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: [email protected]
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
“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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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!
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Understanding Stress and Worry
• Nervous Systems • Genetic
Predisposition• Worry as a Bad
Habit• Choose a Different
Path Dr. Caren Baruch-Feldman, Psychologist
drbaruchfeldman.com [email protected]
Changing One’s Thoughts
How One THINKS About A Situation Affects How One Feels.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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?
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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?
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Experiment 3 Worried Florida Old Lonely Orange Bingo Conservative wrinkleDr. Caren Baruch-Feldman, Psychologist
drbaruchfeldman.com [email protected]
Expecting the Worst ……Worrying
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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……
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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?
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Step 3: Develop Rational Beliefs/Thoughts
RATIONAL BELIEFS
• Wishes/ Preferences• Living in the Gray • I Can Stand It • Total Self Acceptance
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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
drbaruchfeldman.com [email protected]
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Changing Behavior: Where Do I Feel Stress in My Body?
Heart Pounding BlushingChills Feeling FaintDizziness Shortness of BreathButterflies Shaky Headache Tightness in the chest
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Changing Behavior: Physical Sensations
• Spell Your Name with Belly Breaths
• Deep Muscle Relaxation
• Guided Imagery
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
Changing Behavior: Don’t Avoid
• Facing One’s Fear or Stress
• Manageable and Hierarchical Manner
• Success Breeds Success
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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).
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
From Challenge to Opportunity
After SANDY Seeing it as an OPPORTUNITY
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
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.
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
What Did I Learn?
• What Did You Learn? • What Can You Do To Help Your Students to
Decrease Stress?
Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com
