How CBT helps Children deal with Anxiety: Guest blog by Leigh Adley, therapist at Set Your Mind Free

chrisrobin1

(image: Pinterest)

As we know, children are also vulnerable to anxiety. Unfortunately, many parents believe that this type of mental health problem will only be temporary in nature. For example, they may think that their child’s shyness will disappear as they grow older. However, if this shyness is increasingly interfering with the child’s life as well as their family’s, then obtaining help is of paramount importance. If left untreated, a child’s severe anxiety will in all likelihood deteriorate as they will choose to avoid situations that make them anxious.   

People suffering from anxiety, including children, are often treated with medication, particularly antidepressants. However, there are alternatives available, such as cognitive behavioral therapy (CBT), which can help children deal with stress.  

Two decades of research has shown that CBT has been successful in reducing the symptoms of severe anxiety. This therapy also provides children with the tools to identify situations that trigger their anxiety. It also helps them manage the symptoms themselves.

What is CBT?

Cognitive behavioural therapy is used to help people manage their way of thinking and feeling. For example, it can help change distorted thoughts and dysfunctional behavior in order to alter an individual’s emotions. For children, therapists will often focus on getting them to unlearn their undesirable behaviour.     

 

Exposure and response prevention

This is the technique most therapists use for children with anxiety. It is a basic idea whereby a child is exposed to the situations that make them anxious. However, this exposure is structured and incremental and takes place in a safe environment. The goal is to make them accustomed to the triggers so their anxiety response is reduced. 

Exposure therapy has little in common with traditional talking therapy. CBT sessions generally involve talking to the patient to explore the root causes of their anxiety, and they then use this knowledge to alter their behaviour. Once they modify or change their response, the fear also disappears.

Exposure therapy is used for various types of anxiety, such as:

 

Treating anxiety as a person

It is helpful to go to a cognitive behavioral therapist as they will enable a child and their parents to think of the anxiety as an entity that is separate from their identity. The child may consider his or her anxiety to be a bully. To treat the anxiety as a person, the patient may give this bully a name, such as ‘Bossy’. Once the anxiety has been given a form, the CBT therapist can then teach the child how to control this ‘bully’. 

Children are also taught to recognize that anxiety can negatively affect their lives. By letting their fears control them, they miss important events such as:    

  • Sleeping in their own bed
  • Visiting their friends’ homes or going to a restaurant
  • Sharing meals with family or friends

It is also essential that the therapist gains the child’s trust so they can encourage them to face their fears.

 

Steps involved in exposure therapy 

The CBT therapist will firstly identify the triggers. The child will then confront a “pyramid of fears”, namely a sequence of incremental challenges. Every test that the child successfully accomplishes will help build their tolerance to the anxiety.

Before taking the challenges, the child will be asked to consider the degree of difficulty when encountering an uncomfortable situation. For example, a child who is afraid of touching dirt will be asked how difficult it would be (on a scale of 1–10) to write the word ‘dirt’. If they say ‘3’, then saying ‘I will touch dirt today’ could be a ‘5’, seeing a cartoon where a character picks up dirt may merit a ‘7’ and seeing an actual person touch dirt may go up to a ‘9’ on their difficulty scale.

By letting the child rate the scale of difficulty for their various fears, they can distinguish between the easy and extreme levels.

The first exposure trigger should come in its mildest form until the child’s anxiousness subsides. Fear is similar to any sensation; it decreases over time and the child will soon gain some control as the anxiety they feel goes away.

Depending on the severity of the child’s anxiety, a CBT session can take place several times a week, lasting several hours. The exposure often takes place in the CBT office, and then once the child feels comfortable, in an outside environment. For example, children with social anxiety may go outside wearing a funny hat. If they are afraid of germs, the exposure may involve:

  • Riding a bus or train
  • Shaking hands with strangers
  • Eating food without washing their hands

Once they have undergone several vulnerable situations and are feeling more confident, they can try some of the exposure sessions on their own. Parents have a vital role to play in this process. They should encourage their child to tolerate their anxious feelings rather than shielding them.

 

Duration of CBT sessions

It can take 8 to 12 sessions for a child to handle mild to moderate levels of anxiety. In addition, medication can help them reduce their stress while enabling them to engage in the CBT sessions.

