Parent and Child Psychological Services of Sarasota

Teen Dating Violence Part 2: How to prevent it and respond to it By Rachel Funnell, LMFT

5/16/2022

As a parent or caregiver to a teen, you’re a vital part of helping them develop healthy relationships and build up their confidence in order to leave unhealthy ones. During the pre-teem and teen years, it’s important to help your child learn the skills needed to create and maintain healthy relationships. This includes learning how to communicate and manage feelings in a healthy and appropriate way. As a parent or caregiver, you want to start conversations with your child. You want to include the basic, healthy elements of a relationship in the conversation, i.e.: respect, communication, trust, boundaries, honesty and equality.

Discussion points for pre-teen and teens prior to dating:

Teach about consent:
- Consent means asking for permission to do something and accepting the answer.
- Give examples of consent that are relatable to them.
- Help your child practice asking for consent and accepting rejection in everyday ways
- Teach them how to ask for consent
- Model asking for consent
Talk Openly
- Children get a lot of different messages about relationships from TV shows, movies, social media and friends. Be involved, as much as you can, with the different shows they watch or the people they follow. Use moments from the shows and who they follow, to have a conversation about what they think about what happened in it or what that person did.
- Let your child know that they can come to you with questions about relationships.
- Answer their questions honestly and encourage them to continue to have conversations about respect and safety.
Talk about dating
- Ask, “what do you look for in a dating partner?”
  - Treats you with respect
  - Understand your needs and individual goals in life
- Discuss how it’s okay to disagree in relationships as long as they feel they can have an open and honest conversation about their feelings.
- Discuss the need for them to be able to freely express themselves, share their opinions and make decisions that are best for them.
- Discuss how a partner will respect what they wear, who they see and where they go.
- Discuss how they would feel and what they would think if the person they are dating asked them to stop doing something that they loved.
  - Discuss how in a healthy relationship a partner will support their hobbies, friendships, family and coworkers.
  - Give examples of what an unsupportive partner would look like. I.e.: make you stop a sport or club, tell you to stop seeing friends or family, or pressure you to skip class or work.
- Discuss boundaries around money.
  - Who should pay for things?
  - How often do you pay for things?
  - Do you feel pressured to pay for or buy things?
- Discuss boundaries in general
  - How often should you call/text/contact your partner?
  - What do you do if your partner wants space?
  - What do you do if your partner isn’t respecting your boundaries?
  - Discuss not only physical boundaries but also emotional and digital boundaries.

If you suspect that your pre-teen or teen is currently involved in an unhealthy relationship it’s important to know how to start the conversation and support them. Starting the conversation is one of the best ways to help create a safe space for your child to share their experiences and ask for support. Important points to keep in mind when having the conversation include:

Give support: Teens fear that their parents will overreact, blame them or be angry. It’s important to be supportive and non-accusatory or judgmental about the relationship. You can ask your child how they want to be supported and how you can help.
Validate, empathize and create a space where they feel safe: If your teen tells you they feel like their partner is pressuring them to do things they don’t want to do, you can respond by saying “That sounds like a really hard thing to go through. Feeling like you're not being respected and forced to do something can bring up all kinds of difficult emotions. What happens when you try to talk to them about it?”
- Let them know that their feelings are valid, boundaries are healthy, and respect is important in a relationship.
Accept what they are telling you: It’s important to believe them, even if what they are telling you is hard to hear. If you show skepticism or disbelief, it can make them feel unsupported and isolated. Tell them, “thank you for being honest. I believe you and what you’re describing sounds like unhealthy behavior which could lead to abuse - what you are feeling is valid.”
Talk and focus on the behaviors, not the person involved: Remember that your teen may still have feelings of love, connection or compassion for their partner and this is normal. Instead of saying, “Your partner is controlling you”, say “The behaviors you’re describing sound very unhealthy.”
Avoid ultimatums: Resist the urge to tell them to break up with their partner. This will only cut them off from support and they may be less likely to trust that you’re a safe person to talk to in the future.
Decide on the next steps together: Ask them what they feel comfortable doing next, what can you do to support them and what would be helpful.
If you believe that there is a need to take immediate action due to safety, you reach out to create a safety plan and speak with advocates www.loveisrespect.org/personal-safety/create-a-safety-plan/.

