Cognitive-Behavioral Interventions for Children Who

Struggle with Self-Regulation

by Brad Chapin LCP, LMLPbrad.chapin@cpschallenge.com

www.cpschallenge.com ID: chapin55

© 2008 Chapin Psychological Services, LLC

Some Terms

• Self-regulation• Self-monitoring• Executive

function• Good choices• Problem solving

• Self-control• Frontal lobe• Higher order

processes• Responsibility

The Four P’s

Personality = Patterns = Prediction = Power

© 2008 Chapin Psychological Services, LLC

Self-Regulation• “those processes, internal and/or

transactional, that enable an individual to guide his/her goal-directed activities over time and across changing circumstances”

Karoly, 1993. • Appropriate Responding• Negative Emotions, Effortful Control, &

Attention• Generally more Proactive than Reactive• Homeostasis• Adaptive

Poor Self-Regulation

• Associated with Aggression• Victimization• Poor Social Adjustment (Blair, 2003)

• Poor School Adjustment (Blair 2003; Masten & Coatsworth, 1998)

• Increased Risk of Mental Health Diagnosis

• Key in Resilience & Competence (Shapiro, 2000)

• Can be Improved through Intervention

A Moment on Extremes• Yerkes-Dodson Law (1908)

– Plenty of Empirical Support • Grades (Sarid, Anson, Yaari, & Margalith, 2004)

• Test Performance (Bodas & Ollendick, 2005)

• Other Areas Including Job Performance and Sports • Strong Evidence to Support the Importance of Self-

Regulation

PERFORMANCE

Anxiety

Creating Change• Change Process• What Gets You to Change Your Mind

about something?

© 2008 Chapin Psychological Services, LLC

Competence& Self-Efficacy

• Believing that You’re Effective in Your Environment

• Kirsch, 1990

The “Why” Behind the Intervention

• Control – Epictetus, Ellis– Internal vs. External

• Learned helplessness• The child doesn’t “believe or know” that he

can do anything about anything• Powerlessness

• Frustration > Aggression• Extreme Thinking

• An increased potential for:

“Extreme Behavior”

Information we are Assuming

• Cognitive-Behavioral Psychology has Merit

• “Children will do well if they can,” Dr. Ross Greene, www.explosivechild.com

– I’ve Never met an infant that wanted to grow up to be a Horrible Monster or “Bad Person”

Thoughts, Feelings, and Behaviors

• Cognitive– Activating

Event– Belief– Consequence

• Behavioral– Antecedent– Behavior– Consequenc

e

Cognitive Therapy

• S ? R• We know something happens here.• Habits of thought and brain

development/operation• Efficacy• Skill Training• Delivery of treatment

Cognitive & BehavioralInterventions

• Excellent Theoretical Background• Excellent Efficacy Research (Chen & Taylor,

2005; Dodge & Garber, 1991; Miller, Williams, & McCoy, 2004; Etc.)

• Easy to Implement • Works well with Teams • Face Validity Helps with Explanation

to Others, including Parents• Eclectic – uses the best information

from several areas

Unhealthy Thinking

• Rational vs. Irrational• Healthy vs. Unhealthy• Helpful vs. Not Helpful• Accurate vs. Inaccurate• Moderate vs. Extreme• Flexible vs. Rigid• Positive vs. Negative – Don’t use this one

Common Components of Unhealthy Thoughts

• Sometimes preceded by “I can’t stand it if…”

• “Have to”• “Should, must, ought to”• “always, never”• We think in words

Common Examples of Unhealthy Thoughts

• We are typically not Conscious of the Core Belief– “I am worthless.”– “I have to be perfect. Mistakes are

unacceptable.”– “Everyone is against me.”– “The world is a terrible place.”– “You have to get others before they get

you.”

Why as First-Line Intervention?

• Change Process– Belief that one can change is the first

step– If this step isn’t taken, how can we move

forward?• Competence, Self-Efficacy, and Self-

Esteem– Powerless Position– Learned Helplessness – Seligman, 1975

Dog Experiment• Now Go Ahead with All of those Other

Wonderful Interventions!

© 2008 Chapin Psychological Services, LLC

The IMPORTANCE of AGGRESSIVE and EFFICACIOUS

Treatment• The Effects Get Worse and Harder to

Undo the more Time Passes– Brain Damage – (Frodl, et al., 2004)

• Hippocampus & Cortex

– Personal Decline– Social Isolation– Patterns of Thought

The Essence of Empowerment

• Where is the Power?– Internal vs. External Locus of Control– What can you really control?– Where do you want to focus most of your

efforts?– This is EXCITING STUFF!

How do we teach them?

•Challenge Software Program is one option:

• www.cpschallenge.com

Who would you use this Tool with?

