Anxiety and Phobia
Research and Thesis - RKT
Adolescent phobias and anxiety disorders, specifically in grades 6-12, have direct connections to brain function and acute therapy can have positive immediate and long term solutions.
SP-20_PSY3043-SA02B Brain and Behavior - J. Matyas, Rochester University, Michigan
We were charged with a final term paper and research, I have chosen Anxiety and Phobias as these are so prevalent in my world as Principal / Dean of Students for alternative students.
May the research and paper help you understand this most serious aspect of being human.
Richard Kerry Thomspon
Below are the steps to the final thesis, paper, PPT and screencast by RKT
RKT PowerPoint
Video below
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Link below to Google Slides with additional links of research, ideas and therapies by RKT
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Thompson Peer-Reviewed Sources & Notes
Submission status
March 24, 2020
Anxiety Disorders - (Phobias) / Social Agoraphobia
Sub-Categories
Sub-Category #1 - What specific phobias are associated with the most common anxiety in adolescents?
Sub-Category #2 - What part of the brain is connected with phobia and anxiety?
Sub-Category #3 - What therapies are available immediately and long term to help students in grades 6-12?
Potential Title
Adolescent phobias and anxiety disorders, specifically in grades 6-12, have direct connections to brain function and acute therapy can have positive immediate and long-term solutions.
The following references are the ones I am going to use to support my thesis above.
NOTE:
I have put each category I am delving into at the top of each page, followed by the title of the article, APA reference, then the bullet from the article. Under each bullet is my point I am trying to make with the aforementioned statement from the article. This is labeled RKT.
1 -1/1
Sub-Category #1 - What specific phobias are associated with the most common anxiety in adolescents?
THE ROLE OF LONELINESS IN THE RELATIONSHIP BETWEEN ANXIETY AND DEPRESSION IN CLINICAL AND SCHOOL-BASED YOUTH.
Ebesutani, C., Fierstein, M., Viana, A. G., Trent, L., Young, J., & Sprung, M. (2015). The Role of Loneliness in the Relationship between Anxiety and Depression in Clinical and School-Based Youth. Psychology in the Schools, 52(3), 223–234. https://doi.org/10.1002/pits.21818
Youth anxiety and depressive disorders are frequently associated with a number of negative psychological sequelae, including significant functional impairment (Achenbach, Howell, Quay, & Connors, 1991; Langley, Bergman, McCracken, & Piacentini, 2004), impaired emotional functioning (Hughes, Gullone, & Watson, 2011), and poor outcomes (e.g., Compton, Burns, Egger, & Robertson, 2002), such as an increased risk of the development of substance abuse later in life (e.g., Rao et al., 1999) and lower levels of educational attainment (Roeser, Eccles, & Strobel, 1998). Unfortunately, internalizing disorders frequently go unnoticed in school settings until they have caused significant functional impairment, despite being present for a significant period of time.
RKT- The student in an alternative educational setting has suffered from these factors and must be addressed.
Especially in the absence of protective factors, anxious children may suffer the cumulative effects of social avoidance and disengagement because such symptoms limit their exposure to critical developmental experiences in which important social skills are learned and anxiogenic maladaptive beliefs are corrected. Through these mechanisms, anxiety appears to contribute to heightened levels of loneliness.
RKT- Adolescents in grades 6-12 predominantly are lonely and isolate themselves from their peers. These develop further into life in a negative way if not addressed.
Depressive symptoms in youth have also been associated with social skills deficits and difficulties in initiating and maintaining social relationships (Young, 1982)
RKT- Depression often is correlated with phobias and social anxiety, this creates challenges to maintain healthy relationships in adolescence and in older years.
2- 2/1
Sub-Category #1 - What specific phobias are associated with the most common anxiety in adolescents?
Peer victimization and social phobia: a follow-up study among adolescents
Ranta, K., Kaltiala-heino, R., Fröjd, S., & Marttunen, M. (2013). Peer victimization and social phobia: A follow-up study among adolescents. Social Psychiatry and Psychiatric Epidemiology, 48(4), 533-44.
The peak onset for the clinical syndrome of social phobia (SP) is between 11 and 17 years of age [16]. Given that the supportive role of parents decreases, it could be hypothesized that being victimized and experiencing social anxiety may both be related to a greater distress as children progress to adolescence.
