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ADOLESCENT

ANXIETY DISORDERS

FUNCTIONS & SOLUTIONS

Richard Kerry Thompson

Rochester University

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Adolescent phobias and anxiety disorders, specifically in grades 6-12, have direct connections to brain function, and acute therapy can have positive immediate, and long-term solutions.

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INTRODUCTION

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  1. Anxiety disorders & phobia are one of the most significant challenges for adolescents in grades 6-12
  2. Exposure of phobia-specific stimulus elicits brain activation
  3. Empowerment techniques can help change behavior, brain functions thus changing behavior

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MODUS OPERANDI

(M.O.)

Method of Operating

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Adolescents can learn how to identify, understand anxiety, its effects and improve their modus operandi (method of operating)

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1- Introduction

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  • Specific phobias that are associated with the most common anxiety in adolescents
    • Depression, anxiety, social agoraphobia
    • Disorders may lead to loneliness, depression attempted suicide and suicide

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(Ebesutani, et al. 2015)

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2- INTRODUCTION

  • Brain activation that is connected to anxiety and fear
    • Anterior insula and amygdala, as well as the right frontal cortex

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(Ipser et al., 2013)

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3- INTRODUCTION

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  • Therapies to empower students short and long term
    • Resiliency Coaches
    • Autogenic Training Relaxation Interventions
    • Cognitive Behavior Therapy (CBT)

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DISCUSSION

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Adolescent Anxiety Disorders and Phobias

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Peer Victimization and its’ Connection to Anxiety

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Assessment of Anxiety & Depression

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DISCUSSION

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Adolescent Anxiety Disorders and Phobias

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Identified Disorders in Adolescents - DISCUSSION

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  • Most significant challenges in grades 6-12
  • Depression, anxiety & social agoraphobia
    • Silent suffering
  • Not identified can increase
  • Adolescents with multiple phobias have highest rates of mental illness as adults

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(Burstein, et al., 2012)

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Anxiety and Depression - DISCUSSION

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  • Functional Impairment create risk of isolation
    • Heightened levels of loneliness
    • Social avoidance manifests in depression
  • Functional impairment of social & emotional skills lead to
    • Alcohol & drug abuse
    • Possible high school dropout

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(Ebesutani, et al., 2015)

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Peak of Onset of Social Phobia - DISCUSSION

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  • Between ages of 11 - 17
    • Parent/guardian less involved
  • Adolescent becomes independent
    • Not verbal with feelings
    • Unnoticed unless critical breakdown in M.O.

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(Ranta, et al. 2013)

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DISCUSSION

Peer Victimization and its’ Connection to Anxiety

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Peer Victimization - DISCUSSION

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  • Grades K-12 peer victimization is strongly connected to
    • Anxiety, social phobia and suicide
  • Must be addressed as it is a significant threat to mental illness
  • 5-15% of adolescents are victimized by peers

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Peer Victimization - DISCUSSION

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  • Direct Victimization (DV) - personing being victimized
    • Act of verbal aggression
      • Name calling
    • Act of physical aggression
      • Hitting, pushing, shoving

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(Ranta, et al. 2013)

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Peer Victimization - DISCUSSION

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  • Relational Victimization (RV)
  • Intentional victimization of peer via manipulation
    • Interpersonal relationships and social status
      • Exclusion from group
      • Spreading rumors

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Peer Victimization - DISCUSSION

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  • Adolescents suffering from Peer Victimization
    • Already suffering from anxiety
      • Self harm
      • Depression / Self-isolation
      • Anger / Retaliation
      • Suicidology / Suicide

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Statistics on Adolescent Suicide - DISCUSSION

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  • According to the World Health Organization (WHO)
  • Mental health is an acute concern for adolescents
  • One half of all cases of mental health occured before age 14
  • Suicide is leading cause of death in 15-19 year olds
  • Suicide is the second leading cause in girls worldwide

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(Ranta, et al., 2013).

