ANXIETY AND DEPRESSION THINKING SEEDS FEELING SEEDS DOING SEEDS Bob Schuppel, M.Ed., LPCC-S 17800...
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Transcript of ANXIETY AND DEPRESSION THINKING SEEDS FEELING SEEDS DOING SEEDS Bob Schuppel, M.Ed., LPCC-S 17800...
ANXIETY AND DEPRESSION
THINKING SEEDS
FEELING SEEDS
DOING SEEDS
Bob Schuppel, M.Ed., LPCC-S
17800 Chillicothe Road, Ste. 230
(440) 543-4771
bobschuppel.com
2
WHAT ARE SEEDS?
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…OF LIFE?
4
WHAT ARE SEEDS?
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WHAT ARE THE SEEDS?
A Buddhist said the following…
MIND IS A FIELD
IN WHICH EVERY KIND
OF SEED IS SOWN
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WHAT ARE THE SEEDS?
IN US ARE
INFINITE
VARIETIES OF SEEDS
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WHAT ARE THE SEEDS?
MANY SEEDS
ARE INNATE
HANDED DOWN
BY ANCESTORS
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WHAT ARE SEEDS?
…handed down byancestors…
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WHAT ARE THE SEEDS?
SOME SEEDS
SOWN WHILE
IN THE WOMB
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WHAT ARE THE SEEDS?
OTHERS WERE
SOWN WHEN
WE WERE CHILDREN
11WHAT ARE THE SEEDS?
SEEDS FROM
PARENTS AND
FAMILY MEMBERS
12WHAT ARE THE SEEDS?
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WHAT ARE THE SEEDS?
SEEDS FROM
SOCIETY AND
RELIGION
RIGHT and WRONG
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WHAT ARE THE SEEDS?
SEEDS THAT WERE THRUST UPON US
15WHAT ARE THE SEEDS?
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COGNITIVE DEVELOPMENTTHOUGHTS, EMOTIONS AND ACTIONS
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THE BRAIN
relay impulses and especially sensory impulses to and from the cerebral cortex
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THE BRAIN
The cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness.
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THE BRAIN
Selective Attention
20THE BRAIN
perform primary roles in the formation and storage of memories associated with emotional events
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THE BRAIN
Brain has two memory systems, one for ordinary facts and one for emotionally charged one
The stronger the amygdala arousal, the stronger the imprint
Emotional memories can be faulty guides to the present – out of date
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THE BRAIN
Amygdala is a repository for emotional memory – scans experiences comparing what is happening now and what happed in the past
One element appears similar to past? MATCH!
Commands us to react to the present in ways we were imprinted long ago – with thoughts, emotions, and reacts in response to situations ONLY DIMLY SIMILAR, but close enough
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THE BRAIN
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THE BRAIN
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THE BRAIN
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SCHOOL-AGED
ANXIETY
Generalized Anxiety Disorder
Panic Attacks
Agoraphobia
OCD
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GENERALIZED ANXIETY DISORDER
G.A.D.
Worries significantly disrupt school, social activities, family
Worry is uncontrollable
Worries are extremely upsetting and stressful
Worry is about all sorts of things, tend to expect the worst
Worry almost every day and at least for six months
Typical Worries
Worrying doesn’t get in the way of everyday activities & responsibilities
Able to control worries
Worries are unpleasant but don’t cause significant distress
Worries limited to a specific, small number of realistic concerns
Bouts of worry last a short period of time
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PHYSICAL SYMPTOMS OF GAD
Jumpiness or unsteadiness
Edginess or restlessness
Tiring easily
Muscle tension, aches or soreness
Trouble falling asleep or staying asleep
Stomach problems, nausea, or diarrhea
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PSYCHOLOGICAL SYMPTOMS OF GAD
Inability to relax
Difficulty concentrating
Fear of losing control or being rejected
Irritability
Feelings of dread
Inability to control anxious thoughts
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CHILDREN AND GAD
“What if” worries about situation in the future
Perfectionism, excessive self-criticism, and fear of making mistakes
Feeling source of blame for disaster (maturational crisis) and their anxious worries will keep tragedy from occurring
Misfortune is contagious and will happen
Need frequent reassurance and approval
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PANIC ATTACK
Must include a discrete period of intense fear or discomfort, in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes:
Shivers Pounding heart Sweating
Trembling Smothering Choking
Chest pain DizzyLightheaded
Fear dying Chills Hot flashes
Abdominal distress Shortness of breath
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SYMPTOMS OF AGORAPHOBIA
I don’t care if i
t IS Tweety, I a
in’t going out th
ere!
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SYMPTOMS OF AGORAPHOBIA
Anxiety about being in places or
situations from which escape
might be difficult (or
embarrassing) or in which help
may not be available
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CDO!!
