 Hi, my name is Tracy Tokama Espinosa and this is a video on anxiety. As always, the information from these videos comes from Making Classrooms Better. We can find further details. Additionally, the sources for the information is found at the bottom of each slide. Today we're going to consider anxiety. We're going to look at the definitions, certain manifestations or symptoms, what to look for, how we diagnose anxiety disorders, what are some of the predictors that exist for anxiety, as well as the treatments. When we come together in class, we're going to look at this as a tenant. Information that is true about human beings but has a huge range of variabilities. So what does this mean in our classroom settings? So anxiety is one of these 21 tenants that was discovered in the Delphi panel and a tenant is something that's true for all individuals but has a huge range of human variabilities. So we have to be careful when we say something like, well, this might make the kids anxious. Well, who will it make anxious? When will it make them anxious? Why will it make them anxious is really very important to think about as well. So for the purposes of this video, we're going to be using Reynolds and Kampfhaus' definition. This comes from their book on generalized anxiety disorder. They use the DSM diagnostic criteria. So this is why we think it's a good starting point. Everybody gets anxious sometimes, right? But an anxiety disorder is when you have excessive anxiety and worry. And this occurs more times than not over at least six months of observation and has roots in various activities. It's not just that one thing causes the anxiety or not. And the general symptoms that individuals have a hard time controlling the sense of worry that they feel. And generally the DSM criteria say that if you have three or more of the following six symptoms, that would be considered then generalized anxiety disorder. And for kids though, only one item is required, which is kind of interesting, right? So being restless, feeling keyed up or on edge, that kind of like nervousness in your stomach, right? Being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances. Now, as you can see, all of these things are things that happen to all of us all of the time, right? So trying to understand when it becomes a disorder and when is anxiety simple reaction to your environment is again by degrees and over time and over multiple contexts and their impact on your general output. If you are inhibited from actually achieving or performing up to your norm due to the sense of anxiety, that would then be considered a disorder. And a key, remember, looking down at this point E here. Remember, we talked about scaling things up. First, we look for a physiological explanation of things. If that doesn't exist, then we scale up to considering something that would be a psychological cause. And finally, if it's not a psychological cause, could it be something that's neurologically triggered? And finally, even if you meet all of these different criteria to confirm that it's an anxiety disorder, you have to also make sure, okay, it's definitely not explained by anything else that could offer a better diagnosis of the situation. So that's basically the general definition that we use. And it's very important to take this into consideration because this has a huge societal impact. Anxiety, childhood anxiety disorders are among the most common mental health conditions affecting youth. And even though there are proven treatments in terms of therapy, medication, there's a very worrisome 40% to 50% non-response rate. This means that neither therapy nor medication that's been prescribed seems to resolve the disorder. And this is a big problem. Sometimes certain doctors will only prescribe the ex-medicine or ex-therapy as opposed to exploring other options when treatments don't seem to resolve the disorder. And though it might seem a bit high and kind of surprising, there's an estimation of a prevalence between nine and 32% of children will experience anxiety at some point during childhood and adolescence. The causes are pretty, pretty complicated because they are oftentimes confused with the consequences of having anxiety. So for example, is being obese a cause or a consequence? Some authors say that obesity is a cause of childhood anxiety and there's a lot of good defense for that vision as well. But others say the opposite, that because you're anxious, then you eat and then you become obese. And so we have to try to figure out first if something is a cause or if it's a consequence. We do know, however, that some other things, for example, trauma is proven, maltreatment, neglect is proven to be associated with anxiety in children. And aside from trauma itself, there is a theory about the fear of the unknown which has to do with different attachment styles which is really interesting. If you have a fear of the unknown, some kids will become anxious, some will become curious, some will become depressed. So it's a very interesting thing based on personality styles and attachment styles. There are different theories about why a fear of the unknown might make people anxious. And finally, there may be a neurophysiological basis, but again, is this cause or is it the effect of this? Is it a correlation or is it a causation? We know that there are studies about amygdala circuitry as well as certain kinds of neurotransmitters that are different and people that are highly anxious. Is it because the amygdala circuitry is different that the person is anxious or did the circuitry change because the person is anxious? These are things that are still being researched to this day. How do we diagnose things? Well, basically, if we go back to that definition, one of the key ideas is that since everybody has anxiety at some point, the main way that a child is given this diagnosis or that an