Anxiety Dr. Aaron Vallance Consultant in Child & Adolescent - PowerPoint PPT Presentation

Anxiety Dr. Aaron Vallance Consultant in Child & Adolescent Psychiatry, Surrey And Borders Partnership NHS Trust Hon. Clinical Senior Lecturer, Imperial College London Dad to Joe (6W) and Ben (3F)

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Anxiety is… • Normal • Common • Dependent on the context or meaning of a situation.

What happens for you when you get anxious?..

Emotional Unease Distress Physiological Cognitive Muscle tension Restlessness Fears Heart racing Worries Nausea / butterflies Helplessness Sweaty / clammy Difficulty breathing Behavioural Avoidance Irritable

Anxiety is normal… but problems if: wrong time, wrong place, or too much! • Sometimes the brain responds as if there is a danger to run from… when there really isn’t. • Instead of frank danger, triggers tend to be worries or fears . • But still, there’s nowhere for all those chemicals to go, so they end up staying in your body, making you feel more anxious!

Age Typical fears/worries 9 months to 3 years Sudden movements or loud noises, separation from care-givers, strangers 3–6 years Animals, the dark, ‘monsters/ghosts’ 6–12 years Performance anxiety, criticism, burglars 12–18 years Social anxiety, Fear of failure/rejection Adulthood Illness, death

Common worries: “ What if I’m… • Not good enough • Not safe • Not loved • Not wanted • Not liked by other children • Fail • Do not belong in the family • Am embarrassed/shamed • Get hurt • Lose something • Have something important taken away • Fear change

But kids don’t always express what’s wrong… • Complain of feeling ill or tired • Issues with sleeping or eating • Difficulty separating from parent/carer • Avoiding school or a certain situation • Rituals and repetitive patterns of behaviour • Meltdowns, tantrums, ‘acting out’

Anxiety Disorders = Anxiety that is… Excessive, Persistent AND Causes significant distress &/or impact on life

Separation anxiety disorder (1%) • Excessive anxiety about separation from attachment figures. Generalized anxiety disorder (0.4%) Panic disorder • Multiple, persistent, excessive worries not restricted to any one situation (0.2%: 11-15yrs) • Physical symptoms • Repeated unpredicted • 6+ months. attacks of severe anxiety + physical symptoms • unrestricted to any particular situation

Social phobia (0.3%) • Anxiety interacting with people, with excessive fear of embarrassment or Specific phobias (1%) scrutiny. • Avoidance reinforces anxiety • Excessive fear of specific objects/situations that provoke anxiety on exposure. • Animal • Situational (e.g. vomit) • Environment (e.g. heights) • Blood injury • Agoraphobia : • 2+ fears of crowds, OCD (0.1% in 5-10yr; 0.7% in 11-16yr) public places, leaving Repetitive, intrusive thoughts which • home, or travelling are distressing (O bsessions ) alone. +/- Repetitive actions to prevent / • neutralise the anxiety ( Compulsions )

How to help a child with anxiety..

Reassure Encourage Acknowledge calmly “Let’s try this “I can see you’re “You’ll be together..” feeling anxious..” okay..” Reflect “What helped?”

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12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

The effect of repetitive exposures to the anxious situation.. 12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

The effect of repetitive exposures to the anxious situation.. 12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

The effect of repetitive exposures to the anxious situation.. 12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

12 10 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

The effect of avoiding the anxious situation.. 12 10 ..it gets worse! 8 6 4 2 0 Normal Arriving 1 minute 2 minutes 10 20 minutes minutes

Comfort Zone Overwhelming anxiety

Comfort Zone

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Goal Setting • Breaking it down into ‘baby steps’ within the “Amber Zone” • Set achievable, realistic goals • Notice and praise successes, however small • Give it time, and expect ups and downs! • If the step turns out to be too much, break it down further into smaller steps.

Coping with anxiety / stress Breathing Exercises Visualization - slow deep breaths, counting.. - may incorporate breathing exercise e.g. balloon, waves Muscle Tension & Relaxation Mindfulness - work from head to - bringing attention to the toe, tensing muscles present. then release - acknowledging any worries, but gently move on to the senses. - guided mindfulness activities (e.g. Headspace app). Distraction

Distractions… SEE HEAR MOVE ABOUT • Sing a song • Jumping jacks Go outside • Play a musical instrument Run around • • Watch a film • • Count your breath • Go for a walk Read a book / magazine • Listen to music Dance • • Watch a snow globe • Do yoga • Draw a picture • TOUCH • Play with a ball Blow some bubbles Have a bath Ride a bike • • • • Give someone a hug Stroke your pet DO • Brush your hair Write your thoughts in a • • book • Wash your face/hands Colouring in • Apply cream • Play a game • • Paint your nails • Have a laugh Rub a smooth stone • Bake a cake • Play with clay/dough • • Rip up some paper Punch a pillow •

Managing Thoughts § Allocate a regular “ Worry Time ”: 10-15 mins for the child to discuss worries with you. § Thought Diary § Acknowledge the worries – don’t automatically dismiss. § Gently challenge the worries: § “ So what? And so what?..” § “ What’s the worst that can happen? Has it ever happened before?..” § “ What would you tell a friend?..” § Evidence ‘For vs Against’:

A word on sleep strategies • Regular exercise “ Wind-down ” routine • Avoid caffeinated drinks 45-60 mins before bedtime: • Avoid too much lying-in • Calming activities • Avoid naps • bath • Try to reserve bedroom • reading for sleep-time • audio-books • calm music • No screens! • Praise / ‘reward’ Bedroom: • a calm bedtime • Dark or nightlights • good sleep • Blackout blinds? • Good sleep patterns can • Nightlights en route to take time! toilet?

Useful websites • Royal College of Psychiatrists – www.rcpsych.ac.uk/mental-health - for info about all sorts of mental health conditions and issues. • www.youngminds.org.uk • www.headmeds.org.uk - aimed for teenagers, on various conditions and medications. • National Autistic Society - www.autism.org.uk • ADDISS (for ADHD) - www.addiss.co.uk

Books • Helping Your Anxious Child – Rapee et al • What To do When You Worry Too Much: A Kids Guide To Overcoming Anxiety - Huebner • Overcoming Your Child’s Fears and Worries a self-help guide to using CBT Techniques - Creswell & Willetts • Relax Kids Aladdin’s Magic Carpet - Viegas • The Whole Brain Child - Siegel • The Huge bag of worries - Ironside • 1,2,3 Magic - Phelan

An example of a 2-minute Guided Mindfulness activity… https://www.youtube.com/watch?v=7l ssbXfWU_c

Thank you!