Anxiety Management Workshop

1. Anxiety Management Workshop Riannon Greig, CBT Therapist Maddy Sutherland, CWP NSFT

2. Introductions…. • Who we are /what we do • Who youare / what you do

3. What is Anxiety?

4. What is Anxiety? • Group discussion –

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

6. 3 main characteristics of anxiety • Physiological – prepares the body for action, increased physiological arousal • Cognitive – 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.

7. 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

8. Fight/Flight/Freeze response • https://www.youtube.com/watch?v=jEHwB1PG_-Q

9. Anxiety Equation

10. What might cause anxiety to develop?

11. 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

12. Common fears

13. Types of anxiety • GROUP TASK – name as many anxiety types as possible?

14. Worry • What is it? • What might you observe in a young person? • What maintains it?

15. Social Anxiety • What is it? • What might you observe in a young person? • What maintains it?

16. OCD • What is it? • What might you observe in a young person? • What maintains it?

17. Panic • What is it? • What might you observe in a young person? • What maintains it?

18. Health • What is it? • What might you observe in a young person? • What maintains it?

19. Separation anxiety • What is it? • What might you observe in a young person? • What maintains it?

20. School refusal • What is it? • What might you observe in a young person? • What maintains it?

21. SPECIFIC PHOBIAS • What is it? • What might you observe in a young person? • What maintains it?

22. Guess the phobia • - Agoraphobia • - Emetophobia • - Trypophobia • - Spectrophobia • - Anemophobia

23. Break

24. 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)

25. GROUP TASK

26. What do they all have in common? • TRIGGER/ SITUATION • THOUGHTS • EMOTIONS PHYSICAL SENSATIONS BEHAVIOURS

27. CBT

28. Evidence for CBT • NICE recommended treatment for Anxiety Disorders in Young People • https://www.babcp.com/Public/Personal-Accounts/Personal-Accounts.aspx

29. Case Study

30. 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?

31. Common themes - children and young people Things 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

32. 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

33. CBT

34. Practical tools and strategies

35. Rationale – why would I do this?

36. 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

37. Worry tree

38. Progressive Muscle Relaxation • Psychoeducation – tension carried in muscles due to anxiety, need to practice releasing this from our muscles.

39. Safe place imagery

40. 54 321 5Things you can see 4things you can touch 3things you can hear 2things you can smell 1take a slow deep breath…breathe Then focus on your breathing, before shifting your focus of attention onto something different....

41. Coping thoughts

42. 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’

43. Safety behaviours • EXAMPLES: • AVOID • ESCAPE • REASSURANCE

44. 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.

46. Remember….. • Safety behaviours are not bad!!

47. Break

48. Exposure

49. Exposure

50. Habituation