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Sunday, November 30, 2014

Interventions Can Salve Unseen Anxiety Barriers

From Sage Journal's Phi Beta Kappan

By Jessica Minahan, M.Ed., BCBA
and Jerome J. Schultz, Ph.D.
November 26, 2014

Abstract

Jessica Minahan, M.Ed., BCBA
Teachers who understand anxiety and its effect on a student's learning and behavior, and use a few common strategies in different and more effective ways, will be less frustrated and more effective in their work with anxious or emotionally fragile students.

What may appear as a student’s defiance or procrastination often is hidden anxiety or stress. Teachers can employ several strategies to help such students move forward in their learning.

Take a poll of teachers’ greatest concerns. Most likely they’ll put “troubling behaviors” at the top of the list. The National Education Association cites “problem behaviors” as one of the top five reasons teachers leave the profession prematurely (Kopkowski, 2008).

Our recent literature search found multiple articles, similar in tone and content, promising to help teachers deal with negative classroom behaviors that interfere with teaching and learning. They focus on improving teacher-student relationships, creating behavioral expectations and consequences, establishing clear learning goals, outlining assertive behavior that leads to greater control, and establishing a positive, collaborative, and respectful classroom climate.

It’s hard to find fault with these familiar building blocks of a well-managed classroom. But even seasoned, talented educators may not be sufficiently prepared to address the needs of students suffering from anxiety. Anxiety disorders are alarmingly prevalent among U.S. children and adolescents: 31.9% of teens have had an anxiety disorder during their school years (Merikangas et al., 2010). With other disabilities, including ADHD and autism also increasingly prevalent, overburdened teachers are overwhelmed.

Anxiety — and accompanying chronic worry — can result in an increasing variety of negative behaviors. These create major impediments to a student’s learning, to the learning of others, and to a teacher’s ability to teach effectively. Heroic teachers handle this challenge with little to no training in mental health and behavioral principles.

School systems identify the need for social-emotional learning, but put other professional development initiatives first, such as advancing the use of technology in the classroom. In short, an iPad is no substitute for iUnderstand Myself.

Leaving teachers to learn by instinct on the job puts students with mental health or behavior issues at risk for negative outcomes that include leaving school, academic failure, poor social adjustment, and a disproportionate number of suspensions and detentions.

While the right dose of stress aids learning, intense and unrelenting stress or chronic anxiety depletes psychological energy. Cognition suffers and behavior worsens. To understand this, let’s look at what’s happening in the brain.

Jerome J. Schultz, Ph.D.

A Neurobiological View

Linguist and education researcher Stephen Krashen conceived the “affective filter hypothesis” to explain how students can learn a second language more efficiently. The affective (or emotional) filter hypothesis holds that learners’ ability to acquire language is constrained if they experience negative emotions such as fear or embarrassment, or when their “filter is up” (Krashen, 2003).

In Krashen’s view, many factors can activate the affective filter, including low self-confidence, low motivation, stress, and anxiety. The Krashen hypothesis can be applied to any student whose anxiety is impeding learning, and its use becomes obvious when we examine what’s going on in the anxious brain.

Stress and excessive anxiety (here defined as worrying about something over which we believe we have little or no control) impairs the brain’s ability to process, acquire and store new information. The part of the brain’s limbic system known as the amygdala is generally regarded as a fear sensor. In the frightened brain, PET and fMRI scans reveal the physiological effect (increased radioactive glucose and oxygen use) of intense anxiety or stress. In this reactive state, new information is prevented from reaching the cerebral cortex (in particular, the prefrontal cortex) where higher-level processing and memory storage occur.

In the face of fear, the primitive part of the brain — the mid-brain — takes over to keep us safe from perceived threats. That triggers a complex chain of chemical events, causing the prefrontal cortex to actually deactivate in the service of survival. In essence, the anxious brain is sending the message that “you don’t have to think about this, you just have to get outta here!”

