Module: Anxiety Disorders (Page 1 of 14)

Contents

  1. Definition
    1. General Anxiety Disorder (GAD)
    2. Post Traumatic Stress Disorder (PTSD)
    3. Acute Stress Disorder
  2. Manifestation
    1. General
    2. Specific to Academia
  3. Institutional Accommodations
  4. Assistive Technology Accommodations
  5. Teaching Strategies—
    What Can Faculty Do?
    1. Specific Strategies per Disability
    2. General Strategies
    3. Shaping the Environment
  6. Learning Strategies—
    What Can Students do?
  7. Resources
  8. Feedback

Definition

Anxiety disorders are chronic conditions that produce feelings which may interfere with a person's ability to carry out normal or desired activities. Some of the most common anxiety disorders include General Anxiety Disorder (GAD), Postraumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), Obsessive Compulsive Disorder (OCD), Panic Disorder, Social Anxiety Disorder (SAD), and a variety of phobias. The three disorders featured in this module are:

General Anxiety Disorder (GAD)

A person experiencing persistent and excessive worry and anxiety more days than not for a period of six months or more. GAD affects twice as many women as men and usually develops slowly while frequently co-occuring with Major Depressive Disorder, other Anxiety Disorders such as Panic Disorder, Social Phobia, Specific Phobia, and with Substance-Related Disorders. (American Psychiatric Association, 2000; National Institute of Mental Health, 2009)

Post Traumatic Stress Disorder (PTSD)

This disorder follows exposure (directly experienced or witnessed) to an extreme traumatic event such as military combat, violent assault, torture, natural disasters, accidents, a life threatening illness, loss of a loved one, observing the injury or unnatural death of another person, etc. The response to the event must involve intense fear, helplessness and/or horror. PTSD symptoms may develop soon after the event occurs or may be delayed up to 6 months following the event. Central features of PTSD involve persistent re-experiencing of the traumatic event; persistent avoidance of stimuli associated with the trauma; and, persistent symptoms of anxiety and increased arousal. (American Psychiatric Association, 2000)

Note: PTSD is common among veterans that have returned from either witnessing or experiencing violent events due to combat, torture or other traumatic exposure. Veterans are increasingly enrolling in college classes and, typically, injured veterans are new to their disability, without prior history of Section 504 eligibility; therefore, they may be unaware of their rights and procedures, unaware of the impact of their disability, and unaware of adaptations to compensate for new challenges that the disability presents. Additionally, often they equate disability with “weakness”. For more information about CSU veteran services go to: http://veterans.colostate.edu

Acute Stress Disorder

This disorder is very similar to PTSD except that it occurs within one month after the traumatic event and lasts no more than 3 months in duration. If this disorder persists longer than one month, the diagnosis may be changed to Posttraumatic Stress Disorder. (Association, 2000)

General Manifestation

Generalized Anxiety Disorder

GAD predominately features excessive, uncontrollable anxiety and concern about real life circumstances and is typically exhibited by:

  • Muscle tension; possible trembling or twitching; shakiness.
  • Somatic symptoms such as sweating, nausea, diarrhea, exaggerated startle response, headaches, irritable bowel syndrome, feeling out of breath, light-headedness, having to frequently urinate, hot flashes, and having difficulty swallowing (National Institute of Mental Health, 2009).
  • Depression.
  • Fear of failure.
  • Restlessness, feeling keyed up or agitated.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Sleep disturbances.
  • Significant distress or impairment of social, academic, occupational, and other important areas of functioning (American Psychiatric Association, 2000).

Posttraumatic Stress Disorder (PTSD) & Acute Stress Disorder

The development of PTSD symptoms occurs after exposure to an extreme traumatic stressor and includes a response to the event that is marked by intense fear, horror, and/or helplessness. PTSD is characterized by the following features.

Persistent re-experiencing of the traumatic event through:

  • Intrusive and recurrent disturbing recollections of the event including images, thoughts or perceptions.
  • Recurrent distressing dreams of the event or related to the event.
  • Acting or feeling as if the event were recurring; a sense of reliving the experience including illusions, hallucinations, and/or dissociative flashback episodes. More commonly occurs upon awakening or being intoxicated.
  • Exposure to internal or external cues/stimuli that symbolize or resemble an aspect of the traumatic event triggers intense psychological distress and physiological reactivity. E.g. A loud noise in the classroom, a crowd of people, the smell of smoke, etc. may trigger a traumatic re-experiencing episode.

