Anxiety disorders in children and teens can have serious effects on health, self-esteem, social well-being, and of course on academic performance. But they’re often difficult to detect. In this webinar, our researchers examine the factors that contribute to anxiety disorders in kids and how to recognize the signs, as well as the latest insights on treatment and prevention. Watch the full webinar recording at https://explore.ucalgary.ca/overcoming-anxiety-schools

1. Overcoming anxiety in
schools
Dr. Daniel C. Kopala-Sibley, PhD
Assistant Professor, Cumming School of Medicine
Dr. Gabrielle Wilcox, PsyD
Associate Professor, Werklund School of Education
November 21, 2018

2. • Assistant Professor, Cumming
School of Medicine,
Department of Psychiatry
• Member
• Mathison Centre for Mental
Health Research and Education
• Hotchkiss Brain Institute
• Alberta Children’s Hospital
Research Institute
• Contact
• daniel.kopalasibley@ucalgary.ca
Dr. Daniel Kopala-Sibley, PhD
2

3. • Associate Professor, Werklund
School of Education
• Member
• Hotchkiss Brain Institute
• Mathison Centre for Mental
Health Research and Education
• Registered psychologist and
nationally certified school
psychologist
• Contact
• gwilcox@ucalgary.ca
Dr. Gabrielle Wilcox, PsyD, NCSP, RPsych
3

4. Agenda
4
• Prevalence of anxiety
• Definition and origins
• Anxiety types
• Helping anxious students

5. Facts about anxiety
5
• Anxiety disorders are among the most common
mental, emotional, and behavioral problems to occur
• About 13 of every 100 children and adolescents ages
9 to 17 experience some kind of anxiety disorder
• Girls are affected more than boys.
• Anxiety disorders may coexist with other mental and
physical health conditions as well

6. Adults with a Mental Health Disorder
Diagnosed BEFORE 18 Diagnosed AFTER 18
6Bowers et al., 2013

7. Canadian Council on Learning
“Poor mental health in Canadian school children
poses a significant risk to their academic
development and puts them at greater risk of
dropping out of school, substance abuse and
suicide. Schools are well positioned to be at the
vanguard of public health strategies designed to
prevent and detect mental health disorders among
young people.”

8. Core of anxiety
8
• Over-estimating that something bad is going to
happen
• Underestimating one's ability to deal with it

9. Brief definition
9
• Red flags should go up when the feelings become
excessive, thoughts become irrational and everyday
functioning is debilitated
• Anxiety disorders are characterized by excessive
feelings of panic, fear, or irrational discomfort in
everyday situations

10. Production of fear and anxiety
10
• Two main components involved are the
amygdala and the prefrontal cortex
• Amygdala- Emotional memories are stored
here and alerts brain that a threat is
present
• Prefrontal cortex- Processes incoming
information and helps you to plan
decisions and behaviours

11. Other origins of anxiety
11
• Teens learn the world is a scary place
• Parents
• Bullying
• And/or that they’re not capable of handling stress
• Temperamental traits – fearfulness
• Have genetic and environmental origins

12. What contributes to anxiety in the
teenage years?
Biological
development
• Many psychiatric disorders first appear in adolescence
Social
environment
• Adolescence is a unique period
• Increased nuance of social environment
• Dating
• Increased academic demands
• Increased independence and responsibility
Aldridge & McChesney, 2018; Paus, Keshavan, & Giedd, 2008

13. Anxiety and girls
13

14. Why do more girls develop anxiety from
adolescence on?
14
Hormonal
differences?
Paus, Keshavan, & Giedd, 2008

15. Anxiety in junior high girls
15
Junior high girls
reported higher
levels of anxiety
in a local school
division
Wilcox, McQuay, Blackstaffe, Perry, & Hawe, 2018
Decreased
academic
engagement

16. Effects of anxiety
16
• School failure
• Absenteeism
• Classroom disruption
• The inability to complete basic tasks
• Family stress
• Impaired social relationships

17. What does anxiety look like?
17
• Students may feel a sense of dread
• Have fears of impending doom
• Experience a sense of suffocation
• Anticipation of unarticulated catastrophe
• Somatic complaints

18. Types of anxiety
18
• Generalized Anxiety Disorder (GAD)
• GAD results in students experiencing six months or more of
persistent, irrational and extreme worry, causing insomnia,
headaches, and irritability.
• Post-Traumatic Stress Disorder (PTSD)
• PTSD can follow an exposure to a traumatic event such as
natural disasters, sexual or physical assaults, or the death of a
loved one. Three main symptoms: reliving of the traumatic
event, avoidance behaviors and emotional numbing, and
physiological arousal such as difficulty sleeping, irritability or
poor concentration.

