KEYS TO COURAGE
A parent’s guide to treating and preventing
our children’s anxiety and depression by
promoting confidence
Social Pressures
10/06/2016
PARENT SEMINAR
2
Social Pressures
10/06/2016
PARENT SEMINAR
3
Social Pressures
10/06/2016
PARENT SEMINAR
4
Social Pressures
10/06/2016
PARENT SEMINAR
5
Adolescent Mental Health
Youth Beyond Blue reports the following statistics:
• Depression: Breakdown: 6.3% of Australians aged 16 to 24
have experienced a mental health disorder in the last 12
months. This is equivalent to 180,000 young people today
• Anxiety: Breakdown: 15.4% of Australians aged 16 to 24
have experienced an anxiety disorder in the last 12 months.
This is equivalent to 440,000 young people today.
10/06/2016
PARENT SEMINAR
6
Adolescent Mental Health
• Mental Health Condition: Breakdown: 26.4% of Australians
aged 16 to 24 currently have experienced a mental health
disorder in the last 12 months.This figure includes young
people with a substance use disorder. This is equivalent to
750,000 young people today.
• Suicide: 324 Australians (10.5 per 100,000) aged 15-24
dying by suicide in 2012. This compares to 198 (6.4 per
100,000) who died in car accidents (the second highest
killer).
10/06/2016
PARENT SEMINAR
7
EDUCATIONAL PARADIGM
In the 21st Century, when discussing success in education, the
literature shifted focus from one of the most common
measurements – IQ scores, to a motivational and psychological
standpoint.
10/06/2016
PARENT SEMINAR
8
EDUCATIONAL PARADIGM
The question now being asked by schools…what about those
non-cognitive (so-called “soft”) skills?
What about the stuff that will make students / young people
hardy and robust learners?
How do we teach learning agility? Develop students / young
people who take risks, fail and find new and better ways.
10/06/2016
PARENT SEMINAR
9
EDUCATIONAL PARADIGM
We need to let our young people generate ideas, take risks and
fail and then assist them to recalibrate.
Help children move outside their comfort zone – this is where
the real growth happens.
We at Knox believe a quality holistic education includes
character development, tonight the focus is on the character
trait of courage and how it can be harnessed to avoid and
remedy the pitfalls of anxiety and depression often faced by
young people….
10/06/2016
PARENT SEMINAR
10
PRESENTERS
David Schofield
Head of School Psychology Yrs10,11
Doug Angus
School Psychologist
Yrs7,8,12
Dr. Hannah Fiedler School Psychologist
Pre-6
PROMOTING COURAGE
What has helped me the most?
Finding a Big Picture Perspective:
• Know why I exist
• Know the meaning of my existence
• Having a purpose & goals that makes my
fears look trivial
• (I am not at the center of the universe)
PROMOTING COURAGE
1. What works for the Psychologist…
2. What gets in the way
3. What Works for Parents
4. Questions
SUMMARY: PROMOTING COURAGE
Never know till you have a go
• Never Know
(you will probably be OK to have a go)
Till
• You have a go
(face your fear)
PROMOTING COURAGE
1. What works for the Psychologist…
(Evidence-based principles that will be applied to parenting)
• Cognitive Behaviour Therapy:
a. The Therapeutic Alliance (Doug)
b. Cognitive Therapy (Dave)
c. Graded Exposure (Hannah)
You only know(b.) if you have a go (c.)
PROMOTING COURAGE
1. What works for the Psychologist…
• Cognitive Behaviour Therapy:
a. The Therapeutic Alliance
With DOUG!
Carl Rogers 1902-1987
Person Centered Therapy
“In my early professional years I was asking the question: How
can I treat, or cure, or change this person? Now I would
phrase the question in this way: How can I provide a
relationship which this person may use for his own personal
growth.” Carl Rogers
If you are anything like me this all sounds a bit ‘airy fairy’, soft
and cute- BUT how it is said and the behaviour of therapist,
research shows, really does matter and has measurable
impacts on the outcome of treatment.
The data available to back it up
• (Miller and Baca 1983)
• Study of individuals with problematic drinking some
given ‘self help- book based treatment’ others given
same content face to face with therapist. Measure of
therapist empathy was taken.
• 66% of variance in outcomes (level of drinking) post
treatment accounted for by therapist explained by
amount of therapist empathy at 2yrs post treatment
25% still explained by therapist empathy at treatment.
