Childhood is the stage where a majority of our behavioural patterns are learnt and the foundation of our personality is formed. This stage is critical for the development of the basis for appropriate and healthy coping skills, emotion regulation strategies, and the ability to differentiate between feelings and behaviour. If at this point of time, a child learns inappropriate and unhealthy behaviours, then it can become difficult for him or her to unlearn it at a later stage. And so, when your child shows signs of not being able to tame his or her temper, it is time for you to incorporate some strategies for anger management for kids at home.
While anger is a normal emotional reaction, and meltdowns can be common among children, they can often become more destructive. Kids may try to vent out their bottled up frustrations by hitting, screaming, or breaking things in the house.
If left unchecked, smaller issues with anger and defiant behaviour can quickly turn into bigger problems that may stay with your child even during their adulthood.
Signs of Anger in Children
Some of the behaviours that are associated with tantrums and meltdowns among toddlers are:
pulling or shoving,
Throwing objects, etc.
Toddlers, more often than not, respond to emotions like anger with tantrums. In most cases, children grow out of this phase as they develop communication skills and appropriate strategies. But there is a possibility that they don’t, and in that case, it means that they haven’t been able to attain the right developmentally appropriate skills yet.
You have a reason to be concerned if:
your child’s outbursts are getting more frequent; as frequent as multiple breakdowns in a day,
these outbursts last longer than usual despite of you trying to help them manage their behaviour,
and you feel worried about them accidentally injuring themselves in these situations.
If this is the case then you must consider talking to your child’s pediatrician and opt for anger management therapy for kids.
Anger Management Activities for Kids
Trying to raise a child and helping them develop emotional intelligence is, no doubt, a difficult job. On top of that, handling frequent anger tantrums is even more challenging. There are going to be several ups and downs in this journey as your child learns self regulation. He or she is bound to lose control every now and then. But you must try to make it as easy and comfortable as possible for your child.
Anger management for kids doesn’t have to only be about disciplining. As you read on further, you’ll get to know some creative ways in which you can help your child deal with anger.
Cozy Dungeon for Keeping Calm:
Make a safe place somewhere in the house or your child’s room itself where they can go whenever they recognize that they feel angry and need to calm themselves down. This place could be a kids’ tent with fairy lights and your child’s favorite stuffed toys in it. Or, it could be a corner where there are a bunch of pastel cushions, a giant teddy bear, and some crayons and sketchbooks, ready for your child to express themselves into. This soft and cozy place will help the kid to relax and at the same time avoid any injuries, both to themselves and all others in the household.
Tickbox for Triggers:
As for adults and for children, finding one’s triggers which set one off is very important. It can be even more difficult for children as they haven’t developed the kind of emotional intelligence that adults tend to have. Creating a checklist of common triggers will help them figure out what exactly really makes them throw tantrums. Consider discussing it afterwards and helping them understand their emotions even more deeply.
Draw And Tell:
Anger is a very physical emotion. It is physical in the sense that whenever it is felt, anyone, be it a child or an adult, feels strong sensations in the body. Helping your child conceptualize anger using drawings or make-believe stories can be the first step for them to begin identifying anger is an emotion, and aggression as an unhealthy response to that emotion.
Your child may draw an image of them with a warm head and hands indicating that this is where they feel their anger. Or, they may tell you that they feel anger beating in their hearts as if it’s a canine, willing to lash out any second. You may be surprised with how elaborate descriptions children can come up with. This will not only help your child explore and accept what they feel and come to terms with it, but also help them vent it out in the healthiest way possible.
Levels of Anger:
You can help your child create a chart in which they can tell you which triggers or situations makes them angry and rate them from 1 to 5, or 1 to 10 and so on. This may help you find the exact cause of their anger and prompt your child to think about it in-depth.
Breathing exercises help everyone to calm themselves down and be mindful of their emotions and their thoughts. These are the simplest relaxation techniques that can enable you to take control over your anger. For children, too, this is the best way to ensure that they remain calm and composed under all circumstances. A way to make breathing exercises interesting is to hold up your fingers and ask your child to imagine that they are birthday candles. Ask them to take a deep breath and blow them out by breathing out with their mouths.
Role of Parents
As parents, it is important for us to understand how central we are in our children’s little universes as agents of socialization and as the first teachers for life skills. The home environment is supposed to be, in a sense, a simulation of the outside world, which effectively helps children learn coping strategies and how to conduct themselves as they grow up. It is a parent’s duty to set ground rules and restrictions, but at the same time, positive reinforcement strategies are also very important.
Also, we must bear in mind that it is our behaviour that our children model after. We must keep ourselves calm and composed and give ourselves enough time for self care and nourishment to be fit in mind and body for handling our children and other aspects of our lives. Following are a few tips that may help in anger management for children:
Stick to a daily routine for meal times, waking up and going to bed, studying, playing, etc.
