Effective CBT Strategies for Working With School-Age Children

Presented by Dr. Caren Baruch-Feldmandrcarenfeldman@msn.com

Scarsdale Psychologist Meeting July 7, 2010

GOALS FOR TODAY’S TALK1. Applying CBT Principles

to Working With Children.

2. CBT Strategies That Can Be Used in an Office or School Setting.

Why Choose REBT/CBT When Working With Children?

Effective

Short-term

Similar to School

Basics Principles of REBT

.

Albert Ellis

Experiment 1

Worried Florida Old Lonely Orange Bingo Conservative wrinkle

Experiment 2

Picture yourself in the following situation:

You are standing in line at the bank. There are about 50 people around. A robber enters and fires his weapon. You get shot in the arm, but no one else is hurt.

Would you consider yourself lucky or unlucky?

Experiment 3

What Do You See?

Look around the room and try to find all the examples of RED you can see.

What have you spotted?

Changing Ones ThoughtsStep 1: Identify Negative Thoughts.

Step 2: Question and Challenge Those Thoughts.

Step 3: Come Up With More Realistic and

Optimistic Thoughts to Feel Better.

Step 1: Identifying Negative or Irrational Beliefs

IRRATIONAL BELIEFS

• Demandingness – SHOULDs

• Awfulizing – It Is Terrible!

• Low Frustration Tolerance – I Can’t Stand It!

• Global Rating of Self/Others. Self-Downing.

Core Irrational Beliefs For Children

• It’s Awful If Others Don’t Like Me. • I’m Bad If I Make a Mistake.• Everything Should Go My Way; I Should

Always Get What I Want.• Things Should Come Easily to Me. • The World Should Be Fair.

Step 2: Question and Challenge Those Thoughts

• Where is the Evidence? • Is It Helpful How I Am Thinking?• Am I Shoulding on Myself? • Am I Exaggerating? • Am I Focusing Just on the Bad Things? • Is My Whole Self Worth Attached to

One Event?

Step 3: Develop Rational Beliefs/Thoughts

RATIONAL BELIEFS

• Preferences• Living in the Gray • I Can Stand It • Total Self Acceptance

Irrational vs. Rational IRRATIONAL BELIEFS

Demandingness – SHOULDs

Awfulizing – It Is Terrible!

Low Frustration Tolerance –

I Can’t Stand It!

Global Rating of Self/Others - Self Worth

Tied to 1 Behavior or Action. Self-Downing

RATIONAL BELIEFS

Preferences

Living in the Gray

Realizing That They Can Stand It

Not Judging Themselves

Self Acceptance

Let’s Practice Step 1: Identify

Negative Thoughts.Step 2: Question and

Challenge Those Thoughts.

Step 3: Come Up With More Realistic and Optimistic Thoughts to Feel Better.

CBT Therapy With Children: Special Considerations

• Children Rarely Initiate Treatment.• May Have Some Difficulty with the Cognitive Aspect. • Need to Explain in Fun and Engaging Ways What

Thoughts, Feeling, and Behaviors Mean. • Explicit Reinforcement Is Important When Working With

Children.• Need to Work With the School and Parents.

How Do You Introduce CBT to Children in An Engaging and Understanding Way

• Visuals - Thought Bubbles; Cartoons; Picture Book• Baseball Metaphor • Butterfly Thoughts Worksheet• Thought Flower Garden• Rational or Irrational? Game• Best Friend Technique• Reverse Role Playing• Empty Chair Technique• Erase the Irrational• Analyze TV Shows or Movies• Puppets• Rational Advice Column• Rational Emotive Imagery• “Meet Thoughts, Your Thought Maker” by R. Avery

Rational Emotive Imagery• Picture a bad event clearly. One that has either already happened or that

you believe likely to happen. Take your time. Fill in the details. Visualize the people involved, hear them talk, describe the environment, let the situation happen in your mind. Feel the emotions; you can do it. Keep imagining until the emotions are as disturbed as you can get them.

• After a minute or two, change your emotions from disturbed to merely unpleasant. For example, from depressed to sad. How did you do it? If you changed the facts of the matter, you noticed that when the event is different you will feel differently. Why? It is because you think differently about different facts. Check it out. Get into your disturbance with the correct facts. Once done, live with the image a minute or two. Now, change your emotions without changing any relevant factual material. You can do it. Take your time. Once you have it, reflect on how you did it. You changed the things you thought about the event. Its the thinking that causes the emotions.

Internalizing Vs. Externalizing Disorders : The Thought Pattern Associated with these

DisordersInternalizing

Children Deal With Problems Internally Rather Than Acting Out.

Cause Distress To The Child.

Beliefs (B): Self Downing, Catastrophizing, Awfulizing, Expecting the Worst about the Situation and Oneself.

Consequences (C): Depression and Anxiety.

ExternalizingChildren Deal With Problems By

Acting Out. Problem behaviors Are Directed Towards Others.

Causes Distress Primarily to Others.

Beliefs (B): Musts and Shoulds About Others, Awfulizing, Low Frustration Tolerance.

Consequences (C): ODD, CD, ADHD, Aggression.

