Presented by Diana Antinoro-Burke, Psy.D.
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Dr. Antinoro discussed the basic principals and components of CBT to help parents and teachers understand the therapy process. She also spoke about the type of therapies that have show to be most beneficial in treating anxiety disorders.
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My teenager has always had some anxiety, but how that she is taking driver ed it is really evident. I am not sure she is ready to drive, but I’m also not sure how to broach the subject without having it be negative.
I feel like my spouse and other kids undermine me when I am trying to work thru some of the strategies with my daughter. For example, jumping in and ordering for her when I am encouraging her to do that for herself. What is the best way to handle that and not make my daughter feel embarrassed or shut down in the process?
Do you have any familiarity with “habit cough?”
I was wondering what typical treatment guidelines are for parents to address children with trichotillomania/chronic skin picking as the situation can be very discomforting for the patient. I have a lot of difficulty as a clinician helping to convey the child’s problems (mainly with profound shame(
What is the best way to get out of a melt down situation created by the child’s inability to do the compulsion? You might have answered this because this happens due to me trying to avoid a situation when maybe we should have faced it. But what is the best way to get out when it goes very badly?
How do you handle sports related anxiety of perfoming in a game situation when the anxiety builds therefore making it worse as the game goes on.. the anxiety is due to being perfect or fear of making mistakes I should say, not being perfect
How do you differentiate when school avoidance or phobia are related to abuse in the home, or worry about a parent who may be distressed for various reasons?
How do you deal with patients who are afraid or resistant to taking medications?
Can you recommend some strategies to help patients who week after week do not do their exposure homework, even at a very low SUDS?
Can you tell us what relaps prevention looks like? I have a 17 year old son, who is one of these cottag(e) kids. He spent 5 months at Rogers, 1 1/2 years in a therapeutic boarding school, and now is comming home to complete 11th and 12th grade at a non therapeutic school.
If a person takes an SSRI and has successfully completed CBT, what would be a criteria for weaning off the SSRI meds. For example would the person need to be “stable” for at least a year after completing CBT treatment?
What type of evaluation would you recommend?
Since ts kids are often complicated..how can you differentiate a sleep disordertriggered by anxiety vs. some other co morbid conditions
So what do you do with a child that is now an adult ?
What type of professional would you seek out for a child evaluation? How do you find the best person for your child?
I have a 9 year old with an axiety diagnosis and she cannot sleep and wakes up at night too- would appreicate recommendations; she doesnt want me to talk about it to anyone cause she feels it private. My daughter is very emabarrased of her anxiety which makes it very hard.
Yoga and other relaxation techniques are immensely useful skills to manage daily stress and anxiety. Overall, I encourage their use to decrease general stress, yet I tend to discourage the use of these techniques as a distraction when confronting anxiety-provoking situations (such as the exposures I discussed).
With regard to the question about the teen exhibiting more intense anxiety around driver’s education, I would encourage a thoughtful and supportive conversation with the teen. Making a general comment on how certain things can increase some of our stressors and noting that you have seen such an increase may help the conversation begin. It does depend on the teens willingness to acknowledge it, which is often helped by being supportive, normalizing the situation and sharing an understanding of their experience.
In response to the question about family members doing things for the child, practice with less family involvement may be a good start, such as ordering ice cream at a store with only you and your child. Once the child becomes more confident, they can then show the family how well they do. If another adult or older sibling is ordering for the child, having a private conversation with that person can help them to refrain from “helping out” in the moment.
With regard to the question about “habit cough,” I do not have great familiarity with this terminology. I tend to think of this as a potential tic that developed after the child has had a sickness. I would encourage an evaluation to assess the cough and the potential for other tics. We often see children who started coughing, clearing their throats, or sneezing due to allergies/ colds and the behaviors persist after they are better.
When working with children with trichotillomania, we spend a great deal of time normalizing the behavior by comparing it to nail-biting, eating too much, skin-picking, etc. We want the child and family to know that we have seen many individuals, that we will not be surprised by their symptoms and most importantly, they are Not Alone! Unfortunately there is great shame or embarrassment that we see with children and adults with trichotillomania. Normalizing it making a trich-neutral home (no negative talk about pulling) are the most helpful techniques.
In order to help children when they are experiencing great distress and a resulting meltdown, we tend to try to plan ahead to avoid these moments. When it is unavoidable, it becomes more difficult. Depending on the child, we encourage empathy and support, externalizing the anxiety and generally managing the situation to avoid any harm to those involved. Once the meltdown has begun, we would not encourage exposure, but would take the information and plan on how to challenge a similar situation in the future.
With regard to the anxiety about making a mistake in sports, we would use very similar strategies to assess the cognitive components, identify the worst fears, use coping thoughts and begin exposures to making mistakes, possibly in other areas of life (if relevant) and more specifically in sports.
When assessing the cause of school refusal, we always consider the many reasons why children and teens do not go to school. The evaluation focuses on what makes school difficult, what would make school better, and thoughts associated with school to identify anxiety. If the anxiety is typical for fear of a parent’s health that was declining, the treatment would look very different and would target this concern. If it were school refusal for defiance reasons, again the treatment should target that functional component.
Whether or not a patient wants to take medication is a personal choice. We will never tell a patient that they must take medication. When appropriate, we will offer a referral if we believe it will benefit the patient. When a patient is not progressing well or we believe that medication needs to be included in order to achieve success in treatment, we tend to have a blunt conversation about the pros and cons of medication and will ask the patient to talk to a psychiatrist that we trust. In the end, the patient always has the choice to make on their own.
When individuals attend therapy sessions and do not complete their homework each week, I always am considering the person’s motivation. How can we increase that? It is often helpful to put reminders and support in place, have patients text the therapist as a check-in, or use rewards plans. If the patient is able to do the exposure in session, then it should be easier to do it again at home. Sometimes, when resistance is greatest, we will inform the family that treatment may not be appropriate at this time and suggest returning when the child is ready.
Relapse prevention is individualized for each person and symptom presentation. Largely it encompasses a plan of action to take when symptoms arise, prediction of how the symptoms may look so the person can catch the symptoms as early as possible, and identification of more steps to take when the person is struggling to manage it without professional support.
With regard to reducing medication, I encourage patients to speak with their therapists and psychiatrists/medical doctors to determine the level of stability, the intensity of ongoing stressors, and the potential for relapse. It is a very individualized plan that must take into account all of the variables for this individual and must be guided by a medical doctor.
When seeking an evaluation for a child, it is best to identify the primary concerns and see if there are centers or professionals that specialize in these concerns. I also encourage speaking to some community resources, such as teachers, medical professionals, and other mental health providers for information about the best place to get the right type of help. National or local organizations are also a great place to obtain some guidance.
When assessing a sleep disorder that may be triggered by anxiety, the assessment focuses on the pattern of anxiety that occurs around sleep. Often, monitoring of the person’s mood and thoughts prior to sleep will help identify the presence of anxiety.
We often have parents of adults or older teens contacting us with concerns that the patient does not want to address. Largely we attempt to provide information about the disorder and the treatment and we encourage the families to support the patient but to remove any accommodation that may be present. Sometimes having the parents pull back can increase the person’s motivation. Once the person is willing to enter treatment, the treatment looks very similar for adults.
In response to the parent that has an anxious 9 year old daughter who would prefer not to talk about it, I would encourage obtaining a book about other children that have a similar anxiety and having your daughter read it. Sometimes giving the child information and encouraging her to see it as a normal part of life helps to open the door to more discussions. You may have to push your daughter to begin talking about it, but be patient and persistent. In the long run, it is for her best. There are some self-help books that could be tried, but your daughter would have to agree to using the strategies. You can see the list of self-help resources on the powerpoint slides from the presentation. Good luck.
This discussion has been closed. Thank you to everyone who participated!
Your thoughts on the value of yoga or other relaxation techniques to help with anxiety?
Posted on July 28th, 2011 at 9:12am by KelleyT