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Parent and Child Psychological Services PLLC 
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Teen Anxiety in a Post-Covid World by Jessica Custer, BA

1/28/2023

2 Comments

 
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Anxiety is one of the most common mental disorders among teenagers. Before the pandemic, the rates of anxiety and depression among teens were on the rise, but recent CDC data suggests that mental health for teenagers has been heavily impacted by the Covid-19 pandemic. Increased pressure to succeed in school, living in the age of social media, and living in a society plagued with mass shootings and war coverage on the media are all factors that affect how teens cope with symptoms of anxiety. We can now add covid related stressors like social isolation, missed milestones, increases in family stress, and online school pressures to the list of factors that influence teens today.  Teens are especially vulnerable to feeling the effects of these outside stresses because they are in a unique stage of life that is already filled with uncertainty and doubt within themselves. Being aware of what teens worry about, how to best support them, as well as what symptoms to look for that may signal the need for help are all important areas for parents and teachers to be aware of to lower teen risk factors for anxiety disorders.

What is Anxiety?
Anxiety is a broad description of multiple different mental disorders. Some of the more common anxiety disorders are specific phobias, panic disorder, separation anxiety, social anxiety, generalized anxiety, selective mutism, and obsessive-compulsive disorder. Anxiety can look different in different people, but it is generally an overreaction of the sympathetic nervous system, or fight, flight, or freeze response, so something that is perceived as a threat when it is not. Teens today worry about school performance, college admission and scholarships, others’ perceptions of them, and their changing bodies. Some amount of anxiety is normal and healthy, it motivates us to achieve and excel, but often the symptoms of anxiety can become overwhelming and lead to unhealthy effects on the brain and body. There are many outward symptoms of anxiety to look for in teens and different teens may have different combinations of symptoms. Some symptoms include:
  • Recurring worries about many things, frequent need for reassurance
  • Irritability or anger
  • Perfectionism
  • Body dissatisfaction
  • Inability to focus
  • Extreme self-consciousness and sensitivity to criticism
  • Withdrawal from friends or activities
  • Avoidance of stressful or new situations
  • Frequent physical complaints
  • Substance use 

How Can I Help My Teen?
Anxiety disorders may be on the rise, but the good news is that there is hope and help for teens who may be feeling overwhelmed and paralyzed by anxious thoughts and worries. Some good preventative measures can be helpful to incorporate into a healthy lifestyle that can lower a teen’s risk for developing an anxiety disorder but be aware that sometimes genetics play a larger role. Risk factors include genetic predisposition, social isolation, parental overprotection or parental indifference, a temperament prone to behavioral inhibition (fear-based temperament from childhood), high screen time, low physical activity, poor nutrition, and poor sleeping habits. Research suggests that teens with less than 2 hours of screen time have a significantly lower risk for anxiety and this is noteworthy. It may be due to the sleeplessness teens experience when they stay up too late watching videos or movies, or the lack of physical activity that occurs when teens spend too much time on screens, but it is something to pay attention to in lowering the risk of anxiety disorders. It is also important that teens are getting enough sleep, well-rounded nutrition, and regular physical activity to combat the effects of too much stress on their bodies. The best strategy for parenting teens who worry a lot is to acknowledge and empathize with the teens’ feelings while also not giving too much credit to the worry or fear. Showing your support for hard emotions is important but giving too much attention to worry can make it grow.
    
Even when all the preventative measures are taken, some teens have a predisposition to anxiety disorders and may need extra help to learn to manage and overcome the symptoms. Seeing a counselor who can help them learn to combat those anxious thoughts, and tolerate the discomfort through exposure, mindfulness, and coping skills will lead to a healthier and happier life. Cognitive Behavioral Therapy combined with mindfulness strategies has been shown to have great success in combatting anxiety. Medication may be needed by some as well to receive the full benefits of therapy.  It is important not to ignore your teen’s overwhelming anxiety symptoms because untreated anxiety can lead to substance abuse, depression, and even suicidality. Children who are exhibiting behavioral inhibition, fear of strangers, or new activities, have a much higher risk of developing an anxiety disorder as a teen and young adult and would benefit from earlier treatment as a preventative measure. Anxiety is a normal part of life for everyone, and a certain amount can be beneficial, but when teens get overwhelmed and do not have the skills to cope or manage their symptoms, the problem can grow and become unmanageable. Offering support, modeling healthy habits, and encouragement of healthy lifestyle choices can make a big difference in preventing your teen from developing an anxiety disorder.


