Identifying & Supporting Children with Anxiety and Obsessive Compulsive Disorder (OCD) in the Classroom

0:04 Good evening and welcome. Thank you so much for joining us tonight for the webinar Identifying and Supporting Anxiety and OCD in the Classroom, presented by doctor De Vora. Sure. My name is Katie Delaney. I am the Family and Medical Outreach co-ordinator for the New Jersey Center for Tourette’s Syndrome and Associated Disorders. 0:26 I will be your facilitator for this evening. 0:29 Before I introduce doctor Sherm, we have some housekeeping notes. 0:33 All participants are muted. At the end of this presentation we will have a Q&A. 0:38 Please list any questions you may have in the question box at the bottom of your screen and click Send. 0:45 If you have questions after tonight’s session, you can post them on the Wednesday Webinar blog, which can be accessed from our homepage at WWW dot NJ CTS dot org. 0:58 Under the headings programs, this blog will be monitored for the next seven days. 1:03 The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors, and employees assume no responsibility. 1:14 Are the accuracy, completeness, objectivity, or usefulness of the information presented on our site? 1:20 We do not endorse any recommendations or opinion made by any member or physician, Nor do we advocate any treatment. 1:28 You are responsible for your own medical decisions. 1:32 Now, it is my pleasure to introduce our speaker for this evening, doctor Deborah Sherm. 1:37 Doctor Sherm is a licensed psychologist at central therapy. 1:41 She specializes in the treatment of anxiety, obsessive, obsessive compulsive disorder, tech and body focus repetitive behavior disorders. 1:51 In addition to her current work, Doctor Schurr is also an adjunct professor at Touro College. Doctor Schurr, we’re so happy to have you here tonight of floor is all yours. 2:03 Thank you, start, Katie and thank you everyone for joining us tonight. 2:08 It’s really my honor to … Ghana tonight and for those of you, I mean, I know Katie just that but I want to amplify the …. Israeli provides incredibly worthwhile resources. 2:21 two individuals, families, schools add probably much more and if you’re not familiar with that, I’m definitely I encourage you to check out their website. 2:31 And tonight, we’ll be talking a lot about the school setting and how anxiety and OCD are manifested in the classroom. For those of you who may have been at the New Jersey Education Association Association Conference, there might be quite a bit of overlap. 2:50 I do have this challenge, though, because that was a 90 minute presentation, and tonight will be trying to do this and 45 to 50, so that we’ll be able to on. 3:00 I’ll be able to answer some questions, and I’m fine with going over a little if there are questions. 3:04 So we’ll start off by identifying common manifestations of anxiety and OCD symptoms in the classroom. 3:11 Well, really just touch upon empirically, empirically supported treatment protocols. Because I want to be able to focus on practical skills in the classroom to support students with anxiety and OCD impairments. 3:25 There are so many themes, so many flavors to anxiety. And while many of you, well, if you’re not a mental health professional, you don’t really need to know the diagnostic criteria, or I won’t even really be focusing so much on the diagnostic criteria. But I do want to focus on the different themes to anxiety, because by understanding the specific fear as a child has, we’re in a much better position to support them. 3:50 I really want to emphasize the adaptive elements to anxiety, anxiety is great, Anxiety’s really helpful many times. And the goal of any anxiety and OCD trigger event is not to remove anxiety or obsessive thoughts. That’s really, too. 4:06 It’s really only indicated if there is impairment associated with anxiety or OCD. 4:13 And and if, if there’s, if there’s value to addressing it if there’s if there’s a need essentially unfortunately, anxiety disorders are quite prevalent or recent research. I thought I think that was there. 4:27 Cast in 20 18 article showing are approximately 20 to 35% of adolescents between 13 and 18 years old experiencing and anxiety disorder. 4:38 And unfortunately we know that most people who are only approximately a third of people with not with a diagnosable mental health condition are receiving appropriate trademarks are so many reasons for this are unfortunately quite up. 4:53 Quite a number of treatment barriers, including those related to finance, those related to qualified providers, understanding a lot, a lot due to a lack of knowledge in terms of symptoms, and which treatments to pursue, and I know that definitely has opened up more remote therapy, but there are no transportation barriers, and things like that. 5:17 It follows that there are so many advantages of the school setting on my dissertation, actually. 5:25 It really focused on the school setting and mental health treatment in the school setting, because, I mean, children are in their natural setting. There are so many opportunities to intervene, to notice what’s going on, and anxiety and OCD are so much. 5:40 I mean, they’re really internal disorders, and, oftentimes, the child, especially, if they’re young, don’t even necessarily understands what’s happening for them. So, oftentimes, anxiety and OCD, go unnoticed on early intervention is so critical. 5:57 So let’s start talking about different forms of anxiety. We’ll start with generalized anxiety disorder, which can be analogous to a whack a mole game or activity where essentially what happens is? 6:09 And there’s a worry worry pops up and we do whatever we can to reduce that worry about another one just comes right back. 6:17 And that’s really what GAC is about, where the focus the worriers on everyday concerns. 6:23 So, traffic finances, and studying for a test, a lot of daily, normal, quote, unquote, concerns, that the contents of the worry is just keeps on changing. 6:35 It’s interchangeable, and this would have to ourselves and impairment like both mental health disorders last at least six months. 6:43 And in the classroom, what we might be seeing is, in addition to the worrying, a lot of reassurance seeking difficulty, concentrating are completing work, staff criticism, and avoidance, which is the hallmark of most anxiety disorders typically with all anxiety disorders and OCD. 7:00 Really, we’re looking at an overestimation of risk and an underestimation of coping abilities. 7:09 So let’s talk about social anxiety. Social anxiety is, oh, I think I had a 2022 article showing that it’s the third most prevalent mental health disorder. Before that came substance abuse and depression and social anxiety disorder. 7:26 Well, I could have thought about the generalized anxiety going back a second, it’s really quite rare, Especially in Florida, 11 year olds. We’re seeing like, less than 0.4% social anxiety disorder. We’re looking at at least 10% of the population. 7:40 And what this is about is excessive on persistent fear of evaluation, fear of doing, or saying something that will make a person look embarrassing, will make a person look bad. Or, and the fear of the unwanted, they don’t want to be the center of attention. And it’s understandable that the person is going to feel an urge to avoid these situations where the evaluation might occur. 