How different aspects of therapeutic processes influence
outcome of treatment.
Table 2.1 Size of the relationship between theraputic process variables and outcome.
Process Variable
Effect Size
Client Variables
Client suitability to treatment offered
0.5
Client collaborative versus dependent or controlling
0.5
Client co-operation versus resistance
0.5
Client contribution to theraputic bond
0.5
Client affirmation (respect and liking of therapist)
0.5
Client openess versus defensiveness
0.4
Client conversational engagement (verbal activity)
0.4
Client experiencing (articulation of felt meaning)
0.4
Client focus on life problems
0.4
Client expressiveness (linked with therapist empathic response)
0.4
Therapist varables
Therapist affirmation (acceptance, warmth, postive regard) of client
0.5
Therapist skillfullness
0.4
Therapist conrtibution to bond
0.4
Therapist focusing on client problems
0.4
Therapist empathic understanding
0.4
Therapist engagement versus detachment
0.3
Therapist credibility (sureness versus unsureness)
0.3
Variables characterising the relationship
Theraputic bond/cohesion
0.5
Reciprocal affirmation between client and therapist
0.4
Goal consensus/expectation clarity
0.3
Orlinsky et al, 1994
Key points to Therapeutic Alliance
•
•
•
•
•
Genuineness (openness and self disclosure)
Acceptance (unconditional positive regard)
Empathy (being listened to and understood)
Trust (anxiety= fear/control)
Modelling (Therapist looses credibility and damages trust
if they can not model the skills they speak of)
PROMOTING COURAGE
1. What works for the Psychologist…
• Cognitive Behaviour Therapy:
a. The Therapeutic Alliance (tick)
b. Cognitive Therapy (Dave)
COGNITIVE THERAPY
Basis: Distress (fear) arises from
thoughts/perceptions/beliefs
THOUGHTS  FEELINGS
If I actually believe I will be OK if I have a
go – then I will be more likely to act
courageously – and have a go
COGNITIVE THERAPY
Challenges Thinking
Getting to KNOW that having a go is OK
•
• Because anxious perceptions are usually false
TWO THINKING ERRORS
The anxious typically OVER-ESTIMATE:
a. The likelihood of bad things happening
b. How bad it would be if it happened
Teach Self-correcting of
THINKING ERRORS
Reality testing by Investigating the TRUTH:
a. Probability of feared thing happening
b. Magnitude of how bad it would be if
(in the unlikely event)
it actually happened.
REALITY TESTING QUESTIONS
Anxious Thought: “If I go to school, I will feel
anxious & people will notice & I will be
embarrassed & I won’t cope”
Ask Yourself:
•
•
•
•
•
What evidence do I have for that?
What else could happen?
What has happened before when I was worried?
What do I see happen to others?
What is most probable?
REALITY TESTING QUESTIONS
b. Investigate how bad would it really be?
Ask Yourself:
• Even if you were anxious & people noticed….
so what?
What is Another Way of Reality Testing?
REALITY TESTING ACTIONS
Another Way of Reality Testing?
HAVE A GO
Then you will know
Most CONVINCING form of Cognitive Therapy
is the evidence of experience
Never REALLY know, till you have a go.
PROMOTING COURAGE
1. What works for the Psychologist…
• Cognitive Behaviour Therapy:
a. The Therapeutic Alliance (tick)
b. Cognitive Therapy (tick)
c. Graded Exposure (Hannah!)
(Enthusiastic Applause)
GRADED EXPOSURE
• Fighting fears by facing fears – stepladders
– Graded: using small steps that gradually confront
the fear
– Prolonged: exposure must be long enough to
allow levels of anxiety to reduce
– Repeated: needs to be repeated frequently to
allow for learning
– Without distraction: it is important that the child
actually experiences the feeling of anxiety and it
educing. Distracting themselves why doing this
(listening to music, eyes closed) will prevent this
GRADED EXPOSURE
• Creating a stepladder
• Pick a fear you may want to work with (e.g. fear of being
center of attention)
• What is your goal related to this fear? Rate your anxiety level
out of 100 (e.g. give a presentation to peers - 100)
• Brainstorm various activities and exercises that this goal can
be broken down into
• Rate your anxiety level for each of these tasks (0-100)
• Order the activities from least feared (0) to most feared (100)
• Begin your stepladder ensuring to keep a record of your
experiences
GRADED EXPOSURE
• Goal: To be able to give a speech
1. Prepare a short talk and practice it alone
2. Give a short talk to parents
3. Give a talk to parents and deliberately make mistakes (dropping
mispronouncing words, etc.)
