Etc sometimes you need to
delay joint sessions until the parent or caregiver can offer the child support and sometimes that
means not even starting treatment really until the parent and caregiver parent or caregiver
can be on board now you can get started with psychoeducation emotions identification feelings
identification and stress management and coping skills you know there were not really
poking a bunch of bears so you can probably safely get started on that if it’s sometimes it’s
court-ordered and they have to start treatment by April 1st or something so there are things you can
do but you may need to delay the actual beginning of the trauma narrative until the parent is
able to be available to educate everybody on how therapy works and instill in everyone not just
the parent optima optimist that well optimism about the child’s potential for recovery you
know sometimes they’ve been dealing with this child’s acting out behaviors for so long they’re
just like you know we’ve already been to three other therapists I don’t know what’s going to
fix it or I’ve done everything I know how to do good luck so we can talk about you know a
different approach or we can talk about what they’ve done that’s worked for a short period
of time and build on those strengths to instill optimism and hope and empowerment so
initially, when we talk about psycho-education it’s important to provide accurate information
about the trauma when children are traumatized they can be confused and not completely understand
what happened they may blame themselves and they may hold on to myths because they’ve been misled
and/or deliberately given incorrect information so one of the best ways we can help is to correct
that information provides information about how often this happens and whether you know it’s okay
to do this that or the other psychoeducation clarifies inappropriate information children may
have obtained directly from the perpetrator or on their own so the perpetrator may have told them
that this is how I express love or this is how you need to be disciplined because you don’t learn
this is how I was disciplined whatever it is or they could have gotten it on their own they could
have gotten it from school from the internet or just come up with it in their little heads trying
to make sense of what happened psychoeducation also helps them identify safety issues the
difference between safe situations and dangerous situations and as we get through this I really
want you to get away from the notion that TF CBT and childhood trauma are only physical and sexual
abuse there are so many other traumas as evidenced by the adverse childhood experiences survey that
I want you to wrap your head around that and there are things they didn’t cover in the aces such as
bullying and natural disasters so we want to help children whatever the trauma is the trauma made
they feel unsafe so we want to identify safety issues if the trauma was a hurricane then we want
to talk about what hurricanes are how often they hit what to safety plan etc so every time a
the thunderstorm comes they don’t freak out and we want to use psychoeducation to provide another
way to target faulty or maladaptive beliefs by helping to normalize thoughts and feelings about
the traumatic experience you know it makes sense that that was scary and makes sense that
you’re angry it makes sense that you feel this way and we can talk about why that makes
sense and why it makes you feel that way through cycle education you’re getting the child to start
talking about the specific trauma that he or she experienced in a less anxiety-provoking way by
talking in Jen wrong about the type of trauma so you’re talking about natural disasters you’re
talking about plane crashes you’re talking about domestic violence so they start learning about
it and then eventually you’re going to move down to their experience with it so like I said there
are a ton of different traumas and the ACE study even acknowledges that these are just the ten most
common ones that they heard however there are many many many different traumas and types of trauma
some of the biggest ones are physical and sexual abuse physical neglect emotional abuse
and neglect and the Aces identified mother treated violently I would say anyone in the household
treated violently it’s not just the mother’s substance misuse within the household and that
can be by the parents or by siblings household mental illness parental separation or divorce and
an incarcerated household member so those were aces but then like I said there’s also bullying
the death of a parent or sibling is extremely traumatic hurricane tornado natural disaster and
then I put the fire out separately because sometimes fire can be man-made sometimes it can be a wiring
problem but sometimes it can be Jr was playing with matches now even if jr.
Accidentally started
the fire does that make it any less traumatic no it probably makes it more traumatic because then
there’s a whole sense of guilt and responsibility but it’s still a trauma that has to be dealt
with so I put a link to the adverse childhood experiences website if you want to go look more
about that but we’re going to move on psycho-education involves specific information about
the traumatic events the child has experienced not the child’s event we’re not going to go
into police records or something, we’re just going to talk about specific information about
domestic violence or whatever body awareness and sex education in cases of physical or sexual
maltreatment and there are caveats for getting parental consent and permission and all that other
stuff and Risk Reduction skills to decrease the risk of future traumatization now going back to
those other things it’s not just about physical or sexual abuse so we want to look at what was the
the risk created by you know how can you reduce your risk of being bullied how can you reduce your
risk of being traumatized in a tornado you know you can’t stop the tornado from coming
and they’re everywhere so what do you do and talk about a safety plan the same thing with fire
information needs to be tailored to fit a child’s particularly particular experiences and level
of knowledge obviously, you’re going to provide different information to a seven-year-old than
you are to a 17-year-old provide caregivers with handout materials to reinforce the information
discussed in session so this may help educate the parents about some of it but it lets them
know what you talked about and it gets us all on the literal same page you’re providing them a
handout of everything you went over with Junior and we want to encourage caregivers to discuss
this information at home reinforces accurate information about how safe or unsafe they
are and obviously, we’re going towards safe and reinforced accurate information and develop
a safety plan so they feel confident that at home they’re going to be taken care of when you
start psychoeducation you do want to get a sense of what the child already knows and you can use
a question-and-answer game format in which the child gets points for answering questions which I
love this suggestion so you can ask them if you know what is a hurricane or is a tornado and see
if they know and see if they know how much time and much-advanced warning we have for a tornado
versus a hurricane or you know whatever situation you’re talking about you see I did a lot of posts
Hurricane Katrina counseling in northern Florida so that’s one of those things that comes up for
I am talking with children about how likely is it that a category 5 hurricane is going to hit
again but encouraging them to give your aunt’s give answers and if they give the wrong answer you
know it’s great to try now you know try to coach them into a correct answer or provide them the correct
one but give them credit for at least making an effort sample questions might include what is
you know and put in the type of trauma what is bullying how often do you think bullying happens
and why does bullying happen you know those are some questions you can ask to just open a dialogue
about bullying, if this child has been a victim of bullying and is and is traumatized so cultural
considerations meet the child and family where they are by presenting information in a way which
they can relate it to their belief system and you may need to consult with their spiritual
guidance guides leaders whether it be a pastor or you know whatever to get some guidance
on how to handle certain aspects of whether it was the will of God and in the case of sexual abuse
how to handle the concept of virginity and how to handle the concept of bad things happening to bad
people and whatever else they think is coming from or their parents are instilling in them in a
belief system we want to make sure that we’re not necessarily contradicting it and going oh mom dad
and the church is wrong but we also want to help them try to integrate this in a way that can help
they have strong self-esteem so reaching out to those spiritual leaders and the family asking what
their belief system about certain things can be very helpful assess the general beliefs about
the trauma if something happened or when something happens ask the parent or the family that’s there
not necessarily the child but you want to get a sense of what the family stance is on why this
happened what it means how it’s going to impact life hence foreign henceforth and forever more
focus on the events they perceive as traumatic to the family but most especially the child if the
child’s going back to the Aces you know maybe the parents got divorced but the child doesn’t
see that as traumatic because there was domestic violence ahead of time the domestic violence was
traumatic the divorce was a relief so wherever the child is with each trauma we want to
be respectful of what they perceive is traumatic and tailor the information so the family can be
more receptive to it as supportive as possible and sometimes you need to make sure that the language
you know make sure the language is not jargony about general views of mental health and mental health
treatment should also be assessed and addressed in the psychoeducation piece not only with the child
but also with the family, if they are suspicious of it don’t understand it think that you’re just
going to magically fix Junior we want to demystify the process and talk about what is the purpose of
the assessment what is the purpose of each one of these activities and why am I doing this or why
are we doing this as a team and how can it help and then we also want to provide information to
D stigmatize and normalize mental health issues and seeking treatment some cultures are still
resistant to seeking treatment and I use the term cultures broadly because there’s
a stigma associated with it so normalizing for them how many people go to treatment how common
PTSD is or whatever the situation you’re dealing with it doesn’t mean they have to like it but at
At least it will give them a little bit of a nugget to understand that they’re not the only ones if
they are from a cultural group a minority cultural group of some sort you might want to provide
information about how common this particular issue is in their group I’ve done a lot of work
with law enforcement and emergency responders and they’re kind of their little group so
we talk about how common depression is among law enforcement and emergent emergency responders
specifically, because they face so much so many different stressors than you know Joe Schmo over
here so it D stigmatizes and normalizes a little bit now they still may not talk about it and
go well hey you know 37% of us have clinical depression no that’s probably not going to happen
but at least in the back of their mind, they can go you know what I’m looking around this room and
I can bet that at least one other person’s on antidepressants or something and feel a little
less unique and isolated in parent sessions you want to provide a rationale and overview of the
treatment model educates parents about the trauma and talks about the child’s trauma-related symptoms
so we’re going to go over what is hyper-vigilance what is the function it why people become
hypervigilant after trauma and what might it look like in a child because it presents very
differently for different children so we might want to give some ideas and say does this sound
like Johnny or does this sound like Johnny and help them understand why these behaviors may
be coming out we want to talk about how early treatment helps prevent long-term problems okay
maybe the trauma happened three years ago but still, it’s better than waiting ten more years and
you know Johnny’s still not having any Ellucian will want to talk about the importance of talking
directly about the trauma to help the children cope with their experiences and not hedging and
this will be on a case-by-case basis but the manual walks you through handling this discussion with
the parents about exactly how much detail do I go into if Johnny brings it up at home reassure
parents that children will first be taught skills to help them cope with their discomfort
and that talking about the trauma will be done slowly with a great deal of support so we’re not
just going to plop them down and go okay and tell me about the day that all this happened which
is what the child has experienced already if it was reported to law enforcement and/or the child
welfare they’ve probably had somebody sit down and say get right to the nitty-gritty at least
once or twice and it’s completely dehumanizing so we want to reassure parents that we’re not
going to do that to the child again will help the caregiver understand their role in the child’s
treatment since this modified since this model emphasizes working together as a team so I’m not
just going to be educating you it’s not going to be a parallel thing where I go in and I work with
Johnny and then I tell you what I did and then I work with Johnny I’m going to work with Johnny
and then we’re going to discuss what Johnny and I did in session and I’m going to get input from
you and we’re going to talk about how you feel about it and then I’m going to provide you with tools
so you can help Johnny outside of the session because you’re going to be with them for six-and-a-half
other days that I’m not and this can’t work if it’s just one hour once a week and we want to
elicit parent input questions and suggestions as much as possible because they’ve been living with
their kid for you know however many years so they probably have an idea about what works and what
doesn’t so we’ll start with both parents and children in their respective sessions helping
them understand what control breathing is and how it helps slow the heart rate and trigger the
wrist and digest sort of reaction in your body when your breathing slows your heart naturally
slows because the stress reaction tells your brain you’ve got to breathe fast and the heart
rates got to go fast well when you override that then you’re kind of overriding the whole system
and we’ll also talk about thought stopping and this is especially helpful if the trauma is recent
or and/or ever-present in the mind of the youth so they can say I am NOT going to talk about that right
now I’m not going to think about that right talk about distraction techniques go back to
your DBT stuff talks about improving the moment and accepts to help the child develop skills to
handle and work through when those thoughts pop up replace unthawed unwanted thoughts with
a pleasant one so talk about it in session when thoughts like that come up what would you
prefer to think about and then really get into the Nitty Gritty the five senses what do you see
smell hear taste you know help me get into that situation or that thought this teaches that
thoughts even unexpected and intrusive ones can be controlled so that gives them hope and again we’re
not exacerbating the thoughts right now we’re not bringing up their particular trauma and
having them get into detail we are just helping them deal with what’s happening normally on a
day-to-day basis so they feel like they have more control for the older kids you can have them
people log about when this technique is used what they were thinking about and how effective the
thought stopping was and then review it and help them tune it up if it’s not really effective and
give them praise for when they use it effectively relaxation training persons of Asian or Hispanic
origin tend to express stress in more somatic or physical terms so just be aware of that but that
doesn’t mean that Caucasians don’t relaxation training is good for anyone and the medical
school of South Carolina training recommended that relaxation is stress-free and
workbook by Davis Schulman and McKay so and it is still in publication when deciding how to
present relaxation techniques are creative have the child help you to integrate the elements
into the technique that makes it more relevant to them so, what are you thinking about when you
relax you know I know I like to go to the woods but maybe this kid likes to think about a video
game or play with their dog whatever it is but helps them make it relevant to them and then have
they identify other things they do to relax like drawing listening to music walking and making a
list of those things so they can refer to it when you’re teaching relaxation training especially if
you’re doing something like progressive muscular relaxation be sensitive to the child’s wishes if
they don’t wish to close their eyes or lie down which could trigger memories of the trauma we’re
not going there yet so if they feel vulnerable lying down or taking orders like that because
you can imagine how being told to lie down and close their eyes might be a trigger for certain
abuse survivors you know be cognizant of that and say you know get into a comfortable position
or how where would you like to sit while we talk about this like I said parents can often
benefit from the relaxation training as well so because they’re dealing with their issues
about the trauma but they’re also dealing with trying to figure out how to help Johnny and any
of them deal with any of Johnny’s misbehaviors or problematic behaviors then they move on to
feelings identification so it helps the therapist judge the child’s ability to articulate feelings
if you can tell me what makes you happy that’s great but if you can’t then you know we need to
work on figuring out what makes you happy you also want to help the child rate the intensity
of the emotion don’t let them stick with happy mad sad glad and afraid you know let’s talk about
different emotions and use the emotion chart with little faces on it or you can use the emotion
thermometer so is it a hot emotion or is it a cool emotion and helps the child
learn how to express feelings appropriately in different situations I mean sometimes they’re
going to be angry but it might not be appropriate to you know get up and stomp out of the room or
whatever however they communicate it so help them figure out how to articulate that so they can be
heard and supported some children have difficulty discussing or identifying their feelings so
you might try stepping back and discussing the feelings of other children or characters from
books or stories so you know think about Puff the Magic Dragon if they’ve read that you know
that dates me a little bit there but you know how did the little boy feel and talking about things
different characters and different stories where there are elements of anger and shame and loss and
all of that stuff helps children identify how they experience emotions if they seem detached
from the experience because sometimes they just they’ve shut it off it was just too overwhelming
so we want to talk about you know when you’re happy what does that feel like or when you’re
angry what happens what does your body feel like when you’re angry and they might be able
to tell you they hear their heartbeat in their ears or everything gets all fuzzy or whatever
