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Anxiety & Depression: An evidence-based approach to teaching teachers, school psychologists, and school psychology interns how to use evidence-based interventions

to help students in schools.

Gillian Adams Jana Drummond Marissa Malouf

Caroline Weishaupt

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TABLE OF CONTENTS

PART I: INTRODUCTION TO ANXIETY & DEPRESSION………………………………………...... 3

CHAPTER 1: WHAT IS ANXIETY……...…………………………………………………... 4

CHAPTER 2: WHAT IS DEPRESSION..…………………....................................................... 6

PART II: WEB RESOURCES…………………………………………………………………...… 10

CHAPTER 3: HAPPIFY………………………….………………………………………... 11

CHAPTER 4: PBIS WORLD………………………………..…………………………….. 14

CHAPTER 5: CANADIAN MENTAL HEALTH ASSOCIATION…………………………..…. 17

CHAPTER 6: CREATIVE COUNSELING…………………………………………………..20

CHAPTER 7: STUDENTS AGAINST DEPRESSION…………………………...……………. 22

PART III: INTERVENTION RESOURCES………………………………………………………... 24

CHAPTER 8: COGNITIVE BEHAVIORAL THERAPY (CBT)……………………………… 25

CHAPTER 9: DIALECTICAL BEHAVIORAL THERAPY (DBT)……………………………. 27

CHAPTER 10: MINDFULNESS THROUGH THE SENSES….……...……………………….. 29

CHAPTER 11: COMFORT KIT……………….…………………………………………… 33

CHAPTER 12: I THINK, I AM, I FEEL……………………………………………………. 36

CHAPTER 13: BUBBLE BREATHS………………………………..………………………. 38

CHAPTER 14: PARTY HATS ON MONSTERS…………………………………………...…39

PART IV: ADDITIONAL RESOURCES…………………………………………………………… 42

A. CHECK THESE SITES OUT!………………………………………………………. 43

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PART I:

Introduction to Anxiety & Depression

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Chapter 1 Anxiety

Anxiety is a stress-related response that is often characterized by worry, concern,

perceived threat or danger, and nervousness (Yang, 2010). It is triggered by a combination of

biochemical changes in the body, the student’s personal history and memory, and social

situations (Frey & Odle, 2011). There are many different types of anxiety, such as Generalized

Anxiety Disorder, Separation Anxiety Disorder, Test Anxiety, Social Phobia, Panic Disorder,

and Obsessive-Compulsive Disorder (National Institute of Mental Health, 2014). Many students

experience anxiety or anxiety-related symptoms at some time during their educational career.

For example, students often feel anxious when starting at a new school, some students worrying

about their grades, concerns related to their family, their relationships with peers, or their

performances in sports or other extracurricular activities. Anxiety-related behaviors vary and

manifest themselves differently depending on the individual and the type of anxiety the student is

presenting. Some students may cry frequently, have tantrums and have difficulty concentrating

(Ford-Martin & Mertz, 2009). Additionally it is common for students to be irritable, withdrawn,

seek easy tasks, fail to complete tasks, avoid particular situations or places, complain of

stomachaches or headaches, or experience sudden panic attacks (Ford-Martin & Mertz, 2009).

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References:

Frey, R. J., & Odle, T. G. (2011). Anxiety. In L. J. Fundukian (Ed.), The Gale Encyclopedia of

Medicine (4th ed., Vol. 1, pp. 426-430). Detroit: Gale. Retrieved from

http://online.library.marist.edu/login?url=http://go.galegroup.com.online.library.marist.ed

u/ps/i.do?id=GALE%7CCX1919600163&v=2.1&u=nysl_se_marist&it=r&p=GVRL&sw

=w&asid=9e3599de0e2eedf2ffd198edb8ded284

Ford-Martin, P., & Mertz, L. (2009). Anxiety. In L. J. Fundukian (Ed.), The Gale Encyclopedia

of Alternative Medicine (3rd ed., Vol. 1, pp. 113-117). Detroit: Gale. Retrieved from



=w&asid=6d9de52f519381c26763574fe116da00

National Institute of Mental Health. (2014). Anxiety Disorders. Retrieved from

http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Yang, Y.-T. T. (2010). Anxiety. In C. S. Clauss-Ehlers (Ed.), Encyclopedia of Cross-Cultural

