In My Own Words...How I Use CBT To Treat Anxiety Disorders And Trauma.

Recently I got the opportunity to be a part of an online radio show called "Professionals Round Table," where I got the chance to talk about my approach to using cognitive behavioral therapy to treat anxiety disorders and trauma. If you've ever wondered what CBT, or Exposure Therapy looks like in practice, take a listen:

https://empirebroadcastinggroup.com/kaitlin-soule-1-25-17-psychotherapist/

 

 

 

 

 

 

 

 

Setting up a Reward System for Positive Behavior...

In my practice, I use a reward system when children are "brave," or follow through on a task assigned to them. I find that parents are reluctant to put a reward system in place at home for multiple reasons, but the most common fear that parents share is that their child is going to suddenly want "something" for everything.  The simple fact is, we ALL do better when we're working towards something, and rewards are a part of life. While setting up a reward system might take some time (and I know time is precious as a parent), if it helps your child feel better just think of all the time you'll have freed up!  Bravery work is already difficult...but being "brave," in the process of overcoming an anxiety disorder is REALLY hard work.

So here are a few simple tips on how to create a successful reward system for brave, or positive behavior:

1. Make clear rules around what the requirements are for receiving the reward, and decide on those rules together.

2. To help decide on what the reward will be, have a discussion with your child about what is they really LOVE to do. What brings them joy? What tastes REALLY good? Who is their favorite person to spend time with? Rewards do not have to be monetary based...in fact, special time with a parent, loved adult, or friend is often times the most valued reward of all. If your child is on the strong-willed side and suddenly can't think of anything they like to do, it's probably because they are already getting to do a lot of it...for free!  This calls for making some adjustments and setting up a system so that they are "earning"  time on the computer, playing Minecraft, screen time, etc. via the positive behavior rules you have already set up.

3. When setting up a reward system with young children (1-6 yr olds), make sure they are receiving the reward very shortly after they do the desired behavior. For example, if you're practicing separations and your asking you child to spend 5 minutes alone in their room while you're in the kitchen, give them the reward as soon as their time is up. If it's Monday, they will not grasp waiting until Friday for their ice cream cone.

4. Consistency is key. Children like to know what to expect, especially anxious ones. Be mindful of your own emotions, and the desire to bend the rules to make your child feel good in the moment. We all know that the best rewards are the ones that we receive when we work hard.

Eventually, children find that the true reward is in feeling and doing better...but sometimes we all need a little push to get there.

The Child Who is Always Worrying; Simple Ways for Parents to Help

A little bit of anxiety is developmentally appropriate for children. As they grow, children are learning to navigate not only their own increased freedoms and responsibilities, but also the fact that they aren’t always protected in this big and sometimes scary world. This is called normative anxiety and, typically, a child moves on from their worries after a short while. However, some children seem to be magnets for anxiety…and no matter what, worry just seems to stick to them!

While some children struggle with specific situations, such as being apart from their parents, being in new social situations, or fears around natural disasters, kids with generalized anxiety (GAD) may worry about all of these things. As a parent, or caregiver, it can be frustrating and challenging to deal with kids who experience generalized anxiety, as their worry is constant and STUBBORN.  Because most are trying to be good parents, they often go the route of avoiding what may trigger their child’s anxiety by doing any or all of these things; giving in to requests to skip school, promising that specific bad things “will not happen,” reassuring their child that everything is okay, and the list goes on. The down side of this is that reassurance and avoidance often times feed the very worry that is already causing havoc.  

So what is one simple thing a parent can do to help their anxious child? Most importantly, you can help your child adopt a “bravery approach,” to facing their fears. One way to do this is to come up with a name for their fears (such as, the “monster brain,” or “worry mind,”) and encourage them to fight back when the worry sets in. They can “fight back” against the worry by coming up with smart, or helpful thoughts. Here is how that might look:

Child (worried about facing a new situation) “Mommy, my stomach hurts and I don’t want to go to school.”

Mom: “Your stomach hurts. Hmm, it sounds like monster brain is being a bully this morning! What can we tell monster brain to make him go away?”

Child: “Stop being a bully monster brain! I am my own boss.”

