Supporting the Anxious Mind with Children and Adolescents

2 DAY SKILLS PRACTICE INTENSIVE: SUPPORTING THE ANXIOUS MIND WITH CHILDREN AND ADOLESCENTS

Wednesday, May 17, 2023 – Thursday, May 18, 2023 | WINNIPEG, MB

AGENDA

Understanding the neurobiology of anxiety and its contributors

• Gen Z, Generation Alpha, pressures, and technostress

• Normal vs. problematic worry

• Transdiagnostic approach to anxiety

• The nature of anxiety

• Anxiety & the brain

• Anxiety schemas

• 4 key routes to anxiety

• How anxiety shows up

• What maintains anxiety and the anxiety traps to avoid

• Student IPPs addressing anxiety

• Anxiety & neurobiology of trauma

Relationships and effective communication in addressing anxiety and trauma

• Rapport building and safety

• Effective emotion coaching

• Parent management and effective co-regulation

• Building emotional literacy

• Responding to anxiety in helpful ways

• Promoting confidence and independence

LEARNING OBJECTIVES

Establishing parent and child/teen buy-in

• Helping children and teens become experts of anxiety & their own neuropsychology

• Identifying and connecting the “Big Why”

• Collaborative agenda setting

• Motivational interviewing & values clarification

• Promoting an anxiety busting attitude

• Parent buy-in

• Addressing pushback

Externalizing and exposing anxiety

• Externalize and expose anxiety

• The trickster brain

• Identifying & individualizing henchmen

• Building awareness

Accepting anxiety & getting unstuck

• The power of paradox

• Acceptance vs. elimination

• Downfall of experiential avoidance

• Building emotion tolerance (and uncertainty tolerance)

• Explain the unique stress our children and teens face

• Differentiate normal and problematic worries

• Identify how anxiety manifestsin neurobiology, emotions, and behaviours

• Explain the key pathways to anxiety

• Identify the key variables that maintains anxiety and stalls progress

• Develop and provide client-friendly psychoeducation about anxiety

• Explain the impact of traumatic stress on the brain and how traumatic memory is stored

• Exercises to promote acceptance of somatic symptoms

• Building flexibility

Detaching from anxiety & enhancing the thinking brain

• Detaching from anxiety

• Interrupting rumination and overwhelm

• Strategies to demote anxiety

• Building the problem-solving brain (vs. strengthening the anxious one)

• Becoming rulers over anxiety

• Somatic integration

Daring and defying anxiety

• Functional assessments to individualize treatment

• Identifying fear cues and consequences, safety behaviours and functions

• Importance of stress inoculation

• Setting up exposures successfully

• Interoceptive exposure

• Interpersonal exposure

• Cognitive exposure

• Trauma approaches

• Habituation (and its traps)

• Maximizing fear extinction and safety learning

• Promoting an anxiety busting attitude

• Rewiring the anxious brain

• Creating an anxiety-busting lifestyle

• The risk-takers advantage

• Overcoming fear obstacles

• Addressing reverse hypnosis

• Effective responses to anxiety meltdowns and panic attacks

• Case examples

• Panic

• Social anxiety

• Generalized anxiety

• School refusal

Thriving from anxiety into the future and beyond

• Sustaining success

• Success bridges

• Breathing

• Mindfulness

• Healthy anxiety busting habits

• Changing baseline arousal levels & regulating the nervous system

• Discuss the shortcomings of traditional approaches

• Implement rapport-building tips and tools to improve relationships and create safety

• Engage as an effective anxiety coach

• Demonstrate skills to elicit buy-in from any child, teen, or parent

• Utilize strategies that help family members become effective emotion coaches for their children and teens

• Detect and challenge any of anxiety’s henchmen

Caroline Buzanko, Ph.D., R. Psych. is a licensed psychologist and clinical director of Koru Family Psychology. She has worked with children with neurodevelopmental disorders and their families for over 20 years, with a focus on maximizing connection, confidence, learning success, and resilience. In her clinical work, she specializes in the assessment and treatment of ADHD, ASD, learning difficulties, anxiety, and behavioural disorders. Through her specialized assessments, she helps parents and teachers understand kids’ strengths, areas of challenge, what makes learning easy, and how to best support them. She also offers therapeutic interventions to support children, teens, and their families.

WE ARE PLEASED TO WELCOME YOU TO A JACK HIROSE & ASSOCIATES WORKSHOP.

If you have any questions or concerns throughout the day, please notify your on-site coordinator.

PLEASE REMEMBER TO:

ü Wear your name badge every day

ü Turn off your cell phone

ü Hand in your evaluation forms at the end of each day

SCHEDULE:

This schedule may vary depending on the flow of the presentation and participant questions

8:00am – 8:30am Sign-In – Refreshments Provided

8:30am – 10:30am Workshop Begins

10:30am – 10:45am Mid-Morning Break – Refreshments Provided 10:45am – 12:00pm Workshop in Session

12:00pm – 1:00pm Lunch Break - Not Provided

Sign-In - CPA Members Only

1:00pm – 2:30pm Workshop in Session

2:30pm – 2:45pm Mid-Afternoon Break – Refreshments Provided

2:45pm – 4:00pm Workshop in Session

4:00pm Hand-In Evaluation Forms

Sign-Out – CPA Members Only

CERTIFICATES:

• Certifcates are available for all particpants to download.

• To download a copy of your receipt or certificate, please visit: http://registration.jackhirose.com/certificates

• Certificates will be made available to download once the workshop has ended.

Are you a member of the Canadian Psychological Association (CPA), Canadian Counselling and Psychotherapy Association (CCPA) or the Vocational Rehabilitation Association of Canada (VRA)?

Please read the important CEU information below.

• Please request a form from the on-site coordinator. Forms need to be filled out and submitted directly to the association by the participant.

• For CPA Members Only:

- New Policy as mandated by the Canadian Psychological Association

- CPA Members must take their name badge in the morning, sign in after lunch and sign out at the end of the day.

- Early departure means CPA Members are no longer eligible to receive CPA credits

- Certificates will be updated with CPA credits when the forms are returned to our head office for verification (please allow 2 – 4 weeks). Updated certificates are available for download here: http://registration.jackhirose.com/certificates

Untreatedanxietyistheleadingpredictorof depressioninteens&youngadults

susceptiblefordeveloping anxiety

Stress

Alreadyincreasedstressresponses =increasedvulnerabilitytostress.

Addanymore:

•Effectslearningandmemory

•Greaterriskforothermentalhealthproblems

•Greaterriskofemotionaltrauma

•Increasedstress-inducedillnesses

•Altersthematurationofbrains

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70%ofallmentalhealth problemsbegininchildhood andadolescence

80%ofchildrenand teensaffected negativelyfromCOVID

Earlyinterventionhelpsminimizelater problemswithdepression

Anxiety ImpairsDailyFunctioning

•Sleep!!!

•Academics

•Socialinteractions

•Happinessandoutlook

•Familyrelationships

•Doingthings/goingplaces

•Nutrition

•Self-care

•Independence

Intheclassroom, anxietyisan exceptionality thataffectshow studentslearn.