8:02 So, in elementary school, the children might be hiding in the bathroom, they might be crying, they might be complaining of stomach aches or other physical complaints. And usually for younger folks, that’s a more difficult to identify the feared outcomes. And by the time they reach middle school, sometimes they’re able to express what’s going on. Sometimes they pretend nothing is wrong. 8:20 They’re trying to phi of finds excuses trying to avoid with excuses. 8:24 I think there’s missing, were there, and by high school, they might not want to talk that up with are likely much more insightful in terms of the rationale for why they’re feeling anxious before a public speech, or even before a trip, or going to the lunchroom. 8:40 And often times there’s avoidance, they’re refusing to comply with demands, with regard to approaching that activity. 8:49 Panic disorder. Oftentimes people will say that they’re having a panic attack, and I think it’s important for us to talk about what is a panic attack, what isn’t a panic attack. 8:57 And a panic attack is usually peaks at around 10 minutes, and it’s a it’s a period of intense physiological anxiety. Usually, I think it needs for physiological symptoms. Like rapid heartbeat, dizziness, trembling hyperventilation, things like that. 9:16 And oftentimes, there’s a cognitive component here. 9:21 To the effect of lots a fear of going crazy, a fear of dying, their body is out of control And there oftentimes really uncertain whether or not they’re having a heart attack and we know the if it is a panic attack, it will not result in a heart attack, but the person is oftentimes freons by their bodily symptoms. 9:41 And so it’s also uncommon in elementary school students, but if it does happen, the way it would manifest is usually, less of those cognitive concerns, usually not as afraid of the death, just really uncomfortable during those approximate 10 minutes. 9:58 Usually, the child becomes aware of the triggers than, it sounds or stands, Paul, again, that they’ll try to quickly avoid that triggers by the time the child, if the child is in middle school during these panic attacks, Well, that was very striking. Middle schoolers are more likely to be fearful of south. There are more. 10:19 They’re also going to quickly identify and avoid the triggers as high school, high schoolers. Packet size would be more common, and in this population in this population there are less likely to think that they will die, but they are oftentimes thinking that they’re going crazy that this is a huge catastrophe. 10:40 And what we know is that if it’s untreated, it’s much more difficult to face fears in the future. 10:47 Obsessive compulsive disorder I want to talk about next and this is something that I probably see it probably 80% of my caseload is, are people experiencing obsessive compulsive disorder. So I hope I won’t talk about this for a too long and I mean I’m happy to but I want to be mindful of the time. 11:06 Obsessive compulsive disorder is actually no longer an anxiety, is it’s no longer characterized as an anxiety disorder because the research supporting so many other negative affects so many, so many other experiences. 11:22 Aside from fear relating to the obsessive compulsive cycle. So for example, we’re finding that guilt, that shame that discussed are awesome. 11:31 Very much prevalent. And it’s really not exclusively an anxiety disorder. 11:35 So what … is about is, it’s much more than hand-washing, it’s much more than checking locks. 11:42 What it is about, though, it’s, it’s about unwanted thoughts, images, or impulses, that are oftentimes extremely distressing there terrifying. And the person doesn’t like these thoughts, images, or impulses, And they’re trying to get rid of it because it’s so uncomfortable. 12:00 And it’s important to acknowledge that all I think the studies are showing like 98% of people have intrusive thoughts, 98% of people, or something like 90 it over 95% had have fees and sessions in. 12:14 the whoever I hear citing these studies, say something like other people are liars. We all have, or most of us have obsessions obsessions are normal, and what marks a person what differentiates a person with OCD and a person without is the person’s reaction to the obsessions. 12:29 So an example of an obsession that someone might have and without having OCD is, many people have this thought like, oh, no, if I would have pressed the gas instead of the break at the stop sign, Accurate killed three people. That’s a really scary thought. 12:43 Many people, though, are not bothered by that weather because they so many reasons and impact there, trust themselves enough that they’re willing to take the risk and drive either. 12:56 As someone with OCD might try to avoid driving because the thought and the fact that that ensure that the person’s mind carries meaning to it, it feels almost like the possibility of doing that harm is so much more likely, perhaps. 13:12 And if the person is driving in there more, and more, to me, criteria for OCD, they need to engage And compulsions are virtual. 13:19 So in that example, the person might be checking excessively. 13:23 that person might be only driving with a companion to serve as some form of reassurance, or immensely reviewing to themselves immensely reviewing and the likelihood. Or just the fact that they’ve never gotten into a car accident before. So it could really be any repetitive behavior or mental act that’s aimed at reducing the distress or preventing that try to Tibet, And this is an easy formula that I like if I do or don’t do this compulsion. 13:53 If I do or don’t check, Then it’s much more likely for my fear to occur. 13:58 So I need to check in order for need to feel more comfortable with that fear and the heart of OCD. And we’ll talk about some common obsessions. And Compulsions is fear of uncertainty. There is? 14:13 In, I guess, intolerance with doubt. 14:16 So obsessions are oftentimes, a person usually has more than one theme of OCD one, more than one theme of obsessions. They oftentimes latch onto a person’s values. What’s meaningful to a person? 14:30 And they’re really, although about and part of the tree is disengaging from the content because it’s not so much about the content. Whether the contents it’s related to contamination, fear of germs, fear us. 14:42 And an illness, fear of just sticky substances or things like that, or, whether it’s harm related or harm related OCD, could manifest the manifest itself in some form of fear of harming myself. 14:59 So, it’s going to be much harder for me to, I don’t want to touch knives, because I don’t trust myself. And again, there’s this doubt over here of, I don’t know whether or not, I’m going to hurt myself and I don’t, I’m not willing to take the risk or I can only take the risk if I engage in these compulsion. 15:15 If I have someone asked me if I seek reassurance, if I Clean, excessively, Wash, et cetera, et cetera. 