In the above scenario the child was able to fight back against their worry thought very easily, however, most often it takes a lot of coaching and practice. If you keep at it, the new and "brave" mind set will win, and you'll start to see that your child has less trouble with their anxious thoughts. Sometimes it's beneficial to add a reward system which can help your child develop the incentive to be brave. Rewards don’t have to be monetary, in fact, often children enjoy “special time” with a parent the most.

As caregivers, you are the main lens through which your child looks at the world. If you model bravery by not operating out of fear, by encouraging them to try new things, and helping develop “smart thoughts” in response to their worry thoughts, you will start to see improvement!

Written by: Kaitlin Soule, LMFT

Let's talk about panic...

Did you know that about six million American Adults a year experience panic disorder? While panic disorder impacts all ages, it usually develops in early adulthood and grows stronger without intervention or help. So what defines a panic attack? Panic attacks can seemingly come "out of the blue," and even in our sleep. While panic attacks may feel as though they last forever, they reach their peak within a few minutes. Common symptoms of a panic attack include the following: heart palpitations, shortness of breath, sweating, shaking, chest pain, feeling of choking, chills, hot flashes, a feeling of "unreality," a fear of "going crazy," and a fear of dying. If you're one of the many people who have experienced a panic attack in your life (and by the way almost everyone has had at least one) you know first hand how terrifying and confusing they can be.

The first, and possibly the most important thing to know, about panic attacks is that in and of themselves they are not dangerous. To put it simply, a panic attack is our body charging into a primal survival mode. When we come upon danger in the world our body needs to react in a certain way to survive. For instance, if we came across a dangerous predator in nature we would start to breath faster, so that our body is filled with more oxygen allowing us to run faster. Isn't it wonderful to know our body is so capable? All joking aside, the problem with these bodily responses during panic attacks is that since we aren't, in reality, facing real and eminent danger our brain interprets the symptoms as dangerous themselves. So,  it's actually the thoughts we have about the panic symptoms that cause us to be so afraid of the event itself.  This is why people often end up in the ER room thinking they are having a heart attack when it's really a panic attack. Their heart is beating fast, their light-headed (both common symptoms of panic) and so they think “this is it, I’m dying,” and then their brain tells them to jump into action mode and go to the hospital.

Perhaps, more commonly, people are embarrassed to admit they have panic attacks and/or don't know that there are ways to treat them so they chose to silently suffer. Because those who suffer from panic attacks are so afraid of them happening again they may start avoiding situations that could trigger panic, or even try and numb themselves from the fear by using drugs or alcohol. This is often where a problem cycle begins.

So what are a few things you can do to help? First, I believe gaining more knowledge about what panic attacks are, and why they feel the way they do is important. Second, working with a therapist to change the interpretations and thoughts you have attached to your symptoms can positively change your view of panic attacks.  Lastly, while no person or medication can guarantee to stop panic attacks, you can change the way you react to them which will both lesson their impact and intensity.

If you want to find out more about how changing your attitude toward anxiety and panic can help, listen to this podcast by Dr. Reid Wilson, Licensed Psychologist and author of "Don't Panic."

Click here for podcast

Written by: Kaitlin Soule, LMFT

 

What is Trauma and Why Treat it?

 In popular culture there is a lot of talk about trauma. The word trauma is sometimes used too loosely, in efforts to refer to something that was especially challenging. But what is  clinically significant  trauma, and why should it be  treated? People may be diagnosed with PTSD, or other trauma-related and stress disorders when they are exposed to any of the following: natural disasters (not interpersonal in nature), physical abuse, sexual abuse, loss that is particularly devastating or violent in nature, or illnesses and medical treatments that are frightening and invasive. Other types of trauma include repeated exposure to trauma, community violence, and complex trauma. Repeated trauma is commonly experienced in those in combat, police officers, firefighters, and other first responders. The term complex trauma describes both children’s exposure to multiple traumatic events, and the long-lasting negative effects of the trauma. Since these traumatic events often occur in the context of the child’s relationship with a caregiver (physical or sexual abuse), it  interferes with the child’s ability to form a secure attachment bond and healthy physical and mental development.

