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A PROTOCOL FOR SCHOOL PHOBIA/SOCIAL ANXIETY

November 25th, 2014 by Robert DePaolo | Posted in Psychology | No Comments » | 97 views | Send article | Print this Article |


By Robert DePaolo

Abstract

Methods for treating school phobia typically involve systematic desensitization and/or cognitive therapy. The former purports to undo (i.e. counter-condition) the association between anxiety reactions and the stimuli and/or circumstances that provoke them. The latter purports to change the structure of schemata and override anxiety by changing the quasi-logic responsible for provoking and sustaining the phobia. While both methods can be effective, the following treatment suggestions, which incorporate CBT, SD and assertive therapy approaches, adds another factor to the therapeutic mix – the element of self-talk regulation.

The types of social-emotional disorders seen in and outside of school settings seem related increasingly to students’ incapacity for self-regulation (Gross 1998), (Mennin 2004). This skill – referred to variously as metacognition, self-control, conscience and executive functioning is quintessentially important in almost all aspects of the school experience. Once anchored down, students can more easily attend, memorize, modulate emotions and profit from peer interactions. Conversely, with deficiencies in this area a wide variety of negative outcomes tend to crop up.

Dealing with the problem in schools would be easier if one could define in concise terms what self-regulation really means. In psychological terms this is a somewhat Byzantine endeavor – witness the various characterizations mentioned above. In neuro-psychological terms it is a bit easier to do. It is known that the frontal lobes of the brain – which unfortunately for schools and society in general do not fully mature until around age 25 – provide the self-regulatory function. But how is this accomplished?

The frontal lobes are curious structures because they are not devoted to any sensory or motor function. In fact they are a fairly new evolutionary byproduct of brain expansion branching off the parietal lobe which gives us language, fine motor control (including orchestration of mouth, tongue, fingers and hands which are coincidentally responsible for the advent and expansion of human culture). As the parietal lobe moves forward into the frontal area it is met by vast inhibitory circuits that parse and refine its pathways (Sakagami, Pan et. al 2006). The end result is that speech and motor functions become whittled down to fractional versions of language and speech. That process enables us not only to talk implicitly to ourselves but to listen covertly to ourselves, because even covert auditory attention in governed by the prefrontal cortex (Benedict, Shucard et al (2002). It also enables us to manipulate the environment covertly and in effect rehearse, reflect and predict events and outcomes. It is interesting that despite having no specific function – as seen in the classic Phineas Gage head injury episode (MacMillan (2000), the frontal lobes have more connections to other brain sites than any other (Lacruz, Gracia-Seone et al 2007). Thus they are both general and highly influential –the perfect format for an oversight circuit capable of converting external into internal experience.

Some students are less developed in these functions. While they might have normal speech and fine motor proficiency, they are less adept (developed) in the area of fractionated motor and speech functions. In simpler terms they do not, cannot talk and listen to themselves covertly in working their way through task work, social situations and as a means by which to modulate emotional reactions. In effect they have limited internal access.

This is especially important with regard to emotional dynamics, because many types of phobia seem to be related to skill deficits in the self-regulation domain (Rapee & Heimberg 1997). For that reason it would seem a therapeutic/behavior management model that incorporates self-talk, self-regulation into a treatment approach might be effective. The following suggestions incorporate anxiety-reducing tactics such as relaxation training and assertive training as well as self-regulation. The model is not based on research, rather is proposed as a speculative model (subject to the creative revisions by school counselors and psychologists) that just might prove effective in dealing with school phobia.

PRINCIPLES

Anxiety can be defined as an unmanageable arousal level of global, uncontrollable proportions. The main problems with it are uncertainty (not having a behavior by which to control it) and over-generalization (not being able to compartmentalize arousal so as to parse and minimize its impact).

The method here includes three components: Relaxation/Desensitization,
Assertiveness and Self-talk regulation.

Strategies; Anxiety in specific or general situations or can be controlled behaviorally by reversing the factors mentioned above, for example by…
1. Whittling arousal down to narrower influence through self-talk and self-control labeling skills to categorize, parse and ameliorate its effect.
2. Employing relaxation exercises to reduce arousal prior to engaging the anxiety-laden situation
3. Expression of assertive behaviors to enable a semi-aggressive response to drown out the inhibitory effects associated with anxiety in those circumstances.

METHOD

The first step involves discussion of student’s commitment and motivation.

The second step involves identification of anxiety-provoking circumstances and completion of a rating scale (perhaps 1-10, from least to most fearful )

The third step involves learning and practicing relaxation exercises, self-talk strategies and assertive behaviors (scripts to use) that are comfortable to the student and which will be used in real situations. This is done in counseling office for several sessions.

The fourth step involves use of imagination in anxiety-laden situations in states of relaxation and while engaging in an assertive behavior (in office)

The fifth step involves the student will be asked to
a. Use a brief relaxation exercise before in entering the anxiety-provoking situation.
b. Use two self-talk scripts while in the situation…
The first involved first acknowledging the anxiety (“Oh boy, this is hard”… etc etc

The second involves compartmentalizing/parsing using the self-talk response (“It’s just a damn classroom; it won’t kill me”

The third involves expression of the assertive response in the anxiety-provoking situation – possibly a firm greeting to another student or a witty remark to override inhibition/anxiety.

These steps would be carried out gradually, the actual gradation will depend on the person’s learning curve

MEASUREMENT

An ongoing fear rating scale could be filled out weekly at first to see if anxiety has diminished and to what extent – the feedback will help the student recognize his mastery over the fears as well as provide an assessment of progress.

REFERENCES

Benedict, R. Shucard, D.W., Santa Maria, M.P. Shucard, J. Abara, J.P. Coad,
M., Wack, D. Sawusch, J. Lockwood, A. (2002) Covert Auditory Attention Generates Activation in the Anterior Rostral.Dorsal Cingulate Cortex. Journal of Cognitive Neuroscience Vol 14, (4) 637-645

Gross, .J.J. (1998) The Emerging Field of Emotional Regulation: An Integrative Review. Review of Generall Psychology. 2; 217-299

Lacruz, ME, Garcia-Seoane, J.J. Valentin, A. Selway, R. Alarcon, G. (2007) Frontal and Temporal Functional Connections of the Living Brain. European Journal of Neuroscience. Sept. 28 (5) 1357-70

MacMillan, M. (2000) An Odd Kind of Fame; Stories of Phineas Gage. MIT Press pp. 116-119

Mennin, D.S. (2004) Emotional Regulation Treatment for Generalized Anxiety Disorder. Clinical Psychology and Psychotherapy: 11, 17-29

Rappe, R.M. Heimberg, R.G. (1997) A Cognitive-Behavioral Model of Anxiety in Social Phobias. Behavioral Research and Therapy. 35, 741-756

Sakagami, M, Pan, X, Utll, B. (2006) Behavioral Inhibition and Prefrontal Cortex in Decision Making; Neurobiology of Decision Making. Journal of Neural Networks. Vol 19 (8) 1255-1265

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