but help them start tuning in to how they react and connecting that with an emotional word and then
after all, that’s done they can identify feelings they can identify feeling intensity now we want to
differentiate between thoughts and feelings many children describe thoughts when they’ve been
asked about a feeling so if you ask them how they feel they may say I want to run away so
you want to say okay well I hear that you want to run away so I’m wondering if you are bored and you
you’re bored and want to get away from it or if you’re scared can you tell me a little bit more
about what it means to you to want to run away during feelings identification the parent
sessions normalize what is going on with their child and help the parent understand that some
children may be seemingly in constant distress or detached from the trauma and that’s okay
we all react differently to traumas so again we’re going to share with the parents what we’re
Do let them know any specific difficulties if any juniors have encouraged the parent to praise
the child for appropriate management of difficult motions and I put in parenthesis successive
approximations because they’re not going to get it a hundred percent right every time so if they
try to effectively manage their emotions even a little bit let’s give them praise for that and
then help them figure out how to do it a little bit better the next time so instead of having a
complete meltdown maybe they got up and stomped out of the room well that’s an improvement so
then we want to talk about how to shape that behavior so it’s a more appropriate communication
if parents have difficulty identifying their own emotions provide them with examples so
continually ask them questions about how you feel when it’s a rainy day outside and how to do you
feel when somebody’s supposed to call you and they don’t how do you feel when and have about 15 or 20
examples and you can have them on a piece of paper and even give it to the parent to take home for
their homework if parents are overcome with their own emotions about the trauma validate
their feelings and explain how children need to see that their parents can handle talking
about the trauma so there the children need to see the strength and the parents which is what you’re
going to work on in parent sessions to make sure that the parents have the resolve and the skills
handle talking about this topic with junior TFC BT can be an effective intervention
for children or adolescents whose primary presenting issue is trauma-related emotional or
behavioral dysregulation TF CBT is not appropriate for clients who are actively suicidal and severely
depressed or currently abusing substances we want to make sure they’re clean
and sober as much as possible TF CBT starts with psychoeducation and then teaches stress
management and coping skills to aid in the management of distressing feelings psycho IDI
helps to clarify the inappropriate information children may have and start getting them a little
a bit more comfortable talking about the topic in general before we start going deeper and
feelings identification helps participants start effectively labeling and communicating their
feelings so they can receive the support and nurturance they need from their caregivers
and their support system if you enjoy this podcast please like and subscribe either in your
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Snipes
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Alzheimer’s Dementia Brain Health ➫➬ ꆛシ➫ I was losing my memory, focus – and mind! And then… I got it all back again. Case study: Brian Thompson There’s nothing more terrifying than watching your brain health fail. You can feel it… but you can’t stop it. Trauma Focused Cognitive Behavioral Interventions: Trauma Informed Care
this episode was pre-recorded
as part of a live continuing education webinar on-demand, CEUs are
still available for this presentation through all CEUs register at allceus.com/counselortoolbox I’d like to welcome everybody to today’s
presentation on trauma-focused cognitive behavioral therapy part 1 treating trauma and
traumatic grief in children and adolescents in this first part we’re going to define
trauma-focused CBT and talk about what we’re dealing with here because trauma-focused
CBT is a best practice and it is a manualized best practice so you’re going to learn about it
today but you’re not going to have enough skills where you can say you are certified in TF
CBT however I will provide your resources should you want to go out and pursue those so we are
going to talk about TF CBT as a best practice and implementing fidelity but I’m going to
also take a few detours and as I always do and talk about how this might be able be
useful with adults who have a history of trauma in childhood we’ll explore the components
of trauma-focused CBT and their intended functions, we’re not going to get through all of
those today but we’re going to start and we’re going to explore ways to use TF CBT with adult
clients so TF CBT works for children who have experienced any trauma including multiple traumas
so what we’re talking about is children who come to your office who are presenting with
trauma-related issues it’s effective with children from diverse backgrounds and works
in as few as 12 treatment sessions so a lot can be accomplished in 12 sessions they’re not
necessarily weekly sessions they can be spaced out a little bit part of it depends on the age
level of the child how long ago the trauma was any concurrent developmental or mental health
issues that might be present yada yada yada so it may be a little bit longer it may be a little
a bit shorter in terms of calendar time but you can also extend the number of sessions because
some of these things for example when they start talking about cognitive coping differentiating
between thoughts and feelings, some children take a while to get the hang of the
the nuance between the difference between thoughts and feelings so you might have to do two or
three sessions helped them to identify feelings and use the feelings thermometer this
has been used successfully in clinics schools homes foster care residential treatment facilities
and inpatient settings so there’s not an environment in which it can’t be used provided
that there is a supportive caregiver that can be of assistance obviously if you’re working with
a 10 or 11-year-old or a little bit younger or an older adolescent but you know any child who may
need some support outside of session we don’t want to be creating a crisis and then leaving them
kind of defend for themselves between sessions without some sort of emotional and cognitive
support so there must be a relationship that there is a bond if you will a
the rapport between the clinician and the caregiver who may not be the biological parent or the caregiver
and the child it does work even if there is no parent or caregiver to participate in treatment
however again we need to be selective about how we’re using that so if you have a child and
you’re going to use this particular approach and there’s no parent or caregiver to participate
it may be safer to use it in a residential setting or an inpatient setting where there is a
clinician somewhere where they can get emotional support because as you’ll see when we get into
the trauma narrative gets intense TF CBT is intended for children with a trauma history
whose primary symptoms or behavioral reactions are related to the trauma so if you’ve got someone
who has an unfortunate childhood but you think their behaviors may be more related to the peer group
maybe more related to conducting disorder or FASD or something else that may not be appropriate
because what we’re going to look at with TF CBT is reducing the PTSD symptoms the hyper-vigilance
avoidance behaviors etc as well as improving social skills and helping the person identify and
communicate their feelings and needs traumatic stress reactions can be more than simply symptoms
of PTSD and also present as difficulties with affect regulation we’ve talked before about how
people who are experienced who have experienced trauma may develop a situation where they are more
likely to experience emotional dysregulation the HPA axis kind of tightens up and holds on to the
stress hormones hold on to the stress reaction but then when it does perceive a stressor it goes
from 0 to 250 there’s no I’m going to get a little bit upset it is either nothing or it is a huge
mountain there’s no mole hills there so there may be problems with affect regulation there may
be problems in relationships because of difficulty trusting other people because of difficulties with
their self-perception and systems of meaning which you know we’re getting to in a few minutes but
the way they conceptualize the world because all of a sudden their world was turned upside down
somatization feelings coming out as physical symptoms so headaches body aches more illnesses
more days where they just don’t feel well and you know sometimes they just really don’t feel well
however, is it because of a bacteria or a virus or is it because of a stress reaction that is
kicking off all kinds of imbalances in hormones and neurotransmitters so we want to look at what
the effect are these traumas having on this youth or person and if we address this trauma and if we
help help them come to some sort of resolution or acceptance of the trauma and integration into
their world view of why this trauma happened and making meaning from it will help improve
these areas will help them reduce their hyper-vigilance etc and for many clients the answer is
yes and I talked earlier about the fact that this may be useful now it was designed for children
and adolescents but many of the adults I’ve worked with are very Alex thymic they are very unable
to identify their emotions their very unable to express their feelings sometimes they don’t even
know where their fear is coming from they’re just sort of paralyzed with fear and don’t trust the
world and they’re angry at everybody and if it comes from a traumatic experience then helping
them explore how that trauma is impacting them in the present can be useful in their
recovery process so these issues that TF CBT may help improve aren’t just limited to children and
adolescents they can present in adults who were traumatized as children and who didn’t develop
the skill to effectively deal with the trauma components of CBT TF CBT psychoeducation we’re
going to start by teaching them what they need to know about the trauma we’re going to talk about in
depth about these so I’m not going to detail them very much here parenting skills and if you’re
dealing with an adult oftentimes I will provide what I call reap Aron ting skills if your parent
were here or if your parent would have responded how you would have wanted how would they have
responded how can you do that for yourself now because sometimes you don’t have a significant
other or a caregiver with an adult client either but we want to help them figure out how to self
nurture if needed relaxation and stress management skills because some of the stuff we’re fixing to
talk about is going to be extremely distressful so you have some wiggle room if you will in terms of
what skills do you teach here they prescribe some but as far as relaxation and stress management affect
expression and modulation DBT skills seem to fit well into this framework for helping
people tolerate the distress not act on their impulses understand where the emotions are coming
from and preventing vulnerabilities and all that other stuff that can help them function outside of
session and when they’re not doing their homework help them feel like they’re able to focus on
something besides the trauma because we’re just kind of ripping the band-aid off that wound
at a certain point and they may have difficulty focusing on anything else likewise some children
and adolescents will come to you when that trauma is still relatively present and all they can think
about is that trauma or it regularly comes up for them and so we can help them learn skills so
they can start living more of what they might consider a meaningful life that’s not dominated
by memories of this trauma while we’re working through the process we want to give them a little hope
that there’s relief in sight cognitive coping and processing are provided next and enhanced by
illustrating the relationships among thoughts feelings and behaviors so initially cognitive
coping skills are taught and then all of this is going to be applied later as soon as we
get into the trauma narration helping the youth work through narrating the trauma and cope
with the feelings and thoughts that come up in vivo mastery of trauma reminders so any of those
triggers that are triggering flashbacks that are kicking off hyper-vigilant situations we’re going
to address as they come up in the trauma narration we’re going to help the person identify what it
is about certain situations that bring up this particular memory and how we master how to do
we deal with it and then finally conjoint Parent Child sessions and these don’t come till the end
all along the parents or the caregivers are participating in the process assuming there is a
parent or caregiver and understand learning a little bit more about what’s going on but we’ll
talk about what the clinician does in the parent sessions as well as what the clinician does in
the child sessions as we go through each stage effects of TF CBT reduction in intrusive and
upsetting memory so that’s awesome and you know if you think about what’s the function of these
intrusive memories a lot of times it is because either they haven’t been integrated into the
person’s schema of the world and well-being and or they still feel unsafe they have some cognitions
that is telling them they need to be alert they need to be aware they’re not safe so helping them
identify any cognitions and triggers that may be causing intrusive and upsetting memories
and addressing those again in the in vivo desensitization avoidance helping people reduce
their avoidance of certain situations and certain activities so they don’t feel like they are
confined basically to their prison it helps reduce the emotional numbing of a lot of people when they
go through trauma it’s so overwhelming and they’re so afraid if they feel they won’t be able to stop
feeling so they numb emotionally it’s protective it makes sense and as they develop the skills to
handle this and as they learn they can tolerate the distress of the memories of the trauma it
empowers a lot of clients there’s a reduction in hyperarousal depression and anxiety behavior
problems when you’re dealing with adolescents or children, especially ones who don’t have the
ability to articulate their feelings and their thoughts that are underlying these
feelings and how they relate to the trauma I don’t know many adults that can do that so
children typically act out physically to either protect themselves or try to get some
sort of protection comfort attention so they feel more secure so it’ll help reduce some of
that as we empower the child to identify what’s going on and articulate their needs more effectively
communicate with their parent and also deal with some of the stuff that’s making them still feel
threatened or afraid reductions in sexualized behaviors trauma-related shame interpersonal
distrust and again social skills deficits if a youth has been dealing with this trauma issue
for a while, they may have avoided other people because they don’t trust other people they’re
afraid of other people haven’t made sense of it so they may not have developed the social skills
that other youth have developed because they have been avoidant situations that might trigger
the trauma memories so who is is inappropriate for if the primary issue is defiant or conduct
disordered it if you don’t believe from a clinical standpoint that this is coming from a
the root of trauma history and addressing trauma is probably not going to do it now do these
children who are oppositional defiant conduct disordered have traumas in their history sure
probably they do but are those traumas causing the behavior or are those traumas sort of
irrelevant and one thing that you’ll find is a lot of we’ll talk about it more in a minute
a lot of people have multiple traumas but they may have resolved certain ones and be okay with
they but others are still open wounds don’t use it if the child is suicidal homicidal or severely
depressed if a child is in that particular state we don’t want to start poking the bear
especially in an outpatient setting but even in residential and even residential with adults I
was always extraordinarily cautious and hesitant to do any sort of trauma work in the first 30 to
60 days I had a client in residential substance abuse treatment I mean the first 30 days they’re
still kind of sobering up there are a lot of impulse issues and in the next 30 days there’s usually a
a lot of mood issues so I want them to feel like they’ve got a handle on things before we start
ripping band-aids off open wounds if possible and if you’re obviously if you’re dealing with a
a child the safety and ethics would just tell you when this might not be appropriate additionally
when children remain in high-risk situations with a continuing possibility of harm such as in
many cases of physical abuse or exposure to domestic violence some aspects of TF CBT may
not be appropriate for example attempting to desensitize to trauma memories is contraindicated
when real danger is present I took that verbatim from the TF CBT training or one of them
that is cited in your booklet or your class it is important to understand that not all of
these children are coming or existing living in an environment that is healthy and you may
have a parent who is court-ordered or ordered by child welfare to bring the youth to counseling
to address trauma issues but that child is going back to a chaotic situation so again it’s going to
be an ethical decision on your part once you have all of the training and you’ve become
certified and TF CBT it would be an ethical decision at that point whether or not to implement
the program to fidelity and you know we want to make sure that the child is cognizant
of any real and present dangerous challenges, they always come up, especially when you’re dealing with
families if the carrot parent or caregiver does not agree that the trauma occurred and we’ve all
dealt with this whether you deal with adults who were traumatized as children and they say nobody
believed me when I was a child and I tried to get somebody to here or whether you’re dealing
with a child right now who is with a caregiver or removed from a caregiver it doesn’t matter
but the caregiver was present at the time and the caregiver doesn’t believe the trauma occurred
it can be a huge barrier because that caregiver is not going to be able to be as supportive if the
The caregiver agrees the trauma occurred but believes that it is not affecting the child significantly
or thinks that addressing it will make matters worse then we can do some education here we can
identify symptoms that are coming out that are present which may be caused by the trauma and we
can show the research of TF CBT as well as other methods if you choose not to use TF CBT but you
can show the caregiver how addressing this trauma can mediate or mitigate some of those symptoms if
the parent is overwhelmed or highly distressed by his or her emotional reactions and is not
able to attend to the child’s experience so if the parent feels guilty for what happened or you
know such as in the cases of domestic violence the parent is dealing with their trauma
because they are surviving domestic violence they may not be able to attend to the issues of the
child at that point and it’s not a judgment it’s just how much energy you have and if you’re
trying to survive yourself you’re probably not going to be able to devote your full attention to
jr.
