Feelings of anxiety and worry are normal during significant transitions. It's expected that children and teenagers feel nervous before the first day of school. Some children, however, experience more intense fear and subsequently tantrum, refuse and lash out prior to the start of school. If this is occurring, and lasting into the first few weeks of the school year it may be time to seek expert help.
Below are some helpful reminders for your anxious kiddo leading up to the first day/week of school:
1. Avoidance is never the answer. Although the fear may be crippling, avoiding one's fear and anxiety often leads to more severe and long term problems. If your child is refusing, do what you can to get them to attend one class. If that seems impossible, can they make it to the counselor's office? It's important to identify small and realistic goals each step of the way.
2. Do not provide too much reassurance to the worry. Reassurance to worry is like gasoline on the fire. It provides short term relief but can rob your child of their confidence in their own decision making. One question or concern requires assurance, being asked the same question repeatedly is reassurance seeking. Instead, help your child identify their concern and attempt to generate solutions to their problem. If this seems impossible it's likely the concern is unrealistic. This process can help them acknowledge this.
3. Your child's behavior is predictable. If they were an anxious child last year, and the year before, and the year before that, and they have not had specialized treatment please do not expect they have outgrown their distress. It's wishful thinking that causes chaos when they predictably melt down during the days leading up to school. It's easier to avoid talking to your child about their worry. They are enjoying summer and you don't want to ruin it. Help them prepare for the first day by acknowledging their fears and articulating them. Talk about preparing for predictable feelings of anxiety and ways to manage it.
4. In the spirit of preparation see if there are opportunities for your child to practice being at school during the summer. This could be during new student orientation, sports try-outs, or even teacher in-services. Try and spend time at the unfamiliar school and allow your child's brain to recognize there is no danger. It may be helpful to walk the route to each class ahead of time. Anxiety is fueled by uncertainty. In this occasion, it's helpful to reduce this as much as possible.
5. Fitting in is terrifying. It will be helpful if your child has a friend, acquaintance, or familiar face when they arrive at school. Does the school have a program to help new students? Is there a neighbor kid they've made friends with? Some type of ally can help manage the initial worry of walking into a new place.
6. Manage your own anxiety. Are you actually terrified for your child? Does the uncertainty make you anxious, or do you feel responsible for your child's emotional experience? Your anxiety is contagious and can compound you child's worries. If you recognize it's your stuff that's driving your interventions to take a deep breath and stop it. You are not actually responsible for your child's emotional experience. You can walk side by side them but can't own their stuff.
Did you know that 1 in 100 adults likely have OCD? And up to 1 in 200 children? That’s a half a million children in the US alone. OCD can be a debilitating disorder, but there is treatment that can help. Unfortunately, it can take up to 14–17 years from the first onset of symptoms for people to get access to effective treatment, due to obstacles such as stigma and a lack of awareness about mental health, and OCD in particular.
OCD Awareness Week is an international effort to raise awareness and understanding about obsessive compulsive disorder and related disorders, with the goal of helping more people to get timely access to appropriate and effective treatment. Launched in 2009 by the IOCDF, OCD Awareness Week is now celebrated by a number of organizations across the US and around the world, with events such as OCD screening days, lectures, conferences, fundraisers, online Q&As, and more.
OCD Awareness Week takes place during the second full week of October each year, and this year it’s October 9–15, 2016.
#OCDweek YouTube Challenge
Each year, the IOCDF hosts a creative contest as part of OCD Awareness Week, inviting members of the OCD Community to help spread awareness and understanding through storytelling or art. In 2014, the IOCDF began hosting a video contest with the same theme. It has been a great success, and so they are doing it again for 2016! Check out last year’s finalists here for inspiration.
Click here to learn more.
Join the IOCDF's #OCDchat Series
This daily chat series is back for #OCDweek featuring different topics and guest experts every day. The chats will take place Monday–Friday at 1pm ET. A full chat schedule, list of guest experts, and more information on how to participate in the #OCDchat series will be available soon.
