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Parent and Child Psychological Services PLLC 
941.357.4090 (Office)/ 941.877.6683 (SMS Text)/ 727.304.3619 (Fax)
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Combatting Panic Attacks By Jessica Custer, BA

9/30/2022

9 Comments

 
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Panic disorder affects many teens and can have a major impact on how they function in school and with peers. Research shows that many panic disorder is easily misdiagnosed or overlooked for overlapping symptoms with other anxiety disorders. Once Panic disorder has been diagnosed, there are many practical tools that can be implemented to help teens get back to a healthy level of functioning in every area of their lives. Panic disorder is treatable and often
CBT along with third-wave interventions are effective for teens to manage their anxiety levels that lead to panic attacks. One evidence-based treatment specifically targeted toward panic disorder in teens is Riding the Wave therapy, and this incorporates teaching teens to learn to identify their thoughts, emotions, and actions that may trigger panic attacks, and to learn to tolerate the discomfort of those, or “ride the wave” of anxiety. This treatment, along with incorporating mindfulness, meditation, diaphragmatic breathing, and therapeutic lifestyle  changes will help teen clients learn to tolerate anxious thoughts and feelings and calm their overreactive brains. I created a handout for teens to learn more about how to cope with panic in the moment, as well as things they can do daily to decrease the prevalence of panic disorder symptoms. These are helpful tools that a client can test out to find what works best for them.
  1. Knowledge- Know that a panic attack can be very scary, but they are not dangerous.
  2. Deep (Diaphragmatic) breathing- Breathe in through your nose for 4 counts, pause for 1 count, and breathe out through your mouth for 4 counts.
  3. Label it- It is not a heart attack, It is a panic attack. It is temporary and it will pass. 
  4. Close your eyes- Overwhelming stimuli can be a trigger and feed the panic attack. Close your eyes and focus on breathing.
  5. Mindfulness- Focus your attention on the present, recognize your  emotional state, and meditate regularly to reduce stress and help you relax. Mindfulness Grounding Strategy:
    1. Name 5 things you can SEE around you
    2. Name 4 things you can TOUCH around you 
    3. Name 3 things you can HEAR around you  
    4. Name 2 things you can SMELL around you  
    5. Name 1 thing you can TASTE around you 
  6. Focus Object- Find something to focus your attention on until the panic attack passes 
  7. Imagery- Visualize yourself in your happy place and focus on the details as much as possible. “feel the sand on your toes, warm sun on your shoulders, smell the pine trees, hear the rolling waves” 
  8. Calming Yoga- Practice yoga stretches and breathing. Use Youtube, or a favorite yoga App to guide you in your practice. 
  9. Smell Lavender- Lavender essential oil is calming and can help calm you. 
  10. Repeat a Mantra- This can be a favorite Bible Verse, or just a simple “This too shall pass”. Repeat it in a loop in your head until you feel the panic attack subside. 

Therapeutic Lifestyle Changes that can reduce panic attacks:
  • Daily deep breathing- 5- 10 minutes a day
  • Regular light exercise- yoga, walking, or light jogging
  • Reducing sugar and caffeine in your diet
  • Avoid alcohol and smoking

