Beruflich Dokumente
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BEHAVIOR
THERAPY IN
CHILDREN
Dr. Manu Sharma
Ms. Malar
Introduction
CBTs represent a large portion of empirically
supported treatments
cognitions or thoughts can influence
emotions and behaviors across a variety of
situations
Panic disorder- Clark (1986, UK) and Barlow
(1988, USA)
enactive, performance-based procedures as
well as cognitive interventions to produce
changes in thinking, feeling and behavior
(Kendall, 1993)
Assessment
Modes of Assessment
Behavioral interview
Self-monitoring
Rating scales
Information from other people
Direct observation of behavior in clinical
settings
Role play
Behavior tests
Behavioral interview
Initial analysis of the problem situation:
Behavioral excess/deficits/assests
Clarification of the problem
ABC Technique
Motivational analysis
Developmental analysis
Sociological changes
Behavioral changes
Biological changes
Coping, avoidance, beliefs
Behavioral interview
Cognitions
At the moment you were feeling anxious, what
was going through your mind?
What were you thinking to yourself?
What were you saying to yourself?
Did you have an image in your mind at the time?
Did you see anything in particular?
What were you afraid might happen?
What was the worst thing you thought might
happen?
Behavioral interview
Self-Monitoring
Requires the patient to collect information on
their problems between sessions
Needs to be specific with clearly defined
targets
What to collect: Frequency, intensity &
duration of the targets
Provide patients with a record form
Keep it as simple as possible
Record information as soon possible after the
event
Thought diary.
Behavioral interview
Rating scales
CBCL
K-SADS
BDI- children version
CARS
Conners parent/teachers rating scale
CBT formulation
Incorporates consideration of the following:
Predisposing Factors
Precipitating Factors
Perpetuating Factors
Consideration of these factors & thereby guide
any therapeutic intervention
CB Methods
Socratic questioning
Guided discovery
Evidence
Advantages & disadvantages
Identifying errors in thinking
Generating rational explanations
Imagery
Role play
Social skills, Assertiveness training
Behavioral methods
Relaxation
Breathing exercises
Exposure
Desensitization
Behavioral activation
Activity scheduling
etc
Application
The content of the cognition may be typical
Anxiety disorders
Pathological anxietycatastrophisation,
Anxiety disorders
A modified thought diary
Subjective units of distress scale
The aim is to enable the child to recognize triggers
Anxiety disorders
FEAR-a 16-session programme (Kendall et al, 1990)
Feeling frightened? (Awareness of bodily cues,
identifying anxiety and learning to relax)
Expecting bad things to happen? (Identifying
and correcting maladaptive self-talk by using
positive self-talk)
Attitudes and actions that can help. (Coping
and problem-solving strategies)
Results and rewards. (Self-evaluation and
coping with failure)
Anxiety disorders
Family Anxiety Management (FAM) (Barratt et
al, 1996)
This teaches parents contingency
management (rewarding appropriate coping
behaviour and extinguishing avoidance
behaviour)
Coping Cat/Koala program
OCD
Other distortions:
The belief that thinking something is the
same as doing it thoughtaction fusion;
undue sensitivity to responsibility for
omission (If I don't remove every speck of
dirt, someone might become contaminated).
OCD
The aim is to enable the child to appreciate
Conduct disorder
Tend to attribute hostility to others and
Conduct disorder
Children with conduct disorders find it hard to
Conduct disorder
CBT must be part of a multi-modal approach
Social-skills training
Rewarding prosocial behaviour ,
ADHD
Self-instructional progs--Core problems of
The five-step
approach
1 Watching a trainer model and talk through a
task, including planning and talking through
possible difficulties (cognitive modelling)
2 Carrying out the task, prompted by a trainer
3 Carrying out the task, prompting themselves
aloud
4 Carrying out the task, prompting themselves
by whispering
5 Carrying out the task silently using covert
self-instruction/self-talk
Pain management
Behavioral: contracting, time out, modelling,
parental counselling
Cognitive: Relaxation, distraction, imagery,
coping skills, social skills
II.
Loving and hating; wanting & fearing
Experiencing trust & betrayal together
Living with distorted IP boundaries
Other areas
Eating disorders
School refusal
Somatization
Dissociative disorders
Issues
The younger the child, the more the parents
Advantages of CBT
Educative and instructive
Short-term
Emphasizes getting better rather than feeling
better
Cross-cultural
Structured
Can be researched and the psychotherapy
with max evidence
Limitations
Cognitive maturity of children
Inept in labelling feelings, thoughts
Mental retardation
Developmental problems
Severe symptoms
Psychotic symptoms
Conclusion
C-B therapists need the ability to engage their