CSP 517 Mental Health in Schools

Generalized Anxiety Disorder

& Obsessive-Compulsive
Disorder
Presented by
Phoebe Beckman, Luis Garcia, Michelle Le, Keren Lei Mortiz, Kelly Stephens
 dreamstime.com

Anticipation of future threat

American Psychiatric Association, 2013

 Generalized
Anxiety Disorder
Excessive anxiety and worry about a number of events or
activities. The intensity, duration, or frequency of the
anxiety and worry is out of proportion to the actual
likelihood or impact of the anticipated event.

American Psychiatric Association, 2013

 GAD: Diagnostic Criteria/Symptoms
DSM-5 Diagnostic Criteria
(A) Excessive anxiety and worry, occurring more days than not for at least 6
months, about a number of events or activities

(B) Difficult to control the worry

(C) Anxiety and worry are associated with the following symptoms:
Restlessness
Easily fatigued
Difficulty concentrating and mind going blank
Irritability
Muscle tension
Sleep disturbance

Adults: 3 or more required

Children: 1 or more required American Psychiatric Association, 2013
 D. Anxiety, worry, or physical
Diagnostic Criteria
symptoms cause clinically
significant distress or impairment in & Symptoms
areas of functioning

E. The disturbance is not

attributable to the physiological
effects of a substance or another
medical condition

F.
The disturbance is not
better explained by another
mental disorder

American Psychiatric Association, 2013 Generalized Anxiety Disorder

 Associated
Muscle tension Sweating
features
Trembling Nausea
of
Twitching Diarrhea

Feeling shaky
GAD
Exagerrated startle response

Muscle aches Irritable Bowel Syndrome (IBS)

Soreness Headaches

American Psychiatric Association, 2013

What is something that makes you really anxious?

PollEv.com/michellele612
 GAD: Etiology
The exact causes are unknown, but there are risk factors, stressors, and other likely
causes linked to generalized anxiety disorder.

Environmental
Stress Substance Abuse
Factors

Physical Condition Genetics

https://www.ncbi.nlm.nih.gov/books/NBK441870/
 GAD: Epidemiology
Prevalence Onset
Affects 6.8 million adults Age tends to be earlier than in most anxiety and
3.1% of the U.S. population mood disorders
2.2% in adolescents Mean age of onset has been estimated at 21 years
Only 43.2% are receiving treatment old
Women are twice as likely to be affected as men Average time of referral to specialist services
Anxiety disorders are one of the most prevalent is during middle age
mental health problems in youth

Comorbidity
Prevalence in DSM
0.9% adolescents
Known as the comorbid disease
2.9% adults Comorbidity is 80% with depression
most common co-occuring disorder
Comorbidity with personality disorder are also
common
50% of GAD patients meet diagnostic criteria
for personality disorders

https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder
GAD: Treatment in schools:
Cognitive Behavioral Therapy (CBT)
Treatment Commonalities
Most treatment programs are rooted in Cognitive Behavioral Theory (CBT)
Evidence-based
Studies have shown them effective for reducing anxiety in children and
adolescents
Programs focus on:
Psychoeducation
Cognitive restructuring
Graded exposure
Program goals
Teach kids to recognize the signs of anxious arousal & implement
coping strategies to deal with anxious situations

(McLoone et al., 2006)

 Targeted, identified students/Tier 2-3

GAD: Coping Cat

16 weeks

Treatment in
50-minute weekly sessions
Cognitive restructuring using the FEAR plan
Provides youth with acronym to recall their newly acquired skills
F – feeling frightened?

schools
E – expecting bad things to happen?
A – attitudes and actions that can help
R – results and rewards
C.A.T. Project
Coping Cat adaptation for adolescents 14-17
(Podell et al., 2010)

Universal/Tier 1 Cool Kids Program:

Adapted from the clinical setting specifically for use in schools targeting
The FRIENDS Program: early intervention and prevention ages 7-16
The FRIENDS Program 8 weeks
Developed for schools to be delivered to whole classes 1-hour daily sessions
9 weeks Small groups of 8-10 students
60-minute weekly sessions Includes two parent information sessions
F – feelings
(Herzig-Anderson et al., 2012)
R – remember to relax
I – I can do it. I can try my best
E – explore solutions and coping step plans
N – now reward yourself. You’ve done your best
D – don’t forget to practice
S – smile. Stay calm for life
(Stallard et al., 2014)
 Teach Coping Techniques
Deep breathing/breathing exercises
(4-7-8)
Grounding techniques/self-soothing
5, 4, 3, 2, 1 senses exercise: see, feel, hear, etc.
Imagery
Creating mental images of safe, peaceful places
Progressive muscle relaxation
Tighten and relax one muscle group at a time from lower body
up to face
Mindfulness and Meditation
(Duvall & Roddy, 2019)

Help Students 504 Plans/Classroom Accommodations

Extra time for tests/be mindful of timed tests

Build A Coping
Incorporate breaks during tests
Allow extra time during classroom transitions
Provide advanced notice to parents/families of any anticipated changes
in schedule or routine

Toolkit
Develop a strategy for class participation
(OCD Foundation, 2021)
 GAD: Treatment Differences for Kids vs. Adults
It is much easier for kids and teens to get services for GAD in schools
According to Herzig-Anderson et al., (2012), "Schools are already the main point-of-entry into the
mental health service system for youth" Studies show that more than 70% of mental health
treatment for youth is provided by schools (Herzig-Anderson, 2012).