RKT-The middle and high school years are the most vulnerable years for social phobia as the student becomes independent and does not share feelings with parents/ guardians.
Social phobia was assessed with the Social Phobia Inventory (SPIN) [34], a 17-item self-report questionnaire for measuring fear, avoidance behaviors, and physiological arousal in performance or social situations.
RKT- This specific phobia could be addressed in school systems if this test was known and implemented for all students not just identified from staff.
The 13-item Beck Depression Inventory (BDI) [37] was used as a measure of depression.
RKT - Depression inventory as well can be administered for all students.
3- 3/1
Sub-Category #1 - What specific phobias are associated with the most common anxiety in adolescents?
SPECIFIC PHOBIA AMONG U.S. ADOLESCENTS: PHENOMENOLOGY AND TYPOLOGY.
Burstein, M., Georgiades, K., He, J., Schmitz, A., Feig, E., Khazanov, G. K., & Merikangas, K. (2012). Specific Phobia among U.S. Adolescents: Phenomenology and Typology. Depression & Anxiety (1091-4269), 29(12), 1072–1082. https://doi.org/10.1002/da.22008
Adolescents with multiple types of phobias exhibited an early age of onset, elevated severity and impairment, and among the highest rates of other psychiatric disorders.
RKT - When an adolescent begins having symptoms at an early age and it is not addressed it becomes worse with each passing year.
Most adolescents with specific phobia met criteria for more than one type of phobia in their lifetime, however rates were fairly similar across DSM‐IV/5 subtypes
RKT- Once an adolescent has met one phobia many others follow.
4 - 1/2
Sub-Category #2 - What part of the brain is connected with phobia and anxiety?
Meta-analysis of functional brain imaging in specific phobia.
Ipser, J. C., Singh, L., & Stein, D. J. (2013). Meta-analysis of functional brain imaging in specific phobia. Psychiatry & Clinical Neurosciences, 67(5), 311–322. https://doi.org/10.1111/pcn.12055
Regions that were consistently activated in response to phobic stimuli included the left insula, amygdala, and globus pallidus. Compared to healthy controls, phobic subjects had increased activation in response to phobic stimuli in the left amygdala/globus pallidus, left insula, right thalamus (pulvinar), and cerebellum.
RKT - The left insula, amygdala, and globus pallidus are all connected to phobias and anxiety. As well as right thalamus (pulvinar), and cerebellum.
Consistent evidence for functional pathology of structures such as the amygdala and insula in specific phobia support this model, given the emphasis in recent animal models of fear conditioning of the role of the amygdala in responding to external threat and of the insula in responding to internal visceral stimuli
RKT-External threats as well as internal threats create the brain to react.
The main findings of this study were that the largest clusters of activation in patients with specific phobia in response to phobic stimuli were observed bilaterally in the anterior insula and amygdala and in the right frontal cortex, and that of these regions, activation in the left insula and amygdala (in a cluster extending into the basal ganglia)
RKT- Along with the anterior insula and amygdala the right frontal cortex is stimulated when an adolescent experiences phobia and anxiety.
5 - 2/2
Sub-Category #2 - What part of the brain is connected with phobia and anxiety?
The neurobiology of social phobia.
Bell, C. J., Malizia, A. L., & Nutt, D. J. (1999). The neurobiology of social phobia. European Archives of Psychiatry & Clinical Neuroscience, 249, S11. https://doi.org/10.1007/PL00014162
Social phobia is a condition that is likely to have existed for centuries although the term itself was only formally introduced in the 1960s. In 1980 social phobia was incorporated into the DSM III classification system as an independent form of anxiety but since then has been relatively neglected compared with other anxiety conditions such as panic and obsessive-compulsive disorder.
RKT - History of anxiety is relatively new in human kind to be identified and labeled.
The somatic symptoms most commonly reported in social phobia include blushing, sweating, tremor and speech block all of which are usually noticeable to other people and serve to exacerbate the situation. Similar somatic symptoms are also described by patients with panic disorder but the emphasis tends to be different with complaints of palpitations, shortness of breath, dizziness and limb weakness being particularly problematic.
RKT Somatic symptoms can be worse than the reality of the symptom.