4. Give a short talk to close family and friends
5. Volunteer to read aloud in class
6. Give a longer talk to friends
7. Give a toast at Dad’s birthday party
8. Give a two-minute talk in English class
9. Give a longer presentation in History class
10. Make an announcement at assembly
11. Give a speech at assembly
GRADED EXPOSURE
• Rewards
– Important to motivate and encourage and as well as
celebrating courage and bravery
• Bribes vs. rewards
– Bribes are used to get someone to do something for you.
Rewards motivate a child to do something that is
ultimately best for them, and acknowledges hard work
• Rewards should be given as soon as possible after
successfully completing a step.
• Examples of rewards: monetary, computer time, choosing
family meal, choosing activity to do, planned outing with
family, PRAISE
KEYS TO FACING FEARS
• Create opportunities
• Repetition repetition repetition
– Show them it’s important and that you are engaged with
the process
• Duration
– Allow time for learning
• Reward effort not just success
– Encourage COURAGE and motivate them to try again if
didn’t work the first time
• Debrief
– What happened vs. what was predicted? What did they
learn?
– Show them you are there to support from start to finish
PROMOTING COURAGE
1. What works for the Psychologist…
2. What gets in the way
With DOUG
Avoidance
• The facts are always friendly, every bit of evidence one can
acquire, in any area, leads one that much closer to what is
true. Carl Rogers
• Hard to talk someone out of a strongly held
belief but helping them gather evidence
through behavioural experiments can
disprove a belief very quickly BUT this
requires lots of courage (Facing Fear).
How we accidently maintain anxiety
• Therapist Accommodation/Drift… “ involves a
shift from ‘doing therapies’ to ’talking
therapies” P.119 (Waller, 2009).
• Family Accommodation… “ways in which
family members, particularly parents, change
their behaviour to help relieve, diminish or
avoid distress caused by the disorder”p.2
(Lebowitz et al, 2013).
• School Accommodation… ways schools assist
students avoid approaching their anxiety
triggers
Family Accommodation ScaleAnxiety (FASA)
• Made up of 3 components
– Parent participation in symptom related
behaviour
• Example "How often did you assist your child in
avoiding things that might make him/her more
anxious".
– Modification of adults activities
• Example “Have you modified your leisure activities
because of your child’s anxiety”
– Distress/Consequence
• Example “Has your child become angry/abusive when
you have not provided assistance"
Key Point re avoidance
• The B in CBT is a critical part of the solution.
• Be aware of how you may be accidently
perpetuating anxiety through
accommodations and be prepared to stop.
PROMOTING COURAGE
1. What works for the Psychologist…
2. What maintains Anxiety
3. What Works for Parents
(Dave)
PROMOTING COURAGE:
What works for the psychologist
Cognitive/Behaviour Therapy (CBT):
1. Therapeutic Alliance
2. Cognitive (thought) Therapy
3. Exposure (behavioural) Therapy
Same Principles Apply to
Parents
PARENT-CHILD ALLIANCE
FOUNDATION
The quality of the parent-child
relationship
• Is the foundation from which our
children can launch themselves into
courageous behavior
• Safe, secure base from which they
can go out and explore, and take risks
PARENT-CHILD ALLIANCE
Essential Ingredients
1.
2.
3.
4.
5.
Unconditional Positive Regard
Empathy
Respect
Trust
Modelling
FOUNDATION: ALLIANCE
1. Unconditional Positive Regard
• You are OK to me
• Regardless of your Performance
= Unconditional Reliable Acceptance
• No strings attached
• Even if you don’t like me
• I am always on your side
BEGININGS of the ALLIANCE
• What is the conversation?
BEGINNING OF THE FOUNDATION
IDENTITY: I am what you see in me. If you
think I’m OK, then I am OK
THE CORE OF MENTAL FITNESS
HEALTHY IDENTITY
‘Sense of self’ as
- loveable
- acceptable
• Opposite is also true…..
THE CORE OF ANXIETY & DEPRESSION:
UNDERNOURISHED IDENTITY
Poor/unformed “Sense of Self” (out of touch with their
own values and strengths)
And
a TOXIC Sense of self as being:
- Unlovable,
- Worthless
- Powerless
- Never Good Enough
FOUNDATION OF THE FOUNDATION
JUST BE YOU??
