Overcoming Anxiety Information for Families

1. Overcoming AnxietyInformation for Families Dr. Michael Cheng, Children’s Hospital of Eastern Ontario (CHEO) Except where otherwise noted, content is licensed under a Creative Commons Attribution – Non-Commercial License; images are royalty-free stock photos

2. Contents Overview of anxiety What is it What can we do about it Where can we get help

3. Case: Britney • Identifying data • 17-yo female referred for suicidal ideation • Living with mother, a busy professional • Parents separated since age 5; no contact with father for years • Gr. 12 student • Current resources • Individual counselling (1:1 with her and a counselor) for several weeks with no improvement • HPI • Anxiety and depressed for past few months • Precipitating stressor • Boyfriend (of past year) broke up with her • Doesn’t like discussing emotional issues with her mother

4. What is an Anxiety Disorder? We all get worried from time to time But when you have so many worries that it gets in the way of life, we call it an Anxiety Condition (or Anxiety Disorder)

5. Main types of Anxiety Disorders Generalized anxiety disorder Separation anxiety disorder Panic disorder Obsessive compulsive disorder Phobias Social (phobia) / social anxiety Anxiety Disorder Not Otherwise Specified

6. How common are anxiety disorders The most common emotional/ behavioral problem 6.5% of children/youth at any one time I.e. in a classroom of 30, there are at least 1-3 people with anxiety conditions!

7. What Causes Anxiety? Why …does my child have anxiety? …do I have anxiety?

8. Many contributing factors… Family history / genetics Some people are wired to be more sensitive to anxiety, e.g. ‘highly sensitive’ or ‘orchid’ children Stresses in life Past or current stresses which lead a person to feel that 1) “the world is unsafe”, and/or 2) “I am not competent” E.g. abuse, trauma, bullying, separation/divorce, relationship stresses, struggles with school, academics, etc…

9. Stigma and Mental Health Problems Because anxiety is a brain condition, people with anxiety look ‘normal’ Because they look ‘normal’, its often hard for other people to understand what its like for a person to have anxiety Realize that anxiety is not the person’s fault; no one causes them to have anxiety, anymore than a person can cause themself to have a seizure disorder, diabetes or cancer

10. Why Do We Have Anxiety? Q. Where do you get your food from?

11. Where we get our food nowadays!

12. Q. But where did people get their food 10,000 years ago?

13. A. Hunting (or Gathering)!

14. To be a good hunter... • You need to be brave... • You can’t be too anxious or scared because if you were too scared, then you’d stay in your cave all day.

15. Q. But what would happen if you were too brave, with no fear at all?

16. Having no fear at all can get you into big trouble!

17. “Just enough” anxiety is good...!

18. Balance is the key Having just enough anxiety is the key Too little is not good Too much is not good The key is to have JUST ENOUGH

19. What happens in the body during anxiety / stress?

20. When a caveman is dealing with these dangers, the caveman can either • 1) Take flight or • 2) Fight

21. Nature gave human beings an alarm to deal with dangers...

22. Imagine a sabre tooth tiger jumps out at you! Q. What are the TWO main choices you have to survive this? You can either ____ or ____?

23. Body’s alarm helps us deal with danger... • Adrenaline (aka norepinephrine) causes: • Eyes dilate (to see better) • Heart pumps faster (more blood to muscles) • Breathing increases (more oxygen) • Stomach stops working (more blood for muscles) • Sweating (to cool down body when muscles get going) • All this helps the person to either: Take Flight Fight

24. Why is anxiety so common nowadays?

25. Body’s alarm is good with episodic dangers E.g. being attacked by a wild animal, followed by no stress once the danger is gone Body’s alarm is not good with modern “dangers”, which might not be life threatening, but are constant and don’t go away E.g. school pressure E.g. social pressure

26. Q. Why are young children so happy and confident (compared to older children?)

27. Parent Child A. Young children are happy/more confident because they are deeply connected (attached) to parents

28. Although children need strong attachments to parents, unfortunately what often happens to child-parent attachments as children grow older? Parent Child

29. Parent Child A. They weaken…

30. Q. If a child turns away from parents, who do they often turn to instead of parents? Parent Child

31. A. Peers Negative behaviours Peers Technology / Consumerism Parent(s) Child Dalai Lama, 1998; Neufeld, 2005

32. Who do youth talk to about mental health concerns? • Faced with a mental health issue, a female youth is most likely to disclose to: • Friends/peers (46%) • No one (31%) • Family (11%) • Professionals (2%) • Faced with a mental health issue, a male youth is most likely to disclose to: • No one (48%) • Friends/peers (32%) • Family (10%) • Professionals (1%) In other words, youth with mental health issues are even more vulnerable to being disconnected from parents… Youth Net, personal communication; Davidson, S., & Manion, I. G. (1996). Facing the challenge: Mental health and illness in Canadian youth. Psychology, Health & Medicine, 1(1), 41-56.

