CBT for Teens

CBT for Teens is a workshop being offered by a group in New York City.  I just signed up  at the American Institute for Cognitive Therapy.  Workshop will be lead by Dr. Laura Reigada, and focus on Cognitive Behavioral skills when working with children and their parents.  I look forward to learning new skills and insight into parent-child relationships.

CBT for teens
Dr. Reigada’s Training:

Laura Reigada Ph.D.,  American Institute for Cognitive Therapy, is currently an Assistant Professor in the Department of Psychology at Brooklyn College of the City University of New York and an Adjunct Assistant Professor of Pediatrics at Mount Sinai School of Medicine. She completed a two-year NIMH postdoctoral clinical research fellowship at the Institute for Anxiety and Mood Disorders, at the NYU Child Study Center, within the NYU School of Medicine. Dr Reigada continued her education by becoming a NIH Child, Intervention, Prevention and Services fellow. Currently she has grant funding to develop and test an integrative cognitivebehavioral intervention that jointly addresses anxiety and physical complaints within the context of pediatric chronic illness. Based on her research, the Crohn’s and Colitis Foundation of America named her the first Goldman Scholar in Pediatric Research. Dr. Reigada has extensive clinical experience working with children and adults on anxiety, mood disorders, parenting, school avoidance, functional pain and chronic illness. She is a founding member, and pastpresident, of the New York City Cognitive Behavioral Therapy Organization.

Emotional Intelligence

Jennifer Kahn writes in The New York Times about new programs for teaching emotional intelligence to children.  The goals of the programs are to:

  • Help children learn awareness of their own emotions as well as those of others
  • Teach children methods of self-soothing when emotions are triggered
  • Help children recognize the connection between emotions and behaviors.

Scientists believe children who learn these skills have a much lower chance of turning to substance abuse, violent behaviors, bullying, and other unhealthy coping strategies.

emotional intelligence

Photo by: Holly Anders, New York Times

 

Jennifer Kahn teaches at the University of California, Berkeley, Graduate School of Journalism.

Here is her article in its entirety:

One day last spring, James Wade sat cross-legged on the carpet and called his kindergarten class to order. Lanky and soft-spoken, Wade has a gentle charisma well suited to his role as a teacher of small children: steady, rather than exuberant. When a child performs a requested task, like closing the door after recess, he will often acknowledge the moment by murmuring, “Thank you, sweet pea,” in a mild Texas drawl.

 As the children formed a circle, Wade asked the 5-year-olds to think about “anything happening at home, or at school, that’s a problem, that you want to share.” He repeated his invitation twice, in a lulling voice, until a small, round-faced boy in a white shirt and blue cardigan raised his hand. Blinking back tears, he whispered, “My mom does not like me.” The problem, he said, was that he played too much on his mother’s iPhone. “She screams me out every day,” he added, sounding wretched.

Wade let that sink in, then turned to the class and asked, “Have any of your mommies or daddies ever yelled at you?” When half the children raised their hands, Wade nodded encouragingly. “Then maybe we can help.” Turning to a tiny girl in a pink T-shirt, he asked what she felt like when she was yelled at.

“Sad,” the girl said, looking down.

“And what did you do? What words did you use?”

“I said, ‘Mommy, I don’t like to hear you scream at me.’ ”

Wade nodded slowly, then looked around the room. “What do you think? Does that sound like a good thing to say?” When the kids nodded vigorously, Wade clapped his hands once. “O.K., let’s practice. Play like I’m your mommy.” Scooting into the center of the circle, he gave the boy, Reedhom, a small toy bear to stand in for the iPhone, then began to berate him in a ridiculous booming voice. “Lalalala!” Wade hollered, looming overhead in a goofy parody of parental frustration. “Why are you doing that, Reedhom? Reedhom, why?” In the circle, the other kids rocked back and forth in delight. One or two impulsively begin to crawl in Reedhom’s direction, as if joining a game.

Still slightly teary, Reedhom began to giggle. Abruptly, Wade held up a finger. “Now, we talked about this. What can Reedhom do?” Recollecting himself, Reedhom sat up straight. “Mommy, I don’t like it when you scream at me,” he announced firmly.

“Good,” Wade said. “And maybe your mommy will say: ‘I’m sorry, Reedhom. I had to go somewhere in a hurry, and I got a little mad. I’m sorry.’ ”

Reedhom solemnly accepted the apology — then beamed as he shook Wade’s hand.

emotional intelligence
Holly Andres for The New York Times

Wade’s approach — used schoolwide at Garfield Elementary, in Oakland, Calif. — is part of a strategy known as social-emotional learning, which is based on the idea that emotional skills are crucial to academic performance.

“Something we now know, from doing dozens of studies, is that emotions can either enhance or hinder your ability to learn,” Marc Brackett, a senior research scientist in psychology at Yale University, told a crowd of educators at a conference last June. “They affect our attention and our memory. If you’re very anxious about something, or agitated, how well can you focus on what’s being taught?”