Make plans for when your child might throw tantrums using the activities given above.
Let your child express themselves and their emotions with harmless and healthy behaviours like stomping or saying a sentence that may let you know they are angry.
Help your child navigate through their problems and find the right solutions.
Reward your child whenever they exhibit good behaviour.
Try not to put your child in surroundings or with toys that they are not comfortable with.
Control your own emotions and avoid any outbursts as your child will model after your behaviour.
Therapy and Options Beyond The Behavioural Plan
If your child is lashing out more than usual, it may be time for you to consider professional help. Behavioural therapies can help you and your child develop a positive relationship and at the same time reduce the negative effects of anger in your child. Options like PCIT (Parent-child interaction therapy) is known to be a very helpful option for children between ages 2 and 7. Other options are parent management training, in which the parents learn certain skills and techniques, and CPS (collaborative and proactive solutions) which helps children learn skills for emotion regulation and building resilience over anger.
At times, such behavioural plans may not work with some children. This may indicate that your child might have an underlying mental health condition that needs to be treated otherwise. A few such conditions include ADHD (attention deficit hyperactivity disorder), anxiety, learning disabilities, sensory processing issues and autism. Such conditions have a different route of treatment plans which may involve further exploration and maybe seeing an expert in that particular field.
At the end of the day, learning how to handle your child’s aggression with behavioural approaches can prove to be difficult and challenging. This requires patience and willingness on the part of the parents, however, it proves to be worth the effort knowing that it will result in a better relationship, a warm environment at home, and a healthier, happier child.
A majority of the students experience significant or even chronic amounts of stress and this can take a serious toll on their grades, happiness and overall well being. The demands of an institution like university or school, like academic demands, being away from home and friends and family in case of boarding schools and hostels, or bullying and peer pressure from other students require a lot of effort on their part to adapt, adjust and flourish.
Moreover, a study by the American Psychological Association (APA) found that adolescents report stress levels as similar to those of adults. This means that often the stressors that students face may exceed their ability to cope efficiently. However, there are many techniques of stress management, and in severe cases, treatment also helps reduce the symptoms of stress considerably.
What is stress?
Stress is the body’s reaction to adverse situations. Though stress is mostly perceived as something bad, it can in fact be good in some cases. The right kind of stress can help hone our skills and train our brain to help our body perform better and tackle tricky situations to suit our needs. Biologically, stress is a physiological reaction in our body where certain hormones are released resulting in physical manifestations of stress.
A Brief Overview of Stress in Students and Its Types
Student life, for most, involves dealing with a significant amount of stress which takes significant tolls on health, both physical and mental, and often grades too. A well reviewed study by the American Psychology Association (APA) found that teens usually report similar levels of stress as adults. This means that teens experienced significant levels of chronic stress, and a lot of them admitted to their stress levels generally exceeding their ability to cope with it effectively.
Usually there are three kinds of common types of student stress, or in other words, three broad categories of stress triggers:
Social: Social stress puts enormous peer pressure on students. This includes dealing with new relationships, living with or without family members, balancing academic life with their social life, adjusting to new environments, all of these can trigger stress in students.
Academic:Tight schedules, deadlines, projects and assignments, sometimes low grades, exams, managing personal chores and other academic responsibilities, challenging classes or subjects, and often overall poor time management can all lead to a extreme academic stress, just the sheer thought of not being able to finish tasks at hand can add to or cause stress in students.
Daily life: Often non-academic aspects can act as stress triggers too, some students take up part-time jobs which have their own stress dynamic, another common cause of stress is traffic or commute related triggers or even financial issues, and so on.
Signs and symptoms that you might be stressed:
If you are irritable and not enjoying whatever activity you are currently engaged in
If you seem anxious, fidgety and worried all the time
If you have a disturbed sleep schedule and have trouble sleeping
If you cannot concentrate and snap at people too often
If you feel short of breath or breathe very fast
Causes of Stress in Students
Identifying what causes stress in students can be the first step towards addressing it and eventually managing or treating it. Knowing the stress triggers and learning how to micromanage the molecular issues can help the students help experience less stress and also allows people around to support them better.
Following are the issues that can cause stress among students
Tests on subjects that the student finds challenging or difficult: Often, when preparing or sitting for an examination that you have scored badly in earlier, or have negative presumptions about beforehand, a student may display symptoms of stress and develop test anxiety.
Overloaded by homework, projects, presentations with the added burden of group projects: Excessive workload, just as it does in the workplace, often pesters students to the extent that they may even develop stress issues. This can happen due to bad time management practices or simply because there is too much to do.
A heavy workload perhaps due to their part-time job commitments: Part-time jobs are just as tiring as students’ schoolwork. More often than not, they require dull work that the students simply do not enjoy doing and are paid peas for. This could be a source of stress as well.
