1 Welcome Christopher Kaufman, Ph.D. (207) 878-1777 e-mail:
[email protected] web: kaufmanpsychological.org Slide 2
Helping the Anxious Kids & Teens Christopher Kaufman, Ph.D.
Slide 3 Anxiety looks/sounds different in different kids Some
internalize it Some externalize it Slide 4 Social Cognitive Theory
Developmental weakness here.. Combines with challenges/limitations
here.. To produce problems here!! We tend to get stuck here! Slide
5 The Essential Anxiety Treatment Elements 1.Cognitive-Behavioral
Therapy 2.Systematic Desensitization 3.Exposure/Response Prevention
4.Relaxation/Calming Strategies 5.Habit Reversal Techniques Slide 6
Cognitive-Behavioral Therapy Active and skill focused Decent
scientific basis Targets the identification, challenging, and
(ultimately) the elimination of anxiety- maintaining maladaptive
thoughts (e.g., castrophizing, all or nothing thinking,
disqualifying the positive, etc.) Also stresses
self-coaching/self-talk Can be done effectively with kids as young
as 8. Slide 7 The Core Phases of CBT 1.Psycho-education (what
anxiety is on neurological and cognitive levels) 2.Cognitive
Restructuring (learning to monitor and evaluate ones
anxiety-related thinking and challenging the but what ifs)
3.Learning to manage anxiety on a body level (so much of depends on
the management of breathing calm breathing rocks) 4.Systematic
desensitization/gradual exposure/response prevention Slide 8
Systematic Desensitization Gradual exposure to feared stimuli, with
the child now armed with cognitive and body-centered coping
strategies and situational supports Generally begins with the
easiest of the feared elements to approach (based on the childs
SUDS ratings) and then gradually takes on the tougher/scarier
things. Often among the most helpful/powerful elements of treatment
(can be a real time saver!) Slide 9 Habit Reversal Training
Particularly effective for kids with Tourettes and OCD, and
generally centers on three core steps: 1.Starts with awareness
training (helping the student more fully recognize their
maladaptive patterns) 2.Focus shifts to helping the student
recognize the thoughts/feelings that generally precede an anxious
or impulsive response 3.Developing and practicing a competing
response (e.g., when compelled to continually erase certain letters
until they look perfect enough, the student defaults to the
competing cognitive response of looks fine and moves on to the next
word). Slide 10 The Master Plan for Mastering Anxiety: For Parents
& Teachers 1.Empathize with what the child is feeling
2.Re-label the problem (e.g., as the worry brain) 3.Rewire and
resist (act with your smarts, not your fears) 4.Get the body on
board (turn off the alarms) 5.Refocus (on what you want to do)
6.Reinforce the childs efforts at fighting! Chansky, 2004 Slide 11
Step 1: Empathize with What the Kid is Feeling/Going Through
Anxious kids often lash out at their parents Resist the temptation
to tell your kid to stop worrying or get over it or just dont think
about it. This is making you so upset I can tell its tough for you.
I know youre scared, sweetie. Youre working so hard youre Dad and I
can tell and were hear for you. I can see how anxious this makes
you and I can tell youre sick of it. Slide 12 Step 2: Re-label the
problem (as the worry brain) This may be the most important step
(demystification) Kids need to be helped to understand that
excessive anxieties/worries are BRAIN LIES The fears/worries may
feel real, but theyre not. Help the child to re-label their
fears/worries with some type of nonfearful label (worry brain, Mr.
