1. Anxiety Disorders
What School Counselors Need to know!
Dr. Iliana Garcia – Ortega Psychiatrist
Research Associate
Sun Life Financial in Adolescent Mental Health
Dalhousie University & IWK Health Centre
www.teenmentalhealth.org

2. Most people experience anxiety as…
 Feeling tense, edgy, frustrated, irritable or overwhelmed.
 Different degrees of physical symptoms such as: neck
tension, headache, sweaty palms, shakiness, flushing, stomach
sickness, restlessness.
 Although unpleasant, most people are able to tolerate it and have
become so good at coping that other people often can’t even tell
that they are anxious!
 Anxiety can be a good thing!
 It helps us focus and get things done and can even enhance our
performance (ie., exam preparation for a student, performance for a
concert pianist)

3. Anxiety associated with anxiety disorders is different…
 It is unreasonable, excessive or inappropriate to the situation
 It’s intensity exceeds the person’s capacity to endure it
 It may be persistent – continues despite the absence of an acute
stressor or situation
 It prevents the person from doing what they need to
do, achieving their goals, or being who they want to be – it
causes functional impairment
 It leads to unhealthy coping strategies such as avoidance and
withdrawal

4. What is Anxiety?
Initiation
of Physiologic
Cascade
Perceived  Heart Rate Anxiety -
danger in an
normal situation  Alertness
Behaviour
 Perception
 Tension

5. What about the brain?

6. Anxiety Disorders
• They are the most common of all the mental disorders and usually
begin in childhood or adolescence - affect 8-10% .
• Anxiety disorders run in families (anxious young people often have
anxious parents)
• Despite their high lifetime prevalence they remain poorly
identified, diagnosed, and treated.
• They lead to high utilization of health services (many un-necessary
investigations)
• Are frequently very amenable to treatment (psychotherapy;
medications)

7. • Different anxiety disorders throughout life
– Separation anxiety disorder = childhood
– Social Anxiety Disorder; Panic Disorder = teen onset
• Anxiety disorder can lead to:
– Poor economic, vocational, interpersonal outcomes
– Significant negative impact on family, social and school functioning
– Increased morbidity:
• comorbid anxiety disorders, major depressive disorder and
alcohol and drug abuse
• Chronic anxiety disorder can lead to:
– Poorer physical health outcomes
– Increased cardiovascular morbidity and mortality in mid-life

8. Common Anxiety Disorders
Panic Disorder
Agoraphobia
Panic Disorder with Agoraphobia
Social Phobia
Separation Anxiety
Obsessive Compulsive Disorder
Posttraumatic Stress Disorder
Generalized Anxiety Disorder
Anxiety = Anxiety Symptoms + Avoidance + Functional
Disorders (Physical + Behaviors Impairment
Psychological)

9. Diagnosis of Anxiety Disorders
 There are no biological tests that are diagnostic of any
specific anxiety disorder.
 Diagnosis of anxiety disorders is reliant on a careful clinical
assessment of the person’s presenting signs and symptoms
and clinical history taking.
 The symptoms of the anxiety disorders cluster into 3 groups:
1. Physical Symptoms
2. Psychological Symptoms – Thinking/Cognition Symptoms
3. Behavioral Symptoms

10. What’s the difference between
Mental distress and Mental disorders?
Distress Disorder
 Caused by abnormal brain
 Caused by event or trigger of
functioning
brain driven activities
 May have environmental trigger
 Normal/usual Response
 Complex interaction between
 Temporary, ADAPTIVE
genetic and environment
 No professional treatment
 Prolonged
needed
 Usually needs professional
 Not associated with sustained
treatment
disability
 Associated with sustained
 Does not meet recognized
disability
diagnostic criteria for a mental
 Meets recognized diagnostic
disorder criteria: DSM; ICD

11. Normal emotional response to distress:
The Acute Stress Response
Thinking Emotion
WORRY!! Panic
WORRY!! Irritability
WORRY!!
Physical
Loss of Appetite
Perception Difficulty Sleeping
Headaches
Behavior Signaling
Avoidance Physiologic
Withdrawal Hyper-arousal

12. Thinking / Cognition Symptoms
 Excessive worry, obsessive
ruminations, apprehension, difficulties
making decisions, trouble focusing and
concentration, etc.
 People with anxiety disorder often have
dysfunctional thinking patterns –
distorted ways of thinking about
situations, themselves, and others.

13. Faulty logic is a dysfunctional pattern of thinking that is biased, based on
personal assumptions.
• All-or-nothing thinking
• Catastrophizing
• Discounting the positive
• Emotion over logic
• Magnification/Minimization
• Mental Filter
• Mind reading
• Overgeneralization
• Jumping to Conclusions

14. What does faulty logic look like?
If you listen closely to a person who is anxious you
will find they tend to do the following:
 Expect the worst
 Worry about things before they happen
 Predict the future
 Underestimate their strengths
 Underestimate their ability to cope
 Unrealistic negative thinking

15. Examples of behavioral symptoms
1. Social Withdrawal
• Dropping out of recreational activities
• Spending time alone
• Avoiding social situations and events
• Not speaking with or going out with friends
2. Avoidance of stressful situations
• School refusal
• Staying home from school, work or from planned social activities
• Refusing to ride in a car
• Refusing to leave the house
• Refusing to sleep alone or with the lights out

16. Behavior symptoms
• People with anxiety disorders will do what they can to
reduce their anxiety and they quickly learn that by avoiding
the things that make then anxious they can prevent
themselves from feeling worse. DO NOT SUPPORT
AVOIDANT BEHAVIORS
• In addition, self-soothing habits and rituals, repetitive
reassuring behaviors and the may be using of substances
such as drugs and alcohol may be used to reduce anxiety.