Once a small corner of education theory, S.E.L. has gained traction in recent years, driven in part by concerns over school violence, bullying and teen suicide. But while prevention programs tend to focus on a single problem, the goal of social-emotional learning is grander: to instill a deep psychological intelligence that will help children regulate their emotions.

For children, Brackett notes, school is an emotional caldron: a constant stream of academic and social challenges that can generate feelings ranging from loneliness to euphoria. Educators and parents have long assumed that a child’s ability to cope with such stresses is either innate — a matter of temperament — or else acquired “along the way,” in the rough and tumble of ordinary interaction. But in practice, Brackett says, many children never develop those crucial skills. “It’s like saying that a child doesn’t need to study English because she talks with her parents at home,” Brackett told me last spring. “Emotional skills are the same. A teacher might say, ‘Calm down!’ — but how exactly do you calm down when you’re feeling anxious? Where do you learn the skills to manage those feelings?”

A growing number of educators and psychologists now believe that the answer to that question is in school. George Lucas’s Edutopia foundation has lobbied for the teaching of social and emotional skills for the past decade; the State of Illinois passed a bill in 2003 making “social and emotional learning” a part of school curriculums. Thousands of schools now use one of the several dozen programs, including Brackett’s own, that have been approved as “evidence-based” by the Collaborative for Academic, Social and Emotional Learning, a Chicago-based nonprofit. All told, there are now tens of thousands of emotional-literacy programs running in cities nationwide.

The theory that kids need to learn to manage their emotions in order to reach their potential grew out of the research of a pair of psychology professors — John Mayer, at the University of New Hampshire, and Peter Salovey, at Yale. In the 1980s, Mayer and Salovey became curious about the ways in which emotions communicate information, and why some people seem more able to take advantage of those messages than others. While outlining the set of skills that defined this “emotional intelligence,” Salovey realized that it might be even more influential than he had originally suspected, affecting everything from problem solving to job satisfaction: “It was like, this is predictive!”

emotional intelligence
Holly Andres for The New York Times

In the years since, a number of studies have supported this view. So-called noncognitive skills — attributes like self-restraint, persistence and self-awareness — might actually be better predictors of a person’s life trajectory than standard academic measures. A 2011 study using data collected on 17,000 British infants followed over 50 years found that a child’s level of mental well-being correlated strongly with future success. Similar studies have found that kids who develop these skills are not only more likely to do well at work but also to have longer marriages and to suffer less from depression and anxiety. Some evidence even shows that they will be physically healthier.

This was startling news. “Everybody said, Oh, it’s how kids achieve academically that will predict their adult employment, and health, and everything else,” recalls Mark Greenberg, a Penn State University psychologist. “And then it turned out that for both employment and health outcomes, academic achievement actually predicted less than these other factors.”

Should social-emotional learning prove successful, in other words, it could generate a string of benefits that far exceeds a mere bump in test scores. This prospect has led to some giddiness among researchers. Maurice Elias, a psychology professor at Rutgers University and the director of the Rutgers Social-Emotional Learning Lab, has lauded emotional literacy as “the missing piece” in American education.

But finding ways to measure emotional awareness — never mind its effects — is tricky. It’s also still unclear whether S.E.L. programs create the kind of deep and lasting change they aspire to. The history of education reform is rife with failures: promising programs that succeed in studies, only to falter in the real world. The phenomenon is so common that researchers even have a name for it: the Hawthorne effect — the fact that simply focusing attention on something, like a school, is enough to cause a temporary uptick in performance.

The problem of evaluating S.E.L. is compounded both by the variety of “prosocial” programs on offer and by the ways in which they end up being used in the classroom. Some of them — including one of the most popular, Second Step — are heavily scripted: teachers receive grade-appropriate “kits” with detailed lesson plans, exercises and accompanying videos. Others, like Facing History and Ourselves — in which children debate personal ethics after reading the fictionalized letters of a Nazi colonel and a member of the French Resistance — are more free-form: closer to a college philosophy seminar than to a junior-high civics class. ” ‘Mindful eating’ is social-emotional learning, according to some people,” Brackett told me. “It’s a mess. Everybody wants to jump on the bandwagon.”

David Caruso, a psychologist who does consulting and training in emotional intelligence, has called the current boom in social-emotional programs “promising,” but he worries that the field might be getting ahead of itself. “There are people who want to write this into the Common Core right now,” Caruso told me. “But before we institutionalize this, we’d better be sure that it makes a difference in the long run.”

Leataata Floyd Elementary, a school in a low-income part of Sacramento, has few problems with gangs or guns but a long history of dysfunction. Until recently, the staff attrition rate was more than 20 percent a year, and student test scores were regularly among the lowest in the state. Before the current principal, Billy Aydlett, was hired in 2010, there were six separate principals in five years.