15:23 So and excessive down, just going through access of data is really all of OCD. 15:31 But in this case, I can think of so many examples committing to a school schedule, or committing to a certain course, or picking an elective. So obsession. It could be related to perfection as, I’m not necessarily, but I don’t know, I might be making the wrong choice. 15:47 Or I don’t have all the information that I need, and a compulsion that with that might be menzel, or it might be asking for a lot of its face, trying to receive access of information. 15:59 And delaying hesitation, avoiding could happen, in that case. 16:05 Moral concerns are not necessarily related to religion, but of course it can OECD can latch on to religion. 16:12 But an example of a moral concern might be, um, I don’t know. Some Morales about excessive concern with right or wrong or scrupulosity. So I might have touched to that. I might have when I opened my cards, or I might have scratched or dense at the other car. So, I’m going to confess, I’m going to write a note just to be sure, because I can’t handle not knowing whether or not I did something right or wrong. Or in that case wrong. 16:38 Selected me, it says, um, is something very close to my heart, perhaps, something gratified that I find gratifying to treat. 16:45 Likely, because I met criteria for selective mutism as a kindergarten, first grader and probably half of my second grade school year, and because, thankfully, my daughter, and, yes, it’s genetics, my daughter is, it’s recovering from selective mutism. 17:00 So something, I think about a lot, and find that there are oftentimes misconceptions regarding many mental health disorder selecting me. It says, and in particular, what, let’s first talk about …, What size to meet system is? 17:14 So it’s characterized by consistent failure to speak and social situations when speaking is expected, despite being able to speak in other situations. 17:25 So typically, and let’s say in the case, my daughter, she was able to freely space, and her home setting in many outdoor settings. But particular indoor settings, namely schools at a friend’s houses, and other unfamiliar houses there, was consistent failure to speak. 17:43 And some people oftentimes, and this is probably my pet peeve, some people almost say things like, Oh, she’s just shy. And it’s hard to know exactly what the person means without clarifying upon clarification. 17:56 Usually what a person is trying to almost re-assure me by as just shy as, oh, it’s not a problem, it doesn’t new treatment, or maybe this is just my daughter or whoever that says as personality and I certainly agree. There are some people that are quieter, There are some people, there are some advantages. There are advantages to quietness and fighting. 18:15 The system would only be diagnosed if there’s impairment and consistent failure to speak Certain situations with the ability and, and to speak, and others. So, if a person is getting lost and unable to say their name, so someone, it’s homeless. Like, it’s not like there’s an honor all such, oh, right now, there’s a huge need, so I’m able to speak suddenly. 18:37 When my daughter needs to the bathroom, I was unable to ask. 18:42 And those are examples of impairment, And I wouldn’t necessarily, I mean, maybe we can call it a shy, But I think it’s more helpful, too. 18:49 Diagnose that because it is so treatable on, what we do find is that typically the passage of time alone without intervention does not adequately treat so activate. It doesn’t so activates. 19:01 We are unable to design it. Was that if it’s the first month of a school, because that’s more typical or expected for the person? 19:08 Not to talk or be hesitant to speak, and it’s, of course, nothing to, it’s not related to comfort or knowledge of the spoken language, and it’s also we would need a rollout or communications disorder for that diagnosis. 19:23 Um, perfectionism is actually something that I spoke about. I think, last, April, with … and the recording is available if you’re interested on more and with regard to perfection as it is not yet a diagnosis, whether or not it should be. 19:36 I have a feeling. It may be, sometimes, perfectionism is correlated with OCD, but not always. 19:43 And I think it’s oftentimes manifested in school settings. So I wanted to talk briefly about it. 19:50 And perfectionism is about, I guess, this personality, it’s just position when a person I see the strategy for fastest and it’s got an exceedingly high standards for themselves. 20:06 So oftentimes, they’re motivated by the fear of the negative emotions. So for example, they’re playing the game so that they don’t use their studying for the test with almost like the only motivator. 20:20 I mean, yeah, usually, it’s, one of the only motivator is to avoid failing. 20:26 The fear of the failure, the fear of losing is so overwhelming that oftentimes that’s the motivator and they’re going to Josh themselves almost exclusively on the outcome. 20:36 And this oftentimes is manifested so many, so many different ways going to school setting. I’m not sure if I read all the examples, but one of the key hallmarks of perfectionist stick behavior is Procrastination and Avoid. 20:51 And what we find is, I think the reason when we think about how overwhelming a person this, the person standards are for themselves. 21:00 That makes sense, that they put so much pressure on themselves, that it makes so much sense that they would avoid or procrastinate because their goals are essentially unattainable or they feel that their goals are unattainable. Oftentimes, despite positive feedback, despite your commenting about the person’s job while it’s on, there really are disqualified in their performance and really focusing on the mistakes here. 21:26 Oftentimes with perfectionism, there’s a lot of reassurance asking, is this proactive this, right? What would you do? 21:33 And there could be erasing and rewriting, and I think it’s important to mention that perfectionism does not necessarily, is not necessarily the same in every setting. So, the person’s behavior or first of all, might not look perfectionist. 21:48 Oftentimes, a parent might say, like, You have to see the room. They’re not struggling. Perfect shots on the room is a math. 21:55 First of all, it doesn’t necessarily have to apply equally in all settings. But another important point is sometimes, like I said, with avoidance on the procrastination, The fear of maintaining a perfect term. The fear of maintaining a certain standard, is so overwhelming, that all, or nothing thinking comes in, and it feels too difficult to try. 22:18 Um, I’ll let you read the rest of the examples. Another time, or to yourself, because Milan and perfectionist concerns can correlate with both psychiatric and medical condition. 22:32 So, it’s important to really address. 22:36 And at this point, I want you to take a moment to think about some anxiety and OCD behaviors you’ve observed in the classroom or, if you’re not school personnel, what anxiety and OCD behaviors you. 22:50 You’ve observed on a child that you have close contact. 22:57 Oftentimes, these are an overview of red flags in a school setting in particular, focusing on tonight. 23:05 So frequent school nurse or bathroom visits, access of reassurance, saw requests for repetition. 