School Psychology (pp. 111-113). New York: Springer. Retrieved from



=w&asid=1a0a189d9c8b98cbae1e79b6179a371c

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Chapter 2 Depression

Depression is a very serious health problem, which can affect people of all ages

throughout their lives or periods of time. Depression is generally defined as experiencing

sadness or irritability, and lack of energy and happiness in nearly all activities for a consistent

extended period of time (Cash, 2004). It affects the entire person, including a person’s thoughts,

emotions, behavior, and physical health (University of Michigan Depression Center, 2014).

Youth and children with depression are unable to just snap out of it, treatment is required to help

change the behaviors and thoughts of the individual (Cash, 2004). The University of Michigan

Depression Center (2014) discusses the factors that contribute to depression symptoms, include

“genetics, changes in hormone levels, certain medical conditions, stress, grief, and difficult life

circumstances”. If untreated, threatening risks are heightened for the individual.

Prevalence:

The prevalence of depression is rising in adolescences. According to Cash (2004),

depression is starting to occur in individual’s lives earlier than in past years. Research has

shown that 28% of individual’s between the ages thirteen and nineteen, experience at least one

onset period of depression. Of those young adolescents who experience major depression, up to

seven percent may eventually commit suicide (Cash, 2004). The need to provide safe

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environments, resources, preventions and intervention strategies for schools is necessary due to

the prevalence among young adolescents.

Risks:

Schools should be aware of the risks that relate to depression. They need to be aware that

there is a gender difference associated with depression and that female adolescents are twice as

likely to develop depressive disorders as their male peers (Cash, 2004). Students at greater risk

include adolescents from lower socioeconomic status backgrounds (Klein, Torpey, Bufferd, &

Dyson, 2008). Students who experience high stress or significant loss are at a higher risk. As

well as, students with behavioral problems, including attention difficulties, learning disorders,

conduct issues (Cash, 2004). Genetics from hormonal changes, medical issue, or family history

of depression are among other contributing factors (University of Michigan Depression Center,

2015). Adolescents who may become depressed also include risk factors of uncertainty with

sexual identity, poor academic performance, abuse, or neglect (Cash, 2004). Knowing about

depression is important for the school environment because the leading risk factor for youth

suicide is depression. Depression may lead to substance abuse, school dropouts, and unplanned

pregnancies (Klein, Torpey, Bufferd, & Dyson, 2008). Any student within the school may have

experienced these risk factors, and if school psychologists are aware they can provide the tools

and techniques to support these students.

Signs and Symptoms:

Recognizing the common signs and symptoms adolescents express will help to identify

these students in need of support. Symptoms of depression appear through physical, cognitive,

and behavioral signs. Desrochers and Houck (2013) compiled a handout, which includes

symptoms that are common within children and adolescents experiencing depression. Not all

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individuals with depression express every symptom, but may exhibit a variety of symptoms from

each category. The physical signs of depression include changes in sleep patterns, unusually low

energy with talking and activity, restlessness and agitation, changes in eating patterns, or

frequent vague complaints about headaches, stomachaches muscle cramps, and tiredness.

Cognitive signs of depression include, poor attention, increased sensitivity to failure, poor

memory, difficulty completing tasks, difficulty making decisions, pessimistic view on

circumstances, negative view of life and future, helplessness, low self-esteem, and thoughts of

suicide or death. Behavioral signs of depression include, withdrawing from social situations,

increased dependency, and excessive time alone, decreased ability to cope with social events,

and reducing participating in previously enjoyed activities. School behavior symptoms may be

misbehaving in a classroom, a decrease of school performance, and tardy or absent from school.

Other behavioral signs include, running away, substance abuse, lack of self-care, and crying

without apparent cause. With all of these signs and symptoms, it is important to take into account

that not everyone who exhibits these signs are depressed, but recognizing the circumstances, the

individual, and the environment is important to include when assessing the student.

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References: Cash, R.E. (2004). Depression in children and adolescents: Information for parents and

educations. Social/emotional development. Maryland: NASP.