Lack of organizational skills and poor time management: Poor time management skills and bad managerial and organizational skills renders students, or anyone, unable to handle the daily hassles of life. This leads to the development of stress.
Stress due to relationships: High school and college also overlap with the time period when adolescents begin to foster intimate relationships. Any conflict in these can also lead to stress.
Getting too little rest and poor sleep schedule: A poor sleep cycle is linked to numerous mental and physical health issues.
Lack of proper support leading to unhealthy coping mechanisms:
Having difficulty transitioning to a new environment
Various effects of Stress on Students
Stress is a powerful feeling that can drive you to be successful in life, but at the same time, it can also be debilitatingly harmful. It can, if not handled properly, completely shake the foundations of your career and relationships.
If you’re living with an uncontrollably high amount of stress, you’re not just putting your mental health at risk, you’re also very likely to have poor physical health. It is a proven fact that stressed individuals are likelier to expose themselves to pathogens of illnesses. Around 60-80% doctor visits are stress-related. This is because distress impacts our immunity levels drastically.
Moreover, stressed students are also much more susceptible to taking part in health impairing activities such as:
Consuming high amounts of alcohol
High dietary fat consumption
Unsafe sexual practices
Violent or suicidal behaviour
Physical health problems and chronic illnesses like ulcers, hypertension, heart disease, diabetes and even cancer have strong links with stress.
Few tips on managing Stress in Students
The only way to overcome stress is to learn about it. Practical stress management can help students deal with whatever worries them and eventually be more effective and productive with reduced negative feelings.
Usually students tend to have packed schedules and we are notoriously famous for skipping sleep, which leads to poor health which leads to poor hygiene and it keeps adding up until we fall ill.
Students can prevent staying in this vicious cycle by following these few tips to manage their stress:
Getting Organized. Getting organized is often the first step to lower your stress levels. Clutter can often cause decreased productivity, stress and even cost you money. Get soothing lights. Have a minimal indoor setup that is free of distractions.
Getting Enough Sleep. As stated before, a poor sleep cycle can harm a person’s mental and physical health drastically. So, cut back on your coffee intake, limit your screen time in the evening, and grab a book and go to bed at least before the clock ticks at 12.
Maintaining a healthy diet, reducing eating junk food and sugar drinks. The gut-mind connection is stronger than we may give it the credit to be. A balanced diet can solve more problems than we can imagine. So, eat well and stop going for takeaways every alternate day.
Getting enough exercise and getting some air and sunlight. Working out is as important as eating well. It helps release good endorphins into the system that are both immunity-boosting and help us counter stress.
Listening to Music. Soothing music can help beat stress better than any other remedy. So, play some contemporary lo-fi or jazzhop or some classic Hans Zimmer or perhaps even Beethoven, if you wish, in the background when you study to beat the stress and tone down the mental chatter.
It’s a convo potentially more awkward than the birds and the bees: Here’s how to educate and empower when talking to kids about porn and sexting
‘Our kids grow up way too fast’ is a comment we hear more and more frequently in this day and age. It’s all around us. In a world where kids are being sexualised earlier and earlier as a direct result of sexual material on TV, in movies, surfing the net, in music, in magazines, and even on the sides of buses, it’s up to parents to take action.
Research indicates that on average children first encounter porn at age 11 (!). Every parent’s nightmare is to discover that their child – especially a young child – has viewed porn. Maybe they clicked onto something on YouTube. Maybe their friend dared them to Google the word “sex”. Because it is a difficult conversation, we tend to put it on the back burner, but sadly we are only fooling ourselves, because research shows that kids from a very early age may accidentally or intentionally be exposed to material that is sexually explicit, uncensored, often inaccurate and potentially harmful.
As a parent, try to minimize children’s exposure to commercial media and kids’ magazines, and find alternatives that they can enjoy. Get your kids involved in sport and other outdoor activities.
Tell your children from a very early age, and often, that they are loved for who they are, NOT for how they look, advises Ms. O’Sullivan. Be open and firm about your family’s personal values, and explain your reasoning to your child.
Other key tips, via Professor Jessica Zurcher: when talking to your kids about porn it’s important to avoid shame-based messaging. Don’t blame or punish your child for encountering pornography, both because it’s perfectly healthy and natural to be curious about sex and sexuality, but also because you don’t want your child to perceive negative consequences from discussing pornography with adults. Instead, thank your child for confiding in you, and try to ask questions and/or encourage a further open dialogue. For instance, you can discuss how everyone’s definition of pornography differs, and there are blurred lines between art, entertainment and titillation. It’s also a great opportunity to talk about body positivity and feeling a sense of agency over their own body.
