The World has an Anxiety disorder!

 

Ok, folks. Here we go! Covid-19 is among us. Until now, as Director of the Washington Anxiety Center of Capitol Hill, I have decided that as a practice we needed to remain more in the shadows and treat each of our patients’ individual concerns about the virus. Recent events have now propelled me to speak further.

 

As a society (and I will bring social psychology into this), we have what is called diffusion of responsibility. Because we are not physically close to children starving in third-world countries, we do not think about it on a daily basis. We ‘diffuse’ responsibility to others. Now, Covid-19 is on our back doorstep and we are ruminating on it constantly.

 

The purpose of this blog post is to not discuss symptoms or Covid-19 recommendations. It is to discuss what is in our area of expertise: anxiety.

 

I have witnessed several events (majority occurring on social media) that have been concerning to me as a psychologist   These events range from parents teaching their kids how to create medical masks, checking out daily news blogs for the latest information every hour on the hour, telling your child to not talk to friends (even within an acceptable medically-recommended distance), to even telling your child the “world is ending.”

 

One of the robust etiologies (causes) of developing an anxiety disorder is through modeling (e.g., kids witness mom or dad be scared on a plane, so kids learn to fear flying). While there are reasons to be concerned about Covid-19 (I will not address those here), we must also be very aware of how our behaviors impact our children. We do not want our children developing schemas (i.e., ways of thinking about themselves and in relation to others) that the world is scary and dangerous. It is important to teach them that we can tolerate uncertainty, as hard as it may be to stomach. I implore our readers to recognize that each action we take, each sentence you speak, can have a very high potential to create a clinically diagnosable anxiety disorder in your child.

 

As for us as parents, well, it is important that while we recognize everyone is experiencing anxiety as a collective, that it does not mean it is not still clinical. If you are thinking about your response to Covid-19 constantly and it is making you feel very anxious and distressed and/or you are responding with behaviors out of your own normal (e.g., you used to read the newspaper 1x a day and you are now reading it every hour and getting more anxious every time), it may be time to seek out professional guidance. Psychologists who specialize in anxiety are trained to be able to recognize what is functional and what is not. I encourage any adult, if you are questioning your emotional response to Covid-19 or it is really bothering you, please seek out help. We are here for you.

 

Dr. Kaplan

Director of the Washington Anxiety Center of Capitol Hill

 

Talking with your child about difficult topics (i.e., race, disability, sexual minority status)

When talking with a child about hard subjects whether its race, disability, sexual minority status or something else entirely try out the 5 C’s.

  1. Show you C Children respond when they know that you are approaching them from a place of love and admiration for who they are and will become.
  2. Be C What made them say or think that? Why right now?
  3. Encourage C After asking open-ended questions, give them space to answer and let them know that they can always tell you what’s going on in their head.
  4. Provide gentle C If they said something inappropriate, teach them why it wasn’t a good thing to say and collaboratively come up with a better way for them to ask their question or communicate their thoughts in the future or a better context in which to do so.
  5. Celebrate differences. A child can always shock you with a novel thought or question but they are less likely to do so if you have already spent time pointing out differences that they may see in the world, explaining them, and celebrating them. Being different from others is not a bad thing. If the world were all one type of person, what a boring world it would be.

 

Here are some resources to help guide conversations.

Hyperlinks to insert:

https://www.washingtonpost.com/lifestyle/2019/11/22/childrens-books-can-help-start-conversation-about-race-parents-have-continue-it/

https://www.parenttoolkit.com/social-and-emotional-development/advice/social-awareness/how-to-talk-to-kids-about-race-and-racism

https://cecr.ed.psu.edu/sites/default/files/Ten%20Tips%20for%20Teaching%20and%20Talking%20to%20Kids%20About%20Race.pdf

What are some ways you have approached difficult topics with your kids?

 

Thank you to Celenia DeLapp, MA for this blog post!

