Transcript No Slide Title

Kimberly Becker, Ph.D.
Johns Hopkins Child and Adolescent Psychiatry
Objectives
 Gain knowledge about the prevalence
and course of child anxiety
 Understand how to recognize
symptoms and manifestations of
anxiety
 Learn how CBT addresses anxiety
symptoms
Facts about Anxiety Disorders
 Prevalence of anxiety disorder: 10%, but often
unidentified and misdiagnosed
 Mean age of onset: 7-15 years old
 Impairment: academics, attendance, peers, families
 Course:
 Waxes and wanes
 1/3 of kids with anxiety improve without treatment
 Most adult anxiety disorders have pediatric onset
 Comorbidity: very common
Comorbidity
 Having more than one disorder
 Additional anxiety disorder: 30-80%
 Mood disorder: 12-60%
 Externalizing disorder (ADHD, CD, ODD):
3-60%
Symptoms of Anxiety
Physical
Feelings
Behaviors
Thoughts
Physical Feelings
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Muscle tension
Heart palpitations
Abdominal pain
Nausea
Flushed face
Headaches
Perspiration
I have a headache
and stomachache.
Teacher, can I go
see the nurse?
 Anxious youth EXPERIENCE more
physical difficulties/complaints
 Anxious youth are MORE SENSITIVE
to physical sensations
Thoughts
 Catastrophizing: blowing things out of proportion
 Overestimating: expecting the worst will happen
 “What if…??”
What if the teacher
calls on me?
I always get the
answer wrong!
Behavior
 Avoidance/escape
 Reassurance-seeking
 Tantrums/disruptive behavior/school
refusal
Is anxiety good or bad?
Anxiety is normal and adaptive. It serves
as a natural alarm system to alert us to
danger.
When is anxiety a problem?
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Excessive
Persistent
Developmentally inappropriate
Results in accommodation by others
Causes impairment
Evidence-based Assessment
 Multiple informants (e.g., child, parent, teachers,
clinicians, etc.)
 Multiple methods
 Questionnaires
 Interviews (e.g., ADIS-IV-C)
 Behavioral observation
 Repeated, ongoing assessment throughout treatment
 Frequency, duration, intensity, interference
Evidence-Based Treatments for
Anxiety Disorders in Children
 Medication (SSRIs)
 Cognitive Behavioral Therapy (CBT)
 Child Anxiety Multisite Study (CAMS)
 Medication effective
 CBT effective
 Combination most effective
Empirical Evidence Summary
 > 20 controlled trials
 Response: CBT 55-80%
 Treatment gains maintained – 5-7 years
 Parent symptoms = poorer outcomes
Goals of CBT for Anxiety
 Reduce anxiety, but not eliminate it
 Increase ability to manage and cope
with anxiety by teaching skills
 Identify and change anxious behaviors
(avoidance) and thoughts
Anxiety Symptoms and CBT Skills
Physical
Symptoms
Relaxation Skills
Psychoeducation
Behaviors
Problem Solving Skills,
Exposure/Practice
Rewards
Thoughts
Anxious to Coping
Thoughts
Psychoeducation
 Goal: To provide basic facts about anxiety and its
treatment, instill hope
 When: Session 1, and thereafter
 Key Points:
 Define anxiety: find common language
 Normalize anxiety: everyone experiences it
sometimes
 Externalize anxiety: it is a reaction to
situations…an alarm (true alarm vs. false alarm)
 Propose treatment: (1) CBT model, (2) How do
you know the difference between true alarm
and false alarm? Test it out!
Exposure/Practice: Facing Fears
 The key component of CBT for anxiety
 Rationale
 Anxiety is partly learned and can be unlearned
 Learn that feared consequences do not occur
 Fear Ladder
Goal!
 Gradually build from easy to
Step 5
hard situations to practice
Step 4
Step 3
Step 2
Step 1
Sample Fear Hierarchy
Situation
 Giving speech in front of class
 Giving answer aloud in class
 Asking question aloud in class
 Writing on blackboard in class
 Throwing trash away in class
Rating
10
8
6
4
2
Item Selection
 Start exposure/practice by collaboratively choosing
an item that the child will not refuse and that the
child will successfully complete
 Move up the ladder as the child masters each item
 A “good item” is one that provokes anxiety and that
the child habituates or gets used to over time
 Be creative!
Summary
Anxiety :
 Normal and adaptive
 Affects: thoughts, feelings, behaviors
Anxiety disorders are:
 Common
 Misidentified and under-treated
 Amenable to treatment
CBT is:
 Time-limited
 Skill-based
 Effective for treating anxiety (50-80%
improvement rate)
Additional Resources
 ABCT. ORG
 ACADEMYOFCT.ORG
 ADAA.ORG: convention March 2010, Baltimore
 Chorpita, B. F. (2007). Modular Cognitive-Behavioral Therapy for
Childhood Anxiety Disorders. NY: Guilford.
 DuPont Spencer, E. DuPont, R., & DuPont, C. (2003). The Anxiety
Cure for Kids. New Jersey: Wiley.
 Manassis, K. (1996). Keys to Parenting Your Anxious Child.
Hauppauge, NY: Barron’s Education Series.
 Rapee, R. M., Spence, S. H., Cobham, V., & Wignall, A. (2000).
Helping Your Anxious Child. Oakland: New Harbinger Press.