Riding the Wave of anxiety and Panic Attacks
So, we know that we cannot make the waves stop and we cannot rush them to move and go away any faster. They cannot be controlled or avoided. They will come and go, ebbing and flowing. The same goes for anxiety. If we resist the symptoms of anxiety by trying to control it, stop it, avoid it, or push it along quicker, the symptoms are more likely to get worse. So, what do you do about
the waves of anxiety? Well, you want to be more like a surfer. They are not intimidated by giant waves. In fact, to a surfer- the bigger, the better. Surfers are not trying to fight the waves, they are moving with the wave, flowing in the same direction. When you find yourself experiencing a wave of anxiety, try riding the
wave. 
Accept your symptoms, don’t suppress them.
Remember that anxiety and panic attacks cannot kill you. You cannot die
from them. Attempting to control the anxiety will only intensify the emotion.
Try thinking to yourself, “Ok, here it is again. I can handle this. It will pass.” 
Acknowledge your physical symptoms.
Anxiety not only impacts us emotionally and cognitively but also creates
changes in our bodies. Take notice of what your body feels like at the
moment. This may include heart palpitations, shortness of breath, heaviness in the chest, muscle tension, shaking, and sweaty palms. Watch and observe what is happening to your body without reacting to it with further fear or anxiety. 
Redirect Unhelpful Thinking.
Often our perceptions about our physical symptoms of anxiety lead to
further symptoms of fear and panic. Examine your thoughts and beliefs
about your physiological reactions. Instead of thinking “I can’t handle this”
or “I feel like I am going to die” try thinking of something more helpful. For
example, “I know I will be okay” or “I will let my body do its thing and move
through this.”
Utilize Relaxation Techniques.
Try taking some slow deep breaths. This may be called deep breathing,
belly breathing, or diaphragmatic breathing. Slow your breath and become
present in the moment. Focus on your inhale and exhale. You can also try
doing a visualization or mindfulness exercise to help ride the wave and wait
for it to pass. Remember to ride the wave of anxiety and it will eventually pass. You got this! Happy surfing! 

Helpful Apps:
Mindshift- meditations, journaling, symptom tracker, and it is free!
Reflect- Christian mindfulness and meditation app, also free!
Headspace- Great mindfulness and meditation app, good instructional videos, and inspirations as well. It is not free, but they do have a student discount rate.
Downdog Yoga - Great Yoga app that can be customized to your ability level. They offer a free account with your student email.

References

Baker, H. J., & Waite, P. (2020). The identification and psychological treatment of panic disorder
in adolescents: a survey of CAMHS clinicians. Child & Adolescent Mental Health, 25(3),
135–142. https://doi.org/10.1111/camh.12372
LPC, A. B. (2019, July 30). Riding the Wave of Anxiety. Therapists Raleigh Durham Chapel Hill
NC - Third Wave Psychotherapy. https://www.3rdwavetherapy.com/riding-the-wave-of-anxiety/
R.I.D.E. the Wave of Panic | Psychology Today. (n.d.). Retrieved September 22, 2022, from
https://www.psychologytoday.com/us/blog/life-without-anxiety/201110/ride-the-wave-panic
Pincus, D. B., Ehrenreich, J. T., & Spiegel, D. A. (2008). Riding the Wave Workbook: Riding the
Wave Workbook. Oxford University Press, Incorporated.
http://ebookcentral.proquest.com/lib/cochristuniv-ebooks/detail.action?docID=1573048

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Unlocking the Mystery of the Exceptional Student Education Process By Julia Hollinger, PsyD, NCSP

9/20/2022

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​Sarasota County Schools provides a continuum of supportive services to over 7,000 students with disabilities. However, navigating Exceptional Student Education (ESE) can be daunting for parents and private practitioners alike who may not be well- versed in the process or the lingo (see  Alphabet Soup). Below is an overview of the key concepts central to exceptional student identification.

Alphabet Soup: The ABCs of ESE

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At its core, the ESE process is comprised of three main components which are ideally executed in a linear fashion: Pre-referral, evaluation, and placement.

Pre-referral: Districts are responsible for implementing an MTSS process to provide struggling students with evidence based interventions to help determine the least restrictive environment in which a student’s needs can be met.

Evaluation: Conducted by the school if MTSS data indicates that a student is not responding appropriately to evidence based interventions and may require more intensive supports. The evaluation should answer two questions: 1. Does the student have a disability? And 2. Does the student require specially designed instruction?
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Frequently Asked Questions By Parents About Evaluation

Q: Doesn’t the school HAVE to, by law, honor my request?
A: No. The school is only required to respond to you request in a timely manner and to issue prior written notice stating the reason(s) for the school’s refusal to initiate an evaluation.
 
