Anxiety Management Workshop - PowerPoint Presentation

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Anxiety Management Workshop

Riannon Greig, CBT TherapistMaddy Sutherland, CWPNSFT

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Introductions….

Who we are /what we doWho you

are / what

you

do

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What is Anxiety?

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What is Anxiety?

Group discussion –

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Anxiety is normal

Anxiety is a normal emotional response that we all experience and in the right amounts it can be useful…

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3 main characteristics of anxiety

Physiological – prepares the body for action, increased physiological arousalCognitive

– appraise situations and events for anticipated risk; over estimate danger and under estimate ability to cope; “worry” e.g. school, health etc.

Behavioural

– behaviours is aimed at trying to help child anticipate and/or avoid danger e.g. hypervigilance, avoidance.

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GROUP TASK - How does anxiety present?

Identify as many of the physical sensations of anxiety in the body as you can – on the handout given

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Fight/Flight/Freeze response

https://www.youtube.com/watch?v=jEHwB1PG_-Q

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Anxiety Equation

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What might cause anxiety to develop?

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STATS!

- 8% of 5 to 10 year olds and

12%

of 11 to 16 year olds had a clinically diagnosed mental health

condition

- Up

to

25%

of children show signs of mental health problems with more than half continuing through into

adulthood.

-

Half

of all

mental health problems emerge before the age of

14

-

20

%

of adolescents may experience a mental health problem in any given year.

- a

rise of

35%

Childline

counselling sessions about anxiety in the last year

- anxiety

a feature with children as young as 8, with girls

7 times more likely

to contact than boys

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Common fears

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Types of anxiety

GROUP TASK – name as many anxiety types as possible?

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Worry

What is it?What might you observe in a young person?

What maintains it?

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Social Anxiety

What is it?What might you observe in a young person?

What maintains it?

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OCD

What is it?What might you observe in a young person?

What maintains it?

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Panic

What is it?What might you observe in a young person?

What maintains it?

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Health

What is it?What might you observe in a young person?

What maintains it?

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Separation anxiety

What is it?What might you observe in a young person?

What maintains it?

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School refusal

What is it?What might you observe in a young person?

What maintains it?

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SPECIFIC PHOBIAS

What is it?What might you observe in a young person?

What maintains it?

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Guess the phobia

- Agoraphobia- Emetophobia

-

Trypophobia

-

Spectrophobia

-

Anemophobia

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Break

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Is it an anxiety ‘problem?’

Things to consider:

-

When

did the symptoms

develop?

– are they a normal

response

to something that’s happening in their

lives?

e.g. starting school/moving house/ falling out with a friend

 

-

What’s the response of the young person?

– is their response disproportionate to the situation? Is going on for far longer than expected?

-

What’s the functioning of the young person?

–

are they able to do what they want to or should be doing e.g. spending time with friends, going to school,

if it affecting other areas of their life (e.g. physical health, causing them to feel low)

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GROUP TASK

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What do they all have in common?

TRIGGER/ SITUATIONTHOUGHTSEMOTIONS

PHYSICAL SENSATIONS

BEHAVIOURS

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CBT

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Evidence for CBT

NICE recommended treatment for Anxiety Disorders in Young People

https://www.babcp.com/Public/Personal-Accounts/Personal-Accounts.aspx

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Case Study

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Group task

In the case study:What are their thoughts/worries?

How does their anxiety show in their

behaviour

?

How does it show

physically in their body

?

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Common themes - children

and young peopleThings that might keep a child’s anxiety going

Anxious thinking

: notice / remember things that fit with their worries , overestimate danger, underestimate coping

Misinterpret physical symptoms of anxiety

: “something bad is happening”, “something is wrong with me”, “I can’t bear the feeling”

Anxious behaviour

: avoidance, safety behaviours, seek reassurance from others

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Common themes in parents / caregivers

Things that might keep a child’s anxiety going

Demonstrate anxious behaviour

React to the child in an anxious way

Become very involved and protective – maybe too much?

Reassure them – maybe too much?

Don’t encourage them to try / do things – e.g. don’t encourage brave behaviour

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CBT

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Practical tools and strategies

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Rationale – why would I do this?

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Breathing exercises

Imagine a balloon in your tummy breathing

from diaphragm

not

shallow

chest

breathing

Breath

out for longer than breathing in

Relaxed

posture

Counting

might help

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Worry tree

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Progressive Muscle Relaxation

Psychoeducation – tension carried in muscles due to anxiety, need to practice releasing this from our muscles.

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Safe place imagery

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5

4 3 2

1

5

Things you can

see

4

things you can

touch

3

things you can

hear

2

things you can

smell

1

take a slow deep breath…

breathe

Then

focus on your breathing, before shifting your focus of attention onto something different....

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Coping thoughts

Stop, and breathe, I can do this

This will pass

I can be anxious/sad/angry and still deal with this

I have done this before, and I can do it again

It’s okay to feel this way, it’s a normal reaction – it will pass

These are just feelings, they will go away

This won’t last forever

I can feel bad and still choose to take a healthy direction

I don’t need to rush, I can take things slowly

I have survived before, I will survive now

Thoughts are not necessarily true or factual

I can learn from this and it will be easier next time

I can use my coping skills and get through this

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What about when these do not work?