References

Anxiety among kids is on the rise. Wider access to CBT may provide needed solutions. (n.d.). Https://Www.Apa.Org. Retrieved November 9, 2022, from https://www.apa.org/monitor/2022/10/child-anxiety-treatment

Better ways to combat anxiety in youth. (n.d.). Https://Www.Apa.Org. Retrieved November 9, 2022, from https://www.apa.org/monitor/2019/12/combat-anxiety

Kim, S., Favotto, L., Halladay, J., Wang, L., Boyle, M. H., & Georgiades, K. (2020).

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.
Social Psychiatry & Psychiatric
Epidemiology
, 55(11), 1469–1478. https://doi.org/10.1007/s00127-020-01833-9


Miller, C. (2022). 
How Anxiety Affects Teenagers. Child Mind Institute. https://childmind.org/article/signs-of-anxiety-in-teenagers

The Crisis of Youth Mental Health | NAMI: National Alliance on Mental Illness. (n.d.). Retrieved November 9, 2022, from https://www.nami.org/Blogs/From-the-CEO/April-2022/The-Crisis-of-Youth-Mental-Health
​

General, O. of the S. (2021, December 7). U.S. Surgeon General Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-19 Pandemic [Text]. HHS.Gov. https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html

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Dr. Bruce Perry’s Regulate, Relate, Reason Framework By Izzy Devorkin, RMHCI, NCC

1/20/2023

1 Comment

 
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Do you think your child could win an award for having the world's longest tantrums? It may sometimes feel this way. Many times, your child’s tantrums cause extreme frustration for both you and your child. As a parent, there are certain tools that can be used in conjunction with your child’s tantrums to help them learn, think, and reflect. This framework will also help strengthen your relationship with your child. 

Dr. Bruce Perry, a renowned neuroscientist in the field of children's mental health and trauma, created a simple sequence that will help you as a parent feel more prepared for a tantrum, and your child feel more supported. This sequence is known as The Three R’s. 

It’s helpful to learn this framework through an example. Let’s use a classic one - your child is having a tantrum because you won’t let them have a second piece of cake at a birthday party. Your child’s tantrum may feel embarrassing especially when you’re surrounded by others, so what can you do? First, try your best to ignore the reactions of people around you, and focus on what you can do in the moment rather than what other people are thinking about you and your child. 

The Three R’s: Regulate, Relate, Reason

Regulate

This is where we start. The moment your child starts having a tantrum it’s important to take action to help them regulate, and make sure you’re regulated yourself. It may be helpful to ask your child during a time when they are relaxed, what helps them calm down. Some kids like to have space, some like having their back rubbed or having some water and a snack, it really depends on what helps your child feel best. It’s also important that you as a parent are aware of what helps calm you down so you feel like you can handle the situation. Whether that’s taking some deep breaths or having a glass of water, find what it is that helps you feel regulated.

It may be hard to understand that sometimes your child needs space, and you may be tempted to show affection because that’s what will make you feel better, but it’s crucial to do what feels right for them. In the example of wanting a second piece of cake, maybe your child needs physical touch to regulate, so you spend a few minutes or however long it takes rubbing their back until they start to show signs of calming down. It’s important to limit language in this step, and really use it as a time to let your child process their emotions. 

Relate

This is where connection comes in. Once you and your child have both calmed down, this is where a calm and soothing dialogue can be introduced through saying compassionate and empathetic things like “I sometimes want two pieces of cake too” or “it can be really frustrating when we can’t have what we want.” This is a really important moment to build those connections with your child and relate to them. If your child doesn’t seem ready to accept dialogue, you can also let them know that you are there when they are ready. 