Over here so we need to look at timing if the parent is suspicious distrustful or doesn’t
believe in the value of therapy again we can do some education here rapport building and go
slow if the client and I my experience has been this occurs when the client is court-ordered or
ordered by child welfare the parent does not trust the system and by the fact the system
referred them to you you’re part of the system so start low go slow try to be as compassionate
open and honest as possible I try with all of my clients but especially with my clients who are
involuntary I am very open about what’s in my records and what I write down because that could
go to the court which could you know potentially reflect upon them you know we talked about what’s
going in into the chart I don’t use subjective judgment everything’s objective unless we talk
about something and they say yeah I’ve made progress here or I feel like I’m backsliding here
and then we talk about how to how that’s going to be put in the notes I don’t lie I don’t cover-up
but I do want to make them feel more comfortable with what’s being written in that magic file that
gets stored away that nobody can see if the parent is facing many concrete problems such as housing
but consume a great deal of energy again if it’s a domestic violence issue and they’ve moved out
and they’re living in a homeless shelter or a domestic violence shelter the parents may be
exhausted and just not able to fully attend to the increased emotional and psychological demands
of the child during this therapy you know they’re going to be doing good to help junior through
the present crisis let alone anything else or if the parent is not willing or prepared to
change parenting practices even though this may be important for treatment to succeed and
there are few and far between situations where this may happen one of the situations would be
if you have a parent who is the biological parent and you have a boyfriend or girlfriend
who is abusing the child and you know that comes out and there needs to be some change in the
the way that children are introduced to new people or there may need to be some change in another
situation and how to indiscipline there are a lot of variations that may come up but ultimately
we need the parent’s full buy-in we need them to be willing to work with children on emotions
identification and cognitive coping and all this other stuff which ultimately ends up helping them
most of the time anyway because I don’t believe any of these skills can be harmful to a person at
At least the initial skills of the trauma narrative if it’s done inappropriately or incorrectly can be
very very harmful but we’ll get there specific strategies that can be undertaken through perseverance
in establishing the therapeutic alliance reach out to contact and try not to serve as the all-knowing
omniscient person but asking them what they need asking them what changed with jr.
Asking them for
feedback and suggestions about what helps when jr. gets like this and so you can brainstorm put
the parent in the expert role of being the parent imagines that explore past negative interactions
with social service agencies or therapy not that we can undo that but we can make sure not to
repeat it and if they start acting disengaged we can evaluate the situation and come back and
say is this reminding you of that prior situation or you know are you feeling disempowered again or
whatever the case may be being fully aware that n TF CBT you have two very distinct clients plus a
the third one is the family so you’ve got a lot of different things to juggle if you want to explore
the parent’s concerns that may make them feel as if they’re not being understood or accepted
the lead listens to or is respected and that gets a little dicey sometimes especially when we start
talking about cultural sensitivity about belief about why the trauma occurred or a
variety of other things that we’ll talk about it’s important to be able to hear the parent and
come from a culturally sensitive and culturally informed perspective it’s also important if
the parent feels guilty for some reason you know and sometimes they will be cognizant of
any nonverbals or any statements that you make that might make them feel that way and if it comes
out or if there’s no other way to say it you know talk about any feelings they may have that about
being not believed or not respected and how can you best facilitate making them feel respected
and accepted and all that stuff explore and help them to come overcome barriers to participating
in treatment, if it’s transportation if it’s a job if it’s something else there may be some
brainstorming that’s required and a little bit of case management and I recognize that most of us
when we work in private practice or agency work don’t get any credit for billable hours for
case management but it has to be done in the best interest of the client and emphasize the centrality
of the caregiver’s role in the child’s recovery making sure that they understand that this can’t
succeed without their help by using parent sessions to reduce parent caregiver distress and guide them
through structured activities that empower them in interactions with the child so you’re going to
bring them in each week and you’re going to talk to the parent independently about what’s going on
what you’re covering how juniors behaving how you can help them help jr.
Etc sometimes you need to
delay joint sessions until the parent or caregiver can offer the child support and sometimes that
means not even starting treatment really until the parent and caregiver parent or caregiver
can be on board now you can get started with psychoeducation emotions identification feelings
identification and stress management and coping skills you know there were not really
poking a bunch of bears so you can probably safely get started on that if it’s sometimes it’s
court-ordered and they have to start treatment by April 1st or something so there are things you can
do but you may need to delay the actual beginning of the trauma narrative until the parent is
able to be available to educate everybody on how therapy works and instill in everyone not just
the parent optima optimist that well optimism about the child’s potential for recovery you
know sometimes they’ve been dealing with this child’s acting out behaviors for so long they’re
just like you know we’ve already been to three other therapists I don’t know what’s going to
fix it or I’ve done everything I know how to do good luck so we can talk about you know a
different approach or we can talk about what they’ve done that’s worked for a short period
of time and build on those strengths to instill optimism and hope and empowerment so
initially, when we talk about psycho-education it’s important to provide accurate information
about the trauma when children are traumatized they can be confused and not completely understand
what happened they may blame themselves and they may hold on to myths because they’ve been misled
and/or deliberately given incorrect information so one of the best ways we can help is to correct
that information provides information about how often this happens and whether you know it’s okay
to do this that or the other psychoeducation clarifies inappropriate information children may
have obtained directly from the perpetrator or on their own so the perpetrator may have told them
that this is how I express love or this is how you need to be disciplined because you don’t learn
this is how I was disciplined whatever it is or they could have gotten it on their own they could
have gotten it from school from the internet or just come up with it in their little heads trying
to make sense of what happened psychoeducation also helps them identify safety issues the
difference between safe situations and dangerous situations and as we get through this I really
want you to get away from the notion that TF CBT and childhood trauma are only physical and sexual
abuse there are so many other traumas as evidenced by the adverse childhood experiences survey that
I want you to wrap your head around that and there are things they didn’t cover in the aces such as
bullying and natural disasters so we want to help children whatever the trauma is the trauma made
they feel unsafe so we want to identify safety issues if the trauma was a hurricane then we want
to talk about what hurricanes are how often they hit what to safety plan etc so every time a
the thunderstorm comes they don’t freak out and we want to use psychoeducation to provide another
way to target faulty or maladaptive beliefs by helping to normalize thoughts and feelings about
the traumatic experience you know it makes sense that that was scary and makes sense that
you’re angry it makes sense that you feel this way and we can talk about why that makes
sense and why it makes you feel that way through cycle education you’re getting the child to start
talking about the specific trauma that he or she experienced in a less anxiety-provoking way by
talking in Jen wrong about the type of trauma so you’re talking about natural disasters you’re
talking about plane crashes you’re talking about domestic violence so they start learning about
it and then eventually you’re going to move down to their experience with it so like I said there
are a ton of different traumas and the ACE study even acknowledges that these are just the ten most
common ones that they heard however there are many many many different traumas and types of trauma
some of the biggest ones are physical and sexual abuse physical neglect emotional abuse
and neglect and the Aces identified mother treated violently I would say anyone in the household
treated violently it’s not just the mother’s substance misuse within the household and that
can be by the parents or by siblings household mental illness parental separation or divorce and
an incarcerated household member so those were aces but then like I said there’s also bullying
the death of a parent or sibling is extremely traumatic hurricane tornado natural disaster and
then I put the fire out separately because sometimes fire can be man-made sometimes it can be a wiring
problem but sometimes it can be Jr was playing with matches now even if jr.