Not long after he arrived, Aydlett created a detailed plan to boost the school’s academic performance. He recruited a roster of highly regarded teachers and developed an aggressive new curriculum full of rich and invigorating lessons. Once the school year started, however, it became clear that the new strategy was a bust. “Literally within the first month of school, we realized that we hadn’t planned for the right thing,” Aydlett recalled when I visited the school last spring. “What we discovered was that these kids weren’t going to be able to make progress on the academics until they’d gotten help with their social and emotional issues.”

emotional intelligence
Holly Andres for The New York Times

With the district’s support, Aydlett attended social-emotional learning training. The program was an unlikely choice for Aydlett — a socially awkward man who confesses to being “awful” at ordinary human encounters. But since beginning the emotional-literacy work, Aydlett said, he had become more aware of interpersonal dynamics, and even made going on a vacation with his wife a priority — something he never bothered to do before. (“I didn’t see the point in that kind of connectedness,” he admitted. “But I’ve learned that it’s important.”) On the morning I visited, he stood greeting children at the gate with high-fives, then led me to the classroom of Jennifer Garcia, who teaches second grade.

As Aydlett and I watched, Garcia walked her class through an exercise in nonverbal cues, asking the children to imagine times when they felt sad or angry or frustrated, and then to freeze in those expressions and postures. As the kids slumped forward in exaggerated positions of woe, Garcia complimented them on small details: a bowed head or hangdog expression. Afterward, Garcia turned to the class. “This is the thinking part of your brain,” she said, holding up her thumb. She pointed to her fingers. “And this is the feeling part of your brain.” Folding her thumb into the center of her palm, she closed her fingers around it. “When we have strong emotions, the thinking part of our brain can’t always control them,” Garcia explained, waggling her fist. “What do we do in those moments?” As the kids called out answers — counting to five, “self-talk,” “dragon breaths” (a kind of deep-breathing exercise) — Garcia nodded.

Such strategies may seem simplistic, but researchers say they can have a profound effect. When I spoke with Mark Greenberg, who developed a social-emotional curriculum known as Paths (Promoting Alternative Thinking Strategies), he noted that repeatedly practicing these skills means they gradually become automatic. “The ability to stop and calm down is foundational in those moments.”

The value of such skills was evident later that day, when I sat in on a fourth-grade class meeting, in which students worked through interpersonal conflicts as a group. Sitting in a circle on the carpet, Anthony, a small boy in a red shirt, began by recounting how he cried during a class exercise and was laughed at by some of the other students. Asked whether he thought the kids were giggling to be mean, or just giggling because they were uncomfortable, Anthony paused. “I think that some people didn’t know what to do, and so they giggled,” he admitted finally — though he was also adamant that a few of the kids were actually laughing at him. “I was really sad about that,” he added.

Though Anthony was still upset, his acknowledgment that not all the kids were snickering — that some may just have been laughing nervously — felt like a surprisingly nuanced insight for a 9-year-old. In the adult world, this kind of reappraisal is known as “reframing.” It’s a valuable skill, coloring how we interpret events and handle their emotional content. Does a casual remark from an acquaintance get cataloged as a criticism and obsessed over? Or is it reconsidered and dismissed as unintentional?

Depending on our personalities, and how we’re raised, the ability to reframe may or may not come easily. Richard Davidson, a neuroscientist at the University of Wisconsin-Madison, notes that while one child may stay rattled by an event for days or weeks, another child may rebound within hours. (Neurotic people tend to recover more slowly.) In theory, at least, social-emotional training can establish neurological pathways that make a child less vulnerable to anxiety and quicker to recover from unhappy experiences. One study found that preschoolers who had even a single year of a social-emotional learning program continued to perform better two years after they left the program; they weren’t as physically aggressive, and they internalized less anxiety and stress than children who hadn’t participated in the program.

It may also make children smarter. Davidson notes that because social-emotional training develops the prefrontal cortex, it can also enhance academically important skills like impulse control, abstract reasoning, long-term planning and working memory. Though it’s not clear how significant this effect is, a 2011 meta-analysis found that K-12 students who received social-emotional instruction scored an average of 11 percentile points higher on standardized achievement tests. A similar study found a nearly 20 percent decrease in violent or delinquent behavior.

When I spoke with teachers at Leataata Floyd, they reported seeing similar results. One teacher remembered the pre-S.E.L. school as being out of control, with kids throwing food and angrily upending their desks in class. Now, she says, “they may still blow up, but they take responsibility. That’s a new thing: they always used to blame somebody else. For them to take responsibility — it’s huge.”

emotional intelligence
Holly Andres for The New York Times

Starting in the late 19th century, the philosopher John Dewey argued against the development of purely vocational elementary schools, insisting that the true purpose of schooling was not simply to teach children a trade but to train them in deeper habits of mind, including “plasticity” (the ability to take in new information and be changed by it) and interdependence (the ability to work with others).

