MGH Home SchoolPsychiatry Home Page
School-Based Interventions : General Anxiety and Panic
 
Interventions for Worry


Accommodations

  1. Model appropriate behavior for the student in anxiety-provoking situations

    Example:
    Specify how to react to different situations. When a test paper tears, get tape or obtain another copy. When a pencil breaks during a test, raise your hand, resharpen the pencil, or use a different pencil.
  2. Diminish stress within school situations

    Example:
    Allow the student to eat lunch in a small group of familiar peers. If uncomfortable speaking in front of the class, the student may read his or her speech into a recorder.
  3. Forewarn the student of transitions, and have "tasks" for the student to focus on during transitions

    Example:
    If the student is worried about a school trip, provide tasks that distract from anxiety, such as checking attendance, or holding the door at the site.
  4. Address student individually, outside of class whenever possible, about fears

    Example:
    Help the student generate solutions to be implemented when he/she is overwhelmed or "shutting down," or in the presence of fear-provoking situations or stimuli. Preferably discuss outside of class, when the student is not already at a high stress level.
  5. Identify alternatives to avoid unnecessary exposure to anxiety-provoking stimuli

    Example:
    Allow the student to enter school from the side or back so he/she does not have to pass the area where he/she was frightened or traumatized. If the student's parents are divorced, provide writing assignments beyond "family traditions for winter vacation" so the student does not have to think/write about divorce.
  6. Have the student examine worry/anxiety episodes in a larger context to identify improvement

    Example:
    Help the student examine how he/she has handled similar situations over the past year to see improvement (or conversely, to identify what has changed making it harder to use strategies that worked previously).

Modifications 

  • Embed desirable, familiar, or safe content in instruction

    Example:
    Use questions about pets, sports, or preferred literary/TV characters to make new or anxiety-provoking content more comfortable to the student ("What would someone you admire/your hero do in this situation?").
  • Add literature (bibliotherapy) that addresses the student's fears, or exemplifies coping strategies

    Example:
    Use a short story or film that deals with bullying, death of a relative, spending a night apart from parents, or getting sick on a school trip.

Specialized Instruction

  • Have the student employ specific problem-solving steps

    Example:
    Model a "Situation-Alternative-Consequences" (SAC) approach for the student: S: situation identified -  A: alternatives enumerated -
    C: consequences predicted.
  • Devise a desensitization approach agreeable to the student

    Example:
    If the student fears speaking in front of the class, allow the student to: have the speech read by a peer; read the speech into a recorder outside class; introduce other students doing speeches; do the speech with a peer reading some part. Finally, have the student read his/her own speech.
  • Provide group, interactive bibliotherapy activities (group dialogue, peer pairs) that address fears or topics worrisome to the student

    Example:
    Read a book to students and accompany the book with either discussion, role-playing, art activities or creative writing. For example: an adolescent group/pair can compose a diary for a character in a book, write a letter from one character in the book to another, role play an incident in the book with a student taking the part of a key character, or draw pictures in sequence of important incidents in the book.
  • Use visuals to help "pace" the student when he/she is anxious about a parent being away, stressed about completing work, or perservating on a particular upcoming event or activity

    Example:
    Develop a "time schedule" with specific symbols that the student places on a visual board for specific time intervals. This allows the student to see how much time remains before something is over or before something new begins. The student's "want" is visually included on the board as the "end goal."
  • Have the student practice positive self-talk

    Example:
    Introduce positive "scripts" to practice in anxiety-provoking situations, such as "break the task down" with "I have done this many times, so now I'll just start by doing one problem, then checking to see if it's correct."
  • Help the student evaluate the evidence for his/her negative conclusions

    Example:
    The student says "I'm worried that people will see what a loser I am if I play on the soccer team". Ask him/her: "did any good things happen last time you played soccer? Is there another sport that you play better?"
  • Challenge the student's negative cognitions

    Example:
    The student says "I can't go to school because I'm worried people will make fun of me." Ask him/her: "What do students do when they arrive at school? Which students are glad to see you?"
  • Help the student identify automatic negative thoughts

    Example:
    The student says "I can't let my mother go on the subway. The train might explode." Ask the student: "What happened the last time your mom took the subway? Did she come home safely?"
  • Help the student examine other perspectives

    Example:
    The student says "I can't go to the school dance because everyone will notice that I'm nervous." Ask the student: "How would your best friend/someone you admire handle a situation like this? What does your friend think you should do?"
  • Provide the student with competing responses to negative thoughts or behaviors

    Example:
    The student says "I'm afraid I'll start crying in class." Ask the student: "If you start to feel sad, what can you do before you start to cry? Can you read something that makes you laugh? Can you distract yourself by doodling?"

Behavioral Planning 

  • Develop a consistent de-escalation procedure familiar to staff

    Example:
    When worried, the student will: 1) take 10 breaths; 2) identify how a preferred "hero" would handle the situation; 3) access designated staff; 4) do alternative, less stressful work; 5) do reading for five minutes in an alternative area (corner of room, library), then answer questions.
 
   
 
    ©2010 Massachusetts General Hospital, School Psychiatry Program and MADI Resource Center
    Copyright | Disclaimer | Privacy Policy | Department of Psychiatry  | Site Map