Additionally, Professor Zurcher recommends avoiding the ‘third person effect’, or sending the message that ‘good kids don’t encounter pornography.’ If your kids are prepared beforehand to know what’s out there, and they’ve also been made aware of porn’s negative aspects and outcomes, they will feel a truer sense of agency and empowerment.
An Open, Honest and Respectful Relationship is the Key
Ms. O’Sullivan advises that while it’s definitely important to put boundaries on access to the Internet and screens (the app Qustodio earns high marks from parents worldwide), it’s equally key to explain your reasoning openly and honestly to your kids, which in turn can help them feel safe talking to you if they see something inappropriate online.
“Is [your child’s] autonomy being respected? Do you think they feel you are being responsive to their feelings? Rule setting should be dependent on discussing and explaining WHY – not simply telling your kids ‘because I said so!’ There’s a difference between setting rules and being a controlling parent.”
In his research Dr. Yee has found that how parents talk to their children – whether in a more open, respectful, “discursive” manner, or in a more authoritarian and top-down manner – can have a huge effect on children’s perceived emotional climate.
Additionally, Ms. O’Sullivan recommends that parents educate kids that “porn can negatively impact their sexual experiences with partners later on when the time is right, as studies have shown it creates unrealistic expectations of and views on sex and intimacy.”
Why Teens are Drawn to Sexting
We were all teenagers once; hormones, testing boundaries, and trying on different self-identities are a universal part of the experience. But the new addition of mobile phones combined with those factors can make for a combustible combination. A variety of recent studies in the US and UK have indicated that about 30% of preteens and teens report receiving “sexts” (sexual text messages) – though there’s speculation that this figure is under-reported, and on the rise. In a 2018 study in the United States, 1 in 3 girls aged 14-to-19 reported all or most of their friends had been asked by a boy to send a sexy or nude photo of themselves.
“Sexting is one of the issues that’s evolved from having smartphones, but is rooted in the need for belongingness, excitement and risk-taking, along with the peer pressure that all come with the onset of puberty,” says Dr. Puno.
Teens not only receive unwanted sexts, but may also be sending them out without considering the consequences.
The Risks and Consequences of Sexting
And the consequences are myriad and devastating. In the UK, there was a 131% increase in sexting offences registered to the police between 2014 and 2017.
Sadly, there is also a double standard for girls, who might be “slut-shamed” and are more likely to be victimized by a sext going public, whereas for boys possessing nude images or videos is considered an “asset of social capital.” Even worse, victim blaming is often the norm, with girls faulted for not guarding their own sexuality more vigilantly.
This leads into a further wrinkle in the issue: of course girls should feel free to be proud of their bodies, and to want to share images and not be ashamed.
“International anti-sexting campaigns have positioned ‘sexting’ as a problem affecting young girls who lack vigilance in their uses of social media. The media has tended to dramatize this theme of under-age female risk…The implicit message in this and other anti-sexting narratives is that responsibility for an image lies with its producer/sender not its receiver, resulting in a form of victim-blaming (Hasinoff, 2012) that illustrates what commentators have called ‘slut shaming’ (Albury, 2012). In consequence, strict moral boundaries around girls’ (but not boys’) age-appropriate sexual expression are re-drawn through efforts to prevent sexting practices (Renold and Ringrose, 2011).
“Not only, then are discourses of ‘sexting’ risk aged and gendered, they reproduce moral norms about sexual subjects, constructing girls’ sexuality as a particular problem to be surveilled and regulated. Concerns around ‘sexting’, thus dovetail neatly with the wider social concerns explored in this special issue around girls as the main victims of ‘sexualisation’ and related social harms (Tankard-Reist, 2009). The idea that self-sexualising through sexting images puts girls at moral risk of exploitation works through the age-old sexual double standard that not only positions girls’ sexuality as something pure and at risk of contamination through active desire (Jackson and Cram, 2003) but also positions girls as responsible for protecting the virginal body from hard-wired aggressive male sexuality (Holland et al., 1998).”
Here in Singapore, according to the Media Literacy Council sexting is not illegal (and there are no laws restricting the possession of images). However, if someone sends illicit images to a person under 16, or urges them to perform a sexual act, that child is protected by the Children and Young Person’s Act.
What role parents can play?
As parents, it’s crucial to approach texting in a developmentally appropriate way, says Dr. Puno. For instance if the average age of phone use is at 10 (pre-puberty), parents need to stay on top of knowing how your child is using their phone, and guiding appropriate phone use by setting boundaries and limits from the beginning.
“It’s important to outline negotiable use and non-negotiable use, as well as the consequences of losing phone privileges if these are ignored,” she says.
At the onset of puberty (about 13-15), parents should discuss with their teens the possible issues that can arise from being online (from bullying to being approached by people who aren’t who they claim to be). Parents should also be specific with what kids can and cannot put online (e.g. their address, personal details, etc.).