Persistent avoidance behaviors characterized by:

  • Deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event as well as an avoidance of situations, activities, environments, or people that may arouse recollections of the event. May include amnesia for a specific aspect of the traumatic event.
  • Psychic numbing or a lack of responsiveness to the external world.
  • Feeling detached or estranged from others; decreased ability to feel emotions.
  • Significant loss of interest in previously enjoyed activities or events.
  • Diminished or nonexistent expectations for the future; a sense of a foreshortened future.
  • Possible development of a drug and/or alcohol dependency.

Persistent symptoms of increased arousal including:

  • Feeling “keyed up” or jittery, always on the alert and on the lookout for danger.
  • Sudden irritability or anger.
  • Disturbed sleep; difficulty falling or staying asleep.
  • Hypervigilance; fear for one’s personal safety and always feeling on guard.
  • An exaggerated startle response.
  • Trouble concentrating and difficulty with memory.
  • Excessive fatigue and headaches.

Significant distress or impairment of social, academic, occupational, and other important areas of functioning. (American Psychiatric Association, 2000)

Manifestatation Specific to Academia

Difficulty with:

  • Maintaining consistent class attendance and timeliness.
  • Starting and completing assignments.
  • Understanding and remembering verbal directions.
  • Developing and maintaining positive peer and faculty relationships.
  • Motivating oneself to study and plan.
  • Effectively managing time. Maintaining focus and coherent thought during test taking and oral presentations.
  • Demonstration of learning through typical testing procedures.
  • Participating in class discussions and group assignments.
  • Maintaining focus and attention during class sessions.
  • Handling time pressures and multiple tasks; prioritizing and meeting deadlines.
  • Responding to change.
  • Screening out environmental stimuli in order to maintain focus.
  • Responding to negative feedback.
  • Approaching authority figures and peers.
  • Expressing personal needs and wants with faculty and peers.
  • Engaging in social interactions.
  • Maintaining the stamina required to be a successful full-time student.
  • Participating in activities or events.
  • Maintaining confidence and a positive self image.
  • Developing and defining academic, career and life goals.

(Disability Advisors Working Network (DAWN), 2008; Souma, Rickerson, & Burgstahler, 2008)

Institutional Accommodations

  1. Flexible matriculation requirements including:
    • Extended time to complete degree program.
    • Flexible course requirements.
    • Alternative housing options (as opposed to being required to live in a dorm).
    • Course load flexibility.
  2. Alternative Format:
    • Textbooks and print materials can be converted to alternative formats for students.
  3. Alternative testing arrangements:
    • Extra time.
    • A quiet, separate room.
    • Provision of a reader/scribe.
    • Use of a computer, including adaptive software and hardware.
  4. Notetaking support.
  5. Priority registration.

Assistive Technology Accommodations

Teaching Strategies—What Can Faculty do?

Specific Strategies per Disability

Allow alternative testing arrangements
This may include extra time, a separate testing location, alternative testing formats, etc. The Disability Service Office will assist students in providing alternative arrangements.
Consider flexible assignments
Upon request and in certain circumstances, consider allowing extended assignment deadlines, alternative assignment choices, hand written assignment completion, etc. (Kennedy, Treanor, O'Grady, & DAWN Network, 2008)
Clearly communicate your attendance policy
If attendance and class participation are part of the grading system for a class, inform students of this as early as possible. Negotiate alternatives with students who are requesting flexible attendance; encourage them to withdraw from the class if a good resolution cannot be met and then provide alternative suggestions such as distance learning.
Provide notice of changes to the class routine or classroom environment
If there is a change in the classroom environment, class location, class assignments, class schedule or any other change in routine; give the student advance notice so as to allow time for him/her to prepare for and become accustomed to the change ahead of time.
Allow for breaks
Give the student permission to take breaks as needed or prearrange break times.
Foster an encouraging, validating, academic environment
Provide individual feedback on academic performance
Offer to meet with the student on a routine basis throughout the semester; provide performance feedback, encouragement and suggestions. (Souma, Rickerson, & Burgstahler, 2008)
Maintain an awareness of the student’s demeanor
If changes in behavior, mood, quality level of assignment completion and test grades are notable, be ready to inform the student of appropriate campus resources such as counseling, tutoring, etc.
Consider implications of the student’s disability
If any class content (such as a video, group discussion or assignment) relates to something of a violent nature, inform the student in advance so that he or she can decide whether or not to attend class that day.

