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Journal of Cognitive and Behavioral Psychotherapies, Vol. 8, No. 1, March 2008, 133-141.
RATIONAL-EMOTIVE BEHAVIORAL INTERVENTIONS FOR CHILDREN WITH ANXIETY PROBLEMS
Jerry WILDE *
Indiana University East, Richmond, USA
Abstract The purpose of this article is to provide detailed descriptions of specific clinical interventions that can be used by REBT therapists working with children and adolescents who are experiencing difficulties with anxiety. It is worth noting that anxiety disorders are among the most commonly occurring mental and emotional problems in childhood and adolescence. While a majority of publications focus on empirical research, there is still a need for articles that address clinical practices. REBT is, first and foremost, a system devoted to the practice of psychotherapy. Whether it is through articles focused on empirical research or clinical applications, the advancement of REBT is the ultimate goal. One of the most efficient anxiety management techniques involves the use of distraction in which clients are encouraged to substitute a calming mental image to interrupt the anxiety producing thoughts. This article also provides a detailed explanation of rational-emotive imagery (REI), which is a technique that employs relaxation prior to clients generating their own rational coping statements. Finally, a progressive thought-stopping technique is examined. In this intervention, the therapist provides successively less direction and guidance in the hopes that clients will be able to master this technique for use independently. Keywords: anxiety, children, REBT
RATIONAL-EMOTIVE BEHAVIORAL INTERVENTIONS FOR CHILDREN WITH ANXIETY PROBLEMS Anxiety disorders are among the most common mental and emotional problems to occur during childhood and adolescence. According to the U.S. Department of Health and Human Services (1999), 13% of children and
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1976. Gressard.. 1979). poor academic performance (Block. Spence. 1974. DiGiuseppe & Kassinove. 1996a).1%). Meyer. the range of anxiety disorders was between 5 – 20% with a majority of the estimates lying above 10% (Costello & Angold.. et al. et al. K. Lo. 1975. If left untreated. 1974. Therapists are encouraged to use their clinical expertise to make those judgments. 134 Jerry Wilde . 1981. Wasserman & Vogrin.. et al. Maultsby. 1988) which may in part explain why the lifetime prevalence rate for anxiety disorders is 28. et al. 1988. Knaus & McKeever. & Williams.8%. Gilliam. anxiety disorders can persist into adulthood (Keller. 1976. Wilde. Cristea. What follows is a description of several rational-emotive and cognitivebehavioral techniques that have been used in the treatment of childhood anxiety disorders. In community samples of adult populations.8% (Kessler. Knaus & Bokor. Knaus & Bokor. 1976. Omizo. 1978.Clinical Forum Section adolescents ages 9 to 17 experience some type of anxiety disorder. and post-traumatic stress disorder (6. Pfeffer et al. 1986. 1978. Deffenbacher & Brading. 1997a). DiGiuseppe. 1978. 1994). Benga. 1992. A commonly asked question is. 1975. Katz. with a 12-month prevalence of 18. Wilde. (2006) found that 36% of parents report concerns about the possibility of their children struggling with anxiety. Cangelosi. 1978. 1971). Rational-emotive and cognitive-behavior interventions have also been found to be beneficial in a host of other commonly occurring childhood problems such as low frustration tolerance (Brody.. Miller & Kassinove. Harris. 1976. 2001. The utility of CBT with anxiety disorders has led mental health officials in the United Kingdom to identify CBT as the first-line approach to treating anxiety disorders (National Institute for Clinical Excellence. 2004). 1974).2006. Voelm. 2007. Cangelosi.. et al. 1980. & Mines. “Which is the best one?” It is difficult. DiGiuseppe & Kassinove. Lo & Williams. 2004). R.5%). if not impossible. Gressard. 1994.. 1975. 1983. Research also suggests that CBT is effective in the prevention of depression (Clarke. 1995. social anxiety disorder (12. & Merikangas. & Opre. 1974. Blanchard. several studies have established cognitive-behavioral interventions to be effective in increasing rational thinking in children and adolescents (DiGiuseppe & Kassinove. 1982. 1986. 1977. and depression (Wilde. & Mines. 1980). REBT and cognitive behavior therapy (CBT) have an extensive history of being successfully applied to anxiety problems in children (Brody. Miller & Kassinove. Finally. 1976. Ritchie.8%). 1995) and in the improvement of self-concept and coping capabilities (DeVoge. Micco. 1974. to answer because the answer ultimately depends on the client and the situation. It should be noted that this is just a sampling of some of the more commonly used techniques and is not intended to be an exhaustive list. Wasserman & Vogrin. The same study reported the most common subtypes of anxiety disorders to be specific phobia (12. Von Pohl. 1995). 1979. impulsivity (Meichenbaum & Goodman. Warren. Omizo. Knipping & Carpenter.