•
JUST BE YOU
•
•
•
–
–
•
•
•
MOTIVATING YOUR CHILD
MOTIVATING YOUR CHILD
how to drive internal motivation in your
child - so that parents don’t need to do the
‘pushing’”
• Stop pushing (frustrating for all…RESET)
• Find out what he IS internally motivated about
(that isn’t harmful)
• Support/resource/focus on/praise/reward…then:
• Do a deal
MOTIVATIONAL ‘DEAL’
• Non-judgmental (Vs ‘you should….you ought to….you
are slack!’)
• RESPECTFULLY BEING ALLOWED TO PERSUE PASSIONS
BUILDS STRONG IDENTITY
THE CORE OF MENTAL FITNESS
IDENTITY FITNESS
WHEN YOU LET ME FOLLOW MY PASSIONS:
- I feel respected, valued, worthwhile
- I get to know who I am
- I explore my Personal Values
- I get to know my Personal Strengths
- My sense of self is strengthened
- And I am stronger
FOUNDATION: RELATIONSHIP
1.
Unconditional Positive Regard (tick)
2.Empathy
EMPATHY SHOWS UNDERSTANDING
I GET THAT…This is really hard for you.
• “You find it really hard to speak in front of the
class.…is that right?”
•
•
FOUNDATION: RELATIONSHIP
1.
2.
Unconditional Positive Regard (tick)
Empathy (tick)
3.Respect
RESPECT SAYS
•
•
•
•
You are OK to me
I trust that you have basically good intentions
I see how hard this is for you (empathy)
I really respect it when you are willing to face your
fears & have a go
FOUNDATION: RELATIONSHIP
1. Unconditional Positive Regard
2. Empathy
3. Respect
4.Trust
TRUST SAYS
• As long as you are growing, going forward…..
• you are in control
• I won’t push you beyond what you can cope with.
FOUNDATION: RELATIONSHIP
1.
2.
3.
4.
Unconditional Positive Regard (tick)
Empathy (tick)
Respect (tick)
Trust (tick)
5. Modelling
COMPOSURE MODELS COPING
• Show them how to
Keep Calm under stress
Especially when dealing
With their anxiety.
MODEL ANGER MANAGEMENT
Anger FEULS ANXIETY IN CHILDREN.
1. I fear going to school, AND
2. Now, I also fear your anger about me not
going to school & I feel more fear….and I
am less able to face my fear of facing
school.
ANGER FUELS FEAR
MODEL CONFIDENCE
They learn from watching YOU.
They will PICK-UP on your anxiety, and gives the
message:
• If Mum/Dad are distressed…
– This must be dangerous
– I should be concerned
MODEL CONFIDENCE
They learn from watching YOU.
“Mum, I got dropped to the B team this week”
MODEL CONFIDENCE
They learn from watching YOU.
So When YOU are Distressed…
Demonstrate:
•
•
•
•
Keeping Calm
Realistic Thinking
Approach (Not Avoidance)
Help-Seeking
COURAGE PROMOTING PARENTS
1. Alliance
2. Challenges Thinking
•
FITNESS PROMOTING PARENTS
Socratic Questioner
(cognitive therapy):
When he is anxious…
a. Empathy (not judgment)
b. Facilitate Realistic Thinking:
ASK (Don’t TELL……)
HELPFUL QUESTIONS
“I’M NOT GOING, I CAN’T DO
IT; PEOPLE WILL LAUGH”
• What evidence do you have for
that?
• What else could happen?
• What has happened before
when you were worried?
• What do you see happen to
others?
• What is most probable?
HELPFUL QUESTIONS
EVEN IF
• Even if you did perform poorly…
• So what?
• How bad would that really be?
HELPFUL QUESTIONS
EVEN IF
• Even if you did perform poorly…
• So what?
• How bad would that really be?
AVOID REASURANCE
TELLING them they will be OK
• Takes away their opportunity to
reassure themselves
• Makes them dependent on you
• DO tell them: you believe
they CAN cope.
• “I know you have what it
takes to not let this fear
completely stop you today…”
COURAGE PROMOTING PARENTS
Just like good therapist…
1. Alliance
2. Challenges Thinking
3. Allows Exposure to Adversity
ALLOW ADVERSITY
Treatment of Anxiety = Graded Exposure
WHAT ADVERSITY?
