Cognitive-Behavioral Strategies for Treating Stress and Worry in Children: What Every Psychologist Needs to Know Dr. Caren Baruch-Feldman NYASP Conference 2013 website: drbaruchfeldman.com email: drcarenfeldman@msn.com

GOALS FOR TODAY’S TALK 1. Teach You Actual Cognitive Behavioral Strategies that Can Be Used to Treat Anxiety and Stress in Children. 2. Keep You Entertained.

Is Stress and Worry Good, Bad, or Something In Between? My first question to you is Is stress and worry good, bad or something in between? Some stress is appropriate as you can see with this picture of a bear and the man. If a bear came into this room it would be adaptive to have dear and worry. It would be appropriate to be focused and be ready to fight or flee. But as you see in this comic strip. Too much stress or more specifically getting stressed about small stuff, nursery rhymes is problematic. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

“The Yerkes-Dodson Law of Arousal Performance increases with arousal, but only to a certain point. When levels of arousal become too high, performance will decrease. What we know is that there is a relationship between stress and performance. Being in the middle is best. This being in the middle is a challenging concept for children bacesu by nature they are black and white thinkers but this is where you as parents can be helpful. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Why Are Children So Stressed? Pressure to Succeed Need to Be Good at Everything Play Dates, “White Van”, and Helicopter Parents Internet/ Access to Information Let’s spend a moment to discuss why kids are so stressed today. It used to be that ADHD kids were the bread and butter of a psychologist’s practice. This is not true today. Most of us deal with anxious kids. Pressure to succeed- race to nowhere. Parenting and childhood have changed. Children have interpret this change as that the world is less safe. Internet and access to information. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

When Should One Be Concerned About Their Child’s Level of Stress? Behaving Differently From Usual Avoids Activities That He/She Used to Enjoy. Significant Change in School Performance. This is an important question- parents ask me all the time when should I be concerned about my child? All kids have a little stress and learning to deal with stress is good but these are the 3 red flags to look for. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

