Carmel Clay Middle School Parent Presentation Presenters: Amy Daly, LCSW & Laura Guzzi, LCSW St. Vincent Carmel Medical Social Work What is Anxiety? Anxiety is normal. Everyone experiences anxiety at some point in time. For example, it is normal to feel anxious when on a rollercoaster or before an exam. Young children can experience stranger anxiety and older children often get nervous performing in front of their peers. Anxiety is not dangerous. Although anxiety feels uncomfortable, it is temporary, and will eventually decrease. Anxiety is adaptive. Anxiety helps us prepare for real danger, such as crossing a busy street. It can also help us perform at our best, and motivate us to study for an exam or practice for a big game. When we experience anxiety, it triggers our "fight-flight-freeze" response, and prepares our body to react. For instance, our heart beats faster, to pump blood to our muscles, so we have the energy to run away or fight off danger. Without it, we would not survive. How is anxiety triggered? The amygdala is an almond-shaped structure deep in the brain that is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals. It can alert the rest of the brain that a threat is present and trigger a fear or anxiety response. The amygdala is a filter that regulates our emotional states. When we are in a positive emotional state the filter is open and able to send information to the prefrontal cortex, where our higher level thinking and reasoning take place. When the amygdala is stressed, information is not transferred. Information is then processed directly by the amygdala which in turn triggers our fight or flight response. When information is not transferred to the prefrontal cortex, there is not an opportunity to make good decisions for ourselves…we just react. Research has shown that our flight or fight response is equally triggered by events that vary greatly in significance. For example, missing a light in traffic and losing your job both trigger the release of cortisol and other hormones. Stress can become like a drug; something we are addicted to. It revs us up like a hot engine, but also revs up hormones and that can cause inflammation and other changes in our body. What do Middle Schoolers worry about most often? Several studies indicate that the top five worries for Middle School Students include: 1. Having friends and being liked by peers 2. Fitting in, both in terms of physical appearance and social acceptance 3. Getting good grades and managing the demands of school 4. Fretting over being “a failure” or disappointing someone 5. Family issues including finances, relationships, etc. At the Crossroads Middle School Students are in a unique position: At no other stage of development do they encounter so many differences in themselves and others at a time they most want to belong to a peer group and individuate from their parents. In addition, the Middle School setting encourages students to live within a more complicated and demanding system (as opposed to Elementary School) at the very time adolescents are determined to act more independently. While there can be a heightened sense of anxiety, there are also wonderful opportunities to experience a sense of mastery. Children, Teens and Adults often experience anxiety in one of three ways: Physically - what we feel in our body Mentally - what goes through our mind like worrisome thoughts Behaviorally - what we do or our actions, such as avoid or seek-reassurance Manifestations of Anxiety: Physically - Anxiety is felt in the body. Often, when young children feel anxious, they do not actually recognize or describe it as anxiety or nervousness. Instead, they may say that they feel sick, or have a sore tummy. Teens may complain of headaches, insomnia, nightmares or stomachaches. Mentally - Anxious children and teens worry! These worries can be about a current situation or about some future event. Young children may not be able to identify any anxious thoughts even when they are very anxious. What if the other kids don't like me? What if I fail my algebra test? Behaviorally - Some children become anxious that they alter their behavior to protect themselves from experiencing anxiety. For example, some children have rituals they perform as a means of protecting themselves (handwashing) or some may refuse to sleep over at another child’s house. Or some may act out in other ways as a means of avoiding an uncomfortable situation. What Warrants a Closer Look? Sometimes the behaviors of anxious children and teens can seem unreasonable to others. These children and teens may be labeled as "difficult", "stubborn" or "too sensitive". Indeed, their actions can be very frustrating for the entire family! It is important to remember that an anxious child or teen who lashes out, cries, and avoids situations is, in fact, responding instinctually to a perceived threat. Like other animals, your child is reacting by either fighting (e.g. yelling, tantrums), fleeing (e.g. avoiding), and/or freezing (e.g. mind going blank). Anxiety disorders last at least 6 months and can get worse if they are not treated. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread. Types of Anxiety Disorders: Generalized Anxiety Disorder, OCD, Panic Disorder, PTSD, Social phobia or social anxiety disorder Talking with Kids about Anxiety: Use the Smoke Alarm analogy to help kids understand what is going on in their bodies: “An alarm can help protect us when there is an actual fire, but sometimes a smoke alarm is too sensitive and goes off when there isn’t really a fire (e.g. burning toast in toaster). Like a smoke alarm, anxiety is helpful when it works right. But when it goes off when there is no real danger, then we may want to fix it.” Tools and Tips: Take a Deep Breath and Count to Ten! One of the greatest tools we can offer to children is to teach them the power of anchoring or grounding themselves. Learning to become aware of your breath is a powerful tool to interrupting negative thoughts and in turn accessing your prefrontal cortex…so you can then refocus and have time to respond to a stressor, rather than react to it. 10 Ways you can help your Children Cope with Anxiety 1) Establish routines and structure As parents, it is helpful to establish consistency in schedules and discipline. Anxious children cope more effectively if they have an idea of what to expect. It is important for them to have limits and consequences on behavior. Be mindful of your children’s basic needs to prevent fatigue and hunger. Twelve step programs encourage members to be aware of self-care by using the acronym HALT: H – hungry A – angry L – lonely T – tired If your child is hungry, angry, lonely , or tired, he/she is not likely to handle stress well. 2) Help your child(ren) identify feelings and provide opportunities for them to discuss feelings By talking about their feelings, children are better able to