AnxietyLimitsLearning

Worrytakesupalotofcognitivespace…

•Poorattentionandconcentration

•Unabletofollowinstructions

•Unabletotransitionbetweentask

…therefore,superficiallearningishappening…

•Forgetthingspreviouslylearned

•Cannotremembernewconcepts

•Cannotgeneralizeknowledge

•Swisscheeseknowledge

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LimitsLearning

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LimitsLearning

LimitsExecutive Functioning

AnxietyImpairs SocialSuccess

However,whilesocietyhaschanged somucheveninthepasttwo decades,ourbrainhasnotchangedin hundredsofthousandsofyears…

Worriestobeexpected

Developmentallyappropriatefears

•Survival:separation,danger

Lifetransitions

•Newschool,graduation,changeinfamilycomposition,teenageyears

Stressfulexperiences

•Neworunfamiliarsituations

Anxiety Disorder

Significantinterference(home,school, social);anxietystartstomakedecisions

Significantdistressthatismorefrequent andmoreextremethanthatofpeers

HowAnxietyManifests: Affect

•Frequentdoctorvisits

•Releasedhormones

•Increaseheartrate

•Increasebloodpressure

•Increaseenergy

•Increasealertness

•Slowsotherprocesses(tofightor runaway)

•Secretesacidintothestomachto emptyit

Theystarttoworryabout thephysicalfeelings,which aredistressing,andjust wantthemtostop!

Wegetreactive! Misinterpretasdangerousandleadsto morefear,moresensations…

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HowAnxietyManifests: Thoughts

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HowAnxietyManifests: Thoughts

Brainbuiltforsurvival–itsjobis NOTtobehappy

•Negativitybias(primedtosee non-existentdanger)

•Uncertaintymisinterpreted

•Seeeventsasthreats

•Becomesingrained

HowAnxietyManifests: Behaviours

ThoughtsLeadtoPatternsof Behaviours

Basedonthebeliefofhowtheycan manage

Ican’thandleit!

•Believetheyareincompetent

•Dependencybehaviours

•Seekingreassurance

•Seekingassistance

•Repetitivequestions

•Prepareunnecessarily

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•Easilytriggered

•Disrespectful Oppositionalanddefiant

•Difficultytransitioning

Aggression/intimidation

•Difficultiesconcentrating

•Liesorsteals Temperoutbursts

•Restless/fidgety Interrupts/Intrudes

•Impulsive

•Giveupeasily

•Argumentative

•Yell

•Repetitivequestions

•Seekconstantapproval

Behaviours:Internalizing

•Withdrawn/isolated

•Shy

•Sad/irritable

•Head/stomach-aches

•Eatingissues(under-orover-eating;food intolerances)

•Sleepproblems/Fatigue

•Lowself-esteemandconfidence

•Rejection

•Repetitivebehaviours/obsession

•Difficultiesconcentrating,fidgety

•Avoidance

•Disorganized

•Cry

Exposedtosomesituationthat threateneddeath,seriousinjury,or sexualviolence

•Directlyexperienced

•Sawithappeningtosomeoneelse

•Heardaboutithappeningtosomeonethey love

Howpeoplerespondisimportant

•Noteveryonetraumatized

•Mostpeoplerecoverwithoutlong-term impairments

Traumavs. Anxiety

Everyoneisunique!But:

•Hastherebeenatraumatic event?

•Lifethreatening?

•Feltlifethreatening?

•Neglect

•Chronicemotional/verbal abuse

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Traumavs.Anxiety

Trauma

Reactionofsomethinginthepast

Recurringruminationofpastevents

•Potentiallossofawarenessofthenow

•Groundhogday

Samephysiologicaltraumareaction triggered

Changeinworldview

•Lossoftrust

•Lossofloveforlife

•Viewselfmorenegatively

Anxiety

Anticipatingsomethingbadhappening inthefuture

Ruminationofwhat’stocome

•Thoughtscomeoneafteranother

Physiologicalsymptomsmayappear

•Notthesameasthetraumaticreaction

Trauma&Anxiety

•Anxiouspeopleatgreaterriskfor traumaticreactions

•Anxietycantriggeratraumaticevent

•Publicpanicattackandfeelinglike you’regoingtodiewitheveryone watchingyou

•Scaredaboutfuturepanicattackscan triggerpanicdisorder

•Anxietyandtraumacanreinforceeach

Fight-flightanautomaticprocessdeep inthebrainstem

•Brainstemhasadirectconnectiontothe backofoureye

•Reacttothingsoutofourawareness

•Alwaysactivated–quickresponse!

•Everythingfeelsthreatening

•Hyperalertforeverything

•Can’ttellwhat’simportant

•Can’ttellwhatishappeningnow vs.inthepast

•Overwhelmed–thebrainandmind can’tprocesswhat’sgoingon

Freeze&Shutdown

•Parasympatheticsystemactivates

•Musclesfreeze

•Gazemayfreeze

•Breathmayfreeze

•Mayshutdowncompletely(enterano painstate)

•Unawareofwhat'shappeninginternallyor externally

•Can’tprocess

•Rumination Shame

•Self-blame

•Disconnectbetweenthepastandpresent

Trauma

•Adrenalineputsamygdalainto hyperdrive

•Laysdownbigemotional memories

•Cortisolshutsdownour hippocampus

•Memoriesarenotproperly integratedandbecome traumaticmemories

TraumaAffectsDifferentTypesofMemories

TraumaAffectsDifferentTypesofMemories

Flashbacks keepusstuck

Sustainstheoriginal traumaticmemory

Trauma&Context

Thenervoussystem andbodycan’ttellthe difference–feelsthe sameastheoriginal trauma

Unintegrated traumaticmemories triggerthesurvival response

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BrainShortcuts: Importanceof Context

•Turkeymothers

•Goodmothers

•Allmotheringis triggeredby“cheepcheep”

•Smell,touch, appearanceminor roles

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Reminds meof…•Integratedcontext

Flashback

•Unintegratedcontext

•Samesensations& emotionsasoriginal trauma

•Bodycan’ttellthe difference

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CompoundingInternal&ExternalStressors

•Shoulds School

•Teachers •Coursedemands&performance

•Demandsandexpectations

•Familystressors Parents

Peerpressures

•Ownstress&fighting

•Tryingtofitin

•Substanceuse

•Relationships

•Notimeforplay,creativity,orrelaxation

Lack•Notimetolearntocope ofdowntime

Development

Uniquepersonal stressors

•Navigatingstrongemotions

•Buildingidentity

•Makinglifedecisions

•Health

•SensorySensitivities

ChildrenandTeens’MentalHealth

DisruptedroutinesLackofaccessto resources Lackofsocial support LackofstructureInconsistent schedules

Poorlydefined rulesand expectations

Limitedlearning opportunities(and opportunitiesto makemistakes!) Lackofstimulation Inabilitytoexpress themselves effectively

FamilyconflictLackofmeaningfulsocialinteractionsFewerrewards

Lackof understanding& magicalthinking

Farmore:

•Depression

•Self-harm

•Suicide

Noexceptions:

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Pressureand expectations

Technostress

•Hardtodetach=chronicstress

•Don’treceiveanimmediatereplytoatext=anxietyandisolation

•Technology-relatedanxiety(e.g.,pressuretorespond immediately)

•Shame&stigmaifnotconnected

•Validationthroughsocialmedia

Massive-Scale Emotional contagion

Webegintoexperiencethe sameemotionsasothers withoutourawareness

•Long-lastingmoods(e.g., depression)canbe transferredthroughsocial networks

Breakingthecyclethatfuelsanxiety

•Nopick-upplan

•Alternativestophonecallshome

•Nameofworry

•Sameresponses

•Parentcoaching(e.g.,howtorespondtotexts/calls)

•Stipulationsabouthome-schoolcommunication

Optimal

ODDvs.Anxiety?