School refusal, a podcast by our colleagues

School refusal is defined as when a child or adult refuses to attend school or their workplace as a result of anxiety, poor distress tolerance, or pathological avoidance.

Since the explanation of school refusal is long and complicated, our colleagues at Rogers Memorial Hospital recently released a podcast in 4 parts describing it and the treatment for it. We highly recommend you take a listen.

https://rogersbh.org/school-refusal?utm_source=Rogers+Memorial+Hospital&utm_campaign=706f18a9a1-EMAIL_CAMPAIGN_2019_05_14_02_40&utm_medium=email&utm_term=0_2b85836e2e-706f18a9a1-343194849

Great new book recommendation!

One of the best researchers and clinicians in our field of CBT just published an updated version of their book on Exposure Therapy (the MOST evidence-based treatment for anxiety). We highly recommend it for professors and consumers alike!

Our very own Dr. Kaplan was asked to review the book by the publishers! Take a look at her review on the link to the book below!

Summer is a break from school but not mental health!

With the exception of last summer (which I secretly hope is a result of the many talks and outreach activities our practice has given in the DC community), our child/teen appointments dwindle in the summer. Unfortunately this is not due to family vacations, but rather a strongly held “American belief” that kids needs a break from all things in the summer.

We HIGHLY recommend against the practice of only doing therapy during the school year. Our yearly, VERY predictable, schedule is that we become flooded with appointments in late September, early October. This is because the newness of school has worn off and clinical problems get their chance to emerge. In our kids who attend over the summer regularly, we see them frequently and effectively managing the stressors of transition back into the school year.

Remember it’s better to be proactive than retroactive!

 

 

Does my child need therapy?

Parents of young children often say that it can be difficult to decide if what their child is experiencing warrants treatment. They may be wondering if this is a “bump in the road” or something more.

Treatment may be appropriate if your child experiences:

  • Lack of self-confidence or self-esteem
  • Excessive worry about the future
  • Fears or phobias
  • Excessive reassurance-seeking
  • Reluctance or fearfulness when separating from you, sleeping independently, being in new situations, or socializing with new people
  • Repetitive behaviors
  • Difficulties with transitions
  • Frequent negative statements
  • Excessive tantrums or emotional outbursts
  • Challenges following directions
  • Difficulties hearing “no”
  • Toileting concerns

Psychologists use methods that not only treat emotional and behavioral challenges but prevent them. Whether your child needs help navigating typical, age-appropriate challenges or is managing more serious mental health difficulties, psychologists can provide helpful services that can make life healthier and more meaningful for your child and family.

Further, waiting to treat concerns typically results in longer, more intensive treatment. When concerns are left untreated, children may face the compounding challenges that come with rehearsing the same difficulties. Because the problem can seem unsolvable or out of the child and family’s control, it can also lead to decreased confidence and low self-esteem.

By Dr. Rachel LaFleur, Staff Psychologist, Washington Anxiety Center of Capitol Hill

http://www.washingtonanxietycenter.com

Book supplements/recommended reading for parents with children of anxiety and/or behavioral concerns

A frequent question we get asked at our center is, “What books can you recommend?” Well, I finally put together a list of recommended reading that will help supplement treatment (key word there is “supplement”) as it is recommended to have a professional guide you through these and help them to apply specifically to your child.

Check it out (it’s on our website!)

http://www.washingtonanxietycenter.com/book-supplements.html

Preparing for the new year and possibly new treatment!

As the new year approaches, also comes new years resolutions and psychological treatment may be a part of that! If so, our very own Dr. Rachel LaFleur has some tips and tricks about how to navigate your first mental health appointment.

 

If you’re like me, you may feel nervous when you attend your first visit with a new provider. When I feel caught off guard, I may leave the appointment with regrets about the questions I forgot to ask and the things I didn’t advocate for.

Here’s what to expect (or ask for) in your first visit with a mental health clinician who will be providing treatment.

