“Unleash Your Inner Superpower” Overcoming Anxiety & Depression SPIN Conference 2017 Mary Montaldo, Hilary Gould, Dan Wilkie, & Jonni Adaniya University of Hawai ʻ i at Manoa
UH Center for Cognitive Behavior Therapy Child Division
Questions for You: ● Open-ended questions: ○ What are you hoping to get out of this talk today? ○ What would like to know about anxiety and depression? ○ What are the biggest challenges you face? ● Poll Questions: ○ How many of you are parents? Teachers? SBBH? Other counselors/providers outside SBBH? ○ Are you more interested in … ■ What anxiety and depression are? ■ Navigating the system? ■ Intervention strategies? ■ Anything else?
Agenda: 1. Basic statistics on anxiety and depression 2. What is Anxiety? 3. What is Depression? 4. What can we do? a. Assessment b. Treatment Practices (including medications) 5. Additional Resources 6. Parent-to-Parent Discussion 7. Questions
How Common are Internalizing Disorders? ¤ Depression and anxiety are commonly diagnosed disorders ¤Depression: 6.7% of adults and 12.5% of teens had episode in last year ¤Anxiety: 18% of adults and 12.5% of kids ¤Similar gender prevalence until adolescence, when girls have higher rates ¤Anxiety and depression are also highly comorbid ¤~50% diagnosed w/depression are also diagnosed with anxiety ¤Can also be sequentially diagnosed
Anxiety
The Cognitive Behavioral Model The key idea…
What is Anxiety? Sensations: What we feel in our Thoughts: What we think in • • Actions: What we do when • bodies anxiety anxious
Depression
What is Depression?
Possible Indicators of Depression • Attendance problems •Poor/declining academic performance that seems unrelated to the child’s abilities •Declining motivation •Decreased interest in activities that used to be fun, especially social interactions •Changes in energy level: –low energy, fatigue, and sleepiness or –appearing tense, restless, and agitated •Changes in emotional expression or affect: –sadness, irritability, and/or frustration or –showing little or no emotion of any kind, seeming almost numb
The Tripartite Model ¤ The Tripartite Model suggests that depression and anxiety share components as well as have components that differentiate them ¤3 components: ¤High Negative Affect (NA) ¤Low Positive Affect (PA) ¤Physiological Hyperarousal (PH) ¤Depression and anxiety share NA, while PA leads to depression and PH leads to anxiety
What Can We Do?
Overarching Treatment Strategy
First Steps ● Get a professional opinion ○ Pediatrician ○ School staff: counselor, teacher ● Evaluation ○ DOE ○ DOH ○ Outside providers & testing centers ● Educate yourself & seek out support ○ Websites ○ Books ○ Support groups (community, online)
DOE Request for Evaluation http://spinhawaii.org/education-parent-guide/child-find-referral/ Spinhawaii.org → Parent guide (top row) → Child find & referral
DOH SEBD Referral
Treatment Practices
Evidence-Based Treatment for Anxiety
Evidence-Based Treatment for Depression
Cognitive Restructuring ● Three hallmark anxiety cognitive distortions: ○ Probability overestimation ■ If I speak to someone new, he will tell me I am stupid ○ Catastrophic misinterpretation ■ Everyone will think I am stupid and no one will ever want to talk to me ○ Anxiety feelings last until escape is realized ■ When I try to speak to someone new, I will be nervous until I escape or get away from that situation. I should avoid those situations.
Cognitive Restructuring, cont. ● Overarching goals for cognitive ○ Eliciting and examining underlying assumptions ○ “Create doubt where there was once certainty of belief” - are my thoughts accurate? ○ Set the stage for hypothesis-testing - what alternative views are there? ○ What is the worst that can happen if my view of the event is correct? ○ What actions can I take to influence the event? ○ Hypothesis-testing and behavioral experiments
Relaxation/Coping Techniques ● Progressive muscle relaxation ○ http://relax.practicewise.com ● Deep breathing ○ Best mechanism to control our “fight or flight” response - breathing regulates heart rate, sweat activity, temperature, etc ● Mindfulness ○ Present-focused
Exposure for Anxiety
Exposure for Anxiety, cont. ● It’s hard to talk ourselves out of anxiety! We often know it’s a crazy thought or feeling … ● We need to have real life experiences that may make us anxious in the short-term but will help decrease our anxiety in the long-term ● Objectives ○ Practice exposure to feared situations ○ Allow habituation to occur ○ Repeat until fear ratings are reduced
Behavioral Activation for Depression ● Depression decreases energy level, makes us less social and not motivated to do much ○ It’s important to identify this depression loop and create alternative responses ● Objectives ○ Develop repertoire of pleasurable activities ○ Build activities into daily schedule ○ Practice participating in activities until it becomes habitual and mood improves
Safety Planning A plan for reaching out when things are not quite right.
Medications ANXIETY ● Many children treated with selective serotonin reuptake inhibitors (SSRIs - like Prozac or Zoloft) with good response ● Benzodiazepines (like Xanax - are short-term, they can be effective in reducing intense anxiety when in distress, but data supporting long-term usefulness is weak, even in adults. Very addictive and tolerance builds quickly. DEPRESSION ● Antidepressant medications can be beneficial to children and adolescents ○ Most have only been studied in children 8 and older ● Antidepressant medications themselves may induce suicidal behavior in youths- FDA adopted BLACK BOX label warning in 2004 ● Some side effects of SSRI medication include: insomnia, fatigue, sedation, and restlessness
Finding Support
Finding a CBT Therapist Association for Behavioral & Cognitive Therapies (ABCT) http://www.findcbt.org/xFAT/ ● Know what questions to ask… ● http://www.abct.org/Information/?m=mInformation&fa=_HowToChooseTherapist ○ http://helpyourkeiki.com/questions-to-ask-your-childs-therapist/ ○
Top Rated Apps
Additional Resources ● 24-hour ACCESS Crisis Hotline (Oahu): 1-800-832-3100 ○ Outer islands: 1-800-753-6879 ● National Suicide Hotline: 1-800-273-TALK (8255) ○ Also have Lifeline Crisis Chat ○ Website: www.suicidepreventionlifeline.org ● Crisis Text Line - Text “HOME” to 741741 ○ Free w/AT&T, Sprint, Verizon, T-Mobile ○ Other carriers: standard text rates apply
Additional Resources http://spinhawaii.org/Resource- Guide/
Additional Resources http://helpyourkeiki.com/how-can -i-learn-more-about-mental-health -concerns/ “How can I learn more about mental health concerns?”
Additional Resources http://helpyourkeiki.com/how- can-i-find-support-for-my-famil y/ “How can I find support for my family?”
Parent-to-Parent Discussion Jonni Adaniya
Thank You! Questions?
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