23:13 Or additional access of clarification, refusal to touch others. 23:18 books or belongings, compulsive, apologizing explaining or confessing checking and avoidant behaviors as seeking help with communication when it’s not age appropriate. 23:30 So at this point, I want you to consider, I know Iran it’s probably pretty dense. I want you to consider your role as its limits. 23:40 I mean, while I would love to be in the school hour or religious like intervening in real time. That’s not my role. And, similarly, if you’re a school personnel, it’s really not your role to treat it. 23:53 But what I’m hoping you’ll be able to do after tonight is better understand student student experiences, support students as the anxiety is impacting their academic performance, share observations and, and consult center for us. 24:09 So, as Megan said, yeah, well, I guess part two is the part that I’ll review, um, probably a little more quickly, Yvonne. And that’s because I don’t expect this presentation is more geared for school personnel. So I want you to have some familiarity with the treatment approach that will focus on the practical stuff, right? 24:32 So I want to really understand with you how anxiety works, and how it’s nanci. 24:40 So typically, typically, when a person is in a triggering situation, let’s use the example of a Rollercoaster. 24:50 We the person’s online, the person’s anxiety, starts to intensify its climate. 24:56 I don’t know if you see my mouse. 24:57 I don’t think you, too, the they’ll fall along here so the anxiety is climbing, it’s rising. and, at a certain point, it feels like it can’t get much higher. And it’s at that point where the person is going to have to make a decision. Do I have the energy and courage to proceed and ride that rollercoaster? Or does it feel like too much for me to tolerate right now? 25:21 And essentially, that question is, Do I approach my fear activity? Or do I avoid my favorite activity? 25:26 And, let’s say, for purposes of this example, I don’t have the emotional energy I need. I feel so overwhelmed. I feel like my body is hurting. In every which way? 25:37 And I’m going to turn around on the roller coaster ride line and what happens when I turn around are a few things. 25:47 The first thing that happened, the first thing I learned is, I feel better when I turn around, leaving the line, helps my awful anxiety get much better, And it got much better quickly. I want you to notice that, like, sharp decline here, it’s almost like a straight lines out. 26:04 The anxiety quickly drops, one avoidance happened. 26:08 So of course, the next time I’m in that activity, I’m going to learn that. Or even if I’m at a similar activity, I learned how to handle mindsight. Any sort of, I learned that. When my anxiety fuels. 26:22 Like, it’s at that high point, I’m going to avoid or escape and I’m going to feel better. 26:27 As the what I really learned is, unfortunately, if that’s the only reason why I’m OK is because I avoid it or I’ll take it one step further. 26:38 Rituals, or compulsion’s work the same way. 26:41 What I’m going to learn is the only reason why my anxiety got better, is because my teacher said that my answer was correct, and I was feeling such excessive debt with regard to whether or not I was on the right track, whether or not I was going to fail this exam. So I just got some reassurance. 26:57 And that reassurance, me and my anxiety goes down, so I only was OK because of that. 27:03 And this is so incredibly reinforcing because the feeling is good and less stress distressing incident. So it’s extremely understandable. 27:15 Why avoidance is the choice and the problem, of course, is that the person fails to learn that anxiety, it’s tangible, that they can do hard things, that they can tolerate, just intense emotion. 27:30 That anxiety won’t last forever because instead, what I learned was that the reason why it went away was because I avoid it and let’s, I want to really acknowledge, it doesn’t feel great when If I would’ve approach that roller coaster in all likelihood. 27:43 If I have insight about roller coasters, the wind does not go down right away, It’s a much garage, much more gradual process. You will see it. 27:52 We call this riding the wave, which is actually our camp name for the Summer for Anxiety and OCD. 27:57 It’s riding the wave because we’re learning how to ride that really, not real intense discomfort. 28:05 So, oftentimes, as parents, as teachers, even, as psychologists or therapists, easy to contribute, to avoidance. 28:15 It’s easy to help that person avoid, because we want to reduce the child’s stress. It is so hard to see. 28:23 My child’s in distress, and I mentioned she, was struggling with selective mutism, it’s so much easier too, answer that question for her. 28:31 For example, when she’s, on, she’s avoiding a question, and, oftentimes, parents, or teachers, or anyone really also might believe that the child’s will fail, or the child’s might even get hurt if we don’t help, whether it’s failing an exam, or, or failing, another survey, failing a social activity. 28:50 Sometimes, we worry that the child’s will become disruptive, and oftentimes, we’re just really feeling uncomfortable. And we want to reduce our own frustration, guilt, and our anxiety. 29:00 It is so normal. 29:02 Research, again, shows that over 90% of parents and teachers do engage it, Avoidance behaviors, the fancy word for that. We use, and the anxiety roles as accommodations. When we help with avoidance. These are the most common accommodations that we find where we might provide access of reassurance. We might allow extra time to to checking excusing children from assignments. Opening doors are holding back from sir it. 29:27 Topics are using particular words because of the child’s anxiety. 29:31 So, what we also found in the research, and I’ll go back a second, is that most parents know that accommodations are helping with avoidance, isn’t ideal. But most parents in the studies reported that. 29:45 It, that they just don’t know how to handle the child societies, that they don’t have a great alternative on tonight. Well, focused, much more on the alternative. 29:54 The actual treatment, I mean, I cannot. 30:00 I guess like a parents or a teacher supportive moment, which is what the part three is about and treat that we’re gonna focus a lot on psycho education, which is what we’re doing now. 30:10 And, and reading anxiety, And these on the readings, we’re going to craft exposure exercises with response prevention. Essentially, we believe, and the research supports that experience is the greatest teacher. 30:26 Just like you’re not going to be able to convinced an alcoholic lot about the downsides of drinking on that, on its own ship. 30:35 Work with there on abstinence. 30:38 Similarly, we’re going to we’re really going to work behaviorally. It’s a behavioral treatment work. 30:45 We’re we’re gonna craft experiments based on the specific fears so that the child can learn that they can handle uncomfortable things. They can do hard things without relying on the rituals which is the response prevention piece. 