17. Physical symptoms
• Rapid heart rate or racing • Upset stomach:
heart nausea, vomiting, indiges
• Headache tion, heart-burn.
• Muscle Tension • Diarrhea or loose stools
• Chest pains • Shortness of breath or
• Dizziness or faintness difficulty breathing
• Sweating • Sleep trouble
• Trembling or shakiness

18. Signs of Trouble - Warning signs
• Marked changes in personality
• Declining in school performance or failure to achieve expected levels
of functioning
• School refusal or avoidance of age appropriate social activities or
dating
• Inability to cope with usual problems and daily activities
• Excessive / irrational fears, worries or anxiety
• Abuse of alcohol, cigarette or other drugs
• Significant changes in eating or sleeping patterns
• In younger children: crying, tantrums, freezing, clinging, staying close
to parents

19. …What others might notice
• Consistent late arrivals or frequent absences at school or work
• Low morale, low self-esteem
• Social withdrawal
• Difficulties in completing school work
• Lack of cooperation or frequent altercations with others
• Frequent complaints of unexplained aches and pains
• Withdrawal from usual activities

20. …What teachers might notice
• Problems concentrating, making decisions, or remembering things
• Missed deadlines, delays in completing assignments, poor exam
grades
• Constant excuses for missed deadlines, or poor quality work
• Decreased interest or involvement in class topics or academics in
general
Note: Such behavior could indicate the student is having a bad day or week. A pattern that
continues for a long period of time, or repeats, may indicate an underlying serious mental
health problem or mental illness.

21. Differential Diagnosis
A variety of physical conditions can present with or be
accompanied by anxiety symptoms. The most common of these
are the endocrine/hormone disorders.
Think of physical disorder as the cause of anxiety if:
 Physical findings on clinical examination
 No family history of anxiety or depression
 No avoidance behaviors or social withdrawal

22. Anxiety and other common mental disorders
Depression vs. Anxiety ADHD vs. Anxiety
–poor attention
– Low mood, sadness –easily distracted
– sleep disruption –forgetful
– poor concentration –difficulty organizing
–fidgety
– fatigue/energy loss
–restlessness
– diminished interest
–Impulsiveness
–doesn’t wait turn

23. Medication that can Substances that can
produce produce Anxiety symptoms
Anxiety symptoms
• Caffeine
• Ephedrine
• Cocaine
• Pseudo-ephedrine
• Abstinence from alcohol
• Albuterol, Theophylline • Abstinence from
• Thyroid medicines narcotics
• Abstinence from
sedatives

24. School Counselors Collaborate with
Other
Health Providers
Students
Student
Teachers School with Parents
Counselor Mental Disorder
Administrators Community

25. Anxiety Disorders are treated in two primary ways…
and often used concurrently
Two Pathways
Biological Psychosocial
Treatments Treatments
MEDICATIONS/OTHERS COUNSELING/THERAPY

26. Treatment of Anxiety Disorders in
Children and youth
• 1st Line: Cognitive Behavioural Therapy (CBT)
• 2nd Line: Medication plus CBT
SSRI medication has strongest evidence:
fluoxetine – prozac
sertraline – zoloft
citalopram – celexa

27. SSRIs and School Counselors
• If GP choose to use one of the SSRIs. Predict side effects
onset soon after treatment has started.
• Patients with anxiety tend to be very sensitive to the side
effects to medications , they may experience an initial
increase in their anxiety symptoms on initiation of the SSRI.
• Educate that clinical response may not be fully present for 4
– 12 weeks
• Educate that maintenance treatment will be for 12 months
or longer

28. What are the expectations of school counselors ?
– Academic support – Individual student planning
– Goal setting and decision-making – Individual and small-group
– Career awareness counseling
– Education on understanding self and – Individual/family/school crisis
others intervention
– Peer relationships, coping strategies and – Conflict resolution
effective social skills – Consultation/collaboration
– Communication, problem-solving and – Referrals
conflict resolution
– Substance abuse education
– Multicultural/diversity awareness

29. How can you help?
∙ Provide information about what you think the problem – Mental health
education.
∙ Provide supportive psychological assistance, give reassurance and help
the person challenge the worrying thoughts
∙ Help the family (others) understand what the problem is
∙ Help the person find activities that can “get their mind off their worries”
∙ Teach the person how use thinking skills to counter the symptoms and
calm themselves
∙ Teach the person how to focus on positive thoughts and feelings
∙ Teach the patient how to deep breath
∙ Monitor and refer if problems worsen or if other problems arise

30. What else?
Help people learn more balanced ways of thinking!
Learning more realistic ways of thinking about events, situations,
themselves, and others is really hard to do! Remember that
using faulty logic is a habit that people have practiced for MANY YEARS!
Promote self-esteem by offering praise for small accomplishments and
rewarding participation even if the student gives a wrong answer.
If avoidance of social situations persists go with the patient to these
locations and help them face their worries there
In your interactions with the student, speak softly and calmly.
Help the student confront feared situations with gentle encouragement.