Accidentally started
the fire does that make it any less traumatic no it probably makes it more traumatic because then
there’s a whole sense of guilt and responsibility but it’s still a trauma that has to be dealt
with so I put a link to the adverse childhood experiences website if you want to go look more
about that but we’re going to move on psycho-education involves specific information about
the traumatic events the child has experienced not the child’s event we’re not going to go
into police records or something, we’re just going to talk about specific information about
domestic violence or whatever body awareness and sex education in cases of physical or sexual
maltreatment and there are caveats for getting parental consent and permission and all that other
stuff and Risk Reduction skills to decrease the risk of future traumatization now going back to
those other things it’s not just about physical or sexual abuse so we want to look at what was the
the risk created by you know how can you reduce your risk of being bullied how can you reduce your
risk of being traumatized in a tornado you know you can’t stop the tornado from coming
and they’re everywhere so what do you do and talk about a safety plan the same thing with fire
information needs to be tailored to fit a child’s particularly particular experiences and level
of knowledge obviously, you’re going to provide different information to a seven-year-old than
you are to a 17-year-old provide caregivers with handout materials to reinforce the information
discussed in session so this may help educate the parents about some of it but it lets them
know what you talked about and it gets us all on the literal same page you’re providing them a
handout of everything you went over with Junior and we want to encourage caregivers to discuss
this information at home reinforces accurate information about how safe or unsafe they
are and obviously, we’re going towards safe and reinforced accurate information and develop
a safety plan so they feel confident that at home they’re going to be taken care of when you
start psychoeducation you do want to get a sense of what the child already knows and you can use
a question-and-answer game format in which the child gets points for answering questions which I
love this suggestion so you can ask them if you know what is a hurricane or is a tornado and see
if they know and see if they know how much time and much-advanced warning we have for a tornado
versus a hurricane or you know whatever situation you’re talking about you see I did a lot of posts
Hurricane Katrina counseling in northern Florida so that’s one of those things that comes up for
I am talking with children about how likely is it that a category 5 hurricane is going to hit
again but encouraging them to give your aunt’s give answers and if they give the wrong answer you
know it’s great to try now you know try to coach them into a correct answer or provide them the correct
one but give them credit for at least making an effort sample questions might include what is
you know and put in the type of trauma what is bullying how often do you think bullying happens
and why does bullying happen you know those are some questions you can ask to just open a dialogue
about bullying, if this child has been a victim of bullying and is and is traumatized so cultural
considerations meet the child and family where they are by presenting information in a way which
they can relate it to their belief system and you may need to consult with their spiritual
guidance guides leaders whether it be a pastor or you know whatever to get some guidance
on how to handle certain aspects of whether it was the will of God and in the case of sexual abuse
how to handle the concept of virginity and how to handle the concept of bad things happening to bad
people and whatever else they think is coming from or their parents are instilling in them in a
belief system we want to make sure that we’re not necessarily contradicting it and going oh mom dad
and the church is wrong but we also want to help them try to integrate this in a way that can help
they have strong self-esteem so reaching out to those spiritual leaders and the family asking what
their belief system about certain things can be very helpful assess the general beliefs about
the trauma if something happened or when something happens ask the parent or the family that’s there
not necessarily the child but you want to get a sense of what the family stance is on why this
happened what it means how it’s going to impact life hence foreign henceforth and forever more
focus on the events they perceive as traumatic to the family but most especially the child if the
child’s going back to the Aces you know maybe the parents got divorced but the child doesn’t
see that as traumatic because there was domestic violence ahead of time the domestic violence was
traumatic the divorce was a relief so wherever the child is with each trauma we want to
be respectful of what they perceive is traumatic and tailor the information so the family can be
more receptive to it as supportive as possible and sometimes you need to make sure that the language
you know make sure the language is not jargony about general views of mental health and mental health
treatment should also be assessed and addressed in the psychoeducation piece not only with the child
but also with the family, if they are suspicious of it don’t understand it think that you’re just
going to magically fix Junior we want to demystify the process and talk about what is the purpose of
the assessment what is the purpose of each one of these activities and why am I doing this or why
are we doing this as a team and how can it help and then we also want to provide information to
D stigmatize and normalize mental health issues and seeking treatment some cultures are still
resistant to seeking treatment and I use the term cultures broadly because there’s
a stigma associated with it so normalizing for them how many people go to treatment how common
PTSD is or whatever the situation you’re dealing with it doesn’t mean they have to like it but at
At least it will give them a little bit of a nugget to understand that they’re not the only ones if
they are from a cultural group a minority cultural group of some sort you might want to provide
information about how common this particular issue is in their group I’ve done a lot of work
with law enforcement and emergency responders and they’re kind of their little group so
we talk about how common depression is among law enforcement and emergent emergency responders
specifically, because they face so much so many different stressors than you know Joe Schmo over
here so it D stigmatizes and normalizes a little bit now they still may not talk about it and
go well hey you know 37% of us have clinical depression no that’s probably not going to happen
but at least in the back of their mind, they can go you know what I’m looking around this room and
I can bet that at least one other person’s on antidepressants or something and feel a little
less unique and isolated in parent sessions you want to provide a rationale and overview of the
treatment model educates parents about the trauma and talks about the child’s trauma-related symptoms
so we’re going to go over what is hyper-vigilance what is the function it why people become
hypervigilant after trauma and what might it look like in a child because it presents very
differently for different children so we might want to give some ideas and say does this sound
like Johnny or does this sound like Johnny and help them understand why these behaviors may
be coming out we want to talk about how early treatment helps prevent long-term problems okay
maybe the trauma happened three years ago but still, it’s better than waiting ten more years and
you know Johnny’s still not having any Ellucian will want to talk about the importance of talking
directly about the trauma to help the children cope with their experiences and not hedging and
this will be on a case-by-case basis but the manual walks you through handling this discussion with
the parents about exactly how much detail do I go into if Johnny brings it up at home reassure
parents that children will first be taught skills to help them cope with their discomfort
and that talking about the trauma will be done slowly with a great deal of support so we’re not
just going to plop them down and go okay and tell me about the day that all this happened which
is what the child has experienced already if it was reported to law enforcement and/or the child
welfare they’ve probably had somebody sit down and say get right to the nitty-gritty at least
once or twice and it’s completely dehumanizing so we want to reassure parents that we’re not
going to do that to the child again will help the caregiver understand their role in the child’s
treatment since this modified since this model emphasizes working together as a team so I’m not
just going to be educating you it’s not going to be a parallel thing where I go in and I work with
Johnny and then I tell you what I did and then I work with Johnny I’m going to work with Johnny
and then we’re going to discuss what Johnny and I did in session and I’m going to get input from
you and we’re going to talk about how you feel about it and then I’m going to provide you with tools
so you can help Johnny outside of the session because you’re going to be with them for six-and-a-half
other days that I’m not and this can’t work if it’s just one hour once a week and we want to
elicit parent input questions and suggestions as much as possible because they’ve been living with
their kid for you know however many years so they probably have an idea about what works and what
doesn’t so we’ll start with both parents and children in their respective sessions helping
them understand what control breathing is and how it helps slow the heart rate and trigger the
wrist and digest sort of reaction in your body when your breathing slows your heart naturally
slows because the stress reaction tells your brain you’ve got to breathe fast and the heart
rates got to go fast well when you override that then you’re kind of overriding the whole system
and we’ll also talk about thought stopping and this is especially helpful if the trauma is recent
or and/or ever-present in the mind of the youth so they can say I am NOT going to talk about that right
now I’m not going to think about that right talk about distraction techniques go back to
your DBT stuff talks about improving the moment and accepts to help the child develop skills to
handle and work through when those thoughts pop up replace unthawed unwanted thoughts with
a pleasant one so talk about it in session when thoughts like that come up what would you
prefer to think about and then really get into the Nitty Gritty the five senses what do you see
smell hear taste you know help me get into that situation or that thought this teaches that
thoughts even unexpected and intrusive ones can be controlled so that gives them hope and again we’re
not exacerbating the thoughts right now we’re not bringing up their particular trauma and
having them get into detail we are just helping them deal with what’s happening normally on a
day-to-day basis so they feel like they have more control for the older kids you can have them
people log about when this technique is used what they were thinking about and how effective the
thought stopping was and then review it and help them tune it up if it’s not really effective and
give them praise for when they use it effectively relaxation training persons of Asian or Hispanic
origin tend to express stress in more somatic or physical terms so just be aware of that but that
doesn’t mean that Caucasians don’t relaxation training is good for anyone and the medical
school of South Carolina training recommended that relaxation is stress-free and
workbook by Davis Schulman and McKay so and it is still in publication when deciding how to
present relaxation techniques are creative have the child help you to integrate the elements
into the technique that makes it more relevant to them so, what are you thinking about when you
relax you know I know I like to go to the woods but maybe this kid likes to think about a video
game or play with their dog whatever it is but helps them make it relevant to them and then have
they identify other things they do to relax like drawing listening to music walking and making a
list of those things so they can refer to it when you’re teaching relaxation training especially if
you’re doing something like progressive muscular relaxation be sensitive to the child’s wishes if
they don’t wish to close their eyes or lie down which could trigger memories of the trauma we’re
not going there yet so if they feel vulnerable lying down or taking orders like that because
you can imagine how being told to lie down and close their eyes might be a trigger for certain
abuse survivors you know be cognizant of that and say you know get into a comfortable position
or how where would you like to sit while we talk about this like I said parents can often
benefit from the relaxation training as well so because they’re dealing with their issues
about the trauma but they’re also dealing with trying to figure out how to help Johnny and any
of them deal with any of Johnny’s misbehaviors or problematic behaviors then they move on to
feelings identification so it helps the therapist judge the child’s ability to articulate feelings
if you can tell me what makes you happy that’s great but if you can’t then you know we need to
work on figuring out what makes you happy you also want to help the child rate the intensity
of the emotion don’t let them stick with happy mad sad glad and afraid you know let’s talk about
different emotions and use the emotion chart with little faces on it or you can use the emotion
thermometer so is it a hot emotion or is it a cool emotion and helps the child
learn how to express feelings appropriately in different situations I mean sometimes they’re
going to be angry but it might not be appropriate to you know get up and stomp out of the room or
whatever however they communicate it so help them figure out how to articulate that so they can be
heard and supported some children have difficulty discussing or identifying their feelings so
you might try stepping back and discussing the feelings of other children or characters from
books or stories so you know think about Puff the Magic Dragon if they’ve read that you know
that dates me a little bit there but you know how did the little boy feel and talking about things
different characters and different stories where there are elements of anger and shame and loss and
all of that stuff helps children identify how they experience emotions if they seem detached
from the experience because sometimes they just they’ve shut it off it was just too overwhelming
so we want to talk about you know when you’re happy what does that feel like or when you’re
angry what happens what does your body feel like when you’re angry and they might be able
to tell you they hear their heartbeat in their ears or everything gets all fuzzy or whatever
but help them start tuning in to how they react and connecting that with an emotional word and then
after all, that’s done they can identify feelings they can identify feeling intensity now we want to
differentiate between thoughts and feelings many children describe thoughts when they’ve been
asked about a feeling so if you ask them how they feel they may say I want to run away so
you want to say okay well I hear that you want to run away so I’m wondering if you are bored and you
you’re bored and want to get away from it or if you’re scared can you tell me a little bit more
about what it means to you to want to run away during feelings identification the parent
sessions normalize what is going on with their child and help the parent understand that some
children may be seemingly in constant distress or detached from the trauma and that’s okay
we all react differently to traumas so again we’re going to share with the parents what we’re
Do let them know any specific difficulties if any juniors have encouraged the parent to praise
the child for appropriate management of difficult motions and I put in parenthesis successive
approximations because they’re not going to get it a hundred percent right every time so if they
try to effectively manage their emotions even a little bit let’s give them praise for that and
then help them figure out how to do it a little bit better the next time so instead of having a
complete meltdown maybe they got up and stomped out of the room well that’s an improvement so
then we want to talk about how to shape that behavior so it’s a more appropriate communication
if parents have difficulty identifying their own emotions provide them with examples so
continually ask them questions about how you feel when it’s a rainy day outside and how to do you
feel when somebody’s supposed to call you and they don’t how do you feel when and have about 15 or 20
examples and you can have them on a piece of paper and even give it to the parent to take home for
their homework if parents are overcome with their own emotions about the trauma validate
their feelings and explain how children need to see that their parents can handle talking
about the trauma so there the children need to see the strength and the parents which is what you’re
going to work on in parent sessions to make sure that the parents have the resolve and the skills
handle talking about this topic with junior TFC BT can be an effective intervention
for children or adolescents whose primary presenting issue is trauma-related emotional or
behavioral dysregulation TF CBT is not appropriate for clients who are actively suicidal and severely
depressed or currently abusing substances we want to make sure they’re clean
and sober as much as possible TF CBT starts with psychoeducation and then teaches stress
management and coping skills to aid in the management of distressing feelings psycho IDI
helps to clarify the inappropriate information children may have and start getting them a little
a bit more comfortable talking about the topic in general before we start going deeper and
feelings identification helps participants start effectively labeling and communicating their
feelings so they can receive the support and nurturance they need from their caregivers
and their support system if you enjoy this podcast please like and subscribe either in your
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Etc sometimes you need to
delay joint sessions until the parent or caregiver can offer the child support and sometimes that
means not even starting treatment really until the parent and caregiver parent or caregiver
can be on board now you can get started with psychoeducation emotions identification feelings
identification and stress management and coping skills you know there were not really
poking a bunch of bears so you can probably safely get started on that if it’s sometimes it’s
court-ordered and they have to start treatment by April 1st or something so there are things you can
do but you may need to delay the actual beginning of the trauma narrative until the parent is
able to be available to educate everybody on how therapy works and instill in everyone not just
the parent optima optimist that well optimism about the child’s potential for recovery you
know sometimes they’ve been dealing with this child’s acting out behaviors for so long they’re
just like you know we’ve already been to three other therapists I don’t know what’s going to
fix it or I’ve done everything I know how to do good luck so we can talk about you know a
different approach or we can talk about what they’ve done that’s worked for a short period
of time and build on those strengths to instill optimism and hope and empowerment so
initially, when we talk about psycho-education it’s important to provide accurate information
about the trauma when children are traumatized they can be confused and not completely understand
what happened they may blame themselves and they may hold on to myths because they’ve been misled
and/or deliberately given incorrect information so one of the best ways we can help is to correct
that information provides information about how often this happens and whether you know it’s okay
to do this that or the other psychoeducation clarifies inappropriate information children may
have obtained directly from the perpetrator or on their own so the perpetrator may have told them
that this is how I express love or this is how you need to be disciplined because you don’t learn
this is how I was disciplined whatever it is or they could have gotten it on their own they could
have gotten it from school from the internet or just come up with it in their little heads trying
to make sense of what happened psychoeducation also helps them identify safety issues the
difference between safe situations and dangerous situations and as we get through this I really
want you to get away from the notion that TF CBT and childhood trauma are only physical and sexual
abuse there are so many other traumas as evidenced by the adverse childhood experiences survey that
I want you to wrap your head around that and there are things they didn’t cover in the aces such as
bullying and natural disasters so we want to help children whatever the trauma is the trauma made
they feel unsafe so we want to identify safety issues if the trauma was a hurricane then we want
to talk about what hurricanes are how often they hit what to safety plan etc so every time a
the thunderstorm comes they don’t freak out and we want to use psychoeducation to provide another
way to target faulty or maladaptive beliefs by helping to normalize thoughts and feelings about
the traumatic experience you know it makes sense that that was scary and makes sense that
you’re angry it makes sense that you feel this way and we can talk about why that makes
sense and why it makes you feel that way through cycle education you’re getting the child to start
talking about the specific trauma that he or she experienced in a less anxiety-provoking way by
talking in Jen wrong about the type of trauma so you’re talking about natural disasters you’re
talking about plane crashes you’re talking about domestic violence so they start learning about
it and then eventually you’re going to move down to their experience with it so like I said there
are a ton of different traumas and the ACE study even acknowledges that these are just the ten most
common ones that they heard however there are many many many different traumas and types of trauma
some of the biggest ones are physical and sexual abuse physical neglect emotional abuse
and neglect and the Aces identified mother treated violently I would say anyone in the household
treated violently it’s not just the mother’s substance misuse within the household and that
can be by the parents or by siblings household mental illness parental separation or divorce and
an incarcerated household member so those were aces but then like I said there’s also bullying
the death of a parent or sibling is extremely traumatic hurricane tornado natural disaster and
then I put the fire out separately because sometimes fire can be man-made sometimes it can be a wiring
problem but sometimes it can be Jr was playing with matches now even if jr.
