School Based Strategies for Generalized Anxiety Disorder

In this episode Sarah Reeder (College and Career Readiness Counselor) and I cover the most common symptoms of generalized anxiety along with the difference between stress and anxiety. We discuss specific strategies and techniques that are effective to reduce the level of general anxiety someone may experience.  The strategies presented include breathing exercises and the physiological sigh, mindfulness, body scan and dealing with automatic negative thoughts. The skills and techniques are provided to students for use while in school, but the strategies can be applied in most other settings as well.    

Transcript

Intro: Welcome to Mr. O’s Podcast episode 1: Generalized Anxiety Disorder

Intro:

Intro music.

Hello and welcome to Mr. O’s podcast!  I am Doug Olszewski, School Social Worker at NHSD. As a licensed social worker, I have provided over 20 years of counseling supports to students in grades K-12, with the majority of my time being spent helping high school aged students. With me today is Sarah Reeder. Sarah has held many roles in the building including English teacher, school counselor and now college and career readiness counselor.  small talk -Thank you for being here.  How are you? 

So as a school counselor, let me know if this situation has happened to you. When people find out my profession and that I provide counseling supports to students, they often talk about the increased mental health needs of teens today. The conversation continues with them mentioning about how much students are struggling, and that they have a child with anxiety or they know someone who does. They will often ask what type of supports I would recommend, or what strategies students can use in school. This leads me to spend some time reviewing specific techniques with them, the ones that I would recommend to a student.  Has this situation ever happened to you?   (Yes, all the time - the first question is usually about college admissions, and then the second question is usually about anxiety…ironically, those two topics often go hand in hand!)

Because of this, I felt it would be a good idea to put my recommendations in a format that others can benefit from. This is where the idea to record a podcast came about.      

 As a social worker and school counselor in a high school, we have seen a significant number of students who experience a variety of anxiety issues during the day.  I find that the majority of these issues typically fall into 3 distinct categories, although there is some overlap between them. While there are a number of disorders that fall under the anxiety umbrella, I believe that the most common anxiety related issues students experience in the high school are: Generalized anxiety disorder, panic attacks and test anxiety.  I thought it would be helpful to develop a series of podcasts that focus on the specific symptoms of each type, along with the most common school-based techniques that I use directly with students to help reduce the severity of their anxiety. 

Before you get into the symptoms and coping strategies to combat anxiety, can you tell your listeners what the difference is between stress and anxiety? Many people use those term interchangeably, and they are related but I feel there are specific differences between the two.  

According to the American Psychological Association: There’s a fine line between stress and anxiety.  Both are emotional responses, but stress is a normal reaction to everyday pressures and timelines typically caused by triggering events. Anxiety, on the other hand, is defined by persistent, excessive worries that don’t go away even in the absence of a stressor.

People under stress and anxiety can experience a nearly identical combination of mental and physical symptoms, such as irritability, anger, fatigue, muscle pain, digestive troubles, and difficulty sleeping.  As we know, most high school students are sleep deprived in one way or another, which can certainly magnify any mental health issues they are actively dealing with.  The good news is that both stress and anxiety respond well to similar coping mechanisms such as physical activity, a healthy diet, good night sleep, etc., but there are also a variety of effective techniques and strategies available to reduce stress and anxiety that we will be talking about. 

Another point I want to mention is that people often feel that they need to remove all the stress and anxiety in their lives.  I’m not sure that is totally possible but what research shows us is that we function best with mild levels of stress/anxiety.  If you think of a scale from a 0-10 with 10 being the highest, we typically function best between a 2-4 level.  So when people are at an elevated level and think they need to reduce their symptoms from a high number down to zero, or remove all the anxiety they are experiencing all together, this is not actually true. We see this in academic settings (doing well on tests), social settings, and athletic settings (give examples).

Joke: What do you call an English teacher who used to have anxiety? Past tense.

Sarah: So lets talk about anxiety issues in a high school setting. What is the most common form of anxiety you see in school? 