it would not be considered to be bringing about cognitive restructuring. Therefore. This is more difficult than it sounds because when children are getting anxious. Whenever they feel themselves getting anxious. as the name implies. Wilde 1995). the only thing they seem to be able to think about is the situation at hand. they will change their feelings as well. merely attempts to help children think of something other than their current situation. When clients have some free time have them close their eyes and picture their distraction scene.A memorable day at the beach or on vacation . That is why clients need to decide what to think about before they start becoming anxious. Distraction.The time they won a game . What were the people wearing? What were the sounds they can remember? Were there any smells in the air? Encourage clients to create scenes in their minds just like watching a videotape of the event. Clients should be advised to bring in all the details that they can possibly remember to make the scene vivid. You may need to help clients select the scene that fits their individual needs.A hysterically funny event from their past . Since anxiety is produced by beliefs. funniest. they are to concentrate on their distraction scene. 1997b. Instead of getting anxious before an important examination in school. if children are able to modify their thoughts about an event. Encourage clients to pick "a scene" to use before they encounter the event they become anxious about. thinking about a funny or happy Anxiety and children 135 .A memorable birthday party Have clients take a few minutes and think about the distraction scene. therefore. they are to switch to their scene. or most relaxing scene they can remember. It does not involve a change in assessment of the event and. Now they need to practice imagining this scene several times daily for the next few days or weeks. Wilde 1996b. It can also be helpful to have them draw their distraction scene and then explain it to the therapist.Clinical Forum Section THE USE OF DISTRACTION The cardinal tenet of REBT is that emotions are not caused directly by events but are primarily the result of the thoughts and beliefs an individual has about the event. The idea is to switch to this distraction scene when the clients find themselves getting anxious. they are to concentrate on the distraction scene until the feelings start to subside. Distraction is not an “elegant solution” as Ellis would say. This memory should be either the happiest. Instead of focusing on the situation they are getting anxious about. It is impossible for clients to think of a distraction scene and still become anxious. For example: . One of the simplest and most effective techniques designed to bring about a change in thinking involves the use of a distraction technique (Wilde.
The use progressive relaxation techniques with the successive contracting and relaxing of various muscle groups can be very helpful. The jaw may tighten.K. Keep imagining that you are in your classroom. After the client appears to be sufficiently relaxed. When you feel that way. sounds. See all the posters on the walls and everything else that is in your class.A.Allow the child to stay in this state for approximately 20 to 40 seconds. When you can make yourself calm. Stay in the classroom in your mind but try to calm down. Spend several minutes describing relaxing images until you can see the behavioral manifestations of relaxations starting to appear. Then have the child get as relaxed as possible in his or her chair with both feet on the floor. I want you to be aware only of my voice and focus on what I say. Instead of being really anxious. Get as many details as possible about the sights. Remind him or her to mentally stay in the situation. This technique is most effective if there is a particular situation (i. Therapist: Anna. Now go ahead and let yourself feel like you do when it’s reading time. wiggle your finger and let me know you're there. Ellis (1994. 1979) and Wilde (1995. RATIONAL EMOTIVE IMAGERY (A. try to get calmer. I want you to listen very closely to what I'm going to tell you.Clinical Forum Section memory will keep them from getting upset or minimize the intensity of the emotions. (Author's note . eyebrows furrow and many children will shift or squirm in their seats.) Stay with that feeling. 1996a. Instead of being very upset.e. Feel all the anxiety you felt back then.) Now I want you to keep thinking you are in the class but I want you to calm yourself down. public speaking. start with the following dialogue. Keep working at it until you can calm yourself down. Stay with that scene and try to feel just like you felt in the class. THE IMAGINATION GAME) What follows is an example of how the imagination game or rational-emotive imagery (REI) can be used with children and adolescents who have anxiety problems. 136 Jerry Wilde .It's a good idea to look for behavioral signs confirming that the child is actually feeling anxious. Imagine you are back in your classroom and students are taking turns reading aloud. separation from parents) in which anxiety is likely to occur. Try to block everything else out of your mind for the time being. (Author's note . certain social situations. and events in this situation. 1997b) have used REI extensively in the treatment of anxiety and anger problems. Start by having the child vividly describe the troublesome scenario.. wiggle your finger again. Picture the room in your mind. try to work toward feeling calmer.