Accidentally started
the fire does that make it any less traumatic no it probably makes it more traumatic because then
there’s a whole sense of guilt and responsibility but it’s still a trauma that has to be dealt
with so I put a link to the adverse childhood experiences website if you want to go look more
about that but we’re going to move on psycho-education involves specific information about
the traumatic events the child has experienced not the child’s event we’re not going to go
into police records or something, we’re just going to talk about specific information about
domestic violence or whatever body awareness and sex education in cases of physical or sexual
maltreatment and there are caveats for getting parental consent and permission and all that other
stuff and Risk Reduction skills to decrease the risk of future traumatization now going back to
those other things it’s not just about physical or sexual abuse so we want to look at what was the
the risk created by you know how can you reduce your risk of being bullied how can you reduce your
risk of being traumatized in a tornado you know you can’t stop the tornado from coming
and they’re everywhere so what do you do and talk about a safety plan the same thing with fire
information needs to be tailored to fit a child’s particularly particular experiences and level
of knowledge obviously, you’re going to provide different information to a seven-year-old than
you are to a 17-year-old provide caregivers with handout materials to reinforce the information
discussed in session so this may help educate the parents about some of it but it lets them
know what you talked about and it gets us all on the literal same page you’re providing them a
handout of everything you went over with Junior and we want to encourage caregivers to discuss
this information at home reinforces accurate information about how safe or unsafe they
are and obviously, we’re going towards safe and reinforced accurate information and develop
a safety plan so they feel confident that at home they’re going to be taken care of when you
start psychoeducation you do want to get a sense of what the child already knows and you can use
a question-and-answer game format in which the child gets points for answering questions which I
love this suggestion so you can ask them if you know what is a hurricane or is a tornado and see
if they know and see if they know how much time and much-advanced warning we have for a tornado
versus a hurricane or you know whatever situation you’re talking about you see I did a lot of posts
Hurricane Katrina counseling in northern Florida so that’s one of those things that comes up for
I am talking with children about how likely is it that a category 5 hurricane is going to hit
again but encouraging them to give your aunt’s give answers and if they give the wrong answer you
know it’s great to try now you know try to coach them into a correct answer or provide them the correct
one but give them credit for at least making an effort sample questions might include what is
you know and put in the type of trauma what is bullying how often do you think bullying happens
and why does bullying happen you know those are some questions you can ask to just open a dialogue
about bullying, if this child has been a victim of bullying and is and is traumatized so cultural
considerations meet the child and family where they are by presenting information in a way which
they can relate it to their belief system and you may need to consult with their spiritual
guidance guides leaders whether it be a pastor or you know whatever to get some guidance
on how to handle certain aspects of whether it was the will of God and in the case of sexual abuse
how to handle the concept of virginity and how to handle the concept of bad things happening to bad
people and whatever else they think is coming from or their parents are instilling in them in a
belief system we want to make sure that we’re not necessarily contradicting it and going oh mom dad
and the church is wrong but we also want to help them try to integrate this in a way that can help
they have strong self-esteem so reaching out to those spiritual leaders and the family asking what
their belief system about certain things can be very helpful assess the general beliefs about
the trauma if something happened or when something happens ask the parent or the family that’s there
not necessarily the child but you want to get a sense of what the family stance is on why this
happened what it means how it’s going to impact life hence foreign henceforth and forever more
focus on the events they perceive as traumatic to the family but most especially the child if the
child’s going back to the Aces you know maybe the parents got divorced but the child doesn’t
see that as traumatic because there was domestic violence ahead of time the domestic violence was
traumatic the divorce was a relief so wherever the child is with each trauma we want to
be respectful of what they perceive is traumatic and tailor the information so the family can be
more receptive to it as supportive as possible and sometimes you need to make sure that the language
you know make sure the language is not jargony about general views of mental health and mental health
treatment should also be assessed and addressed in the psychoeducation piece not only with the child
but also with the family, if they are suspicious of it don’t understand it think that you’re just
going to magically fix Junior we want to demystify the process and talk about what is the purpose of
the assessment what is the purpose of each one of these activities and why am I doing this or why
are we doing this as a team and how can it help and then we also want to provide information to
D stigmatize and normalize mental health issues and seeking treatment some cultures are still
resistant to seeking treatment and I use the term cultures broadly because there’s
a stigma associated with it so normalizing for them how many people go to treatment how common
PTSD is or whatever the situation you’re dealing with it doesn’t mean they have to like it but at
At least it will give them a little bit of a nugget to understand that they’re not the only ones if
they are from a cultural group a minority cultural group of some sort you might want to provide
information about how common this particular issue is in their group I’ve done a lot of work
with law enforcement and emergency responders and they’re kind of their little group so
we talk about how common depression is among law enforcement and emergent emergency responders
specifically, because they face so much so many different stressors than you know Joe Schmo over
here so it D stigmatizes and normalizes a little bit now they still may not talk about it and
go well hey you know 37% of us have clinical depression no that’s probably not going to happen
but at least in the back of their mind, they can go you know what I’m looking around this room and
I can bet that at least one other person’s on antidepressants or something and feel a little
less unique and isolated in parent sessions you want to provide a rationale and overview of the
treatment model educates parents about the trauma and talks about the child’s trauma-related symptoms
so we’re going to go over what is hyper-vigilance what is the function it why people become
hypervigilant after trauma and what might it look like in a child because it presents very
differently for different children so we might want to give some ideas and say does this sound
like Johnny or does this sound like Johnny and help them understand why these behaviors may
be coming out we want to talk about how early treatment helps prevent long-term problems okay
maybe the trauma happened three years ago but still, it’s better than waiting ten more years and
you know Johnny’s still not having any Ellucian will want to talk about the importance of talking
directly about the trauma to help the children cope with their experiences and not hedging and
this will be on a case-by-case basis but the manual walks you through handling this discussion with
the parents about exactly how much detail do I go into if Johnny brings it up at home reassure
parents that children will first be taught skills to help them cope with their discomfort
and that talking about the trauma will be done slowly with a great deal of support so we’re not
just going to plop them down and go okay and tell me about the day that all this happened which
is what the child has experienced already if it was reported to law enforcement and/or the child
welfare they’ve probably had somebody sit down and say get right to the nitty-gritty at least
once or twice and it’s completely dehumanizing so we want to reassure parents that we’re not
going to do that to the child again will help the caregiver understand their role in the child’s
treatment since this modified since this model emphasizes working together as a team so I’m not
just going to be educating you it’s not going to be a parallel thing where I go in and I work with
Johnny and then I tell you what I did and then I work with Johnny I’m going to work with Johnny
and then we’re going to discuss what Johnny and I did in session and I’m going to get input from
you and we’re going to talk about how you feel about it and then I’m going to provide you with tools
so you can help Johnny outside of the session because you’re going to be with them for six-and-a-half
other days that I’m not and this can’t work if it’s just one hour once a week and we want to
elicit parent input questions and suggestions as much as possible because they’ve been living with
their kid for you know however many years so they probably have an idea about what works and what
doesn’t so we’ll start with both parents and children in their respective sessions helping
them understand what control breathing is and how it helps slow the heart rate and trigger the
wrist and digest sort of reaction in your body when your breathing slows your heart naturally
slows because the stress reaction tells your brain you’ve got to breathe fast and the heart
rates got to go fast well when you override that then you’re kind of overriding the whole system
and we’ll also talk about thought stopping and this is especially helpful if the trauma is recent
or and/or ever-present in the mind of the youth so they can say I am NOT going to talk about that right
now I’m not going to think about that right talk about distraction techniques go back to
your DBT stuff talks about improving the moment and accepts to help the child develop skills to
handle and work through when those thoughts pop up replace unthawed unwanted thoughts with
a pleasant one so talk about it in session when thoughts like that come up what would you
prefer to think about and then really get into the Nitty Gritty the five senses what do you see
smell hear taste you know help me get into that situation or that thought this teaches that
thoughts even unexpected and intrusive ones can be controlled so that gives them hope and again we’re
not exacerbating the thoughts right now we’re not bringing up their particular trauma and
having them get into detail we are just helping them deal with what’s happening normally on a
day-to-day basis so they feel like they have more control for the older kids you can have them
people log about when this technique is used what they were thinking about and how effective the
thought stopping was and then review it and help them tune it up if it’s not really effective and
give them praise for when they use it effectively relaxation training persons of Asian or Hispanic
origin tend to express stress in more somatic or physical terms so just be aware of that but that
doesn’t mean that Caucasians don’t relaxation training is good for anyone and the medical
school of South Carolina training recommended that relaxation is stress-free and
workbook by Davis Schulman and McKay so and it is still in publication when deciding how to
present relaxation techniques are creative have the child help you to integrate the elements
into the technique that makes it more relevant to them so, what are you thinking about when you
relax you know I know I like to go to the woods but maybe this kid likes to think about a video
game or play with their dog whatever it is but helps them make it relevant to them and then have
they identify other things they do to relax like drawing listening to music walking and making a
list of those things so they can refer to it when you’re teaching relaxation training especially if
you’re doing something like progressive muscular relaxation be sensitive to the child’s wishes if
they don’t wish to close their eyes or lie down which could trigger memories of the trauma we’re
not going there yet so if they feel vulnerable lying down or taking orders like that because
you can imagine how being told to lie down and close their eyes might be a trigger for certain
abuse survivors you know be cognizant of that and say you know get into a comfortable position
or how where would you like to sit while we talk about this like I said parents can often
benefit from the relaxation training as well so because they’re dealing with their issues
about the trauma but they’re also dealing with trying to figure out how to help Johnny and any
of them deal with any of Johnny’s misbehaviors or problematic behaviors then they move on to
feelings identification so it helps the therapist judge the child’s ability to articulate feelings
if you can tell me what makes you happy that’s great but if you can’t then you know we need to
work on figuring out what makes you happy you also want to help the child rate the intensity
of the emotion don’t let them stick with happy mad sad glad and afraid you know let’s talk about
different emotions and use the emotion chart with little faces on it or you can use the emotion
thermometer so is it a hot emotion or is it a cool emotion and helps the child
learn how to express feelings appropriately in different situations I mean sometimes they’re
going to be angry but it might not be appropriate to you know get up and stomp out of the room or
whatever however they communicate it so help them figure out how to articulate that so they can be
heard and supported some children have difficulty discussing or identifying their feelings so
you might try stepping back and discussing the feelings of other children or characters from
books or stories so you know think about Puff the Magic Dragon if they’ve read that you know
that dates me a little bit there but you know how did the little boy feel and talking about things
different characters and different stories where there are elements of anger and shame and loss and
all of that stuff helps children identify how they experience emotions if they seem detached
from the experience because sometimes they just they’ve shut it off it was just too overwhelming
so we want to talk about you know when you’re happy what does that feel like or when you’re
angry what happens what does your body feel like when you’re angry and they might be able
to tell you they hear their heartbeat in their ears or everything gets all fuzzy or whatever
but help them start tuning in to how they react and connecting that with an emotional word and then
after all, that’s done they can identify feelings they can identify feeling intensity now we want to
differentiate between thoughts and feelings many children describe thoughts when they’ve been
asked about a feeling so if you ask them how they feel they may say I want to run away so
you want to say okay well I hear that you want to run away so I’m wondering if you are bored and you
you’re bored and want to get away from it or if you’re scared can you tell me a little bit more
about what it means to you to want to run away during feelings identification the parent
sessions normalize what is going on with their child and help the parent understand that some
children may be seemingly in constant distress or detached from the trauma and that’s okay
we all react differently to traumas so again we’re going to share with the parents what we’re
Do let them know any specific difficulties if any juniors have encouraged the parent to praise
the child for appropriate management of difficult motions and I put in parenthesis successive
approximations because they’re not going to get it a hundred percent right every time so if they
try to effectively manage their emotions even a little bit let’s give them praise for that and
then help them figure out how to do it a little bit better the next time so instead of having a
complete meltdown maybe they got up and stomped out of the room well that’s an improvement so
then we want to talk about how to shape that behavior so it’s a more appropriate communication
if parents have difficulty identifying their own emotions provide them with examples so
continually ask them questions about how you feel when it’s a rainy day outside and how to do you
feel when somebody’s supposed to call you and they don’t how do you feel when and have about 15 or 20
examples and you can have them on a piece of paper and even give it to the parent to take home for
their homework if parents are overcome with their own emotions about the trauma validate
their feelings and explain how children need to see that their parents can handle talking
about the trauma so there the children need to see the strength and the parents which is what you’re
going to work on in parent sessions to make sure that the parents have the resolve and the skills
handle talking about this topic with junior TFC BT can be an effective intervention
for children or adolescents whose primary presenting issue is trauma-related emotional or
behavioral dysregulation TF CBT is not appropriate for clients who are actively suicidal and severely
depressed or currently abusing substances we want to make sure they’re clean
and sober as much as possible TF CBT starts with psychoeducation and then teaches stress
management and coping skills to aid in the management of distressing feelings psycho IDI
helps to clarify the inappropriate information children may have and start getting them a little
a bit more comfortable talking about the topic in general before we start going deeper and
feelings identification helps participants start effectively labeling and communicating their
feelings so they can receive the support and nurturance they need from their caregivers
and their support system if you enjoy this podcast please like and subscribe either in your
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Alzheimer’s Dementia Brain Health ➫➬ ꆛシ➫ I was losing my memory, focus – and mind! And then… I got it all back again. Case study: Brian Thompson There’s nothing more terrifying than watching your brain health fail. You can feel it… but you can’t stop it. 