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OBSESSIVE-COMPULSIVE DISORDER
Obsessions are recurrent and persistent thoughts, impulses, or
images
They are unwanted and cause marked anxiety or
distress
Frequently, they are unrealistic or irrational
They are not simply excessive worries about real-life problems or preoccupations
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OBSESSIVE-COMPULSIVE DISORDER
Compulsions are repetitive behaviors or rituals
Appears in behaviors like hand washing, hoarding, keeping things in order, checking something over and over
“Appears” in mental acts like counting, repeating words silently, avoiding, tally marks
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OBSESSIONS
Fear of contamination or dirt
Having things orderly and symmetrical
Aggressive or horrific impulses
Making a Mistake
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COMPULSIONS
Washing and cleaning
Counting
Checking
Demanding reassurances
Performing the same action repeatedly
Orderliness
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WHAT DO WE DO?
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Neurotransmitter
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NEW ENGLAND JOURNAL OF MEDICINECOGNITIVE BEHAVIORAL THERAPY, SERTRALINE, OR A COMBINATION IN CHILDHOOD ANXIETYOCTOBER, 2008
80.7% rated ‘very much’ or ‘much improved’ for combination therapy: c.t. & sertraline (Zoloft)
59.7% for cognitive therapy
54.9% for sertraline (Zoloft)
23.7% placebo
Anxiety disorders are common in children and adolescents and cause significant impairment in school, in family relationships, and in social functioning
High prevalence (10-20%) and substantial morbidity, anxiety disorders in children and adolescents remain underrecognized and undertreated
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WHAT IS NEUROPLASTICITY?
The human brain is incredibly adaptive. The brain’s ability to act and react in ever-changing ways is known, in the scientific community, as “neuroplasticity” - 100 billion nerve cells, constantly laying down new pathways for neural communication and to rearrange existing ones throughout life
Aids the processes of learning, memory, and adaptation through experience
Because of the brain’s neuroplasticity, old dogs, so to speak, regularly learn new tricks of every conceivable kind
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COGNITIVE THERAPY
Creatures of Habits
Thinking
Feeling
Behaving
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MINI FORMULATIONS OF ANXIETY-INDUCED PROBLEMS
1. What happen?
2. What did I think?
3. How did I feel?
4. What did I do? or How did it change my body?
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PREPARATION FOR DEALING WITHANXIETY CAUSING PROBLEMS
1. Where might it happen?
2. What is the best thought I can think?
3. What might I feel?
4. What can I do?
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MEASURINGTHEANXIETY
Out of Control
Feeling Worried
Doing Alright
Calm & Cool
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
There are many ways that schools can help a child with anxiety disorders
Meetings between parents, school staff, such as teachers, guidance counselors, or nurses, AND community-based counselors / therapists will allow for collaborative process to develop helpful school structure for the child
The child may need particular changes (accommodations and modifications) within a classroom and home
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Schedule check-ins on arrival and throughout the day to reduce the child's anxiety and facilitate transition during school, even at home
Accommodate late arrival due to difficulty separating, getting to school
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Identify a safe place where the child may go to reduce anxiety during stressful periods. Developing guidelines for appropriate use of the safe place will help both the child and staff or parents
Develop relaxation techniques to help reduce anxiety at school. The same techniques that are useful at home can often be implemented at school as well. Gym time, run time, etc.
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Provide times for the child to convey messages to family. Brief (a minute or so) contact with family may substantially reduce anxiety and may help younger children recognize that their connection to their parents is intact. (In some children, this strategy may instead heighten awareness of the separation.) In preparation for possible times when the parent is not available, identify additional people for the child to contact
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Ask the parent to send short notes for the child to read as a reward for staying in school. These can be placed in the child's lunchbox or locker, so that they can be obtained after the child has succeeded in class for a period of time. Could also be a problem!
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
If the child is avoiding school, address the cause(s) and initiate an immediate plan for him or her to return. The child may require gradual reintroduction to school and may readjust more quickly if allowed to attend for partial days at first
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Encourage the child to help develop interventions. Enlisting the child's ideas in the task will lead to more successful strategies and will foster the child's ability to problem-solve. However, sometimes children will try to negotiate a "date" to attempt to return to school or go to some other activity. In most cases this strategy is not successful, and it can increase conflict ("You promised you'd go today")
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Provide assistance to the child during interactions with peers. An adult's help may be very beneficial for both the child and his or her peers. Small, initially supervised, group activities. Pair-up
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Be aware that transitions may be difficult for the child. When a child with separation anxiety refuses to follow directions, for example, the reason may be anxiety rather than intentional oppositionality
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Reward a child's efforts. Every good effort, or step in the desired direction, deserves to be praised!
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
“A child reaps the benefits of affirming words for a
lifetime!”The 5 Love Languages of Children
by Gary Chapman & Ross Campbell
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Discuss anxiety symptoms privately with the child. Never single out a child or call attention to their anxiety in front of the class or siblings at home. This can cause humiliation or embarrassment and increase anxiety symptoms.
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Teach positive self-talk to the entire class or family. Helping children to be aware of the negative way they talk to themselves, such as the use of “I can’t” and help them to develop a more positive way of talking to themselves.