Reason

This is the last step of the sequence, and it’s crucial to not jump to reasoning until you have gone through the other R’s. Many times, it’s a natural response to want to reason with your child right away and say things like “if you have another piece of cake your tummy will hurt and you will feel sick.” Trying to reason first will not work as it takes a higher level of thinking, and when a child is completely dysregulated and having big emotions, their thinking brain is not turned on, and your dialogue may cause even more frustration for the child. 

After you and your child are regulated, and you have related with your child, then the reasoning can come into play. This is when you can say things like “I don’t want your tummy to hurt and having a lot of cake can make you feel sick.” This is a great time to name the child’s emotions and use this as an opportunity to help your child learn more about their big feelings. 

If this sequence was skipped and you just took your child home from the birthday party without utilizing this sequence, the tantrum may have been prolonged and you have missed an opportunity to connect with your child and help them learn and reflect.

The Three R’s can be used any time a child is having a meltdown. To help you remember Three R’s, it may be beneficial to have post-it notes throughout your home that say ‘RRR’ to help jog your memory in times of dysregulation. Having this simple reminder will allow you to feel in control of your emotions, and increase your confidence in your ability to approach the situation at hand. It will take practice to feel prepared in utilizing this approach, but the more you practice implementing it, the more natural and effective it will become.

Resources:
  • https://wvpbis.org/wp-content/uploads/Effective-Responses-to-Trauma.pdf
  • https://chosen.care/videos/the-three-rs-regulate-relate-and-reason/
Visual
  • https://beaconhouse.org.uk/wp-content/uploads/2019/09/The-Three-Rs.pdf

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What to do with Worry by Kirsten Ellingsen, PhD, PMH-C

1/13/2023

0 Comments

 
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Worry is the thought component of anxiety.  An important part of effectively managing anxiety is recognizing, challenging, and changing unhelpful thoughts and thinking patterns. 

Worry can be productive and facilitate planning and problem solving for an upcoming event or figuring out how to prepare for an upcoming challenge.  It can be beneficial for academic achievement. It can enhance focus and motivation.  For example, if your child is worried about an upcoming test worry can encourage productive studying and enhance performance. It can also motivate action to prepare for potential risk or challenges, such as gathering supplies and an evaluation plan if a predicted hurricane nears. Worry might also help a child think through consequences and be more cautious to moderate risk-taking behavior.  

When worry is addressed or facilitates productive action it is a manageable and helpful part of normal life. Everyone worries. Just like we do not want to get rid of all anxiety, we do not want to get rid of all worry. The goal is to recognize and use worry to make safe choices and prepare or plan for necessary responses to challenges.

However, worry is an ineffective method to solve problems if thoughts begin to focus on extremes (e.g., the “what if…” or highly unlikely 1% possible negative outcomes) and become out of balance to real danger or circumstances. When worry is excessive, frequent and/or interferes with enjoying and full functioning in life it can become a significant problem.  It is a problem when worry is unrealistic with an exaggerated risk or probability that results in a child not wanting to participate in expected or otherwise enjoyable activities.

What anxiety might look like for children and teens
  • Frequent reassurance-seeking.
  • Afraid to separate from parents; fear of being alone.
  • Complaints about physical symptoms (headaches, stomachaches). 
  • Anger or Oppositional behavior. Increased moodiness or irritability.
  • More tantrums or meltdowns (particularly toddlers and preschool age children). 
  • Changes in appetite or eating behavior. Trouble falling asleep or regression in sleep.
  • Trouble falling asleep or regression in sleep.

Steps to Managing Worry
THOUGHTS: Teaching children that they can reduce worry and that worry thoughts are connected to how they feel is the first step to helping them effectively manage worry. Helping children identify worry as thoughts and choose more helpful and realistic thoughts is the goal.

Different types of thoughts can make a person feel more or less anxious. Encourage the Maybe for unknown. Help children become comfortable tolerating uncertainty (and that we cannot know 100% what will happen in any given situation). Learning strategies to increase calming thoughts and relaxation strategies to calm our body can help reduce worry and better manage anxiety. 

