Reducing Depression and Anxiety

Mindfulness at School Reduces Teen Depression-Related Symptoms http://t.co/qxGOTKmOsW

School Refusal

Written by: Angela Lacalamita, MA, LCPC


School anxiety, refusal and avoidance are increasingly becoming a problem with children/adolescents. Researchers estimate that 2-5% of school age children suffer from anxiety related school refusal. School refusal encompasses a broad spectrum of behaviors to include:

• prolonged absence from school

• sporadic attendance

• skipping classes

• emotional or behavioral difficulty in an attempt to refuse school

• physical complaints of illness without medical explanation (somatic) when faced with having to attend school

There are numerous factors that may influence school refusal. Generally, youth refuse school to avoid academic situations that cause distress (i.e. homework or other school related situations), escape social or evaluative situations (i.e. peer groups or tests), to gain attention from a person in which the child has an emotional attachment toward, to obtain rewards outside of the school setting (i.e. sleeping in, or video games). Many children that display school refusal also display other emotional or behavioral difficulty to avoid school settings i.e., running away, substance use, noncompliance, temper tantrums and aggression. If left untreated, school refusal can lead to significant difficulty with a child’s social, emotional and educational development.

The long-term outcome for children who refuse school is not well established, primarily due to an inconsistent definition.  Regardless of the terminology used, school refusal may be a precursor to disturbances later in life if left untreated. If your child is experiencing difficulty in attending school, a comprehensive evaluation from a mental health professional will reveal the reasons behind the school refusal.

The following are tips that can help your child manage school related anxiety or other stressful situations.

• Relaxation Training: a combination of progressive muscle relaxation and breathing exercises can be helpful. Diaphragm breathing is achieved by inhaling through the nose and exhaling through the mouth for a set number of times. Progressive muscle relaxation is a technique in which a muscle group is isolated and contracted for five seconds and then released. This technique can begin by starting with the feet and gradually work up to the head or vice versa.

• Gradually introduce school to your child in small degrees. Eventually this will help them realize there is nothing to fear and that nothing bad will happen (generally for younger children just beginning school).

• Have your child identify the positive aspects of going to school: being with friends or learning a favorite subject.

• Have your child identify any negative thoughts they may be having. Encourage your child to replace the anxious (negative thoughts) with supportive and calming statements, i.e., “I can handle this.”, “I have done this before.”

• Arrange a meeting with your child’s counselor for support and direction.

• Establish routines: Having a routine offers predictability, improves transitions to school and reduces anxiety. The morning routine prior to school should be the primary focus. It can be a benefit to have regular routines for all parts of the day to limit any behavioral difficulty.

• Learn about your child’s anxiety disorder and research the treatment options.

iPhone/iPad Apps Can be Helpful in Treating Stress and Anxiety

Written by Laura Piuca Hinkes, L.C.S.W.

It is well documented that deep breathing exercises can reduce the body's response to stress and help manage anger and anxiety. Though breathing is a natural reflex, many of us fail to properly breathe. We tend to take shallow breaths and let our breathing become rapid when we are stressed, which only heightens our stress and anxiety. Deep breathing can be easily learned and should be practiced consistently to avoid returning to a less effective breathing style. As we increasingly become tech savvy, we are depending more and more on our smart gadgets to get us through the day- to get directions find recipes, do our shopping. It makes perfect sense that we can use apps  to improve our well being. Apps for the iPhone and iPad such as Breathe2Relax or Long Deep Breathing are easy to use, free or very inexpensive. They demonstrate how to properly conduct deep breathing exercises and allow you to personalize the application by choosing the music and graphics. You can also adjust the duration of time you inhale and exhale during the exercises.  Using these apps during stressful times of your day or at bedtime can help develop a routine where you pay more attention to your stress levels and dedicate some time to take care of yourself.

Of course these apps are not intended to replace professional therapy but are merely an adjunct to the work you do in your therapist's office.

When Worrying is a Problem

Written by Laura Piuca Hinkes, LCSW 

Everybody worries from time to time. However, when it begins to consume you, lead to avoidance, distract you from important areas in life and inhibit your ability to problem solve, it's time to take some action. People who suffer from chronic worry experience a variety of symptoms, some symptoms include:

• Difficulty concentrating
• Difficulty controlling the worrying
• Muscle tension
• Feeling nervous
• Fatigue
• Restlessness
• Irritability
• Sleep disturbance

Chronic worriers may try to distract themselves or push worrisome thoughts out of their head only to have the worries creep back in. It would be more helpful to learn to postpone worrying. In this strategy you create a “worry period” where you set aside a time (say 20 minutes) and a place for worrying, preferably the same time and place daily. During the day when a worry or anxious thought arises write it down on your worry list and tell yourself you will attend to it later during your worry period. Postponing worrying in this way can help because it interrupts our tendency to dwell on what is worrying us but doesn't have the expectation that we have to suppress these thoughts. 

How often do we spend time worrying about things we have no control over?  You can ask yourself if there is something you can do to solve the problem. If for example, you are worrying about paying bills, brainstorm all the possible solutions. You could call your creditors, cut back on expenses or get a second job. Try to focus on the things you have the power to change rather than those that are beyond your control.

But what about all those things I have no control over? The truth is we have to accept that there is a certain amount of uncertainty in our lives. Dwelling on all the things that could go wrong doesn't make our life more predictable. Do you tend to predict that bad things will happen when there is just as much likelihood that the outcome will be positive or at least neutral?  People who's tendency is to worry all the time tend to have a pessimistic view of their world. If you tend to assume the worst and focus only on the negatives this will increase your worrying and anxiety. You can focus on ways to retrain your thoughts to be more positive. When plagued with a worried thought challenge the thought with these questions:

• What is the evidence that the thought is true? That it is not true?

• Is there a more positive, realistic way of looking at the situation?

• What's the probability that what I'm afraid of will actually happen?

• If the probability is low, what are some more likely outcomes?

• Will worrying about it help?

• If someone else had this worry what would I tell them?

Talking with someone may help you sort out some possible solutions. It can be especially helpful to talk with a counselor who is impartial. Many counselors use Cognitive Behavior Therapy to help individuals see how negative thinking can affect our lives and how they can discover healthier patterns that will decrease their worry and anxiety.

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Challenging intolerance of uncertainty: The key to anxiety relief

Ask yourself the following questions and write down your responses. See if you can come to an understanding of the disadvantages and problems of being intolerant of uncertainty. 

• Is it possible to be certain about everything in life?

• What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful?

• Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes?

• Is it  possible to live with the small chance that something negative may happen, given its likelihood is very low?

Adapted from: Accepting Uncertainty, Centre for Clinical Interventions

Why You Keep Worrying

You have mixed feelings about your worries. On one hand, your worries are bothering you - you can't sleep, and you can't get these pessimistic thoughts out of your head. But there is a way that these worries make sense to you. For example, you think:

- Maybe I'll find a solution.- I don't want to overlook anything.
- If I keep thinking a little longer, maybe I'll figure it out.- I don't want to be surprised.- I want to be responsible.You have a hard time giving up on your worries because, in a sense, your worries have been working for you.Source: The Worry Cure: Seven Steps to Stop Worry from Stopping You
by Robert L. Leahy, Ph.D.by Robert L. Leahy, Ph.D.by Robert L. Leahy, Ph.D.