Hilber Psychological Services
Therapy for Children, Teens, & Adults in San Diego
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Hilber Psychological Services

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Posts tagged Cognitive-Behavioral
Parental Therapy for Children who have Anxiety

In the article, “New Childhood Anxiety Treatment Focuses on the Parents,” author Matt Kristoffersen discusses how Supportive Parenting for Anxious Childhood Emotions (SPACE) is an alternative to behavioral therapy used to treat childhood anxiety. He acknowledges that it all starts with the parents and how they perceive their child’s anxiety in the given situation.

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Stated by the National Institute of Mental Health, “nearly one in three American children will experience at least some kind of anxiety disorder before reaching adulthood.” Although drugs and therapy techniques have shown to be proven successful in the past years, a recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry, promulgates a new technique developed for the parents.

A team of Yale researchers randomly selected 124 children with anxiety and assigned them to a therapy-based group or a parent-only group for 12 weeks. In these meetings they were divided into two groups, one in cognitive behavioral therapy and one in SPACE therapy. They learned how to control their symptoms and confront their fears through therapeutic exposure. The researchers observed that children in the first group never spoke to a therapist about their specific anxiety during the trial. The researchers suggested that parents should support their child in a sense of letting them figure out how to cope with anxiety on their own, by using the SPACE treatment, rather than continuing to oblige to their child’s behavior. For example, “if a child gets anxious when there are guests in the house, parents may stop inviting people over. However, according to the study, children can grow accustomed to these accommodations over time, which can lead to greater difficulty with anxiety later in life.” In this case, parents should take a step back and “replace accommodation with words of support and with expressions of confidence in their children’s abilities to deal with anxiety on their own.”

In the first study administered in 2013, author Lebowitz prompted parents to follow a script of ways to be supportive and reassuring in order to reduce accommodations for their child with anxiety:

We understand it makes you feel really anxious or afraid,” the script said. “We want you to know that this is perfectly natural and everyone feels afraid some of the time. But we also want you to know that it is our job as your parents to help you get better at things that are hard for you, and we have decided to do exactly that. We are going to be working on this for a while and we know it will probably take time, but we love you too much not to help you when you need help.”

Through SPACE therapy, parents were able to form a much closer relationship with their children than those of the children in the cognitive therapy-based group and help them work on their anxiety problem. Because of this study, “SPACE will provide an alternative for children with anxiety who may not respond well to traditional therapy or who refuse to participate.”

For more information on therapy for anxiety with the parents or the children, or any other therapy, please contact us at Hilber Psychological Services.

-Written by Lily Schmitt and Tanya L. Hilber, PsyD

Reference

Kristoffersen, Matt.New Childhood Anxiety Treatment Focuses on the Parents.” Yale News. Scitech. Web. 26 March 2019. https://yaledailynews.com/blog/2019/03/26/new-childhood-anxiety-treatment-focuses-on-the-parents/?fbclid=IwAR1_yDjSIF9njsJ6ATplIrWwivPIqbj-OgqtehNYIxvfE85vrVkfTFoOj7k

The Cognitive Triad and Cognitive Distortion Part 2:  by Dr. Ben Alpert

In our last blog (Click here to read if you missed it) we found ourselves in math class and for some reason our friend wasn’t talking to us. We didn’t know why and so instead of just paying attention in class and then calmly asking them afterwards we tried to figure out what was wrong without any facts. We thought they might be angry at us, that we might have done something wrong or that something bad might have happened. Having these thoughts then led to a shift in our mood, now by creating those thoughts, we may be experiencing anxiety and depressive symptoms. Eventually these thoughts and feelings might lead to a fight with our friend or perhaps we may hold a grudge or stop talking to them altogether, simply because we created a false reality without any facts to support it.  This false reality is called Cognitive Distortion.

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Humans are psychologically lazy and so we put together bits and pieces of information without knowing the whole picture in order to save time. Sometimes this works out great, but without all of the pieces, this picture of reality becomes somewhat distorted or skewed and over time can lead to truly negative thoughts about ourselves and feeling intense emotions that start to control our lives. We become Mind Readers stating that we know what others are thinking and feeling without having any idea and so we become convinced that they have negative thoughts about us. We become Fortune Tellers, negatively predicting what the future holds and inhibiting our progress at work, school or in relationships and so we don’t try for that promotion or honors class or relationship.