https://www.loveisrespect.org/supporting-others-dating-abuse/

www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html

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Stop Asking Questions! The Top Tip for Getting Your Kids to Share More Information by Tara Motzenbecker, LMHC, NCSP

5/6/2022

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Rehearsal and Shaping: Ways to Help Children with Selective Mutism or Social Anxiety Face their Fears By Kate Gibson, PsyD, ABPP

4/21/2022

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Children with Selective Mutism can be chatterboxes at home with gregarious personalities. When anxious, which often happens outside the home, they can look frozen and unable to speak. Sometimes this means they fly under the radar at school because they are not causing problems. Other times it is clear to everyone that the child does not talk, which can lead to worries about developmental delays and a reputation as the kid who does not talk. Children with social anxiety disorder may have an easier tome speaking outside of the home but can freeze when in attention is on them. This happens with peers and adults. Social anxiety impedes children’s ability to do things such as raise their hand, take photos, wave or smile at a friend, eat lunch or snack or use the bathroom.

Getting therapy early can be critical for helping children with these anxiety disorders tolerate their anxiety and regain their voices. We know that children whose anxiety is significant enough to meet a diagnosis for SM or social anxiety disorder do not tend to just outgrow these struggles, and that each day they practice not talking or not participating their worry links with those behaviors get even stronger. Parents can use the same ideas and strategies the therapist will use to help their child with their brave talking and participating outside the home.

The ideas discussed here are drawn from Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM) developed by Dr. Steven Kurtz and the behavioral theories on which it is based. PCIT-SM uses positive reinforcement in the form of verbal and tangible reinforcement and has been used to successfully treat both SM and social anxiety disorder. Verbal reinforcement is given through specific paise for the child’s brave talking or participating and reflecting or repeating what the child says. Tangible reinforcement is given in the form of stickers for each brave statement or action and a prize for earning enough stickers. But “how do we get them talking and participating in order to be able to reinforce them for it?” you might ask.

Two important and connected strategies for helping children face their fears that both come from behavioral theory are rehearsal and shaping. So, what do these mean and how do you use them?

Rehearsal means practice! If you want your child with SM to order their own donut, they will need to practice first. If you want your child with social anxiety disorder to wave at their friend as they walk up to the school building, they will need to practice first. They will likely need to practice many times. Do not underestimate the power of practice in getting your child ready to face a new challenge with their brave talking or participating. Rehearsal could mean practicing with you multiple times, it could mean practicing with a bunch of different people, it could mean practicing in a bunch of different places. You might be wondering “what is the best way to approach this rehearsal?” That is where shaping comes in.

Shaping is used to establish a behavior that does not currently get performed. It involves breaking the ultimate goal down into smaller steps to take toward that goal. Shaping is a process of taking small steps starting with a lower difficulty action and gradually increasing the difficulty working progressively toward the ultimate goal. You want to wait until your child has more confidence with the step they are working on before increasing the difficulty. If you take things a step harder and your child is completely unable to do it then you probably need to break the steps down into smaller steps toward their goal. There are many different ways to use rehearsal and shaping. Here are examples that walk through possible steps for the donut and waving situations referenced above.

SM example- ordering a donut

Start by finding out what flavor donut your child would like to order. In this situation getting the donut itself could be the larger reward, however long that takes. Have your child practice ordering with you acting as the person at the donut counter. Have your child practice with other adults they are already comfortable speaking to. If your child does not speak to anyone else, have them practice ordering from you in gradually closer proximity to people they know and are comfortable with. Then practice in gradually closer proximity to less known people or strangers. Then practice ordering from you on the way to the store, in front of the store, and maybe that’s it for that day. When your child is ready to speak inside the store practice right inside the door to the store, practice in line, and practice in front of the person at the counter. It may take several trips to the store before they get that donut. They can earn other small prizes for their hard work on days they are not ready to order the donut themselves but save that donut for when (not if) your child is able to order that donut!!

Social Anxiety example- waving hello to a friend walking up to the school building.