 

Conclusion

CBT is a good way of helping children deal with their anxiety. CBT utilises various methods to overcome anxiety, and the exposure and response prevention techniques are particularly suitable for children. The child will confront their fears in increments until they can handle the stress on their own.

However, both the child and their parents need to understand that exposure therapy can be difficult. Nevertheless, once their fears diminish, the family can participate in activities that they previously found difficult.  

 

Author’s bio:

This blog was written by Leigh Adley, Hypnotherapist/Psychotherapist at Set Your Mind Free, based in the UK.

Guest Post: The Efficacy of Online Cognitive Behavioural Therapy- CBT by Dr Stacey Leibowitz- Levy

We are delighted to have Dr Stacey Leibowitz-Levy, psychologist writing about Cognitive Behavioural Therapy for us. As with any therapeutic practice, it is very much individual as to whether it will work for you and CBT will not work for everyone- but has been proven to work for many. Here Dr Leibowitz-Levy explains how it can work online.                        

CBT1

Online counselling is a growing field with more and more people turning to the internet to seek out counselling help. Counselling services offered online incorporate the range of therapeutic approaches that have been developed within the field of psychology. Approaches to understanding mental ill health and treatment include therapeutic approaches such as logo therapy, psychodynamic therapy, systemic therapy, psychodynamic therapy and Cognitive Behavioral Therapy (CBT). How do these therapeutic modalities translate to the online environment? This article will address the compatibility of CBT in particular as an online counselling approach.

CBT is a widely-utilised mode of therapy that focuses on an awareness of the relationship between thoughts, feelings and behaviour. The aim of CBT is to address difficulties through modifying distorted thoughts, unhelpful behaviour and unpleasant emotions. In order to achieve this end, the client works collaboratively with the therapist in building awareness and understanding of his/her condition, and an accompanying skill set for evaluating and changing distorted beliefs (as well as modifying dysfunctional behavior). The therapist develops clear objectives and a treatment plan that requires active participation from the client during sessions, and follows through on homework assignments between sessions.

This form of therapy is characterized by a structured, time limited and outcome focused approach to managing mental health challenges. Often CBT is focused on a specific issue such as anxiety or managing depressive thoughts and, as such, many CBT interventions are available in a protocol format. CBT offers a delineated and clearly defined intervention that is largely directed by a clearly defined process and structure. This is in contrast to many other therapeutic approaches that have less defined parameters and take their cue on a session to session basis from the client.

The format and approach of CBT lends itself to an online format in that the structure and process are not only defined and constrained by the relationship between therapist and client but are also defined by a clearly delineated therapeutic procedure. This procedure offers a framework within which to deliver support which can easily be translated to an online process. CBT follows a set format. It is driven by the imperative of building an understanding of the issues the client is experiencing and imparting a certain skill set to assist the client in managing his/her mental health issues. CBT is thus based on specific content and has a strong psychoeducational aspect, which means that delivery online can be located in tangible and clear cut content and outcomes for the client.

This also allows for versatility in the delivery of CBT online. While face to face time with a therapist may be desirable for some clients, the option of online delivery of psychoeducational as well as skills based elements in other formats also works well. For instance, the psychoeducational aspect could be communicated very effectively through a video delivery. CBT lends itself to the format of online courses where clients are guided through a process of identifying and understanding their particular issues and developing the skills to manage them. Interspersing this with face to face time or the opportunity to clarify or ask questions in a chat or e-mail format makes for a very effective online intervention.

While many of the issues addressed in CBT are personal to the client, the possibility of locating these issues within a more general format is very much part of the CBT approach. There is a set way of getting information from, and accessing and understanding the client’s experience, with the client having to act on this information between sessions. This more “scientific” process also makes for an approach that lends itself to an online format.

The efficacy of CBT as an online intervention is borne out by the number of sites specifically offering online CBT in a variety of formats (for some examples, see here and here). The online availability of this well researched and well-verified approach to managing mental health problems offers increased affordability, accessibility and greater choice for mental health consumers.

Dr. Stacey Leibowitz-Levy is a highly-experienced psychologist with a Master’s Degree in Clinical Psychology and a PhD in the area of stress and its relation to goals and emotion. Dr. Stacey has wide ranging skills and expertise in the areas of trauma, complex trauma, anxiety, stress and adjustment issues. Stacey enjoys spending time with her husband and children, being outdoors and doing yoga.