Desrochers, J.E., & Houck, G. (2013). Signs of depression in children and adolescents.

In Depression in children and adolescents: Guidelines for school practice. Maryland:

NASP

Klein, D.N., Torpey, D.C., Buffered, & S.J., Dyson, M.W. (2008). Depressive disorders. In T. P.

Beauchaine, & S. P. Hinshaw (eds.), Child and adolescent psychopathology. (pp. 447-

509). New Jersey: John Wiley & Sons.

The University of Michigan Depression Center. (2014). Depression. Regents of the University of

Michigan. Retrieved from:

http://www.depressiontoolkit.org/aboutyourdiagnosis/depression.asp

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PART II:

Web Resources

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Chapter 3

Happify Website: www.my.happify.com

Mission: Happify contains resources for teachers, parents, students, and staff to use to improve

their happiness through mindfulness and cognitive behavioral therapy (CBT). The happify.com

website is scientifically researched and provides multiple science articles, data with graphs and

charts, and research to provide knowledge to users to learn more about the effectiveness and

research behind Happify.

About the Website:

This interactive website uses mindfulness and CBT to provide multiple ‘tracks’ for users

to create an account and follow a daily track. The tracks include: Coping With Stress, Reducing

Negative Thoughts, Building Social Relationships, Feeling Less Lonely, Seeing the Good in Life,

Nurture the Body and Soul, and Boosting Happiness with Positivity. Within these tracks are

multiple activities, games, information and worksheets for users to engage in that relate to the

course they selected. For example, within Reducing Negative Thoughts, the first activity is a

worksheet that asks the user to identify three positive events that have occurred that day and to

write about these events and rate how the individual felt during them.

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The next activity is a game where the individual must click on positive words that appear

quickly on the screen to identify the difference between positive and negative words. The

activity changes as the individual progresses along the track. The user is monitored to ensure

daily check-in and capability to complete tasks within a timeframe without overloading on tasks

in one day. This is to ensure that the user is not progressing too quickly through any given track.

These tracks listed are free for members who sign up.

Signing-up is quick and simple when first entering the website, since the instructions for

each step are provided. For those looking to become HappifyPlus members, you will be required

to pay a monthly fee. For one year, the price is $4.76 per month or two years the fee drops to

$3.16 per month. Becoming a HappifyPlus member expands the games, activities, some levels,

courses, and an in-depth progress-monitoring chart. Users signed in under the free membership

are able to complete free courses without paying but are limited to tracking their in-depth

progress and unlocking levels at an earlier time. Once an account is created, there is an

assessment to find out more about the individual user. Everything can remain private, unless the

user chooses to connect with other users on the website. These connections create a social bond

within Happify to track how other members are progressing and promote positive encouragement

between users. After gaining membership, you gain access to the Community blogs and forum

posts to receive social support through open communication about concerns and interests.

Members also receive access to Happify Daily, which provides news, updates, and motivational

articles about healthy living styles. Unfortunately, you need to be 18 years or older to be a

member, but these interactive courses can be tailored to young adolescents with parent or teacher

supervision due to lack of vocabulary knowledge and potential access to public forums. Happify

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also provides a free mobile application to access daily activities throughout an individual’s day.

All activities are family friendly and provide resourceful guidance to living a positive healthy life.

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Chapter 4

PBIS World

Website: http://www.pbisworld.com

Mission: PBIS World was created by a school social worker who was the PBIS Coach for his

district. He created this website to enable and empower teachers and staff to implement and

carry out PBIS more autonomously. There are over 200 pages of content on this website and

hundreds of resources. While this website was designed to be used with PBIS Implementation, it

provides valuable information regarding different behaviors that might be seen in a school that

would negatively affect a student’s abilities to be successful in the classroom.

What is PBIS?

According to the website, PBIS (positive behavior interventions and supports) is an

architecture for addressing behavior through the prevention-oriented structuring of research-

based interventions and supports in a hierarchical and progressive manner. PBIS is a prevention-

oriented way for school personnel to (a) organize evidence-based practices, (b) improve their

implementation of those practices, and (c) maximize academic and social behavior outcomes for

all students. The purpose of this is to improve behavioral and academic outcomes (PBIS, 2015).

