My therapist gave me a handout on anger management yesterday.

I just lost it.

Anger is a healthy and normal emotion. Everyone gets angry, but not everyone expresses it well. This is the first in a two-part blog series on Managing Anger with Recognizing & Resetting (part 2 coming in January 2021). This blog will focus on the Recognize and the second blog will focus on how to Reset by learning relaxation strategies and effective ways to release anger.

THE GOOD AND THE MAD. All feelings are ok. Being angry or mad can be a signal that something is wrong or needs to change. It might be a response to a perceived threat. Anger can indicate that boundaries have been crossed, that we have been treated poorly, or that an injustice has occurred. It can be protective, preparing us to respond fighting when there is a real threat (setting off the Fight-Flight-Freeze response). It always involves a physiological response in our body. Adrenaline and hormones are released, heart rates and breathing quicken, blood pressure rises, focus narrows.

Anger is problem when it results in aggressive, destructive, and harmful behavior, when it hurts others either physically or emotionally. It is a problem when it is too intense, affects health, hinders functioning and school/work. Expressing anger in violence can have serious consequences. Expressing anger with yelling and demeaning comments can also cause lasting harm to relationships and is particularly damaging to trust and connection between parents and children.

The goal is not to stop feeling angry, the goal is to learn how to choose behaviors or actions that are helpful and not harmful. The work is being able to know when anger is escalating and to learn techniques to be able to calm down and release anger before losing control. This is true for parents and children. The best way to help your child calm down is to stay calm or calm down yourself first.

One of the first steps to manage anger effectively is to become aware or RECOGNIZE how we experience anger, how anger feels in our body as it increases in intensity, and what “triggers” our anger.

This begins by knowing how to talk about feelings and to have words to identify emotions. It is also important to consider that anger can also be a secondary emotion that is covering or connected to other “hidden” emotions such as embarrassed, anxious, discomfort, grief, powerlessness, and fear.                                                                                                                                                                                                                                                                 
Talk about feelings and emotions. 

• Label feelings- yours, your child’s, even characters on TV shows
• Teach how to recognize all different emotions (by facial expressions, body language) when children are young. Having a word to express an emotion is the beginning of learning to handle it.
• When you notice your child starting to get annoyed, frustrated, or angry label this and point it out. Do this calmly and validate the feeling. (Remember you do not have to agree with why, but do not try to dismiss or minimize what they are feeling or indicate that there is anything wrong with having this feeling).
• Model and give children/teens language to use.
• When your child expresses anger. Listen. Acknowledge how upset your child is and why he or she is angry.
• Validate feelings. Rephrase or repeat what your child/teen says (active listening to help him or her feel heard and understood).
• Remember to say you FEEL angry not you ARE angry.
• Encourage empathy and seeing the perspective of other people

 
It is also important to talk about the difference between feelings and behavior (“It’s ok to feel angry, it is never ok to hit”). Children can learn that you can feel your feelings without acting on them- especially in a way that is hurtful or harmful. They, like us, can learn to tolerate the physiological response without losing control and lashing out.
 
Identify what situations, issues, or behaviors make you feel angry.

• Learn your own triggers to be proactive.
• Help children and teens increase self-awareness about why they are angry
• Watch for tired, hungry or feeling ill- for yourself or your child. Do a “body scan” to see if there is something you need that might affect how you feel.
• Talk about your own feelings (appropriately) and never blame a child, if a behavior makes you angry identify that behavior as something you do not like, rather than telling saying your child made you angry).
• Watch for patterns with your child and what happened leading up to anger (as well as when increasing intensity of emotion.

 
Pay attention to how you experience anger in your body.

• Notice your physical sensations or signals you experience when becoming angry
• Anger creates the Fight-Flight-or Freeze reaction with physiological changes including increased blood pressure, faster heart rate, release of adrenaline and hormones. Your body is preparing to protect you and thinking becomes less clear and more hyper-focused. Decisions and consequences of actions often become less controlled as anger increases.
• Watch your child/teen and help identify signals and point out changes you see (clenched jaw, tight fist, red face etc). This is particularly important- build awareness of how it feels in your body to be angry and at different levels of intensity.
• Recognizing the progression of anger is essential (irritation to frustration to rage) in learning how to manage anger effectively.

