Assessment: Andrew (06:28)
Andrew's parents divorced when he was five and sees his father weekly. Goals include obtaining an understanding of a young person's issues, define areas of strength, assess CBT efficacy, establish a good rapport, and explain the nature of the therapy. The therapist discusses Andrew's and his mother's goal for CBT therapy.
Generating a Graded Hierarchy and Education (05:43)
Andrew and the therapist discussed phone call steps that gradually increase his anxiety. Fear thermometers are not used for adolescents. Andrew completed homework to help him understand the link between thoughts, emotions, and behaviors and identify emotional triggers.
Education: Self-Monitoring (11:43)
Goals include helping the young person separate thoughts, feelings, and behavior patterns and learning to use coping strategies after physical reactions occur. Encourage a diary when anxiety manifests. The therapist reviews different instances when Andrew should write in his diary and commends his involvement.
Education: Homework Review (04:58)
The therapist reviews instances where Andrew felt anxious over the past week and asks him to add additional information. Separating thoughts, feelings, and behavior forms the framework of the exposure process.
Developing Coping Skills (04:58)
The therapist provides a breathing exercise as a coping mechanism when Andrew experiences physical symptoms.
Exposure: Behavioral Experiments Easy (04:58)
Developing coping skills and exposure often run parallel during CBT therapy. Adolescents tend to be extremely self-critical and exaggerate negative aspects. The therapist records the session on video and asks Andrew to make predictions on how well he will answer the phone.
Exposure: Behavioral Experiments Analysis (03:47)
Andrew watches the videotape of him answering the phone and realizes none of his fears occurred. The therapist reassured him of her confidentiality and would not force him to do anything he did not feel comfortable performing.
Exposure: Behavioral Experiments More Difficult (05:32)
The therapist asks Andrew to call her secretary. His mother gave him a cellular phone for doing well with his therapy. Andrew is tasked with calling his grandmother and the secretary every day for the next week in between sessions.
Cognitive Techniques: Judge and Jury (08:02)
Techniques include judge and jury, pie charts, and survey methods to challenge anxious thoughts, helping subjects realize alternative views of the world. Andrew realizes that there is little evidence that he can't speak on the telephone.
Cognitive Techniques: Pie Charts (10:32)
This technique helps the adolescent realize that his interpretation of an event may differ from how others perceive it. Andrew realizes that people may not think him stupid, but that he has pressed the wrong button or distracted.
Being Prepared: Examining Feared Outcomes (03:33)
The therapist asks Andrew to consider whether it is important that the pizza man thinks he is stupid. Everybody wants to be liked all the time, but it is not realistic. Roleplay, problem solving, and self-talk helps a young prepare for difficult situations.
Cognitive Techniques: Survey Method (04:40)
The therapist brainstorms ten people Andrew could ask if they get nervous when calling a restaurant for takeout. Andrew is amazed when eight people say they get anxious and he feels a bit more normal.
Exposure: Relapse Prevention (06:42)
Be on alert for avoidance and negative thoughts, use positive coping strategies, and maintain diaries. The therapist role-plays with Andrew about reading aloud in class.
The clips shown demonstrate only a portion of a therapy session. Parental Interaction is an integral portion of therapy. Slides shown on the screen are available in the manual.
Credits: CBT for Anxiety in Adolescents, Part 2 (02:54)
Credits: CBT for Anxiety in Adolescents, Part 2
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