Select the friend your child wants to work on waving to. Have your child pretend you are the friend and at home practice walking up to school with their backpack on and waving at you as the friend. If even with you they need to work up to raising their hand to shoulder height, then having them start by waving their hand with their arm still long by their side, then with their elbow bent a tiny bit, then gradually raising their hand higher and higher. If you are using stickers, you can put a sticker on your finger and raise the sticker as high as you want their hand to go each time. Practice outside of school with other people – kids and adults they are comfortable with. Go to the school building on the weekend and practice in multiples spots out front when no one else is around. Practice in the car on eh way to school or on the walk to school. If needed, practice waving directly to the friend starting with just moving the outstretched hand with the arm still by their side and over a few days or however long is needed gradually lift their arm higher until finally the friend is able to see the wave.

I use the word “when” not “if” because with enough practice and small enough steps, they will get there!! If this ends up feeling to daunting or overwhelming to try on your own reach out to an child anxiety therapist to assist you. There is help for childhood anxiety. Your kids can learn to be brave and you can learn to be there coach to help get them there!

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Teens and Panic attacks: What they are and what to do By Dr Kirsten Ellingsen

3/17/2022

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Anxiety is a normal and expected part of life. It keeps us safe when there is danger or a threat of danger. It occurs for common reasons at different developmental stages of life. Anxiety can also be a problem when it is frequent, exaggerated, and negatively affects functioning and participation in daily activities. It can also reach a level that meets criteria to be diagnosed as an anxiety disorder.

The emotional and physical response of anxiety is panic. It is the Fight-Flight-Freeze body response to perceived danger. The brain signals the amygdala to activate adrenaline and stress hormones that can help a person survive danger. It is an automatic response and useful when there is an actual threat of danger. (See the video for teens from Anxiety Canada to explain the fight or flight response to anxiety for teens: https://www.anxietycanada.com/articles/fight-flight-freeze-anxiety-explained-for-teens/).

What is a panic attack?

A panic attack is a “sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause” https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021. They are common and almost 1 in 4 adults will experience at least one in their life.

It “is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms…[a teen might feel] feel overwhelmed by an intense fear or discomfort, a sense of impending doom, the fear of going crazy, or sensations of unreality. Accompanying the emotional symptoms may be shortness of breath, sweating, choking, chest pains, nausea, dizziness, and numbness or tingling in his extremities. During an attack, some teens may feel they're dying or can't think.” (From: Your Adolescent - Anxiety and Avoidant Disorders. American Academy of Child and Adolescent Psychology.
https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/Your_Adolescent_Anxiety_and_Avoidant_Disorders.aspx)

Symptoms of a panic attack include:

Pounding or “racing” heart
Sweating
Shaking or Trembling
Difficulty breathing
A feeling of choking
Sense of impending doom or danger
Chest pain or discomfort
Stomach pain or nausea
Fear of loss of control “going crazy” or dying
Shortness of breath or tightness in your throat
Chills
Nausea
Abdominal cramping
Headache
Weakness or dizziness, lightheadedness, or faintness
Tingling or numbness in the hands and fingers
Feeling of unreality or detachment

(https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021; https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms https://www.webmd.com/anxiety-panic/guide/panic-attack-symptoms)

It is a sudden experience of intense anxiety (the physiological symptoms) with or without an apparent cause. While anxiety also produces these symptoms, in panic attacks the psychological sensations are dominant. They are sudden and abrupt in onset. They usually peak within 10 minutes and are over in 30. Panic attacks usually seem to come out of nowhere (rather than triggered by a specific fear). While not dangerous, the physical symptoms can be so concerning a person ends up in the emergency room to assess for a heart attack.

After a panic attack, a teen might avoid situations that might trigger another panic attack including daily expected routines and activities. A panic attack can occur for no apparent reason. They are a problem when panic attacks are frequent, are unexpected, and extended time is spent in fear of another attack indicating a potential Panic Disorder. Panic attacks might occur in different anxiety disorders (e.g., Social Anxiety Disorder triggered by feared social situations or occur with specific phobias and Generalized Anxiety Disorder).

A panic attack can occur when a teen has an anxiety disorder but does not always indicate that the teen has a Panic Disorder or that a teen meets diagnostic criteria for any Anxiety Disorder.
A teen can experience one or two panic attacks in a stressful time, but then not again after a stressful circumstance is over. Yet, once experienced, a teen might start to get anxiety thinking about the possibility of another panic attack (anticipatory anxiety).

What can a teen to do manage a panic attack?