Core emotional pain

Shame-based experiences

Lonelinessbased experiences SADNESS

BehaviouralStoriesNeeds patterns Responses (internal/external situations)

Rejection,judgement, humiliation,negative self-treatment

Hide, disappear, shrinkaway, actout

Grieveoract out Isolation,lossof connection/lovedone

Fear-basedFear,lackofcontrol experiences

Iamflawed, worthless, don’tdeserve goodthings

Iamonmy own,lonely

EscapeNotsafe oract out

Considerproblem behavioursrelatedto

trauma

•Predictableoutcome:safetyfor thenervoussystem

•Gettingcloseisuncomfortable–easiertodisrupttherelationship (becausetheyarescaryand painful)

•Distractsfromuncomfortable feelings

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Behaviour!

Freeze,distracted, non-compliant, explosive

Anxiety, self-doubt &criticism

Tobevalued,appreciated, recognized,accepted, validated

Closeness,support,love, connection,caredfor, inclusion

Safety,stability,protection, control,personalstrength

Assigned task Challenged (perceived orreal)

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Relationship

Protectorfrom:

Violentbehaviour

Schoolfailure

Schooldropout

Substanceabuse

Depression

Suicidalideation

Unwantedpregnancy

Long-termhappiness

•Findawayin

•Createstrengths-based opportunities

•Acknowledgeadaptive behaviours

•Collaborate

•Nonjudgmentalstance

•Showstatusandrespect

•Validate

•Avoidpowerstruggles

•Teach!

Safe,nurturing relationships

•Senseofcontrol

•Senseofbelonging

•Lunchbuddies

•Anycueofsimilarity

•Colouredshirtsorwristbands, birthdays,classshirts,team jerseys

•Websofconnections,peer mentoring

Safe,nurturing relationships…

•Senseofcontribution

•Collaborativetests.

•Brainstormideasinsmallgroups howtosupportpeers/otherclasses

•Acknowledgepeerandteacher birthdays

•Evaluateprogramsandactivities

•Writtensurveysandfocusgroups

•Brainstormideasforimprovement

Reciprocityring

Easiertoaskforhelp–everyoneis!

Initiatehelpingothersontheirown

Promotesgenerosity

Promotescontribution

Createsconnection

Emotioncoach

Coachesvalidate&thenask open-endedquestions.

•Whatareyougoingtodo?

•Howareyougoingtofigure thatout?

EffectiveResponse

CoachingCues

•Showconfidencethattheycanfigureit out

•Collaborateideasre:howtheycan figureitout

•Helpthemmakepredictions

•Ipredict…(e.g.,Iwillfeel8/10proud whenIamdone.).

•Focusonlearning

•Howdidyoudo?

•Whatwentwell?

•Whatdidyoulearn?

•Whatwillyoudodifferentlynext time?

Effective CoachingCues

Iknowyoucanfigureitout.Brainstormwith _______andmakeaplan.Lemmeknow!

Ilookforwardtohearingthepositivethingsyou willsaytoyourselfasthisgetshard.

Letsbrainstormthewaysyoucanbossbackthis innercritic.

Whatareotherwaystodealwiththisproblem insteadoffighting?

Iknowyoucanstickupforyourself.Whatare thingsyoucansaytothem?

ThepowerofIDon’tKnow

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Whenthingsgo sideways

Todayisyourluckyday!

•Thismeansyougettotry again!Yay!

•Nowwehaveallofthis informationwecanlearn from…Nowweknowso muchmore

•Whatdidyounotice?

•Whatdidyoulearn?

•Whatneedstohappen nexttime?

Director

Focusonlack anddeficits

Pullupyour socks

Consequence

•Tooinvolved

•Cripplesresilience andmotivation

•Undermines learningand autonomy

Follower

•Noattention atall

•Passive

•Focusonstrengths

•Askopen-ended

•R+competence& confidence

•Promotesautonomy

•Promotesmotivation &engagement

EffectiveCommunication

•Youacknowledgetheir feelings

•Youacknowledgetheir perspective

•Yourattitudeis respectfulandcaring

•Yourespecttheir autonomy

Connect

•Compassion

•Acceptance

•Collaborative

•Evocation

Notsogreat Communication

•Youignoretheirfeelings

•Youignoretheir perspective

•Yourattitudeisnot respectfulandcaring

•Youtrytolecture,teach, orfixthesituation

Withthatattitudeit’snowonderyouare failing.Icalledyouinheretotellyouto straightenupifyouwanttohaveanyhopeof passingthisclass.

Icanseethatyoutriedhard,anditisn’teasy.I wantedtocheckinandseewhatIcoulddo thatwouldbehelpful?

LabellingEmotions

LabellingEmotions

Whatdoyouneed fromotherswhen dysregulated?

Weallneeddifferentthings whenwe’redistressed

Needto manageour ownstress, perceptions &responses sowecan provide:

Choice

Context

Connection

Choice

•Nocontrol=fight/flight

•Buildsconnection

•Choicestimulatesinnersecurity(innerwisdom)

•Empowering(wetrusttheirownexpertiseandinternalresources)

•Smallchoicesininteractions

•Choicethroughelicitingtheirinnerwisdom

•Getmeta!

•Getmindful(noticingnow)&followthat

•Context

•Nervoussystemonalert

•Arewesafe?

•Isitsafetoengage?

•DoIneedtorunaway?Orshutdown?

•Connection

•Fundamentalpriority

•Physiologicallyconstantlyseekingconnection

OptimizingSelfRegulationThrough Relationship

Down-regulating “negative”emotions

•Being

•Tolerating

•Validating

CostBenefitAnalysis

Benefitofbeingslavetoanxiety

Peopletellmewhenthingsaregoingtochange soIamalwayscomfortableandneverstartled IcantakeabreakwheneverIwant

Easier

Morecomfortable

Won’tmakeamistake

Costofbeingslavetoanxiety

NothingisalwayspredictableandIgettooupset whensomethingunexpectedhappens Ioverreact/cry–kidsmakefunofme

Ican’tgotosleepovers

Momalwayshastocomeonfieldtrips

Can’tdoanythingonmyown

Feellikeababy

OtherkidsaregettingbetterandIamstillstuck

Allthethingsanxietymakes youavoid

•Seeingfriends

•Sleepovers

•Birthdayparties

•School

•Tryoutsforsports(and thereforesportteams)

•Sleepinginownbed

•Makingnewfriends

•ButImissoutongoingtoBF’shouse becauseshehasadogIavoiddogsbecauseImightgetbit

Iavoidputtingmyhandupinclass becauseitmightsounddumb

•ButImissoutonsayingthingsIwanttosay, especiallyreallygoodideas

•ButImissoutonhavingfunwithmyfriendsIavoidsleepoversbecauseIamworried Iwillhavetogotothebathroom

•ButIfeellikeabigbaby

Iavoidbeingalonebecausesomething mighthappen

•ButImissoutonlearningandseeingfriendsIavoidschoolbecauseImightthrowup

•ButImissoutonorderingwhatIreallywantIavoidorderingfoodbecauseImight messItup

•Whytheywanttocontrol theirownlife

•Howexhaustinganxietyis

•Howlifewillbedifferent

•Whattheyaremissingouton

EmotionsAreTellingUs SomethingAboutReality (ourthoughtsmakeup conspiracies)!