CBT Approach to Working With Children Who Are Anxious

(1) Psycho-Educational

(3) Changing One’s Behavior (physiological and avoidance)

(2) Changing One’s Thoughts

No?Yes!

Psycho-Education: Understanding Worry

• Nervous Systems • Genetic

Predisposition• Worry as a Bad

Habit• Choose a Different

Path

Changing One’s Thoughts: Worry • Something bad might

happen; it must not happen.

• I can’t stand being anxious. I should not feel anxious.

• Something is wrong about me as a person because I am worrying.

• If something bad happens it will be terrible.

• How One THINKS About A Situation Affects How One Feels

Mom, I’m Worried!Test Anxiety Expecting the Worst

• I am going to fail! • It is going to be

terrible!• I will need to repeat

the grade. • If I fail I am a bad

person!

Disputing Negative Thoughts• Where is the evidence that what I

am expecting will happen? • Am I exaggerating? • Am I jumping to conclusions? • Am I focusing just on the bad things? • Is it helpful how I am thinking?

Mom- I’m Confident!Confident Test Taker

Realistic and Positive Thoughts• There is no evidence that I will

fail. I haven’t failed previous tests.

• Even if I fail, I am exaggerating how bad the results will be. Nobody gets left back in 4th grade because of one test.

• Worrying is really the worst thing I can do. Since when I worry, I am not paying attention fully to the test.

To Sum Up: Worry - Changing Ones Thoughts

Identify Negative Thoughts.1) Look for Expecting the Worst.

Question and Challenge Thoughts. 1) Where is the Evidence?2) Is it Helpful?

Come Up With More Realistic andOptimistic Thoughts to Feel Better.1)There is no evidence…2) Worrying won’t help……

Changing Behavior: Physical Sensations

• Be A Detective • Rather than think of fear as a signal to RETREAT, consider it a CUE to go forward.

Changing Behavior: Physical Sensations

• Spell Your Name with Belly Breaths

• Breathing Happy Thoughts

• Deep Muscle Relaxation

• Guided Imagery

• Change Your Breath

Changing Behavior: Don’t Avoid

• Facing One’s Fear or Stress

• Manageable and Hierarchical Manner

• Success Breeds Success

Putting It All Together

Coping Cat- FEAR Plan

• F = Feeling Frightened?• E = Expecting Bad Things to Happen?• A = Attitudes and Actions that can Help.• R = Results and Rewards• FEAR Ladder or Situation Cards

Other Internalizing Disorders: Depression

Beliefs Associated With Depression

• B = Self-downing, Awfulizing, Black and White Thinking, Seeing Only the Negative

• Cognitive Errors = Permanence, Pervasiveness, Personalizing.

Strategies for Childhood Depression

• Exercise • Eating and Sleep Right • Be A Good Role Model/ Mirror

Neurons• Identify Strengths and Talents/FLOW• Grateful Activity • Journal the Positive • Random Acts of Kindness• Take Action• “When You Need A Helping Hand” -

A. Vernon • Make It a Habit

Other Internalizing Disorders: OCD• Talking Back to OCD and OCD in Children and

Adolescents : A Cognitive Behavioral Manual by J. March

• Psycho-Education: What is OCD? What Does OCD Look Like? What Causes OCD? How is It Treated?

• • Identifying Obsessions and Compulsions - Children’s Yale

Brown Obsessive Compulsive Scale

• Talking Back to OCD: Naming and Mapping

• Developing a Hierarchy; Exposure and Response Prevention

Externalizing Problems Beliefs Associated With

Externalizing Disorders (Anger)

B = Musts Instead of Preferences; Low

Frustration Tolerance; I Can’t Stand It!

Examples: I must have what I want! The world should be fair!

Other people must treat me the way I wanted them to, and when they don’t they deserve to be punished!

Challenges for Anger Related Irrational

Beliefs

Where Is It Written That You Should Always Get

What You Want, That The World Must Be Fair, and That You Always Have To

Get Your Way?

Functional Disputes How Is Your Anger Helping You? Or, is it Like Pouring Salt On An Open Wound?

Interventions for Externalizing Disorders (Anger, Aggression)

• Act Now Pay Later • Step Into Their Shoes

Interventions for Externalizing Disorders (Anger, Aggression)

• It’s All How You Look At It

• Mad Dog

CBT Approaches for the Classroom or Group Setting

Smart Board Presentation: • What is the Situation?• What Is the Feeling Associated With That Situation?• What Are Your Thoughts About The Situation?• Challenging Those Thoughts.• Alternative Way Of Thinking About the Situation.• New Feeling.

References• What Works With Children and Adolescents by Ann

Vernon. • Rational Emotive Behavior Therapy With Children and

Adolescents by Jerry Wilde.• Meet Thotso, Your Thought Maker by Rachel Robb Avery.• The Relaxation & Stress Reduction Workbook for Kids by

L. Shapiro and R. Sprague.• Bringing the Science of Positive Psychology to Life by S.

Anchor & E. Peterson.• The Coping Cat by P. Kendall.• Stop and Think by P. Kendall.