Generalized Anxiety Disorders. 

I feel that Generalized Anxiety Disorder or GAD is the most common and generic form of anxiety which most people experience at some point throughout their life.  In my opinion, this is definitely the most prevalent anxiety issue in high school as it can develop from any situation that causes distress and can certainly cross over into other areas such as social anxiety, school avoidance and panic attacks.   

Generalized Anxiety Disorder can be defined by the following diagnostic criteria:

1. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).   Sarah: I think the “at least 6 months” criterion is something that most people don’t realize. It’s possible for someone to be incredibly anxious about a specific event or experience, but if the anxiety disappears as soon as that event is over, it wouldn’t be classified as Generalized Anxiety Disorder - is that correct?       Yes you are correct. Some of the timelines of a clinical diagnosis is not always where people assume they would be. In this case, if the 6 months were not reached it would likely be considered more on the lines of an adjustment disorder.    
2. The person finds it difficult to control the worry.      
3. The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).

●       Restlessness, feeling keyed up or on edge

●       Being easily fatigued

●       Difficulty concentrating or mind going blank

●       Irritability

●       Muscle tension

●       Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

The anxiety, worry, or physical symptoms can cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  Well isn’t that concerning! 

+Sarah: So how has this looked with high school students that you have worked with? 

Students have presented with all the above!  In school I find that excessive worry is often about academic achievement and grades, peers and social situations, test performance, SAT scores, getting into good colleges, etc. Students have thoughts like: what if I fail, what if they don’t like me, what if I get a low SAT score, what if I mess up, what if I don’t get accepted to my preferred school, etc.  Students also experience a significant amount of fatigue and difficulty concentrating along with being tired, having headaches or muscle tension, and stomach aches. In your current role, how have you seen anxiety present itself? I speak to many students who talk about feeling pressure to push themselves beyond their capabilities in order to get ahead for the purpose of college admissions. Most of the time that pressure is coming from within themselves and from society as a whole, not from their parents or teachers - but unfortunately the anxiety usually backfires and causes them to be less successful as it makes them less focused, more sleep deprived, and less happy. 

Yeah, students put a lot of pressure on themselves. I am sure that happens pretty often in a high achieving district like New Hope. Thanks for mentioning that. 

I think GAD is something most of us have experienced at one point in our lives or another.  The good news is that typically GAD and other anxiety disorders can be treated with a variety of therapeutic techniques, medication, or a combination of the two. Since medications are typically prescribed by a doctor or psychiatrist, and seeing how I am neither of those, I will stick with the techniques and strategies most effective for use in schools. 

+Sarah: So what can someone with GAD do, specifically in a school setting to deal with this?

If someone is interested in the reduction and management of anxiety, one of the most widely used therapeutic approaches is cognitive behavioral therapy or CBT. CBT focuses on changing maladaptive thought patterns or cognitive distortions, implementing behavior modification and using exposure to confront anxiety triggers in a safe, controlled way in order to break the cycle of fear around the trigger. Unfortunately, ongoing CBT requires a significant time commitment, so I’ve adapted some of its practices and combined them with other practical strategies for use in a school setting. Basically, I have modified them to be a little more direct and user friendly.

So let’s begin. For a student who has GAD, I find that a combination of relaxation techniques and identifying automatic negative thoughts can be very effective. Certainly, you can and should practice these techniques anywhere, at home, on the bus, during a boring class lecture… just kidding about that one.     

If a student came to see me and they were experiencing symptoms of GAD, I would spend some time over a few sessions discussing the following proactive strategies to reduce their symptoms:

●       Breathing exercises – Breathing techniques are great to help calm your nervous system (lowering your heart rate, racing thoughts and blood pressure) because your breath is always with you, whether you are walking in the hallway, sitting in class, eating lunch, texting with friends, etc.  There are many different types of breathing exercises including diaphragmatic breathing, counting breath up to 10, 478 or 418 breathing, etc. I would encourage them to pick one and try it out, practice it to see how it works for you. 