self-monitor when their anxiety might be ramping up. You might ask, “In what part of your body do you feel anxiety?” (Examples are: stomach, chest, head) Here are two exercises that might help you get started: High/Low At the dinner table or in the evening when the family has time to gather, have each family member talk about the high point and low point of his/her day. Other family members can ask questions about how they felt, handled the situation, etc. Feeling Cards Use card stock or index cards and write a feeling on each one (happy, anxious, jealous, sad, angry, etc). We have about 10 of them or so. Each person draws a card and talks about the last time they experienced the feeling on the card. Again, other family members can ask questions. The benefit of these activities is two-fold: First, they help the child talk about feelings. Second, parents can be role models in showing children that it’s okay to talk about your feelings and that parents do not always know how to handle their feelings and struggle, too. 3) Comfort and Soothe Your Child: Sometimes we, as parents, think it’s babyish to cuddle with are children or show them affection. Preteens/Teens do not often seem receptive to it, either. However, they are often needing to be held and soothed. 4) Model positive coping behaviors: Children look to their parents for guidance, even when we do not know they are watching us. It is important that we take time to engage in relaxation ourselves and set a positive example. It is helpful if parents are able to be confident in themselves and their children in varying situations. A very important message parents can give their child is that they have confidence in their child and have confidence that their child can handle the situation. 5) Encourage engagement in activities they enjoy and even those that might be uncomfortable When children can have a sense of mastery, it helps build confidence. Gently coax them to do things that might be outside of their comfort zone, particularly with their anxiety. For example, we enrolled my 17 y/o son in a summer academy camp at Hanover College last summer. He spent a week at the college with a group of about 10 other high school students studying cinematography. Prior to leaving, he was extremely anxious and did not want to go. At the end of the week, I went to the school to see pick him up. His group had become good friends in a short amount of time and he came away with a CD containing plays and skits the group had performed. Now when he is nervous about meeting new people, we remind him of his success at Hanover. 6) Teach problem solving Rather than being helicopter parents and swooping in to fix their problems, it will be a lifelong benefit to them if we instead help them with problem-solving. Solving their problems with some independence gives them confidence and a sense of control. 7) Monitor your child’s social group Are they supportive of one another? Do they tear each other down? Helping your child recognize patterns of interaction can be helpful as they continue to develop friendships with new peers. 8) Help your child identify helpful adults and/or friends in their peer group and have a plan in place It’s often helpful to let your child’s guidance counselor know that your child is struggling with anxiety and the guidance counselor can talk to your child and get to know him/her. If your child has more anxiety in certain social settings, maybe there is another parent or coach they can see if things get difficult. Sometimes it’s helpful if your child’s close friend is aware and the two have a code word for when your child gets overwhelmed. For example, my 14 y/o daughter’s best friend knows Savannah has difficulty in choir class so Savannah told that if she ever has to leave the room quickly, it’s because of anxiety and the friend can let the teacher know. My daughter also has a “hot pass” that she can show to the teacher which automatically allows her to leave the room. This is helpful because it serves as an escape strategy. Children’s anxiety is often heightened if they do not have a plan or they are fearful of having a panic attack in front of their peers. 9) Encourage a healthy lifestyle Exercise, diet, sleep, avoid caffeinated beverages 10) Challenge unhelpful thoughts Anxious children and adults often catastrophize, for example. Your child might think of all the things that could go poorly during an important event. What if I blank out during the test?, for example. It is helpful to encourage the child to stay in the present. Unhelpful thoughts sometimes include absolutes, like always and never. “I always mess things up.”, Challenge that by reminding your child of a time he or she did well. Be a detective. Look for patterns. Have your child track when, where, and in what situations they experience anxiety and what makes them feel good. Coping Strategies Relaxation Breathing (diaphragmatic or deep belly) When we are anxious or in pain, we often engage in shallow breathing without even realizing it. If we focus on our breathing, it can help calm us down. Progressive muscle relaxation Meditation These strategies can be done anywhere but they are more of preventative in nature. For example, I take Vitamin C every day to try to prevent getting a cold and I brush my teeth to avoid getting cavities. In the same way, it is helpful to practice relaxation regularly. Research shows that these types of practices reduce stress. Often you can download free guided meditations, relaxation tracks from the internet or purchase CDs. One of the most well-known experts in the field is John Kabbat-Zinn. Stay in the present When one starts ruminating about the past or thinking about the future, he/she will usually become more anxious. Journal Journaling about daily events or stressors can help us better recognize patterns of coping that may or may not be helpful. It can help us devise a plan of how we would like to react to specific stressors. This is particularly helpful if you can encourage kids to keep a “Gratitude” Journal to keep record of a few (3-5) things each day that they are grateful for. There are many ways to journal that include writing, collage or photo journaling. Listen to music, play an instrument Music can be an incredible way to help us relax or re-energize, depending on the music we choose to listen to. Playing an instrument can help us articulate things in a different way than we can with words alone. 5) Practice positivity Avoid the news Reflect on gratitude—List on paper or in your prayers/meditation the things for which you are grateful. 6) Draw, color, doodle, scribble 7) Read a book, magazine article, etc, that is uplifting. As we mentioned in the beginning, each of us struggles with some anxiety each day. Teaching our children at a young age how to better manage daily worries will be a huge benefit to them as they grow to become the adults we know they can be.