Promote OCD Awareness Week October 9-15th, 2016, on Social MediaFacebook, Twitter, Instagram, LinkedIn, and other social media networks are a great way to spread awareness about OCD and related disorders. By telling your story to your friends and family, you can help dispel myths about mental health disorders, eliminate stigma, and most importantly, raise awareness about OCD symptoms and available treatments. During OCD Awareness Week, there are a number of ways you can get involved online:
For OCD Awareness Week, I donate my status in support of anyone who has ever battled this disorder. May they find treatment, comfort, and hope. Together we can end the stigma around mental illness. Please copy and paste this as your status to promote the International OCD Foundation’s OCD Awareness Week efforts. Learn more at www.iocdf.org. #OCDweek
Following the adjustment to the potent smell of fruitful air fresher and classical music I spot the sign for the elevators. I’ve made it to the hotel. Fortunately, I don't have to push the button for “up” or even wait. There is a door open. Standing in front of the elevator door is a mother with her child. The child is frozen while she gazes into the elevator and watches her mother walk in first, uttering reassurances of safety to the young girl.
I recognize the fear immediately.
I hold the door for the young girl and reassure her we are not in any hurry. “Take your time,” I said. And, “try to move one foot in front of the other.” She cautiously walks in and shoots me a grin.
“Feel better?” I ask. “Yes,” she states with a smile.
Her mother gives me a look of gratitude and states, “I guess we are in the right place for this kind of stuff.”
The mother, child, two other strangers and myself share the elevator to the floor designated for registration for the International Obsessive Compulsive Disorder Foundation Conference (IOCDF). The IOCDF conference is an annual conference focused on the treatment, research, and support of individuals who struggle with OCD. This conference is unlike any other in that it welcomes world-renowned OCD researchers, expert clinicians, training clinicians, suffers of OCD, and their loved ones. Together, we all share in support and learning. It's remarkable.
This year’s conference was in Chicago, Illinois. It hosted to 1600 attendees and provided four days of learning. Several members of NW Anxiety Institute, LLC attended as learners, supporters, and even shared an exhibit. We joined daily discussions and connected with numerous families who shared with us their struggle of managing OCD in their lives. We met young adults who were excited to share their recovery and offer support. We admired others who attended as newly diagnosed individuals.
The conference provided many “nuggets" of education and inspiration, but the key note speaker, David Adam, stole the show. Adam, the author of The Man Who Couldn’t Stop, shared his experience of living with OCD. Adam is a journalist in the UK who has written scientific pieces for The Guardian. He eloquently, yet realistically described the torture OCD instills in its suffers while connecting deeply with the audience.
Overall, the conference highlighted the need for well trained therapists and reminded us that, not long ago, in our history was it grossly misunderstood and poorly treated. Thanks to the tireless research and collaboration of scientists and therapists over the years, we now know OCD is effectively treated with exposure response prevention (ERP) and medicine. And now the IOCDF provides a vast community to support one another.
We encourage anyone affected by OCD to attend this annual national conference. If you are interested in learning more about IOCDF or attending next year's conference, click here.
“How was your session?”
“Fine, I guess.”
“What did you do?”
“I don’t know, talked I guess.”
Is your child or teenager attending therapy? Can you tell if it’s helpful? Frequently, parents feel uncertain of what occurs within the therapy office. They are likely equally concerned as they are curious. The concern can potentially be a source of frustration particularly when it can feel as though they are paying for someone to “chat” with their child. When progress isn’t obvious and the child continues to suffer, concern may graduate to worry.
The process of therapy is dynamic, individualized, and unique. Therapists become trained in techniques to elicit emotion, identify ambivalence, challenge distorted thinking, and most importantly, provide empathy to one’s experience. Therapy is not advice-giving, but can be problem-solving. It’s not a panacea to your child’s problems and can take significant time. Progress at times can be quantified, but not always. Similar to life, therapy is uncertain and this can be incredibly challenging for parents.
The aforementioned concern and curiosity can lead parents to inquire about their child’s therapy session. Naturally, this occurs within two minutes into their car ride home. Parents ask, “How was it? What did you learn?” Unfortunately, these questions are often met with, “It was good. We chatted.” Neither answer provides more insight, or helps the parent identify whether therapy is helpful.
There may be a huge desire for a child to state,“Mom, Dad, in therapy we discussed problems I’m having with expressing myself. It seems my therapist believes these are related to areas of vulnerability likely caused by episodes of shame and guilt during my childhood and adolescence. Furthermore, we explored my support network and patterns I make when making friends. We identified the difficulties I have with attention and how I often isolate when I feel stupid.”
Although as parents, we would so appreciate a response such as this, we know it is unlikely and unrealistic. In fact, the expectation that a child is able to express himself/herself in a cohesive and articulate manner what they discussed in therapy is unattainable.
Of course, some of this depends on the reason your child is in therapy. With many of the clients I work with it’s pretty clear what we did, or discussed during the therapy hour. When working with teenage clients to overcome OCD, panic, or social phobia we engage in specific exposure activities to challenge their fears. This is concrete, objective, and parents often seen rather quick results. Sprinkled amongst these session, however, is “chatting” to build our relationship and develop insight.
Maybe the best response to your child climbing in the car after therapy is, “I’m glad you did that today. Good job.” And if you’re curious whether therapy is helpful, ask, “Do you want to come back next week?” If the answer is yes, they likely find value in it.
Talking with the Therapist
Therapists are not off the hook, however, in providing rationale for what they do.
I would ask the therapist either following the intake appointment or a few sessions in, what the treatment plan is?
I would inquire into what diagnosis the therapist believes best describes your child’s symptoms. “Depression and anxiety” are not clinical diagnoses and provide little understanding into how your child is suffering. Ask the therapist to be more specific.
Inquire how the therapist intends to track progress? For some symptoms, it is helpful to use specific, validated questionnaires that help with rating symptoms and allow one to track progress. This helps your child and you see weekly change (in one direction or another). Other ways can be specific behavioral changes such as improve sleep, school attendance, decrease isolation, etc. Sometimes, it is rather difficult to measure insight, the development of self-esteem, and ability to communicate. This is fine, but your therapist should be able to explain the rationale behind this.
What are the goals for therapy? Again, these can be very specific, but often the goal is to establish a strong relationship, provide support, and offer a safe-place for your child to express herself/himself. There aren’t “incorrect” goals for therapy, but there should be thoughtfulness on what your child is working on.
Lastly, request that the therapist provide a parent-session to educate you on your child’s symptoms, get recommendations on how to be helpful, or at minimum provide yourself with reassurance that someone understands what is going on.
Spring is here. The days are getting longer, flowers are blooming, and nature is waking from months of hibernation. The air is still crisp, though we have enjoyed a few unusually hot days in the Pacific Northwest thus far, and mornings are cool.
With spring break come and gone, parents are planning their child’s summer adventures. For many, the American tradition of summer camp is on the books. Unfortunately, for many others, camp is out of the question. These parents are dealing with one of the millions of American children who are plagued with anxiety, intense shyness, excessive worry, obsessive thoughts, panic attacks, and homesickness. For these families, convincing their child to spend a few nights away from home is almost impossible.
The benefits of attending a summer camp have been shared by Americans for generations. We have likely experienced this, or know someone who has returned to the same camp each year, and look forward to seeing their camp friends, participating in camp activities and “unplugging” from daily stress. We know this to be true anecdotally, and the mere amount of camps available is evidence to their growing popularity and enjoyment. The question is, why are they so great, and will the aforementioned anxious kids benefit too?
Researchers are interested in this topic as well and have conducted decades of studies showing evidence that summer camps are effective for building relationships, increasing self-esteem, and achieving mastery in outdoor activities. Camps are shown to help individuals who feel “different” feel included and bring together children with common illnesses or traumatic experiences.
When coping isn't enough:
Fight Fear Summer Camp, our camp for youth with OCD and/or other anxiety disorders, strives to build the same cohesiveness for children who may not have otherwise attended camp. The gold standard treatment for Anxiety Disorders is a type of Cognitive Behavioral Therapy (CBT): Exposure Response Prevention, commonly known as exposure therapy.
The premise of exposure therapy is to help individuals experience the feared stimuli (i.e., social event, being away from home, performing in public, or eating with peers) without avoiding. This teaches the brain that no actual or real harm will come and that the body’s alarm system can turn off.
Attending camp will be exposure enough for many children - an opportunity to feel anxious around other children while supported by licensed therapists. They eventually feel safe and calm, all the while retraining the brain. Children naturally cope. We hope to help build tolerance to those yucky feelings.
Other examples of exposure tasks while at the camp:
Why Attend Fight Fear Summer Camp?
Fight Fear Summer Camp will utilize highly effective cognitive-behavioral therapy (CBT) techniques to teach campers self-soothing skills, confidence building techniques, thought challenging tools and provide social opportunities.
Examples of these include:
Less is more:
Camp is about unplugging and being present with oneself. Attending camp is a vacation for the mind. A place where sleep, meals, and activities are scheduled. Campers can relax from the uncertainty of daily worry, breathe fresh air, and learn to tolerate their own thoughts (and themselves). These basic changes to a camper’s day can reduce overall stress and anxiety considerably. When there are no tv’s, iPads, or phones, campers engage with one another, have fun and laugh. Camp is about fun. And when we laugh and smile, we activate mirror neurons (part of the brain designed to identify what we see and copy) in those around us. This is contagious.
Few things build confidence like challenging oneself. The intensity and degree of the challenge is less important than the act of engaging in a novel situation. Fight Fear Summer Camp, led by therapists, provides daily opportunities for campers to challenge themselves and develop a sense of mastery in an activity. This could be socially asserting oneself to navigating a high ropes course, from playing a sport for the first time to asking a peer to sit with them.
Insight is derived from awareness and feedback. Insight is often the precursor to change. At Fight Fear Summer Camp, we provide ongoing feedback to our campers, regular coaching, group therapy, and individual attention to help campers reach specific goals. Staff are trained to help campers recognize changes in mood, physiology, and negative thinking patterns.
We all experience anxiety and distress. For some of us, it’s too intense and can take over our lives. We created Fight Fear Summer Camp for children who deserve the camp experience but, due to anxiety, may have not thought about attending. We also created this camp for experienced campers who want to be around other teens and peers who share similar fears. There are few better therapeutic interventions than feeling like you fit in!
Anxiety is a normative experience that we share with each other and it becomes problematic when it impacts our day-to-day function or we develop anticipatory worry of its reemergence. Anxiety is the brain’s interpretation of perceived threat in the absence of danger. The physiological changes we experience (e.g., increased heart rate, sweating, racing thoughts, numbness in extremities) when running from a bear are never thought of as an anxious response. They may be initiated by fear but are bloody necessary!
This need changes, however, when the same damaging symptoms arise before a public presentation, or networking opportunity. In these circumstances we are not actually in danger, but our brains get stuck in a loop between our physical symptoms and cognitive appraisals. This emotional reasoning, “If I feel bad it must be because there is reason to be” is commonly experienced by individuals who struggle with anxiety disorders. For example, individuals with social anxiety use their body’s physiology as cues for their social success or failure (e.g., “Sweating, blushing, and stomach knots are ‘proof’ I’m screwing this up!”).
Effective therapies (i.e., CBT, Exposure Response Prevention, Mindfulness, & Acceptance and Commitment Therapy) help individuals shift their relationship with their anxiety by challenging distorted thinking and breaking the anxiety brain-body loop through behavioral techniques. Methods to help individuals cope can sometimes be problematic. When utilizing coping skills, individuals continue to perceive their anxiety symptoms as dangerous and run the risk of temporary relief.
Although immediate symptom reduction can be seductive, it produces continued intolerance for distress - the major contributor to anxiety disorders. Treatment should focus on increasing a person’s tolerance for distressing feeling and separating feelings of anxiety from themselves. The feelings of panic will never be pleasurable, but tips to make them manageable and ultimately less significant do exist.
5 Tips for Shifting Your Relationship with Anxiety
Written by Kevin Ashworth, MA, LPC. Kevin is a licensed therapist and co-founder of NW Anxiety Institute in Portland, Oregon. He specializes in CBT and ERP treatments of anxiety disorders in children and adults.
OCD loves your smartphone.
If an intrusive thought is the seasoned cedar logs on a beautiful camp fire then a compulsion is a plumbed line of gasoline. This combination makes for a raging fire both dependent on each other to burn. No more wood, no more fire. Lots of wood and no additional fuel, fire eventually burns out. This is common analogy used when describing OCD, and part of one’s treatment is to reduce compulsions, essentially choking the gasoline line, and suffocating the fire. OCD is cunning, tricky, and apparently hip. Similar to many baby-boomers, OCD took a little time getting use to the mobile handheld device, understanding its potential, and being efficient in its operation. It’s not only cunning but relentless. Time is always on its side. It has become proficient in the use of search engines, and now the ability to take photos and video. OCD can now force its host to search anything, at any moment, about any concern - turning technology into more of a hinderance than a help.
Has asbestos been safely removed from this current building?
Could this sensation in my leg be a blood clot?
Could I really be a pedophile?
Did I turn off the stove, and unplug the lamps?
Could I have I hit someone while driving?
Video while walking around my car.
The trick OCD plays is convincing its host that the use of the device will ease the distress. Don’t want to worry? Take a quick pic and refer back later. Need evidence you didn’t post that rude comment? Take a quick screenshot? This trap is equivalent to hooking up another gasoline line to the fire. People get stuck reviewing their pictures and videos, and become unable to delete them filling up their devices and limiting their ability to take pictures of loved ones (and their lunch!) instead. Additionally, others fear that their use of their own device will become dangerous and actually have their phones turned off for fear they may accidentally post something inappropriate, or impulsively call and yell at someone. These devices are intended to make our lives easier, not worse.
If you feel comfortable sharing, what are some ways you've used technology to feed compulsions? How has it affected the way you use your devices?
But It's Mine. I Like It. Why Would You Try To Take It?
They come in different colors, but mine is white. It’s shiny. Not the kind of shine that catches your eye; more like it’s elegant, even sexy. I take it everywhere I go. I even take it with me from room to room just in case it needs me. Yes, it has practical utility. It’s a device for communicating, for taking pictures, checking email, seeing in the dark, playing music, or even making sure there is nothing stuck in my teeth. But it’s more than that. It’s comforting. It’s hard to explain but it feels good to know it’s near. It alerts me with a gentle buzz when it needs me. I find myself gently touching my back pocket just to make sure it’s there. Sometimes people touch it without permission. This bothers me a lot. It’s mine. Do not touch. My loved ones worry I care about it too much. “Put it down” they say, “It’s not going anywhere.” They don’t get it.
We are connected to our belongings. More than we’d like to admit. We all have a similar relationship to a possession, a memento, souvenir, or sentimental item as was describe above. And, it’s easy to understand this relationship when something has a high monetary value. The item described above is an iPhone 6 plus. It cost me around $600. You’d consider me mad if I were to throw it away, and likewise I’d share the same sentiment if you were to ask me to discard it.
But what if the item seemingly had no monetary value? What if it appeared to be junk?
You’d further consider me mad if I chose to keep it, correct? The problem with having too many items has nothing to do with the value of each item or the utility of these belongings. The saying, “One man’s trash is another man’s treasure,” refers to judgement of taste versus a literal interpretation; however, the latter can also be true.
Instead of infusing this judgement, when working with individuals who struggle with Hoarding Disorder, the focus should be on how their belongings (not trash or junk) impacts their life. Can they find all of their valued possessions? Can they enjoy them? Are they displayed? Can they use their homes and spaces for their intended purposes? If you're eating in the garage because the kitchen is cramped, maybe you’d like some help in organizing?
Hoarding Disorder is a serious psychological condition that causes suffering and has huge emotional and financial cost. Effective treatments are available that don't necessarily require giving up your beloved possessions, rather changing your relationship with them.
NW Anxiety Institute is extremely thrilled to be opening an Intensive Outpatient Program (IOP) for children and adolescents with Obsessive-Compulsive Disorder (OCD) and other anxiety disorders.
NW Anxiety Institute’s program is the first of its kind in the Pacific NW and will offer daily intensive therapy for kids struggling with debilitating anxiety because of their OCD. At NW Anxiety, we specialize in Exposure Response Prevention. Exposure Response Prevention (ERP) is well established as the treatment of choice for OCD, Panic Disorder, Social Anxiety, and other anxiety disorders, and many individuals improve greatly with traditional weekly therapy which is why it will be incorporated into the IOP.
The Intensive Outpatient Program is designed for children and adolescents whose anxiety is debilitating and significantly impairing their quality of life. Many of the adolescent patients at NWAI are unable to attend school regularly due to their symptoms and require intensive treatment.
The “intensive” in IOP refers to the frequency of therapies in a relatively short time frame. Patients will continue to systematically challenge their fears in a collaborative and supportive way, however, much faster than can be done in weekly therapy. Furthermore, the frequency allows us to maximize on therapy success and gains before a client can return to their obsessions or compulsions in the six days between appointments.
When a patient is enrolled in our IOP treatment becomes their focus. They are not distracted by friends, school, and family dynamics, and can put forth their energy to overcome their fears and make considerable behavioral change. Successful exposure therapy requires four principles:
These principles are necessary for an individual to challenge an irrational thought, learn and maintain new behaviors, and evoke emotional processing. Essentially, the more (frequency) a patient can engage in a difficult (intensity) exposure task, while maintaining that task until their anxiety diminishes (duration) the more successful the exercise will be. Ah yes, they also have to minimize any delay while initiating the task (latency).
The ideal patient for our IOP is a child/adolescent between the age of 10-18 who is suffering greatly with OCD or another anxiety disorder. This individual believes they would benefit from a three-week structured program to aggressively target their symptoms, and regain their independence.
Interested in registering your child?