Research has shown that our brain is much more malleable than we once thought it was, and many can heal from devastating events without therapeutic intervention. On the other hand, many trauma survivors suffer from serious side effects, and need professional help to get better. So how is it possible that a similarly traumatic event can cause one person to experience long lasting side effects, and another person can heal without intervention? There is a great deal of research around what causes PTSD, but from the stand point of cognitive-behavioral therapy, trauma disorders are born from the way in which a traumatic memory is stored in the brain.

In order to explain how trauma works, I often use the analogy of a fire alarm. If there is an actual fire and the fire alarm has gone off, the alarm has done its  job and saved us from danger. But,  if the fire alarm is going off because of burnt popcorn  and not an actual fire, it’s a false alarm. People with PTSD are constantly experiencing false alarms, but their brain doesn’t know the difference. Because their brain interprets a false alarm as a real danger, their body goes into flight or flight mode.  Fight or flight mode is necessary to our survival as human beings but when that switch is stuck on, trouble arises. Because the body is stuck in “go mode” there is often a depletion of two important hormones, cortisol and adrenaline, which can cause both hyperactive behavior, and under responsive behavior.  In children, for example, hyperactivity as a trauma response may look like ADHD, making it easy to misdiagnose. This is why it is important for those in the community who work with children to be trauma-informed. Under responsive behavior can cause a child to act shy, hide, or show little positive or negative emotion.

Some common symptoms of trauma, for both adults and children, are: irritability, night terrors, flashbacks, avoidance of places or situations that trigger memories of the event, intense fear, sleep problems, worry, sadness, and emotional numbing. Let’s face it, traumatic events are tough to talk about both for the person who experienced them as well as for those around them.. This may be one of the reasons why people use avoidance as a tactic to feel better. However, avoidance is anxiety’s best friend, and by avoiding triggers (things that remind them of the trauma) the brain receives a strong message that there is actually something to afraid of. Another problem with avoidance is that one can never identify all of their possible triggers, making it impossible to avoid them. So while avoidance often feels like a safe choice, it doesn’t lead trauma survivors to a path of healing... but instead to a place of isolation. 

So what is helpful? When it comes to trauma, cognitive-behavioral therapy can help people with trauma or stress-related disorders to organize and restore the memory in a way that allows their brain to interpret it in a way that is more accurate and helpful. By doing so, we can readjust our “fight or flight” switch, so that is only turned on when real danger exists. The overarching goal for  treating clients who are suffering from a traumatic event/events is  to help them get to a healthier level of functioning. The hope for treatment is that trauma wounds turn into scars. Unlike open wounds, scars don't usually hurt. With treatment, the once open wound becomes a scar, and while it may serve as a reminder of a painful time it becomes just another part of the person, not the whole.

Written by: Kaitlin Soule, LMFT

Contact: kaitlin@petalumacbt.org

Helpful Resources:

Www.nctsn.org  (National Child Traumatic Stress Network)

Www.TFCBT.org (Trauma-Focused Cognitive Behavioral Therapy)

Www.ptsd.va.gov (National Center for PTSD)

Why is change so hard? How CBT can help!

Change is hard for everyone...and no matter how bad you know you need to change, and even if you have the best laid plains, getting the ball rolling can seem impossible. One of the biggest reasons why I have chosen to work with clients using Cognitive-Behavioral Therapy is because it helps to break down the process, from start to finish, that is holding you back from change. What are the thoughts that you are telling yourself that are keeping you stuck? Yes, they may be true...but are they helpful? Or, maybe they are not true AND unhelpful. Just as food is fuel to our physical bodies, the thoughts we tell ourselves are fuel to our emotional brains. If we are telling ourselves thoughts that are not quite accurate, or unhelpful, we are helping to create negative, or difficult emotions which can lead to unwanted behavior. While negative emotions are normal, and as much of a part of life as positive ones, we sometimes need help to train our brains how to think in a way that will lead to a more emotionally balanced mental state. Once we start doing the work of changing thoughts, our emotions follow suit, clearing the path for positive behavioral changes. This process is true for both children and adults, regardless of life circumstances, or misfortunes. Give it a try with the old "fake it until you make it," theory....tell yourself something positive about who you are, once a day, and see if you notice any changes in your behavior....even small ones are progress!