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 Increase Your Understanding of the Causes of Stress/Worry Faced by Children Today. 2. Teach You Cognitive Behavioral Strategies that Can Be Used to Treat Worry and Stress in Children. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Is Stress and Worry Good, Bad, or Something In Between? Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Why Are Children So Stressed Today? Pressure to succeed. Uncertainty in society as a whole that is contagious (mirror neurons). Internet/Media. We overestimate risk based on: accessibility, recency, powerful images, severity of outcome. People can’t just sit with their feelings. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

How Can We Help 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! 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: a. Identifying productive and unproductive worry. b. Accepting reality and committing to change. c. Challenging your worried thinking. d. Changing your behavior. e. Using your emotions to help you rather than worry. f. Keeping it going. When failure occurs, turn it into an opportunity. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Worry More Effectively Signs of Unproductive Worry Rules for Productive Worry 1. You are worrying about unanswerable questions. 2. You are worrying about a chain reaction of events. 3. You reject a solution because it is not perfect. 4. You think you should worry until you feel less worried. 5. You think you should worry until you feel totally in control and/or certain. 1. Figure out if the problem is plausible or reasonable. 2. Decide if you can do something about it right now or very soon. 3. Quickly move from worrying to problem solving. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

What Doesn’t Work!!! 1. Seeking Reassurance. 2. Trying to Stop Your Thoughts. 3. Checking and Checking. 4. Avoiding Discomfort. 5. Demanding Certainty. 6. Not Seeing Crazy Thoughts as Anxiety But Instead Thinking It’s True. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing One’s Thoughts How One THINKS About A Situation Affects How One Feels. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Basics Principles of REBT Albert Ellis . 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? 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 Taken together, these 3 slides demonstrate that what 1) you focus on shapes your view (experiment 1), that the situation alone does not dictate the emotional responses (experiment 2), and that on a very profound level, our thoughts affect our behavior (3rd experiment). Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

What Are the Thoughts Associated with Anxiety? Expecting the Worst … Seven Rules of Highly Worried People - R. Leahy (The Worry Cure) 1. If something bad could happen – then it’s your responsibility to worry about it. 2. Don’t accept uncertainty-you need to know for sure. 3. Treat all your negative feelings as if they are really true. 4. Anything bad that happens is a reflection of you as a person. 5. Failure is unacceptable. 6. Get rid of any negative feelings immediately. 7. Treat everything like an emergency. * Worry about your worry. 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

Core Irrational Beliefs/Thinking Traps Associated With Anxiety It’s going to be terrible. From 1-100 it will be 100 (fortune telling). I can’t stand it (catastrophizing). I shouldn’t feel this way (shoulds/musts). I am a failure because I did poorly (personalizing). I will fall apart if I feel uncomfortable (low frustration tolerance). A disaster is definitely going to happen (over-generalizing). I have to get a 100 or do perfectly (all-or-nothing-thinking). If I don’t do well on my chemistry test, I will fail the class. If I fail the class, I won’t get into medical school. Then everything will be terrible (sliding down a slippery slope). 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? What are the costs and benefits to my 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

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

EXAMPLE: 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! The test shouldn’t be this hard! Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

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

Let’s Practice Step 1: Identify Negative Thoughts. Step 2: Question and Challenge Those Thoughts. Step 3: Come Up With More Realistic and Optimistic Thoughts to Feel Better. 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: Your Emotions Are Your Friends Be A Detective Rather than think of fear as a signal to RETREAT, consider it a CUE to go forward. 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 Meditation Change Your Breath Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Changing Behavior: Don’t Avoid Face One’s Fear(s) or Stress. Address Worry in a Manageable and Hierarchical Manner. Remember, Success Breeds Success . Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com

Coping Cat by Kendall- 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

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

What Else Can You Do Possibility vs. Probability. Determine How Likely It Will Happen. Give Worry a Name. Living in the Here and Now, Not the Future. Appreciate the Moment. Worry Tape. Flood Yourself with Uncertainty. 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…. Describe What Is in Front of You. Don’t Jump to Conclusions. 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

CBT Sheet by Caren Baruch- Feldman What is the Situation? What Is the Feeling Associated With That Situation? What Are Your Thoughts About The Situation? Challenging Those Thoughts. Alternative Way Of Thinking About the Situation. New Feeling. Dr. Caren Baruch-Feldman, Psychologist drbaruchfeldman.com drcarenfeldman@msn.com