[Katharina_Manassis]_Cognitive_Behavioral_Therapy

eventually have less of them. They focus more on the meditation image, and they find it easier to become calm.

Letting Go

Some people find it very hard to let go of certain distracting thoughts or worries. If this happens to you, try writing down or drawing the thought or worry, then return to the meditation exercise. Writing or drawing gives us the sense of having done something about the issue, and then we can let it go. Afterward, you can choose to either act on what you’ve written or drawn (if it was a really good idea), or rip up the paper. Most of the time when people do this, they find they rip up the paper. Really good ideas rarely come out of a worried, distracted mind.

If writing or drawing is hard when you’re stressed, imagine instead that you take the worries and hang them on a tree in the park. Then walk away. The tree will hold your worries, leaving you free to focus on more relaxing thoughts and images.

Of course, if you really have a good reason to be worried, like a science project you haven’t finished, stop meditating and just do it! Always do what you can to solve the problem first, but when you’ve done all you can, give yourself a break. That’s the time to return to your calm self.

Want to know a secret? Nervous feelings are just like distracting thoughts. They come and go as well. You can’t be really fearful for more than a few minutes. After that, your body runs out of adrenaline, the chemical that makes you tense, and fear stops. Fearful thoughts and feelings come and go. They’re temporary. Unless you really focus on them, they don’t last. Then, you return to being calm. Being calm is actually your natural way of being. Fear interferes with it for a short time, but then it leaves. Then you go back to being who you really are: your calm self returns.

As you practice your meditation for one more week, do not fight thoughts and feelings that intrude, but don’t chase after them either. They are not part of your calm self. Recognize them, observe them as if from a distance, and watch them go as you return to focusing on your meditation image.

most important step! It’s a way of reassuring yourself that you’re not helpless or crazy: it’s just fear, and fear may be a nuisance but you know how to handle it.

Any of these combinations can also help you face what you fear. If you’re not sure you can handle a situation, just do 1, 2, or 3, and stay where you are. You may not be able to solve the problem with it right away, but at least you won’t panic at that moment, and you won’t run away.

If you’ve handled the situation before, or you think it’s not too bad, definitely go into it once you’ve done 1, 2, or 3. Anything you’ve done before, you can do again, if you remember you are a Fear-Master. What about things which are just a little bit frightening? They often turn into adventures once you try them!

Making a Plan: The Treasure Map

Think about what you will do when you’re no longer controlled by fear. What would you like to do that fear is stopping you from doing? Take a moment to imagine yourself doing it. Picture it in detail. Include smells, sounds, and feelings you might experience as well. Before long, you will be doing just that! Throughout this course, you have strengthened your calm self, so you can cope with that situation in spite of fear. Fear can’t win! How will you begin to do it this week? Do you have any ideas? See if Mom or Dad can help.

Another nice way to think about your strategies is to imagine them as buried treasure. You decide where to bury it, and what your treasure map will look like. Find a spot to keep your Fear-Master card, your favorite meditation recording, and any other reminders that help you use your strategies. You could even get a box for them, and decorate it like a treasure chest. Then, draw a map of your house and put a big “X” on each spot where you keep your reminders. Just like on a real treasure map, X marks the spot! Add some people to your map. They are your treasure-hunting team! All the people who help you use your strategies are on the team. Start with your parents, and then think about other people who could help and add them. By the time you are finished, you will be leading a whole expedition!

Draw Your Treasure Map Here:

Questions to Help You Make a Plan

Fear Signal: What is the best Fear Signal for your child? Will you help identify the Fear Signal for the child, or will the child tell you when they are afraid?

Fear-Master: Will your child keep the Fear-Master card in their pocket, or in their room? Will your child use the card showing the Fear-Master Image on its own or the one showing it defeating Fear Tricks? How will the Fear-Master Image help with facing the fears we talked about in the parent session at the beginning? Which situations is the child ready to work on now? Which situations should wait until he or she is more confident?

Calm Self: Will you meditate together? Will other family members join in? Where and when will you meditate? Will you make a recording of a favorite meditation, or read it to your child? Will your child begin using meditation during the day, and for what situations?

Be as concrete and as specific as you can about what you will try. Then, tell us your plan (or have the child tell us). We’ll troubleshoot a bit and then see how it went at our follow-up meeting. Remember to be positive about even minimal participation by the child in this exercise. It’s not easy to try something new like this!

Parent will:

Child will:

Example Plans

1.Parent will ask child about times when fear signal noticed periodically, and do meditation at bedtime together. Lots of praise will be offered for noticing fear signal and trying to cope, regardless of outcome. Child will carry Fear-Master card in school backpack and use whenever fear signal noticed.

2.Coping with nightmares (where child has almost no control over fear): once he/she wakes up and goes to mother’s bed (as most children do), mother will offer a comforting reminder that it’s just a

dream and can’t hurt you, and do a meditation together with the child. The second or third time it happens, she’ll see if child can do at least part of the meditation himself/herself, working toward greater independence, with praise for becoming calm and brave. If the same nightmare repeats (e.g., falling down stairs in a child with poor coordination), child will be encouraged to practice coping with that fear during the day (e.g., walking down steps alternating feet until confident doing so).