You experience sleep issues and low energy are you having a hard time with sleep lately a study on 2316 people showed that those experiencing more stressful events had a higher risk of insomnia continuously having poor sleep may make you feel sluggish during the day the change in eating habits mentioned before may also contribute to low blood sugar leading to feelings of low energy five deep breathing can become difficult stress and strong emotions can cause the breathing Airway to constrict resulting in symptoms such as shortness of breath and Rapid breathing almost like panting some studies show that acute stress can actually cause an asthma attack or a panic attack and six cravings for substance misuse become stronger like food substances may cause temporary immediate satisfaction in the brain so you feel better however abusing anything new intake can have devastating consequences such as excessively consuming alcohol or nicotine are you craving substances or even unhealthy food more than normal it may be a sign that you’re stressed we can see that all these physical symptoms impact each other impact your mood and impact your behavior if you notice that you’re experiencing several of these symptoms mentioned it may be your body telling you to take a break be sure to take care of yourself and get the rest you need after all you only have one body and all your bodily systems affect one another how do you de-stress let us know in the comments below share this with someone you think might be showing signs of stress as well don’t forget to click the like button and subscribe for more psychology content and as always thanks for watching [Applause] [Music]
These problems include bloating,
cramping, and diarrhea, according to Dr. Deborah Rhodes, a Mayo Clinic medicine physician. Additionally, the American
Institute of Stress has reported that your digestive system can be affected by the
increased heart rate from stress, causing
heartburn and acid reflux. Taking an over-the-counter
antiacid, or simple ginger tea, can reduce discomfort. And number six, your body
weight is fluctuating. Are you someone who tends
to check their weight? Have you noticed any unusual changes? Shauna Levine, a clinical
instructor of medicine at Icahn School of Medicine states that the way stress
affects your body weight is by releasing cortisol, and this hormone will
inhibit your body’s ability to process blood sugar while
changing the way your body metabolizes fat,
carbohydrates, and protein.
As a result of all these changes, as well as the effects that
stress has on undereating and overeating, you might start to notice unusual weight fluctuations. If you’re undereating,
try snacking on nuts with high protein
content to help you. If you’re overeating,
try to eat more fiber, since this will fill you up. Although these points have
individual treatments, you will eventually have to address the stress causing
all these problems. Stress isn’t all bad, as short bursts of stress
can help you, but you need to try things that can help with long-term stress, such as mindfulness, meditation, or yoga. Learning how to deal with stress through different techniques will help you avoid the emotional and physical
burden that comes with it.
Do you relate to any of these signs? Let us know in the comments below. If your stress persists, or you have any concerns
about your symptoms, please see a healthcare professional. Psych2Go is not certified to
provide official treatments or advice, and serious issues
require professional advice. Thanks so much for watching our video. What are the different ways that you like to cope with your stress? What has been the most effective for you? We’d love everyone to share and help each other out in the comments. If you enjoyed it, please consider giving this video a like, and subscribing to our channel to see more content like this. We’ll see you at the next one.
They might only be able to nod or whisper Four) Panic disorder It becomes a disorder when an individual experiences panic attacks multiple times in their lifetime Panic attacks are intense bursts of fear followed by a range of physical symptoms, these include at least four of the following: Cold sweats, Muscle stiffness or Trembling, Hyperventilation, which is fast, shallow breathing Lightheadedness, Numbness or the Fear of death and/or Insanity The fear afterward of another panic attack. Sometimes actually provokes more panic attacks More often than not, panic attacks are had in combination with other anxiety disorders Therapy along with medications can help in handling panic disorder Five) Agoraphobia Does your local train station seem intimidating? Do you feel faint in a crowded place? Agoraphobia is the fear of public places Anxiety arises because they deem them as too open or dangerous It’s triggered by fears like becoming a victim of crime or of contracting a disease or illness Its sufferers coop themselves up in their homes where they’re comfortable and familiar with their environment Agoraphobe often become over-dependent on other people to compensate for their inability to cope in public Agoraphobia can develop at any age and can be extremely debilitating Exposure therapy works effectively against Agoraphobia in conjunction with medication Six) Specific Phobia These are persistent and extreme fears about a specific object or situation and cause a ton of stress to the sufferer Phobias can be environmental like Acrophobia, the fear of heights and they can be animal-based Or even situational like Taphophobia, the fear of being buried alive Such phobias often arise due to traumatic experiences that cause people to make negative associations with these objects or situations Someone who was clawed in the face by a cat in their childhood might have an avid fear of cats in their adulthood In cases where exposure therapy may not be safe or applicable Cognitive behavioural therapy can be effective in changing a person’s negative association to their feared object or situation Seven) Obsessive-Compulsive Disorder OCD and Post-Traumatic StressDisorder PTSD Yes, OCD and PTSD were categorized by many psychiatrists as disorders to be grouped with the aforementioned anxiety disorders Recently there have been new findings about these disorders that team them both unique enough to be in categories of their own, However, this is not to suggest that OCD and PTSD are any less important to deal with The common thread that group disorders like GAD, S.A.D., panic disorder, and phobias together Is that sufferers of these anxiety disorders experience future-oriented fear? OCD differs, and though there is anxiety felt in the sufferer’s obsession They can find temporary relief in their ritualistic compulsions Unfortunately for OCD sufferers, this means a life of cyclical ritualism that can affect daily living Those suffering from PTSD May suffer anxiety-like symptoms similar to GAD or even panic disorder But PTSD is unique and that its past oriented The sufferer suffers flashbacks that bring them back to the event of their traumatization If you’re diagnosed with anxiety disorder, it’s okay Millions of people around the world understand what it’s like to suffer from an anxiety disorder, so you’re not alone Understand that every single one of these anxiety types is often treatable and manageable Also, if you know someone who may benefit from online counseling we’ve partnered up with Better Help, an affordable online counseling platform that you can utilize They’re constantly striving to improve their services and terms and conditions.
The link will be in the description box Did you find this video helpful? If so, remember to share this video with those you think might benefit from it As always, Thanks for watching!
Sometimes, people with Bipolar disorder can
show other, less common symptoms as well, for example having what is referred to as
mixed episodes—experiencing symptoms of both depression and mania at the same time. Another symptom they might have is rapid cycling,
which describes a situation where a person has 4 or more episodes of depression or mania
within a given year. Like most mental health conditions, the exact
the underlying cause of the bipolar disorder isn’t known, and there is no single “bipolar gene”
identified, but it’s thought that there are genetic and environmental factors that
play a part.
For example, one interesting clue is that
people with family members who have bipolar disorder are 10 times more likely to have
it themselves. Another clue is that some drugs and medications
can trigger manic episodes, like selective serotonin reuptake inhibitors (or SSRIs). It’s also worth mentioning that people with
bipolar disorder often have other disorders like anxiety disorders, substance use disorders,
ADHD, and personality disorders as well, making diagnosis and treatment a real challenge. Even though there’s no cure for bipolar
disorder, identifying and treating individuals is important, since there’s a real
danger that the person could harm themselves or commit suicide. One of the oldest treatments is also one of
the most effective treatments, and that’s lithium salts. Lithium acts as a mood stabilizer—smoothing
out the highs and lows they experience. That said, it is much better at treating manic
rather than depressive episodes, and so individuals who take it often have to take other medications
as well, which can be problematic since some antidepressants (like the SSRIs) can trigger
manic episodes in individuals who are predisposed to them.
Other treatment options include antipsychotics,
anticonvulsants, and benzodiazepines, but many of these—including lithium—have side
effects that can be severe and lead to non-adherence which can be dangerous for an individual. Now, unlike certain disorders like unipolar
depression, psychological interventions, like talk therapy, or cognitive-behavioral therapy
are not particularly effective in treating the manic episodes of bipolar disorder. Having said that, they can still be very helpful
tools to help individuals with bipolar disorder in general—especially after a manic episode
has ended. They can also help an individual handle stressful
situations that might otherwise lead to a manic episode, thereby helping to prevent a potential
manic episode in the first place. Alright, so super fast recap: bipolar disorder
is a mental disorder characterized by depression, periods of lowered mood, as well as mania,
and periods of heightened mood.
Thanks for watching, you can help support
us by donating on Patreon, subscribing to our channel, or telling your friends about
us on social media.
There is a real threat here, in which case,
there’s a different intervention that needs to happen in order
to, to ensure one’s safety, right, but I think that is
really key. We do not want to fall into the trap of weighing
in and saying, This is no big deal. Just get over it. That is
problematic if there is a true threat and it is very
problematic, even if there is not a true threat, right,
because it’s also super invalidating for people who are
like, actually, this is really hard for me, right? So either
way, that’s problematic for us to say, this is no big deal.
This isn’t a problem. We want to – our goal is to help them
evaluate the situation and really pull in more evidence. Kendra Read: One of the things
that Jen noted earlier is that youth and actually people with
problematic anxiety tends to interpret the information around
them in ways that are either extra picking up on threatening
situations or misinterpreting things, so we just want to be
careful and for into – for when we think about racial
microaggressions, this may not be misinterpretations and often
are not misinterpretations.
So, we want to be really fair and
saying, in laying out the evidence for what’s, what’s
happening. So, we can be really clear and not be having
conversations where we’ve already arrived at a decision
and we’re just teaching you, that’s where, or dismissive in
some way. Anything you would add to that,
Jen? Jennifer Blossom: I think, to
the point that you’re making one of the things that we think
about when approaching a situation that kiddo or family
is describing as anxiety provoking, just kind of a
decision tree that we work through and initially you ask is
the fear realistic? So when I think about the question that
was asked, and the consequences of racism? The answer to that
would be yes. Right? The fear is realistic in that situation and
when that situation arises, then we work on figuring out if is this
something that the kiddo should know how to manage. If there are
specific things that we want them to know how to manage, then
we want to give them the skills to do that.
So, that’s kind of
our initial decision point there and I think that that’s where we
want to be thoughtful of experience of racism, there’s
the very real reason why that would be immediately threatening to
somebody. So that’s, that’s the lens through which we would approach
it. Yeah, totally agree. Totally
agree. All right. So, in terms of what teachers can do,
truthfully, we want teachers to work with students and families
as issues come up to encourage this idea of the approach
instead of avoidance.
I think Jen and I have both read a lot
of different, you know, IEP or 504 plans that have clauses in
it that end up accidentally reinforcing avoidance and then
our feedback is, is around how to turn this piece around so
that we’re actually moving toward the feared situation and
learning more adaptive responses, rather than
encouraging avoidance, just in order to reduce that experience
of anxiety and in many ways, we use a school-to-home note, which
I’ll show you in a second. I’m sure many of you have used
variations of these notes for different behavioral concerns
that have come up in classrooms and the application of this to
anxiety is not really so different but as you work with
youth with anxiety, I really think about how to be supportive
and what it actually means to be supportive to somebody with
anxiety and that means approaching situations with this
an important combination of both validation and confidence.
It’s
the “I know it’s hard and I know you can do it.” combination.
Oftentimes, we see people fall into traps where they’re just,
you know, holding on to one of those two pieces of that
equation. So either just validating like this is so hard
and kind of getting stuck in the admiration of the difficulty, or
holding on to the confidence piece of like, buck up, kid,
come on, you can do it, this is no big deal, and both of those
alone are problematic and in terms of moving anxiety
intervention forward, so we really need the combination of
both of those to build a supportive environment. Kendra Read: So just, you know,
as I mentioned, this is an example of a school to home
note, as we apply it to anxiety and I would imagine, you know, I
kind of took the framework from this directly from our ADHD
disruptive behaviors clinic, which shows you just how similar
the behavioral approaches can be.
So essentially, we just want
to set a behavioral goal with a family around anxiety, obviously
this example is for a younger child. If you look at the smiley
faces and all of that, we want to set like a really specific,
observable, time-limited, you know, smart goal around an
anxious anxiety or brave behavior. So for this child,
this example child, their goals are around, walking into class
independently, whispering to the teacher three times throughout
the day, and raising their hands during specials and then we want
to make sure that we’re giving them opportunities to reach
these goals, tracking their progress and then finding
having some way of coordinating that information back to parents
so that they can or other caregivers, so they can really
reward and reinforce their youth progress toward more brave
versus avoidant behaviors in the school setting.
Jennifer Blossom: Kenda, if you
could just go back to the last slide there is relevant to one
of the questions that came in asking about what age you can
use these principles with kids and, as noted, Kendra noted
here with the smiley faces, this is a school-to-home note that’s
really designed for, you know, kiddo as young as in
kindergarten, what we know is that you can employ these
strategies, you can use these approaches with kids as young as
three, you know, oftentimes, we’re then talking more to the
adults in the kid’s life. So, talking to the teachers, talking
to the parents or other caregivers, that these skills
and these strategies still work well, even with really young
kids and that oftentimes, if we can catch them that early, we’re
just setting them up for better success so that we can really
leverage the strengths of that of those brains that are wired
more towards anxiety and help them meet their goals.
Absolutely, thanks, Jen and I
would say that actually our anxiety programs go down to age
two at Seattle Children’s, and all the way up through age 18
and beyond. I mean, not at Children’s but these principles
are universal, regardless of age and there are just some
adaptations in terms of exactly how you would apply this for
different age groups. So as Jen mentioned, for kids, I would
say roughly seven and younger, I’d be working much more with
parents than with kids directly. That’s really different than
those than you know, it’s a different kind of story or
opportunity for those of you in school settings. So we can talk
more about that in the question and answer period if you would
like.