Parents should know – and warn their kids – that sexting can quickly arise from normal, interesting exchanges to suddenly explicit sexual messages, photos or videos. This is in part due to curiosity on the topic, or extreme peer pressure or bullying. It’s important that parents talk about the consequences of being pulled into a situation where you feel out of control, and remind kids that sending a message to seemingly one person could quickly escalate into a broad public exposure of themselves and their thoughts. In the UK, an app called Zipit(which kids need to install on their own phones) helps “keep flirty chat under control” by helping kids steer the situation and suggesting alternative responses when they’re being pressured to send nude photos. It’s proven to be effective and was cited in recent studies.
Once again (we sound like a broken record here!), maintaining a strong connection and an open, trusting relationship with your child is absolutely essential to ensuring they’ll come to you if and when something happens. Remember to reassure your kids that if this happens, you will be available and supportive.
By the time kids hit their mid-late teens (ages 16 to 18), they are growing in independence and maintaining their own friendships and relationships. Ideally if parents and teens have a strong foundation of honesty and open communication, along with modelling of appropriate behavior and a good grasp of healthy sexuality – then kids will know how to engage with presented with texting.
In a recent study, researchers in the UK spoke to 13- and 14-year-olds about the types of support, intervention and sexting education they felt they needed. Some key takeaways: students felt it should be part of their core curriculum (and not just a special school assembly or presentation with scary messaging).
“We only had an assembly, but it only showed us how a girl was bullied after”, a female participant said. “It never told us why not to do it and if it’s illegal”, she added.
Additionally, students were more open-minded and less fearful of texting, viewing certain circumstances for sharing nude photos as “understandable and beneficial,” according to the study’s co-author. For instance, sharing naked images with friends to gain reassurance that their body was normal; sharing a nude photo as an expression of body confidence; or sexting as “a means for creating intimacy and establishing trust within a romantic relationship.” Teens also felt that they had been better prepared to fear texts and harassment from strangers, whereas in fact most bullying and coercion comes from friends and acquaintances.
Finally – and this is a key one for parents – the teens in the study said they did not feel comfortable seeking support from parents and teachers, but rather preferred talking with someone “who you don’t see every day” such as a doctor, guidance counsellor, or peer/mentor.
Taking away their phone or screen time is NOT the answer
As Professor Lim Sun Sun told us in an interview earlier this year, her research has indicated that one major reason kids refrain from talking to their parents about cyber-bullying and other online problems is that they’re “terrified their devices will be taken away from them.” Dr. Lim recommends that total denial is not a good solution; however if your child feels secure and confident that they can avoid that out come, they are apt to feel better about discussing online problems with you more openly.
So what should parents recommend their child does if they receive a sext? Dr. Puno provides the following tips:
Ignore and disengage from the chat
Let an adult know
If it persists, block off contact with people who are engaging in it
If it persists offline, ask help from an adult you trust, or seek help from professionals or authorities (such as school administrators) who make the behavior stop
Conclusion: Parental and Family Values are a ‘Super-Protector’
Topics like sexting and pornography both provide the opportunity to talk about your family’s strong identity and core values so as to provide that much-needed sense of belonging to your child. In fact, says Dr. Puno, “Recent research has shown that parent-child connectedness has emerged as a ‘super-protector’ of family life that could potentially protect young people from the many unique stressors and challenges that face them in today’s world.”
In other words, the “emotional environment” of the home – one that is surrounded by affection, warmth, satisfaction, trust, and minimal conflict – has been show to help children make the right choices.
A 2018 study in the United States that surveyed over 1,000 children between ages 10-19 found that parental attitudes influenced teens’ own attitudes and behavior when it came to both sexting and viewing pornography, as well as their treatment of the opposite sex.
Importantly, kids who had been spoken to by a parent about these issues, and the emergent #metoo movement, or who played with gender-neutral toys growing up, were more likely to report more favourable attitudes towards gender equality, and to experience less gendered discrimination online.
A strong family bond is seen as a protective factor for the prevention of social and emotional problems, Dr. Puno says, so make every effort to build a positive relationship with your child from the early years of their life to empower them with the skills and strategies that will enable them to navigate difficult life experiences.
International Counselling & Psychology Centre (ICPC), 360 Orchard Road, #06-08 International Building, Singapore 238869, Tel: (+65) 6734 6463, www.intlcounselling.com. Note that Dr. Puno also offers the workshop “Connected Parents, Thriving Kids, and ‘Getting the Love that You Want’”
Cognitive behavioural therapy (CBT) is a psychotherapeutic intervention that aims at challenging and changing your thoughts and behaviours, especially the ‘unhelpful’ ones which are destructive and distorted, and replaces them with much more helpful, healthier thought and behavioural patterns.