Cognitive Behavioral Therapy (CBT) is a form of research supported treatment for anxiety and panic attacks. (This focuses on the interconnection between thoughts, feelings, and behaviors). Medication is sometimes warranted when the level of anxiety reaches criteria for a Panic Disorder or Anxiety Disorder and is negatively and significantly affecting the daily life and functioning of a teen. (See: https://childmind.org/article/panic-attacks-best-treatments/).

Teens can learn relaxation strategies and breathing techniques to help in the moment. Calm breathing and Progressive Muscle Relaxation are important tools to learn and practice. Mindfulness, acceptance strategies and exposures are also helpful. Teens can also work with a therapist or find resources to identify thinking patterns that increase anxiety (e.g., catastrophizing) and help them address specific thoughts that can trigger or increase feelings of panic. Both strategies are important because the more a teen focuses on the physical sensations and catastrophizes the meaning of the symptoms, the more adrenaline and stress hormones are released and this can extend the panic experience.

How can parents help?

Listen to your teen and provide opportunities to talk about fears and anxiety. Normalize anxiety about social interactions, physical appearance, and uncertainty with the future as well as acknowledge anxious feelings in high stress circumstances. Know the facts about anxiety and panic attacks to share.

Facts about anxiety: (From https://www.anxietycanada.com/articles/home-management-strategies-for-panic-disorder/).

Fact 1: Anxiety is normal and adaptive, as it helps us prepare for danger.
Fact 2: Anxiety can become a problem when our body tells us that there is danger when there is no real danger.

Facts about panic attacks:

They are the fight-flight-freeze response
This response can occur even when there is no real threat of harm or danger
Panic attacks might feel scary and are uncomfortable, but not dangerous
They are brief (usually 10-20 minutes)
Other people cannot tell you are having a panic attack
People tend to breath faster when anxious yet get in less oxygen which can make them feel dizzy or lightheaded. This can increase feelings of anxiety. Slowing down and breathing deeper through the nose and out of the mouth can help move through anxiety and relax.

Encourage learning and practicing relaxation strategies. Help teens identify and examine specific thoughts and patterns of thinking that increase feelings of panic. If panic attacks are frequent or the fear of having another panic attack is interfering with your teens ability to attend school or participate in social interactions, hobbies, or otherwise enjoyable activities please talk with your pediatrician or reach out to a therapist specializing in child and adolescence populations for support.

Additional References and Resources:
https://kidshealth.org/en/teens/anxiety.html
https://www.anxietycanada.com/articles/child-and-teen-panic-disorder/
The CBT Workbook for Panic Attacks, Elena Welsh, PhD

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How to Make Time-Out Work By Tara Motzenbecker, LMHC, NCSP

3/10/2022

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Teen Dating Violence: What does it look like? Part 1 By Rachel Funnell, LMFT

3/5/2022

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Teen dating violence is never a subject that parents want to even think about or even believe could affect their child. However, it affects millions of teens in the US. The following are some statistics to give you some perspective.

Data from CDC’s Youth Risk Behavior Survey reported that among US high school students who reported dating during the 12 months before the survey:
- 1 in 12 experience physical dating violence
- 1 in 12 experienced sexual dating violence.
The National Sexual Violence Resource Center (NSVRC) reported:
- Over 71% of women and over 55% of men first experienced intimate partner violence (sexual or physical violence, and/or stalking) under the age of 25.
- One in four women first experienced intimate partner violence prior to the age of 18.
- Over 80% of women and over 70% of male rape victims experienced their first completed or attempted rape under the age of 25.
- Sexual violence is usually committed by someone the survivor knows. Over 28% of girls who experienced sexual violence under the age of 18 were raped by a current or former intimate partner.
- Youth who experience sexual violence as children or teens are more likely to experience sexual violence in adulthood. Thirty-five percent of women who were raped as minors were also raped as adults, compared to 10% of women raped as an adult who were not raped as minors.