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INTERVENTIONS FOR SCHOOL & HOME
PROACTIVE
Post the daily routine in the classroom and at home and let children know in advance any changes in the schedule.
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONS
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Respond calmly to the child’s crisis (maturational or actual), anger and outbursts. At the same time make it clear, both verbally and nonverbally, that you are taking their crisis seriously.
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Be sure that you do not inadvertently reinforce the intense expressions of affect. Avoid defensive or confrontational words. Be mindful of body posture.
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Notice what behavior on your part may have triggered intense reactions. Monitor your own behaviors (behavior include thoughts, words spoken, emotions expressed and physical movements).
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Work collaboratively with the child to maintain a moderate level of intensity. Solicit feedback/expression of emotion (moderately) from the child and take it seriously.
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Once the child is calm, highlight the disadvantages of intense reactions, the ways in which they interfere with achieving the child’s goals. Then collaboratively work to identify more adaptive alternatives (such as dealing with situations and emotions before the reactions become too intense)
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Encourage recognition and acceptance of moderate levels of affect. Encourage and reinforce moderate expressions of affect. When affect is expressed in more adaptive ways, make a point to recognize it, validating the child’s reactions, trying to understand and respect the responses
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DECREASING THE EMOTIONAL INTENSITY OF CHILDREN’S REACTIONSREACTING
Identify and address the child’s fears regarding expression of affect. Address dichotomous (polar, extreme) thinking (i.e. use of always; never; should; must; need, etc.).
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BREAKIN’ HABITS
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NONVIOLENT COMMUNICATIONMARSHALL B. ROSENBERG, PH.D.
NVC Process: Compassion Based
The concrete actions we observe that affect our well-being
How we feel in relation to what we observe
The needs, values, desires that create our feelings
The concrete actions we request in order to enrich
our lives… WANTS not NEEDS or HAVE TOs!
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NONVIOLENT COMMUNICATIONMARSHALL B. ROSENBERG, PH.D.
Positive Feeling Words
Astonished Calm EagerExcited
Grateful Happy HopefulLoving
Peaceful Powerful RelaxedRelieved
Satisfied Sensitive SurprisedThankful
Trusting UnderstoodWarm
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NONVIOLENT COMMUNICATIONMARSHALL B. ROSENBERG, PH.D.
Negative Feeling Words
Afraid Aggravated AgitatedAnnoyed
Anxious Bored ConfusedDepressed
Disappointed DiscouragedEmbarrassed Fearful
Furious Guilty HelplessHopeless
Jealous Miserable NumbSad
Scared Sorry
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SUPER-PARENTS!
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STRATEGIES THAT WORK!
Relaxation
Letting go of random and focusing on automatic (i.e. breathing)
Acceptance of Anxiety
Do not fight or try to control anxiety, then control
Agreeing to other’s requests
Letting others be in control puts you in control
Accepting others
Trying to control others leads to feeling out of control
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INTERVENTIONS FOR SCHOOLA.W.A.R.E.
A: Accept the anxiety. Welcome it. Don’t fight it
W: Watch your anxiety. Look at it without judgment
A: Act with the anxiety. Act as if you aren’t anxious
R: Repeat the steps. Accept, watch, and act with it
E: Expect the best. What you fear the most rarely happens
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THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.
Be dispassionate! Be Cool!
Listen, even as you are being shouted at
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THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.
Never, ever shout! Speak wisely
Add 15 minutes to every interaction involving a teen
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THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.
Check your ego and pride, it’s not about YOU!
Never, ever harm or injure
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THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.
Apologize at every opportunity
Acknowledge and respect the child’s identity
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THE 10 RULES OF PARENTINGMICHAEL BRADLEY, ED. D.
Be your true self
Know that “This Too Shall Pass”
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References
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of
depression. New York: The Guildford Press.
Bradley, M.J. (2003). Yes, your teen is crazy! Loving your kid without losing your mind.
Gig Harbor, WA: Harbor Press
Freeman, A., Pretzer, J., Fleming, B., & Simon, K.M. (2004). Clinical applications of
cognitive therapy (2nd ed.). New York: Springer.
Goldstein, A.P. & Glick, B. (1987). Aggression replacement training. Champaign, Il:
Research Press.
Greenberger, D. & Padesky, C.A. (1995). Mind over mood, change how you feel by
changing the way you think. New York: The Guildford Press.
Greenberger, D. & Padesky, C.A. (1995). The clinician’s guide to mind over mood. New
York: The Guildford Press.
McKay, M. & Fanning, P. (1992). Self-esteem (2nd ed.). Oakland, CA: New Harbinger
Publications, Inc.
Reineke, M.A., Dattilio, F.M., & Freeman, A. (1996). Cognitive therapy with children
and adolescents, a casebook for clinical practice. New York: The Guildford
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Rosenberg, M.B. (2003). Nonviolent communication, a language of life. Encinitas, CA:
PuddleDancer Press.