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

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.

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.

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

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

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/)

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.

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

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