Social-emotional learning takes Dewey’s theory further, suggesting that all emotions — not just the right ones — are adaptive if properly managed. Studies have shown that people in a slightly sad mood are better at analyzing or editing a written document (they focus better on details), while people who are slightly angry are better able to discriminate between weak and strong arguments. The purpose of a social-emotional learning program, then, isn’t to elide emotion but to channel it: to surf the rapids rather than to be swamped by them. This can be hard to do. When we feel angry, we usually act angry — even when that makes the situation worse. The nature of emotion is that it tends to run away with us. “When a feeling is unpleasant, how are you going to handle it?” asks Stephanie Jones, a Harvard psychologist who has studied a number of social-emotional learning programs. “Do you default to an angry response, a defensive response? Or do you go into a mode that’s more information-seeking?”

Social-emotional learning programs often rely on strategies from conventional therapy, like the ability to get distance on a feeling, or to unpack the deeper emotions that may be hidden within it. But fostering these skills in a child is a complex undertaking. For a child to master empathy, Jones notes, she first needs to understand her own emotions: to develop a sense of what sadness, anger or disappointment feels like — its intensity and duration, its causes. That awareness is what lays the groundwork for the next step: the ability to intuit how another person might be feeling about a situation based on how you would feel in a similar circumstance.

When it comes to making social-emotional learning effective, Jones says, determining which skills can constructively be taught at what ages is “a critically important question.” So far, however, few studies have been done on which skills are actually acquired through S.E.L., and even fewer have included the kind of rigorous, controlled trials needed to prove that acquiring a specific skill produces a specific outcome over the long term. “If skills aren’t nurtured in an ongoing way,” Jones says, “it may be that those skills are lost.”

Even a handful of poorly designed programs, Caruso notes, could cause educators who are just warming up to the idea of a social-emotional curriculum to dismiss the entire field. Critics already charge that social-emotional programs are a kind of “therapy light” and a waste of valuable classroom time. In 2010, a report from the U.S. Department of Education that evaluated seven different S.E.L. programs found no increase in academic achievement and no decline in behavioral problems. S.E.L. supporters criticized the study’s methodology and pointed out that the researchers couldn’t be sure that the comparison schools weren’t using S.E.L. techniques even if they weren’t using a formal program. Still, to show that S.E.L. is effective, Caruso says, programs will have to be tested the same way a new pharmaceutical is: through a randomized trial that could distinguish short-term placebo effects from lasting improvements. Without such evidence, social-emotional learning could go the way of the self-esteem movement, an ill-fated program from the 1980s in which schoolchildren repeated mantras like “I am special” and “I am beautiful.” At the time, it, too, was considered the height of progressive education. The program was largely abandoned after it ended up being connected to rising rates of narcissism.

“It’s a big messy field, with a lot of promises, but very little data,” Caruso says of S.E.L. “Right now I think people are just throwing stuff at the wall to see what sticks.”

One of social-emotional learning’s “stickiest” programs is Second Step, the plug-and-play curriculum that provides teachers with grade-appropriate emotional-skills lessons. Originally developed as a violence-prevention program in 1986, Second Step is currently used by approximately 25,000 schools in the U.S. and Canada, according to Joan Cole Duffell, executive director of Committee for Children, the nonprofit behind the program.

At Ella Flagg Young School in Chicago, I sat in on a sixth-grade Second Step class taught by Latasha Little-Brown, the dedicated “social-emotional learning coordinator” who has worked at the school for nine years. That day, Little-Brown began by playing a Second Step video featuring good friends, Lydia and Maria. In the story, Maria’s aunt gives her a cool new necklace, which has beads made of paper. Lydia loves it, so Maria lets her borrow it. But as Lydia is walking back from the party, it suddenly starts to rain and the necklace is ruined. Lydia doesn’t know what to do.

In the teachers’ edition of the exercise, the goal is for students to write out the steps of an apology, including reparation. (Step 1: “Maria, I was wrong for taking the necklace and not caring for it properly.” Step 2: Offer to pay for the necklace.) Little-Brown nudged the students in this direction, until one boy — a chubby kid who had kept his jacket and backpack on during the entire class — finally raised his hand in frustration. Lydia hadn’t been negligent, he pointed out: she’d just been walking home and got soaked by a thunderstorm. How was the loss of the necklace her fault?

Lawyering ensued. One girl insisted that Lydia could have put the necklace in her pocket, or balled it up in her hand — leading another student to argue that just clutching the necklace in a downpour wouldn’t have protected it. Meanwhile, Backpack Boy was still trying to parse the details of friendly obligation. If someone dumped a bucket of water on you as you walked by, he wanted to know, would that be your fault? What if someone robbed you or threatened you with a gun?

Little-Brown allowed the debate to go on for several minutes, then moved crisply to the official point of the lesson: that once a thing is in your possession, you are responsible for it. The class ended with each group writing the steps of restitution on a piece of poster board. It was a disappointing moment. Though Little-Brown was engaged and thoughtful, the class still felt more like a rote exercise in social obligation than a nuanced exploration of a complicated issue. It was hard to believe that the resolution was satisfying to someone like Backpack Boy — one of the few students who seemed eager to wrestle with the knotty issues on which justice can turn.

