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Anxiety in a world full of triggers

Updated: Jul 5, 2020

Imagine if you could support those experiencing anxiety without exacerbating or inflaming the situation! How awesome would it be to have the tools you needed as a professional or parent at your finger tips to relieve suffering & prevent the re triggering of trauma. Sounds fantastic doesn't it?

The struggle with behaviour support and understanding behaviour today is not that we don't have the tools or enough funding (as so many services continue to demand), the information has been around for decades. There are already incredibly skilled, qualified & passionate professionals out there changing lives, improving outcomes, supporting behaviour change.

Last year I was working with many behaviours presenting as a result of anxiety. The importance of conducting a through assessment & analysis, including the data to a form a clear understanding of both the behaviour of social significance & it's function, cannot be under estimated, as the foundation of planning & intervention.

School refusal involves a variety of behaviours, without knowledge of the individuals pattern & history of behaviour of concerns, a trauma-sensitive approach, generalised programs risk missing the mark. A thorough understanding of the function of the behaviour, supported by the data & information gathered from a collaborative approach with the family & professionals working with the student, can provide valuable insight to support effective planning & results. If the target behaviour is related to a repertoire of escape & avoidance due to anxiety, then let's start there & keep focussed, rather than be distracted by other labels & assumptions. When supporting wellbeing, a child who is absolutely petrified of a particular situation or environment, whose anxiety includes a PTSD diagnosis, panic attacks causing physiological symptoms, school attendance should be on the list, education is a priority for sure, however, wellbeing, what is in the best interest of the child should remain paramount. The individual wellbeing of a student, their health, psychological & physical health should remain the priority. If the goal is for children to attend school, then start with understanding why they are not attending, rather than leap ahead into interventions, reacting to behaviours without adequate understanding, to ensure intervention is supporting behaviour change not reinforcing the behaviour.

Our society has a fairly familiar understanding of one of the most talked about anxiety disorders, Post Traumatic Stress Disorder (PTSD). Some years ago in a meeting with an educational professional about a young child diagnosed with PTSD, in relation to supporting the school to understand triggers, the professional replied "to be honest, I had no idea, I thought PTSD was something soldiers and police officers were diagnosed with". As a society there is still a struggle to apply that same acceptance to all individuals, to consider behaviour occurs by conditioning, however there are many unconditioned responses, your leg moves as the doctor taps your knee, pain, sudden noise responses, salivating; with many more behaviours shaped by experiences, the environment. This includes children, includes substance users, violence, eating disorders & it includes a repertoire of behaviours which are the result of anxiety - the list is long, after all it's human behaviour!

The nature of responses can include involuntary (classical/reflexive) or voluntary usually/or both involuntary/voluntary (operant conditioning), the timing of a stimulus (before or after) impacts on the role of the learner (passive or active). If we are to really begin to support those who experience traumatic events, experiences which impact on socially significant behaviours, whose behaviours are shaped by their experiences, resulting in anxiety related behaviours, then its time to start educating professionals about understanding the function of behaviour.

If behaviours with a significant impact on the individual, socially significant behaviours are to be supported then it needs to be with the best possible knowledge, skill & approach available. The risk if far too high, inadvertent, well meaning support could actually be reinforcing the behaviours needing change. The science of behaviour, as an applied behaviour analyst, requires adherence to the 7 dimensions of applied behaviour analysis. So when you engage a behaviour analyst, you are seeking the services of someone who not only understands behaviour function, they are committed to evidence-based practice, to ensuring changes must occur across environments, improve an individual's life & the intervention is detailed, documented, measured & able to be replicated, there are no guesstimates, no throw ideas around in a meeting & then pick one that sounds good & try that.

A behaviour analyst's focus is the behaviour. Your behaviour analyst professional works alongside & collaboratively with the professionals supporting the individual. The behaviour analyst is focussed on supporting the individual to change their behaviour which is having a socially significant impact on their life.