Life hands us plenty of real problems and issues that we have to deal with, adding this extra layer of distorted stress and pain certainly doesn’t help any of that. Exploring these distortions places emphasis on facts rather than guessing what might be facts. It’s hard, but if we jump back to that classroom desk, we can say to ourselves, “I am not sure what is going on right now, but let’s focus on math and I can speak to my friend afterwards to find out what is going on”. Another great example of this in all of our lives is if we text someone and they don’t immediately text back. Maybe you did something wrong maybe not, but spiraling into depression and anxiety is not the answer and learning how to communicate without jumping to conclusions solves the majority of these dilemmas. If we simply change the first thought from negative to positive or even just neutral, we prevent the intense negative emotion and we stop the negative behaviors.

Deconstructing and limiting cognitive distortions is a difficult process but attending therapy can provide you with the skills to analyze your thoughts and feelings leading to diminished depression and anxiety as well as significantly less couple and familial discord. We will be happy to help you on this journey!

Be well,

Dr. Ben Alpert

To discuss this and other issues or behaviors in detail, contact us at Hilber Psychological Services. And if you want to read previous posts about cognitive distortion, click here

Burns, D. D. (1999). The feeling good handbook. New York, N.Y., U.S.A: Plume.

Greenberger, D., & Padesky, C. A. (2016). Mind over mood: change how you feel by changing the way you think. Second edition. New York, NY: The Guilford Press.

The Cognitive Triad and Cognitive Distortion Part 1: by Dr. Ben Alpert

During the first therapy session, I like to teach patients about the different styles of therapy that might help them depending on their specific problem or issue. Cognitive Behavior Therapy (CBT) is an orientation based on the Cognitive Triad, the connection between Thoughts, Feelings and Behaviors. Patients usually nod their heads at this psychology jargon stating that they grasp the basic concepts but in order to help connect it to their real lives, I introduce the following scenario:

Imagine you’re in high school and sitting in the front row of math class. There is one empty seat next to you and the minute before the bell rings for class to start, your best friend sits down next to you. You say “Hey, what’s up!” and your friend doesn’t respond and doesn’t even look at you. Class begins and the teacher is standing right in front of you so you can’t talk, text or pass notes until class is over. Why didn’t your friend respond? What are you thinking? What emotions are you feeling? What physical reactions occur in your body? How are you behaving in the moment? How will you act after class?

Your answer to all of these questions will depend on your specific personality characteristics, life experiences and perhaps on the psychological issues (anxiety, depression, PTSD, low self-esteem, relationship conflict) you may be struggling with. Your brain starts moving at a mile a minute to figure it all out.

Let’s break this math class situation down because it’s sometimes hard to differentiate between thoughts, feelings and behaviors.

Thoughts: Why didn’t my friend talk to me? What did I do wrong? Are they angry at me? Did I say or do something that made them angry or upset? Let’s replay every conversation I have had with them over the past week or month or year or decade. This may take a while. Was it that joke I told? Maybe they took it the wrong way? Did I forget their birthday or to call them back? Did they think I was trying to hit on someone they liked? Did I not wear pink on pink day last week? Are they still angry that I borrowed their favorite stuffed animal when we were 5 and I never gave it back? I always do these things, nobody will ever like me. Wait, maybe something terrible happened to my friend, maybe someone died, who could it be, oh this is terrible. Your mind will continue to jump from place to place struggling to figure out what might be occurring.

Wow, all of those intense thoughts have now led to a whirlwind of emotions.

Moods/Emotions/Feelings: I am so anxious about all of the things I might have done or might have happened. I feel super depressed because my friendship may be over. I am so angry at them for feeling this way about me.

These emotions are so strong, I can feel them physically.

Physical Reactions: I may throw up, my heart is racing, my lungs feel heavy, I am sweating, I am shaking.

Now that I am experiencing all of these physical changes, I can’t just let it go, I am going to do or say something at the end of class.