•Helpwithlearning

•Guide(andmotivate)our behaviours

•Canhelpusproblemsolveand respondflexibly

EmotionsAreTellingUsSomething (justlikePhysicalPain):

Understandthetruths!

Ourbodiesareintuitiveanddesignedtoprotectus.

Whenuncomfortable, EVERYONE’sbrain wantsustoquit.

Emotionsaresimply emotions!

Keysto

Stress&Worries

Expectpositive outcomes

Howdohighschoolstudentscopesocially whentheyaretoldthatpeoplecanchange sociallyrelevanttraits?

Expectpositive outcomes:Theywill too!

Theygotoveranxiety&improvedtheir stressresponsetosocialinteractions

WeCanChangeOurBrain!

•Ourbrainisbuiltforustobesuccessful

•Brainnetworksfixandgrowwhenwelearn newskills

•NeuralbundlesDOUBLEwithanhourof practice

•Rewireourbrainthroughrepetitionand practice

•Whateverisnotused,thebrainprunesitself

WeGrowOurBrain

WheneverWe:

•Takeonnewchallenges

•THINKwecanlearnsomethinghard

•THINKwecanlearnfromourmistakes

MishmashofaBrain

Piecedtogetherovermillenia

•Someareascancommunicatedirectly, othersonlyindirectcontact Canholdcontradictinginformationin differentpartsofthebrain NooneCEO.Lotsofsubselves–differentpartsofthebraincan communicateandworktogethereasily

•Nooneparthascomplete information

Exposeit

•Remindhowanxietyworks

•Yep,there’sBob,that’swhatit does.

•Wow,itisreallyworkinghardto makemethinktheworsttoday!

•Yeah,weknewit’dshowupnow.It doesn’twantmetowritethetest.

•Itwantsmetoavoidnewthings.

•Itreallyknowshowtotrytostress peopleout. 250

Sayingitoutloudgivesus

Physiological

Emotion

MisattributionError

•Mostpowerful

•Usuallyshowsupfirst

•Triggersanxietyresponsebefore weevenrealizeit

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FeelingsSubjectto Distortion

•Wrongcontext

•Needtolearntocorrectlyinterpret ourinteroceptivesignals

•Betterabletointerpretsignals

•Canmakemoreadaptive decisions

•Boostresilience

•Betteremotionregulationand overallemotionalfunctioning

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Self-Coach

Iunderstandwhatmybodyisdoing

Icanhandlewhatmybodydoes

Icanhandlediscomfort

IknowIcanbreathetomakemy brainandbodycalmdown

Expectingphysicalsensationshelps reducesignalstoamygdala

MomandDadare late–theymust havediedinacar accident.

…Whatit soundslike…

Triggers

•Worriesaboutapanicattack

•Worriesaboutbeing embarrassed

•Worriesaboutsomething happening

•Worriesaboutfacingsomething scary

•Worriesofhavingbadthoughts

Intensifiers

•Contextvariables

•Who

•What

•Where

•When

Motivationof Emotions: OurReactions

Whatdowefocuson?

•Dowemovetowardsorawayfromwhatis upsettingus?

Whatdowedo?

•Loudorquiet?

•Bigorsmall?

•Fightorrunaway?

Thoughtsleadto(avoidant)behaviours

People•Iavoidputtingmyhandupinclass willthinkyouare stupid

•IavoidgoingtomyBF’sbecauseshehasa dogDogswillbiteyourfaceoff

Everything•IavoidanythingIcan’tdoperfectly hastobedone perfectly •Ihaveabigtantrumtoavoidgoingout

WhatamIavoidingbecauseofworries?

IavoiddogsbecauseImightgetbit

IavoidsleepoversbecauseImighthavetogotothebathroomin themiddleofthenightandfalldown

Iavoidbeingalonebecausesomethingmighthappen

IavoidorderingfoodbecauseImightmessitup

Peoplewillthinkyouarealoser-KickedBobbywhenIlostthegame

Youaregoingtofail-Screamedatmomwhenshemademegotoschool

It’sgoingtopainful-PunchedaholeinthewallwhenIhadtogotothedentist

Theplaneisgoingtocrash-Hidmysuitcasewhenwehadtogototheairport

Nobodylikesyou-Leftthesleepoverwhenmyfriendteasedme

Yourhaircutisterrible-Yelledatmyfriendstogoawaywhentheysaidhi

Yourfriendsfoundnewfriends-Sworeatmyfriendwhenhedidn’ttextmeback

Motivationof Emotions: OurReactions

Intensity&durationofanxiety&the Importanceofthesituation

•Wastheanxietyhelpful?

•Whydiditlastaslongasitdid?

•Whywasitasintenseasitwas?

•Whatfueledit?

RightBrain

Theseareonly guesses!!!!

(Basedonunhelpful trickster assumptions)

Leadstospiralling Laughed at No friendsFailHomeless

Acknowledge &Detach!

•Yep,that’syourstoryyou’re tryingtotell.

•Nicefirstdraft.Niceconspiracy.

•Thisisnormal.

•Thisisnotanemergency.

•You’reannoying.

•Iamlearning.

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Detachfrom&Demotethoughts Distancing

•“InoticeI’mhavingthethoughtthat….” •Usethirdpersonlanguage Train,balloons,bubblesclouds,orleavesontheriver Thankthem

Detach&Demote WaroftheWorlds Objectify

•Whatcolour?Howbig?Whatshape?What texture?Howwoulditmoveifitcould?

Thought:Aw.He’sso cute!

Feeling:Scared

Behaviour:Runaway

Feeling:Calm

Behaviour:Pethim

EnhanceCriticalThinking:SeparatefromtheNoise WhatshouldIbuyinto?

Helpful

Iamgoingtohaveso muchfun!

Ican’twaittoseeDanny!

Ihavetorememberto bringmyswimsuit

Enhance Critical Thinking withHelpful Questions

Unhelpful Iamgoingtothrowup(eventhoughI haven’tthrownupinoverfiveyears)

Momisgoingtoforgettopickmeup(even thoughshehasneverforgottenbefore)

Nooneisgoingtoplaywithme(even thoughmyfriendisgoingtobethere)

Allthebadthingsthatwillhappen

Isthereanyshredof usefulnessinthisthought?

Isthisanoldstory?

WhatwouldIgetforbuying intothisstory?

AmIgoingtofollowmy thoughtsormyexperience?

Whatwould bebad aboutthat?

WillgetlaughedatIwillcry

Theywon’tbemy friend

EveryonewillthinkI amababy

WhatamI goingtodo next?

