managing anxiety disorders – let’s talk facts …
TRANSCRIPT
MANAGING ANXIETY DISORDERS –LET’S TALK FACTS
NOVEMBER 8, 2019
DR. ANGELA LYKINS, PH.D., HSPP
LICENSED CLINICAL PSYCHOLOGIST
HEALTH SERVICE PROVIDER IN PSYCHOLOGY
OBJECTIVES
• LIST POTENTIAL CAUSES OF ANXIETY
• ADDRESS SYMPTOMS AND CHARACTERISTICS
• UNDERSTAND PREVALENCE RATES
• DISCUSS POTENTIAL TECHNIQUES
• IDENTIFY ASSESSMENTS AND RESOURCES
WHAT IS AN ANXIETY DISORDER?
DIAGNOSTIC AND STATISTICAL MANUAL, 5TH
EDITION
A) PERSISTENT FEAR
B) EXPOSURE TO THE FEAR PROVOKES ANXIETY
C) THE PERSON KNOWS THE FEAR IS UNREASONABLE
D) THE FEARED SITUATIONS ARE AVOIDED
E) ANXIETY INTERFERES SIGNIFICANTLY WITH DAILY LIFE
F) THE FEAR, ANXIETY, OR AVOIDANCE IS PERSISTENT, TYPICALLY LASTING 6 OR MORE MONTHS
G) THE FEAR OR ANXIETY IS NOT DUE TO DIRECT PHYSIOLOGICAL EFFECTS
MANY
COMPLICATED
TERMS
WHERE DO WE
BEGIN?
CAUSES OF ANXIETY DISORDERS:NEUROBIOLOGICAL
Dysregulation of autonomic nervous system
Sensory integration
Abnormal cardiovascular and electrodermal responses
Genetic temperament of family
CAUSES OF ANXIETY DISORDERS:
STRUCTURAL ABNORMALITIES
ABNORMALITIES OF SEROTONIN AND DOPAMINE
METABOLIC DEFICITS IN FRONT CORTEX
STRUCTURE ABNORMALITIES IN AMYGDALA AND HIPPOCAMPUS; LIMBIC SYSTEM AS A WHOLE
LIMBIC SYSTEM: PREFRONTAL CORTEX
CAUSES OF ANXIETY DISORDERS: ENVIRONMENTAL
Trauma/bullying Multiple homes TransitionsStressful work
and social situations
IllnessStrict routines
and lack of choice
Service providers from different disciplines and
agencies
COMMON TYPES OF ANXIETY DISORDERS
Generalized Anxiety Disorder (GAD)
COMMON TYPES OF ANXIETY DISORDERS
Panic Disorder
STRESS METER/ PANIC CYCLE
COMMON TYPES OF ANXIETY DISORDERS
Obsessive Compulsive Disorder
COMMON TYPES OF ANXIETY DISORDERS
Specific Phobia
COMMON TYPES OF ANXIETY DISORDERS
Social Anxiety Disorder
COMMON TYPES OF ANXIETY DISORDERS
Posttraumatic Stress Disorder
COMMON TYPES OF ANXIETY DISORDERS
Generalized Anxiety Disorder (GAD)
Panic Disorder
Obsessive Compulsive Disorder
Phobia
Social Anxiety Disorder
Posttraumatic Stress Disorder (PTSD)
SYMPTOMS
excessive worry
restlessness fatiguedifficulty
concentratingirritability
muscle
tension
heart palpitations
accelerated heart rate
sweating trembling phobias hypervigilance
panic
attacks
obsessive thoughts
compulsive behaviors
screaming yelling flapping rocking
sleep disturbances
withdrawal aggression Interruptingrepetitive questions
self-injurious
behaviors????
HOW DO WE RECOGNIZE
SYMPTOMS IN
OURSELVES AND WITH
OTHERS?
PREVALENCE• STATISTICS: MOST COMMON MENTAL HEALTH
DIAGNOSIS IN THE U.S. (PER NATIONAL
INSTITUTE OF MENTAL HEALTH-NIMH).