 
ACTIVITIES TO HELP YOUR CHILD BUILD RECOGNITION OF ANGER SIGNALS:

• Color anger in your body. Draw a picture/outline of a person and ask your child to color where in their body they feel anger. Head? Heart? Fists? Talk about what this feels like and why. Talk about what you notice and how you feel anger.
• The Anger Thermometer. Draw a thermometer. Label 1-10 (or low/medium/high for younger children). Identify a feeling for each level from calm/peaceful to explosive/out of control. Talk about how each level of anger feels- from irritated/annoyed to frustrated to angry to furious. Talk about what your child/teen/self could do at each level to express anger appropriately and calm (*blog 2 will share ideas about specific calming or coping strategies for each level to add to the anger thermometer.) You can also download: https://www.therapistaid.com/worksheets/anger-thermometer.pdf

 
ADDITIONAL RESOURCES
https://childmind.org/article/angry-kids-dealing-with-explosive-behavior/
https://kidshealth.org/en/teens/deal-with-anger.html 
https://www.mother.ly/child/proven-techniques-to-help-your-kid-get-control-of-anger
https://www.ahaparenting.com/parenting-tools/emotional-intelligence/angry-child
https://www.therapistaid.com/worksheets/when-is-anger-a-problem.pdf
https://www.therapistaid.com/worksheets/anger-warning-signs.pdf

​Who is PCIT for:  For parents who are tired of getting phone calls from school about your child’s behavior; for parents of children who can be destructive on purpose; for parents who are overwhelmed by their child’s tantrums; for parents who are embarrassed by their child’s behavior; for parents who love their child, but struggle to like their child because of challenging behaviors……..

PCIT is an evidence-based treatment for young children (2-7) with behavioral problems. PCIT is conducted through live coaching sessions during which parent(s) and child are in a playroom while the therapist is in an observation room.  The therapist coaches the parent through an ear-piece live while the parent learns to manage the child’s behavior. 

PCIT includes two treatment phases. The first phase establishes warmth in the parent-child relationship and helps the child to feel calm, secure and increase self-esteem. The first phase may also decrease tantrums, activity levels, negative attention-seeking behaviors, and parental frustration. 

The second phase equips parents to manage the most challenging behaviors, while remaining confident, calm and consistent. Parents learn proven strategies to help children accept limits, comply with directions, respect rules and to behavior appropriately in public. This phase will also decrease destructive and defiant behavior, while increasing compliance and respect. 

While PCIT is evidence-based for young children, it has been adapted for older children (7-10) as well. PCIT can be offered in the therapist’s office or in one’s own home via telehealth. 
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For more information about PCIT or to find a PCIT Certified Therapist, go to www.PCIT.org

​You may have heard some of these terms before but been unsure what they are really about. Or maybe they are completely new to you and sound quite complicated. We have all seen someone bite their nails, twirl their hair, or maybe chew on their cheeks or lips... Although seeing this is common, for some people, it is harder for them to stop these behaviors and it may become more problematic.  

Here is an explanation of Body-Focused Repetitive Behaviors (BFRBs) adapted from the TLC Foundation for Body-Focused Repetitive Behaviors (https://www.bfrb.org/). Some children and adults engage in repetitive behaviors that fall under the category of self-grooming and involve doing something to their bodies that causes damage. These behaviors become habits and can be exacerbated by stress. Many times people are not aware they are doing it, and need help noticing when it occurs. There are often triggers happening inside the person or in the setting around the person that may not have been identified as triggers yet. The symptoms cause emotional distress and have physical effects. This can be a persistent condition that worsens and improves at various times throughout a person’s life.

BFRBs occur in both boys and girls, but in adulthood are more common in women.

For kids the MOST COMMON types of BFRBs are:
 
Skin Picking (Excoriation) Disorder: Involves repetitively touching, rubbing, scratching, picking at, or digging into their skin, resulting in skin discoloration or scarring.
 
Hair-Pulling Disorder (Trichotillomania): Involves pulling out the hair from their scalp, eyelashes, eyebrows, and other parts of the body, and may behind leave patches without hair.
 
Nail-biting Disorder (Onychophagia): Involves biting their nails past the nail bed and chewing on cuticles until they hurt themselves, which may lead to soreness and infection.
 
Some other BFRBs are: cheek and lip biting, nail picking, scab eating.
 
How do you know when it’s a problem?
 
Body-focused behaviors are considered problematic for children when they are happening repeatedly over time and they result in negative physical, social, or emotional consequences.
  
Good news, there is help!!
 
Treatments such as cognitive behavioral therapy (CBT) or a form of behavioral therapy called Habit Reversal Training (HRT) have been shown to be very helpful for children with body-focused repetitive behaviors! HRT involves building motivation to change the behavior and building substitute behaviors to replace the unhelpful BFRB.
 
Often times kids need help bringing attention to when they are doing the behavior. This can be a gentle reminder from a parent at home or a teacher at school. Having something tactile to fidget with helps the child do something else with their hands, which allows them to work on changing the behavior.
 
