What are the 4 Steps of the FEAR Plan?
- Feeling Frightened?
- Expecting Bad Things to Happen?
- Attitudes and Actions that can help
- Results and Rewards
4 major components of the Coping Cats protocol for treating children with GAD, SAD or specific phobias
Describe the F in the FEAR Plan
Feeling Frightened?
- Identifying that you’re afraid, take inventory of emotion and physical symptoms
- How do you know? Awareness of physical symptoms, feelings
Describe the E in the FEAR Plan
Expecting BAD things to happen? (what do you think will happen and examining evidence, are there thinking traps, build positive self talk)
- Identify and challenge faulty “self-talk”
- Test them, try out new ways to view situations, learn to review and reduce negative self-talk, apply coping self-talk
Describe the A in the FEAR Plan
Attitudes and actions that can help.
- Problem-solving: brainstorm actions to help change situation/reaction, plan a solution
Describe the R in the FEAR Plan
Results and rewards.
- Self-monitoring (SUDS) and contingent reinforcement (reward for effort rather than outcome)
What are the key components of an exposure hierachy?
o Many effective CBT programs for anxiety
– Common, key ingredient: Exposure
– Hierarchy-based exposure
o Keys to successful exposure
– Child’s engagement
– Clinician’s understanding of scientific theory
– Planning exposures
– Exposure to feared stimuli
– Adapting exposures for individual children
– Really trying them out: You can do it!
How do you create a fear hierachy?
- Review fear provoking cues
- Teach child to use SUDS (0-10) based on anxiety felt when encountered with each thought/situation
- Rank cues from least to most anxiety provoking: “Exposure Hierarchy”
– Usually a main theme, but can be related to one behavior (the bus) or broad (all fears of rejection)
– Be specific: If child is scared of talking to new people, break down into new kids never met, new kids met once before, a neighbor, new teacher, etc.
Peterman - Uses of Technology in Exposure
- store exposure
- track SUDS
- set alarm reminder
- audio and video for imaginal exposures at home
- be careful phone doesn't becme a safety behavior
- computer games or rewards post-exposure as a reinforcer
- Virtual reality -- can do a 3d simulaiton, shown effectivenss
What are some components in a Hassle Log?
Functions of a hassle log
(6)
○ teaching tool to help determine individual sequences to triggers, setting events, responses, and self- evaluation;
○ scripts for role plays
○ self-recording tool that serves as an alternative response to provocation;
○ way to teach self-observation and self-evaluative skills; and
○ a prompt for self-reinforcement for anger well managed and a generalization strategy for the introduction of treatment in naturalistic settings.
○ can be altered to fit any client population or treatment context and serves as an early compliance probe to assess an adolescent’s likelihood of following treatment recommendations/homework assignments.
Understanding of Patterson’s coercive cycle (in reference to ODD; 4)
- Parent and child train each other to act in aversive ways
- Child’s behavior worsens → parent loses control
- Reinforced if other withdrawals and/or gets what they want (positive reinforcement)
- Idea of winning the battle, but losing the war → fights will occur again and likely with a greater frequency
What are some examples of Patterson’s coercive cycle?
- Parent directs → child refuses → parent increases demand → child argues → parent backs off = child’s arguing is negatively reinforced
- Child whines → parent says stop → child whines more/louder → parent yells → child stops whining = parent’s yelling is reinforced
What does PRIDE stand for?
Praise,
Reflections,
Imitation,
Describe BEH,
Enthusiasm
Describe each PRIDE component.
-
Praise -- Labeled: specifically state what parent likes about child, play, etc
-
Reflections: Repeat or paraphrase what child says
-
Imitation: Do what child does in play
-
Descriptions -- Behavioral: Talk about what child is doing
-
Enthusiasm: Show excitement, interest
Name PCIT child directed interaction (CDI) skills
- PRIDE
- Avoid skills
-
Commands, questions, criticism/sarcasm
-
Effective commands (prompts)
-
Planned ignoring/differential attention
-
Positive play → special 1:1 time
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Commands, questions, criticism/sarcasm
-
Effective commands (prompts)
-
Planned ignoring/differential attention
-
Positive play → special 1:1 time
Components of effective commands, an avoidance PCIT skill
- Direct
- Single
- Positive Opposite (what to do)
- Specific
- Polite, firm tone (no yelling or begging)
- Developmentally appropriate
- Give choices when appropriate
- Only give when necessary
- Provide opportunity for compliance
- Labeled praise if comply; or repeat with warning
Components of planned ignoring/differential attention, an avoidance PCIT skill
-
Ignore inappropriate, non-destructive behavior
-
Avoid looking at, talking to, or engaging with child
-
Ignore each time behavior happens
-
Expect extinction burst!
-
Wait until child acts appropriately → enthusiastically praise behavior!
Ignore inappropriate, non-destructive behavior
Avoid looking at, talking to, or engaging with child
Ignore each time behavior happens
Expect extinction burst!
Wait until child acts appropriately → enthusiastically praise behavior!
Components of Positive Play, an avoidance PCIT skill
Set up (4) and rationale (5)
Set-Up:
1. What: creative, interactive toys, no pre-set rules, non-violent, non-messy
2. Where: Area without distractions → use table or floor
3. When: 5-15 minutes, set time → unrelated to behavior
4. How: Inform child when play will occur and that the child will lead play
Rationale:
1. Shifts from negative to positive attn
2. Parents can practice differential reinforcement (e.g., praise, ignore)
3. Practice in play helps generalize skills for more challenging situations
4. Can improve parent-child relationship & child’s self-esteem
5. Child will likely increase positive behaviors
Child can feel a sense of autonomy & control
Treatment components for ADHD in Verduin et al.
Strategies used:
- Behavioral parent training
- School consultation and educator behavioral training
- School-based contingency management
- Daily behavioral report card (DRC)
- Assess Tx gains
What are types of thinking traps?
-
· Catastrophizing: worst is going to happen
· All or Nothing Thinking
· Fortune Telling
· Discounting the Positive
· Mind reading
· Shoulds, can’ts
· Labeling yourself
· Make up names of your own traps
· Catastrophizing: worst is going to happen
· All or Nothing Thinking
· Fortune Telling
· Discounting the Positive
· Mind reading
· Shoulds, can’ts
· Labeling yourself
· Make up names of your own trapsDifferences between coach a and coach b
- Coach A
- “Oh NO NO NO! What are you doing? I can’t believe you missed that! Pay attention, come on kid, what’s wrong with you!”
- Self-criticism
- Coach B
- “That’s okay kid, good try! It’s alright. Now, the next time a ball is hit towards you, keep your eye on it, watch for where it’s heading, and move towards the ball. Okay? Let’s try it again, and do the best you can.”
- Self-encouragement
- “Oh NO NO NO! What are you doing? I can’t believe you missed that! Pay attention, come on kid, what’s wrong with you!”
- Self-criticism
- “That’s okay kid, good try! It’s alright. Now, the next time a ball is hit towards you, keep your eye on it, watch for where it’s heading, and move towards the ball. Okay? Let’s try it again, and do the best you can.”
- Self-encouragement
- One skill to teach adolescents in getting them to question and talk back to negative automatic thoughts and cognitive distortions
- The “contrasting coaches” analogy:
- The therapist may want to use the analogy of a hypercritical versus a supportive coach to illustrate the difference between excessive self-criticism and self-encouragement.