Kendra Read: Okay, as I
mentioned, in terms of supporting youth with anxiety in
school settings, we tend to see some common pitfalls, of tending
more toward accommodation versus approach in anxiety-provoking
situations in formalized 504/IEP plans and I -accommodation is
this good word, bad word. In a school setting, it tends to have
a really positive connotation. In the anxiety world, it has a
really negative connotation. So, accommodation means essentially,
you know, being complicit with a child’s anxiety and helping them
avoid anxiety-provoking situations. So when Jen and I
talk about accommodating anxiety, we’re thinking of, you
know, parents who will never ever go out on a date night
because their child doesn’t want to be alone or will never
eat at the same table as their kid because their child can’t
handle it, different things like that. So just want to note that
we use that word really differently across our different
settings but in general, it has it all goes back to that
approach versus avoidance difference. So, a lot of problematic
pitfalls that we run into are things like these
contra-indicated accommodations, like extra time, not calling on
a student or allowing, directly allowing avoidance of certain
specific activities.
Extra time is a really tricky one and I
know, we have a lot of conversations about this all the
time, it comes from a good place of wanting youth who may be
distracted by their anxiety to have more time to, you know,
manage that, when in reality, what tends to happen when we
give you extra time, when we give youth with anxiety extra
time is that they tend to spend that time worrying or engaging
in more anxious behaviors more avoidance, so it ends up not
being a helpful intervention in the end.
My internet connection is a
little unstable. So, apologies if I’m breaking up. As I mentioned, things like
relaxation strategies, strategies, and journaling are
not bad things to do, but they’re also not helpful. So we
would not want those to be considered the primary
interventions for anxiety in any setting and really, it also
comes down to really requiring this partnership from all
parties, from teachers, specialists, and caregivers, so that
there is a clear plan for what we’re working on and how we’re
going to be approaching this in a situation that is supportive
to the child, so involving that combination of confidence and
validation. The “I know it’s hard, and I know you can do it,
and here’s what we’re going to work on” and I think sometimes
we’ve, you know, heard from school-based personnel who feel
kind of reticent to approach exposures in their setting thing
like, “Well, I’m not a therapist, maybe I shouldn’t be
doing this.” but in reality, we all have ownership and agency in
this in this behavior change and this change in problem
problematic anxiety, even if you’re not a quote-unquote
therapist or psychologist, we need youth to practice exposures
in all settings in order for this to generalize to all
settings.
So, it’s really important that these things are
practiced in the school setting as well. Okay, Jen, come back on for our
Q&A. Jennifer Blossom: So, we have
been working with a lot of people internally at Seattle
Children’s, as Kendra mentioned, I was there. The working
remotely, as I’m sure many of you are just over a month ago,
as well as many, many people throughout the greater WWAMI
region and there’s been a few common questions that have come
up that we opted to highlight here and I’m also aware that
there have been a number of questions that may have been
coming in over the Q&A section. So, thank you so much for
sending those in, please feel free to continue sending those. So, my thought is that we’ll
just jump right into the question and answer questions
that are coming in. So I think one, one question in which I’m
seeing kind of a few iterations are going back to this idea of
the 504 plan and how we develop a 504 plan that acknowledges and
integrates the evidence-based recommendations for anxiety and
one of the ways that I think about that is really getting
concrete on some of the goals in the school setting and instead
of providing, providing kind of a blanket statement, like more
time to finish something is figuring out where the child
currently, what are they currently able to do, and where
do we want them to be? and then how do we find those steps to
get them towards that ultimate goal? So, how can we phrase
something that allows them to take steps towards participating
in the class? You know, being able to complete that assignment
when they’re asked to, in particular, think about a
a child who might have difficulty speaking in the classroom, one
of the questions that came in was relevant to whether we can
apply these principles to selective mutism and the answer
is certainly yes, Kendra and I do this a lot.
Kendra has a
specialty clinic that specifically works with families
and helping kids learn how to speak in settings that they feel
uncomfortable doing so. So, thinking about a 504 plan in
particular with a selective mutism kind of focus, if you
have a child who is completely nonverbal, who is not able to
speak out in the classroom, oftentimes what happens is we
find that teachers are jumping in or providing answers for
them. Other students might recognize again, well-meaning
compassionate people jumping in providing answers for them, what
we want to do is help, help encourage the child to start to
be able to answer the question themselves. So, a 504 plan might
say something like – initially might say something like respond
to nonverbal. So, being able to shake your head yes or no,
that’s still providing some kind of information in engaging in
some kind of communication.
If there’s the complete absence of
communication, then it might be being able to whisper an answer
to the teacher. So we can think about what is the
steps and how can we integrate them into the 504 plan? So that
we’re getting the student and supporting them to
be able to answer a question in the middle class when, when
other students’ peers are there. I would just add that, you know,
I know that 504 plans often we can’t change them as quickly as
we would like to change behavioral goals. So, sometimes
I encourage schools to phrase a 504 accommodation or an IEP
the goal, you know, honestly, IEP s with their, like the goal
framework kind of lends themselves a little bit more to
this idea but the idea that we’re going to gradually be
approaching and, you know, moving from totally not speaking
to respond, you know, 80% of the time to the teacher in at
least a voiced response. So, you know, if you put your hand on
your throat, you feel your hand vibrating, right, and we just
state in the plan that we’ll be identifying weekly goals.
The teacher will be providing, enough opportunities for the child
to reach their goal, and we’ll be providing support for the
child to try again and just kind of discuss what the
communication plan from school to home looks like because that
can – that looks different for every school that I’ve worked
with, depending on what’s feasible.
There’s no one exact
the right way to do it and that gives us a little bit more
flexibility to work on those successive shaping steps of
moving from, you know, just, you know, shaking our head, no, to
mouthing no, to then whispering, to then talking. So, the
exposures in school said that’s one example. Kendra Read: There are exposures
in school settings that can look so many different ways. It just
really depends on the different situation. So sometimes we are,
you know, as the adults in the situation, setting up some
social opportunities, for one child to talk to another,
sometimes it’s like, okay, just so you know, I’m going to call
on you during this part of the day or sometimes I – a lot of
kids have, are so anxious about making any mistake or they redo
and redo and redo their work or they, you know that, or there
work has to be perfectly neat.
So, then we have them turn in
work that they finished with their non-dominant hand or they
definitely made a mistake in there on purpose and they’re
going to turn it in and see what is so bad about this, what is
the worst thing that happens when I turn in a mistake? So
there are all sorts of different exposures that you do in a
school setting and it just so depends on the specific fears
that the child is endorsing. Okay, so let’s, there was a
the question at the top about PTSD and anxiety, and whether or not
they can co-occur or would not be concurrently diagnosed,
and absolutely PTSD and anxiety disorders can co-occur 100% they
can be diagnosed at the same time, we just want to be careful
that we’re not to double counting the same symptoms and
we want to be clear that not every anxiety disorder, you
know, anxiety disorders don’t come about because someone
definitely experienced a traumatic event.
Right. You
know, fear of spiders doesn’t mean they’ve definitely
experienced a horrible situation with spiders, for
example, or for selective mutism. This is one of the big
ones, where there’s this myth that they’ve experienced a
traumatic event and that’s why they’re not speaking. Not true,
but for PTSD, you know, that is like one of the only DSM
diagnoses where we know exactly that there was an event that
precipitated the onset of this disorder. So, it is common for
youth who have are just get like anxious. Pre-traumatic events say
they have social anxiety. A traumatic event happens they get
in a really bad car accident and they can’t get back in the car
anymore.
They have true PTSD related to the car accident, and
they have social anxiety. So these two things were not
double counting, but they are happening at the same time. Okay, Jen, I’ll let you pick
one. Jennifer Blossom: So, I’m seeing
a lot of questions and just getting some clarification
around skill building and why we are recommending against using
strategies like relaxation or journaling and so in particular,
just thinking about why and Kendra talks about relaxation in
terms of the message that sends or the threat of the physical
experience of anxiety and the general idea is that we want
kids to have that physical experience of anxiety and know
that does not automatically mean that the worst is going to
happen or that they’re not able to handle those feelings.
There are many situations we’re experiencing that physical
anxieties, really helpful.
In the beginning, Kendra was
talking about, you know, if you’re preparing, if you have a
test on Friday, and I have no anxiety about that, then I’m
probably outside playing with my dogs not sitting – in front of a
book trying to understand the material, right? In some ways,
anxiety is really helpful and adaptive. What can become
problematic is when anxiety is so high about the test that I
can’t even think about opening the book, because I’m so worried
that I’m not going to be able, to learn what I need to
learn. So, we really want to help, help kids and help
students figure out that I can notice that I’m experiencing
some of that anxiety but I can still do the things I need
to do. I feel anxious about the test but I’m still able to sit
down and focus on the material and study the way that I need
to.
When we tell them, “Oh you
notice that your heart is racing or you notice that your muscles
feel tense. Let’s take a moment and sit back and spend some
time breathing.”. What we’re doing is we’re sending the
the message that bad anxiety is really something to be worried
about or scary that they aren’t able to handle those feelings
and then what happens is when they walk into class to take
that test and they’re feeling those same feelings, they think
they can’t handle it.
So, we want them to do is practice
handling and practice tolerating. When I think about a
strategy, like journaling, one of the things that I think about
is that, you know, anxious brains again, they do a really
good job of thinking. They’re constantly thinking, they’re
constantly coming up with the what ifs, what if, what if,
that’s what gets in the way of sleep, that’s what gets in the
way of paying attention in class. So, if we ask somebody to
write down all of those thoughts, and those what-ifs,
we’re not necessarily giving them the skills or the
strategies to still be able to do what they need to do and in
In some cases, we may be letting those what-ifs allow for
avoidance because now they’re writing about those what ifs
instead of doing that thing, that’s hard and this is
something Kendra and I have just recently started talking about
kind of how can we rephrase and reframe thinking about exposure
and practice based on your fear as a coping skill.
I think
that’s one of the things that can get lost or is confusing is
that when we think about facing your fears that we’re ignoring
that, that is still is learning a coping skill because what I’m
learning is that when I feel anxious, I can still do what I
need to do. When I feel anxious, I can still pick up that book
and sit down and read the first paragraph when I feel anxious, I
can still open my computer to start writing that essay. That’s
coping skill and the way that you build that coping skills by
taking those smaller steps until you’re able to do that thing
that’s really hard. What would you add to that? Kendra Read: I would just want
to add about there’s this piece that we call expectancy
violations. We also want kids to have those learning experiences,
to see that the thing that I expect to happen, really doesn’t
always happen or even if it does, it’s not as bad as my
the brain is assuming it is.
This is the coping skill and I think a
lot of people get wrapped up in the toolbox, and I need to give
kids all these other things to do when they feel anxious but
the thing we need them to do is to practice staying in the
situation, and quote-unquote, riding the wave. So, I’m seeing
some other questions about like, what do we do in situations?
Like when a kid is anxious, what do I do? and really, when that
happens for me, like all day long, I just want to – I sit
with them and I say, okay, so you’re experiencing anxiety,
what’s happening in your body right now? How are you feeling
it? What’s your number? and so I want them to practice rating on
a scale from say, zero to 10, how anxious they feel. So,
that’s one way that they can build some mindfulness of saying
like, okay, I’m at like a seven right now and I’m noticing that
my stomach really hurts and that’s like, okay, so what are
you thinking at this moment? I’m thinking, I’m totally going to
fail this presentation, I’m going to bomb it, everybody’s
gonna laugh, etc, etc.
And say like, okay, well what is
happening in this situation is anybody laughing? Like, well, I
can’t hear that anybody’s laughing. So maybe they’re not.
Maybe they are in their own homes, but nobody’s mics are on
everybody’s automatically muted. So, if I don’t know, if they’re
laughing, how will it ever change my life? So, just some
thinking through some different situations like that to think
through that expectancy violation, violating what we
expect – the anxious anticipation of what’s going to
happen. Okay. Jennifer Blossom: I see, I think
we, I hope we answered some of the questions about the Final
Four Planner IEP is about how we can approach it. I see some
questions about like homeschooling and one on one
the school supports, and how do we help families understand this
and man, is it hard, you know, I just want to validate that like,
as much as we do this for a job, we don’t convince every family
that this is the important way to go and we really try to, to
bring them in and discuss how, you know, you know, one of the
other programs run at Children’s as a school avoidance program,
which is not running this fall because most schools are remote.
So, there’s no brick-and-mortar school to avoid for most of our
students, but what I tend to see is that the families that pull
out into homeschooling because of anxiety, those kids tend to
have really escalating very problematic anxiety, very
interfering anxiety that continues for years.
So it does
become a really big problem and so I just want to describe that
the trajectory that I see for them before they make that decision
and be very clear that homeschooling online homeschool,
That like we’re all pigeonholed into that right now
because of COVID or most of us are, so we’re not making that
decision because of anxiety but when we do make that decision
because anxiety is contraindicated. It is
problematic in terms of changing this cycle. So it’s very, very
much not recommended. ] Kendra Read: Jen, do you have a
the question you wanna? Jennifer Blossom: Yeah, I was
just searching through the Q&A and I see a lot of questions and
thinking about how we can adapt some of these recommendations
and approaches, particularly for older students.
So, thinking
about high school students, and thinking about it, there were some
comments about the student kind of report card can be more
challenging with a high school student and I think, you know,
in some ways, really just kind of working, working with the
student and figuring out kind of what’s going on for them at
school and at home. I think one of the things that we know that
comes up commonly when working with families is that oftentimes
parents are not necessarily as attuned to some of the things
that may be coming up at school for their kiddos, Kendra and I
have worked with families where, you know, after kind of years of
school difficulty and some anxious avoidance in high
school, that’s when the parent found out about kind of what was
going on.