When students feel trapped in situations over which they have little or no control, they go into the “fight, flight, or freeze” mode that we see in any organism experiencing extreme stress (Schultz, 2011). This neurobiological reframing offers a plausible alternative interpretation of the negative, unproductive behaviors that even the best teachers see as a major challenge — and which we feel has not been addressed in the mainstream literature dealing with classroom management.

When viewed from a survival perspective, it’s easy to understand that much of the negative behavior seen in the otherwise well-run classroom is the protective, fear-avoiding mechanism of students who don’t want to experience the shame and embarrassment they often feel in school. Students with specific learning disabilities as well as those with unimpaired learning who set unrealistically high standards for themselves can be affected by this dynamic.

Teachers and others often misread these protective behaviors as willful, oppositional, or defiant, or as the lack of motivation. Too often, these negative behaviors are misinterpreted as symptoms of Attention Deficit Hyperactivity Disorder (ADHD).

Trying to teach a child to relax in the midst of high anxiety is like trying to teach someone how to swim when there are sharks in the water.

Looking at negative behaviors through a neurobehavioral lens provides a different and more helpful way to interpret the irritating, aggressive, or even hostile behaviors that frustrate/frighten even the best teacher. Before offering practical strategies based on this approach to help students who don’t benefit from the typical approaches to behavior management, let’s examine why these methods haven’t been effective for this group of anxious learners.

Rewards and Consequences

Behavior plans for students with challenging behaviors typically include rewards or consequences designed to increase expected behaviors. (“Do your homework all week, and you’ll earn extra time on the computer … If you don’t finish your math, you’ll stay in for recess.”) This approach can be ineffective for students with anxiety because it emphasizes and rewards consistently regulated behavior and performance — the exact skill many of these students lack.

Requiring a quiet voice all day, in every subject area, is an inflexible approach based on unrealistic expectations. Virtually all students may exhibit inconsistent behavior that fluctuates with their emotional state. As anxiety and mood shift, so does a student’s ability to attend, behave appropriately, and do schoolwork. Maybe he can write a two-page essay in the morning but anxiously struggles to produce a coherent sentence that afternoon. She might act appropriately during a spelling quiz but launch into a tearful tantrum when asked to do something even easier.

Faced with this confusing change of emotions, the teacher is likely to react by using a common but ill-suited intervention like reminding students of rewards and consequences. “Do this or else” or even “Do this and you’ll get … ” approaches can have the effect of backing an anxious student into a dark and depressing corner.

Ross Greene (1998) often says students would behave if they could. We agree: Students misbehave because of an underdeveloped skill. If the student can’t behave, this may indicate she isn’t able to behave, which is why the incentive doesn’t help. Reminding her that she’ll miss recess unless she behaves doesn’t produce positive results. As if anxiety-generated fluctuations in the ability to behave weren’t enough of an impediment, many anxious students also have underdeveloped skills in areas such as self-regulation, positive thinking/thought stopping, self-monitoring, executive functioning, and flexible thinking. Weakness in any of these skills increases his inability to behave according to expectation.

Effective behavior interventions for students with this constellation of challenges should emphasize two pivotal components:
  • Teaching skills - flexible plans emphasizing reinforcement for skill development and practice of underdeveloped skills, rather than consistent behavior performance;
  • Prevention - adequate identification and support for anxiety-provoking activities and situations (Minahan, 2014).

If we help students learn self-calming strategies, like deep breathing, meditation, and mindfulness, we may avert behavior incidents. When we objectively collect data to systematically examine what happened before the incident, we begin to see patterns in anxiety-provoking situations or events that contribute to the student’s anxiety. This best-practice approach helps us better understand inappropriate behavior and the role anxiety plays.

Ninety percent of every behavior plan should be dedicated to prevention and skill building (Minahan & Rappaport, 2012). Until the student can consistently apply these skills, they’ll require accommodations and environmental modifications to keep them feeling safe and competent.

