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

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

Sep 19, 2023 205 likes •638 views

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) 4 / 10 anxiety thermomete r 8 / 10 10

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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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4 / 10 anxiety thermomete r

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8 / 10

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10 / 10

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Anxiety is…

  • Normal
  • Common
  • Dependent on the context or meaning of a

situation.

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What happens for you when you get anxious?..

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Emotional

Unease Distress

Cognitive

Fears Worries Helplessness

Physiological

Muscle tension Restlessness Heart racing Nausea / butterflies Sweaty / clammy Difficulty breathing

Behavioural

Avoidance Irritable

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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!

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Age Typical fears/worries 9 months to 3 years 3–6 years 6–12 years 12–18 years Adulthood Sudden movements

  • r

loud noises, separation from care-givers, strangers Animals, the dark, ‘monsters/ghosts’ Performance anxiety, criticism, burglars Social anxiety, Fear of failure/rejection Illness, death

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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
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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’
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Anxiety Disorders = Anxiety that is…

Excessive, Persistent

AND

Causes significant distress

&/or impact on life

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Separation anxiety disorder (1%)

  • Excessive anxiety about separation from

attachment figures.

Generalized anxiety disorder (0.4%)

  • Multiple, persistent, excessive worries

not restricted to any one situation

  • Physical symptoms
  • 6+ months.

Panic disorder

(0.2%: 11-15yrs)

  • Repeated unpredicted

attacks of severe anxiety + physical symptoms

  • unrestricted to any

particular situation

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Social phobia (0.3%)

  • Anxiety interacting with people, with

excessive fear of embarrassment or scrutiny.

  • Avoidance reinforces anxiety

Specific phobias (1%)

  • Excessive fear of specific
  • bjects/situations that provoke

anxiety on exposure.

  • Animal
  • Situational (e.g. vomit)
  • Environment (e.g. heights)
  • Blood injury
  • Agoraphobia:
  • 2+ fears of crowds,

public places, leaving home, or travelling alone.

OCD (0.1% in 5-10yr; 0.7% in 11-16yr)

  • Repetitive, intrusive thoughts which

are distressing (Obsessions)

  • +/- Repetitive actions to prevent /

neutralise the anxiety (Compulsions)

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How to help a child with anxiety..

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Acknowledge

“I can see you’re feeling anxious..”

Reassure calmly

“You’ll be

  • kay..”

Encourage

“Let’s try this together..”

Reflect

“What helped?”

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4 / 10

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

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

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

The effect of repetitive exposures to the anxious situation..

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

The effect of repetitive exposures to the anxious situation..

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

The effect of repetitive exposures to the anxious situation..

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

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

The effect of avoiding the anxious situation.. ..it gets worse!

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Comfort Zone

Overwhelming anxiety

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Comfort Zone

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ALERT - Spiders on next slide!

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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.

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Coping with anxiety / stress

Breathing Exercises

  • slow deep breaths, counting..

Visualization

  • may incorporate

breathing exercise e.g. balloon, waves

Muscle Tension & Relaxation

  • work from head to

toe, tensing muscles then release

Mindfulness

  • bringing attention to the

present.

  • acknowledging any worries, but

gently move on to the senses.

  • guided mindfulness activities

(e.g. Headspace app).

Distraction

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Distractions…

HEAR

  • Sing a song
  • Play a musical instrument
  • Count your breath
  • Listen to music

TOUCH

  • Have a bath
  • Give someone a hug
  • Stroke your pet
  • Brush your hair
  • Wash your face/hands
  • Apply cream
  • Paint your nails
  • Rub a smooth stone
  • Play with clay/dough

MOVE ABOUT

  • Jumping jacks
  • Run around
  • Go for a walk
  • Dance
  • Do yoga
  • Play with a ball
  • Ride a bike

DO

  • Write your thoughts in a

book

  • Colouring in
  • Play a game
  • Have a laugh
  • Bake a cake
  • Rip up some paper
  • Punch a pillow

SEE

  • Go outside
  • Watch a film
  • Read a book / magazine
  • Watch a snow globe
  • Draw a picture
  • Blow some bubbles
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§ 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’:

Managing Thoughts

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A word on sleep strategies

  • Regular exercise
  • Avoid caffeinated drinks
  • Avoid too much lying-in
  • Avoid naps
  • Try to reserve bedroom

for sleep-time “Wind-down” routine 45-60 mins before bedtime:

  • Calming activities
  • bath
  • reading
  • audio-books
  • calm music
  • No screens!

Bedroom:

  • Dark or nightlights
  • Blackout blinds?
  • Nightlights en route to

toilet?

  • Praise / ‘reward’
  • a calm bedtime
  • good sleep
  • Good sleep patterns can

take time!

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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,
  • n various conditions and medications.
  • National Autistic Society - www.autism.org.uk
  • ADDISS (for ADHD) - www.addiss.co.uk
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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
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An example of a 2-minute Guided Mindfulness activity… https://www.youtube.com/watch?v=7l ssbXfWU_c

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Thank you!