cognitive-behavioral strategies for treating stress and worry in children: what every psychologist...

Cognitive-Behavioral Strategies for Treating Stress and Worry in

Children: What Every Psychologist Needs to Know

Dr. Caren Baruch-Feldman

NYASP Conference 2013

website: drbaruchfeldman.comemail: drcarenfeldman@msn.com

GOALS FOR TODAY’S TALK

1. Teach You Actual Cognitive Behavioral Strategies that Can Be Used to Treat Anxiety and Stress in Children. 2. Keep You Entertained.

Is Stress and Worry Good, Bad, or Something In Between?

Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com

drcarenfeldman@msn.com

“The Yerkes-Dodson Law of Arousal

Performance increases with arousal, but only to a certain point.

When levels of arousal become too high, performance will decrease.

Why Are Children So Stressed? • Pressure to Succeed• Need to Be Good at

Everything • Play Dates, “White

Van”, and Helicopter Parents

• Internet/ Access to Information

When Should One Be Concerned About Their Child’s Level of Stress?

• Behaving Differently From Usual

• Avoids Activities That He/She Used to Enjoy.

• Significant Change in School Performance.

How Can Children Turn Their Worry Into an Appropriate Level of Concern To Feel Better?

(1) Psycho-Educational

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

(2) Changing One’s Thoughts

No?Yes!

Understanding Stress and Worry

• Nervous Systems • Genetic

Predisposition• Worry as a Bad

Habit• Choose a Different

Path Dr. Caren Baruch-Feldman, Psychologist

drbaruchfeldman.com drcarenfeldman@msn.com

Changing One’s Thoughts

How One THINKS About A Situation Affects How One Feels.

Experiment 1

What Do You See?

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

What have you spotted?

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 is hurt.

Would you consider yourself lucky or unlucky?

Experiment 3 Worried Florida Old Lonely Orange Bingo Conservative wrinkleDr. Caren Baruch-Feldman, Psychologist

Expecting the Worst ……Worrying

Changing Ones ThoughtsStep1: Identify Negative Thoughts.1)Look for Expecting the Worst.

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

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

1)There is no evidence…2) Worrying won’t help……

Step 1: Identifying Negative or Irrational Beliefs/Thinking Traps

IRRATIONAL BELIEFS

• Demandingness – SHOULDS/ MUSTS

• Awfulizing – It Is Terrible!

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

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

Step 2: Question and Challenge Thoughts

• Where is the evidence that what I am expecting will happen?

• Is it helpful how I am thinking?• Would I think the same way if a

friend presented this issue?

Step 3: Develop Rational Beliefs/Thoughts

RATIONAL BELIEFS

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

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! Dr. Caren Baruch-Feldman, Psychologist

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 7th grade because of one test.

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

Irrational vs. Rational

IRRATIONAL BELIEFS

Demandingness – SHOULDS/MUSTS

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

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. Did you change your thinking? Was your thinking more realistic? It’s the thinking that causes the emotional response.

Changing Behavior: Where Do I Feel Stress in My Body?

Heart Pounding BlushingChills Feeling FaintDizziness Shortness of BreathButterflies Shaky Headache Tightness in the chest

Changing Behavior: Physical Sensations

• Be A Detective Use your symptoms as clues to knowing when you are feeling worried. Think of fear not as a signal to RETREAT, but rather consider it a CUE to go forward.

Changing Behavior: Physical Sensations

• Spell Your Name with Belly Breaths

• Deep Muscle Relaxation

• Guided Imagery

Changing Behavior: Don’t Avoid

• Facing One’s Fear or Stress

• Manageable and Hierarchical Manner

• Success Breeds Success

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

What Else Can You Do• Possibility vs. Probability. Determine How Likely It Will Happen. • Productive vs. Unproductive Worry • Living in the here and now, not the future.• Acceptance, not fighting pink elephants. • Be A Good Role Model: Mirror Neurons• Give Worry a Name.• Set Aside a Worry Time. • What’s the Best, Worst, Most Likely Outcome?• Write Down a Story With a Better Outcome.• Separate Thinking from Action. I am simply having the thought….• Can’t Tell Someone to Relax/Calm Down. The Person Needs to Get There

Him/Herself.• Positive Psychology: Grateful Activity, Journal the Positive, Random Acts

of Kindness. • Exercising, Eating, and Sleeping Right.

SUMMARY• An intolerance for uncertainty and a need

for control are at the heart of worrying. • Be a long-term hedonist vs. a short term

one.• Live in the moment. • Turn failure into opportunity (e.g., I didn’t

fail, my behavior did. Failure is not fatal).

From Challenge to Opportunity

After SANDY Seeing it as an OPPORTUNITY

CBT Worksheet Situation What is the feeling associated with the

Situation?

How are you thinking about the situation?

Challenging those thoughts

1. What Is the Evidence?________

2. How Is It Helpful? ________

New more helpful way of thinking. New Feeling.

What Did I Learn?

• What Did You Learn? • What Can You Do To Help Your Students to

Decrease Stress?

cognitive-behavioral strategies for treating stress and worry in children: what every psychologist...

negative thoughts

challenge thoughts

positive thoughts

optimistic thoughts

changing ones thoughts

understanding stress

childs level of stress

bad habit

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