•
•
•
•
•
•
•
•
•
•
•
•
•
EXAMPLE
• Fear/anxiety around being noticed or centre
of attention
– Read out loud to your family
– Drop something at the shops
– Answer a question in class
– Wear something funny out in public
– Give a speech
SHIELDING FROM ADVERSITY
Cost of Over-Protection:
•
•
•
–
–
–
–
OPTIMAL ADVERSITY
SUPPORTING THROUGH ADVERSITY
• Create opportunities
• Repetition repetition repetition
– Show them it’s important and that you are engaged with
the process
• Duration
– Allow time for learning
• Reward effort not success
– Encourage bravery and motivate them to try again if
didn’t work the first time
• Debrief
– What happened vs. what was predicted? What did they
learn?
– Show them you are there to support from start to finish
A concrete actionable next step….
90Participants free of Primary Diagnosis
Percentage loosing diagnosis
80
70
60
50
NET
40
CLIN
30
WLC
20
10
0
12
6
1 year
week month
https://www.youtube.com/watch?v=IfcE10Ar3uY
Spence et al (2011)
Courage
QUESTIONS QUESTIONS
?
0467054962
QUESTIONS QUESTIONS
How do I help my child when he has a panic attack?
- get their eye contact,
- slow breathing
- keep calm
0467054962
QUESTIONS QUESTIONS
How to repair a line of communication
and move on after a fight with a
teenager?
• Apologise
• Indicate what you think you did wrong
and how you think it affected your child
• Ask: is there anything I can do to help?
QUESTIONS QUESTIONS
“How to build a resilient child?"
What are the Indicators (of a resilient child)
• Resilience = enduring good character in the face of
adversity/stress, ie, ability to remain Good People.
• Resilience means acting according to your values despite
pressure/suffering.
• Despite the adversity the resilient person continues to show:
• Solid Integrity
• Loving
• Moral
• Faithful
• Hopeful
QUESTIONS QUESTIONS
Musician’s Performance Nerves: How to
overcome?
• Reframe nerves as “excitement”
• Psycho-education about the value of some
anxiety for performance (inverted U)
• Perspective taking
• Rehearse (through visualisation) feeling the
nerves, then reframing, and enjoying and
using the energy of the nerves to perform
well
QUESTIONS QUESTIONS
How do we know when to move on to the next
step on a stepladder?
• The child should be exposed to a situation
until it no longer produces excessive
discomfort or fear
• Complete the step enough times until the
child is confident that they can manage that
situation - until they are bored of it!
QUESTIONS QUESTIONS
What if a step was unsuccessful?
• Talk about it!
–
–
–
–
What went wrong?
Was it too hard?
Can we break this down further?
Do I need additional skills to help me through?
• If a step is not completed successfully, the reward
should not be given BUT praise and encourage them to
try again. Often praise and attention is the best reward
GETTING HELP @ KNOX
WHO DOES WHAT@ KNOX?
PSYCHOLOGIST
YEAR GROUPS
DR HANNAH FIEDLER
Pre – 6
HAYLEY WILTON
Pre – 6
DOUG ANGUS
7, 8 & 12
DAVE SCHOFIELD
[email protected]
ROSS WHITFELD
10 & 11
LINDA GOMEZ (Careers 3 days)
9
10, 11 & 12
INTERNS
• Provisionally Registered Psychologists
• Clinical Masters Placements (6th Year)
– 2 days a week for 2 Terms
– Fresh Cutting Edge Ideas
– Best Counsellor to Student Ratio
CURRENT (Term 2) INTERNS:
INTERN
1. Dr Adem Aydogan
2. Vanessa Leongue
3. Karen Watson
4. Shannon Lang
UNI
MU
UWS
UoN
MU
INTERNS: TERM 3-4
INTERN
1. Rebecca Lazarus
2. Belinda Favaloro
3. Terri Katz
4. Tahlia Ricciardi
5. Karen Watson
6. Christine Au Yeung
UNI
MU
UWS
UWS
MU
NEW
MU
APS Website: Find a Psychologist
• https://www.psychology.org.au/FindAPsychol
ogist/
• Search by
– Client type (adolescent, adult etc),
– Issue (depression, anxiety…)
– Medicare status,
– Gender,
– Appointment times,
– Languages