These statistics are very sobering and it poses the question “How do I know if my teen is experiencing teen violence?” First, it’s important to know exactly what teen dating violence is. It’s defined as a pattern of coercive, intimidating or manipulative behaviors used to exert power and control over a partner. According to the CDC, this includes the following:

Physical violence: a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force.
Sexual Violence: forcing or attempting to force a partner to take part in a sex act and/or sexual touching when the parenter doesn’t consent or is unable to consent or refuse. It also includes posting or sharing sexual pictures of a partner without their consent or sexting someone without their consent.
Psychological aggression: use of verbal and non-verbal communication with the intent to harm a partner mentally or emotionally and exert control over a partner.
Stalking: pattern of repeated, unwanted attention and contact by a current or former partner that causes fear or safety concern for an individual victim or someone close to the victim.

Most parents might think to themselves, “I would know if my teen was in an abusive relationship.” However, some of the warning signs may not be as obvious as one would think. Teen dating violence and abuse could look like any of the following:

A partner checking your teens phone, email or social media accounts without their permission
A partner putting down your teen frequently, especially in front of others
A partner isolating your teen from friends or family this could be physically, financially, or emotionally
A partner having extreme jealousy or insecurity (accusing your teen of cheating all the time)
A partner having explosive outbursts, temper or mood swings
A partner being possessive or having controlling behavior (monitors where they go, who they call or who they spend time with)
A partner pressuring your teen or forcing them to have sex
A partner that punishes your teen by withholding affection
A partner that expects your teen to ask permission before doing things
A partner yelling or screaming at your teen
A partner gaslighting your teen by pretending not to understand or refusing to listen to them
A partner constantly texting or calling your teen and/or making them feel like they can’t be separated from their phone
A partner showing up at place uninvited
A partner leaving unwanted items, gifts, or flowers
A partner using social media to track your teens activities
A partner blaming your teen for abusive or unhealthy behaviors
A partner threatening suicide if your teen doesn’t stay with them

It’s important to also be aware of changes in your teens' behaviors or appearance. Other warning signs to look for include:

Unexplained marks, bruises or injuries
Depression or anxiety
Decreased interest in extracurricular activities or other interests
Isolation from other friends and family
Changes in appearance including clothes, makeup or hairstyle

As a parent, this is a scary topic to talk about but it’s one that is extremely important to discuss. The more that you are aware of what to look for, the better chance you can help your child get out of this relationship. It’s also important to be proactive with your teens. Talk to them about the warning signs and the difference between a healthy and an abusive relationship. Teach your teens how to set healthy boundaries with others as well as how to be respectful and appropriate when dating. The more prepared your teen is, the better chance that they will not get into or stay in an abusive relationship or even be the one being abusive.

References

https://www.loveisrespect.org/dating-basics-for-healthy-relationships/dating-101/

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html

https://www.nsvrc.org/blogs/teen-dating-violence-prevention-resources-2022

www.dvs-or.org/what-is-domestic-violence

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Making Friends: Early Childhood and Elementary School By Kirsten Ellingsen, PhD

2/24/2022

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Making friends and building positive relationships with peers is an important aspect of life. Some children have an easier time developing friendships. Others have more difficulty making friends and maintaining friendships. All children need foundational social skills to be successful.

Different reasons might account for difficulty making and sustaining friendships. When a child struggles with communication or understanding social cues, experiences social anxiety, has difficulty managing impulsivity or experiences problems regulating emotions it can be even more difficult to connect and establish healthy friendships. See also the Child Mind Institute for more information https://childmind.org/article/kids-who-need-a-little-help-to-make-friends/.

In addition, during the COVID-19 pandemic, many children were at home and had limited access to peers. They might need additional support connecting to peers and re-establishing friendships. Children might experience apprehension and anxiety about making friends after being home and only playing with siblings. Social skills such as regulating frustration, cooperating, and focusing
might have been impacted during the past two years (https://www.nationalgeographic.com/family/article/your-kids-might-now-be-socially-awkwardand-theyre-not-alone).

As one elementary age child stated after returning to school in person, “Well dad, you have to be around other people to make friends”. So true. For tips to help your child returning to school make friends see this article on the PBS website: https://www.pbs.org/parents/thrive/helping-your-child-make-friends-again.

While you as a parent might not be able to make a friend for your child, you can help build and enhance social skills and provide opportunities to encourage this process. Supporting the underlying social skills that can establish and maintain friendships is particularly important when children are young.

Understood.org (https://www.understood.org/articles/en/4-skills-for-making-friends) outlines 4 foundational skills for making friends as: 1) Starting Conversations 2) Interpreting Social Situations, 3) Interacting Positively and 4) Listening to Others.