  1. Paperwork to complete in advance.
    • Oftentimes, there is very specific and detailed information that your clinician needs to gather in the first visit. If you fill out the paperwork ahead of time, we can use our face-to-face time to dialogue about why you decided to visit us and discuss what treatment will be like. I would muchrather be spending our time together listening to you tell your story and describe what would make treatment meaningful than ask you to list off information, such as whether the client has asthma or allergies.
    • I bet you’re wondering why paperwork sometimes ask about things that don’t seem to have anything to do with why you’re coming in. Because so many aspects of life can relate to behavior, we like to cast a wide net at this first appointment to be sure there we aren’t missing a piece of the puzzle. Don’t worry – once we get past this first appointment, clinicians tend to narrow their focus.
    • It is a good idea to bring:
      1. Documentation of potentially relevant medical conditions.
      2. If the client is a child or adolescent:
        1. His/her latest report card, information regarding accommodations or specialized instruction (e.g., 504 plan, Individualized Education Plan, behavior intervention plans, and behavior charts).
        2. Custody documents if a legal guardian is not a parent or his/her parents are separated/divorced and there is a court order or formal agreement.
        3. Written permission from a legal guardian if the person bringing the client is not a legal guardian. This should be discussed in advance as the clinician may have particular paperwork that need to be completed.
  • If your clinician does not provide paperwork in advance:
    1. Be prepared to answer questions related to medical history, developmental milestones, academic history, and previous treatment received to address developmental, behavioral, psychological, or related concerns.
    2. Here’s something really important: it’s okay if you don’t know the answer to a question. If the client is a child and I ask his/her parent about birthweight, weeks gestation at delivery, and developmental milestones, some of the very best and most caring parents don’t know, especially when put on the spot.
  1. Support and understanding in uncomfortable situations. Depending on the person and situation, aspects of the first appointment can be uncomfortable.
    • If there are others with you, let your clinician know if you would rather discuss certain topics privately.
    • It’s okay to tell your clinician that you are uncomfortable, especially if you need to pause or take a break. Do you need water, a trip to the bathroom, or a snack? It’s okay to let your clinician know!
    • Inappropriate behavior between family members or from children and adolescents happens. In fact, it may be why you scheduled the appointment in the first place. You’re in the right place. This is what we do. Depending on the goals and format of the first appointment, your clinician may not address the inappropriate behavior. But don’t worry – that doesn’t mean your clinician won’t address it soon.
  1. Assistance in understanding challenging concepts and terminology.
  • In mental health, a first visit is often called an “initial evaluation,” “intake interview,” or “diagnostic interview.”
  • Your clinician will do his/her best to help you learn the lingo. Please let us know if there is a term or concept we can explain. The smartest and most confident people I know ask questions and it is good feedback for your clinician, who may have formed a habit of speaking over people’s heads and doesn’t know.
  1. Discussion of expectations.
  • On our side, in the first appointment we often discuss:
    1. Payment
    2. Limits to confidentiality
    3. Expectations for attendance
    4. Commitment to treatment
    5. How to get in touch between sessions
    6. What to expect from treatment
  • It comes in handy for you to have thought about the things you expect from your clinician. For example, you might answer the following questions:
  1. What type of treatment were you hoping to receive?
  2. What type of clinician do you want to work with?
  3. What are your expectations for scheduling?
  4. In what ways can you clinician present information to you given the way that you learn?
  5. What does your clinician need to know about you to be able to adapt to who you are as a person?

 

  • While a clinician may not be able to accommodate all of your preferences, it is nonetheless important to have the conversation as this meeting plays an important role in establishing your relationship with your clinician. Because this is your treatment, it is essential that you to have clear information about what you are signing up for and to leave knowing that your requests were heard, and when possible, accommodated.

 

Have a very happy holiday season and a great start to the new year!

Dr. Rachel La Fleur and all the staff at WACCH