Question 1

How can you incorporate these concepts with OCD treatment for children 10-13 yrs old?

Robert D. Friedberg · Accepted Answer

Great question. The use of stories align with the current approach to  "bossing back" OCD where young patients label the OCD with a fictitious name  (e.g. Professor Just Right and the talk back is empowering (for more depth). A story can incorporate these boss back principles and include dialogue between the OCD and a counter character. For more info see March and Benton's book Talking Back to OCD (https://www.guilford.com/books/Talking-Back-to-OCD/John-March/9781593853556).  Up and down the worry hill is a great example (https://www.lighthouse-press.com/products/up-and-down-the-worry-hill-third-edition?_pos=1&_sid=debe47fdf&_ss=r) Additionally,  Huber's what to do when your brain gets stuck is another excellent resource (https://www.dawnhuebnerphd.com/overcoming-ocd/)

Question 2

Do you have a good resource for finding stories? How do you match the story to the client?

Robert D. Friedberg · Accepted Answer

Thank you for the question. Matching the stories to children is pivotal. When you create your own stories with the child, matching is natural. I attached two articles that might be helpful

Question 3

What is the best way to use CBT with children 10-12 yrs old who have germaphobia? They are not always able to conceptualize monitoring negative thought patterns.

Robert D. Friedberg · Accepted Answer

Thanks for your question. Identifying anxiogenic thoughts is not easy. A good tip is make sure the child is feeling anxious at the time. Then ask a question such as "what is going through your mind right now? or What popped into your head. Try to avoid asking "what are you thinking? which often produces an intellectualized response. Like all anxiety disorders, exposure is ESSENTIAL. So with kids with contamination fears exposure is key.  It is now more difficult in the peri and post pandemic periods.  Here is a great reference to doing exposure at this time
Sheu, J. C., McKay, D., & Storch, E. A. (2020). COVID-19 and OCD: Potential impact of exposure and response prevention therapy. Journal of Anxiety Disorders, 76, 102314. 
Storch, E. A., Schneider, S. C., Guzick, A., McKay, D., & Goodman, W. K. (2020). Impact of COVID-19 on exposure and response prevention for obsessive-compulsive disorder: Present and post-pandemic considerations. Psychiatry Research, 292, 113310.

Question 4

Hello, 
My question is: How do you adapt exposure to 7 y.o. children who have anxiety?
Best Regards

Robert D. Friedberg · Accepted Answer

Thanks for your question. It is a very important one because exposure is essential to treating anxiety yet far too often it is not delivered to young patients. Like all CBT procedures, exposures can be adapted for younger patients. Often you have to make the exposures simple and engaging. Adding rewards for willingness to complete them is a common practice. Here are a couple of great references and I have attached an article that might help as well.

Jeremy S. Peterman, Kendra L. Read, Chiaying Wei, Philip C. Kendall,
The Art of Exposure: Putting Science Into Practice,
Cognitive and Behavioral Practice,
Volume 22, Issue 3,
2015,
Pages 379-392,
ISSN 1077-7229,
https://doi.org/10.1016/j.cbpra.2014.02.003.
(https://www.sciencedirect.com/science/article/pii/S1077722914000157)

Southam-Gerow MA Exposure therapy with children and adolescents https://www.guilford.com/books/Exposure-Therapy-with-Children-and-Adolescents/Michael-Southam-Gerow/9781462539581

Peris, Storch and McGuire Exp Tx for children with anx and OCD https://www.elsevier.com/books/exposure-therapy-for-children-with-anxiety-and-ocd/peris/978-0-12-815915-6

Question 5

Are there any stories that are particularly helpful in supporting children (12) in identifying distortions related to fear of abduction?

Robert D. Friedberg · Accepted Answer

A useful intervention is to do mutual storytelling with these children particularly tailored to their specific fears. I have attached two potentially helpful resources.

Question 6

Hello. Can you recommend online literature in the form of stories and symbolism for CBT therapy in children?

Robert D. Friedberg · Accepted Answer

Thanks for your question there are a number of really excellent stories based on CBT. I am not sure if they are on line but you can PURCHASE them on-line. Here are just a  few:
Rational Stories (Waters, 1980
What to do when your brain gets stuck (Huebner, 2007), What do to when your temper flares (Huebner, 2008)
Worry Wart Wes (Thompson, 2003)  Loud Lips Lucy (Thompson, 2002)
The Rabbit who lost his hop (Nass, 2004)
The Penguin who lost her cool (Sobel, 2000)
The Hyena who lost her laugh (Lamb-Shapiro, 2001)
Mind over basketball (Weierbach & Phillips-Hershey, 2008)

I also attached an article that might be helpful

Question 7

What are the limitations of cognitive behavior therapy for children?

Robert D. Friedberg · Accepted Answer

Thank you for this question.  There are a few limitations to CBT with youth but they are relative rather than absolute. First, to do well in CBT, the patient needs to have access to their thoughts and feelings. Thus, executive functioning and theory of mind skills need to be at least minimally present. Many CBT interventions can scaled down to younger children and those with limited meta-cognitive abilities.

Question 8

Can you explain what is a metaphor and give an example of how it can be used in therapy? Thank you

Robert D. Friedberg · Accepted Answer

Thanks for the question. A metaphor is a symbol, image , word, etc that represents something else. For example, repetitive song lyrics are a metaphor for automatic thoughts. I have attached an article which gives you some ideas about how to use them in therapy.  hope this is helpful

Question 9

Is there evidence proving the effectiveness of bibliotherapy for things like phobias with children? And is just reading the story enough or what kind of follow-up work is needed?

Robert D. Friedberg · Accepted Answer

Thanks for your question.  The short answer to this question is that for anxiety and phobias, exposure based treatment is essential. Bibliotherapy has its place in the psychoeducation module of treatment to orient young patients and their families to treatment.

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