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In practice, this appears as 3 tiers of increasingly intensive and individualized behavior

interventions and supports as well as a system of data collection and analysis.

About the Website

This website provides valuable information regarding a wide variety of externalizing and

internalizing behaviors, including Anxiety and Depression. When first looking at the home page,

the user is directed to list of these behaviors and have an option to choose which behavior to look

at. When clicking on a link, the page then directs them to another page about the behavior they

are looking at. This page contains information about the behavior, such as characteristics about

the behavior and common symptoms that may be associated. At the bottom of the page, it then

asks if these characteristics describe the student’s behavior, and if it does the user is then brought

to a page with suggestions for Tier 1 interventions. From this page, it gives the user an option to

see all Tier 1 interventions, get data tracking forms and strategies, or see more supportive Tier 2

interventions. Tier 3 interventions are also provided if necessary.

For Parents

While this website is designed for school educators and those who work with children,

parents may also find the information provided on this website useful. The profile of the student

may be helpful for parents to narrow down the target behaviors that they are seeing in their child.

This information may be especially helpful for parents who think that are seeing Anxiety and

Depression in their child, and may provide them information as to whether or not their child’s

behaviors are consistent with the criteria of the disorders and warrants a doctor’s visit. This

website also provides parents with additional information about the behaviors they are seeing

and helps them be more informed when speaking with educators or outside providers about their

child’s actions. Some of the example Tier 1 interventions, such a positive praise and reward

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systems, may be helpful for parents to know about and may improve the behaviors in the home

environment when implemented by the parents.

For School Psychologists and Educators

This website provides many great resources for school psychologists and educators alike.

The tiered interventions and data tracking forms are useful to school personnel who are looking

to implement interventions to reduce specific behaviors. This website also educates the users on

the typical profile of a student who exhibits these negative behaviors. This is helpful to see if an

intervention that is being used addresses the target behavior it is intended for. In addition to this,

this website is easily accessible and provides educators with interventions for a wide variety of

behaviors all on the same site. This website is also user friendly and provides teachers and

school psychologists with detailed data tracking sheets which is a valuable resource.

References:

Positive Behavioral Interventions & Supports. (2015). Retrieved April 22, 2015,

from https://www.pbis.org/school/swpbis-for-beginners

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Chapter 5

Canadian Mental Health Association (CMHA)

Website: http://www.cmha.ca/highschool/english.htm Mission: The purpose of this website is to provide easily accessible and free mental health

advice and information to high school students, parents of high school students, and educators

(teachers and school staff) at the high school level. Designed in a user-friendly way, this website

seeks to make visitors feel welcome by normalizing the event of browsing the site and the

availability to read past experiences and stories of other teens, parents, and educators who have

faced similar experiences. Although all three sections have similar formatting (i.e. welcome,

introduction, recognition, high school information, personal stories and examples, and

resources/links), they are designed to gear the information toward the specific target audience.

Overall, it develops comfort in letting visitors know they are not alone.

About the Website: Students

The web resource provides an engaging introduction for student viewers. The site

provides easy access to issues related to a teen’s mental health. It offers avenues of access for

issues related to teen mental health and its affects on adolescent life and academics. The venue

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offers ways to recover by providing examples of effective coping mechanisms as well as various

experiences of the reader’s peers. It presents students with basic information regarding the

differences between “mental health problems” and “mental illnesses.” The student section

concludes by providing “cool” links and resources to help the student get through high school

and transition to their next step.

Parents

The next segment of the site is directed at the parents of teenage adolescents. The site

provides examples and ways to assist parents in recognizing whether a child presents

characteristics of one whom might be in need of help. This webpage offers tools for parents to

assist them in identifying and understanding the means in which their children are being affected

by mental health related issues in both their general lives and the academic world. The site

provides input in the form of examples and experiences of other parents who have experienced

similar issues. It allows the reader the ability to recognize, provide support, and collaborate with

other parents. Children and school sharing personal experiences, which will assist the reader in

adapting responses to their own child. The site also supplies information regarding transition in

the post high school years to assist the parents in dealing with the tumultuous times of adolescent

development; physical, mental, and emotional changes. The site provides parents with the

critical information to allow them to recognize that the adolescent years between the ages of 16

and 24 have a higher risk for young adults to develop mental health problems including serious

mental illness than any other period in their lives. Parents are also given links and resources if

they are seeking extra supports.