• Cognitive Abilities approximately 8 and up

• Poor Self-regulation• Behavior Problems• Poor Social Skills• Computer Interests• Anger Problems• Trouble making “Healthy Choices”• Poor Self-Esteem• Depression, Anxiety, PTSD, ADHD,

ODD

“Cognitive” & “Behavioral”Is CBT an Oxymoron?

• How can you use both?• Behavioral can be seen as punitive,

based on fear, control, and consequences

• Cognitive is sometimes seen as love-based where understanding is most important

© 2008 Chapin Psychological Services, LLC

BLENDING CAN BE A CHALLENGE

Perception

• “Your Perception is your reality”

A Moment About Safety:

• What Do Individuals or Groups of People who feel like they have no control tend to do?

• What often Precedes Extreme Behavior?

Recent Examples• Virginia Tech Shooting - Aaron Beck

– “Evil and violence are also rooted in distorted cognitions”

– “People locked in emotional disagreements start to have distorted views of each other”

– “They’re not attacking each other—the real person—they’re attacking the image”

– The same process happens in mass violence, he said. An individual or individuals in one group demonize members of another group. Once that happens, the people in this group become homogenized into a single category: the enemy that must be destroyed, said Beck.

• Waco, Georgia: Third-Graders Plot to Kill Teacher– They had developed “a distorted view” of their

teacher and saw the teacher as the enemy, (Audrey Dearborn, Mental health counselor)

Extreme vs. Moderate

• Extreme Interpretations Lead to Extreme Thoughts

• Extreme Thoughts Lead to Extreme Behaviors

• Moderate is More Accurate and Typically More Flexible

Bullying Connection?

• 1 in every 3 Students is involved in one role or another (Macklem, 2008).

• Children involved suffer long-term effects including Anxiety, Depression (Macklem, 2003).

• There are also short-term effects on children’s Self-worth and sense of self-efficacy (Murphy & Quesal, 2002).

More on Bullying

• Who Gets Bullied?– Those who respond by crying or fighting

are most likely to continue to be victimized • Does this sound like Poor Self-Regulation to

you?

– Bullies are looking for some Emotional Reaction (Children aren’t the only ones- Celebrity Drama)

• Those Children with Poor Emotion Regulation are easy targets for Bullies (Macklem, 2003)

© 2008 Chapin Psychological Services, LLC

Role of Trauma• Biological Role• Coping and Resilience • Social Implications

Efficacy of CBT with Trauma

• Meta-Analysis from American Journal of Psychiatry in February of 2009 (Roberts, N., et al., 2009).

– Reviewed 25 studies using CBT with Trauma victims

– Concluded that CBT is effective for individuals exhibiting traumatic stress symptoms

– More effective than simple supportive counseling

• CBT with Children and Adolescents – Trauma symptoms 8-18 year-olds– 92% of participants no longer met criteria

after CBT (Smith, P. et al., 2007)

© 2008 Chapin Psychological Services, LLC

Case Example: Cody

– 8 years old when we met– Hospitalized 3 times that year– Bipolar 1 and ADHD– Bipolar and ADHD on Both sides of the

family• Bio Father spent several years in Maximum

Security Prison with Intensive Mental Health Services

– “Zombie” from the meds. • Couldn’t stay awake• Violent Aggression• Attention span was only a few seconds

More Cody

• Assessment Factors:– Several Family Problems– Failing Every Class– No Friends– Very Low Self-Worth– Very Low Motivation– Low Income – Few Family Supports

More Cody

• Aggressive Cognitive/Behavioral Interventions

• Start to Build Self-Efficacy• Calming Strategies• Focus on Misinterpretations

Cody: Role of Challenge Software

• He was the First Client to use the Program• Assessment Scores• Passing All Classes• Has Friends• Out for Soccer

Date Teacher Tommy Other

12/5/07 4 2 4

2/29/08 1 7 2

7/14/08 1 8 1

Effective Ways to Challenge Thinking

• Reframing– Temporary vs. Permanent– “If your friend told you what you just

told me, what would your advice to them be?”

• Help them find Evidence– Statistics and Numbers– You CAN stand it!

Reminders

• Best when Calm – Teach Calming Strategies• Children Are Making Interpretations all the

time, whether we help them with it or not!• Don’t Forget the Importance of Accurate

Empathy– Just because the thoughts are irrational, doesn’t

mean the emotions they’re experiencing aren’t real

– Challenge Thoughts, NOT Feelings

Exercise

• A friend of yours Just found out that they lost their job today and calls you on the phone– Your Friend is saying things like:

• “I’ll never be able to get another good job.”• “I can’t stand this.”• “It’s hopeless.”

• What do you do?

Advantages of Using theChallenge Software Program

• Quick Engagement • Lowered Defenses • Practicing• Progress Monitoring built in• Find Challenge Software at:

– www.cpschallenge.com

ID is chapin55