According to an article by Dr. Candy Lawson, a clinical psychologist at the Center for Development and Learning, (https://gostrengths.com/social-skills-and-school/) children need to be able to initiate, maintain and end conversations. This includes knowing how to greet, start a conversation, understand the listener, take perspective or see the point of view of another person,
empathize, read verbal and understand non-verbal social cues, including tone. They also need to develop problem solving skills and be able to resolve peer conflict and appropriately apologize.

Parents can directly teach and build social skills by modeling behavior, role-playing, and practicing skills. Ask your child “What is a friend?” and talk about shared values, interests, and choice. Help your child identify the values and traits that are most important to him or her. Encourage participation in safe activities. Help your child find shared interests. Join clubs. Play a sport. Take a class. Set up play-dates and opportunities to rehearse skills. More tips are below.

Tips for Parents of Young children:

Take turns practicing how to make an introduction (including rehearsing non-verbal communication such as appropriate eye contact and smiling).
Coach and role play how to initiate a conversation and join play. If a child needs more support, develop a social script and practice together.
Use a toy or object to approach another child and ask to do an activity together. Role play asking questions or saying, “can I play?” to enter a game, or “do you want to ___(go down the slide, play tag, build blocks) ” to start a new activity that they can do together.
Encourage and model sharing and taking turns.
Use books to talk about emotions and learn how to identify feelings in characters. For a list of 15 books on friendship see: https://www.pbs.org/parents/thrive/childrens-books-about-friendship
Act out different emotions and take turns guessing from facial cues and body language.
Discuss and teach how to handle peer conflict without aggression.

For very young children see: https://www.zerotothree.org/resources/227-tips-on-helping-your-child-build-relationships

Tips for Parents of Elementary School Age Children:

Encourage learning and practicing how to introduce yourself.
Talk about the goal of conversations with peers. Encourage children to ask questions to get to know the peer better, find out if they have shared or common interests. Help children understand that more you talk, the more you will get to know if someone might be a person that you want to be friends with.
Practice how to keep conversations going using open ended questions. Practice asking related follow-up questions.
Try to find something in common.
Point out and build awareness about non-verbal communication.
Demonstrate and act out different emotions to help teach identification of emotions and facial and body cues. Talk about how different body language might be interpreted by others. Practice in the mirror.
Discuss and practice perspective taking. How would you feel if? How would you know if your friend was comfortable? Sad?
It can help to approach another child who is alone rather than in a group. Offer to help someone. Offer an invitation to join in an activity.
Focus on getting to know the new friend and take your time before rushing to be “best friends.”

Acknowledge that it takes courage to talk to someone new and make a new friend. Reflect and validate feelings and show confidence that your child or teen will be able to develop friendships. If your child is shy, this can be a challenge. If your child has an ASD or social anxiety, making friends might be even more difficult and require additional support and strategies.

It is important to understand your individual child and his or her needs and concerns about friendships. Some children are more introverted and like time alone. Other children want to make friends and have more challenges One or two good friends is all many children need. Check your expectations and what is reasonable and desired by your child.

Helping your Child Maintain friendships

Help your child identify behaviors that can hinder or end friendships. Talk about DO and DON’T behaviors.

DO: Communicate and spend time together. Be kind. Celebrate accomplishments and good news. Be empathetic. Listen. Take turns sharing. Ask about your friend more than telling about yourself. Support when something is difficult.

DON’T: Talking behind someone’s back. Being Bossy. Breaking a promise. Asking another friend to take sides. Leaving someone out. Being competitive or jealous of your friend. Embarrassing your friend.

If your child needs additional support to build social skills and develop friendships it can be helpful to reach out to your school counselor or talk with a child therapist for targeted strategies.