31:01 So we’re gonna remove the compulsion while approaching manage about work, and work gradually. 31:07 And while we’re working but we are going to approach these activities. 31:12 This is a very similar graph, I guess diagram to the riding the wave on and I’ll use a different example while we go through it. So this is more OCD focus. 31:25 So let’s say, and I’m person has more of a perfectionist Dick type of OCD. 31:32 And their trigger is taking a test or doing a homework assignment and their obsession. 31:39 As they’re obsessing over the accuracy, how do I know I got it right? Again, OCTs, all about, How do I know? 31:45 So, I need to know, I need, I have this urgent, urgent need to figure out whether I got this question, right? 31:54 Their minds is stuck there, it’s causing anxiety, or distress, then, there’s going to be this urge to neutralize fashion. And that’s gonna, in this case, results. And, let’s say, reassurance seeking, So, I’m at home, I’m going to ask my mom to review, edit this work, or review this problem. Make sure that I got it right, I’m at school, even if I’m taking it out. 32:15 So I’m gonna figure out any way to try to get that answer out of the teacher. 32:20 Or chart a base something on whether or not They might even tell me the answer if I’m on the right track or if I got it right. But sometimes, even just, I’ll try to figure out based on their facial expression. 32:32 And all of these compulsion are two are intended to got as far as the way afar, get as far away from the fear of outcome occurring. So in this case, the fear outcome might be fear of failure. So I want to make sure, And it’s so understands Bell, and there’s a lot of room for validation here. 32:50 Know how hard this is. Of course, you want to get this right. 32:54 And the problem is, task taking for these individuals might become extremely difficult, because these compulsion are essentially teaching that child. 33:05 That the only reason why you felt better was because you got that reassurance and that’s how OCD is reinforced in this case. 33:13 So we’ll talk about how to respond to those reassurance seeking behaviors soon. 33:19 Mindfulness is actually not taught in the midst of an expert which are practiced. 33:23 So in the midst of distressing loan that we don’t necessarily add On’s thinking carefully. Because it really some of this does depends. 33:31 But ideally, we don’t want to prompt the use of mindfulness skills. Mindfulness skills isn’t necessarily about just like sitting quietly. I’m thinking it’s really about there are two types of mindfulness really being being attentive to one’s thoughts, emotions, physical, sensations, or in the attentional control. 33:53 Work we’re working on staying focused on one thing at a time. 33:57 And there’s a lot of value to this. And I’ll talk later about why we don’t want to do it in the middle of an exposure. 34:03 But the bottom line is obsessions and anxiety is ARR distressing. And oftentimes, a person wants to try not to think about that thought or feeling. 34:13 How well does that work? When we try not to think about a thought or feeling, we could use you might be familiar with the pink elephant example. 34:21 Aware. I tell you, don’t think about that pink elephant. 34:26 If there’s a five minute exercise there, where it’s even harder. But of course, that’s it. 34:33 Likely that they think, oh, that the pink elephant will pop up, even though you probably don’t think about the pink elephant all day. 34:38 And similarly the beach ball metaphor. 34:41 Where if you try to get that beach ball Unser the water, not only will it re-emerged, but it’ll actually make quite a big splash. It’ll actually be more prominent. 34:51 So just don’t think about. that doesn’t usually work with anxiety. 34:56 And, oh, well, I thought I would talk briefly about. So, the reason why we don’t usually encourage mindfulness in the middle of an exposure exercise is because we don’t want the person to think that. 35:07 The only reason why you handle that was because you are extremely mindful. We do often have to be mindful. But, we have to be cautious about any type of coping skill, like deep breathing, like even. And there might be some questions on this. 35:22 On this, the Q&A, even things like benzodiazepines, like klonopin, or a quick acting anxiety pill. We’re really not going to want to use in the middle of an exposure exercise, an unsurmountable exposure and teaches the person. The only reason why they were able to engage in that activity was because their mood because they’re breathing was a certain way. 35:45 and we want them to be able to hands on heart base even if their body is a little anxious or very anxious. 35:53 Part of restructuring, we use more for social anxiety that OCD on other anxieties. 35:59 And that’s really about being mindful, noticing the helpfulness of particular thoughts on developing coping thoughts needed. 36:09 And now, we’re up Part three. 36:13 Though, Part three, we’re going to talk about practical skills to support children with anxiety and OCD. 36:21 So this acronym was taught to me by doctor … and at Johns Hopkins. 36:29 She’s great on, and she developed this Limor Model as a way to help parents help teachers respond when their child is expressing particular anxiety. 36:43 So I’m actually gonna, for the sake of time, I’ll, I’ll review the model again, after, but we’ll jump into the L over here, which is the labeling. 36:55 one of the most important things is to resist the urge to problem solve immediately. 37:00 And instead focus on lethally Express with curiosity, Non-judgemental interests, to try to understand as best as you can. The child’s belief, the child’s concerns, the child’s exact various kinds of like what we did on. the first is, are we talking about a fear of harm? Are we talking about fear of being in the Center of Attention? 37:20 Don’t run away from talking about the details, in fact, the more we can approach the details, the more we’re really able to help them and help them identify. 37:30 They’re action urges what they feel like doing. 37:33 And the goal, of course, will be to resist action, urge us if they’re unhelpful, So we’re going into a lot of expressing interest. 37:41 Or if the child’s older, we might, and even if they’re younger, like intensifying the triggers, helping them, understands in, when they’re in certain situations that are more vulnerable to these thoughts so that way they can almost be prepared, expect. Oh that fault might come up, when you’re at that stop sign that thought might come off when. 38:00 You’re taking the test and observing past past helpful and unhelpful responses to the triggers and this, this might be more of a therapist role, you don’t have to. It could be other. 38:13 And the next part is probably one of the most dense skills here. And one of the most important. 38:21 And that’s about expressing empathy, expressing confidence, expressing compassion, without rushing to accommodate and remember accommodate means without rushing to help them avoid and without rushing to immediately minimize the child’s distress. 38:36 So, on this note, I’m gonna go on a little tangent to talk briefly about anxious parents, a Saucer, Oleanna leibowitz whose, and the director of the space program. 