Anxiety — and accompanying chronic worry — can result in an increasing variety of negative behaviors.

Don’t Throw Out Those Tokens!

So where does this leave the teacher who’s been trained in the traditional reward-and-punishment model? Without an alternative, they may be unclear about how to reinforce the behavior of an anxious student.

Here’s a simple formula: Go ahead and use positive reinforcements like points or tokens, but don’t focus on anxious students’ behavior performance. Use these incentives to positively reinforce students when they practice or use appropriate social skills, or use learned strategies to reduce anxiety in difficult moments.

This approach enhances the student’s ability to cope with anxiety and makes practicing these new skills enjoyable and rewarding. Remember: Underdeveloped skills — not willfulness, opposition, or negativity — cause many negative behaviors in anxious students (Minahan & Rappaport, 2012).

Get Started and Keep Working

Teachers obviously are concerned about students who don’t produce work or avoid even the simplest of tasks. Anyone who has procrastinated on writing a report can identify with the instinct to avoid a task perceived as difficult. For anxious students, avoiding a task is the flight part of the “fight, flight, or freeze” anxiety response. It’s often a result of the student’s anxious thinking, “I’m horrible at this! If I try this, I’m going to look dumb.”

Ever stand next to a chilly swimming pool, afraid to jump in? The first thing you do is check the temperature with your toe. Too often, teachers focus on the production of a product rather than the student’s inability to get started. The ability to initiate is often the primary barrier. Since most students can jump into new assignments without fear, teachers typically give the class a task and then help those who can’t seem to get it in gear. Usually a slight prod or encouraging word is all it takes to get a student engaged.

But what about students who are frozen in fear when confronting a new task they think is too different or difficult? How can we help them get over their initial panicked reaction to a task and take the temperature of the academic water?

Here’s our approach. We figure you’ve got about a minute to get highly anxious students engaged in the task with a sense of confidence — the natural enemy of anxiety. Focus your attention on these students — the most likely to crash on liftoff — and help them get started. If you have a lot of needy students and no time to help them all, consider giving a warm-up or waiting activity, like a crossword puzzle, until you can get to them. Say something like, “I believe you can do this, but if it seems too hard or if you have questions for me, then get your brain ready by doing the warm-up. I’ll get to you very soon.”

Making this an option for all students makes anxious students feel less self-conscious, and buys you enough time to head off embarrassing meltdowns that make recovery difficult.

Being Proactive

Effective teachers are expert at zeroing in on students who seem upset, then de-escalating their worries with gentle suggestions and words of encouragement. Anxious students tend to crash and burn when they perceive a task is too challenging. If a student has a history of rapid escalation of negative affect, catching it early is one of the easiest ways to head off challenging behavior. You must be on high alert with these students, noting seemingly insignificant behavioral changes, like a shift from sitting calmly to fidgeting, from talking respectfully to getting snippy, or from working hard to putting their head down on the desk. Any of these signs can signal a meltdown. Strategic interventions can lead to positive outcomes.

What’s great about these interventions is they’re easy to do and cost nothing! Simply asking, “How’re you doing right now?” is a great way to help a student contain and manage anxiety. This question conveys that you care about her. If the answer is “not so great,” you can intervene immediately. That’s a great comfort to an emotionally fragile student.

Thought journals are another way to check in with the student throughout the day. By using a small notebook to write brief notes, you or the student can initiate the correspondence. Giving the student a private, personalized way to let you know he’s worried about something can be less anxiety provoking than verbal interaction.

While the right dose of stress aids learning, intense and unrelenting stress or chronic anxiety depletes psychological energy.

Having a student complete a check-in sheet when she comes into school is an effective way to get a read on the student’s level of anxiety as she walks through the door. You can then create or suggest individualized interventions or support to quell the anxiety. Similarly, you might want to do a check-out before dismissal, giving the student the chance to reflect on today and plan for a better tomorrow.