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DISCUSSION

Assessment of Anxiety & Depression

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Identifying Questionnaires - DISCUSSION

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  • Social Phobia Inventory (SPIN)
    • 17 item self reporting questionnaire
      • Measuring fear,
      • Avoidance behavior
      • Psychological arousal

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Identifying Questionnaires - DISCUSSION

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  • Beck Depression Inventory (BDI)
    • interviews and observation
  • Life Events Checklist (LEC)
    • Assess the extent of anxiety and depression.

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Assessment - DISCUSSION

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  • Classification of anxiety formally introduced in the 1960s.
  • In 1980, social phobia was incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM).
    • DSM III
      • 2020 DSM IV

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BRAIN

CONNECTIVITY

TO

PHOBIA AND ANXIETY

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Brain functions activated in response to phobic stimuli - BRAIN CONNECTIVITY...

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  • Areas of the brain that are activated in an anxiety disorder
    • Activity in the left insula, amygdala, and globus pallidus
  • The right thalamus and cerebellum were activated to a greater extent in the phobic subjects than controls

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Brain functions activated in response to phobic stimuli - BRAIN CONNECTIVITY...

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  • Exposure of phobia-specific stimulus elicits brain activation
    • consistent with current understandings of the neuroanatomy of fear conditioning
  • Fear factor of the fight, flight, or freeze is connected to the amygdala
    • Brain activation center for fear, and anxiety trigger

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Brain functions activated in response to phobic stimuli - BRAIN CONNECTIVITY...

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  • Fear is linked to anxiety
    • Create a chemical reaction in the brain, specifically in the amygdala.
    • Cognitive understanding of the phobia itself
      • Stop and prevent a situationally panic attack.
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Brain Stimuli in Somatic Symptoms -

BRAIN CONNECTIVITY...

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  • During anxiety attacks the mind creates reactions in the body
    • Blood flow decreases in the left parietal cortex and the right cerebellum.
    • Blood increases in the thalamus, right insula, and lateral frontal areas in the left parietal cortex and the right cerebellum
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METHODS

OF

EMPOWERMENT

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Techniques - METHODS OF EMPOWERMENT

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  • Resiliency Coaches, Autogenic Training Relaxation Interventions, and Cognitive Behavior Therapy. (CBT)
  • These techniques are cognitive therapies
    • Cognitive alters thinking - intrinsic behavior
      • Modus Operandi - change
    • Not chemical that alter brain chemically

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(Silverstone, et al. 2017)

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Resiliency Coaches - METHODS OF EMPOWERMENT

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  • Establishing a relationship with the student
    • Not a Therapist or Counselor
  • Curriculum about social and emotional learning
    • Available during unstructured student time
  • Creates bond and refers to professions

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Resiliency Coaches - METHODS OF EMPOWERMENT

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  • Empathy Scale of five interests

1- Depression

2- Anxiety

3- Use of drugs and alcohol

4- Self-esteem

5- Quality of life

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Autogenic Training (AT) Relaxation Interventions -

METHODS OF EMPOWERMENT

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  • Relaxation techniques and training used as an intervention
    • In addition to cognitive or psychotherapeutic curriculums
  • Purposeful Muscle-Relaxation (PMR) and controlled breathing
    • Raise self-esteem
    • Reduce aggression
    • Mental health, and social functioning.

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Autogenic Training (AT) Relaxation Interventions -

METHODS OF EMPOWERMENT

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  • Example 4 by 4
    • Breath in for 4 counts
    • Hold for 4 counts
    • Breath out for 4 counts

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Empirically Supported Treatments (EST)-

METHODS OF EMPOWERMENT

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  • Cognitive behavioral empirically supported treatments (ESTs)
  • Effective as the therapist empowering the client
    • The therapist-client relationship
    • Effort on the client wanting to change their MO

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Empirically Supported Treatments (EST)-

METHODS OF EMPOWERMENT

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  • Clinical psychology is Evidence-Based Practice (EBP)
    • Treatments with proven efficacy include those who meet (EST) criteria
    • Set out by the American Psychological Association (APA).

