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Joanna Bettmann Schaefer, Ph.D, LCSW Open Sky’s Research Director

Agenda Clinical and Sub-clinical Anxiety Anxiety Disorders in the DSM-IV TR Treatments for Anxiety How you can help

Clinical and Sub-clinical Anxiety Everyone experiences anxiety: worry, concern, fear Not everyone experiences clinical levels of anxiety: anxiety which cause “clinically significant impairment or distress” Many people experience sub-clinical anxiety – occasionally or frequently Common symptoms of anxiety: Rapid heartbeat Muscle tension Queasiness Dry mouth Sweating Apprehension and sense of unease Repetitive thoughts

Anxiety Disorders in the Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision (DSM-IV TR) Panic Disorder with Agoraphobia Panic Disorder without Agoraphobia Agoraphobia without Panic Specific Phobia (animal, environment, blood, situational, other) Social Phobia Obsessive-Compulsive Disorder Posttraumatic Stress Disorder Generalized Anxiety Disorder

Panic Disorder Consists of recurrent panic attacks: sudden onset of panic symptoms Palpitations, increased heart rate Sweating Trembling, shaking Sensation of shortness of breath Feeling of choking Chest pain Nausea or abdominal distress Feeling dizzy or light-headed Feeling detached from self Fear of losing control or going crazy Fear of dying Numbness or tingling Chills or hot flashes

Agoraphobia and Specific Phobias Agoraphobia: Anxiety about being in places from which you cannot escape or where leaving might be embarrassing Specific Phobia Marked and persistent fear that is unreasonable Can be animal, environment (storms, heights, water, etc.), blood (injection, doctors, etc.), situational (flying, bridges, elevators, tunnels, etc.), or other Children may express phobias through crying, clinging, tantrums, or freezing behavior

Social Phobia (Social Anxiety Disorder) Persistent fear of social or performance situations in which you are exposed to unfamiliar people or to possible scrutiny by others Fearing that you will act in a way that will be humiliating or embarrassing Exposure to the feared social situation provokes anxiety or panic (in children, can be expressed as crying, avoidance, tantrums) Adults (but not children) with this disorder recognize their fears as unreasonable These fears lead to avoidance

Obsessive Compulsive Disorder Obsessions Recurrent/persistent thoughts, impulses or images that are intrusive and cause anxiety or distress These are more than excessive worries about real-life problems The person attempts to ignore or suppress the thoughts Compulsions Repetitive behaviors (washing, ordering, checking) or mental acts (praying, counting, repeating words) that the person feels driven to perform These behaviors are aimed at preventing or reducing distress, but are not realistically connected to what they are designed to neutralize The adult person (not the child) recognizes their behaviors/thoughts are excessive or unreasonable

Post Traumatic Stress Disorder (PTSD) The person experienced/witnessed events that involved actual or threatened death or serious injury or threat to the physical integrity of self or others The person’s response involved intense fear, helplessness, horror Symptoms last more than 1 month Symptoms consist of Re-experiencing symptoms Avoidance symptoms Increased arousal symptoms

Generalized Anxiety Disorder Excessive anxiety/worry – for more days than not for at least 6 months The person finds it difficult to control the worry Symptoms include: Restlessness, feeling keyed up or on edge Being easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance

Anxiety in Adolescents and Young Adults Looks similar to adult presentation of anxiety Children often manifest anxious symptoms somatically: vague somatic complaints, bed- wetting, minor illnesses, situational avoidance Consider developmental level of your child in considering how their anxiety presents

Treatments for Anxiety Relaxation training Mindfulness/meditation exercises Social skills training Exposure therapy Cognitive/behavioral therapy Relationally-oriented psychotherapy Medication

How You Can Help Don’t diagnose your child – leave that to trained professionals Be supportive of their treatment by identifying your own anxieties and worries – you can help them by getting centered and supported yourself Attend family therapy at home in order to identify which family issues might contribute to your child’s distress and how you can best support their recovery If you know your child has an anxiety disorder, learn more about it. Ask your Open Sky therapist or home therapist for resources or check out The Anxiety and Phobia Workbook, by Edmund J. Bourne (2011: New Harbinger Publications)

Working with Anxiety in Wilderness The nature of wilderness: environment, weather, future information, lack of control, group dynamics and how Open Sky supports students Interventions designed to work with Anxiety and students

Contact Information for the Presenter: Joanna Bettmann Schaefer, Ph.D, LCSW Research Director, Open Sky Wilderness Therapy Salt Lake office: Please keep this browser window open; when the webinar is over, it will take you to a short survey for today’s session.