Later, I mentioned this incident to Marc Brackett. Like many researchers, Brackett worries about the spread of programs like Second Step, in part because they can be overly formulaic. He is also concerned that they can serve as social-emotional placebos, allowing administrators to seem as if they’re working to fix a troubled school without actually doing anything. “When the superintendent wants to show the state that they bought their anti-bully program, or whatever, they buy these kits,” he said. “But then the box just sits on the shelf.”(To be fair, Brackett’s program is one of Second Step’s competitors. Duffell says that Second Step is “dedicated to good-quality implementation” and now has an online system to monitor how teachers use the program.)

Brackett’s program, Ruler, created with David Caruso and others, is more intensive. A school interested in trying Ruler must sign a three-year commitment that involves regular training, including Brackett’s four-day “Anchors of Emotional Intelligence” workshop, which costs $1,800 per person. Though Brackett emphasized to me that Ruler is used by a variety of schools, in a range of income brackets, the program costs significantly more than Second Step, especially when teacher and staff training is factored in. (Only about 500 schools use Ruler.)

In the Ruler cosmology, social-emotional lessons aren’t restricted to one class a week, or even to one class a day. Rather, such moments of observation are expected to pervade every class, from English and math to music and P.E. “Emotional skills aren’t something that develop overnight,” Brackett emphasized. “For most people, it will take a lot of practice.”

Starting in kindergarten, students begin each day by locating themselves on the “mood meter,” a set of four colored squares — blue for moods like malaise, yellow for excitement — that represent the four quadrants of emotional experience. (The other squares are red, for anger, and green, for calm.) The goal is to develop children’s capacity for self-reflection and critical thinking. “We never say, ‘The best thing to do is to take three deep breaths,’ ” Brackett told me. “For some people, taking deep breaths works. But for me, when I take deep breaths, I just think about how I can wring your neck.”

Growing up, Brackett told me, he was bullied “horrifically” — the kind of experience he believes Ruler could help prevent. Not long after being hired at Yale, he said, he went back to his old school, hoping to persuade it to implement the program. “I said, ‘I’ll give you a gift that would normally cost $100,000’ ” — what the Ruler program can amount to, with all the training. “They said, ‘Oh, that’s O.K. — we already have a speaker on emotional intelligence.’ ”

Even now, Brackett says, many educators don’t grasp the importance of emotional awareness. For Ruler to work, he maintains, the tools need to be embraced not just by students but also by teachers and administrators. “They have to be able to walk around that school and say: ‘Hey, where are you on the mood meter? I’m in the yellow right now. I’m feeling excited, how about you?’ or ‘Man, I had a really tough morning. I had to take a meta-moment because that parent was so crazy, I really had to manage my emotions.’ ”

Brackett’s approach may strike some as overkill, but a growing number of social-emotional learning programs now offer separate training for teachers. “It’s like that old airplane maxim,” Mark Greenberg told me. “Put your own mask on before you put your child’s on. You have to help yourself first.” Greenberg notes that a great teacher can change how students learn and behave, creating a climate that is engaged, caring and respectful. In theory, S.E.L. training could help more teachers develop those skills. “The one constant in education research has been the power of these great teachers,” Greenberg said. “What has been less clear is how you bottle that.”

Located high in the hills a few miles north of Berkeley, Prospect Sierra, a private elementary school, is also a Ruler school. It’s a cheerful place filled with the subtle accessories of wealth: airy classrooms outfitted with iMacs and a sprawling sports field with an unobstructed view of the San Francisco Bay.

Walking the halls one day last spring, I spied posters for empathy (“I say what I am feeling, and listen empathetically to what the other person is saying”), with examples of various mood meters, including one made by first graders that struck me as both impressive and alarming. Alongside “energetic,” “peaceful,” and “curious,” the meter listed “frantic,” “lonely,” “depressed,” “excluded” and “joyless.”

In the afternoon, I joined a P.E. class to watch a capture-the-flag-style game, in which teams tried to retrieve colored banners without being tagged. The teacher, a lean, blond woman named Jacqueline Byrne Bressan, began by having students sit in a circle to discuss problems that came up in the last game and how they could be prevented this time around. One boy, whose silky brown hair gave him the look of a miniature British soccer star, raised his hand to note that “some people” hadn’t been willing to “roshambo” — do “rock, paper, scissors” — the school’s accepted practice for settling disputes over whether a player had been tagged or not. When Bressan asked what he did about that, the boy sat up. “I told them they weren’t playing fair,” he said solemnly. “And then I let it go.”

Not long after this discussion, I watched as a beefy blond kid in a red shirt and white Nikes was patently tagged by a small brown-haired girl, but kept running. “You’re tagged!” the girl yelled. Another boy echoed her: “You’re tagged!” The boy yelled back, “No, I’m not!” Glancing at Bressan, he slowed briefly to a walk — then moved furtively around the edge of the field and sneaked back into the game.