●       One of the most effective breathing exercise is called the physiological sigh. The physiological sigh occurs when you double inhale, where you fully breathe in from your nose, fill your lungs to capacity, but then force yourself to inhale a little more before you exhale slowly through your mouth.  Be sure to exhale longer then you inhale. I would demonstrate this for the student and suggest that they repeat it 5x’s in a row. This exercise has been proven to be one of the best techniques to reduce anxiety immediately. Let’s practice +  For GAD, the idea is to practice this breathing technique multiple times a day, which helps lower the overall anxiety response.    

●       Mindfulness activities – for anxiety reduction I totally support a regular guided meditation practice, using an app such as Headspace or Calm, along with routine exercise or doing yoga, but those may be difficult while in school, so I suggest using mindfulness. Mindfulness is a type of meditation in which you focus on being intently aware of what you're sensing and feeling in the present moment, without interpretation or judgment. Focusing on being present in the “here and now”, and not thinking about the past or future events. You can practice mindfulness anytime, while you are walking, sitting, eating, talking, etc. just try to be in the present moment.  I also love the Mindfulness app in Apple watches. I always tell students that this is something they can utilize in class without anyone knowing if they have an Apple watch. It guides you to breathe in time to a pretty image that moves in and out for one minute. It’s very simple and effective!  Absolutely, that is a great options for students.

●       Body Scan – I would encourage students to do a body scan activity where you would be aware of the sensations or tension you have in your body. I would have them start at the top of their head and slowly continue to scan their entire body and acknowledge the areas of stress or tension. They should be aware of these areas, but do not focus too much on them, or change them in any way.  Accept how they are feeling in this moment.  

●        Automatic Negative Thoughts - ANTS. Now this is the big one! Catching and effectively dealing with ANTS could be a whole section dedicated to itself! It takes a lot of time and practice to be able to do this effectively, so this is the short version.  The first step is to actually catch yourself when you are having an automatic negative thought. Catch the negative thought and say out loud if possible “I am having the negative thought that…”  and fill in the blank with whatever is appropriate – I’m going to mess up, I’m going to fail, no one will like me, etc. Once you have identified the negative thought, challenge it by asking “Is this thought true? What purpose does this thought serve me?” Talk back to that thought and find a way to prove the negative thought is not accurate. Lastly, prevent it from spiraling downward by asking yourself “how likely is it that I will…” mess up, fail, or that no one will like me. Then ask yourself what is a more realistic outcome? Perhaps I will not do as well as I would have liked to do, or I might be a little embarrassed, but I’m not going to fail the class for the year. The realistic outcome is something that you can actually live with.  We all have experienced disappointment from not doing as well as we would have liked, or have been embarrassed about something, but we can actually get through it!  

You can see how dealing with ANTS can be effective in reducing someone’s level of anxiety.

Those are the main techniques that I would discuss with a student and recommend for use in school if they were struggling with Generalized Anxiety. So Sarah, what do you think about what we discussed? Which strategy do you feel would be most helpful to use in a school setting? Which technique do you feel you would use? Deep breath whenever the bell rings (from Challenge Day), body scan, etc. 

 I did want to add that when working with a student, I would review the details of their specific circumstances and modify the strategies to fit their personal needs, but generally speaking, these are the steps that would be focused on. It’s really about a student finding which strategies or combination of skills to use, then practicing and using them effectively, to reduce their overall level of anxiety. With some practice, reducing their level of anxiety is very possible.   

So, this concludes the discussion on Generalized Anxiety Disorders. I want to reiterate again that this is not a comprehensive list of every anxiety treatment available, only some of the strategies which are most effective for in school use. The next episode will focus specifically on panic attacks, their symptoms and effective school-based strategies to help manage them.  Sarah, thank you so much for being here, asking good questions, along with providing great insight and perspective to the discussion. I really appreciate your time and support with this podcast. 

Thank you for listening.  

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