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Teachers and School Staff Members

Here also the site provides succinct information and access to pointed information as it

relates to teachers observations of students within the academic setting. Teachers are informed

that they are often the first persons to observe and hone in on early warning signs of mental

health issues in students. The site provides personnel with necessary tools and information to

become more aware of mental illness and mental health issues. The site supplies examples for

how these issues can impact a child’s learning and provides support information that can be

integrated into lessons to facilitate increase levels of student learning once mental health issues

have been identified by the teacher or school staff member. The site as it relates to teachers, also

presents peer experiences that can facilitate a teachers adapting to situations that will assist the

student in the classroom environment.

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Chapter 6 Creative Counseling

Website: www.creativecounseling101.com Mission: This website provides a rich resource for creative counseling. The information

provided on the website focuses on play therapy as a means for providing students with the

counseling they need using fun, creative, and new techniques. The resources are intended for

school psychologists and other professionals in the mental health field (e.g. School Psychology

Interns). Their mission is to increase awareness and promote education about play therapy, the

various techniques that are evidence-based, how to apply these techniques in a counseling setting

and how to address various student needs.

What is Play Therapy?

Play therapy is therapeutic technique useful for School psychologists, teachers, and parents,

when counseling students. Play therapy has many benefits, some of which include, preparing for

social situations, learning to deal with negative feelings (e.g. anger and sadness), and helps

students work through challenging situations in a creative manner.

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What is Creative Counseling?

Creative Counseling is a modern spin on the traditional counseling experience for students. This

approach offers a creative way to educate and promote emotional wellbeing for students, using a

variety of therapeutic approaches.

About the Website:

For School Psychologists

• Creative Counseling 101 provides school psychologists with a thorough understanding of

what creative counseling is all about.

• The website aims at helping school psychologists better understand how to construct a

counseling plan, and incorporating play therapy, art therapy, sand tray therapy, music

therapy, movement therapy, social skills stories, and other creative mediums into each

counseling session.

• The website provides many resources, sample intervention scripts and examples of

creative techniques that school psychologists can use to guide their learning and

implementation of creative counseling in the school.

• Additionally, there are over eight hundred pages of free play therapy, sand tray therapy,

school counseling ideas and lesson plans, art therapy & counseling, and creative ideas for

all mental health professionals. This website is an incredible reference and useful tool for

all school psychologists.

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Chapter 7 Students Against Depression

Website: http://studentsagainstdepression.org/ Mission: This website is a great resource for students, parents, teachers, and school

psychologists. The website is designed to help students spread awareness, while providing them

with useful resources to cope with and manage their depression. In addition, this website

provides additional references and websites that students can go to, to find more information

about stress, depression, suicide, and other student issues. Lastly, one of the greatest aspects of

this website is Take Action! Take action focuses on spreading awareness and educating your

own community about depression by providing access to free resources, modules to help students

take action in their own lives, and suggestions for how to help our peers or community members

work through challenging situations or issues, like depression.

About the Website:

For School Psychologists

• A useful website for school psychologists to be aware of as they may be working with

students who have depressive symptoms or students have a medical diagnosis of

depression.

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For Students

• This website provides students with tips and suggestions for tackling depression, where

to start, how to develop a healthy daily routine, and changing attitudes to live better.

• Another great aspect is that students can stay connected with Students Against

Depression on social media sites, such as Facebook and Twitter.

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PART III:

Intervention Resources

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Chapter 9 What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a form of treatment that is used to treat a wide

variety of mental illnesses. This form of treatment is unique in that is focuses on examining the

relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that

lead to self-destructive actions and the beliefs that direct these thoughts, people with a mental

illness can modify their patterns of thinking to improve coping (NAMI, 2012). It is because of

this, that CBT is especially useful to treat Anxiety and Depression. Challenging the irrational

fears or beliefs associated with these disorders and replacing these negative feelings with

healthier patterns of thinking has proved to be very successful.