CBT is relatively shorter in duration and is quite efficacious for a myriad of mental health problems. It uses the biopsychosocial approach for the treatment. Both cognitive and behavioural techniques are used. All of that makes CBT a comprehensive and easy approach to adopt which can be applied to a variety of disorders. CBT is also proven to be very efficacious according to the research into the outcome and the application of the treatment.
Uses Of CBT
CBT is a solution-focused & goal-directed treatment that is short in duration and helps you pinpoint the source of the problem quickly and efficiently. It requires a limited, small number of sessions for the completion of the whole treatment. It is thus one of the most preferred forms of psychotherapy for many disorders. The disorders where CBT can most effectively help improve the patient’s condition are as follows:
It can also be specifically used as a tool for managing some emotional and/or challenges. CBT practitioners may also refer to the principles of therapy as lifestyle guides. They can be applied in many contexts, for instance:
Equipping oneself with tools to lead a better, happier life in general
Managing life challenges, difficulties, stressful environments or events.
Managing conflict in all sorts of situations, or relationships
Coping with grief, loneliness
Coping with trauma
Coping with a medical illness
Managing the symptoms of a mental disorder better
Preventing relapse of a mental disorder
What are the types of CBT?
CBT principles are based on the fact that a person’s problems are based in the psychological, social and biological realms. Moreover, these problems are instilled in their thought processes and behavioural patterns which have to be reformed and unlearnt. There are many tools, techniques and concepts which can be applied for the same. These concepts are also involved in the following variations of psychotherapy:
The cause of psychological distress, according to cognitive therapy, resides in an individual’s distorted thinking patterns, emotional responses, and behaviours. These are refuted through a process of non-directive questioning.
Rational Emotive Behaviour Therapy (REBT)
REBT locates the causes of distress in irrational thoughts and beliefs of an individual which are tackled through an ABC analysis, which is the antecedent-belief-consequence analysis.
Dialectical Behaviour Therapy (DBT)
DBT involves usage of mindfulness and emotional regulation to address the unhelpful thoughts and behaviours of an individual.
Multimodal therapy involves addressing seven distinct, yet connected modalities that are behaviour, sensation, cognition, imagery, drug/biological factors, and interpersonal relationships and behaviour.
How CBT works
Cognitive Behavioural therapy is, as stated earlier, a very problem-focused and goal-directed psychotherapeutic approach. It has a basic principle that the way we think and perceive our life circumstances and situations, even the minutest details, have a drastic impact on how we behave and feel. It requires a lot of effort on part of the client as they are the ones working on themselves, while the therapist acts as an enabler. It is very present-orientated and the past is only relevant to the extent of understanding and identifying current behavioural and thought patterns that one could have picked up earlier.
Through CBT, the client learns to develop cognitive reflexibility, which ultimately helps them overcome their cognitive distortions. Cognitive distortions, like catastrophizing, looking at things only in black and white, over-generalizing, personalizing, jumping to conclusions, being too negative or unrealistically positive, having self-esteem issues i.e an inferiority complex or a superiority complex, etc., affect our behaviour and moods drastically. When we become more aware of ourselves, and look at things around us differently and adopt a degree of openness in life, we’re able to fully transform the way we think and become healthier, wholesome, and more compassionate individuals. CBT equips us with many tools and regular exercises which one can adopt to live a better life.
The CBT therapist merely guides the session and helps you structure your thinking just by asking you open-ended questions, and you yourself identify your own unhealthy patterns. Upon identifying such problems, and fully understanding them, the therapist teaches you techniques to address these problems. Once these techniques are fully established and turn into habits which replace the earlier unhealthy habits, the treatment comes to an end. A follow up is also recommended for the prevention of relapse.
CBT for Children
CBT uses the same basic principles on children that it does on adults. All our thoughts, emotions, behaviours are interconnected and constantly affect each other, according to the CBT principles. Thus, for children, the core principles that are applied are the same. CBT is a very effective therapeutic approach for children with anxiety disorders, depression, PTSD, behavioural problems and substance abuse.
While the basic principles used in CBT for children are the same, there are some differences on other levels. The commonalities, however, are:
The treatment remains goal-directed throughout the course of it, and the child, his/her parents, and the therapist together mark their goals and assess the process.
The therapist aims to simply enable and guide the client in his/her journey towards self-awareness, self-development, and learning positive behaviours and cognitive tools.
The child behavioural therapist and client both develop a deep therapeutic relationship in which the client has respect for the therapist’s knowledge and expertise of the subject matter, and the therapist appreciates and acknowledges the client’s ability to understand himself/herself the best.
The therapy is present-oriented and short-term. There are also more than often homework assignments for the client to work upon before the next session.