So I think, really making sure to work as a team.
In some capacity, I think something that can happen
developmentally when working with younger kids that there’s a
tendency to exclude them completely as if they can’t
understand these principles. When, as Kendra says two and
three-year-olds, even if they’re not coming in for the treatment
the session, they get the idea that was brave, awesome job, right?
So we can still be working with them directly and integrating
these strategies with really young kids and in the same way
when you’re working with high school students, just as you
would reach out to parents for, other types of concerns, if
you were seeing chronic absenteeism or if there was a
lot of missed work but bringing parents in to support high
school students are a really helpful and a great opportunity
too as much alignment as we can get with practicing some of
these strategies both in and outside of school, I think can
be really helpful and effective and when we think about some of
the types of anxiety that we see, more commonly, social
anxiety is much more common in adolescence.
By very definition,
adolescence is a time period where we are more prone to peer
evaluation and judgments and that’s an opportunity that’s
ripe for the onset of social anxiety and fears, and really
coming up with creative ways to practice bringing on that
anxiety, like answering a question, just wrong,
purposefully making a mistake or having a long pause in the
middle of a presentation. Wearing a t-shirt to a zoom
meeting with a huge stain across the front, you know, thinking
about ways that you can help bring that on because one of the
things I know from working with lots and lots of teams with
social anxiety is that it’s really hard for them to be in
these situations and they really want those peer relationships
and connections. So, figuring out how we can work with their
own goals and use their own motivation to help them take
those steps, towards doing the things that they want
to do.
What would you add to that
Kendra? Kendra Read: You know, I’m not
sure that there’s a whole lot more I would add to that, Jen. You know, one of the things that
I’m noticing a lot of the questions are just like, yes,
but how do we do exposures? Yeah, how does what does it look
like? and so I just wanted to give a couple of more examples
for different kinds of areas that kids are anxious, about and how we can
do that in a school setting. So, we’ve talked a little bit about
how to set up, you know, brave talking exposures for selective
mutism. So, really, it’s setting a goal for Okay, so today we’re
going to whisper three times and so I’m going to give three
opportunities for you to whisper with me one on one, or I’m going
to get five opportunities and your goal is to do three out of
five. So, I’m going to come by your desk and say, what was the
answer to number four? and you’re going to tell me to
practice whispering to me the answer to number four.
A lot of
times as Jen was noting, we need some kid involvement in some
youth involvement in setting this goal. We need them to know
what the goal is, so that they can practice reaching it and
they can, we can give them some forced choice of like, okay, so
it sounds like from your parents that, you know, we’re going to
work on, you know, saying hi to a peer. So do you want to
practice that? This time of day or this time of day? Do you want
to do that with you know, you sit next to Johnny and Susie, do
you want to practice with Johnny or Susie first and I’ll be
listening. So just some, some different examples like that.
Practicing making mistakes, practicing, turning in imperfect
work.
I think I’ve said those already. Jen, do you have any other
specific exposure examples? I don’t want to overcomplicate
really what exposure is it really is simple. So like I’m
telling a kid, okay, let’s go do some trivia with some people
down the hall. Here’s a list of trivia questions I’m going to
give them I want you to get two of those wrong and then we just
go do it.
It’s really as simple as that. Jennifer Blossom: Yeah, I think
one of the things that come to mind, particularly when we think
about the context of COVID-19, is that everyone is managing a
lot of uncertainty right now and not being able to tolerate
uncertainty is a hallmark of anxiety, right? Anxious brains
want to plan they want to know they want to be able to
anticipate what’s going to come up, that’s where worry comes
from. Worry is a maladaptive coping strategy that if I think
about something enough, or if I think about all the possible
outcomes, then I’ll be prepared to handle them. So, when we
think about the current situation, in particular for
kids, maybe who didn’t have, didn’t have much anxiety before
wasn’t really getting in the way but right now with COVID and
everything and that there’s been a lot of back and forth, of not
knowing what to expect for school and as they get used to
the startup school still having, you know, trying to navigate
what’s going to be expected in terms of grades or things like
that is really opening up opportunities to practice
tolerating uncertainty.
So in going with the example that
Kendra had just had, of asking them to go answer questions that
they’re not going to know what the questions are in advance and
being prepared to answer questions that they’re
unexpected for, or having, you know, coming up with a plan
that’s not shared and advanced so that they can they can
tolerate being in a situation where they weren’t able to think
about and plan for really thinking about what are ways
that we can think about some of the uncertainty that is typical
of everyday life, COVID-19 is causing a lot of stress and a
a lot of realistic anxiety for people, particularly when we
think about the disproportionality of COVID risk
and consequences of COVID we know that there are going to be
significant mental health concerns for particularly
communities of color. So we want to think about, what are the
things happening right now? How can we, again, assess,
understand the full context for this kiddo? What are things that
are coming up? What are the objective risks that they might
be facing? and then what are ways that this anxiety might be
creeping in that it’s getting in the way of them being able to do
the things that they are able to do right now that they are able
to participate in staples that are going to keep them connected
to some of those, those social supports? and how can we
leverage some of the strengths that they might have currently,
certainly, Zoom meetings, Zoom parties, and Zoom classrooms are not
the ideal setting for many people, but there are ways that
we can still encourage that participation and get creative
with getting kids involved.
So I think, you know, the uncertainty
piece is one that I think comes up a lot. In particular, I think
again, we think of that as the – perhaps more commonly with older
kids, but certainly right now with COVID, because it’s just a
prime situation for us all to be thinking about it. So, think
of just different creative ways that you can help kids
experience situations that they’re not able to prepare for. I’m curious Kendra, have some
other ideas that you might have about thinking in a new school
context or particularly in the online school context? What are
ways to introduce uncertainty that would allow students to be
able to better tolerate that? Well, I think there are just a
lot of natural opportunities that come up that we can
capitalize on.
Sometimes I set up like more contrived
situations of like, okay, we’re going to do exposure and
you’re not going to know what it is or sometime this weekend,
your parents are going to change their plans. You don’t know when
you don’t know how you don’t know what it is. So different
things like that and their job is to tolerate that meaning to
keep their behavior within you know, appropriately behavioral
bounds, they can still experience anxiety and
frustration and so I would just note like, there are so many
natural opportunities coming up for us to tolerate uncertainty
every day with COVID and remote learning, and will we have
Internet connection? and will this work and, and all the other
things happening around us like, the wildfires, like there’s so
much uncertainty, and so much we don’t know and, and just sitting
in that place of like, what if we don’t know? What if there’s
no answer? and that feels really anxiety-provoking, but we just
need to sit in that place.
So I see a lot of questions like,
but what do I do during the exposure? What do I say to them?
and I really, especially when they’re starting to get really
anxious, and I really just say I want them to check in with them
just repeatedly to say like, hey, what number you at, what do
you – what are you doing? I know this is hard, but I know you can
do this. So just keep going back to that supportive statement of
I know this is how I think you can do it. I know you can stick
with this situation, and then point out all the little ways
that they are already doing it. Like, life is uncertain, and you
survived every moment of uncertainty up until today. So,
is there any evidence that you’re not going to survive the
uncertainty hereafter? No, we have no evidence that that’s
true. Might we have evidence that the opposite is true? So
the truth is, we all survive uncertainty every minute of the
day.
I don’t know what, I don’t know actually what’s going to
happen in the next hour of my life. I have some things that
might, you know, help me predict that but I don’t actually know.
So I think just pointing out all these little successes that they
may not be giving themselves credit for during the exposure
of like, you’re still here, you’re doing it like we’re just
going to ride this wave. You don’t have to do anything to
make this feeling come down. You are not responsible for that. It
just will. It is what it is. So we just need to stay in this
situation. So I really want everybody to release themselves
and have the responsibility to make themselves calm down, but it’s
nobody’s responsibility. It’s just what goes up will come down and
we’re just going to ride that wave. If you think about it
like you’re in the ocean and like the waves are coming and
you’re trying to push them back, like calm down waves, like
they’re just gonna knock you over, right? So instead if we
ride that wave, and we accepted remindful of it, and we’re like,
okay, like, how hard is this? What number is this? Okay, this
is a really big wave, oh, I’m going up really high.
Wow I’m
going really fast into the shore, right? We just want to
observe what’s happening. We’re more likely to experience
improvement and greater success in the situation than if we’re
like, must calm down, got to force this down. So, I really
want to let go of that sentence. Kendra Read: I’m jumping around
a lot, but I’m feeling the Jen, what did you want to
add? pressure of time. So, I just
want to note that there are some Jennifer Blossom: Yeah, so I
think just to kind of end and questions in there around
partnering with PCPs and other medical professionals. I want to
say that Jen, and I do have an ongoing connection with PAL or the
Physician Access Line here in the Northwest and we are creating and together we call laboratory Nat Young Bluth in into
connection for primary care for anxiety and OCD. So that is forthcoming
for those of you who are school nurses, I just want
your job to be is to help to connect some of
the somatic feelings that address some of the questions
that come up with how to help how we’re experiencing anxiety
and being a part of the goal setting with others around like may-
be their goal is to not check in at the nurse so much, which me
annoys that they’re avoiding the classroom, potentially
avoiding the thing that’s anxiety-provoking, and potentially
trying to just exit altogether.
That’s less so happens
in the times of COVID but just in terms of like what we typically
see. support when kids are in the
thick of the anxiety, while anxious brains do a really good
the job of being detail-oriented, those details tend towards the
threat. So, sitting with them and commenting on what they are
doing while they’re feeling anxious is really a way
an effective way to be supportive of students and help get them
engaged in exposure situations. So, if you notice that they are
feeling anxious, or they share with you that they’re feeling
anxious, commenting on what they’re able to do in that
moment, finding what it, finding, even if it’s a small
step, something that they are doing at that moment that is
helping them be effective in whatever the strategy is.
So,
thinking back about participating in a zoom class,
if a student went from not participating at all to using
the chat, jump on that, that’s the first step towards talking
in class and joining via video and joining the class. So, an
an effective strategy is really focused on what they’re doing
well because at that moment, it’s hard for them to see it and
that’s going to be a really rewarding opportunity for you
and for them to be able to continue taking these steps
towards facing their fears.
This has been really great. I’ve
so appreciated all the questions that you’ve raised. Kendra, and
I love doing these types of presentations and as she’s noted
multiple times, it’s a bit of a different situation not
seeing any faces, but we’ve really appreciated the
engagement and so looking forward to working with you and
meeting with you again, in just a few weeks, and with that, I’ll
turn it, Kelcey. Kelcey Schmitz: All right, thank
you. A huge thanks to Kendra and to Jen for their presentation
today. I know for me, personally and professionally, I couldn’t
take notes fast enough and for those of you who have
participated today, just a reminder that we will have the
recording up for you who like me will probably be watching this
and sharing it with other people who need to see this.
On the next slide, it’s just a
a reminder of how you can get in touch with us. We have many
opportunities for you to participate in live webinars, we
have many recorded School Mental Health webinars that you can
check out. We have a newsletter, that we send out monthly
newsletters and event blast to you. So, we just highly
encourage you to connect with us, especially if you’re in our
Northwest region but you’re also welcome outside of our region,
as well as reaching out to your local regional center to get
more support and then our last slide is to thank you and a
a reminder that part two, managing anxiety during COVID-19 will
happen on October 20.
So we hope that you will register for that.
I will say this, this session sold out so if you haven’t
registered already for session two, it might be a good
opportunity for you to take care of that now. We know we still
have lots of questions in the Q&A and we will carry those
forward to future events that we have with Kendra and Jen. So,
huge thanks to Kendra and Jen. Huge thanks to our Northwest
School Mental Health team that is been working behind the
scenes to help with the chat and the Q&A and just keep this
webinar running smoothly with that, we will officially
end the webinar but keep the room open for just a few
moments. So, you can take down those links and complete the
evaluation but at this time, I want to thank everyone and we
will end the webinar.
A high, prolonged cortisol level can mess with a lot of stuff. It’s even been seen to decrease the volume of your hippocampus, the area responsible
for learning and memory, and a reduced hippocampus
is more often seen in people with depression than those without. So all this is to say that the extra stress is probably not doing your brain or your body any favors. And humans are historically
bad at making decisions when they don’t know
what’s going to happen?
So, what can you do to
reduce the allostatic load? Reduce stress. Eating well, exercising, and maintaining a regular sleep schedule cannot be overlooked. Exercising alone can
reduce stress hormones, even with just a 20-minute walk. And a different way of
thinking could also help us: an idea called model-free learning. It’s trial and error. Instead of basing your risk assessment on similar examples from the past or envisioning future scenarios, you just take it one step at a time. This way, you reassess and
update your estimate of what’s happening and how to prepare. We’re dealing with a new virus, constantly changing policies, and likely a completely different schedule and maybe even environment. Our brain is on high alert at all times to identify potential threats.
This means that even if you’re spending most of your time laying around, your brain isn’t, so try not to beat yourself up for feeling tired or fuzzy, or unmotivated. You just don’t need anything
else to stress about. Now that you know all of this, how are you feeling? Alex: To be honest, I
do still feel the same. Fran: I think I’m feeling a
bit better after watching it. Victoria: It’s
my body is exhausted from feeling things and being under stress all day, all the time. Graham: Whenever I feel
that allostatic load starting to weigh down on me, you know, I can put a
name on it, a face on it, and it makes it a lot
easier to deal with it.