In a symptom provocation study (Malizia et al., 1997) in which patients with social phobia were made anxious by the use of autobiographical scripts, the experience of anxiety in these patients was associated with the following charges: increases in blood flow in the thalamus, right insula and lateral frontal areas, in the left parietal cortex and in the right cerebellum and with decreases in the left parietal cortex and in the right cerebellum and with decreases in the left amygdala and in the left posterior middle temporal gyrus.
RKT- Brain activity is indeed correlated to social phobia and is debilitating to the human even if it is psychosomatic onset.
6-3/2
Sub-Category #2 - What part of the brain is connected with phobia and anxiety?
ABERRANT AMYGDALA–FRONTAL CORTEX CONNECTIVITY DURING PERCEPTION OF FEARFUL FACES AND AT REST IN GENERALIZED SOCIAL ANXIETY DISORDER
Prater, K. E., Hosanagar, A., Klumpp, H., Angstadt, M., & Luan Phan, K. (2013). Aberrant Amygdala-Frontal Cortex Connectivity during Perception of Fearful Faces and at Rest in Generalized Social Anxiety Disorder. Depression & Anxiety (1091-4269), 30(3), 234–241. https://doi.org/10.1002/da.22014
Generalized social anxiety disorder (gSAD) is characterized by exaggerated amygdala reactivity to social signals of threat, but if and how the amygdala interacts with functionally and anatomically connected prefrontal cortex (PFC) remains largely unknown.
RKT- The connection of the amygdala and the prefrontal cortex is unknown and shows that we have far to go in understanding.
Prominent in most brain models of gSAD is the amygdala,[6] which plays a key role in fear responses,[7] social information processing,[8] and the perception of salient emotional stimuli
RKT- The amygdala is the key role and the fight, flight or freeze is evident in adolescents with this challenge.
7-1/3
Sub-Category #3 - What therapies are available immediately and long term to help students in grades 6-12?
Long-term Results from the Empowering a Multimodal Pathway Toward Healthy Youth Program, a Multimodal School-Based Approach, Show Marked Reductions in Suicidality, Depression, and Anxiety in 6,227 Students in Grades 6–12 (Aged 11–18)
Silverstone PH, Bercov M, Suen VYM, Allen A, Cribben I, Goodrick J, Henry S, Pryce C, Langstraat P, Rittenbach K, Chakraborty S, Engles RC and McCabe C (2017) Long-term Results from the Empowering a Multimodal Pathway Toward Healthy Youth Program, a Multimodal School-Based Approach, Show Marked Reductions in Suicidality, Depression, and Anxiety in 6,227 Students in Grades 6–12 (Aged 11–18). Front. Psychiatry 8:81. doi: 10.3389/fpsyt.2017.00081
It is widely recognized that depression is common in those aged 11–17, with up to 10% of this group meeting criteria for depression, with diagnostic rates possibly increasing (1–3).
RKT- 10% of School age grades 6-12 suffer from depression and other anxiety disorders. That is 1 in 10 / 3 students in a class of 30 and that is not a fair assessment as most suffer quietly.
These individuals were termed “Resiliency Coaches,” and each was attached to a specific school, but were not therapists or counselors, and did not act in those roles.
RKT - Resiliency is indeed the key to all therapies yet how does one teach it?
RKT - Christian Moore the Resilience Breakthrough and curriculum is a key to use and is very new to the educational world. https://www.smore.com/app/pages/preview/at2hn
It is also accepted that schools are the most appropriate setting to screen and intervene
for those aged 11–18, including to increase resiliency against both depression and suicidality. Therefore, combining both universal and high-risk approaches in schools may offer the potential to offer the most positive outcomes. Supporting such an approach, a recent review and meta-analysis concluded that future “refinement of school-based prevention programs has the potential to reduce mental health burden and advance public health outcomes”
RKT- Schools have the best opportunity to implement solid programs for mental health than any other venue.
All students completed questionnaires for five separate areas of interest: (1) depression (including questions on suicidal thinking); (2) anxiety; (3) use of drugs, alcohol, and tobacco; (4) self-esteem; and (5) quality of life. A measure combining all of these measurements, the so-called “EMPATHY scale,” was also captured.
RKT- Once a student is identified on one scale many follow with connection to phobia and anxiety
This group was also provided with information regarding the possibility of taking part in guided CBT approaches that have previously been recognized as clinically effective in this age group.