individual is given a diagnosis of an anxiety disorder is the level of severity and the persistence of the symptoms. This is usually conducted through a structured interview and perhaps one of the most popular tools to do this is the anxiety disorder interview schedule for children and parents, mainly because it follows the DSM criteria and is widely shared by physicians as well as counselors, psychiatrists, and other people who work with kids with anxiety disorder. So this particular instrument comes from Alvano and Silverman, but there are other types of instruments that can also be used. For example, Creswell and colleagues have discussed a pretty wide range of different ways to assess and manage anxiety disorders in their article, which we'll be putting in the bundle. And then there's other tools that look at the big crossover between anxiety and depression, although those are very different in terms of circuitry and neurotransmitters that are released in the brain. And we really haven't nailed down exactly what is going on in human brains related to the precise neurotransmitters. There's a lot of research going on, looking at microRNA-34 or looking at things related to vitamin E deficiencies or catechromines and serotonin or monoamidgenic neurotransmitters. All of these things, GABA, for example, most of these studies are beginning in mice, in animals, and we don't have a lot on kids in human studies. So it does leave this question sort of in the air. The main reason we'd like to nail down and figure out what are those neurotransmitters that are being released or suppressed during states of anxiety is because if we could do that, we could then manage medications, for example, that would help that person. But another new angle, a very interesting angle that's growing right now has to do with this gut brain access and the microbiota that's found in just basically the way we eat or the nutritional balances that we have, how could that actually contribute to help or alleviate effects of anxiety? So we know that when somebody is anxious, they may have eating disorders. Again, is that a cause or a consequence of having anxiety, right? Phobias also exist. Suicide can result with highly anxious people. Poor emotional processing as adults can be direct occurrence of childhood anxiety disorder, the tendency to self-criticize, shame-pronus, as well as things like separation anxiety or agoraphobia, which is a fear of places or situations, right? Panic disorders and an unnatural, biased attention to threats. You pick up on threatening situations far more or you're always piqued to look for those things, right? And again, the physiological structure of certain circuitry related to the amygdala, which plays a very big role in emotional processing. But again, we don't know if that is a cause or a consequence. If the circuitry looks differently, is that because the person is anxious or is it because it was different, the person becomes anxious? So some predictors of people who will have anxiety disorder are things like maltreatment in childhood, trauma, household dysfunction, physical and emotional neglect. Basically all of these things that are considered to be living under chronic stress for prolonged periods of time. These are strong predictors that a person may succumb to an anxiety disorder. So what are some of the treatments? There's some very interesting treatments that actually try to look at a root cause. For children, for example, oftentimes the root cause of their anxiety actually are their parents or their home situations. In that case, there are a lot of therapies that look at group therapy with parents, with the kids working with their own parents, working out issues together as a family. But aside from focusing on the actors, there's also two large groups of treatments. One is basically cognitive behavioral therapy, trying to change your reaction to situations. And the other has to do with medication. So sometimes taking a drug that modifies the serotonin reuptake combined with therapy is normally more effective than just the medication alone or just the therapy alone. General rule of thumb is that doing both of them together is more beneficial for long-term results. There's also a lot out there right now still being researched, for example, in the UK. There's a different kind of therapy which is called attention bias modification training. So basically rather than allowing people's peak sensation to be alerted to anxious situations and negative feelings all the time, it's basically helping them make more positive attachments to all the situations around them. So you basically change a person's individual outlook more through this relation to positive psychology and helping individuals look for positive stimuli rather than their default anxiety stimuli. Okay, so all of that is sort of a big backdrop to this big question. This is a tenant. This means that different kids in our classes are gonna have different levels of anxiety that are tipped by different types of things. So we know for a fact, anxiety influences learning. But what we need to reflect on a bit more is what tips those students? What causes this? Now we talked about a lot of root causes that might be within the family situation, right? Maltreatment at home. But school can also be a source of anxiety for some kids, mainly because they are probably humiliated or they feel bullied within a classroom setting. So to what extent can we influence a positive school environment that would reduce the anxiety and keep those kids from feeling that constant negative sensation that we know impedes learning progress? So we'll be talking about these things. So please come to class with a lot of questions about anxiety so that we can better identify the ways that you and I can interact with our students to maximize their potential for learning. Thanks, see you soon.