Q: I want an evaluation but I don’t want my child to be labeled or placed in special education.
A: Determination of eligibility for a disability and the need for special education is the purpose of a school-based evaluation.  If you would like an evaluation just for diagnostic clarification or to provide recommendations or strategies, a private evaluation may be more appropriate.
​
Q: What if I obtain a private evaluation or a prescription for an IEP by my child’s doctor or therapist?
A: You are encouraged to share any private evaluations and recommendations with the school.  However, recommendations pertaining to diagnosis or placement do not supersede the MTSS process. 
 
Q: My child already has a diagnosis. Doesn’t this mean s/he needs special education?
A: Not necessarily.  Privately diagnosed conditions may or may not translate to educational diagnoses, and your child may or may not need specially designed instruction.  Existing diagnoses do not supersede the MTSS process. 
 
Q: My child is struggling and I don’t know how else to help other than to request an evaluation.
A: Evaluation is a last resort after all other options have been exhausted.  It may or may not be appropriate for your child.  Your best bet is to contact your child’s teacher to ask how the school is helping your child and what more, if anything, you can do. 


Placement: Should a student be identified with a disability and found eligible for specially designed instruction, an IEP is developed and the decision of where the student’s needs can best be met is made by the team.

The IEP

The IEP written document for a student with a disability that is developed, reviewed, and revised in accordance with the law.  It includes information about a student’s present levels of functioning, goals and objectives, related services, specially designed instruction, testing accommodations, progress monitoring, and transition needs. IEPs are fluid documents and can be changed or revised at any time (with prior written notice and parent consent), but must be reviewed at least annually.  Parents have the right to due process should they be dissatisfied with the IEP.

The 504 Plan

For students with disabilities who do not require specially designed instruction, a 504 Plan may be an appropriate support.  A 504 Plan includes accommodations and changes to the learning environment that are implemented in the regular education setting for students whose disabilities interfere with their ability to access their education in the same manner as their nondisabled peers.  Like an IEP, a 504 Plan is a legally binding document that must be reviewed at least annually but can be revised at any time with parental consent.  In order to be eligible for a 504 Plan, the answer to all of the following questions must be “Yes”:
  1. Does the student have a physical or mental impairment?
  2. Does the impairment affect one or more major life activities such that the student is prohibited in having access to their educational program?
  3. Is the student substantially limited by the major life activity?
  4. Is an aid, service or accommodation needed to enable the student to participate in their educational program?​                    

More information on Sarasota County ESE can be found here: https://www.sarasotacountyschools.net/domain/1172
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How Parents Can Stay Calm When Your Child Is Not By Tara Motzenbecker, NCSP, LMHC

9/11/2022

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When a child is tantruming or losing control, it is extremely hard for parents to stay calm and regulated. This can be due to mirror neurons, which is when you observe the behaviors or emotions of another, the neurons in your brain fire as if you were having that same experience.  It can also be due to parents’ other emotions being triggered such as embarrassment or anxiety that you will now be late. 

Unfortunately, the mirror neurons continue working and until one person is regulated, the other will not be. Since a child’s brain is not fully developed, the adult has a better regulation capacity. Here are some ways parents can regulate themselves:

Breathe
Neuroscience shows that slow deep breaths in and out is the most effective way to calm your body. Breathing slows your heart rate and actually gives signals to your brain that your environment is safe - taking you out of the flight/fight response of anxiety and anger. The key is to breathe out for twice as long as you breathe in - think in for 4 and out for 8. Not only will your child’s neurons mirror yours to begin calming, but their breathing will also match up with yours, further calming their system. 

Self talk
The human brain can naturally go to negative thoughts such as “Ugh here we go again” or “now the day is ruined”. These thoughts can lead to further dysregulation.  Instead, try to be intentional and use positive self-talk such as “I can do this” or “All kids do this. I just need to breathe”. 

Grounding skills
Grounding skills help us stay in the here and now and allow us to be present and regulate through the duration of the tantrum. Some great ways to ground are identifying and naming (in your head) 5 things you see, 4 things you hear, 3 things you touch, 2 things you smell, and one thing you taste. It can also be as simple as holding a grounding object like a stone, intentionally noticing the air going in through your nose and out through your mouth, or looking for something around you for each color of the rainbow. 


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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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