33. A. Turning to 1) peers, 2) things (“consumerism”), 3) negative behaviours is bad because… • They can never meet a child’s emotional/ attachment needs as well as only healthy parents can • Only parents can reliably provide emotional support, acceptance and validation • Especially with peers • Friendships come and go • Peers are still maturing and changing • Your BFF one day can be your worst enemy the next…

34. Even if peer orientation works out temporarily… • A child that turns to peers for their needs may be temporarily happy when things are going well with peers • But with peers, the attachment will always be insecure -- there will inevitably be some disappointment • Best friend moves away; conflicts, disagreements with friends • Peer-oriented child will be insecure, stressed, anxious child…

35. Attachments with peers can be healthy when… • Peers do not replace parents as the primary attachment • Friends as secondary attachments • Peers are mature • By adulthood, peers will hopefully be mature enough to be able to meet the attachment needs (that perhaps parents cannot provide)

36. Why do so many of today’s children/youth detach from parents? • Peer oriented culture • Today’s television, movies, music promotes the view that parents are incompetent, and that friends (and having things, i.e. consumerism) are the most important goal in life • Modern technology such as internet, cell phones, social media • Studies confirm that while our media may help keep us more connected superficially, for many people they damage deeper, more intimate connections, e.g. “Facebook Depression” • Violence • Desensitizing effects of video game, but also internet, television and movie violence has the effect of reducing empathy for others, but also causes anxiety by directly teaching one that the world is an unsafe place

37. Video games are bad • Research confirms video games are bad for • Behaviour / mood / relationships • Physical health, sleep • Empathy • Video games great for • Desensitizing people to killing • Creating children/youth who lack empathy and see violence as a way of solving problems American Academy of Paediatrics, Media Policy Statement

38. TV Violence • Decades of studies confirms that TV violence contributes to aggression • Typical North American child watches 28-hrs of TV per week, more time than is spent in school • Prior to age 4, young children cannot distinguish between reality and fantasy • Young children imitate aggressive acts • Older youth see violent heroes as cool • Violence is justified against your ‘opponents/enemies’ • Media rarely shows non-violent conflict resolution American Academy of Child and Adolescent Psychiatry, http://www.aacap.org/cs/root/developmentor/the_impact_of_media_violence_on_children_and_adolescents_opportunities_for_clinical_interventions

39. Evidence confirms that adult-child relationships are the key • Key component to preventing depression/suicide is positive social and emotional connections between • Teens and supportive adults • Teens and school • Teens and community • If you have strong connections with adults, then peer connections are not as important (or unnecessary) • Teens with strong connections with adults, even if socially isolated from peers are still resistant to depression/suicide Keith, 2012

40. What to do if you suspect anxiety

41. Start by seeing the family physician or paediatrician... Assessment Questions to learn more about the problem and whether or not it really is anxiety Seeing if any medical conditions contribute Diagnosis Treatment plans

42. Attachment Strategies for Anxiety Except where otherwise noted, content is licensed under a Creative Commons Attribution – Non-Commercial License; images are royalty-free stock photos

43. Ensure strong attachments and relationships with your child • Studies show that the strongest resiliency factor for mental health is strong connections between a parent and child • Humans are a social species • Children are dependent on parents for survival • The need to connect is hard-wired into all of us, and the need to connect is important throughout the life span • This need for connection or attachment is thus crucial for • Normal physical, cognitive and emotional development • Happiness and contentment

44. How strongly does your child try to attach to you? • Does your child want to spend 1:1 time with you? • Does your child want to be like you or have things in common with you? • Does your child try to be loyal to you and take your side? • Does your child try to be useful or helpful to you? • Does your child express love and affection to you? • Does your child talk to you about feelings, and do you provide 100% unconditional acceptance? Neufeld, 1991

45. How strongly do you try to attach to your child? • Does your child want to spend 1:1 time with you? • Does your child want to be like you or have things in common with you? • Does your child try to be loyal to you and take your side? • Does your child try to be useful or helpful to you? • Does your child express love and affection to you? • Does your child talk to you about feelings, and do you provide 100% unconditional acceptance? Neufeld, 1991

46. Connecting through Empathy • Of the various modes that people can attach or connect to one another, the deepest mode is through empathy and validation…

47. Your close (female) friend / spouse tells you about the horrible day that she is having… • Q. Most of the time, what does your (female) friend want you to do? 1) Give brilliant advice, 2) Listen and validate those feelings

48. Your close (female) friend / spouse tells you about the horrible day that she is having… • Q. Most of the time, what does your (female) friend want you to do? 1) Give brilliant advice, 2) Listen and validate those feelings

49. Empathy and Validation • A core need that everyone has is to feel loved, validated, appreciated, respected no matter what • No matter how good/bad you are • No matter how smart/dumb • No matter how pretty/ugly • Secure, consistent caregivers can meet this need better than (insecure, inconsistent) peers • Empathize • Validate / Accept • Soothe

50. Listen for feelings, accept and validate (Connection before Direction) EMPATHIZE “I can see that you’re feeling really sad about this…” (giving supportive hug) VALIDATE/ACCEPT “That’s okay if you’re feeling sad…” SOOTHE “We’ll get through this…”“How can I support you?”“Do you want me to listen?”“Or do you want some advice?”