General Strategies

Provide Accessible Course Materials
Ensure that all curriculum materials (syllabus, notes, presentations, assignments, etc.) are available in an accessible format that can be used and manipulated by a computer (Word, HTML, RTF, PDF, etc.). To learn how to create accessible materials, see Training Modules and Tutorials on this website.
Plan Ahead
Select textbooks and materials needed for the semester as early as possible.  Students with disabilities will need time to take class materials to the Disability Service Office for conversion to an alternative format.
Provide Structure
Provide a syllabus and class assignments with clearly delineated expectations and due dates.
Provide Guided Notes on the Web
Prior to lectures, provide students with consistent, structured notes that are in an accessible format. Since students with disabilities sometimes have more difficulty than others in processing new information (especially while simultaneously trying to take notes), having notes ahead of time will increase students’ ability to follow along during class and more effectively process course content. If it is not acceptable for all students to have lecture notes ahead of time, make alternative arrangements for students with disabilities such as emailing lecture notes to the student(s) or setting up an office mailbox where the student(s) can receive notes ahead of time.
Provide Multiple Methods of Presentation
Present information and ideas in multiple ways in order to address different learning styles.
Engage students in multiple ways of learning
Incorporate active teaching/learning methods where possible. For example, problem-based learning activities, community projects, in-class activities and discussions, etc.
Encourage Multiple Methods of Expression
Offer more than one way for students to demonstrate what they have learned in class. For example, students can be given a choice between taking a test, writing a paper, giving an oral presentation, producing a video, etc. Additionally, keep in mind that some students may have difficulty working in a group. Alternative ways of completing a group assignment may need to be considered.
Repeat or paraphrase questions and responses so that the whole class can hear.
This is especially important in large classrooms and when a microphone is used during live and taped presentations.
Highlight Key Points
Provide an overview when introducing a new topic, and highlight key points in a variety of ways throughout class lessons and in written materials. Use visual, verbal and interactive cues for added emphasis. This helps students know what to expect and what is most important, thus improving their ability to achieve the learning objectives.
Summarize Key Points
Summarizing key points at the end of each class will increase the student’s ability to process and integrate new information.
Chunk Information
Break large amounts of information or instructions into smaller segments (“chunking”).
Provide Study Aids
Provide study questions, study guides, and opportunities for questions and answers to help students review and clarify essential course content.
Engage with Students who Self Advocate
Team up with students with disabilities (who disclose their accommodation needs) to determine a plan that is effective for all involved.

Shaping the Environment

Create a calming environment
If possible, turn off fluorescent lights and provide natural lighting. Decrease extraneous distracting stimuli and maintain a routine.
Seating and positioning
Allow preferential seating located near the door so that the student can easily leave class for breaks when needed (Souma, Rickerson, & Burgstahler, 2008). Additionally, encourage the student to sit away from any possible sources of distraction such as air conditioning units, windows, etc.

Learning Strategies—What Can the Student do?

Advocate for self
Connect with the disability service office to learn about available services and supports. Communicate with instructors about personal learning style and any individual accommodations that are being requested. Students should also be encouraged to read the ACCESS Self-Advocacy Handbook for College Students with Disabilities, available on this website.
Consider alternative class formats
If consistent class attendance is difficult, consider online, distance coursework as an alternative.
Chunk Information
Break larger tasks and assignments into smaller, more manageable pieces. Use an organizer and map out the semester detailing due dates, assignments, test dates, etc.
Enroll as a part-time student Consider attending school as a part-time student as opposed to full-time.
Plan ahead for books in alternative format If alternative formats are required for textbooks and other reading materials, students should notify the disability service office as early as possible, ideally before the semester begins. Acquiring and converting alternative formats takes time, and advance planning will ensure the materials are available when they’re needed.
Record class lectures
Ask professors for permission to record class lectures.
Peer support
Seek the peer support of other students with disabilities. Refer to the Disability Service Office for information about peer support groups. Form or join a study group with classmates who are considerate of diverse learning needs.
Schedule regular breaks
Decrease overstimulation by taking regular breaks during study time, assignment completion, class sessions, etc.