38:52 Child study sponsor at Yale talks a lot in his book. 38:57 It’s a great book about anxious parenting, and the two common pitfalls that emerge, and those relate to that advancing nature, were oftentimes parents might find themselves. Teachers, also therapists. 39:13 Almost encouraging the demanding, essentially, the child, that the child approach, certain activities, by saying, just do it, it’s not too hard, everyone else is doing it. 39:24 Um, how long will this take? You just come? 39:28 Almost putting pressure on demands, and the protective nature, which is the other extreme, where the person where the parent, the teacher, the therapist, might try to encourage, almost like, try to rescue the child and skip school. Let’s give you, it’s a lay. Let’s give you extra time. It’s too hard for you. 39:47 And the problem with each of these, and the way that well a trusted is, without acceptance, without, without, the demanding nature, almost increases the risk of a lack of validation or lack of acceptance. 40:03 And it’s really important for the child to sense that you understand their internal experiences because internal experiences our hearts of verbalize as if you, there’ll be skeptical about your recommendation, There’ll be skeptical in their mind, though, the risk of, let’s say, touching. That’s not the risk of committing to a certain course. The risk of there are so many examples I could use. 40:27 The risk of raising their hands on, giving a guess in class. Those risks are almost as terrifying for them as asking you to drive the wrong way on a highway. 40:38 And we want to really acknowledge that it makes sense, that they’re scared, and it’s not their fault. 40:42 This is, this is a disorder. This is something that they didn’t cause you didn’t cause, this is something that is emerging, is making them very pink and I’m happy to take a difficult time, and we need confidence. 40:54 We need to express confidence. 40:55 We need the child to believe that sense, that you believe that they can handle this hard thing. 41:01 That’s hard activity. So acceptance is about, it makes sense that you’re scared. 41:06 And confidence is about, as I believe, you can cope without, running away, without avoidance without compulsion. 41:12 So we’re going to work on crafting supportive statements, too. 41:17 Really help the child sentence that It makes sense. You’re scared. And I believe you can do this hard thing. 41:25 So I think I’m going to skip this. You can take a look. This is just a quick exercise if we had time, But I’m not sure if we have time to understand. 41:32 Some of these statements are supportive. Actually, we could just look at the. some of them were acceptance geared. Some of them were more competence focused on them. Neither. And then there was one that was both, which is ideal. So it’s hard, and you can do it. 41:48 Acceptance would be something like, I get it, it’s not easy, anxieties uncomfortable confidence as you can power through it, but we don’t want to only have confidence. We can combine this. Anxiety is uncomfortable, and I believe you can power through. 42:01 And neither, it’s all on your minds. You can’t be thinking about this. 42:04 And unfortunately, some of these things are often data. 42:09 Responding to reassurance, seeking behaviors, awful, awful, falls under this expressing confidence and compassion, because essentially, what’s happening is, like we talked about, the obsession might be, I need to know, I need to get this right. 42:24 I’m terrified of the failure, or what if I don’t do well, and they’re asking you, Is this safe? 42:29 Or, will I get sick? 42:31 If I touch that star, and Yeah. 42:36 Is this correct? Did I say something weird in that social activity was normal? 42:41 So, had a response or reassurance seeking behaviors is all about agreeing with the fear. Because, like we talked about OCD in particular, also anxiety is somewhat about the difficulty with what’s hollering the unknown. 42:55 And unfortunately, despite our best efforts, the feared outcome might occur. 43:00 We don’t know if they think that you’re weird, and we want you to be able to tolerate it. We want them to be able to tolerate even tolerate that possibility, essentially. 43:08 So I’m going to response or reassurance seeking behaviors with the supportive statements that we just talked about on the previous slides. So I know this is scary. That’s the acceptance alma and I also know you can handle it. 43:21 I don’t have a better answer for you. I don’t know which class to pick. I don’t know what to wear. 43:27 I don’t know what you should wear. I’m not 14 anymore. 43:30 And you’re gonna, You’re going to make the best decision that you have. 43:34 And this is a more lengthy answer, but I just want to show a variety here, because I want you to develop things that are consistent with your style. The feeling of not knowing is so when it comes through, but I get it. Of course, you want to know, and I’m confident in your abilities to make a decision with information that you have. 43:52 So, so far, we said, We talked about labeling the exact fear, non-judgemental. 43:56 eight, we talked about crafting supportive statements, and reducing reassurance. 44:02 And now, we’re going to talk about modeling. So, it’s important to model calm, non anxious behavior. 44:09 So, if someone says, if a child is asking me, is that OK, I forgot to say bless you after someone sees true case. I won’t provide more details, though, for confidentiality. Is that OK? I’m almost like running down the stairs. 44:24 I don’t know if I said Blasio to that person’s views. 44:27 I don’t want to, I don’t want to amplify their concern. I want to have and I don’t want to judge them by saying, are you crazy? This is what you’re thinking about. Don’t worry. Because don’t worry is a form of reassurance. 44:37 I might say I don’t know if you did. 44:40 I don’t know I don’t have a better answer for you. SOCOM non anxious behavior and tolerating uncertainty. 44:46 If someone’s someone’s really stress that they fail the test, especially if you didn’t get back the test at which is so common to, with anxiety disorders to almost charter prepare oneself for that worst-case scenario. 45:00 And what do you mean? Who fails? You left the whole thing blank. 45:04 OK, I guess we’ll have to see, is what we want to model. 45:08 Especially, like I said, if we didn’t get that suspect, using skills is big. you, and Limor. 45:15 And this is, You think, skills is important For the person, the parent, teacher, caregiver in this situation, And also, we want to, I want to, I guess, like, give a very broad, general rule for helping the child’s use skills. So, we don’t talk so much I mean, I talk briefly about exposure, response prevention skills, how that’s important. 45:38 Sometimes, mindfulness skills will be able to use, personally, because, like I said, accommodations often happen when words, stress want to work. 45:48 We know it’s not ideal, and, of course, in a moment, we sense that child’s urgency. If we care about that child, we want to relieve thoughts of stress. 