Watching this, Bressan smiled dryly. The beefy boy, she observed, is “one of the kids who really struggles” with basic social-emotional concepts like fairness and accountability. But she also said she felt that he was gradually improving. “It used to be, he wouldn’t roshambo at all,” she said. “Or he’d lie and say that he did. Now it may take a minute, but he usually does it.”

While it was hard to tell if roshambo was teaching deeper lessons of fairness and problem-solving, Bressan told me that it radically cut the number of arguments she had to resolve, and also made it easy to identify the kids who needed more help socially. She also said that it gave the other students the moral authority to hold another player accountable.

There seemed to be something to this. While the game had its share of elementary-school drama (at one point, a girl started to cry after a boy bragged that he was faster than her “by a million miles”), it was noticeable how quickly most kids moved on. A tiny blond girl who was in tears over being pushed — her new white jeans now had a grass stain on the knee — handled the matter by walking once around the field, then talking about it in the postgame debriefing. “We talked about not tagging too hard during the game, but it was still happening,” she said, sounding surprisingly sanguine.

When I mentioned this to Bressan, she nodded. “I think it makes a difference sometimes for them just to be able to say it,” she said. “Just to have it discussed.”

Talking later, Bressan told me that in her last job, at an inner-city school in New York, students behaved differently; when one kid was punched in the stomach during recess, she recalled, he didn’t even go to the teacher. By comparison, it was hard to know how the kids at Prospect Sierra might fare in the “real world.” But she added, “The real question is: What kind of world do we want?”

That question is one that Marc Brackett thinks about often. He envisions a generation of kids who have grown up immersed in an environment of total emotional awareness — who receive new insights at the developmentally appropriate times, and in deliberately constructive ways.

“If you have that kind of instruction, from kindergarten,” he said, “I think that in 20 years the world will be a very different place.”

Jennifer Kahn teaches at the University of California, Berkeley, Graduate School of Journalism. She last wrote for the magazine about prepsychopathic children.

Your Brain Changes After "Talk Therapy"

colorful brain
As a Cognitive Behavioral Therapist, I am excited by any new research that demonstrates a biological brian change after patients undergo “talk therapy”.  A group of scientists just published a study showing:
  • biological brain changes after cognitive behavioral therapy
  • the effects of cognitive behavioral therapy can be studied empirically
The New York Times published an article by Eric R. Kandel on September 6, 2013 describing the biological basis of mental disorders.  He writes about scientists at Emory University who performed a study on depressed individuals looking for evidence of biological changes after psychotherapy and after anti-depressant medications.  They used brian scans before and after treatment to identify biological brain changes.  During this study, the scientists were able to accurately predict whether patients would respond to psychotherapy or medications for the treatment of their depression.
Dr. Kandel summarizes the significance of the study as:
First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.
Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.
Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.
And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science.
Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.  The entire article is posted on the New York Times website here.
Eric R. Kandel, a professor at the Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia, a senior investigator at the Howard Hughes Medical Institute and a recipient of the 2000 Nobel Prize in Physiology or Medicine, is the author of “The Age of Insight: The Quest to Understand the Unconscious in Art, Mind and Brain, From Vienna 1900 to the Present.”

College and Mental Health

Adolescents-2The Jed Foundation is a not-for-profit organization that promotes emotional health among college students.  The foundation’s Medical Director, Dr. Victor Schwartz, states “of the 20 million students in post-secondary education in the United States, 20 percent have received counseling or some type of mental health diagnosis.”

Many colleges and universities are reviewing and updating their comprehensive mental health and suicide prevention programs.  In an article based on an interview with Dr. Schwartz, Matthew Lynch, Ed. D. summarizes the Jed Foundation’s recommendations for schools to strengthen their mental health support systems.  The foundation recommends:

  • Engaging in campus-wide strategic planning to identify specific issues related to mental health and substance abuse and develop action plans to address them
  • Training new faculty, students and staff to identify at-risk students and refer them to appropriate counseling services
  • Advocating for mental health as a campus-wide issue
  • Creating a task force to promote mental health
  • Increasing programs to identify and support incoming at-risk students
  • Engaging in environmental safety scans of a campus to locate potential sources of danger
  • Building student affairs programs that enhance life skills and student connectedness
If you have a college student, I encourage you to explore the school’s mental health program.  Increasing awareness of resources available to students is key to their success.
  Dr. Lynch’s entire article appears in his HuffingtonPost blog here.

Great Resource in Dallas

The National Alliance on Mental Illness (NAMI) has a Dallas Chapter.  This wonderful group of volunteers provides great services to those in the Dallas area affected by mental illness.  One of the most important things they do is facilitate and guide SUPPORT GROUPS.