‘OMG I NEED TO DISTRACT MYSELF!’‘This is not working I still feel anxious!’

VERSUS

‘I’m noticing I feel scared but I’m not giving all my attention to it’

‘I am making a choice not to focus on my anxiety’

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Safety behaviours

EXAMPLES:AVOID

ESCAPE

REASSURANCE

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Safety Behaviours vs Coping behaviours

‘Hannah relaxes her shoulders and slows her breathing in response to feeling tense and feels calmer’Thought A: I only feel better because I used my relaxation routine and if I hadn’t practiced my breathing, something awful would have happened!

Thought B: I feel better because I helped myself to calm when I was feeling stressed.

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Remember…..

Safety behaviours are not bad!!

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Break

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Exposure

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Exposure

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Habituation

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Exposure Principles

GradedProlonged

Repeated

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Graded

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Prolonged

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Repeated

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EXPOSURE LADDER

What’s the situation(s) being avoided?How much anxiety/distress does it cause?

What factors can be changed to make a hierarchy?

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Example Hierarchy

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Support from others

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Back up Team

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Work with parents

* Overcoming your child’s fears and worries by Cathy Creswell*

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The difference between Support & Reassurance

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Child expresses fear/asks for reassurance

Interpret as child is not able to cope on their own

Completes task for them or does not encourage them to engage in activity/gives reassurance

Reduced sense of ability to cope/increased need for reassurance

Pink = child

Blue = parent

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Child expresses fear/asks for reassurance

Interpret as child needing support to cope with anxiety

Supports them to complete activity/use helpful coping strategies

increased sense of ability to cope/decreased need for reassurance

Pink = child

Blue = parent

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The difference between Support & Reassurance

Step 1: make plan to reduce anxiety – fully understand that longer term this is keeping their anxiety high and this is to help. Agreed something to be said in

response

Step 2:

start practicing

–

‘I’m

not going to answer that question as I want to help you defeat your anxiety gremlin/cope with anxiety, what can you do to focus on something else

?’ ‘How

can you cope with your

anxiety?’

(suggest

strategies, engage in another activity with child)

Step 3:

lots of praise and focus on what did happen

e.g. went to school and coped

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Barriers

Anxiety gets worse (before

it gets

better)

Parents not understanding rationale or supporting them to carry out activities that seem counterintuitive e.g. exposure

Bullying

Ambivalence to change

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Autism

Anxiety higher in young people with autism

Fear

of the

unknown

M

ore

concrete and options

Incorporating

special interests

Visual aids

M

ore

time on emotion recognition

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Exam stress

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Exam Stress

Study PlanBreak things down

Prioritise

Manage our

time

Maximise our cognitive

resource

Manage

mind blocks

Make use of

Support

Exams

Same as Study &

Reduce

uncertainty

Calming the reptilian brain once rational brain has gone

!

Plan for

immediately

after exam

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RISK

Helpline numbers:

Childline

: CYP 19 and under

T: 0800 1111

 

MIND:

CYP 16 and over – if currently within mental health services,

4pm

– 12am M-F, 10am – 12am weekends

T: 08088 02 02 88

Samaritans:

24/7

T: 116 123

E:

jo@samaritans.org

 

Papyrus

Hopeline

:

10am-10pm

M-F, 2pm – 10pm Weekends

T: 0800 068 41 41

M: (Text only) 07786 209 697

E:

pat@papyrus-uk.org

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Useful books / resources

The Huge Box of Worries (younger children)

What to do when you worry too much (ages 7-11 approx.)

Starving the anxiety

gremlin

‘Overcoming’ series

From Timid to Tiger (parenting intervention)

Cool connections with CBT

Think Good, Feel Good

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Signposting

In Norwich:

MAP

YMCA

Eating Matters

MIND

Nelson's

journey

/

Cruse

bereavement support (16+)

The Norwich

Centre

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ONLINE RESOURCES

Young minds

MIND

The Mix

National Self Harm Network

Get Self Help

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APPS

FearTools

:

Provides information on anxiety and some ideas for ways to improve. Gives you a tool to create exposure to a fearful situation. Also includes a thought diary.

SAMapp

:

An anxiety app with information and ways to track you feeling anxious.

Worrytime

:

This app allows you to write down worries on your mind and put aside a short period where can think about them so they don’t sit on your mind.

PanicShield

:

Centred

on panic, this app has information on what panic is and different ways in which you can expose yourself to what makes you panic.

MindShift

:

Allows you to pick scenarios you would like help with, improve thought patterns, and get information on anxiety in general. Has a rating scale for anxiety with what you feel when feeling anxious

.

Calm:

A relaxation app based on mindfulness. This app gives you relaxation tips breathing, meditation or attempting to sleep.

WellMind

:

Provides information and help for stress, anxiety and depression. Also contains relaxation audio clips.

Headspace

:

Meditation and relaxation app.

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Revisit aims for the session

Did you achieve what you wanted out of the session?

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Any questions?