• OF THE 40 MILLION PEOPLE DIAGNOSED
WITH ANXIETY DISORDER
A) ALMOST 7 MILLION SUFFER FROM GAD
B) ALMOST 14 MILLION SUFFER FROM SOCIAL ANXIETY DIOSRDER
C) ALMOST 7 MILLION AFFECTED BY PTSD
D) ALMOST 13 MILLION EXPERIENCE COMORBID DX OF DEPRESSION
COMORBIDITY
POTENTIAL TECHNIQUES
• PSYCHOTHERAPY: COGNITIVE BEHAVIORAL THERAPY
• TELL YOURSELF: “IT’S OK TO FEEL ANXIOUS”
• WILLINGNESS: CHOOSING AND ACCEPTING TO FEEL WHAT YOU ARE EXPERIENCING IN THE MOMENT
• WHY DO YOU WANT TO BEAT ANXIETY? TALK OUT LOUD
• MINDFULNESS: PRESENT MOMENT HEADSPACE OR STOP, BREATHE & THINK – 10 MINUTES A DAY
• ACCEPTANCE AND COMMITMENT THERAPY (ACT)
• GROUNDING (ANXIETY, FLASHBACKS, PTSD, IMPROVING MENTAL HEALTH) – PARASYMPATHETIC RESPONSE COUNTERACTS THE FEAR RESPONSE
• SELF-REGULATION ACTIVITIES (BREATHING TECHNIQUES)
• SHARING DAILY A MISTAKE YOU MADE (AT DINNER TABLE, JOURNAL, SOCIAL MEDIA)
COGNITIVEBEHAVIORALTHERAPY
GROUNDING EXERCISE 5-4-3-2-1
DEEP BREATHING
POTENTIAL TECHNIQUES: BEHAVIORAL
• LIFE STYLE
• REDUCE STIMULI (LIGHTING, CLUTTER, NOISE,
TEMPERATURE)
• REDUCE TRANSITIONS
• SKILL BUILDING
• PROVIDE ACTIVITIES TO ENGAGE WITH OTHERS
• TEACH CAREGIVER TECHNIQUES TO IMPROVE
COMMUNICATION SKILLS
• REDIRECTION
• POSITIVELY REINFORCE FOR DESIRED BEHAVIORS
POTENTIAL TECHNIQUES : PHARMACOTHERAPY
Selective Serotonin Reuptake Inhibitors
(SSRI): Prozac, Celexa, Lexapro,
Zoloft, Paxil, Luvox
Serotonin Norepinephrine
Reuptake Inhibitors (SNRI): Pristiq,
Cymbalta, Effexor
Benzodiazepine: Xanax, Klonopin,
Valium
ASSESSMENTS/RESOURCES
• SELF-REPORT & INFORMANT REPORT:
GLASGOW ANXIETY SCALE
• PHQ-9 (PATIENT HEALTH QUESTIONNAIRE) –
USED BY HEALTH CARE PROFESSIONALS
• MASS (MOOD AND ANXIETY SEMI-STRUCTURED
INTERVIEW) –USED BY HEALTH CARE
PROFESSIONALS
• ADAMS (ANXIETY, DEPRESSION, AND MOOD
SCALE) – USED BY HEALTH CARE
PROFESSIONALS
ASSESSMENTS/RESOURCES
• THE FEAR SURVEY
• (ABC-2) ABERRANT BEHAVIOR CHECKLIST-2
• (PAS-ADD-10) THE PSYCHIATRIC ASSESSMENT
SCHEDULE FOR ADULTS WITH
DEVELOPMENTAL DISABILITIES
• PAS-ADD CHECKLIST FOR NON-SPECIALISTS
REFERENCES
• ADDRESSING ANXIETY IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, DR. JULIE STECK, CRG, JUNE 2016
• ANXIETY AND INTELLECTUAL DISABILITY, MOLLY FAULKNER, PH.D., CNP, LISW UNIVERSITY OF NEW MEXICO, MARCH 2015
• ANXIETY, DEPRESSION AND MOOD SCALE, AJ ESBENSEN , J ROJAHN , MG AMAN,S RUEDRICH , 2003
• THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; 5TH EDITION, PUBLISHED BY AMERICAN
PSYCHIATRIC ASSOCIATION, 2013
• GLASGOW ANXIETY SCALE FOR PEOPLE WITH AN INTELLECTUAL DISABILITY (GAS-ID), BLACKWELL PUBLISHING 2003
• INDIANA FAMILY & SOCIAL SERVICES ADMINISTRATION
• MENTAL HEALTH ISSUES FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, KAREN TOTO, LMFT,
JANUARY 2017
• THE MOOD AND ANXIETY SEMI-STRUCTURED INTERVIEW, CHARLOT, DEUTSCH, HUNT, FLETCHER, & MCILVANE, 2007
• PATIENT HEALTH QUESTIONNAIRE-9, EDUCATIONAL GRANTS FOR DRS SPITZER, WILLIAMS AND KROENKE
CONTACT INFORMATION
Dr. Angela Lykins
Lykins Counseling Clinic
4221 N Broadway Avenue
Muncie, IN 47303
765-282-7150