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Diving into the “C” in CBT: Exploring Techniques for Changing Your or Your Child’s Thinking By Kate Gibson, PsyD, ABPP

2/17/2022

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CBT is a common form of therapy short for Cognitive Behavioral Therapy. CBT focuses on the interconnection between thoughts, emotions and behavior. People participating in CBT learn to identify the thoughts that trigger their feelings and reactions. Oftentimes the thinking can be flawed, meaning inaccurate or unhelpful. Thinking errors can lead to or exacerbate anxiety and depression. One goal of CBT is to improve happiness and overall functioning by helping people catch their problematic thinking and begin to think about things in a different way. Before diving in to using a strategy to change one's thinking first identify the thought. Once you have the thought in mind there are various cognitive strategies that can help adjust your thinking, a few of which are explained here. The differences can be subtle but as long as you are working to ensure that your thinking is not making things harder for you then you are on the right track. If you are a parent of a child with inaccurate or unhelpful thinking, you can use these strategies to help your child work through their thinking. You can always seek the support of a CBT therapist for yourself or your child as well.

Cognitive Challenging
Cognitive challenging can often start with telling yourself that just because you’re having that thought does not automatically make it true. This technique involves testing the accuracy of your thought. Ask yourself if it is true. If you think it is true can you be sure it is true? What is the evidence to support this thought? If the thought seems to be inaccurate or lack support then challenge it with a thought that is more accurate or a thought you know to be true. If you are supporting your child in challenging their thinking you could have them interview several people to see how accurate their thought is compared to other people’s experiences. For example, if the thought were “all dogs bite” they could find out about people’s experiences with dogs where no biting has occurred. The new thought that they would use to challenge the original thought might be “many dogs don’t bite.”

Cognitive Restructuring
Cognitive restructuring is also referred to as reframing. Cognitive restructuring begins much the same way as cognitive challenging. Reframing or restructuring one's thinking, however, involves generating a more balanced thought which may be more elaborate than purely directly challenging the thought. It involves coming up with a thought that more fully explains the situation by also looking at the situation through a different filter. We may be bringing a negative or worried filter to our thinking so we are trying to see things through a more optimistic or resilient filter instead. In the example of the “dogs bite” thought, reframing that thought might lead you to something like “though it is possible for any dog to bite, most dogs are friendly and safe to be around, and dogs that are not comfortable around you give you signs that they are not comfortable.”

Cognitive Processing
Processing your thoughts involves looking for the meaning that you may be attaching to or that may be underlying your thoughts. Again first identify the thought causing you trouble. The type of thoughts that need to be “processed” are ones that are keeping you or your child stuck and holding you back. They have often become attached to negative beliefs about yourself. Processing is about asking yourself “what does it mean to me if that thought is true?” Processing is generally best done with the support of a CBT trained therapist.

Acceptance and Encouragement
Sometimes rather than changing your thoughts, accepting them can help you feel better. This means accepting the struggle you are having without feeling defeated by it. We can add on encouraging thoughts after our acceptance thought as well. If the thought was “this presentation is going to be so scary” the new thoughts could be “this presentation IS going to be scary AND I can do it.” Encouraging thoughts include thoughts such as “I can do it,” “I can handle it,” “I will get through it,” “I’ve got this.” Often adding the encouraging thought to the acceptance thought after the word “AND” helps you feel better able to handle the situation. These simple adjustments to how we are phrasing the words in our thoughts has the potential to make a huge difference.

Leaving Room for Thoughts to Change
Sometimes we can think in extremes that do not leave much room for the possibility of change. This approach is about tempering the thought with some key words. Maybe the thoughts are “this is always too hard” or “I can’t do it.” Adding words that make the thought less definitive can help leave room for the possibility of overcoming your struggles. You might add words like “yet” or “sometimes” so your thoughts become “sometimes this is so hard” or “I can’t do this YET.” This allows you or your child to believe in the possibility of success.

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Sarasota County Gifted Magnet Testing FAQs By Tara Motzenbecker, NCSP, LMHC

2/10/2022

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Treating Anxiety During Pregnancy by Kirsten Ellingsen, PhD, PMH-C

1/20/2022

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Anxiety during pregnancy is common. This is particularly true (and more likely to be higher) if a woman had past infant loss, miscarriage, infertility, or a history of anxiety pre-pregnancy. Worry about the health and viability of a baby, delivery, role changes, as well as financial and relationship changes and demands, are real and can be expected.

However, when anxiety is interfering with functioning, causing distress, and persistent a women might be experiencing a Perinatal Mood and Anxiety Disorder (PMAD). In fact, PMADs are the most common medical complications of childbearing. They are under screened for and under treated worldwide.