Example: Cool Kids Program, Friends Program, CBT, Psychoeducation, daily contact with the
student

Lack (2012), states that SRI's show a large effect size with adults and a moderate effect size for
children.

Commonly used drugs are Lexapro, Paxil, and Zoloft (Bandelowet al., 2017).

Bandelow et al. (2017)

Herzig-Anderson et al. (2012)
Lack C. W. (2012)
Obsessive-
Compulsive
Disorder
Characterized by the
presence of obsessions
(repetitive thoughts) and
compulsions (repetitive
behaviors or mental acts)
that an individual feels
driven to perform in
response to an obsession or
according to rules.

American Psychiatric Association, 2013

 Obsessions & Complusions
Obsessions

Recurrent and persistent thoughts, urges, or images experienced at some time during
the disturbance
Intrusive and unwanted
In most individuals cause marked anxiety or distress
The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (i.e. performing compulsion)

Compulsions

Repetitive behaviors or mental acts

Individual feels driven to perform them in response to an obsession or according to rules
that must be rigidly applied
Aimed at preventing or reducing anxiety or distress, or preventing some dreaded event
or situation
But, they are not connected in a realistic way with what they are designed to neutralize
or prevent, or are clearly excessive
 Diagnostic Criteria & Symptoms
Obsessive-Complulsive Disorder

A. Presence of obsessions, The obsessive-compulsive

C.
compulsions, or both symptoms are not attributable to
the physiological effects of
substances or another medical
condition

Obsessions or compulsions are D. The disturbance is not better

B.
time consuming or cause clinically explained by the symptoms of
significant distress or impairment another mental disorder
in areas of functioning

American Psychiatric Association, 2013

 With good or fair insight: Individual
recognizes that obsessive-compulsive
disorder beliefs are definitely or probably
not true or that they may or may not be true

OCD With poor insight: Individual thinks obsessive-

Specifiers
compulsive disorder beliefs are probably true

With absent insight/delusional beliefs: Individual is

completely convinced obsessive-compulsive disorder
beliefs are true

Tic-related: Individual has a current or past history of a

tic disorder
American Psychiatric Association, 2013
When do you feel like you have OCD? What obsessions and
compulsions do you have?

PollEv.com/michellele612
 OCD: Etiology
The exact causes are unknown, but there are
risk factors, stressors, and other likely
causes linked to obsessive-compulsive
disorder.
Genetics
Genetic predisposition &
heritability

Coping,
Responsibility, &
Magical Thinking

Streptococcal
Infection
Very rare Other
Neurological
Disorders
https://www.ncbi.nlm.nih.gov/books/NBK553162/
OCD: Epidemiology
Prevalence Comorbidity

2-3% in the United

States with adults Associated with
1-3% in childhood other disorders
depression,
Worldwide Onset anxiety
1.5 % women
disorders
1.0% men
Can occur at any age Overlap with
childhood Tourette's
late Syndrome
adolescence/early
adulthood
Prevalence in DSM Earlier onset in males
12-month prevalence of OCD in U.S. is 1.2%
Worldwide
1.1% to 1.8%

https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd
 CBT:

OCD:
Exposure and Response Prevention
Exposure – expose student to anxiety inducing situations that evoke rituals
Response Prevention – refraining from engaging with rituals or avoidance that

Treatment in
reduces anxiety
Cognitive therapy – teaching student how to be aware and correct atypical
thought patterns

schools
Things to consider...
Exposure response prevention can be applied in the classroom setting
Requires trained personnel to administer CBT tasks during classroom activities

Classroom Accommodations
504 plans are one way to establish & implement Camp Cope-A-Lot (for ages 7-
accommodations - not the same as treatment
Pending the child’s individual obsessive thoughts, 13)
accommodations might include:
Based on Coping Cat
Administering tests on computers or orally vs. written
Seating in the back of the room to avoid 12-module online program
embarrassment, etc. Self-led through first 6 sessions
Child having their own set of supplies (crayons, scissors, Last 6 sessions are to be done with guidance from a
tape, books, etc.) parent or therapist
Scheduled bathroom breaks to avoid high-traffic times
 OCD: Treatment Differences for Kids vs. Adults

For adults, CBT, Exposure therapy and SSRI's are commonly used to treat OCD

Gallant et al., (2007), states that it's difficult for a school psychologist to
administer intensive therapeutic services due to their large caseload.

