Supporting Students with Anxiety: Solution Focused Strategies for the Busy School Counselor

1. Supporting Students with Anxiety: Solution Focused Strategies for the Busy School Counselor LACA Fall Workshop October 29, 2013 Rick Auger, PhD Jackie Brand, LSC Minnesota State University, Mankato

2. Session Goals Provide basic information about childhood anxiety—what it is and how it works Present a number of interventions for anxiety that are appropriate for use by school counselors (and try a few out) Discuss special considerations for young children Have everyone leave with at least two important ideas related to childhood anxiety that can be applied in schools immediately

3. Anxiety is…. What happens when you focus on perceived future threats… Believing the challenges facing you exceed your ability to meet those challenges… A combination of physiological, cognitive, and behavioral reactions... Fueled by self-doubt… What you should target in your intervention (rather than targeting the object of the anxiety)

4. Anxiety as a spectrum… Minimal Symptoms Troubling Symptoms Anxiety Disorder 10% - 20%

5. 2010 Minnesota Student Survey During the past 30 days, have you felt nervous, worried, or upset?

6. Percentage of students in your building who experience significant anxiety: 1% – 5% 6% – 10% 11% - 20% 21% - 30% More than 30%

7. Emotional response to perceived threats

8. Types of anxiety disorders • Separation anxiety disorder • Selective mutism • Specific phobia • Social anxiety disorder (social phobia) • Panic disorder • Agoraphobia • Generalized anxiety disorder • Separate disorders in DSM-5 but sometimes grouped with anxiety disorders: • Obsessive-compulsive disorder • PTSD • Acute stress disorder • Adjustment disorder with anxiety

9. Neurobiology of Anxiety

13. The neurobiologyof anxietyRettew (2012) • Adolescents’ two brain-related problems: too much accelerator and not enough brake • Individual differences in behavioral inhibition • The link between temperament/personality and anxiety • Anxiety is real and in moderation is adaptive

14. Interventions for Anxiety

15. There is just one of you

16. And there are many of them

17. Relaxation: The go-to anxiety intervention

18. Relaxation strategies • Progressive muscle relaxation • Guided imagery • Deep breathing

19. Progressive muscle relaxation

20. http://www.youtube.com/watch?v=HFwCKKa--18

21. http://visuals.autism.net/

22. Exposure strategies • Help students face their fears—GRADUALLY • Involves gently exposing students to their fears, and then helping them relax away the fear • Start with visualization, then move to in vivo

23. Steps for Gradual Exposure: Relaxation training Create anxiety hierarchy Anxiety arousal (via imagery) Recognition of anxiety cues Relaxation coping Homework, practice

25. Cognitive strategies • Slogans • Reframing • Developing coping strategies for the possibility that things might go wrong • Teach and model going with the flow

26. Cognitive strategies Reframing Student: “I’m always so stressed about my assignments!” Counselor: “I wonder if that stress is really just energy that you could use to keep yourself working hard?

27. Cognitive strategies Reassurance therapy: “It seems like you’re catastrophizing again. I’m sure your mind won’t go completely blank during your speech. You’ll do fine.” Developing coping strategies: “Well, I think it is very unlikely that your mind will go completely blank, but just in case let’s talk about what you can do if that does happen. How could you cope with that?”

29. Cognitive strategies Example: Keep a thought record

30. Solution focused strategies

31. Students with anxiety have ways of thinking that are naturally problem-focused: • Unrealistic worry: “It will be awful if I fail” • Exaggerating the risks and dangers of life: “I’ll definitely fail if I take Advanced English” • Excessive self-consciousness: “Everyone noticed when I tripped walking up the steps, and now they all think I’m a dork”

32. Assumptions of Solution-Focused Counseling • Concentration on solutions can better facilitate positive change • Every problem has exceptions and contains seeds of a solution • Small improvements can lead to bigger improvements • All students have untapped strengths and resources and the ability to solve/manage their own problems

33. Assumptions of Solution-Focused Counseling • Focusing on positive goals facilitates change • There is no single right way to look at problems and issues • Insight into the cause of a behavior is not necessary to change the behavior • It is not necessary to know a great deal about the problem in order to be helpful

34. Solution-Focused Guidelines Looking at problems differently can encourage their resolution Example: From “I have high anxiety”to “I haven’t figured out the right strategies to manage my anxiety”

35. Solution-Focused Guidelines Engage in solution talk rather than problem talk Problem talk: “How was your anxiety this week?” Solution talk: “Tell me about the times this week when you felt comfortable and relaxed”

36. Solution-Focused Guidelines Look for exceptions – times when students are effectively managing their lives and issues Example: Tell me about a time you did not feel anxious? What were you doing?

37. Solution-Focused Guidelines Focus on small and reasonable changes rather than dramatic wide ranging changes Example: Setting a goal of moving from 2 to 3 instead of 2 to 10

38. Solution-Focused Guidelines Externalize the problem Examples: What name could you give to what we are talking about here? Tell me times when you have beat worry and have felt at ease? Anxiety is sure bullying you around! What can you tell anxiety to get it off your back?

39. Solution-Focused Guidelines Compliment students on past and current accomplishments and positive changes Example: “You were really able to tackle that anxiety and get through that test!”

40. Solution-Focused Guidelines Don’t ask students to do something new – rather, ask them to do a variation of what they have already had success with. Example: “You’ve done such a nice job of turning around your relationship with Mr. Green. I wonder if you could do some of that same work to get along better with Ms. Brown?

41. Solution-Focused Guidelines Help form goals that are in positive terms and that are concrete, specific, and measurable Examples: Be on time for school three or more days this week Participate in two social events weekly with peers

42. Solution-Focused Guidelines Flag the minefield Examples: “What has gotten in your way of achieving this goal in the past? What can you do to make sure that doesn’t happen this time?” “Last week you got pulled away from your goal of paying attention in class by your friends. How will you overcome that this week?”

43. A counseling dialogue… Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…” A support-oriented school counselor might say: “I can hear the discouragement in your voice. That must be hard—to know that you can do better, but to have your anxiety interfere so much.”

44. A counseling dialogue… Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…” A cognitive-oriented school counselor might say: “That sounds really discouraging. I wonder if your mind really goes blank or if you just haven’t really listened to the thoughts you have. Let’s try to figure out what thoughts you have during tests, and whether those thoughts help you or hurt you.”

45. A counseling dialogue… Student: “I get so worried about big tests. My mind just goes blank. I can feel myself blowing it. I hate it…” A solution-focused school counselor might say: “That sounds really discouraging. But I see from your transcript that you are still getting solid grades. There must be times when you are able to contain your anxiety enough to let your knowledge shine through. When is the last time that happened, even a little? Let’s talk about that…”

47. Mindfulness strategies • Mindfulness: Bringing one’s complete attention to the present experience on a moment-by-moment basis • Exercise: Focus on doing one thing at a time (the opposite of multitasking) for a day • Exercise: Use self-message to narrate your activity • Exercise: Practice bringing one’s attention back to the present with self-message “Come back to the present”

48. Anxiety management apps… AnxietyCoach (Mayo clinic) Anti-Stress Quotes Calming Breath Optimism ZenView

49. Time management for anxiety • Help student do a “time study” for a week. How many hours studying? Overcommitted? • Create a month-long calendar. Insert study times, major projects, etc. • Work the calendar a day at a time.

50. Anxiety in Young Children