In terms of the therapy structure, CBT is a structured and goal-orientated evidence-based

therapy. CBT is time-limited, and it is assumed that the client will not be in continuous on-going

treatment; the average length of CBT is 16 sessions (NACBT, 2014). It is because of this time

limitation that each CBT session has a specific agenda and goals that need to be accomplished

during the time allotted. Homework is also an integral part of therapy so the concepts that are

discussed during the time limited therapy sessions can be practiced and ingrained for the client.

Since CBT is based on the idea that our thoughts cause our feelings and behaviors, not

external things, like people, situations, and events, it can be especially useful to use with client

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who suffer from Anxiety or Depression. The benefit of CBT is that clients can change the way

they think or feel even if the situation does not change, which is helpful for people who have no

control over the external stimuli that may trigger their disorders. CBT encourages clients to

restructure their thinking to interpret their environment as less negative or dangerous, which

allows the clients to reduce the intensity of their Anxiety or Depression. Studies have shown that

CBT actually changes brain activity in people with mental illnesses who receive this treatment,

suggesting that the brain is actually improving its functioning as a result of engaging in this form

of therapy (NAMI, 2012). CBT has shown to be highly effective in treating mental illnesses, and

many interventions utilize strategies that come from this type of therapy.

References:

National Alliance on Mental Illness (2012). Cognitive behavioral therapy? Retrieved April 29,

2015, from http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_

Mental_Illness/About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm

National Association of Cognitive-Behavioral Therapists (2014). What is CBT? Retrieved April

29, 2015, from http://www.nacbt.org/

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Chapter 10 What is Dialectical Behavioral Therapy?

Dialectical Behavior Therapy (DBT; Linehan, 1993) is a cognitive behavioral treatment

approach initially developed to treat suicidal adults with borderline personality disorder (BPD),

which was subsequently adapted for suicidal adolescents. DBT is a skills-based approach that

targets emotional dysregulation, suicidal behavior, interpersonal deficits, and treatment

resistance. Research has shown that in addition to the above, DBT is effective in treating a

myriad of additional disorders such as depression, substance dependence, post-traumatic stress

disorder (PTSD), and eating disorders (Robins, Ivanoff and Linehan, 2001).

It was understood by Linehan that individual therapy was not sufficient for treating high-

risk clients, rather, a multi-faceted approach was better suiting the needs of the targeted group.

The intervention consists of two modalities: Family Skills Training (conducted with individual

family units) and Individual DBT Therapy with the adolescent. In keeping with this strategy,

there are three main components of DBT: individual therapy, skills training group, and therapist

consultation team (Robins et. al., 2001). More specifically, DBT improves and maintains the

clients’ internal motivation to change their behaviors through effective collaboration with their

therapist, enhancement of both client and therapists’ motivation to continue therapy, the

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improvement of client capabilities, and the restructuring of their internal and external

environment. For effective treatment to occur, inclusion of family members is crucial to ensure

collaboration of effective treatment in all environments (Linehan, 1987).

Within DBT there are also four sets of behavioral skills addressed to the client:

mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation (Robins et.

al., 2001). Throughout sessions these sets of behavioral skills are developed through effective

treatment and the collaboration of therapist and client. Because DBT clients typically have

multiple issues that require treatment, targets are prioritized through a triage style hierarchy to

determine the order that problems should be addressed, beginning with life-threatening behaviors

and matriculating to therapy-interfering behaviors, quality of life behaviors, and lastly, skills

acquisition (Robins et. al., 2001).

References: Dialectical Behavior Therapy for borderline personality disorder: Theory and method. Linehan, Marsha M.Bulletin of the Menninger Clinic, Vol 51(3), May 1987, 261-276. Linehan, M. M. (1993a). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. Robins, C. J., Ivanoff, A. M., & Linehan, M. M. (2001). Dialectical behavior therapy. Handbook of personality disorders: Theory, research, and treatment, 437-459.

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Chapter 11

Mindfulness Through the Senses

Appropriate Grade Level: Elementary, Middle, and High School students working on being

present in the moment.

Brief Description: Mindfulness is a behavioral intervention, which incorporates techniques

using the Cognitive Behavioral Theory and Dialectical Behavioral Theory models.