RKT-CBT Cognitive Behavior Therapy is a known therapy to help.
8-2/3
Sub-Category #3 - What therapies are available immediately and long term to help students in grades 6-12?
Evaluating the impact of an autogenic training relaxation intervention on levels of anxiety amongst adolescents in school.
Atkins, T., & Hayes, B. (2019). Evaluating the impact of an autogenic training relaxation intervention on levels of anxiety amongst adolescents in school. Educational & Child Psychology, 36(3), 33–51.
MENTAL HEALTH difficulties in young people are a serious cause for concern across the world. The World Health Organization (WHO) reports that in half of all cases of mental health conditions, onset has occurred by the age of 14 years old; suicide is the third leading cause of death in 15–19-year-old; and the second leading cause of death in girls.
RKT- The school age student grades 6-12 are most at risk and data proves this.
It is estimated that one in ten children and young people aged 5–16 years old have a diagnosable mental health disorder in the UK alone; and at least one in 12 children and young people deliberately self-harm.
RKT- Adolescents are indeed living a battle in quiet desperation.
Adolescence is recognized as a period of social and psychological change and neuro-biological development that can either enhance vulnerability or provide a window of opportunity for growth and learning (Dahl et al., 2018).
RKT - Neuroscience is connected to anxiety and growth while mental health is also connected.
Purposeful muscle-relaxation and controlled breathing techniques have been used to treat a range of psychological problems (Kobayashi-Suzuki et al., 2014) and educational stress.
RKT- Meditation and breathing techniques can reduce stress. The 4 for 4 technique is one along with fidget toys to reduce stress and anxiety.
9-3/3
Sub-Category #3 - What therapies are available immediately and long term to help students in grades 6-12?
A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders.
Sburlati, E. S., Schniering, C. A., Lyneham, H. J., & Rapee, R. M. (2011). A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders. Clinical Child & Family Psychology Review, 14(1), 89–109. https://doi.org/10.1007/s10567-011-0083-6
As is the case with adults, children and adolescents are more likely to engage in therapy if the therapist shows appropriate levels of warmth, concern, confidence, and genuineness and avoids negative interpersonal behaviors such as aloofness or impatience.
RKT- Relationship is the key to therapy of any kind, relationship before rules equals rejoicing, rules before relationship equals rebellion.
Drawing upon the knowledge of those cognitive, behavioral, and environmental factors which tend to maintain anxiety and depression, and information obtained through the assessment process, a CBT case formulation of the causes and maintaining factors of the individual’s problem can be devised.
RKT - CBT cognitive behavior therapy changes the modus operandi as opposed to medication that is physiological.
As seen in Fig. 1, these techniques are divided into five categories, based on whether they aim to modify thoughts (Managing Negative Thoughts), behaviors (Changing Maladaptive Behaviors), mood and arousal (Managing Maladaptive Mood and Arousal), general skills (General Skills Training), or the family environment (Modifying the Family Environment)
RKT- Many forms of Cognitive Behavior Therapy can be used if not all.
Table 2 - Page 100 - Cognitive restructuring, Behavioral experiments, thought substitution/self-talk, Positive imagery, thought stopping/ interruption, Thought acceptance,
Table 3 - Page 100 -Interoceptive exposure, In vivo exposure, Imaginal/narrative exposure, Response prevention, Behavioral activation, Pleasant events scheduling, Self-evaluation and self-rewards
Table 4 - Page 101 – Emotion identification, expression and regulation, Progressive muscle relaxation, applied tension, Breathing retraining.
Table 5 Page 101 - Problem-solving skills, Interpersonal engagement skills, Friendship skills, Communication and negotiation skills, Assertiveness skills, Dealing with bullying skills.
RKT- I am the master of my fate, I am the captain of my soul, Invictus by William Henley, CBT can change the modus operandi which in turn can change behavior and take control of anxiety and phobias, while understanding the brain neuroscience all of this together can be live changing and go from striving to thriving
Table 6 – Page 102 - Family communication and conflict resolution, Parental expectations management, Parent intrusiveness and overprotection management, Parent contingency management, Parent emotion management, Parent modeling of adaptive behavior.
RKT- Parent /Guardian can help or hinder the anxiety in an adolescent
Thank you
I know that I have more than was asked, yet I hope I have what you were looking for in this assignment.
Thank you
Richard