Estimated rates from past studies found up to 1 in 5 (or 20%) of women experience a PMAD; understandably, these rates have started to be documented as even higher in the pandemic. Recent studies suggest significantly higher rates of depression, anxiety, posttraumatic stress symptoms, as well as feelings of isolation and loneliness for perinatal women during the pandemic. Anxiety in pregnancy has also been a predictor of postpartum depression. It is important that women are identified and provided the support needed.

The United Nations Children’s Fund estimates that there were 116 million births in the first ten months after the COVID-19 was declared a pandemic by the World Health Organization (WHO) (March 2020). Rates for PMADs remain high. When mood and anxiety disorders are not treated during pregnancy, there are adverse outcomes for the mother, child, and family. For mothers this might include increase in substance use, smoking, lack of medical care. Infants are more likely to be preterm, lower birth weight. The relationship, attachment and bonding between a mother and her infant can be significantly affected. It can affect spouse or partner relationships and family functioning. Yet, there are research supported “evidence-based” treatments to help significantly reduce symptoms of anxiety and depression during the perinatal period (conception to one year after birth).

One such approach that aims to treat anxiety during pregnancy is Cognitive Behavioral Therapy (CBT). CBT focuses on the inter-connection between thoughts, feelings, and behavior. It is based on the view that how you think affects how you feel. To feel better a person needs to think “better” or in a more balanced and realistic way. The focus is on increasing awareness of thoughts and how they affect feelings and behavior. This is not ignoring or dismissing feelings. The goal is to build awareness of automatic thoughts and thought patterns that are inaccurate, overly negative, unproductive or unhelpful. It helps a person replace unhealthy and anxious thinking with more helpful and accurate thoughts.

With CBT, pregnant women with anxiety learn calming and relaxation strategies (Diaphragmatic breathing, Progressive Muscle Relaxation, Mindfulness, Guided Imagery) and cognitive coping strategies to identify, examine, and modify thoughts. Techniques to evaluate and change negative, inaccurate, or unhelpful thoughts or thinking errors are taught and practiced. Typical unhelpful cognitive distortions or thought patterns for anxiety include catastrophizing (“what if” thinking for the 1% uncertainty), predicting the future, jumping to conclusions without all the information, dismissing the positive and focusing on the negative. These are also connected to deeply held beliefs about the world, self, and interpretations about situations. It intends to help build skills to effectively manage and reduce anxiety symptoms. Self-care, practice goal setting, and support are also essential for helpful treatment pregnancy women in therapy. When loss or trauma has been experienced, women need additional grief processing and support.

If you or someone you know is experiencing a PMAD, please reach out for help and support. The earlier the better. Cognitive Behavior Therapy (CBT) is one “evidence-based” treatment; providers who are certified or advanced trained in EMDR and Interpersonal Therapy (IPT) are also excellent resources for depression and birth trauma and loss. Training providers can be found in the provider directory at the Postpartum Support International website https://www.postpartum.net/get-help/provider-directory/. When symptoms are not helped with therapy, medication might we warranted and safely prescribed by psychiatrist trained to support Maternal Mental Health (MMH).

If you have questions or concerns, please reach out to a provider trained in MMH, talk with your OBGYN, pediatrician, primary care provider, or contact us to discuss how you can access support. Taking care of yourself is taking care of your baby. There are both formal therapy and informal support groups that can help. You are not alone. Please know that there are effective options for treatment and providers who can support you during pregnancy.

Resources and References:

Postpartum Support International: https://www.postpartum.net

Anxiety During Pregnancy: Options for Treatment By MGH Center for Women's Mental Health https://womensmentalhealth.org/posts/anxiety-during-pregnancy-options-for-treatment/How you can mange anxiety during pregnancy: https://www.health.harvard.edu/blog/how-can-you-manage-anxiety-during-pregnancy-202106252512

Guide: http://www.bcmhsus.ca/Documents/coping-with-anxiety-during-pregnancy-and-following-the-birth.pdf

What is Postpartum Depression https://www.therapistaid.com/therapy-worksheet/what-is-postpartum-depression

Anxiety Coping Skills: https://www.therapistaid.com/therapy-worksheet/coping-skills-anxiety

CBT Training for Therapists: https://beckinstitute.org/training/

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Parent and Child Psychological Services PLLC
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