By Emily Hanlon
CBT (cognitive behavioural therapy) is a method of psychological intervention that is based on the notion that our thoughts influence our feelings and our behaviours. The main principal of CBT is that our thoughts about a situation are what cause negative feelings. I often use CBT (where appropriate) with children who are experiencing anxiety. I love CBT for children, because if we can help children become aware that their thoughts influence their emotions and their behaviours, they will be able to carry this principal into other aspects of their lives. It also means that, children can realise that when negative events occur, they can reduce the negative emotional and behavioural impact by managing their thinking patterns in response to these negative events.
This concept can be challenging to explain, especially to younger children. One way that I have found extremely helpful, is to use the ‘rollercoaster story.’ I stumbled across this story as a provisional psychologist in the book Cognitive Therapy for Adolescents in School Settings by Dr. Torrey A. Creed, Dr Jarrod Reisweber and Aaron T. Beck.
Here is the story:
"One day, two friends headed to an amusement park for some fun. In the centre of the park was a huge roller coaster. When the boys saw the ride, something very strange happened. One boy, named Moe, ran to get in line to ride the roller coaster. The other boy, Joe, walked much more slowly to get in line. As they stood together, they looked something like this."
At this point, the therapist would draw a picture of the two boys. Moe should show non-verbal cues that he is very excited: a big smile, open body posture, and so on. Joe's non-verbal cues should suggest that he is quite anxious: wide-open eyes, a more grimly-set mouth, and so on. Alternatively, the therapist could point to pictures on a pre-prepared illustration or use other methods to show two boys with these two different emotions.
"Let's look at Moe. How do you think Moe is feeling?"
The emphasis in this question should be on how Moe feels, based on the nonverbal cues, rather than what he is thinking or doing. If necessary, use guided discovery questions to help the client recognize that Moe is excited and happy.
"And if you look at Joe, how do you think Joe is feeling?"
Again, emphasize how Joe feels, rather than what he is thinking or doing.
"I think you're right--Moe looks like he is feeling really (excited/good) about riding the rollercoaster, but Joe looks really (worried/nervous/unhappy). So here's the interesting thing: Some people think that situations make them feel a certain way--like the rollercoaster making Moe excited and making Joe scared. But if they're both in line for the same rollercoaster, how could it be that they feel so differently? What could be making them feel differently?"
Encourage the client to take some guesses. If necessary, use guided discovery or float ideas to help the client consider that what the boys are thinking about the rollercoaster is quite different. If necessary, ask something like, "What do you think Moe is saying to himself while he's standing in line? And what is Joe saying to himself?" We are looking for the (automatic) thoughts that each boy is having when he looks at the roller coaster. Drawing a thought bubble over each boy's head may also help clients to consider what is going through each boy's mind. The goal is for the client to consider that Moe is having positive or optimistic thoughts, and Joe is having negative or pessimistic thoughts.
"I bet you're right. Moe is probably thinking about how fun the rollercoaster will be, and Joe is probably thinking that something pretty bad will happen. So I wonder . . . is it possible that the roller coaster is not making the boys feel this way? Is it possible that something else might be doing it?"
Use other questions as needed to help the client draw the conclusion that the boys' feelings are related to their different thoughts about the rollercoaster ride.
"So now let's think about something else. What could Moe whisper in Joe's ear to help Joe feel a little bit better about riding the roller coaster?"
Here, the therapist is looking for a thought that could help Joe cope with his worry and ride (not avoid) the rollercoaster. Examples include, "I'll sit next to you so you feel better," "I know you can handle it!" or "Think of how proud you'll feel afterward!"
"I think you're right. If Moe tells Joe he'll sit with him, and then Joe focuses on feeling proud afterward, Joe will probably feel better about riding the rollercoaster. He may still feel a little nervous but changing his thoughts may help him be brave enough to give it a try."
"That's a lot like the kind of work we'll be doing together. We're going to help you learn to catch what you're saying to yourself, and then whisper something in your own ear to help you feel (less angry, more brave, less sad, more relaxed, etc.) We'll figure out what you are thinking in different situations and how those thoughts lead to feelings and actions. Then we'll figure out what you can tell yourself, or whisper in your own ear, to help you feel better and act differently. How does that sound?"
This story perfectly lays the foundation to then begin CBT therapy.
Useful Links
For more information on CBT, the following links might be useful:
CBT worksheets for kids: Free Resources
I have included below, some links to my favourite CBT worksheets that are free to download. My favourite worksheet websites (for free resources) is Therapist Aide, but I have linked a few of my favourite free resources below:
