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Anxiety in schools

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What is Anxiety?

Melanie Cole (Host):  Hello, I’m Melanie Cole. Welcome to Anxiety in Schools, a special podcast series from Rogers Behavioral Health. This is episode number one of our six-part series where we look at anxiety and how it can impact learning. In this episode, we will discuss what anxiety really is and I’d like to welcome Dr. Stephanie Eken. She’s the Regional Medical Director at Rogers Behavioral Health. Dr. Eken, please tell us what actually defines anxiety? 

Stephanie Eken, MD (Guest):  Well, anxiety is something that we all experience and is in response to something that is stressful. It’s not dangerous, but it's something that might make us feel physically or emotionally different and worried. And it’s an adaptive feature that we have as human beings.  

Melanie:  Then what’s considered an anxiety disorder? 

Dr. Eken:  So, the difference when people experience anxiety or something that is typical to cause us anxiety such as if something scary is happening right that worry and then our body adapts and to that particular situation; that’s normal. But it becomes a disorder when people experiencing typical things in life - like going to school, going to work - that shouldn’t cause anxiety start to lead to those symptoms. So, we may have physical symptoms like nausea, headaches, sweatiness, shakiness, and then we may have anxious thoughts as well such as overthinking situations or being concerned about judgment and so it becomes disorder when it starts to impact our ability to function in a setting that would not typically cause other people to be anxious.  

Melanie:  What are some risk factors and /or causes of an anxiety disorder? 

Dr. Eken:  So, there are numerous things that can lead to an anxiety disorder. Certainly, genetically we can be predisposed to an anxiety disorder, so perhaps if a parent or other family member has anxiety, that would put us at a higher risk for that. There are also biological factors. Some people’s brains seem to be wired differently and are more at risk for having an anxiety disorder and some of those things that could put a brain at risk for an anxiety disorder would be things like really stressful negative life events that are happening. Trauma can be a risk factor certainly for anxiety, being exposed to abuse or perhaps drug use in utero; those can all be potential issues that lead to anxiety and even certain medical conditions can lend themselves more to people feeling anxious. People with diabetes and asthma seem to have a higher risk for anxiety. But it is really can be this mixture of a variety of things that can lead to anxiety.  

Melanie:  Does it run in families? You know people make jokes that, oh, if your mother was a worrier, you’re a worrier. But is that really the case? Does it have a genetic component to it? 

Dr. Eken:  Yes. It definitely has a genetic component as well as an environmental factor there as well, right so if your mother is one who worries, we may have the genetic risk factor to have a higher risk for anxiety, but also the way that your mother handles situations, also becomes and environmental piece that can lead one to be more at risk for anxiety because the mother may have or whatever family member, showed you a style of how they deal with particular issues that can be anxiety based as well.  

Melanie:  When does normal anxiety, normal worries, when does that become a disorder that might need professional help? 

Dr. Eken:  As I mentioned before, anxiety can be normal for a lot of people; it doesn’t get in the way of their day to day life. But when we start to see people having impacts in a variety of environments, that’s when we start to become concerned. Certainly, if it affects and adult in their work place or a child in their ability to attend school or to pay attention at school, when it starts to affect relationships. Some people with anxiety can’t even leave their home, so certainly that would be very concerning, and you would need professional help. But also, when we see it impact mood. So, people with anxiety, very often can go on to have a secondary depression because anxiety is getting in their way of going out and doing things that they may enjoy or being around others, which is good for human beings to be social. So, those – when we start to see it impact in those environments and our relationships, our mood; then it's really important to seek help because anxiety disorders are really treatable and that’s the great news about them.  

Melanie:  Are there different types of anxiety disorders and you mentioned that they can even cause you not to want to go out and see people? Tell us about some of the different types that are out there.  

Dr. Eken:  There are several types of anxiety disorders. There are things that we call separation anxiety disorder happens most often in children but difficulty being away from a parent usually. There's generalized anxiety disorder which is typically worries about more common everyday things. Social anxiety disorder and a severe form of that being something called selective mutism. There's panic disorder and then there is something else called obsessive compulsive disorder which technically from a psychiatrist’s standpoint is no longer in the anxiety disorder category; it has its own category, but it leads to tremendous anxiety for people and so we talk about it a lot with the anxiety disorders.  

Melanie:  Let’s break a few of those down Dr. Eken. What is panic disorder? 

Dr. Eken:  So, panic disorder, people may be more familiar with something called panic attacks because it’s very common for people to have had a panic attack. You know up to 30% of adults have had them. So, those are these events that occur. They typically last for 15 to 30 minutes. You have this fight or flight part that happens in your body where you get intensely scared. You have – your nervous system kind of goes haywire and your heart races, you sweat, you get really nauseous a lot of times or your stomach doesn’t feel good. And so, panic attacks happen – that’s not panic disorder, but when you start to have those – a recurrence of the panic attacks that’s when we start to talk about something called panic disorder. So, people who have panic disorder also have great fear that a panic attack is going to happen at a time where it could lead to like feelings of embarrassment, or that they couldn’t get away from the situation and so it starts to lead to changes in how they behave, such as their unwilling to perhaps leave the house or go to a place where they had a panic attack before. And we commonly see this in adults and adolescents; less often in children, but certainly possible to see it in children.  

Melanie:  And you mentioned obsessive compulsive disorder as sort of a category of its own now. What separates that out? 

Dr. Eken:  Obsessive compulsive disorder a lot of people are familiar with some components of it from movies or television shows. But it leads to a lot of anxiety, so people obsess, and I like to always define how we are talking about obsessions because it gets used differently in everyday terms and how we mean it clinically. So, obsessions are these recurrent, intrusive typically thoughts, sometimes images that happen that are very distressing. So, I always like to give an example of like when people say oh I’m obsessed with video games. That is something that is desirable to the person and they enjoy doing that thing. With obsessions, that is not a desirable thought and in fact it is very much unwanted. So, it might be concerns that worry that I’m going to get sick from germs is a really common one.  

And then what happens is then compulsions are what people start to do to bring down the worry and anxiety that they have about their obsessions. So, in my example of if you are worried about getting sick; then it's common for people to have a compulsion to wash their hands excessively or to avoid touching things that might be considered germ ridden such as door handles to public places. And so, the compulsions temporarily reduce the anxiety. But what happens is you get in this really dysfunctional cycle in which you must continue to either do the compulsions or avoid any of the triggers that get your obsessions going and cause the anxiety. So, it can be really impairing and also make it very difficult to go to a variety of places or interact with people.  

Melanie:  What are some of the associated comorbidities or symptoms of these disorders? What else can they have physiological affects even though it is a psychological disorder? 

Dr. Eken:  Yeah. So, there are numerous comorbidities that we see with people who have any of these anxiety disorders and I actually mentioned one early on and it’s very common for people to have some kind of depression when they have severe anxiety, again, because of the limitation that is happening in their lifetime. And interestingly about 80% of people who have one anxiety disorder are likely to be diagnosed with another anxiety disorder. So that can be common as well. People can sometimes also go seek medical treatment because they think that something medically is happening to them, so they may get workups, but we certainly see anxiety in certain medical conditions: diabetes; and asthma; people who have had heart attacks, are more likely also to have anxiety. So, there are a variety of conditions you can see that can go along with all the different anxiety disorders.  

Melanie:  What about things like irritability or sleep disturbance and as we are talking in this series about anxiety in schools, this can have a real impact if there’s a sleep disturbance or concentration issue.  

Dr. Eken:  Absolutely. So, really common for us to see sleep disturbances in people with anxiety. Either difficulty falling asleep because they can’t shut their minds off with their worries, or early morning awakenings so waking up at three or four o’clock in the morning with worries, struggling to go back to sleep. Very common to see what we call executive dysfunction in patients with anxiety because if we all think about our own circumstances, in situations where we feel anxious you may find that it is hard to remember what happened in that situation. So, short-term memory being a problem, concentration especially in activities that are not something that you really enjoy can become very difficult, so we can really this start to affect school or work performance. And then absolutely irritability is very common, really common in kids, but common in many people with anxiety disorders. So, definitely can see all of those impairments.  

Melanie:  So, what are some treatment modalities that might be considered if someone is suffering from one of these anxiety disorders, Dr. Eken, and what would you recommend as the time for referral? 

Dr. Eken:  Anxiety disorders again, are very treatable and we have evidence-based practices that we use to treat people with anxiety, so one is a therapeutic intervention called cognitive behavioral therapy and it has a lot of evidence around being helpful for all the anxiety disorders that I mentioned. There is also a particular part of cognitive behavioral therapy called exposure and response prevention that we use specifically for obsessive compulsive disorder. And all of these treatments are working to help one recognize that the situation is not as dangerous as your brain is telling you and to be able to rationally think through and challenge some of the thoughts as well approaching anxiety instead of avoiding.  

Many people who have anxiety disorders become more dysfunctional because they are avoiding the things that trigger it. But actually, approaching the anxiety in a graduated manner is a really effective form of treatment. So, that’s under that umbrella of cognitive behavioral therapy. There are also medications that we use in combination with therapy. Sometimes we use it stand alone, but certainly, the research shows us that the combination of CBT and medications can be one of the most effective treatments that we have to offer.  

So, seeing a psychiatrist to help with medication management and there are several medications that can be helpful but the classic one is an antidepressant which can be odd for people because they are like why am I taking an antidepressant for anxiety. But those particular medications have been shown to be helpful with anxiety as well. And in terms of referral, I talk to people about looking at what are they not able to do or if it’s impairing them in a particularly important place like work, school, and then looking at their mood and getting to referrals for see therapists and some people can – that’s all they need is CBT. They don’t need necessarily medications. But therapists can also help guide people in determining do they need medication to go along with this.  

Melanie:  Wrap it up for us with your best advice and information about anxiety and anxiety disorders.  

Dr. Eken:  Well, what I really like to talk about when I’m talking – when I talk to people about anxiety disorders and treatment is to get it treated earlier rather than later because – it starts to stack up, right, all these other things that can happen with the depression, not being engaged in relationships as much or not enjoying life the way you can. So, because we know it’s so treatable what is so hard for me to hear from some patients that we treat is that they have lived with anxiety their entire life. And so, I want people to know that there are effective treatments. Getting them to the right treatment is critical, just like we need the right treatment for other medical conditions; getting them to evidence-based treatment which is CBT, is so important and we can help them function better and we can help them stay well which just give so much more ability to engage in life. So, early treatment, whether it’s a child, adolescent, adult getting in and getting it treated is something that can be so hopeful for people suffering from anxiety disorders.  

Melanie:  Thank you so much for joining us Dr. Eken. Rogers Behavioral Health is working each day to ensure those with mental health challenges have access to the highest quality of care and most effective treatment available today. To learn more about the many way Rogers can help children, teens, families and schools please visit rogersbh.org today. That’s rogersbh.org. I’m Melanie Cole. Thanks for tuning in.  

Anxiety and kids

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