Along with individual or group CBT, the following approaches are also used:
Inclusion of parents in the process
Motivational-Enhancement Therapy (MET)
Frequently Asked Questions About CBT
Q. How do I know if CBT is working on me?
A big part of what CBT is involves constantly tracking your progress, and so both you and your therapist will know how you’re doing and whether or not you’re progressing towards your goals. This means that while we will ask you for your feedback during every session, we’ll also assign to you some questionnaires so that we can properly assess your symptoms throughout the course of the treatment.
Q. Is CBT based on all “positive thinking” and affirmations?
No. When we do CBT, we guide you through healthier ways of reacting to a situation. We’re aiming at being realistic here. If something really bad happens, or did happen, then merely thinking positively could mean that you’re ignoring how bad the situation was. That said, positive thinking isn’t always the healthiest option in all contexts.
SINGAPORE – Wearing a mask daily has become routine during the Covid-19 outbreak, and it is a practice expected to continue under the “new normal”.
But parents and experts have raised concerns over the long-term effects of mask wearing for children.
A 2016 study by Frontiers in Psychology – a peer-reviewed, open-access academic journal – showed that facial expressions and visual cues are of great importance in that they allow children to share and identify emotions during social interactions.
Ms Aarti Mundae, director of Incontact Counselling and Training, said that wearing a mask could lead to developmental delays in communication matters just as children are learning to express themselves.
Said Ms Mundae: “Communication is deeply influenced by visual cues. It is only 38 per cent affected by vocal cues and surprisingly, seven per cent by verbal. This makes the need to express and see facial cues significant.”
Verbal cues refer to words while vocal cues encompass tone of voice, volume and pitch.
“It could also cause delays in their development of social and emotional intelligence as they are unable to pick up the finer nuances that are critical to their comprehension of feelings,” she added.
But pre-schools are finding ways to work around this.
Childhood trauma is a consequence of overwhelmingly negative experiences that a child might have, which can have lasting negative effects. Some of these experiences include but are not limited to – abuse, neglect or violence, which mostly happen in relationships and are called interpersonal trauma. Children can also experience traumatic events such as, accidents, natural disasters, medical procedures or sudden loss of a parent/guardian. Another thing to note is that childhood trauma does not necessarily have to occur to the child directly. For example, watching their parents or a loved one suffer can be extremely traumatic to a child. Exposure to violent media or a violent household can equally traumatize children. However, just because an experience is upsetting it does not mean they are likely to cause trauma.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not list or define childhood trauma separately, however, under child mental disorders classification it provides a clear definition for diagnosis of post-traumatic stress disorder PTSD in children. PTSD is the most commonly diagnosed form of trauma and refers to the phenomena of re-experiencing the traumatic events again and again in your mind and the stress that comes with it. Therapy for childhood trauma is available but many of those in need live with the effects of trauma without ever getting a formal diagnosis or the sort of trauma treatment that could help them. There is an undisputed correlation between adult ill-health, both physical and psychological, and unresolved trauma.
Signs and symptoms of childhood trauma
Some children are at a higher risk than others for suffering from long-term effects from a traumatizing event. How a child processes or experiences these events and how it is handled by people around them can have a strong influence on the extent of trauma that they actually end up going through.
Children tend to have difficulty articulating their feelings and thoughts and are often unable to verbalize the emotions inside them. They use the only alternate channel and act it out. Therefore, these are a few overlooked signs and symptoms to look out for trauma related stresses in children:
Psychosomatic symptoms: Children can complain of stomach upsets or headaches, but on seeing a doctor they might declare the child to be physically fit. It may seem as though they are using this as an excuse to avoid doing a task or going somewhere.
Outbursts: Irrational and unexplainable anger outbursts might lead parents or guardians to believe that their child is becoming disobedient or mischievous and does not want to follow instructions and can be a sign of a trauma stress.
Clinginess: Sudden clingy behaviour among young children towards their parents can be evident post a traumatic event.
Restlessness: Loss in focus and concentration in academics or even play time. An obvious sign would be a sudden plunge in academic performance in an otherwise conscientious student.
Intrusive thoughts: One common sign of PTSD is increased thinking about death and safety. While some kids are naturally more morbid and fascinated by death, others tend to develop an obsession with their and their loved ones’ safety.
Other common signs: Anxiety, depression, fear of isolation, poor self-esteem, increased irritability, changes in appetite and problem sleeping.
Common causes for childhood trauma
Among clinicians, a common term that deals with researching trauma in children and its lasting effects that goes around, is Adverse Childhood Experiences (ACE). The ACE study began in the mid-1990s and was done by the Centers for Disease Control and Prevention in Atlanta, USA where more than 17000 people volunteered.
The study identified ten of the most traumatic events or experiences that a child is likely to encounter. The consequences of such events have the potential to leave lasting negative effects on the child for their entire lifetimes without effective trauma therapy. With more data and volunteers that list has broadened, and following are the ten common causes for childhood trauma:
Growing up in the presence of a parent/guardian who is an addict or a chronic substance abuser.