It is estimated over 2 million Australians have anxiety (Beyond Blue, 2020). The definition of anxiety is a feeling of worry, nervousness, uncertainty regarding an outcome & it would appear at some time most people if not all, experience mild forms of anxiety as a result of new, challenging & at times difficult situations. The essence of anxiety is when we worry about something, anxiety disorders are conditioned behaviours of this worry into outcomes which begin to restrict, challenge, impact on the individuals day to day routines, relationships & lives. For some behaviour analysts, the term anxiety is a little to fuzzy, unclear. I would suggest this is the case for so many socially significant behaviours until further discussion can be had, consultation occurs, information is gathered & assessment can clearly identify the target behaviour. For those who experience anxiety related behaviours impacting on their day to day lives, this includes escape & avoid functions of their behaviour.

I don't know about you, but if something scared the bejeebers out of me, there wouldn't be a next time, I'd be consciously avoiding that as much as I could! Makes sense right? Anxiety occurs when the individual experiences a threat or danger, something which could or might occur. Now to others around the individual, it may not appear concerning at all. For the individual who experiences an ongoing anxiety disorder, develops behaviours of scanning the environment, tuned to changes in sound (changes, volume), develops an acute awareness of changes to their heart rate, perspiration, tension in the muscles (depending on the individual), may become more aware of changes in the behaviours of others.

Now the word experience is a very broad term; this could include witnessing, as the victim of an experience, it may even be hearing, reading, watching something traumatic on television. For many people they may be unaware of how the anxiety began, so to speak. So understanding, documenting, collecting data on anxiety is critical to developing a functional understanding - what does the 'anxiety', what are the target behaviours & what do they look like, then following up with a 'functional analysis' of the information gathered, to determine what is the function of the behaviour. This is foundation of intervention plans. Anxiety can be debilitating, overwhelming & impacts on every aspect of the individuals life from daily routine, to accessing activities, socialising, employment, education, opportunities. Individual's who experience anxiety develop a repertoire of responses to potential threats, by avoiding or escaping (removing the threat), where they experience temporary relief. When the anxiety continues, the avoidance behaviour may increase in intensity or frequency if the individual continues to be exposed to experiences which are of the same magnitude as the catalyst & so the cycle continues. Escape and avoidance has been a function of human behaviour since the beginning of our kind, it works well across species, we have the ability to adapt as we learn risk, threat, harm might occur. For children, avoidance is not so easy as an adult, who has the capacity to make their own choices, restrict & avoid situations. Children must attend school, must do certain things & I say 'must' not because it is certain, as a societal expectation of children, however without a clear understanding of the function of the behaviour, again there is a high risk of children being placed in situations which keeps filling that cup full of stressors, now overflowing.

Human avoidance has been occurring since we developed bipedal movement, we began walking on two legs. Human beings responded accordingly to risk, threats, fear. With our fabulous response repertoire in our tool kit, developed behaviours to enable escape and avoid situations which are likely to cause harm, to remind us that didn't work so well last time so best not to do that again. Sometimes the response is reinforced by the removal of that harm, at other times it may be reinforced by the introduction of comforts to reduce the anxiety, if it works, it's likely to reinforce the behaviour. Understanding the function of behaviour is the basis of providing support to change a behaviour of social significance.

The difficulty with anxiety is not everyone experiences it the same. What makes one person anxious to a level of social significance and how they respond, will be different to someone else. Changing behaviour requires an individual response, unique to the needs of each person.

For a child exposed to family violence, to a violent event involving loud, threatening voices, sudden sounds, scary stuff & let's not forget a child's brain is still developing, so their amygdala & hippocampus, those parts of the brain still wiring up have not fully developed & they are operating on a percentage of the cognitive power that an adult may have.

Their anxiety may present, tummy might start swishing around, feeling nauseous, heart rate starts rising, palms start sweating, everything the teacher is saying is going nowhere near processing through their ears, they're alarm bell has already been triggered & they are looking for threat, danger, fear, what to do next. This could have been triggered by a number of situations, a teacher raising their voice at another student, a verbal interaction with another student, bullying or a sudden sound from outside the room. There is no clear indication without the data & without the evidence.

The challenge for professionals is recognising old patterns & beliefs may not be useful today if there is to be a greater understanding of anxiety related behaviours & if supports are to be effective. Forcing individuals to 'face their fear' is not a useful tool for many adults, let alone children. Some fears are deeply entrenched, some fears are real dangers. What can we do? Understand the individual's behaviour first.

Validate that while some repertoire's are restricting the individual's social experiences, it is in fact keeping the individual safe (for some), reassurance, validation, basic good interpersonal communication & compassion is a good start.

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