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • Categorized into five areas:

(1) Managing Negative Thoughts

(2) Changing Maladaptive Behaviors

(3) Managing Maladaptive Mood and Arousal

(4) General Skills Training

(5) Modifying the Family Environment.

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(Silverstone, et al. 2017)

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (1) Managing Negative Thoughts
    • Managing negative thoughts or cognitive distortions are those that stop a person from acting positively.
    • Example: Overgeneralizing, mind reading, all or nothing.
    • Specific CBT Techniques to empower
      • cognitive restructuring, behavioral experiments, thought substitution/self-talk, positive imagery, and thought to stop/ interruption and considered acceptance.

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (2) Changing Maladaptive Behaviors
    • Maladaptive behaviors are those that prevent a person from adapting to new or challenging circumstances.
    • Example: Avoidance behaviors drinking, numbing, gambling
    • Specific CBT Techniques to empower
      • interoceptive exposure, response prevention, behavioral activation, pleasant events scheduling, self-evaluation, and self-rewards.

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (3) Managing Maladaptive Mood and Arousal
    • Behavior that inhibit a person from a situation because of their mood.
    • Moods thought to be involved in a triangulated explanation
      • Brain: Biology (hormones and brain chemicals)
      • Psychology (personality and learned responses),
      • Environment (like illness and emotional stress).

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (3) Managing Maladaptive Mood and Arousal - Continued
    • Specific CBT Techniques to empower
      • Emotion identification, expression and regulation, progressive muscle relaxation, applied tension, and breathing retraining.

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (4) General Skills Training
    • The intrinsic confidence and execution of dealing with others in a way that respects oneself.
    • Specific CBT Techniques to empower
      • Problem-solving skills, interpersonal engagement skills, friendship skills, communication and negotiation skills, assertiveness skills, and dealing with bullying skills.

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Cognitive Behavioral Therapy (CBT) -

METHODS OF EMPOWERMENT

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  • (5) Modifying the Family Environment.
  • Changing the way the family interacts and supports
  • Specific CBT Techniques to empower
    • Family communication and conflict resolution, family communication and conflict resolution, parent intrusiveness and overprotection management, parent contingency management, parent emotion management, and parent modeling of adaptive behavior.

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SUMMARY

1- Adolescents & Anxiety

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2- Brain Connectivity

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3- Empowerment Techniques

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1- Adolescents & Anxiety - SUMMARY -

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  • One in ten children and young people aged 5–16 years old have a diagnosable mental health disorder
  • Adolescence is a period of social and psychological change
    • Neurobiological development
      • Enhance vulnerability or provide growth and learning

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1- Adolescents & Anxiety - SUMMARY -

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  • Many adolescents are living a battle in quiet desperation without diagnosis or therapy.
  • Depression is especially common in adolescents aged 11–17, with up to 10% of this group meeting diagnostic criteria for clinical depression, with rates, possibly increasing.

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2- Brain Connectivity - SUMMARY

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  • Brain connectivity
  • Fear factor of the fight, flight, or freeze is connected to the amygdala
    • Brain activation center for fear, and anxiety trigger

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2- Brain Connectivity - SUMMARY

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  • Exposure of phobia-specific stimulus elicits brain activation
    • consistent with current understandings of the neuroanatomy of fear conditioning

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3- Empowerment Techniques - SUMMARY

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    • Resiliency coaches
    • Autogenic Training Relaxation Interventions
    • Cognitive Behavior Therapy (CBT)

(1) Managing Negative Thoughts

(2) Changing Maladaptive Behaviors

(3) Managing Maladaptive Mood and Arousal

(4) General Skills Training

(5) Modifying the Family Environment.

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3- Empowerment Techniques - SUMMARY

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  • An adolescent can learn how to identify, understand, and improve their modus operandi (method of operating).
    • Change thinking, change behavior

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FUTURE DIRECTIONS

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FUTURE DIRECTIONS

  • What effect does anxiety and phobia have on the high school dropout crisis in America?
    • Can intervention in mental health raise the dropout rate?

