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Archive for May, 2013

phone calendar

Currently I work with a teen who has tremendous anxiety, specifically when in school. His anxiety presents as fear of certain individuals in the school who he believes are threatening (school police officer, vice principal, etc), and an overall feeling of being unsafe in the school environment. When in my office, this young man can recognize these negative automatic thoughts (“I’m not safe…someone is going to arrest me”) and re-evaluate them (by recognizing they are unrealistic beliefs based on fear, not on fact). However, when on his own and in the moment, he still struggles to recognize and then reevaluate these negative and debilitating thoughts – Thoughts that greatly impact his ability to function and be successful in school.

With that said, here is my next step intervention for this young man: PHONE OR IPOD, with TIMER, set incrementally throughout the day with reminders of time elapsed (time left), cue to recognize negative thoughts and reevaluate them, positive and empowering self-statements, cue to get support from safe school individuals, etc. Preferably the technology can be set on a vibrate mode, to avoid disruption. Also, it would be important to make school staff aware of this intervention beforehand.

Here’s what it might look like.

TIMER GOES OFF – “4 hours left: Your halfway through the day. Take 5 deep breaths (hold them in your chest and slowly let them out). Recognize the negative automatic thoughts and REVALUE THEM (as facts or beliefs/have these thoughts been true in the past?/what makes you feel they are true now?/is it possible your mind is making something feel stronger or more likely than it actually is?/etc). YOU CAN DO THIS. YOU’VE DONE IT BEFORE, hundreds of times. Ask for help when you need it.

TIMER GOES OFF – “3 hours left: There are people here who care about you and want to support you. You’ve gotten through this day safely. Recognize your negative automatic thoughts. How are these thoughts making your body feel? Revalue what is belief and what is fact. You cannot predict the future. Just complete one class at a time.

TIMER GOES OFF – “2 hours left: Your almost home. Focus. YOU ARE SAFE. You can do this and have done it hundreds of times. Do SSS54321 grounding exercise. (Sights, sounds, sensations).

TIMER GOES OFF – “1 hour left: You’re so close. Picture yourself walking through the doors, heading towards home, dropping your bag as you get through the door, listening to music in your room, and relaxing. You made it.

TIMER GOES OFF– “GO HOME. YOU’RE SAFE. YOU MADE IT! YOU DIDN’T LET YOUR THOUGHTS DEFEAT YOU.”

Above is just an example of how this might work. This intervention is a built in support/trigger to use skills, that the individual can rely on when they cannot rely on themselves. This should be done for each individual differently and should speak to particular insecurities/anxieties that have been previously identified.

As always, let me know if you use this idea and how it works for you or your child. I’ll keep you posted as to this young man’s response.

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We trust our minds to give us the answer to life’s unknowns. We do this because it’s really the only tool we have. And yet, we rarely question the mind’s accuracy. We listen to our thoughts, allowing them to dictate what we can and cannot do. We allow our thoughts to create a reality that often limits us from reaching our full potential in school, in relationships, in personal goals, in everything. In doing this, we allow our thoughts, to dictate our beliefs, which then dictate our behaviors (thoughts->beliefs->behaviors, this is Cognitive behavioral therapy 101). We all do it.

Below are two engaging articles which discuss examples of the brain being wrong. In the case of world class cyclists, scientists misled riders during a “personal best” physical assessment into believing they were competing against their previously set personal best time (in actuality, the on screen avatar they were competing against was a few seconds faster than their personal best).
The second article discusses an example of the “4 minute mile” and how physiologists said it could never be broken… until it was. This article provides some positive psychology advice and insights, along with some cognitive behavioral techniques.

Cyclist beating their “best” times:

http://www.nytimes.com/2011/09/20/health/nutrition/20best.html?_r=0&pagewanted=print

The impossible “4 Minute Mile”:

http://zenhabits.net/heal/

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Headphones Before Big Game. Why?

Think of every pre-game show you’ve seen on tv in the last few years. Look at the players as they sit in the locker room or on the team bus or as they walk through the arena hallway before the game. Anyone remotely into competitive sports has witnessed the frenetic energy that radiates around the players as the minutes before the game tic away. Notice how many of the players are wearing headphones – presumably listening to music, certainly trying to make their overwhelming world smaller.
Now imagine your child (anxious to begin with) walking into his/her first baseball/track/basketball/social skills group/art lesson/new school lunchroom/etc. Maybe these players are onto something. Maybe this minimizing of outside auditory distraction (and control of what sound comes in and at what volume) is a valuable strategy that we need to pay more attention to. If you ask the players why they do this pre-game ritual, they’d probably say something like – “It helps me focus…keep my mind from getting distracted”. But I think it does more. I believe that the headphones reduce the amount of exposure to outside stimuli. And in doing so allow the players to remain more attuned to their bodies. Thus more regulated and able to take on the task ahead.
If you want to test this hypothesis out, put in a pair of earplugs and sit on your bed. Breath in and out slowly and deliberately. You’ll soon notice the sound of your heart beating, your lungs inhaling and exhaling, and you’re body slowly settling down.
If we’re thinking about a tool for new or uncomfortable situations, it may be worth giving headphones/earplugs a chance. It certainly seems to be doing something for these players.
When trying this with your child, use the picture above (or one like it) as an example. This provides a visual of cool looking superstars using the tool we are asking our kids to try.

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Steven is 9 years old. He is small for his age with dark hair and an active little body. Steven loves Sponge Bob, Angry Birds, and anything that allows him to get on the floor and play with toys (set up in a carefully organized way).
During play sessions, I began to notice that after all the toys were placed in their proper spots, Steven would become visually overstimulated (every inch of floorspace spoken for by a small toy). When overstimulated, Steven would begin throwing the toys all over the room while yelling loudly and physically jerking his body. After two to three weeks of seeing this pattern (2-3 times), I decided to communicate my expectations for play with Steven visually (previously just verbally). I also decided to simplify my toy collection when Steven was present. I cartooned the event both for a visual reference for Steven and also to see if he was in fact comprehending the expectation (Steven is largely non-verbal but can write and read).
Following another instance of toy-throwing, I collected all the toys and placed them in a black bag. I then placed the bag out of reach and went up to my whiteboard to cartoon what happened in a sequential (step-by-step way) visual.
b's process
– Disregard the drawings located on either side of the squares. They are unrelated and came after the cartoon intervention. Follow the line.

The initial Cartoon, which displayed what occurred and the obvious consequence was left without words. Upon reviewing the cartoon with Steven, he picked up a marker and began to fill in dialogue. In the first cartoon square, Steven wrote “Good Job”- the picture of he and therapist playing nicely with the toys. In the second square, Steven wrote “Angry” in the thought bubble above his head (also drawing many toys being thrown). Therapist filled in the other wording like “No throwing”. Steven then requested to take the cartoon home. In the next weeks session, we had the cartoon out to be viewed as a reminder of expected behavior. He has not thrown toys since.

I am continually reminded of the importance of taking the next (visual) step in processing information. This cartoon gave Steven a chance to show me and more importantly his mother, that he understood what was expected of him. He communicated in a real way. When he picked up that marker and began filling in appropriate dialogue, we were speechless. I hope this technique for setting expectations continues to be effective for this boy. If so, it will significantly help his mother in a very functional way.

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