Point Bank

Award one point for each homework example or time a strategy was used during the week (note: multiple strategies earn multiple points, even for the same situation) and one point for each in-session example. Double the point value if the child actually stays in the feared situation! Facing fear is the key to overcoming it, regardless of how you do it. Give extra points for the child volunteering to face a feared situation. That’s very brave!

Module 1 Point Tally:

(Recognizing Fear Signal; “It’s just my fear acting up”)

Parent response was:

Any fearful situations you’d like to do more work on? Tell your parents!

Module 2 Point Tally:

(Any of: Fear Signal, Fear-Master Card)

Parent response was:

Any fearful situations you’d like to do more work on? Tell your parents!

Module 3 Point Tally:

(Any of: Fear Signal, Fear-Master Card, Calming Meditation)

Parent response was:

Any fearful situations you’d like to do more work on? Tell your parents!

Module 4 Point Tally:

(Any of: Fear Signal, Fear-Master Card, Calming Meditation) Parent response was:

Any fearful situations you’d like to do more work on? Tell your parents! Total Points:

Congratulations, you did it!!!

Cohesion: Sense of loyalty to a group and desire to work together with

other members.

Comorbidity: Having more than one psychiatric disorder at the same time. Concurrent therapies: Therapies that are provided to the child or family at

the same time.

Conditioned response: A response that occurs when a stimulus that evokes a particular reaction is repeatedly paired with a second stimulus,

until the second stimulus evokes the same reaction.

Contagion: Children picking up negative behaviors from other children, especially in groups; it is rare in well-run groups but is commonly

feared by parents.

Didactic: An approach to therapy that is based on direct teaching. Eἀectiveness: Treatment benefit in usual community practice.

Efficacy: Treatment benefit in research environments.

Empathic encouragement: Validating the child’s feelings while expressing

genuine confidence in his or her ability to master a given situation. Externalization: Finding a concrete symbol for emotional symptoms, so

that the child can see the symptoms as external to himself or herself,

and therefore not overwhelming.

Externalizing disorder: Psychiatric diagnosis characterized mainly by disruptive behavior (for example, oppositional defiant disorder, atten-

tion deficit hyperactivity disorder).

Functional analysis: A detailed examination of the main behaviors targeted

in a child’s treatment.

Ground rules: Basic behavioral limits for the child that are spelled out at the

beginning of therapy.

Hidden agenda: Covert wish about therapy harbored by the child or parent,

but not explicitly stated as a goal of therapy.

Imaginal exposure: Facing a feared situation in imagination, for example by recreating a traumatic event in one’s mind to overcome posttrau-

matic stress.

Internalizing disorder: Psychiatric diagnosis characterized mainly by child

feeling distressed (for example, mood disorder, anxiety disorder). Mastery: A sense of personal competence that results in the ability to man-

age certain situations or feeling states.

Mediator: A factor or mechanism that may account for therapeutic change Moderator: A factor that influences the degree of therapeutic change in a

child.

Module: Therapy unit focused on a particular CBT concept or skill. P.A.S.T.E.: A common problem-solving acronym that represents: pick a

problem, look at alternatives, select an alternative, try it out, and evaluate the result.

Probabilistic thinking: Focusing on how likely or unlikely certain events

are, usually in order to reassure oneself and reduce anxiety. Resilience: The ability to cope despite encountering adverse circumstances

or events.

Selective mutism: A condition related to social anxiety in which children speak normally at home with close family but are silent in certain

environments and with certain people.

Self-esteem: A sense of being a competent and loveable person. Sequential therapies: When one therapy is provided to the child or family

after another therapy, rather than providing both at the same time. Serotonin-specific medication: Medication that targets the brain chemical

serotonin, thought to be involved in anxiety and depression. Also termed “selective serotonin reuptake inhibitors,” these medications include fluoxetine, fluvoxamine, sertraline, paroxetine, and citalo-

pram. (Note: these are the generic names.)

Socratic questions: Therapist questions designed to elicit a particular

answer or answers that may be helpful to the client.

Stimulants or Stimulant medication: Medications designed to improve attention. Methylphenidate and dextroamphetamine are the most

common ones. (Note: these are the generic names.)

Termination: Conclusion or ending of therapy, which sometimes provokes

anxiety in the client or his or her parents.

Therapeutic alliance: Ability of the client (child or parent) and therapist to

work together collaboratively to achieve the goals of therapy. Therapeutic flexibility: Individualizing the use of manuals by selecting

those strategies or exercises that will aid the therapist in achieving

goals with a given child.

Transference: The tendency to transfer feelings we had in relationships in

the past into current relationships.

Treatment adherence: Degree to which the therapist follows the treatment

as prescribed in a manual or text, also termed “treatment fidelity”. Universality: the sense of not being the only one affected by a certain prob-

lem, often develops in group treatment.

Verbal working memory: The ability to simultaneously store and manipulate verbal information, an important cognitive ability when doing

CBT.

Vicious cycles: Circular interactions that result in mutual frustration and

upset.

Yerkes-Dodson curve: The finding that low-anxiety states and high-anx- iety states both have adverse effects on cognitive performance, but mildly anxious states result in optimal performance.