You can find more information and resources at: 
https://www.bfrb.org/
https://adaa.org/body-focused-repetitive-behaviors
https://www.stoppulling.com/
https://www.stoppulling.com/
 
 
 
 

School and learning will be different this year.  While stress and uncertainty are common at the start of every school year, these are particularly high for many children and their families this year. Both in- person or virtual / online learning options will require new routines, expectations, and behaviors. Students also begin the school year with different family stressors, resources, and pandemic experiences that will influence how ready and able they are to engage in school and learning. Supporting the social and emotional development, mental health, and resiliency of children provides the essential foundation for learning to occur, regardless of location. Below are four general tips that all parents can use support their children as they start school.

1. Talk About It

Check in with your child to see how he or she is feeling. Ask calmly as an open-ended question “How are you feeling about this?”.  (This allows any feelings to come from your child; rather than assuming how they feel). (See: https://biglifejournal.com/blogs/blog/back-to-school-free-printable-care-package).
 
Validate all feelings. Children might feel sad, disappointed, frustrated, as well as excited, happy, bored. Their feelings might change throughout the day and might be conflicting. All these feelings are OK. Listen and allow a child to express feelings without dismissing or trying to “fix” and negative feelings that they express. Help children to find positive ways to express difficult emotions. Also, allow positive feelings and try not to question these. Some children are doing well.  (See: https://www-huffpost-com.cdn.ampproject.org/c/s/www.huffpost.com/entry/help-kid-cope-back-to-school_l_5f329ca9c5b64cc99fde5586/amp).
 
 
2. Manage Worry and Expectations
Listen to concerns calmly and respond with kindness. Show Empathy and Understanding. Focus on PRACTICAL vs HYPOTHETICAL WORRIES. It is ok to acknowledge risks. Create an action plan for how to reduce worries. Limit “what if” discussions that focus on extreme negative outcomes that are not likely.
 
Be careful not to make general reassurance statements (e.g., “everything will be OK, you have nothing to worry about"). No one can predict the future or give this guarantee. These types of statements minimize feelings and make children feel their concerns are not valid. Rather, focus on what is in your control. Discuss how schools are taking precautions and how students can minimize risk (distancing, hand washing, masking).
 
Practice Relaxation Strategies. Do slow calm breathing with your child/teen daily Practice with a mask on if a child is returning to school.  Have time to just relax and reset at the end of the day. in through the nose, out through the mouth with a longer exhale. Finally, Monitor signs for stress and anxiety.  (See https://parentsupportduringcovid19.com for more relaxation techniques including Progressive Muscle Relaxation, Guided Imagery and Grounding).
 
Try the STOP Technique: 
S (Scared) What is going on in your body? 
T (Thoughts) What are you thinking?
O (Other thoughts) What is something else you can think?
P (Praise & Plan) What is something nice to say to yourself? What can you do next time? What is good? What can you control?  What can you control? What is good in new routine?
(https://www.pbs.org/parents/thrive/help-children-cope-with-back-to-school-anxiety)
 
 
3. Problem Solve and Prepare
Discuss the plan for school days. Encourage proactively talking about potential problems and issues. Identify what worked and what did not work well last spring (particularly if online learning was challenging). Ask your child/teen, “how can we make this a better experience?” and come up with specific changes to try.
 
Problem solve together. Listen and consider all suggestions. Don’t immediately dismiss what is said. Offer your own practical suggestions for change. Evaluate and point out what is working and make changes as needed. Troubleshoot together. This will help children feel some control and practice coming up with ideas and changes to make learning work better. Monitor stress (for you and your child). Remember the big picture, children learn best when calm and emotionally regulated. This is an unusual time and everyone needs more compassion.
 
Role play or rehearse potentially stressful situations (e.g., what to say when someone gets too close at school, technology issues, how to express frustrations or ask for breaks). Practicing how to handle potentially difficult or upsetting situations will help you and your child stay calm. Come up with a notecard of calming options when a child starts to get frustrated or visual cue to ask for a break. Talk about what might happen, there will be difficult moments and new challenges. Talking about it and identifying what to do before a problem occurs will also build problem solving and emotion regulation skills so that everyone can better manage challenging moments. (See also: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/kids-covid-19/art-20482508).
 
4. Set Your Child Up for Success
 
Schedule and Routines. Establish a schedule together for work and relaxation time. Schedules provides structure and predictability (make simple visual schedule with built in “down time”/free choice times).  Create and maintain consistent morning routine and bedtime routine. Keep these as consistent as possible. Consistency and predictability help reduce anxiety. Use visual schedules or checklists to promote independence.
 