Challenge Worry: Break it down to understand concerns. Guide child/teen to more balanced or helpful thoughts. Ask “What is the evidence for this/against this”? Question “Are you sure?” “Is that a fact or feeling?” “Am I jumping to conclusions?”.

Help children identify and choose more helpful and realistic second thoughts, so that children realize that they are able to handle worry and feel better by noticing and transforming self-talk, perspective, and the thoughts.

Model healthy coping and express how you manage worries.

Facilitate problem solving and work together to come up with a plan rather than offering a solution or fixing the problem so your child is empowered to address the problem.

ACTIONS: While worry is the thought component of anxiety, there are actions that can help decrease and manage worry. 
Physical sensations (our fight or flight response) and emotional reactions are also part of anxiety.  Relaxation strategies (diaphragmatic “belly” breathing, progressive muscle relaxation, and guided imagery) can help reduce the physiological symptoms of anxiety.  Some suggestions for helping children manage anxious thoughts and worry (particularly when it is problematic) are presented below.
Finally, show compassion and help your child identify and express his or her feelings. Keep the worry in perspective. Validate feelings first. Don’t minimize feelings or dismiss worry Listen. Model calm. Acknowledge concerns and then help them come up with more useful thoughts. Make sure your child gets adequate sleep and re-sets with physical activity every day. 

Additional Resources:
Coping Skills for Anxiety www.therapistaid.com/worksheets/coping-skills-anxiety
Worry Less in 3 Steps: kidshealth.org/Nemours/en/kids/worry-less.html



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The Power of Forgiveness and Letting Go By Rachel Funnell, LMFT

1/6/2023

2 Comments

 
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It’s nearly impossible to go through life without experiencing some form of betrayal, aggression or just plain insensitivity from someone. People can hurt you in so many different ways and forgiving them is not always easy. When we feel betrayed by someone we trust and love, it can be extremely hard to understand why that person hurt us, intentionally or not. However, unresolved conflict, holding on to grudges or ruminating can have a significant effect on your physical and mental health. 

Chronic anger puts your body in flight or fight mode, which results in numerous changes to your heart rate, blood pressure and immune response. It can cause depression, anxiety, problems sleeping and concentrating. Studies have found that the act of forgiveness can lower the risk of heart attack, improve cholesterol levels, improve sleep, reduce pain, reduce blood pressure and decrease levels of anxiety, depression and stress. 

Depending on the offense, forgiveness can seem nearly impossible. It can be difficult to find compassion for someone who has wronged you. It may even feel like forgiving them is like letting them off the hook. However, forgiveness allows you to let go of the negative emotions and thoughts and be able to move forward, either with or without that person. 

Forgiveness is not just saying the words. It’s a choice that is made. It’s a process in which you are actively making a decision to let go of negative feelings whether it’s deserved or not. Depending on the severity of the offense, the process could take weeks, months or even years. 

    The following steps can help with the process of forgiveness:

  1. Before you can forgive, you have to reflect and process the offense. What happened? How did you react? How did you feel? How has the hurt and anger affected you since it happened? 
  2. As hard as this may be, empathize with the person. If you can put yourself in their shoes, you may better understand why they did what they did. This act of empathizing doesn’t excuse the offense or the person but it helps you see them as a human being that made a mistake. 
  3. Let go of the expectation that they will or should apologize. If you don’t expect it then you won’t be disappointed. 
  4. If able, tell the person that you forgive them. If that is too difficult or not possible, talk about it with someone you trust or write about it in a journal. 

Forgiveness is tough at times, however, the more you practice forgiveness the better you’ll be at it. And the research is clear, that forgiveness leads to a happier and healthier life. 


https://www.verywellmind.com/the-benefits-of-forgiveness-3144954

https://blog.aamft.org/clinical-topics/page/3/
​

https://www.hopkinsmedicine.org/health/wellness-and-prevention/forgiveness-your-health-depends-on-it

https://wa-health.kaiserpermanente.org/forgiveness-health-benefits/


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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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