19. Types of anxiety
19
• Panic Disorders
• Characterized by unpredictable panic attacks, which are
episodes of intense fear, physiological arousal, and escape
behaviors. Common symptoms: heart palpitations, shortness
of breath, dizziness and anxiety and these symptoms are often
confused with those of a heart attack.
• Specific Phobias
• Intense fear reaction to a specific object or situation (such as
spiders, dogs, or heights) which often leads to avoidance
behavior. The level of fear is usually inappropriate to the
situation and is recognized by the sufferer as being irrational

20. Types of anxiety
20
• Social Phobia
• Extreme anxiety about being judged by others or behaving
in a way that might cause embarrassment or ridicule and
may lead to avoidance behavior.
• Separation Anxiety Disorder
• Intense anxiety associated with being away from
caregivers, results in youths clinging to parents or refusing
to do daily activities such as going to school.
• Obsessive-Compulsive Disorder (OCD)
• Students may be plagued by persistent, recurring thoughts
(obsessions) and engage in compulsive ritualistic
behaviors in order to reduce the anxiety associated with
these obsessions (e.g. constant hand washing).

21. Helping anxious students
21
• Teens often don’t recognize their own anxiety as anxiety
• Teach them about anxiety
• Anxiety is not dangerous
• Anxiety can be adaptive
• Do not dismiss or minimize their worries!
• It is often a youth’s anxiety that causes him or her to disregard
directions, rather than an intentional desire to be
oppositional.
• Relaxation techniques

22. Helping anxious students
22
• Work with a child regarding class participation and answering
questions on the board, understanding that many anxious
youth fear answering incorrectly.
• Encourage small group interactions and provide assistance in
increasing competency and developing peer relationships.
• For maximum effectiveness, foster feedback from youths
about these interventions

23. Helping anxious students
23
• It is important for behaviors to be reinforced at home as well
as in school therefore parents should be involved in the
treatment process
• Avoidance of the things the student fears may be alright in the
short term, but is not helpful in the long run.

24. Agenda
24
Mental health and anxiety in schools
Mental health stigma in schools
Anxiety and the transition from high schools
Cognitive-Behavioural Therapy (CBT)

25. Mental health and anxiety in schools
25

26. Mental health problems in kids
Merkingas et al., 2010

27. Mental health problems in schools:
Related problems
Bullying
High absenteeism
• Truancy
• other
Witnessing violence
Low educational attainment
• Weaker achievement
• More likely to drop out
Poorer relationships
• Peers
• Family
Nijs et al., 2014; Whitley et al., 2012

28. Access to Adolescent MH Services
Access No Access
70-80% of
these students
access services
through school
28
Bowers et al., 2013; Froese-Germain & Riel, 2012; Whitley et al., 2012

29. Mental health stigma in schools
29

30. What is stigma?
“ Beliefs and attitudes about mental health and mental illness
that lead to negative stereotyping of people and to prejudice
against them and their families.”
Mental Health Commission of Canada 2009

31. 31
0
10
20
30
40
50
60
70
80
90
100
School-Based Mental
Health Providers
Teachers Students
Percentage of Participants Who See Stigma as a
Barrier to Mental Health Services
Bowers et al., 2013; Froese-Germain & Riel, 2012

32. Anti-stigma intervention: Headstrong
https://www.mentalhealthcommission.ca/En
glish/resources/training/headstrong
HEADSTRONG is an evidence-
based anti-stigma initiative
created by the Mental Health
Commission of Canada (MHCC)
HEADSTRONG teaches students
how to reduce stigma and become
mental health champions in their
schools.

33. Anxiety and transition from high school
33

34. Transition is stressful!
34
Move
Increased
work load
Freedom

35. Mental health in university students
35
Higher rates of
distress
Especially in
females
More and 1/3
report a mental
health symptoms
Eisenberg et al., 2007; Stallman, 2010; Zavin et al., 2009

36. Anxiety and achievement in university
36
Increased
anxiety
Lower
GPA
Stallman, 2010; Wilcox & Nordstokke, submitted

37. • Students who report high levels of distress, don’t
always seek help
Help seeking
37
Feldman et al., 2016

38. Treating anxiety

39. Cognitive-Behaviour Therapy (CBT)
39
• Therapy
• Usually indicated as a primary
treatment option
• Sometimes combined with
medication
• Medication
• Often prescribed for acute
and/or severe anxiety
• Talk to your physician and
therapist to find the best
combination for you

40. 40
Thoughts
BehavioursFeelings

41. Thoughts: Thinking error
41
I know I failed that test! I bet I will fail the whole
class. I won’t pass grade 10, then I will have to
drop out of school and live in my parents’
basement FOREVER!

42. Helpful thought
42
“I know that I studied
hard, and I am prepared
for this test.”
“I don’t think that I studied enough
for that test and earned a poor mark. I
will ask my teacher for help, and I
will set aside more time to study for
the next test, so that I am prepared.”

43. Feelings
43
Emotions
• Scared
• Worried
• Afraid
• Intensely alert
Physical feelings
• Increased heart rate
• Sweating
• Hot
• Stomach ache

44. Behaviours: Helpful fear response
44

45. Behaviours: Unhelpful fear response
45

46. Key Takeaways
46
Anxiety is common in children and adolescents
• Anxiety increases other risks
Schools are a good place to support kids
• Reduce stigma
• Prevention
• Early intervention
Multiple options