Anxiety / Depression

Symptoms of childhood/adolescent Anxiety and Depression can cross-over to varying degrees (e.g., sleep and appetite disturbances, stomach aches and other physical symptoms, irritability, and difficulties concentrating). Depression is more often characterized by feelings of hopelessness and loss of interest in pleasurable activities, whereas Anxiety is characterized by excessive worry and avoidance of particular stimuli or situations. Treatment for both Anxiety and Depression require Cognitive-Behavioural Therapy to confront and challenge maladaptive thinking patterns.

Treatment for Depression places greater emphasis on positive activity scheduling, more accurately evaluating others’ behaviours and intentions, and improving social skills (e.g., initiating conversations, assertiveness training, etc.) Treatment for Anxiety heavily stresses effective dealing of panic, relaxation techniques, more logical evaluations of risk, and utilizing incentives to gradually confront feared situations (e.g., sleeping alone, doctor/dentist appointments, test taking, public evaluation), or perfectionist tendencies.

Recovery depends on enabling children to recognize when they are anxious, utilizing cognitive restructuring to view fears as excessive and unreasonable, approaching feared situations in safe increments, and assisting in adopting lifestyle changes to promote a more relaxed, balanced, and healthy approach to life.

There are three characteristics which distinguish a phobia from ordinary, everyday fears. First, there is a persistent fear of the object or situation over a long period of time. Second, recognizing that the fear is unreasonable does not help to dispel it. Third, the feared situation (e.g., public speaking) becomes regularly avoided. Avoiding anxiety-provoking situations are rewarding because anxiety is reduced.

Anxiety disorders are distinguished from everyday, normal anxiety in that they involve anxiety that:

1. Is more intense (e.g., panic attacks)
2. Lasts longer (anxiety that may persist for months instead of going away after a stressful situation has passed)
3. Leads to phobias that interfere with your life.

Before embarking on a program for recovery, it is important that the following questions are given attention:

• What are the most important positive changes I want to make in my/my child’s life? • What would a complete recovery from my/my child’s present condition look like?
• Specifically, how will I/my child think, feel, and act when fully recovered?
• What new opportunities will I/my child take advantage of once fully recovered?

Once you’ve defined what your own/your child’s recovery might be like, it can be very helpful to practice visualizing it.

SPECIFIC ANXIETY DISORDERS

The anxiety field has moved increasingly towards specialization. Today, there are conferences, assessment tools, and treatment approaches devoted to each particular anxiety disorder. Here are a number of the various anxiety disorders defined by the DSM-IV:

PANIC ATTACKS

Physiologically, anxiety is a subjective state of apprehension and uneasiness. In its most extreme form, it can cause you to feel detached from yourself and even fearful of dying or going crazy. Panic disorder is characterized by sudden episodes of acute apprehension or intense fear that occur “out of the blue”, without any apparent cause. Intense panic usually lasts no more than a few minutes, but, in rare instances, can return in “waves” for a period of up to two hours. During the panic attack itself, any of the following symptoms can occur:

• Shortness of breath or a feeling of being smothered
• Heart palpitations-pounding heart or accelerated heart rate
• Dizziness, unsteadiness, or faintness
• Feeling of choking
• Sweating
• Nausea or abdominal distress
• Feeling of unreality- as if you’re “not all there” (depersonalization)
• Numbness or tingling in the hands and feet
• Hot and cold flashes
• Chest pain or discomfort
• Fears of going crazy or losing control
• Fears of dying

At least four of these symptoms are present in a full-blown panic attack, while having two or three of them are referred to as a limited-symptom attack. There is a tendency to develop anticipatory anxiety or apprehension between panic attacks focusing on fear of having another one.

AGORAPHOBIA

The essence of agoraphobia is a fear of panic attacks. Agoraphobics fear being in situations from which escape might be difficult in the case of a sudden panic attack. Fear of embarrassment plays a key role. Depression is a condition that often accompanies agoraphobia. Researchers have found a connection between separation anxiety disorder in childhood and panic attacks and agoraphobia in adolescence and adulthood. Separation Anxiety Disorder is a condition where children experience anxiety, panic, or somatic symptoms when separated from their parents (e.g., going to school or to bed).

SOCIAL PHOBIA

Social Phobia involves fear of embarrassment or humiliation in situations where one feels his performance is being evaluated by others (e.g., reading aloud). Social phobias tend to develop earlier than many other phobias. Social Skills Training and Assertiveness Training are skills typically integrated into the treatment program for Social Phobia.

GENERALIZED ANXIETY DISORDER

Generalized Anxiety Disorder is characterized by chronic anxiety that persists for at least six months but is unaccompanied by panic attacks, phobias, or obsessions. Anxiety and worry focus on two or more stressful life circumstances (e.g., relationships, health, finances) a majority of days during a six-month period. Generalized Anxiety Disorder involves having at least three of the following symptoms (with some symptoms present more days than not over the past six months):

• Restlessness-feeling keyed up
• Being easily fatigued
• Difficulties concentrating
• Irritability
• Muscle tension
• Sleep difficulties

Problem Solving and Distraction exercises are typically integrated into treatment approaches. Generalized Anxiety Disorder often occurs together with depression.