School of Psychology & Clinical Language Sciences

Anxiety and depression in children and teenagers

Mental Health Awareness Evening 10th June 2015

Professor Cathy Creswell & Professor Shirley Reynolds

What do we mean by

Anxiety

• Fear, stress, worry, nervousness

• Body: Heart racing, sweaty, butterflies…

• Thoughts: “Something bad is going to happen”

• Behaviour: Flight or fight.

Depression

• Low mood, irritability, lack of pleasure

• Body: Low energy• Thoughts: ‘I’m a

failure’• Behaviour: Withdrawal

Why anxiety and depression?

• Both are common in under 18s• Often appear together or in sequence• Interfere with normal life at home and at school• Share several features

– Genetics– Environment– Thinking and behaviour

• Treatment is similar (not identical)

Should I worry?

• All children and young people (and adults) have changes in mood

• Being fearful is very common

during childhood (strangers,

animals, leaving parents,

new school, public speaking)

• Adolescence is often a time

of self consciousness, change

and challenges

When might anxiety be a problem?• Some anxiety is developmentally appropriate• Possible excessive anxiety when:

– Fear is out of proportion to the level of threat.– Fear in the absence of actual threat.– Difficulty settling back to a normal state

• Anxiety becomes a problem when it prevents children from enjoying normal life

experiences e.g. impacts on school,

friendships, family life.

Ben, aged 12‘Ben’ becomes tearful each morning before school and complains of feeling sick. Although his teachers report that he is fine when he has settled in, he is most comfortable when he can meet a teaching assistant each morning when he arrives. He finds it difficult to sleep alone, frequently comes down to his parents throughout the evening and often goes to sleep in their bed during the night. If his parents go out without him he texts them frequently to check that they are OK and to find out when they will be home. He is reluctant to go out with friends or join activities after school.

Depression in adolescence: Aren’t all teenagers ‘moody’?

Everyone has times when they feel miserable

Teenagers also have to learn to cope with a number of additional challenges

Grief, low mood, sadness and other negative feelings are all ‘normal’

But: Depression is not the same as being moody, sad & upset

1. Core symptoms – low mood/irritability and/or lack of pleasure most of the day, nearly every day

2. lasts for more than 2 weeks,

3. Plus 4 additional symptoms, e.g. sleep problems, change in appetite, suicidal thoughts, lack of energy, feelings of worthlessness etc, and

4. Difficulties interfere with functioning (e.g school, work, friends, family)

Ellie, aged 16‘Ellie’ is 16 years old, and at school studying for her GCSE’s. She feels down most days and cries a lot. Ellie finds it a real struggle to concentrate on homework, and even though she still goes to school and has dance classes twice a week, she feels like she isn’t enjoying anything she does. Ellie finds it hard to get to sleep, and often wakes up in the middle of the night. Ellie has lost her appetite since she started feeling low, and only eats when her mum makes her. She thinks she is a failure and things are never going to improve.

What predicts anxiety & depression?

Biology / genetics - these difficulties run in families

Environment - life events, triggers, learning

Relationships - are often protective

What keeps anxiety and depression going?

It is a cloudy day and you are sitting on the beach. You look up to notice the weather

really beginning to change.

Thinking biases

• Negative anticipated outcome:

‘It’s probably going to rain’

• Positive anticipated outcome:

‘The sun’s coming out’

• Depressed or anxious young people make more negative interpretations. They see themselves as less capable, the world as more frightening & the future less hopeful

What keeps problems going?

Thoughts

FeelingsBehaviours

What keeps problems going?

That’s a dangerous

dog

TerrifiedRun away,

hide

What keeps problems going?

They think I’m stupid

Sad, lonely

Keep to myself

What keeps problems going?

Thoughts and beliefs that interpret the world more negatively

Behaviours that make us feel better immediately but worse in the long run (e.g. avoidance)

Treatment for anxiety/depression

• Is usually based on Cognitive Behaviour

Therapy (CBT)• CBT can be delivered in many different ways

– Parents, self help, books, internet, face to face, groups etc

• CBT involves– Working together as a team– Identifying goals for treatment– Focusing on the here and now– Using strategies to help learn how the world really works – Challenging thinking & changing behaviours by

undertaking ‘experiments’

How can you help as a parent?

• Pay attention – anxiety and depression are not always obvious

• Quality time- be available in gentle way

• Listen, support, acknowledge feelings and that it’s hard

• Healthy lifestyles – exercise/healthy eating/ sleep

How can you help as a parent?

• Create opportuities for independence

• Encourage curiosity to test out negative thoughts

• Encourage brave behaviour, activity, ‘try things out’

• Provide support rather than reassurance

• Praise/reward effort, ‘having a go’

How can you help as a parent?

• Show them how to deal with problems and face fears (model what you want to see)

• Get support

How can you (teacher) help?

• Observe (anxiety and depression are not obvious)

• Include well-being and mental health in lessons, whole school approach

• Positive support, acknowledgement of fears or low mood, normalise

• Acknowledge difficulties, empathy• Encouragement to try, to have a go at things

that are frightening. • Be a good role model

How can you (teacher) help?

Encourage independence and problem solving

Give less reassurance but more support

Q ‘is this right?’

A ‘What have you done so far?’ (rather than ‘Yes’)

Give opportunities to build confidence`; can they help you or another child?

Distract; if they find change difficult ask them to carry supplies or to take a message to the next teacherLearn more about mental health in children and teenagers

E-learning

The MindEd programme

Seeking help• Seek help via GP/health professional

– They refer to CPE CAMHS

• For teenagers aged 17½ (or earlier if left school or living independently) or parents– can be referred by GP or self-refer to Increasing

Access to Psychological Therapies (IAPT), a.k.a. Talking Therapies

– www.talkingtherapies.berkshire.nhs.uk– 0300 365 2000– talkingtherapies@berkshire.nhs.uk

www.andyresearchclinic.com

Thank you

Any questions?