How Can Children Turn Their Worry Into an Appropriate Level of Concern To Feel Better? Psycho-Educational (3) Changing One’s Behavior (physiological and avoidance)   (2) Changing One’s Thoughts No? Yes! When I work with families I share with them that there are 3 components of effective treatment. Each are equally important. I will go into each component in more detail. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Understanding Stress and Worry Nervous Systems Genetic Predisposition Worry as a Bad Habit Choose a Different Path By understanding what causes stress you will be more equipped to handling it. Our body is like a machine. Our heart is part of this machine. So is our lungs. Another thing that our body has is a nervous system. The nervous system is in charge of handing what happens when we are nervous. We actually have two nervous systems. One of these systems is activated when we are in a dangerous situation. The other one works when we are calm. When we are calm and relaxed all the blood is in our major organs and brain, but when our body perceives danger all the blood leaves our major organs and moves to our feet and hands so we can fight or flee a dangerous situation. As a result, the food that was in your stomach can’t be as easily digested so your stomach may hurt and you may sweat from the adrenaline that runs through your body, and you may feel short of breath. It is good that all the blood is in your feet and hands in a true emergency so you could flee or fight. However, if that is what you are doing to yourself all the time, for every day stressors, it can make you feel sick and it is not the best for your body. Worry runs in family. However, that doesn’t mean you are stuck with it. See becoming worried as a bad habit. It is important to try to change it like you would any other habit. So instead of giving in to worry and avoiding stuff that makes you afraid you need to face your fears. By facing your fears and not fearing fear or the physical symptoms you may be having, worry will go down. Choose a different path- we all experience feeling startled or fearful. However, what separates those people who worry vs. those who do not are what they do afterwards. By facing ones fears, thinking rationally, and breathing slowly you are picking a path that will move you away from worry. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing One’s Thoughts How One THINKS About A Situation Affects How One Feels. The next thing that is important in reducing stress is learning the connection between how you think and how you feel. To demonstrate this I want to do a few experiments with you. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Experiment 1 What Do You See? Look around the room and try to find all the examples of RED you can see. What have you spotted? Experiment 1 – What do you learn from this? That what we focuses on expands, but what we don’t focus on goes into the background. How is this related to stress and worry? When we worry, we over think all the things that can go wrong. For example, when people are scared of bridges they over think all the possible things that can go wrong. However, if you are not afraid you just don’t think about it. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Experiment 2 Picture yourself in the following situation: You are standing in line at the bank. There are about 50 people around. A robber enters and fires his weapon. You get shot in the arm, but no one is hurt. Would you consider yourself lucky or unlucky? Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Experiment 3 Florida Old Lonely Orange Bingo Conservative wrinkle Worried Florida Old Lonely Orange Bingo Conservative wrinkle Experiment 3: What comes to mind when you see these words? Old age, nursing home. When these words were shown to college students they actually walked slower from the experiment as compared to being shown other words. This experiment demonstrates the power of thought and how it can influence one’s behavior. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Expecting the Worst ……Worrying So I hope that I demonstrated that What we focus on is prominent in our minds. That we always have a choice in what we think. That thinking is profound and that it can affect something as basic as our gait. Core thought associated with anxiety is expecting the worst. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Ones Thoughts Step1: Identify Negative Thoughts. Look for Expecting the Worst. Step 2: Question and Challenge Thoughts. Where is the Evidence? Is it Helpful? Step 3: Come Up With More Realistic and Optimistic Thoughts to Feel Better. 1)There is no evidence… 2) Worrying won’t help…… Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Step 1: Identifying Negative or Irrational Beliefs/Thinking Traps Demandingness – SHOULDS/ MUSTS Awfulizing – It Is Terrible! Low Frustration Tolerance – I Can’t Stand It! Global Rating of Self/Others. Self-Downing. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Step 2: Question and Challenge Thoughts Where is the evidence that what I am expecting will happen? Is it helpful how I am thinking? Would I think the same way if a friend presented this issue? Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Step 3: Develop Rational Beliefs/Thoughts Wishes/ Preferences Living in the Gray I Can Stand It Total Self Acceptance Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Mom, I’m Worried! Test Anxiety Expecting the Worst I am going to fail! It is going to be terrible! I will need to repeat the grade. If I fail I am a bad person! Let’s look at a common anxiety- test anxiety- what thoughts do you think people have when they worry about tests? Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Mom- I’m Confident! Confident Test Taker Realistic and Positive Thoughts There is no evidence that I will fail. I haven’t failed previous tests. Even if I fail, I am exaggerating how bad the results will be. Nobody gets left back in 7th grade because of one test. Worrying is a waste of energy. It is really the worst thing I can do. Since when I worry, I am not paying attention fully to the test. What does the thoughts of a confident test taker look like? Get a volunteer to demonstrate how negative thoughts interfere with performance. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Irrational vs. Rational RATIONAL BELIEFS Preferences Living in the Gray Realizing That They Can Stand It Not Judging Themselves Self Acceptance IRRATIONAL BELIEFS Demandingness – SHOULDS/MUSTS Awfulizing – It Is Terrible! Low Frustration Tolerance – I Can’t Stand It! Global Rating of Self/Others - Self Worth Tied to 1 Behavior or Action. Self-Downing Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Rational Emotive Imagery Picture a bad event clearly. One that has either already happened or that you believe likely to happen. Take your time. Fill in the details. Visualize the people involved, hear them talk, describe the environment, let the situation happen in your mind. Feel the emotions; you can do it. Keep imagining until the emotions are as disturbed as you can get them. After a minute or two, change your emotions from disturbed to merely unpleasant. Did you change your thinking? Was your thinking more realistic? It’s the thinking that causes the emotional response. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Behavior: Where Do I Feel Stress in My Body? Heart Pounding Blushing Chills Feeling Faint Dizziness Shortness of Breath Butterflies Shaky Headache Tightness in the chest When dealing with stress and worry, just as important as changing you thoughts, it is important to change your behavior. The first step in changing ones behavior is figuring out where in your body you may feel stress. Some common places are listed on this slide. It is important to recognize that the pain you are feeling is real, but that it is not coming from bad food or a virus, but rather from stress. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Behavior: Physical Sensations Be A Detective Use your symptoms as clues to knowing when you are feeling worried. Think of fear not as a signal to RETREAT, but rather consider it a CUE to go forward. Once you know where you feel stress in your body, you can use your symptoms as clues. Use these symptoms/clues to knowing when you are feeling worried. Once you know you are worried you can then change your thinking and your behavior so you can feel better. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Behavior: Physical Sensations Spell Your Name with Belly Breaths Deep Muscle Relaxation Guided Imagery One of the most important ways to calm yourself down is through breathing. It sounds so simple, but your breath is powerful. One easy way to relax is by spelling your name with belly breaths. Let’s try. Two other ways are deep muscle relaxation and guided imagery. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Behavior: Don’t Avoid Facing One’s Fear or Stress Manageable and Hierarchical Manner Success Breeds Success Also, as was mentioned before- don’t avoid your fears it just makes it worse. Instead face them. By facing them you get used to them. Give pool example. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Coping Cat- FEAR Plan F = Feeling Frightened? E = Expecting Bad Things to Happen? A = Attitudes and Actions that can Help. R = Results and Rewards FEAR Ladder or Situation Cards Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

What Else Can You Do Possibility vs. Probability. Determine How Likely It Will Happen. Productive vs. Unproductive Worry Living in the here and now, not the future. Acceptance, not fighting pink elephants. Be A Good Role Model: Mirror Neurons Give Worry a Name. Set Aside a Worry Time. What’s the Best, Worst, Most Likely Outcome? Write Down a Story With a Better Outcome. Separate Thinking from Action. I am simply having the thought…. Can’t Tell Someone to Relax/Calm Down. The Person Needs to Get There Him/Herself. Positive Psychology: Grateful Activity, Journal the Positive, Random Acts of Kindness. Exercising, Eating, and Sleeping Right. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

SUMMARY An intolerance for uncertainty and a need for control are at the heart of worrying. Be a long-term hedonist vs. a short term one. Live in the moment. Turn failure into opportunity (e.g., I didn’t fail, my behavior did. Failure is not fatal). Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

From Challenge to Opportunity After SANDY Seeing it as an OPPORTUNITY Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

CBT Worksheet Situation What is the feeling associated with the Situation? How are you thinking about the situation? Challenging those thoughts 1. What Is the Evidence?________ 2. How Is It Helpful? ________ New more helpful way of thinking. New Feeling. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

What Did I Learn? What Did You Learn? What Can You Do To Help Your Students to Decrease Stress? In the beginning of the talk today I had you id some of child's worries and how he/she was handling them and how you were helping them with these fears. Now on the back of the index card please indicate one new thing you learned about stress and worry and 2 ways you will help your child to cope more effectively. Also, I would appreciate if you could also fill out an index card for me. Can you list something that was valuable that you learned and one thing you wish we had more time for. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com