Implementing Mindfulness within daily activities through multiple senses increases the student’s

ability to stay engaged in the present task at hand. Mindfulness can be used for a variety of

behaviors including concentration, controlling anger, testing anxiety, depression, emotion

regulation, and independence. Students learn multiple types of strategies to cope with their

emotions and bring their attention to the present moment through sight, smells, touch, taste, and

sound. Mindfulness is a calming intervention that varies between five to fifteen minutes

depending on the activity and can be administered to individuals, small groups, or class wide.

Intervention Goal: Provide students with the techniques and ability to manage emotions, have

awareness and attention in the present moment, and promote independent thinkers.

Progress Monitoring:

Before administering the intervention, the targeted behavior should be determined as well as the target audience, whether it’s a student, multiple students or whole classroom. Duration and frequency of the targeted behavior should be measured to gather baseline data. Mindfulness incorporates multiple types of behaviors, so it is important to identify the specific behavior to track over the course of the intervention.

• Examples of behaviors that may be seen would include: o Putting head on their desk in frustration, o Eye contact is not being made with the teacher, o Eye contact may be wandering around the classroom,

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o Sweating palms, o Foot tapping, o Biting nails, o A student who typically smiles but isn't smiling anymore in the classroom, o Pen tapping

• Progress will be monitored through tracking frequency or duration of the behavior daily.

o Compare results to baseline data weekly throughout the intervention.

• Though the use of Progress Monitoring we should be able to identify when the student

achieves the behavioral goal set by the teacher.

Materials Needed:

• SeeingàCalming pictures: Beach, sunrise/sunset, woods, snowcapped mountains,

clouds/sky, etc.

• SmellàIncense, flowers, tea, lavender

• Touchà Dryer sheets, felt pieces, feathers, rabbits foot, velvet cloth, stress ball

• Tasteà Mint, hard candies, citrus flavor, tea, ginger

• Soundà rain, waterfalls, mindful bell, wind, nature/jungle noise

Script:

1. Identify the behavior of the student, students, or class.

2. Prepare the appropriate materials, needed for the session.

3. Introduce mindfulness to the class: what it is, how it can be used in the classroom, how it

applies to anxiety and stress, and how it can be applied to outside events.

a. To help explain mindfulness teachers may use:

“Mindfulness can help us in our day-to-day lives. Over the next few weeks

we will be learning and practicing ways to be mindful in the classroom to

become mentally stronger. Mindfulness helps us calm our minds so that

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we can be relaxed, refreshed, and more attentive. It is also a way of

building our inner strength and being more balanced. One of the

disadvantages of mindlessness is that we miss a lot of what’s going on in

our lives. Let’s learn ways to bring mindfulness into our daily lives.

“Sometimes when we are asked to do something new or unusual, we may

feel awkward or uncomfortable. It’s okay if these feelings occur. Try your

best to notice these feelings without acting on them and distracting

others.”

4. The first week, the teacher spends time with each sense explaining the sense and types of

strategies to incorporate mindfulness with the senses. Select a sense for each day of the

week to teach the students the different types of mindfulness and provide consistency

with the class schedule.

a. Smell: “As we focus our attention on the smell of [scent] I’d like you to focus your

attention on what the smell consists of. When emotions and thoughts arise, let the

smell refocus your mind let the thoughts and emotions just pass through. Notice

the sensations in your nose, mind, and body as you smell the scent.”

b. Sound: “recognize and notice the sounds you encounter within the classroom,

hallways, and outside the school. Notice sounds close to you and far away from

you. Notice how some sounds may disappear, while others may appear. As you

continue to listen to the sound playing, focus your attention on the different tones,

rhythms, and vibrations of the sounds”

c. Touch: “I’d like you to focus on one of the objects as if you’ve never seen it

before. Imagine that you’ve arrived here from another planet and the object is

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completely new. Pick up the object and become aware of what you see, the shape,

the texture, color, size, temperature, hardness or softness. Recognize these

feelings and notice the sensations through your fingers and you become aware of

the object. Remember to let the outside thoughts pass through you mind and

remain attentive on the object in your hand.”

d. Taste: “Let us recognize the way our minds and body feel when we eat something.

Become aware of all the sensations as you place the [food item] in your mouth.