Iwillbelonely&fail outofschool&be homeless

•Helpful: Will•Unhelpful: getlaughedat

•Helpful: I•Unhelpful:

•Helpful: Everyone•Unhelpful:

•Helpful:

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Overestimate

•Believesomethingbadisforsuregoingtohappen

Fortunetelling

•Believeyouknowwhatisgoingtohappen

Overgeneralize

•Believeoneexperienceisalwaysgoingtohappenagain

•Believeyouknowwhatothersarethinking. Mindreading

•Focusonlyonnegativewhilemissingpositives Negativityblind

•Mustknow,needstobemyway,yeahbut Rigid

All-or-nothing

•Never,always,nomatterwhat,nothingcanchange

•Ican’tunless…,Idon’twantto,Iamsick Avoidant

•Iwillalwaysbelikethis. Permanent

•Worsecasescenario Catastrophic

PerfectionistPaula GetsintheWayofLife

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Perfectionismisthemost seriousthinkingtrap& rootofdepression

Focusoncoreconcepts

•Unrealisticexpectations

•Rumination

•

Perfectionism

Helpfulparts

Helpsusstrivefor excellence

BuildProceduralThinking!

Unhelpfulparts

Becomeparalyzed

Procrastinate&create morestress

Stifleslearningand growth

Narrowsourworld

Makesusperformworse

•Striveforexcellence,butaddressunrealisticstandards

•Emotionsrelatedtoexpectations

•Focusonwhat’snext(vs.circumstances,rumination,should’s)

What’s next?

What’s next?

What’s next?

BuildBinaryThinking!

Makesuccesseasierthanfailure

•LowerthebarforACTION&customize confidence

•Focusonwhatwecandoconfidently nowandbuildfromthere

•Setbenchmarksthatareimpossible tomiss

•Objective:Didyoudoityes/no

•NeveraboutHOWitwasdone

Embracingmistakes

Whatwasthisexperiencelike?

Whatdidyoulearnfromthismistake

Whatwillyoudothenexttimeyouareinthissituation?

Whatadvicecanyoutellothersbasedonthis?

Forgingahead

•Avoidgettingstuck

•Noneedtoaskwhy,lecture, orexplaintheproblem

•HaveTHEMthinkofthehows

•Howwilltheyfixthis mistake?

•Howwilltheymoveon?

•Howwilltheyhandle ______________?

Ratherthandeflectfailure,focusonthechild’sroleto learnfromtheexperiencetogrowandimprove

1.Whatwasyourrole?

2.Whatcouldyouhavedonedifferently?

3.Whathaveyoulearned?

4.What’snext?

PracticeFlexibility: GetUnstuck

Lookslikeyouramygdala hasgottenstuck

•Whatlittlechangecan help?

•Howcanyoutry somethingdifferent?

***Brainstormtobuild flexibleproblemsolving.

Chainofflexibility

•Underestimatesour

•Youwillalwaysbe likethis.

HypothesisTesting

Columbo Approach

Imissrollcallandwon’tgetyelled

Consofbelieving

Imissbeingchosenforfunjobs.

FlipReality

•

CopingCards

•

•Iamnotgoingtoletworrygetinmy way.

•Theoutingwillbesomuchfun–thereisnowayIamgoingtomissit!

•Thisworryistemporaryandwillpass.

•

Problem solving

Problemsolving

Problemsolving: Fearofunknown

•WhatifImissthebus?

•Whatifnoonepicksmeup?

•Whatifsomeoneismean?

•WhatifIhaveanallergicreaction?

•WhatifIgetlost?

•WhatifIamlate? WhatifIhavetogopee?

•WhatifIgethurt?

Jim’smom getsaflat tire

•WaitwithJim atthewaiting spot

Jim’smom forgetsto pickmeup

•Goto the office

Theoffice islocked •Find the janitor

Can’tfind thejanitor •Walk home

Modelling

•Ifeelfrustrated.Ineedtotakea minutetothinkwhattodonext.

•Canyouhelpmebrainstorm ideas?

•That’satighttimeline.Iamgoing toplanthisout.

•Iamalittlenervous;Ihavenoidea whatwillhappen.Let’sfigurethis out.

StrengthenProblemsolving: FosterCreativity

•Creativeplayandactivities

•Divergentthinking:Findoutofthebox solutions

•Schoolproblems

•Classroomproblems

•Familyproblems

•Individualsituations

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RejectionPractice

Askastoretostayopenanextra30minutesforme

Askastrangertotakeaselfiewithme

Askforabiteofastranger’sfoodatarestaurant

Asktomakeanannouncementovertheloudspeakeratagrocerystore

Askastrangerfor$50

“Anyonewhoisn'tembarrassedof whotheywerelastyearprobablyisn't learningenough.”

AlaindeBotton

“Thewaytogreaterconfidenceisnot toreassureourselvesofourown dignity;it’stocometopeacewithour inevitableridiculousness.”

Practice! BeingRidiculous

NoSafetyBehaviours

(It’sonlyanillusionofsafetyanyway)

TheProblemwith SafetyBehaviours

•Worsensanxietybecauseno learningishappening(e.g.,no danger,theycanhandleitontheir own)becauseitwasthebehaviour thatpreventedcatastrophe

•Stilltryingtocontrolanxiety(so neverconfrontfears)

•Effortfulandexhausting(which causesmoreanxietyand dysregulation) Speedofrecovery

FunctionalAssessment: Whatmaintainsanxiety?

Antecedents

•Triggers:Situations,stimuliandoverallcontext

•Externalsituationsandstimuli

•Internalbodysensations

•Intrusivethoughts

•Anticipatedfearedconsequences

Consequences

•Safetybehaviours&othermaladaptivecoping strategies

•Everyone’sresponsestoanxiety

Connectionsbetweenthetwo

Important: Don’tassumeyouknow!

•Mustunderstandthethingtheyworry about(fearcue)ANDthemeaningthey givethatthing

•Whatwillhappeniftheyfacetheirworry withoutcomfort,withoutsafetybehaviours

Snakes

TeenageboyCaroline

•Snakemightbepoisonous

•Snakemightbiteme

•IfIgetbit,Iwillgetaninfection inmylimbs

•Allmylimbswillbeamputated

•Lifewillbeover

•Therefore,needtoavoid

•Disgustresponse!

•Needtovomit

•Therefore,needtoavoid

Whatwould beawful aboutthat?

•Kidswill laughatme

Whatwould beawful aboutthat?

•Iwillbe embarrassed

Whatwould beawful aboutthat?

•Kidswon’t likeme

Whatwould beawful aboutthat?

•Kidswill laughatme

Whatwould beawful aboutthat?

•Iwillbe embarrassed

Whatwould beawful aboutthat?

•Kidswon’t likeme

Antecedents(Triggerstoanxiety)

Snakes

Askingsomeonetoplay

Tryingsomethingnew

Sleepingalone

Beinghomealone

CreateaMenuofFearedSituations&Stimuli

Togetusstarted:OurfocusisonthePROCESSvs.specificfears

Matchsituations,thoughts,and physiologicalexperiences

Whatdotheyhavetolearn? Whatdotheyhavetodotolearn?