Behaviors/Actions: In the moment: Lack of focus on math. After class: I am too scared to talk to my friend, maybe I’ll just walk out of class without talking to them (this may lead to a rift in your relationship). I am going to yell at my friend or say the meanest things I can to them for not talking to me because I am certain that they are angry at me so I am going to attack first. Let me come up with that list of meanest things now so I will be ready. Perhaps you bad mouth your friend behind their back or tell others that you are angry or upset with this friend for what they did which could lead to the destruction of your friendship or their friendships with others. Some of these may seem like extreme reactions but they happen all the time.

Gosh, that’s a lot of stuff going on in terms of possible thoughts, feelings, physical reactions and behaviors! Now what if I told you that your friend was just super tired because they stayed up late watching a movie, they barely got any sleep and they didn’t even hear you say hello. You have just spent the last 45 minutes creating countless scenarios of what you may have done wrong, you are possibly highly anxious, super depressed or incredibly angry, you made yourself physically ill, you may hurt or destroy your friendship with your behaviors afterwards by separating or retaliating, oh and you didn’t learn any math so you might fail the next test all because you created a false reality in your head. Learning how to stop this spiral is crucial in learning how to better our relationships and also manage stress, anxiety and depression.

In part two we will discuss why this happens and what to do to stop ourselves from getting caught in negative thought spirals. Check it out here: Part Two

Be well,

Dr. Ben Alpert :-)

To discuss this and other issues or behaviors in detail, contact us at Hilber Psychological Services. To read more about cognitive distortion, feel free to click on this additional blog post.

Burns, D. D. (1999). The feeling good handbook. New York, N.Y., U.S.A: Plume.

Greenberger, D., & Padesky, C. A. (2016). Mind over mood: change how you feel by changing the way you think. Second edition. New York, NY: The Guilford Press.

How do you start therapy? What is it like?
Deep breathing

Ever wondered how to start therapy? How does it work? What is it like behind the closed doors? What happens in the beginning? Every therapist is different in their personality, orientation and type of therapy, and style of conversation in therapy. To be brief, there are a few types or orientations to psychotherapy that include humanistic, cognitive-behavioral, behavioral, psychodynamic, and psychoanalytic. Some therapists focus on one type and others may integrate a few of these. Some therapists may ask more questions and others may allow space for clients to fill. Hilber Psychological Services therapists provide therapy mostly from a Cognitive-Behavioral therapy orientation or CBT. Since all personalities and office procedures are different, this will give you a good idea of what it's like to start your work together with us at Hilber Psychological Services.

Before the Appointment Before setting up an appointment at Hilber Psychological Services, there will be a short conversation via phone or email to verify important details. These details include whether there are custody issues and if both parents are supportive of treatment and your insurance carrier if you choose to use your insurance plan.

After you have discussed these details, an appointment is set up. If you consent to an email, you will receive a confirmation email with the office address, your appointment time, and the paperwork for you to fill out in the privacy of your own home. You may bring that paperwork with you to the first appointment.

First Appointment or "Intake" At the first session, there will be a brief review of the paperwork you signed. The rest of the session is then focused on getting to know you and your situation. This is the time to bring up your concerns and presenting issues you want help with, as well as any questions you may have for us. At the end of the first session you may make a follow up appointment if you felt like the appointment and therapist was a good fit with you.

Second Appointment For adults and teens, typically the second appointment is to get to know each other better, talk about any topics that you feel are important but haven't mentioned yet, and move forward to discuss the steps recommended and continue with your treatment.

For children, the second appointment is about meeting the child, getting to know each other, discussing emotions and "wild card" coping skills of deep breathing and muscle relaxation. Typically the last part of the session is saved for playing a game to build the relationship, reward the child for working so hard, and practice the skills they have just learned. Finally, during the last few minutes, the parent is brought into the room and given a brief overview of the topics discussed and skills introduced.

Now you are ready for the following appointments. These are more dependent on the situations and individuals, but you may find that you are comfortable in session.

For detailed questions, please contact us via Hilber Psychological Services or at drhilber@hilberpsychsandiego.com to set up an appointment. For more common questions about therapy, see FAQ at HPS.