Acceptance and Mindfulness with Cognitive Behavioral Therapy for Children/Adolescents with Anxiety, Panic, Fears and OCD/PTSD
Cognitive-Behavioral Therapy with Acceptance and Mindfulness for Anxiety is an integrative approach founded on the assumption that both behavioral and cognitive processes can cause and maintain anxiety. Variations in these interventions exist depending on the specific disorder to be treated. Such disorders include Separation Anxiety, Social Anxiety, Generalized Anxiety Disorder and Panic Disorder. Most Cognitive-Behavioral Therapy protocols with Mindfulness and Acceptance skills aim to teach the child or adolescent new problem-solving skills and behaviors and strategies for challenging unrealistic or anxious thoughts and beliefs.
Included in the Mindfulness approach is the child or adolescent to develop a healthier relationship to thoughts and emotions, giving them a perspective where to identify the unhealthy thoughts and not “buy into” what these thoughts “say” and then to proceed with behaviors according to their healthy values. This is also known as developing “Emotional and Cognitive Resiliency” which is a vital skill to have in life with its many struggles and ups and downs.
Cognitive distortions play a key role in the maintenance of youth anxiety since they can lead to misinterpretations of environmental threats and undermine the child’s ability to cope satisfactorily. When children feel anxiety, they are more likely to avoid people and situations that trigger the anxiety. Such avoidant behavior is often triggered by a distressing event. It may provide temporary relief, but in the long term, avoidance can perpetuate a cycle of fear and withdrawal.
Cognitive-behavioral therapy aims to alter maladaptive thought processes by highlighting the link between thoughts, feelings and behaviors and then cultivating new problem-solving and coping skills. The therapy uses direct reinforcement, modeling and in-vivo exposures to foster safe thoughts and behaviors.
Empirical support has been found for multiple treatment formats, including single-session treatments for specific phobias, week-long intensive formats for phobic and obsessive compulsive disorders (OCD) and traditional, short-term therapy protocols, which typically last between 12 and 20 weeks. Parents are frequently involved in the treatment.
Core Components of Mindfulness-based Cognitive Therapy for Anxious Youth
Cognitive-Behavioral Therapy with Mindfulness uses a variety of strategies to help a child reduce anxiety, challenge anxious thinking and counteract avoidance behavior, including cognitive restructuring, affective education, behavioral relaxation, imaginal and in-vivo exposure, modeling and rewards and behavioral parent training. Several of these techniques include:
Emotions, Education, Relaxation and Anxiety Reduction Strategies
Parents and the child are taught about the interrelated physiological, cognitive/thought and behavioral components of Anxiety. Activities help demonstrate how different components to Anxiety, such as the emotions, body / physiological experiences and cognition/thoughts correlate. The treatment is how you change the relationship to these components, respond differently to them and by doing so the maladaptive reactions and behavior changes. Cognitive Restructuring, Progressive Relaxation, Diaphragmatic Breathing and Mindfulness Skills Training helps anxious children develop awareness and control over their cognitive and physiological responses to Anxiety components and then allows appropriate healthy functioning.
The goal is to help children identify how they see and interpret the world and how to replace any distorted cognitions with more productive beliefs. Basic strategies include helping children identify and reduce self-defeating self-talk, developing positive self-image statements, testing both dysfunctional and adaptive beliefs, not always holding thoughts as facts and formulating a plan to cope with situations that might trigger fear.
Imaginal and In-Vivo Exposure
The goal is to encourage “approach behavior” by placing the child in a previously challenging or feared situation through the use of imagination or therapeutic exercises in sessions. The Process is to interrupt the Anxiety/Avoidance cycle (see Turnaround Program). The child attempts to complete tasks in a so-called “fear hierarchy” so that he or she experiences early success before moving on to greater challenges. The child is encouraged to use helpful coping skills outside of the Exposure treatment, which will in addition to the exposures, create a healthy response to the fear and eventually the fear will lighten. The additional strategies are Relaxation Exercises, Mindfulness skills, challenging anxious thoughts with more positive and realistic thoughts, problem-solving and rehearsing attainable skills.
Parents may have their own notions about the threatening nature of anxiety and may not know how best to encourage a child to cope with Anxiety. Cognitive-Behavioral Therapy provides parents with information about the risks of their child’s continued avoidance strategies and gives guidance in managing their own Anxiety. The therapy also may impart basic parenting strategies (positive/negative reinforcement, modeling, reward planning) so that these practices can be replicated at home.
Exposure and Response Prevention for Obsessive Compulsive Disorder
This technique is a variant of traditional exposures wherein exposures target specific repetitive compulsions and obsessions. The child is exposed to a stimulus that triggers Anxiety and intrusive thoughts and is coached to resist performing the compulsions that he or she thinks will relieve the anxiety. Exposures often proceed in a hierarchical, progressive manner.
Trauma-focused Cognitive-Behavioral Therapy for Post-Traumatic Stress Disorder
This intervention is designed to help children and their parents overcome the negative effects of traumatic life events, such as physical or sexual abuse, traumatic loss of a loved one, home, school or community violence or exposure to disasters or a terrorist attack. It integrates Behavioral and Cognitive intervention strategies that are commonly used in child abuse therapies to foster interpersonal trust. For more information, please see http://tfcbt.musc.edu.
Mindfulness and Acceptance Strategies
Mindfulness and Acceptance strategies are taught Formally and are generally integrated in all the therapeutic approaches. These skills help cultivate a compassionate and accepting stance with difficult/dysfunctional thoughts and difficult emotions. With these skills a child can identify what thoughts are of benefit that work towards healthy behavior according to healthy values and then chose a healthy course of action. Mindfulness skills have been shown in the research to help develop “emotional and cognitive resiliency: where one becomes more responsive to difficult emotions and thoughts and less reactive and impulsive.
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