Growing up in a household where the parent or the main caregiver goes to prison.
Growing up in a home where the parent has been diagnosed with a mental illness such as schizophrenia, or depression.
Witnessing either of their parents being physically abused by the other.
Experiencing emotional abuse. This can include parents being emotionally unavailable due to long working hours or parents being routinely demeaning, scaring or verbally abusing the child.
Experiencing physical abuse. This can be experienced either at home by parents who use physical abuse to discipline, or outside home by an authority figure.
Experiencing sexual abuse. Can be caused by parents, family members, even other children or sometimes people who have authority or power over the child.
Losing their parent or guardian, which might happen due to their death, divorce or abandonment.
Growing up with emotional neglect. Sometimes parents fail to notice or respond enough or appropriately to a child’s feelings and there is little or no emotional support or validation.
Growing up with physical neglect -this applies when children are not adequately fed or clothed, kept clean, or kept warm in cold weather.
Growing up with emotional abuse and neglect- when parent are very critical and may have unreasonable expectations that could hamper the development of the child.
Effects of childhood trauma
Early childhood trauma can lead to many complications both in childhood and in adulthood. It is a risk factor for many mental health conditions including adult depression, PTSD and most psychiatric disorders, as well as a host of medical problems like heart attack and stroke, cancer, and obesity.
Childhood trauma leads to behavioural changes in the sense that people who suffer from it try to find escape routes from traumatic memories through risky behaviours. Such risky behaviours are driven by impulsivity, and involve drinking, smoking, drug use and even bingeing for comfort. Again, these habits lead to health problems.
Moreover, there is a direct biological effect that occurs when one’s body undergoes extreme stress. When a person experiences something anxiety-provoking, the stress response activates which leads to the production of adrenaline, increase in heartbeat, etc. When stronger surges of adrenaline happen more often than usual and natural, it causes a lot of wear and tear of the body and leads to inflammation. Inflammation has been associated with many illnesses including cardiovascular disease and autoimmune diseases.
Diagnosis of childhood trauma
As mentioned earlier, it is important to note that not all experiences of trauma will lead to a trauma response or trauma-related disorder or diagnosis. Usually these experiences take their natural course of time until the signs of trauma related response become clearer, and they only meet a specific diagnostic criteria if they extend for more than a month or longer while disrupting the child’s daily life and start impacting their social and emotional well-being.
Broadly, there are two trauma diagnosis:
Post-Traumatic Stress Disorder (PTSD): Symptoms including recurrent bad dreams, loss of appetite and or interest in doing things, flashbacks, avoiding reminders of the traumatic event by avoiding conversations. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not list or define childhood trauma separately, however, under child mental disorders classification it provides a clear definition for diagnosis of post-traumatic stress disorder PTSD in children.
Complex Trauma: Also known as Complex PTSD, has been proposed as a potential new diagnostic category in the DSM-5. This describes how exposure to prolonged traumatic events impact development in children and its extended negative effects via emotional dysregulation through to their adult lives. Complex trauma is chronic and begins in early childhood and usually occurs with the child’s primary caregiving system and or social environment.
Dealing with childhood trauma
Family can be a good and often the only support system for a child and a key element towards reducing the impact trauma has on a child, because they are the most influenced by the people immediately around them. A few ways to support a child after a distressing event are:
A reassuring pat on the back, or hugs gives them a feeling of security which is essential in the aftermath of a disturbing event.
Children always look to adults for reassurance after traumatic events, so it is important that as a caregiver or parent you act calm. Try not to discuss your anxieties with your children or when they are around as children quickly pick up on anxiety.
Encourage kids to play with others and enjoy themselves. The distraction is good for them and gives them a sense of normalcy.
It is extremely important to listen and listen well. It is important to understand how the child views the situation and what is confusing or troubling them. Let the child know that it is okay to let you know how they are feeling.
Help them relax by following breathing exercises because breathing becomes shallow when anxiety sets in and deep belly breaths can help children calm down.
Try to acknowledge what they are feeling when they tell you, do not be dismissive about their concerns. Simply confirm whatever you are hearing.
Frequently Asked Questions
Q. What are some of the signs of PTSD in children?
In very young children, some indicators would be bedwetting, inability to speak, and being overly clingy with a parent or a caregiver. The adolescents, however, may show some disruptive and destructive behaviour.
Q. Does the DSM-5 enlist childhood trauma as a mental health condition?
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not list or define childhood trauma separately, however, under child mental disorders classification it provides a clear definition for diagnosis of post-traumatic stress disorder PTSD in children. Moreover, childhood trauma is a critical risk factor for many mental and physical health conditions.