Makeitworthwhile:Includethe hardest,scariestthingstheythink arevalidandneedtobeavoided Nomorethan10

Getthick!

•Whatwashappeningrightbefore?

•Whatdiditfeellikeinyourbody?

•Howintense?

•Howlongdiditlast?

•Whatconspiracywasittryingtospin?

•Whatdidyou?

•Whatdidyoudototrytofeelsafe?

•Howhelpfulwasit?

•Whatendeduphappening?Howdidyou feelafter?

Safety behaviours

Habitsthatmaintain anxiety

•Strategiesto control,avoid,or reduceanxiety

•Createa comprehensivelist ofbehaviours& FUNCTIONofthose behaviours

Safetybehaviours

Howdothesafetybehaviours

•Preventthefearedoutcomefrom happening?

•Work?

Safety behaviours: Canbe

obviousor subtle

Passiveavoidance

•Purposelyavoidingsituationsbasedonpredictions

•Needtoknowwhattheyavoid,whytheyavoid,andhowtheyavoid

Excessivechecking

•Reassuranceseeking

•Ensuringcertaintyofsafety

•Preventativebehaviours–solidifythebeliefthatthesearewhatsavesthem

Overtcompulsions

•Reduceanxietyordanger/Preventfearedoutcomes

•Negativelyreinforced

•Needtoknowwhattheritualsare,triggers,function,whatwillhappenifthey don’t,andhowtheyfeelafter

Covert(mental)compulsions

•Quickattemptstoreduceanxiety

•Relaxation,distraction,positiveaffirmations

Safetysignals

•Makekidsfeelsafer

SafetyBehaviours

Youarethe expertandI needyour expertise!

Antecedents(Triggerstoanxiety)

Setupthesituation:GetDetailed(Distance)

Antecedents(Triggerstoanxiety)

Seeingapictureofasnake

Thinkingaboutasnake

Someonetalkingaboutasnake SeeingasnakeinItscage

Wewillputourexpertheadstogethertofigureoutthebestplan.

Getdetailed(Time)

GetDetailed(People)

SettingupExposures

SettingupExposure: Collaborateaspecificplan

•Step-by-stepplan

•Iwillentertheroomandgostraighttothesnake cage

•Iwillstandfacingthecagestraightonandlookat thesnake

•OnceIamatthecage,Cindywillstartthetimerfor 30seconds

•Cindywillstandbythedoorwithnooneelse around

•Whenthealarmisdone,Iwillleavetheroomwith Cindy

•Cindyisonlygoingtolookatthetimer.Sheisnot goingtosayanythingexcept,“Timeisup”

1.Thenatureofanxiety

•Anxietyisnormal

•Anxietyissafe

•Anxietyistolerable

•Anxietyistemporary

•Youcanhandleitonyourown

•Withoutothers

Withoutothersafetybehaviours

2.Somethingaboutthespecificissue (basedontheirprediction)

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AddressObstacles

Predict:

Whatwillworrysay?

Howwillyourbodyfeel?

Whatwillworrywantyoutodo?

Whatwillworrywantotherstodo?

Address Obstacles

Ithrowup

•Iwill:bringapapertowelwithmetowipeit up

•Cindywill:

•Keeplookingatthetimerandnotsayanything excepttimeisup

•Helpmecleanitupwhentheexposureisover

Worrymakesmefeeloverwhelmed

•Iwill:

•Bringinmycopingcardstotalkback

•Gotothesnakecageanyway

•Cindywill:keeplookingatthetimerandnot sayanythingexcepttimeisup

Evaluate

•

EndingExposureSession

•

Important!

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Hard Working onIt Success!

Provokeexaggeratedpredictions

•Combinedmultiplefearstimuliinasinglesession

•Moreeffortenhanceslong-termretention

•Maximizeslearningandminimizesanxietyrelapse

Provokeexaggeratedpredictions

Spontaneouslyconfrontthefearof heights,snakes,andelevators(mustall provokethesamefearedoutcome)

Settingup Exposures

ReasonableRisk

Notabsolutelyrisk-freebut somethingpeopledoeveryday

•Saysomethingstupid

•Dosomethingembarrassing

•Makeamistake

•Sweatinfrontofothers

•Wearsomethingatrocious

•Askacrushout

•Forgettolockthedoor

•Gotothetoiletinpublic

•Walkoutsideonareallywindy day 526

Provokeexaggeratedpredictions

Spontaneouslyconfrontthefearof heights,snakes,andelevators(mustall provokethesamefearedoutcome)

Controlis important

•Signalsofcontrolcankeepourprefrontal cortexonline

•Lackofcontrolsuffocatesourcapacity tocope

•Anotherreasoneliminationdoesn’t work:hopelessness

•Collaborationovertheprocess

•Skillstocreatechoicewhenanxietydoes showup

Acknowledgingwhensomethingishardandnot pretendingitisn’t Withanhonestappraisal,wecanrespond productively

Drawontheir resources: Usepastsuccesses

Whatarethingsyouhavealready done/learnedtodo?

•Whatuncertaintywas there?Howdidyouhandle it?

FlipIt

What’stheopposite? Howdoyoustarttomoveinthat direction?

-Whatstepwillyoubemost proudofnextweek?

-Ayearfromnow?

•Iwanttogoontheoutingand havefun,soIamwillingtonot knowwhat’sgoingtohappen

•Iwanttobepartoftheplay,so Iamwillingtofeelnervousand gototheaudition

•Iwanttoshowmyscience project,soIamwillingtogoto thesciencefairevenifIfeel likeIamgoingtopuke

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InteroceptiveExposure:LeanIn!

•Confrontworrisomebodysensations

•Evokethingstheyworryabout

•Learning:Theuncomfortablephysicalsensationsaretolerable, temporary,andnotdangerous.

InteroceptiveExposure

Ultimategoal:Toleratethephysicalsensationswithout beingscaredofthem(andthereforemakingthem worse)

•Newlearning:Iamnothavingaheartattack,lose completecontrol,suffocate

InteroceptiveExposure

Beprepared!Weneedtheirconfidenceinthisprocess

Hyperventilate/fast breathing(dizziness)

Spininplace(dizziness, nausea)

Wearsomethingtight aroundneck(tightnessin throat)

Breathethroughastraw reallyfast(breathlessness)

•Holdyournose!

Shakeheadfastsideto sideordrawingacircle withyournose(dizziness)

Stareatceilinglightfor1 min.andthentrytoread something(blurredvision)

Jumpingjacks,runonthe spotorupanddownstairs (increasedheartrate)

Stareathandsfor2-3min. (unreality)

Getthemtodowhatever causesthefeelings

Step1: Elicit Symptoms

Trya seriesof exercises and record thedata

Lengthoftime

Thephysicalsensationsthatcome up

Theintensityofthosesensations

Thelevelofdistressexperienced (wewanttorepeattheonesthat aremostdistressing)

548

Step2:Exposure

•Pickoneofthemoderate+distressingexercise andrepeatit

•Evokesensationsasintenselyaspossible

•Sustainsensationsbeyondfearedoutcomelimits

•Repeat–especiallywithany“yeahbut’s”

•Nodistractionnoravoidance

•Record

•Lengthoftime&numberofrepetitions

•Sensations

•Intensity

•Levelofdistress

•Assignforhomework!

