Week 2 - Anxiety disorders kids

Question 1

What are the factors included in the Child Anxiety Model

Answer 1

• parental anxiety –> genetic and biological factors
• avoidance behaviour
• processing bias
  ANXIETY
• interacts with parental reaction
  continues on…

Question 2

How can we change parent reactions?

Answer 2

MANIPULATE ATTENTION:
- ignore anxious behaviours 
- praising and rewarding non-anxious behaviours
- reduce reassurance provided
PROMOTING INDEPENDENCE:
- allowing natural consequences to occur
- encourage age-appropriate behaviour
- reduce the amount of support provided for daily activities
- reduce accomodation
CONSISTENCY:
- expectations and rewards kept consistent
- avoiding use of empty threats

Question 3

How do we deal with parental anxiety?

Answer 3

• encourage modelling
• controlling parental frustration, anger and worry
• DEMONSTRATING APPROPRIATE COPING SKILLS
  (ask parents to acknowledge concerns and if adaptive, how they manage the anxiety; having parents apply the skills to their own fears/worries with their child acting as coach)
• PARENT-FOCUSED TREATMENT (where the parent also has an anxiety disorder, growing evidence indicates that child outcomes are improved if the parent is provided with parent-focused anxiety management training; in may need to also consider referral of parent)

Question 4

What does psychoeducation of anxiety involve for the child?

Answer 4

• discuss the fears of others then self
• discuss the impact of anxiety
• set measurable goals
• introduce the worry scale
• explain rating feelings
• practice ratings in varied situations

Question 5

How do we explain the nature of anxiety to kids?

Answer 5

• anxiety is normal and can in fact be helpful (Flight-fight)
• e.g. if you smell smoke, think “I’m in danger, feel fear and anxiety, body reacts by making your heart beat fast and muscles work quickly, get out of the house as quickly as possible.
• however, some people experience anxiety more easily
• can have same experience when we are not in real danger
• goal of treatment is not to eliminate anxiety, but to stop ‘false alarms’

Question 6

How do we introduce linking thoughts and feelings for kids?

Answer 6

• initially need to ensure comprehension of ‘thoughts’
• introduce the idea that thoughts influence feelings
• repeated practice of identifying situation, thought and feeling (and rating strength of feeling)

Question 7

How can we help kids recognise thoughts?

Answer 7

• the recognition of the internal thought is developmentally mediated
• training through ambiguous situations
• alternate thoughts
• how would you feel?
• what would you do?

Question 8

How do we do cognitive restructuring in kids?

Answer 8

“Detective Thinking for children/Realistic thinking for adolescents”
PROCESS:
- identify event
- identify worried thought and rate worry
- find the evidence
- identify a realistic thought based on the evidence and re-rate the worry

Question 9

What are some evidence finding questions for kids?

Answer 9

• what are the facts?
• what has happened in the past?
• what else could happen?
• what happens to other people in this situation?
• what would I think of another person in this situation?
• how likely is it that the bad thing will happen?
• if does happen what will be the consequences? what could I do/how could I cope?

Question 10

How do we make cognitive restructuring effective for kids?

Answer 10

• need to take into account the developmental age of the child and increase/decrease guidance and detail/evidence collected
• challenge the child to consider MULTIPLE POINTS OF VIEW
• return to previous CR attempts to add evidence following exposure or other real life experiences
• aim ultimately to drop SUDS to <2, this may take several attempts at the CR process
• parental/therapist role initially to guide through each step, slowly reducing support to allow independent use of skill

Question 11

How do you introduce graded exposure to a child?

Answer 11

• to enable a fear to be faced, a gradual approach is most likely to lead to success
• guide the child/adolescent to idea of exposure by asking them to solve an issue faced by an imagined freinds e.g. party at centrepoint but you’re scared of heights

Question 12

What are the principles of exposure for children?

Answer 12

• work up a hierarchy
• duration
• repetition
• incorporation of parent magagement and realistic thinking
• myth of smooth progress

Question 13

How do you create a fear hierarchy with children?

Answer 13

• make a list of fears: low, medium, high
• group similar fears together
• set a practical goal
• list the possible ways that a fear could be broken down and rate each one
• create a step ladder by ordering the situation, make sure no big gaps exist
• ALLOCATE A REWARD TO EACH STEP

Question 14

What are some review questions to use?

Answer 14

• what fear did you face and how?
• what did you think would happen?
• what actually happened?
• what was your worry rating before and after?
• what reward did you receive?

Question 15

What are some strategies to use when exposure gets stuck?

Answer 15

• are steps too big?
• are steps too small? - (i.e. reduced motivation)
• combine with detective thinking
• look for safety cues and safety behaviours
• physical symptoms - need to make sure family does not believe it is medical
• check for parent protection and family accomodation