Exposure therapy is an option but school psychologist may feel like it will
disrupt their learning. and although not proven it may negatively reinforce
anxiety with school (Gallant et al, 2007).

Ponniah et al., (2013), found that exposure therapy and CBT are effective and
specific to treating adults with OCD.

Gallant et al. (2007) & Ponniah et al. (2013)

GAD & OCD: Check all that apply to you!

PollEv.com/michellele612
One-Pagers
 References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.
https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Chaturvedi, A., Murdick, N. L., & Gartin, B. C. (2014). Obsessive compulsive disorder: What an educator needs to know. Physical Disabilities: Education and Related
Services, 33(2), 71–83. https://doi.org/10.14434/pders.v33i2.13134

Duvall, A., & Roddy, C. (2019, January). Coping with student anxiety. ASCA School Counselor - January/February 2019 COPING WITH STUDENT ANXIETY.
Retrieved October 17, 2021, from https://www.ascaschoolcounselor-digital.org/ascaschoolcounselor/january_february_2019/MobilePagedArticle.action?
articleId=1458871#articleId1458871.
Herzig-Anderson, K., Colognori, D., Fox, J. K., Stewart, C. E., & Masia Warner, C. (2012). School-based anxiety treatments for children and adolescents. Child and
Adolescent Psychiatric Clinics of North America, 21(3), 655–668. https://doi.org/10.1016/j.chc.2012.05.006

Gallant, J., Storch, E. A., Valderhaug, R., & Geffken, G. R. (2007). School Psychologists’ Views and Management of Obsessive-Compulsive Disorder in Children and
Adolescents. Canadian Journal of School Psychology, 22(2), 205–218. https://doi.org/10.1177/0829573507306448

Herzig-Anderson, K., Colognori, D., Fox, J. K., Stewart, C. E., & Masia Warner, C. (2012). School-based anxiety treatments for children and adolescents. Child and
adolescent psychiatric clinics of North America, 21(3), 655–668. https://doi.org/10.1016/j.chc.2012.05.006

Lack C. W. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World journal of psychiatry, 2(6), 86–90.
https://doi.org/10.5498/wjp.v2.i6.86

McLoone, J., Hudson, J. L., & Rapee, R. M. (2006, May). Treating anxiety disorders in a school setting. Education and Treatment of Children. Retrieved October 17,
2021, from https://www.jstor.org/stable/pdfplus/42899883.pdf.

Mychailyszyn, M. P., Beidas, R. S., Benjamin, C. L., Edmunds, J. M., Podell, J. L., Cohen, J. S., & Kendall, P. C. (2011). Assessing and treating child anxiety in schools.
Psychology in the Schools, 48(3), 223–232. https://doi.org/10.1002/pits.20548

OCD Foundation, I. (2021, February 19). For teachers - sample 504s/IEPS. Anxiety In The Classroom. Retrieved October 17, 2021, from
https://anxietyintheclassroom.org/school-system/profession-specific-resources/for-teachers-sample-504-iep/.
 References
Perini, S. J., Wuthrich, V. M., & Rapee, R. M. (2013, October 27). Cool kids in Denmark: Commentary on a cognitive-behavioral ...
https://pcsp.libraries.rutgers.edu/index.php/pcsp. Retrieved October 17, 2021, from
https://pcsp.libraries.rutgers.edu/index.php/pcsp/article/viewFile/1828/3248.

Podell, J. L., Mychailyszyn, M., Edmunds, J., Puleo, C. M., & Kendall, P. C. (2010). The coping cat program for anxious youth: The fear plan comes to life. Cognitive
and Behavioral Practice, 17(2), 132–141. https://doi.org/10.1016/j.cbpra.2009.11.001

Sloman, G. M., Gallant, J., & Storch, E. A. (2007). A school-based treatment model for pediatric obsessive-compulsive disorder. Child Psychiatry and Human
Development, 38(4), 303–319. https://doi.org/10.1007/s10578-007-0064-7

Ponniah, K., Magiati, I., & Hollon, S. D. (2013). An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults.
Journal of obsessive-compulsive and related disorders, 2(2), 207–218. https://doi.org/10.1016/j.jocrd.2013.02.005

Sloman, G. M., Gallant, J., & Storch, E. A. (2007). A school-based treatment model for pediatric obsessive-compulsive disorder. Child Psychiatry and Human
Development, 38(4), 303–319. https://doi.org/10.1007/s10578-007-0064-7

Stallard, P., Skryabina, E., Taylor, G., Phillips, R., Daniels, H., Anderson, R., & Simpson, N. (2014). Classroom-based cognitive behaviour therapy (friends): A cluster
randomised controlled trial to prevent anxiety in children through education in schools (paces). The Lancet Psychiatry, 1(3), 185–192.
https://doi.org/10.1016/s2215-0366(14)70244-5
 ANY
Questions?