Resources — Anxiety Disorders

Anxiety Disorders Association of America
General information on anxiety disorders and the ADAA, consumer resources, message boards and chatrooms.
Encyclopedia of Mental Disorders
Definition, description and additional resources for Anxiety Disorders.
Obsessive Compulsive Foundation
A variety of resources and services regarding obsessive compulsive disorders.
WebMD
Definition and descriptions of various types of anxiety disorders.

Resources for Psychological Disabilities

Academic Accommodations for Students with Psychiatric Disabilities
Specific strategies for working with students who have psychiatric impairments.
American Academy of Child and Adolescent Psychiatry
Information is provided as a public service to aid in the understanding and treatment of the developmental, behavioral, and mental disorders.
American Academy of Psychiatry and the Law
Organization of psychiatrists dedicated to excellence in practice, teaching and research of forensic psychiatry.
American Anorexia and Bulimia Association Inc.
National organization dedicated to the elimination of eating disorders.
American Psychiatric Association
Health information for patients and physicians and other online APA programs.
American Psychological Association
Information and links to a number of psychology-related topics.
American Psychological Society
To promote, protect, and advance the interests of scientifically oriented psychology.
Anxiety Disorders Association of America
General information on anxiety disorders and the ADAA, consumer resources, message boards and chatrooms.
Center for Psychiatric Rehabilitation, How-to Tips for Educators
Practical information about reasonable accommodations for people who have psychiatric disabilities.
Disability-Related Resources on the Internet
A comprehensive list of Web sites and discussion lists related to disability.
Mental Health Information Source
Source for mental health and medical continuing education.
National Alliance for the Mentally Ill (NAMI)
Support and advocacy organization of consumers, families, and friends of people with severe mental illnesses. Award-winning Web site.
National Institute of Mental Health (NIMH)
General information on mental health-related issues, news, facts, and statistics (available en Español).
National Mental Health Association
The country's oldest and largest nonprofit organization addressing all aspects of mental health and mental illness through advocacy, education, research and service.
Obsessive Compulsive Foundation
A variety of resources and services regarding obsessive compulsive disorders.
Washington Advocates for the Mentally Ill
W/AMI's mission is to address the unmet needs of individuals with mental illness and their families through advocacy, public education, information and referral, and self-help support groups.

General Disability Resources

Americans with Disabilities Act (ADA)
ADA Home Page (U.S. Department of Justice)
Equal Access to Software and Information (EASI)
Workshops, publications, and resources about computer access for people with disabilities
ERIC Digest
Overview of ADA, IDEA, and Section 504
Faculty Room
The Faculty Room is a site for faculty and administrators at postsecondary institutions to learn about how to create classroom environments and activities that maximize the learning of all students, including those with disabilities. This page is specific to faculty rights.
Northern Arizona University
Faculty guide
Northern Illinois University
Faculty training on disability, UDL, and accommodation
Ohio State University
Fast Facts for Faculty Series
PACER Center – Champions for Children with Disabilities
ADA Q& A: Section 504 & Postsecondary Education
Trace Research and Development Center
An interdisciplinary research, development, and resource center on technology and disability.
University of Delaware Applied Science and Engineering Laboratory
A program devoted to development and dissemination of new technologies for people with disabilities.
University of Washington - Disability-Related Resources on the Internet
A comprehensive list of Web sites and discussion lists related to disability.
U.S. Department of Education
Model Notification of Rights under FERPA for Postsecondary Institutions
U.S Department of Education, Office of Civil Rights
Three documents by the Office of Civil Rights describing the rights of wounded warriors to a postsecondary education under the new GI Bill:
U.S. Department of Health and Human Services (HHS),
Office of Civil Rights (OCR)
Discrimination on the Basis of Disability
U.S. Equal Employment Opportunity Commission (EEOC)
Titles I and V of the Americans with Disabilities Act of 1990 (ADA)

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