Worry, Brain Bug, Worry Pest) Help the child draw a picture or even
make a puppet of their brain pest (and then act out its annoying
messages, using silly voices as needed) With teens: Use labels
like, My tweaky amygdala Brain Lies Slide 13 Two Great Books to
Help Kids Understand Anxiety/Worry Slide 14 Step 3: Rewire and
Resist This is the CBT (Cognitive Behavioral Therapy) Step. Kid
learns to separate false anxiety-based feelings and brain lies from
the truth He or she then learns to boss back the brain lies (the
most essential step!) Shut up, brain bug! Im not listening to you
right now. Im sick of your lies, Mr. Worry. Give it a rest. Slide
15 RESIST!! Systematic Desensitization: Gradual exposure to the
feared stimuli, with anxiety. Anxiety Management: Learning to
control the frequency and power of cognitive and physical symptoms
of fear and anxiety Slide 16 Step Five: Focus on What You Want to
Do Because the anxious feeling will take several minutes to pass
(particularly early on), its good to get the kid moving quickly
into doing what they want to do Physical activity is best Something
fun and relaxing Bottom line: Brains can only focus on one thing at
a time!! Slide 17 Reinforce The Kids Efforts! Reinforcement is not
bribery!! Working to overcome anxiety is hard work which should be
praised by parents/teachers and reinforced in other ways. Focus on
whats going right praise even the smallest of positive steps!! Be
specific with suggestions and praise (I was so amazed and happy
when I saw you..) Dont expect consecutive successes (e.g., five
days in a row in his own bed). Instead, praise reinforce cumulative
successes. Slide 18 Help creative a feeling of safety: Keep the
stress low Be aware of a childs specific physical expressions of
anxiety and respond quickly (and discretely..) when needed Keep
surprises/changes to a minimum Play soothing music, particularly at
the start of the day and other key transition times Decrease
situations that induce stress (e.g., avoid having the child read
aloud or make sure he has practiced ahead of time the passage to
read or the question to answer) Slide 19 More stress
prevention/management strategies: Preferential seating (away from
potentially high stress kids..) Allow the student some additional
time transition in at the start of the day Post the days routine in
the classroom, given emphasis to changes/deviations Slide 20
Treating Anxiety-Related School Refusal 1.FBA (interviews and
School Refusal Assessment Scale) 2.Lower the bar and lighten the
load (diminish academic and social sources of anxiety) 3.CBT
(Cognitive Behavioral Therapy) 4.Systematic Desensitization
(gradual return to school, following a stage-defined/scheduled
series of time-in-school increases until a full-day is achieved)
Slide 21 Safety first.. Create a safe place for the child to go
when anxiety/stress spikes (e.g., nurses office, counselors office,
or even main office) Some anxious need a designated safe person
Cool down pass or exit signal (a pass or signal the child can flash
on his way out the door worked out with the teacher in advance)
Slide 22 Build Coping Capacity Talk to the student about the
management strategies they might find helpful (then make a list!)
Teach the child relaxation strategies she can use at school (see
next slide) Teach positive self-talk (to the whole class) Role play
ways of managing specific anxiety-arousing situations Slide 23
Self-talk: Teach the child to say a statement inside her head to
help her stay calm and handle the stress. Here are a few: "Chill
out, calm down." "I can do this." "Stay calm and breathe slowly."
Or "It's nothing I can't handle." Elevator breathing Tell the child
to close his eyes, slowly breathe out three times, then imagine
he's in an elevator on the top of a very tall building. He presses
the button for the first floor and watches the buttons for each
level slowly light up as the elevator goes down. As the elevator
descends, his stress fades away. Stress melting Ask the kid to find
the spot in his body where he feels the most tension; perhaps his
neck, shoulder muscles, or jaw. He then closes his eyes,
concentrates on the spot, tensing it up for three or four seconds,
and then lets it go. While doing so, tell him to imagine the stress
slowly melting away. Visualize a calm place Ask the kid to think of
an actual place he's been where he feels peaceful. For instance:
the beach, his bed, Grandpa's backyard, a tree house. When anxiety
kicks in, tell him to close his eyes, imagine that spot, while
breathing slowly. Ah... Step Four: Get Your Body on Board Slide 24
A great program for teaching emotional self-regulation to kids:
Slide 25 Three Great Books for Parents/Teachers Slide 26