Reducing Resistance to Writing

Writing is required in almost all subject areas, so it’s understandable for teachers to be concerned if students balk when asked to put pen to paper (or fingers to keyboard). Students who don’t believe they have what it takes to be a good writer also have difficulty with the executive functions required for planning and executing a written assignment. Many students are debilitated by “all-or-nothing” thoughts around writing: “I’m the worst writer,” “I hate writing.” Once he’s adopted this thought pattern, his anxiety usually rises along with avoidant behavior.

Teachers can work to replace these unproductive, debilitating thoughts with a more realistic and optimistic frame of mind. The How I Feel about Writing sheet is one strategy to help reduce all-or-nothing thoughts and statements (Minahan, 2014). Using this approach, you can deconstruct writing into small components (e.g., writing lower case letters, sharpening a pencil, etc.).

Then, have the student rate his feelings about each (e.g., “I like it,” “OK,” or “I don’t like it”). Include components that will garner a neutral or even positive response, as well as those that engender a negative rating.

The goal of this exercise is to get students to see writing as “OK” and “I like it,” rather than staying in the “I don’t like it” category. When a student says, “I hate writing,” take out the sheet and encourage him to reframe his response: “Actually, you like writing, but you’re still learning how to spell and think of an idea. That’s the hard part that’s getting you stuck. Let’s review your strategies.”

Underdeveloped skills, not willfulness, opposition, or negativity, cause many negative behaviors in anxious students.

Another strategy is to have the student rate the difficulty of a writing assignment before and after the activity (e.g. on a scale of 1 to 5, easy to difficult) (Schultz, 2012). Before the activity, the student might rate it very hard due to her anxiety-fueled perception. After the activity, she very likely will have a more accurate perception and assign a lower number. In the future, if a student says a particular activity will be too hard, teachers can resort to a similar activity that the student has agreed is “not that hard.”

Comparing the stress-inducing task with a similar one the student performed puts the whole self-rating construct into perspective. “It’s interesting you think this is a 5. Look, yesterday you thought this assignment was going to be a 5, and it turned out to only be a 3! Let’s see what happens with this assignment.”

After several days, maybe weeks, teachers will have helped challenge the student’s irrational idea that writing is extremely difficult and move her from an “I can’t” to an “I can” mindset. A brain that believes it can do something is often a brain that’s right.

In Summary

Teachers who understand anxiety and its effect on a student’s learning and behavior and who use a few common strategies in different and more effective ways will be less frustrated and more effective in their work with anxious or emotionally fragile students. Guiding a student successfully through unexpected and emotionally charged moments will help both gain confidence.

When students learn that taking a deep breath or counting to 10 is more effective and pleasant than yelling or crying, they become more productive and successful. When they learn to monitor their emotions, negative thoughts, and unproductive behaviors during class, they’re more likely to independently initiate and complete work.

Confidence leads to competence, and competence reduces anxiety. It’s a complex formula with what we think is a fairly simple solution.
.................................................................

Jessica Minahan is a behavior analyst, special educator, and director of behavioral services at NESCA (Neuropsychology & Education Services for Children & Adolescents, in Newton, Mass.) She is an adjunct professor at Boston University and author of The Behavior Code Companion (Harvard Education Press, 2014) and coauthor with Nancy Rappaport of The Behavior Code (Harvard Education Press, 2012).

Jerome J. Schultz is a former public school teacher of children with emotional disorders and currently a clinical neuropsychologist at Harvard Medical School. He is author of Nowhere to Hide: Why Kids with ADHD and LD Hate School and What We Can Do About It (Jossey-Bass, 2011).

References
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  • Minahan J. (2014). The behavior code companion: Strategies, tools, and interventions for supporting students with anxiety-related or oppositional behaviors.Cambridge, MA: Harvard Education Press. Google Scholar
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  • Schultz J.J. (2012, February). The stress connection: The missing piece of the LD puzzle. Paper presented at the annual meeting of the Learning Disabilities Association of America, Chicago, Ill. Google Scholar

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