As behavioral health becomes more integrated into treatment diagnosis and planning, there will be increased focus on diagnosing and addressing anxiety, but there is a national shortage of psychologists and a rise in treatable anxiety that complicate this. Anxiety in moderation can actually be ‘very helpful’ because it can be used as a motivational tool in times of danger or in acts of performance, according Dr. Christine Dargon, Ph.D., a licensed psychologist, but if left untreated anxiety can increase hospitalization and other medical and pharmacy costs, affect a provider’s ability to demonstrate its value to managed care, and delay good outcomes. Our own Erin O’Donnell listened to Dr. Dargon speak at the PESI Healthcare Conference on Anxiety Disorders, August 11th.
“The body responds immediately to stress,” said Dr. Dargon, who asked the room where they thought anxiety could be noticed in the body. Answers varied from tightness in the chest to wearing shoulders as earrings, to an upset stomach, a tense neck, and headaches. The prefrontal cortex in the brain is a type of “regulator” that keeps things acting as they should, and when a person is stressed, it produces norepinephrine and dopamine, causing it to “shut down,” Dr. Dargon said. This explains why when a person is stressed, they might lose their appetite, sex drive, become aggressive, or fearful.
Anxiety treatment will be particularly relevant as a way to prevent more costly conditions from occurring in children and adolescents. Dr. Dargon spoke about the importance of analogies when working with children, particularly in ways that helps them to understand, like using games or reward systems. Dr. Dargon said children cannot make the distinction between fear and anxiety because young children’s brains do not have access to abstract thinking. Therefore, it can be helpful to use code words for cognitive restructuring. She used the example of a “Court Room” analogy in which the patient represents the judge and two attorneys, each making a case in favor or against the patient’s anxious thought or idea. This ultimately allows the patient to “look at the evidence” of what they were feeling fearful of and helps them to realize that it’s irrational. Another useful technique Dr. Dargon suggested is to create a code word for “Habit Reversal Training (HRT)” to help stop a child from OCD behaviors such as skin picking, nail biting or hair pulling. She suggested using a fun or creative code word as a reminder to the child to help them stop these behaviors, as it is effective and easy to teach the child. A reward system isn’t harmful when it’s not punitive said Dr. Dargon, because a reward for good behavior from therapy is affective.