After completing the imagination game students should then be able to state the thought that allowed them to calm down. This usually doesn't happen but if it does. It doesn’t mean I’m a bad person. Several of these studies have suffered from methodological shortcomings such as the lack of a control group or no follow-up analysis to determine if results have been maintained. it’s not that big of a deal.Clinical Forum Section Usually students can reach a state of relative calm within a fairly short period of time.e. Other students have problems reading aloud. The only other way to calm down would be to mentally leave the situation (i. clinicians have been applying these types of interventions. this technique allows kids to mentally practice dealing with a difficult situation in a new. Simply say something like. Now he or she can practice this mental imagery several times a day and use this same calming thought each time. "What did you say to yourself to calm yourself down?" If the child was able to calm down. It's very important that they practice REI on a regular basis if they are going to learn to handle their anxiety in a more productive fashion." Next ask.” Practice this first step Anxiety and children 137 . now open your eyes. "Even though I don't read well. no longer visualize the classroom). I’d die. the results of experimental investigations have been inconsistent. more productive way. Usually children can learn to do the Imagination Game by themselves after having been led through the technique a few times by the therapist. Both can be effective if used regularly. This interventions starts by having clients imagine the anxiety-provoking situation and vocalizing their thoughts. “Stop. THOUGHT STOPPING Ever since Joseph Wolpe (1958) first published descriptions of thoughtstopping techniques. it is time to bring him or her back to the here and now. When clients first utter an irrational anxiety-producing thought such as." Once the child has produced a rational coping statement. "Okay.” the therapist shouts. Once a child has wiggled his or her finger. There has been a plethora of case studies published over the years claiming reductions in anxiety symptoms with both adults and children. However. try the exercise over encouraging the child to keep imagining the scene but working to calm down. “If I did a bad job of reading in front of the class.. It is also possible to make a tape recording of this intervention for the child to use at home as some students like using the tape rather than leading themselves through this technique. write it down. he or she had to be thinking some type of rational coping statement. The general framework for teaching clients to use thought-stopping techniques follows a progression that begins with the therapist being more overtly involved and gradually diminishing involvement until the client is able to use the intervention independently. A typical calming thought that might have been produced from the above scenario would be. In effect.
Clinical Forum Section until clients report that the therapist shouting. SUMMARY Anxiety problems are among the most commonly diagnosed mental and emotional problems to occur during childhood and adolescence. Learning anxiety management skills will take time and effort but the benefits are well worth the effort. “Stop. The interventions discussed in this article are brief and not difficult for children to learn. The next important step involves having clients think about positive. It is beyond the scope of this article to delve too deeply into that issue.T. 1202-1212. Research suggests that if left untreated. children need to be closely monitored and given encouragement. The use of a self-report scale (such as the subjective units of discomfort scale) with a range from 1-10 can be helpful to quantify the intensity of their emotions. Clients can learn how to stop a disturbing thought but unless they can replace the anxiety-producing thought with a rational cognition. The problem with most thought stopping interventions is that they stop at this point. many children will struggle with anxiety later in life. Be prepared for both success and setbacks during the course of treatment. (2004). To maximize the potential for success.” It essential that the therapist spend time helping clients learn to distinguish between rational and irrational thoughts. practice this until clients report that they are able to consistently reduce their anxiety to a manageable level. Emotional. Now they are to merely think their rational coping statement whenever they notice they are beginning to feel anxious. 6. Gukra. J. M. Blackman.. “Stop” interrupted their irrational thinking. The second step involves having clients merely think of the anxietyprovoking situation and signal the therapist whenever they were thinking an irrational thought. Pediatrics. rational and/or calming thoughts that could substitute for the anxiety producing thought. and behavioral health of American children and their families: A report from the 2003 National Survey of Children’s Health. developmental. The final step involves having clients practice transferring the rational coping statement from an overt statement to internal dialogue. Clients are taught to imagine the anxiety-provoking situation and when they began to think irrational thought they are to say their rational coping statement aloud. Interested readers can refer to Wilde (1997a) for detailed information on teaching rational thinking skills to elementary students. the therapist again shouts.. the original thought will quickly return. 138 Jerry Wilde . REFERENCES Blanchard L. Once again. Upon observing the signal.
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