45:55 So, it’s really important to consider what’s needed for the child to be more successful and what’s needed for me to be more successful, rather than thinking, what do I do now help? 46:08 What do I, rather than almost like, what’s needed to be less upset. 46:14 So, we want to focus a lot on what’s needed most consistent with my long term goals, rather than what’s needed right now. 46:22 And, along similar lines, we want to think about what would the child’s be doing. If their anxiety or OCD wasn’t as intense. If they’re, if they’re …, wasn’t present at all, what would they be doing instead? And try to encourage them to take their normal self. 46:38 But this is also about us here, because you’re going to have to use the skills, so that you are able to stay mind and thought for, in terms of like what’s needed the most right now, in order for the child to be most successful. 46:54 Lastly, reinforcement, reinforcing, break behavior. This is so hard. 46:59 Again, I really wanna like validate that for some of this, oftentimes if fear is really intense, which anxiety can be intense and severe, it really feels like that they’re risking death, they’re risking. 47:14 It’s almost like like I sat like driving on the wrong side of a highway. 47:17 If I don’t check this pimple out, this temple that aren’t preoccupied about really might cause the serious infection. It may lead to my death. It’s so much easier to monitor it excessively to maybe what we call body scan, rather than engage in a much harder thing to do. 47:35 So we want to reinforce that behavior and even if the child’s older, definitely a specific phrase works for any age, but sometimes Recently even like A teenager asked me. I want warfare on skin picking, which is often a co-occurring problem with OCD and the person was like I think I wanted to points. 47:55 Just got to Starbucks drink every week. If I’m able to resist …, which is, it’s funny, I don’t, I oftentimes don’t recommend. not purposely, I almost forget about things like points for older teenagers, but it they’re powerful there. 48:11 We want to acknowledge the positive learning. 48:14 We want to acknowledge a phrase that I often uses when you did this. So, I felt very proud of it. So that way, I’m just making sure that, I’m very specific, when you talk to that stranger, when you talk to that new person that. 48:27 And for the first time at their house, I was so proud of you. And sometimes, I’ve been at, and it motivated me. And I remember a top reviewer, as I was able to do XYZ hard thing. 48:38 Um, the reinforcing bar a behavior sometimes with younger kids, things like token economy, is, you’ll see what works on different point systems, like we talked about, or points can earn things. And let’s review the lemur model here. 48:51 And as we are reviewing, I, again want to acknowledge that I know that, and on this is almost like a marriage. This is almost a marathon of the presentation. We’re reviewing a lot. And think about, almost, like, what we would ask for of our children that we’re working with, and think about your strengths and weaknesses in terms of the lemur skills in terms of labeling, and what areas are. 49:14 Could you use more improvement? Which areas do you feel? 49:16 you do well in, and thinking about maybe focusing on one skill at a time. 49:22 So, first, labeling and as much specificity as possible as possible the child’s anxious or perfectionist or OCD, I guess, feelings and beliefs. 49:33 The next skill, we talked about a lot about supportive statements. How to express empathy and compassion without looking to immediately reduce the behavior. 49:42 Modeling calm, non anxious behavior, and using skills. And that’s where we’re talking about, just what, what does the child needs to be more successful instead of what is the child needs to be less upset. Sometimes. 49:55 Hopefully, it could be the same thing, but oftentimes the immediate relief of distress is often a compulsion and rewarding brief behavior is the last. 50:08 And oftentimes, as we wrap up presentations, I just feel a need to acknowledge that. 50:14 This feels dense to me. And I hope I didn’t overwhelm you with content the last 15 minutes, and I want you to remind yourself, what motivated you to join today, where you’re just being nice to you? Or was there? So what extent is this a worthwhile investment for you, thinking about the kids that you engage with? 50:34 Obviously, this is. 50:38 It requires a lot of effort on practice to learn new things. Which is why I want you to think about three takeaways from tonight. 50:47 Definitely, new skills that require effort on practice to implement and it’s possibly one of the best gifts. You can give children, the gift, to be able to handle overwhelming feelings. 51:00 The gift of being able to approach difficult emotions, do hard things, essentially. 51:08 And let’s review, even though he’s sort of review of the lemur model. So we talked a lot about labeling. thanks that’s your unbelief non-judgemental. We talked about how anxiety and OCD disorders might manifest themselves in the classroom across age groups. We talked about providing support statements, acceptance. 51:26 I understand how hard that says, It makes sense. It’s so hard And I believe you could do it. 51:30 That we’re looking to reduce the accommodation And modeling, motivating and prompting the use of effective skills. How can you seek your normal self even though this is really on your mind’s eye? 51:44 I really get that. 51:45 It’s, you know, on your minds, how can you essentially act as if you didn’t have this anxiety or obsesses obsession right now? 51:54 And agreeing with a fear, we talked about reducing reassurance because unfortunately, despite our best efforts failing can occur because anxiety and OCD is oftentimes about intolerance of the doubt and tolerance. 52:07 And Underestimate overestimation, Nebraska, underestimating the cool thing. We want to really approach the possibility. 52:13 It’s possible that is it possible or probable, and hopefully, if the fear is possible, but not probable, we want to be able to agree: I know it’s possible, how would we handle that. And, the feeling is so hard. 52:27 How can you try to do approach up gradually? 52:33 This quote I often pass, we must see the child that’s in trouble, not in the cost of travel. Here are great resources, Charles, to wellness, things that in the classroom. You have the slides. So, I’m not going to review this, and the next one to add book recommendations. 52:48 And some references, and I am happy to take questions, if there are. 52:55 You, so much to Laura. That presentation was absolutely phenomenal, and I’m definitely ready to shoot into some questions. So, first, we had a comment. Someone said, it is helpful to have examples of what to say, to encourage. 53:11 Yeah, sure, I would really start with a supportive statement, and if the person wants to even bring up an example of that, is occurring in their setting, that’s totally fine. Let’s an example that’s coming to mind. I don’t know why a phobia is coming to mind, but that might not be as relevant. 53:28 Let’s do, like, uh, someone’s procrastinating studying or doing their work, because they feel overwhelmed by the volume, the quantity. 