If you are looking for a SUPPORT GROUP, here’s a link to their monthly newsletter:

couple

http://library.constantcontact.com/download/get/file/1101971778974-178/September+2013.pdf

You will find a list of SUPPORT GROUPS and other information about NAMI-Dallas.

 

Does Cognitive Behavioral Therapy Work? Will it Work for ME??

CBT-therapy

As a Cognitive Behavioral Therapist, I believe in what I do, see daily results, and know that Cognitive Behavioral Therapy (CBT) can change lives.  My confidence in this type of therapy was strengthened when I came across a scientific study analyzing the effectiveness of CBT.  Experts in the psychology field reviewed the therapeutic results of using CBT when working with patients with differing mental health disorders.  The study was published in the Clinical Psychology Review 26 (2006) under the title:  The empirical status of cognitive-behavioral therapy: A review of meta-analyses by Andrew C. Butler, Jason E. Chapman, Evan M. Forman, and Aaron T. Beck.

The psychologists found CBT to be an effective treatment for:

Cognitive behavioral therapy
  • depression
  • generalized anxiety disorder
  • panic disorder with or without agoraphobia
  • social phobia
  • posttraumatic stress disorder
  • childhood depressive and anxiety disorders
  • marital distress
  • anger
  • childhood somatic disorders
  • chronic pain

(Savannah Krantz (Greenhill, 2014) provides a comprehensive summary of the study at the end of this post.)

These results are so encouraging to patients and treatment providers who deal with the pain of mental illness everyday.  This wide-ranging, scientifically significant study gives confidence and hope to people entering therapy.  If you are reading this post, and looking for help with a mental health challenge, consider finding a Cognitive Behavioral Therapist.  You can find more information and details about the treatment process by going to the Beck Institute of Cognitive Therapy.

If you live in the Dallas area, and would like to talk about treatment with a Cognitive Behavioral Therapist, please read my web page at Holly Scott, MBA, MS, LPC.

Effectiveness of Treatment with Cognitive Behavioral Therapy

by Savannah Krantz (Greenhill, 2014)

therapy for depression 
Cognitive Behavioral Therapy, also known as CBT or CT, has been closely examined in many psychological studies relating to treatment results. The cognitive-behavioral treatment of mental disorders is often compared and contrasted with other treatments. CBT differs from behavioral therapy because it suggests that cognitive thoughts produce aberrant behavior, and therefore, CBT focuses on cognation. In an attempt to determine whether CBT has a higher success rate than other treatments, this study required a meta-analysis. This type of research pulls results from previous studies, works to sort out their differences, and essentially combines them. Meta-analysis measures what is called the effect size, which is the measure of strength in statistics. This process aims to estimate the effect size with a large sample of studies rather than a single study, which would only provide data drawn from a single set of circumstances. Similar to using a large sample size in an experiment, using meta-analysis sharpens the precision of the effect size because it eliminates the involvement of erroneous factors.

therapy for depression

This CBT study examined many mental disorders: adolescent and adult unipolar depression, generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, anger, bulimia nervosa, internalizing childhood disorders, sexual offending, and chronic pain. Not only does the meta-analysis inspect the effects of CBT treatment, but the study also compares the results to other treatment results whenever possible. Out of these disorders, three used data from an uncontrolled effect size: obsessive-compulsive disorder, schizophrenia, and bulimia nervosa. Unlike a controlled effect size, the improvement was measured within its group, rather than being compared to other treatments and/or conditions.

In the results, the U3 score is provided next to the effect size. The U3 score is a percentage that indicates whether or not CBT was more successful than other treatments. If the U3 score is 50%, that means that on average, the CBT patient experienced the same results as the control patient who received other treatment. If the percentage is above 50% and the effect size is positive, the CBT patient’s outcome was superior. If the percentage is above 50% and the effect size is negative, the CBT patient’s outcome was inferior to the control. The higher the percentage, the more (if positive ES) or less (if negative ES) successful CBT was on average.

CBT was proved to be superior to all other treatments for adult and adolescent depression, but was only very slightly more successful than behavioral treatment, with a U3 score of 52%. CBT was more successful than all other treatments for general anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, anger, bulimia nervosa, internalizing childhood disorders, and sexual offending. Two exceptions, chronic pain and panic disorder (with and without agoraphobia), had either one or two elements that were proven to be less successful when treated by CBT.

couple couple

Overall, the meta-analysis proved that CBT appears to be the superior treatment for these sixteen mental disorders. This can be accredited in part to the fact that CBT differs from other treatments due to its ability to teach the patient therapeutic skills that the patient can then apply, without external assistance, into his or her everyday life.

Source:

Clinical Psychology Review 26 (2006), The empirical status of cognitive-behavioral therapy: A review of meta-analyses by Andrew C. Butler, Jason E. Chapman, Evan M. Forman, and Aaron T. Beck.

 

A View from the Roof | Rewire Me

Author Psychotherapist Pamela Milam shares inspirational thoughts on viewing others from a place of greater emotional generosity.