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FUTURE DIRECTIONS

  • Can school systems identify anxiety as part of standard practice and empower all adolescents with social and emotional curriculums.
      • How does a school system incorporate this?

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FUTURE DIRECTIONS

  • If is the intrinsic resolve that is needed to change the modus operandi and ultimately change the neuroscience of the brain and the trajectory of an adolescents life...
      • How can this be empowered in adolescents?

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REFERENCES

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References

Atkins, T., & Hayes, B. (2019). Evaluating the impact of an autogenic training relaxation

intervention on levels of anxiety amongst adolescents in school. Educational & Child Psychology, 36(3), 33–51.

Barnett, S. C., & Roskams, A. J. (2008). Olfactory ensheathing cells: Isolation and culture from

the neonatal olfactory bulb. Neural Stem Cells Methods in Molecular Biology™,

85-94. doi:10.1007/978-1-59745-133-8_8

Bell, C. J., Malizia, A. L., & Nutt, D. J. (1999). The neurobiology of social phobia. European

Archives of Psychiatry & Clinical Neuroscience, 249, S11.

https://doi.org/10.1007/PL00014162

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References

Burstein, M., Georgiades, K., He, J., Schmitz, A., Feig, E., Khazanov, G. K., & Merikangas, K.

(2012). Specific Phobia among US Adolescents: Phenomenology and Typology.

Depression & Anxiety (1091-4269), 29(12), 1072–1082.

https://doi.org/10.1002/da.22008

Ebesutani, Fierstein, M., Viana, A. G., Trent, L., Young, J., & Sprung, M. (2015). The role of

loneliness in the relationship between anxiety and depression in clinical and school-based

youth. Psychology in the Schools, 52(3), 223-234. doi:10.1002/pits.21818

Kalat, JW (2019) Biological Psychology. Cengage Learning.

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References

Ipser, J. C., Singh, L., & Stein, D. J. (2013). Meta-analysis of functional brain imaging in specific phobia. Psychiatry & Clinical Neurosciences, 67(5), 311–322. https://doi.org/10.1111/pcn.12055

Prater, K. E., Hosanagar, A., Klumpp, H., Angstadt, M., & Luan Phan, K. (2013). Aberrant

Amygdala-Frontal Cortex Connectivity during Perception of Fearful Faces and at Rest in

Generalized Social Anxiety Disorder. Depression & anxiety (1091-4269), 30(3),

234–241. https://doi.org/10.1002/da.22014

Ranta, K., Kaltiala-heino, R., Fröjd, S., & Marttunen, M. (2013). Peer victimization and social phobia: A follow-up study among adolescents. Social Psychiatry and Psychiatric

Epidemiology, 48(4), 533-44.

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References

Silverstone H., Bercov, M., Suen, V. Y., Allen, A., Cribben, I., Goodrick, J., . . . Mccabe, C.

(2017). Long-term results from the empowering a multimodal pathway toward healthy

youth program, a multimodal school-based Approach, show Marked reductions in

Suicidality, depression, and anxiety in 6,227 students in Grades 6–12 (AGED 11–18).

Frontiers in Psychiatry, 8. doi:10.3389/fpsyt.2017.00081

Sburlati, E. S., Schniering, C. A., Lyneham, H. J., & Rapee, R. M. (2011). A Model of Therapist

Competencies for the Empirically Supported Cognitive-Behavioral Treatment of Child

and Adolescent Anxiety and Depressive Disorders. Clinical Child & Family Psychology

Review, 14(1), 89–109. https://doi.org/10.1007/s10567-011-0083-6

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ADOLESCENT PHOBIAS

&

ANXIETY DISORDERS

FUNCTIONS AND SOLUTIONS

By Richard Kerry Thompson

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https://drive.google.com/file/d/1zRvs52RoT3VwgZAECEgrluhpODdcG2mz/view

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Richard Kerry Thompson

Final Research Paper

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