53:39 So, I might start with the acceptance and confidence piece, I know you really do have a lot. You have four tests done in specificity because we want them to realize that we really got it, you afford CO two quizzes. And I believe that you could do it, how can we start? 53:54 So, not focusing on the all or nothing element to it, really focusing on, what would you be doing? 54:01 If you didn’t have all of that on your minds, how would you be starting? 54:06 And I hope that’s helpful, happy. If you want to follow up with that, that’s fine. 54:13 So, another question that we have is, how do you help your child with anxiety, if you also struggle with it? 54:23 Yeah, that’s hard. 54:25 And, definitely, I think the lemur model can be helpful, and in being able to recognize what the other person is, what your child’s anxiety is eliciting. 54:38 and in you. 54:40 And definitely, there are good treatments if, if you are interested in pursuing exposure, and response prevention, has a really high effective effectiveness rate of over 70%. 54:53 And it’s a really great gift. 54:57 I do believe oftentimes, that it’s helpful to remove the shame And guilt often with, oftentimes, parents with anxiety is feeling like they’re causing their child’s difficulties, and the research and the way that we think about it is not a helpful thought. 55:11 But we also find that in many cases, I mean, there often is a genetic component, and the more that a person a parents is able to work on their own, it is possible and very likely that the child will get better. So, I would say, focused on your own first. 55:29 And another one that we have is, How would a therapist deal with a child who is stubborn and their avoidance? 55:36 What phraseology or strategies can be used to get the child to be more open minded about facing their anxiety? 55:46 OK, yeah, it’s hard because you’re never going to be able to force someone to do something. 55:51 So, I, oftentimes, would really try to understand the child’s values in, what ways is their anxiety or OCD, interfering or robbing them of their life worth living? 56:11 In terms of, I don’t know if it’s any social activities that they’re fearful of missing, or, I mean, there are such, there’s an infinite examples on, or why I focused on that one. 56:21 But really focusing on, in which ways their anxiety is getting, taking away from their valued activities. 56:29 But also, it’s possible that incentives would help, that may have been tried. I acknowledge that and oftentimes more gradual exposures can be very helpful. 56:43 So it’s possible that when exposures aren’t working and I know there might be a problem of willingness here, we often think about can we approach this more gradually? And are we really targeting the fear of outcome appropriately? 56:56 So I would start there. 56:58 And good luck, It’s hard. 57:02 Another question that we have is you mentioned that OCD is often correlated with values or even religion. 57:11 How do you teach a patient to avoid Compulsions when they have strict religious rituals? Yeah. 57:17 And that’s there’s actually a great OCC group that focuses on based OCD and we never violate religious activities. 57:31 So oftentimes, it’s really important to really with OCD, we’re working on disengaging from the contents because it’s not about the content. It’s really about that fear of unknown. 57:43 So, we’re gonna focus on, let’s say it’s the fear of whether or not I’m going to go to ****? 57:50 And so, we’re going to focus on that. We’re not. 57:53 We’re really not violating religious sites, if it’s and it’s really important to collaborate with a trusted, religious individual to help the person identify, what is the SEC and how someone without OCD would engage in that particular religious activity. 58:12 And another question that we have is, my son has Tourette’s syndrome, ADHD, and anxiety. He often goes to the bathroom during class time. 58:22 It only has a 504 plan. The school is struggling with trying to set up a plan to avoid this. 58:30 He is not a behavior and it is not a behavior issue, so they allow it. 58:35 I don’t like, Uh, huh. It’s tricky to understand without more detail. 58:43 I’d be curious to understand what the child is doing in the bathroom. If he actually needs a bathroom, is this a medical situation? Is this more of an employee dance? 58:53 And if it’s an avoidance, trying to understand what is the child’s avoiding on the questioner is correct, in that we’re careful when providing a child with accommodations, because we, we don’t want them to rely on. We want them to be able to handle their anxiety. And oftentimes, probably in the past month, I did sign letters encouraging. Or recommends a 500 for an IEP plan. So we, when they are used, we do recommend frequent revisiting. So we don’t want them to be permanent accommodations and perhaps more I guess a patriotic plan to help the child approach. These activities that, he may be avoiding while being in the bathroom. That could be helpful. 59:44 So that the same person said that their child, that they’re just avoiding and it’s because of their trucks. 59:54 Yeah, I guess they’re going to the bathroom to be able to let it out. And I guess just rent’s idea of being the class. It’s often embarrassing, I don’t know exactly what this person’s experience as many people it takes to describe how embarrassing it is on, how they, they to feel like they need a break. And I would be mindful of helping the child try to get back into the classroom with the use of competing responses. 1:00:21 If, if the child has tried cebit therapy, cognitive behavioral intervention for text, that could be helpful. 1:00:29 And best of luck, I’m happy to follow up if you want to share more details. 1:00:37 And just, for my own personal oh, she says, thank you for my own personal experience. 1:00:41 I know that a lot of times, especially in school I know I would go into the bathroom to let out my tics, and I would, literally come out of the bathroom, like, out of breath. It would seem, like a room, but, that was, for me, where I would let them out. 1:00:56 But, I think that what you’re saying is 100% correct, and if this individual does want more information, or wants to contact you, I can definitely get them, your contact information. 1:01:07 And, providers will text, hopefully, Mary tradeable. 1:01:15 So that is the last question that we have. is currently 8 32, so we’re going to start wrapping up to Laura. Thank you so so much. OK, so thank you for joining our webinar tonight on Identifying and Supporting Anxiety and OCD in the Classroom. 1:01:36 And archived recording of tonight’s webinar will be posted to our website, WWW dot NJ CTAS dot org. Under the Heading Programs webinar blog is now open and accessible underneath the archived Webinar. It will remain open for the next seven days for any additional questions that were not covered this evening. We will be back in September with a whole new look and feel to our webinars. We’re so excited for you to see what we have in store. So, make sure to tune and this ends tonight’s webinar and thank you again, doctor …, so much for your presentation and thank you, everyone, for attending. We hope you have a wonderful night. 1:02:20 Think, yeah, thank you, Katy, thank you. Over and goodnight.