A View from the Roof | Rewire Mecounseling for happiness

I know someone who had a series of different jobs: clerk, cook, waitress, courier, even construction worker. She told me that she once had a stint as a roofer. She worked every day with the same guy, a blue-collar philosopher who used to take breaks sitting on the roof eating his sandwich and telling her stories: “People think they’re alone, that no one can see them, but up here I can’t help but see people living their lives—in their living rooms, bedrooms, backyards. The world’s a different place to me because of that.”

He felt a warmth and grace toward the people living in those houses, cooking barbecue, pushing swings for children, vacuuming rugs, fighting with spouses, clicking away on laptops, cooking spaghetti, or reading books by windows. He saw them in private moments and tried his best to honor that privacy. I might see, for instance, a client who is a tough businesswoman, but in fact is anxiety-ridden and worried about her young son’s autism diagnosis.

It struck me later that, as a therapist, my view can be similar. We are the roofers of the soul, seeing into hearts and minds and getting a look into the private lives and relationships of people who otherwise might seem like just “the guy in the next cubicle” or “that jogger I see every Saturday on the trail” or “the unassuming neighbor down the block.”

I might see, for instance, a client who is a tough businesswoman, but in fact is anxiety-ridden and worried about her young son’s autism diagnosis. Many of her colleagues write her off as being brusque and cold, but that’s nowhere near the truth. Or I meet the olive-skinned young model who radiates a golden beauty, but discover that he is wracked with self-doubt. I encounter the narcissist who admits that he feels empty in spite of his résumé of accomplishments, or the pregnant teen who pretends to look forward to motherhood but confesses that she’s terrified.

It’s helpful to get a different view, looking into their lives and seeing them, really seeing them live life: struggling, failing, succeeding, and managing to get through it all somehow.

Getting a new perspective—simply paying attention—helps me break free from assumptions or stale beliefs about neighbors, friends, colleagues, and even strangers.There’s a freedom that comes from getting an alternate view. The more you really notice other people, the less likely you are to write them off or pigeonhole them. Getting a new perspective—simply paying attention—helps me break free from assumptions or stale beliefs about neighbors, friends, colleagues, and even strangers.

For me, it’s important not to get locked into a mindset, one of judgment or negativity or willful oblivion. The key to unlocking my mind is the very same key to building good relationships: noticing people, taking my time, imagining how they might feel, making an effort to do no harm, and trying to do good when I can.

If I find myself taking a knee-jerk attitude toward a person or summing someone up based on one or two obvious traits, it’s a sure bet that I’m missing something that I might understand more clearly from a place of greater emotional generosity. I try to remember that I’m always free to take a fresh look. I’m the roofer casting a graceful look into their hidden lives.

Read about Pamela Milam.

– See more at: http://www.rewireme.com/explorations/a-view-from-the-roof/#comment-3827

 

Happiness and Belonging

happiness

How Do We Find Happiness?


Dallas author and psychotherapist, Pamela Milam, writes about finding happiness on the website www.RewireMe.com.  In her article, I love the way Pamela describes her thinking as a young adult in the line:

“I just went with the societal flow without examining how I really felt or what I really wanted.”

As a psychotherapist, I regularly treat clients who are struggling with life choices and decisions of all kinds (financial, career, family) that were made based on societal flow. They describe themselves as very successful and “having it all”, and state they cannot understand their overwhelming feelings of emptiness or sadness. During the therapy process, they often find relief by allowing themselves to explore what they really want and separating individual wants from societal influences. They are able to find joy by making changes in their lives to honor their true feelings.

Can you find a way to allow yourself to explore what you really want, change your thinking, and create happiness?

Anger and Divorce: a better way

Here is a great article by author and Licensed Professional Counselor, Pamela Milam, on reframing anger and other negative emotions following a divorce or break-up.
http://tracycoopercounselingblog.wordpress.com/2013/06/12/the-angry-ex-tips-for-self-respect-fairness-and-insight/

Feeling Stressed? READ!

Research shows taking just a 6 minute break to read something can significantly lower stress levels. 

happy teenagerIn this study, it took volunteers only 6 minutes of silent reading to lower heart rates and relax muscle tension. Next time you need a break, try reading.

This excerpt from Cynthia Cruz’s beautiful essay on www.therumpus.net describes the reading and relaxing process so well.

ON READING
BY CYNTHIA CRUZ
April 29th, 2013
So deep into this other world do I drop, I no longer notice, nor do I care, what’s happening outside the book, in the “real” world. Like a drug, the book seduces me. I can’t resist. And is this not a small simulation of death, of suicide? And suicide, let us not forget, is what this specific book is about. The confection-like seduction Adorjan creates for us, the warm promise of the other world inside the book, is an enactment of the seduction she imagines her grandmother and grandfather felt, their drive for the drug of death: a lozenge, a garden, an invisible lullaby only the two could hear. And isn’t this precisely what the experience of reading a book is?


Happy Reading!

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