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Maximize Learning

Combineexposures! (Interoceptiveandsituational)

Teenagerwhowasterrifiedshe’d hurtsomeoneifshefeltpanicky(lots ofnightmares)

•Teenagerterrifiedofhavingapanic attackwhiledrivingandgettinginto anaccident

•Womanterrifiedofturningredin frontofothers 550

MaximizeLearning

Combineexposures! (Interoceptiveandsituational)

•Teenagerwhowasterrifiedshe’dhurtsomeone ifshefeltpanicky(lotsofnightmares)

•Teenagerterrifiedofhavingapanicattackwhile drivingandgettingintoanaccident

•Womanterrifiedofturningredinfrontofothers

•Elicitthephysiological response(e.g.,ofpanic) first

•Thenputthemintothe situation

•Inaroomalonewitha friend Inacardriving Inapresentationinfrontof others

551

MaximizeLearning

•Fearofbeingnauseousingymclass:Spin beforegymclassoreatabigmealandthen runaroundontheplayground

•Fearofsuffocatinginclass:Breathethrougha strawreallyfastandgotoclass(withnowater bottle!)

•Fearofheartracingwithnoonearoundwho knowsCPR:runupanddownthestairsand thengoplaywithfriends

552

ImaginalExposures

Bestforinternalthoughts,visualizations,andtraumaticmemories causingdistress

ImaginalExposures

•Thinkaboutthem

•Justthoughts!

•Temporary

•Notharmful

•Manageable

•Defusionstrategies

•Reviewtheconspiracystory

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CognitiveFlooding

•Getasanxiousaspossible

•

•

Helpfultips

•Model

•Don’trush!

•Gooddebrief

•Lotsofminisessionsclosetogether

•

Whensomething badDOEShappen

•Yay!

•Importanceofkeepinggoing

WhenAnxietyOverwhelms

DuringaMeltdown

•Remaincalmandneutral

•Createsafety

•Eyelevel

•Soothingtone

•Disengagebutremainclosefor support

CommonObstacles:

•Lackofunderstandingaboutanxietyandwhat maintainsit

•Unclearrationale

•Rationaleirrelevantorweak

•Fusiontounhelpfulthoughts(e.g.,justifications)

•Excessive(e.g.,toobig,skillsorresourceslacking)

•Kidsnotinvolvedinselectingandplanning

•Exposuresaren’tworrying–tooeasy

•Somethingstillmakesthemfeelsafe(yeahbut…)

•Practicesessionstoonarrow

•Responsepreventionimplementedincorrectly

•Focustoomuchonconvincingorreframing

•Nolearninghappening

•Poorrelationship

•Depression

Afterameltdown

•Acknowledgeandpraise

•Validateandempathize

•Ifcalm

•Workthroughit

•Lessonslearned

•Functionofemotion

•Rewindanddoover

Habituation

Sendingthewrongmessages

•Anxietyisbad(becauseitmustbe reduced)

•Somethingiswrongwithme (becausetheonlywayIwillbefixed isifIdon’tfeelanxious)

•Misinterpretinevitableand normalunexpectedanxiety becomessignsoffailure

•Hopelessness

•Anxietyiscontrollable

•Exposurecanbecomeanother safetysignal

HabituationFocusonlearning:Feared outcomebeliefscontradicted?Did youhandleit? Whattodoinstead…

associations Createnewlearningpatternsthat competewitholdones

LearnedFearGeneralizesEasily

•Safetylearningaffectedbycontext

•People

•Place

•Time

•Accesstosafetysignals

•Intensityofarousal

IfStuckon Safety Behaviours

•Wewanttoletgooftheseasquickas possible.

•Useonlytobuildmomentumandsuccessif absolutelyneeded

•Doacostbenefitanalysis(e.g.,short-termgain forlong-termpain) 569

ConditionalSafetyLearningLearnnon-danger-based associationsacrosscontextswith differentpeopleandeverywhere anxietycanshowup

Whattodoinstead…

AdultsBeing

BeingHelpful

Challengesarepartoflife. Dealingwiththemispartoflearning thattheycanhandleit

Optimizeteachable moments

•Letthemtry.

•Letthemfail(butdon’tset themupforfailure)

•Letthemtakeaccountability

•Helpthemunderstand other’sperspectives

•Ensuretheyseethe consequencesoftheir behaviours

•Letthemworkthroughnext stepsandhowtofixthings

Embrace mistakes

Havea“Mistakeoftheday”tosharea mistakeorchallengetheyfaced,how theyfixed/handledit,andwhatthey learned

•Usefeedbackstatementsand questionstoanalyzetheproblem andlearnfromit

Embracingmistakes

Whatwasthisexperiencelike?

Whatdidyoulearntoday?

Whatmistakedidyoumakethattaughtyousomething?

Whatdidyoutryhardattoday?

Whatcanyoulearnfromthis?

Whatwillyoudothenexttimeyouareinthissituation?

Whatadvicecanyoutellothersbasedonthis?

Itisnotwhat theydidwrong thatcounts,but whattheydo next.

Letthemtake accountabilityfor mistakes

Ratherthandeflectfailure, focusontheirroletolearnfrom theexperiencetogrowand improve

•Whatwasyourrole?

•Whatcouldyouhavedone differently?

•Whathaveyoulearned?

•What’snext?

Forgingahead

•Avoidgettingstuck

•Noneedtoaskwhy,lecture,or explaintheproblem

•Havethemthinkofhows

•Howwilltheyfixthismistake?

•Howwilltheymoveon?

•Howwilltheyhandle ______________(e.g.,theunfair teacherorthenoisychewerbeside thematlunch)?

Askingforhelp

Resilientkidsknowhowtoseek appropriatesupport

Thekeyistoallowthemtodo thingstheyknowhowtodo themselvesbutagreetoprovide appropriatesupportand guidancewhentheyaskforit

TakeRisks! 592

Risk-takersadvantage

Exposingkidstoopportunitiesforsomeriskishelpful

•Limitsonscreentime

Learntheskillstheyneedtosurviveearly

•HelpwithImportantevents

Decoratingtheclass

•Eskimoclub

Usingtools

•Planningschoolevents

Opportunities forresilience:

Makingtheir owndecisions

Powerfulidentities

•Learnwhowearebasedonwhatotherstelland valueaboutourselves:Co-creation

•Seethemselvesaspowerfulandrespected

•Kidsfeeltheyhavesomethingtooffertheworld

•Createopportunitiesforkidstoknow themselvesinbetterways

•Spacetoexpressstrengthsanddemonstratethem toothers

•Kidscanmakedecisionsintheirownlives

•Opportunitiestomakedecisionsforthemselves

•Decisionsthatmatter!

Experiencesof powerandcontrol

Createchallenges!

Whoworewhichcolor?

Rachel,LindaandEvewerefriendssittinginacircleonthe grass.

Rachelpassed3chocolatechipcookiestothepersoninblue. Evepassed3macaroonstothepersonwhopassedhercookies tothepersonwearinggreen.

