the child's anxiety and facilitate transition during school, even at home Accommodate late arrival due to difficulty separating, getting to school Interventions for School & HomeProactive

49. Identify a safe place where the child may go to reduce anxiety during stressful periods. Developing guidelines for appropriate use of the safe place will help both the child and staff or parents Develop relaxation techniques to help reduce anxiety at school. The same techniques that are useful at home can often be implemented at school as well. Gym time, run time, etc. Interventions for School & Home Proactive

50. Provide times for the child to convey messages to family. Brief (a minute or so) contact with family may substantially reduce anxiety and may help younger children recognize that their connection to their parents is intact. (In some children, this strategy may instead heighten awareness of the separation.) In preparation for possible times when the parent is not available, identify additional people for the child to contact Interventions for School & Home Proactive