Adequate sleep, good nutrition, and exercise daily are important for health and absolutely protective during stressful times. (See also
https://www.unicef.org/coronavirus/supporting-your-childs-mental-health-during-covid-19-school-return).
 
Keep online activity safe. Check that your child’s device has the privacy settings are on. Keep webcams covered when not in use and set parental controls, including safe search. Use a common area or check in when you can. Encourage children to be kind and respectful to classmates and to tell you about any bullying or inappropriate contact or interactions. See Tips and Scripts for Managing Screen Time When School Is Online at https://www.commonsensemedia.org/blog/tips-and-scripts-for-managing-screen-time-when-school-is-online-0.
 
Model Resiliency and Healthy Coping. Be careful what you say. How you talk about school sets the tone. Be aware about the impact of complaining about your frustration and concerns in front of your children.  Rather than complaining and venting in front of your child, acknowledge their feelings and help them look for some positive, alternative ways to view their situation. Use “and” rather than “but” to accept both thoughts (e.g., “you feel __because __, but you get to ___). Practice deep breathing to calm the nervous system and relaxation strategies daily. (See https://childmind.org/article/how-to-avoid-passing-anxiety-on-to-your-kids/).
 
Remember how you handle your anxiety, your own stress, and how you act throughout the day will strongly influence how children react and think about their own situation. Take breaks when you are able, even short breaks to calm or self-care, so you can connect, be present, and enjoy positive moments with your child during each day.
 
As much as possible, children need to feel safe, secure and positive about their current circumstance and the future. Even in a pandemic. Please seek support from schools, your pediatrician, or a therapist if you or your child are struggling or you need more strategies to manage anxiety or learning.  Please contact us if you need more support or help. 

At many times throughout life, people will want to change something about themselves. Whether it’s weight, a character “flaw”, how they view things or think, or an unhelpful habit. Then there are times when others think that we need to change something and we just don’t see it. Either way, it’s important to understand the Stages of Change model. By understanding this model, you will have a better understanding as to which stage you or someone you know is in. This insight could help give you the push you need to make the change or help you to accept where you or others are at in the process. 
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The Stages of Change is a model that was introduced in the late 1970s by researchers James Prochaska and Carlo DiClemente. This model has been found to be an effective aid in understanding how people go through a change in behavior. It’s important to note that change occurs gradually and relapses are an inevitable part of the process. 

Stage 1: Precontemplation 
    People in the precontemplation stage of change aren’t even thinking about changing. They don’t see that there is a problem to begin with. Dr. DiClemente referred to the reasons to be in precontemplation as the “Four Rs”. 

1. Reluctant precontemplators: Those that lack the knowledge or desire to even want to consider change. The impact of the problem hasn’t become fully conscious. 
2. Rebellious precontemplators: Those that have a heavy investment in continuing the behavior and in making their own decisions. They do not want to be told what to do. 
3. Resigned precontemplators: Those that have given up hope about a possibility of change and the problem seems too overwhelming. These individuals have made many attempts to change. 
4. Rationalizating precontemplators: Those that have all the answers and lots of reasons to continue the behavior. The behavior is a problem for others but not them. 

Stage 2: Contemplation
    People in this stage are willing to consider the possibility of changing the behavior. Those in this stage are highly ambivalent. They are often interested in learning about how to change their behavior and have reasons for changing their behavior but still can’t make a decision to change. These people often tell themselves and others that “someday I’ll change”. 

Stage 3: Preparation
    Those in this stage make the decision to change/stop the behavior. In this stage the person is making the plans to change. Not all ambivalence is resolved yet but it’s no longer a huge barrier to change. In this stage, people will make a serious attempt to change in the near future. 

Stage 4: Action
    People in this stage of change put their plan into action. This stage often includes some form of public commitment to change the behavior in order to get external confirmation of the plan. The person may avoid previous triggers, reach out for help, or take other steps to avoid temptation. This stage normally takes three to six months to complete. 

Stage 5: Maintenance
    In this stage, a person is able to maintain their changed behavior over a sustained period of time. The real test of change is long-term sustained change over many years. In this stage a person is building new patterns of behavior that continue on its own momentum with little outside intervention.


Stage 6: Relapse
    In any behavior change, relapses are a common occurrence. The key to success is to not let these setbacks undermine your self-confidence. If you lapse back into old behaviors, ask yourself why it happened. Sometimes people begin to relax their guard and they think that they have control over it. It is not uncommon to relapse and go through the Stages of Change several times. But slips give people the chance to learn and grow. 

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