Eachpersonpassed3cookiestothefriendonherleft. Rachel,Linda,andEveweredressedInred,blue,andgreen, butnotnecessarilyinthatorder. Thepersonwhoworegreendidnotgetamacaroon. Thepersonwearingredpassedalong3oatmealcookies.

LifestyleFocus

Self-guidedexposure

Smash Patterns

Smash Patterns

AcknowledgeLearning!

Praisecourageousbehaviour

•Beingbraveiseffortfulandcanbe exhausting!

•Needtokeepthemmotivated

•Reinforceany&signsofwillingnessand flexibility

WhatIcouldn’tdobecause ofworry:

•Gotoschool

•Seefriends

•Askforhelp

Eventhough…. Nevertheless…. Moving

WhatIcandonow:

•Gotoschoolonmyown

•Stayatafriend’shouseonmyown

•Putmyhandupinclass

•Ridethebus

Trauma

•Traumaticmemoriesaretrappedintheamygdala&continuouslyringthealarm

•Amygdalahijacksthebrain

•Brainconnections&integrationdisrupted

•Keyfocus:Promotingbrainintegration

•Emotional&thinkingbrain,left&righthemispheres

Stressis Contagious!

Trauma

•Relationshipisessential

•Manytraumasareinterpersonal

•Traumamostlyaffectstherightbrain,which canimpairemotionalconnectionwith others

•Workingtogethersafelypromotes integration&reducesdissociation

•Focusingoncreatingsafetywithyou&in theirbodies

•Notdonethroughtalking:Listeningandfeeling physically

Needtomanageourownstresssowecanprovide:

•Choice

•Nocontrol=fight/flight

•Context

•Nervoussystem:Isitsafetoengage?Orshutdown?

•Connection

•Fundamentalpriority

Trauma

•Stoptrauma

•Howareparentsdoing?

•Theirownanxietyandtraumacan getinthewaywithhowthey interactandrespondtotheir children

•Co-regulationimportantmost often

•Rupturesareinevitablebutthey needtoknowhowtorepairthings whentheydo

•Opportunitiesforchildrenand teenstotoleratenegative affect 616

Trauma

•Normalize

•Ofcourseyou’refeeling thisway!Andbehavingthis way!Nowonder...

•Yourbrainandbodyare doingexactlywhatthey shouldbedoing

•Thisisagoodthing–it tellsusweneedtostay present 617

Trauma Embeddedmemoriesinnervous system

Whenimplicit,wewillneverhaveamemoryofwhathappensthatwecantalk about.Memorybecomespatternsinthebody.

•

Exposure

Stillneedtowakeuptheamygdalatoworkthrough dysregulation

•Bewith&toleratethefeelings,responses,thoughts,& imagesconnectedtothetrauma

•Dropintothebody

•Maintainpresentawareness&keeptheprefrontal cortexonlinetointegratethebrainvs.dissociate

•Interactandrelate

•It’ssafe!

Helpingthe NervousSystem

CreateaNew Responseto

Trauma: Tolerance

•Don’tgetstuckincontent

•It’snotabouttellingstoriesofthepastor tryingtofigureoutexactlywhatahppened

•BUTitcanbehelpfultofindstrengthsfora reparativenarrative

•It’sabouttoleratingwhateveriscomingupfor themnowinthepresentmoment

•Keepingtheprefrontalcortexonline

•Realizing,respondingto,tolerating,& integratingthetraumaticmemory

•Andlearnthatitwillcometoanend

Beflexible!MUSTFOSTERSAFETY!

•Yoga,relaxation,meditation,bodyscans,mindfulpractices,self-compass, lovingkindnesscancausemorepainand/orcreatepanicattacks

•Evenbeingnicecanbetriggering

•Gotowhereissafe

Avoidretriggering

•Gradualprocessofintegratingthoughts,feelings,andbehaviours

•Clashoftimezones:NOW(sopastmightbeplayingoutinthepresent)

•Firstgetusedtomanagingthephysiologicalsensationsthenaddonthoughts wheretheycanaddressthemsafely,fromthepast,now

WindowofTolerance

•Sacredplace(vs.safeplace)

•Howfeelinthebodybeingthere

•Realorimagined

•Nodemandsorexpectations

•Nothreatsorhurt

•Nointrusionsordistractions

•Getdetailed!

•Allsenses

•Getgrounded

•

WindowofTolerance

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•

Exercise!!!

Exercise

Diet

•Healthygutimportanttoreduce physicalstress

•Sugarandprocessedfoodmaintains highalertandagitatedstate,which createsmorestressinbody

•Alsoinhibitstheneurogenesisandbrain rewiring

•Regulareatingtimeshelpsregulate ourcircadianrhythms

Powerofwater

SleepTips

•Bestbedtimebasedonwhenneedto wakeup

•Besttowakeuponown

•Samebedandwakeuptimes,even weekends

•Wakeupearlier

•Helpsreduceanxiety

•Getsbodyreadyforbedeasier

•Usethetimeformovementand goodbreakfast

SleepTips

•Optimalenvironment

•DarkandcoolCool

•15-18Celsius(60-65F)

•Bedroomonlyforsleeping,no activities

•Avoidco-sleeping

•Limitstressandconflict

•Positiveactivitiesthroughtheday

Winddownthenight

•Pre-bedtimecalmingroutine45 minutes

•Sameactivitiestohabituatethe bodyforsleep

•Dimlights

•Read,softmusicok

•Gentlestretch

•Reviewofpositives

•Meals&exercise3hoursbefore

•Snack:Proteinandcarb–cottagecheeseor Greekyogurtwithdriedapricots.Turkeyon breadwithmilk.Nococoa.

•

Connections •

ReduceHome Stress

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Relaxation AsaGroup!

•Mindfulness

•Musclerelaxation

•Deepbreathing

•Mantras(Positiveself-talk)

Mindfulness

•Practice!

•Transitiontimes3x/day

5senses countdown

Mindful walking

Mindful eating

Embedded within activities

•5thingsyousee

•4thingsyoufeel

•3thingsyouhear

•2thingsyousmell

•1thingyouareproudof

•Feelbothfeetontheground.

•Feelshiftingyourweight.

•Feelyourlegswingandmakingcontactwith theground.

•Chocolate

•Thefirst3bitesofeverymeal

•Bathing/showering

•Washinghands

•Writing

Mindfulness

•Create!

•Anyrepetitiveaction

•Chewinggum

•Rollingcoins,sorting rainbowloom

•Experiment!

•Physicalactivities

•Music

•Outdoors

Modelling

•Noticing

•Lightacandleandgazeattheendoftheday

•Frostontrees

•Raindripping

•Takingmindfulwalkoutside

•Useallyoursensestodrinkcoffeeinthe morning

•Smelllaundry

•Soakupthesun

•Commentingasyoudo

Breathingisimportanttoreset (butisnottreatmentonItsown)

BreatheProactively

•BreatheintoLUNGSthenchest

•Slowlyexhalesayingcueword(e.g., calm,relax,letgo)underbreath

•Exhaleshouldbetwiceaslongas inhale

•Letmusclesgolimpandwarm. Loosenfaceandjawmuscles.

•Remaininrestingposition10-15 seconds

•Iftime,consciouslycount10breathes

BreatheProactively

•Visualization

•Blowinghot chocolate

•4squares

MeaningfulActivities