Take a bite and notice the taste, texture, and sensations occurring. Remain

focused on what you’re tasting and feeling.”

e. Sight: “Looking at the [object], what is it that you’re seeing? Notice the details of

the picture, notice the coloring, and notice the feelings that cross your mind when

you look at this picture. As thoughts arise, let them drift out as quickly as they

came. Maintain focused on what the actual image is you’re looking at and what

details you can become aware of.”

5. Practice the mindfulness senses three times throughout the day (beginning, middle, and

end), and spend five to fifteen minutes working on the techniques. The introduction days

will take longer to discuss but the more times the mindfulness occurs, the less

explanation needed.

6. Prompt students throughout the mindfulness session to remain attentive and focused on

the activity presented to them.

7. Implement this for 6-8 weeks and adjust length as needed for the behavioral goal to be

reached.

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References: Burke, C. (2009). Mindfulness-based approaches with children and adolescents: A preliminary

review of current research in an emergent field. Journal of Family Studies. Springer

Science and Business Media, LLC.

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Chapter 12 Comfort Kit

Target Problem: Anxiety Disorder

Brief Description: The purpose of this intervention is to facilitate children in learning self-

soothing strategies by providing them with a tactile approach to coping with fear in a healthy

way. The child is provided with a bag and fills it with self-care items that will be used to cope

when faced with a stressful/fearful situation. The overall objective is to assist the child in

changing their negative thoughts to positive and healthy thoughts by encouraging positive self-

talk and self-care during times of need.

Materials:

(Note: The child will select all materials; however the counselor will brainstorm with the child a

list of items that bring them comfort. Therefore, the following list is examples and suggestions

of items that may be used).

• Large bag/shoebox to contain personal items of comfort.

• Stress ball

• Dream-catcher

• Picture of a proud moment

• Meaningful letter

• Worry stone

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• Journal and a pen

• Fabric (piece of a “safe persons” or “loved ones” clothing/ blanket

• Favorite stuffed animal

• Bubbles

• Favorite book

• Etc.

• Art supplies for decoration of bag/box (i.e. markers, crayons, stickers, etc.)

Directions:

1. The counselor begins with educating the child (and, if possible, the parents/caregivers)

about the technique and the purpose it will serve when the child is faced with a

stressful/fearful situation.

2. Counselors then facilitate the child in brainstorming and creating their list of items that

bring them comfort and make them feel better. (Although the counselor guides the

process, it should be noted that the child chooses what will go inside of their bag or box.)

3. Children then select a container that will hold the items they have selected. (If it is to be

used within a school building it is better to advise the child to choose fewer items and a

smaller container for easier travel accommodations).

4. Next, the child can decorate the outside of the container.

5. The child can also develop directions on how to use the comfort kit and will be adhered

to the inside of the bag or box.

6. Counselor will then provide the child with a self-monitoring checklist that they will use

during the school day to track their anxiety in combination with their Comfort Kit to

reduce the anxious symptoms.

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a. Make sure to go through the directions in detail (step by step) with the child so

they understand what is expected of them.

b. If needed, modify the self-monitoring sheet to the developmental level of the

child.


Students will utilize a self-monitoring checklist throughout their school day to

monitor their anxiety levels. Older students at the middle and high school level will do this at the

beginning of each class period. For younger students, this will take place at the start of the day

and will continue at least 4 more times throughout the school day. This may include before

recess, before the start of a new activity, before lunch, and before the student goes home.

The idea of the daily journal in combination with the Comfort Kit will be to help

adolescents recognize their anxiety symptoms in hopes to reduce these feelings. The self-

observation and self-recording required of them will allow the child to become aware of their

symptoms and emotional states, internally and externally, and label their own behavior. School

psychologists and/or school staff will then be responsible for discussing the self-monitoring sheet

with the child and go over the directions in detail, making sure they understand what is expected

of them and the reasoning behind this method.

For younger students, journaling may be more difficult. It is suggested that when working

with elementary aged students, you have them create a drawing or verbally tell a story, as this

approach may be more appropriate. The drawing can be completed independently or overseen by

the teacher or school psychologist, and for a student who prefers to talk about their experiences,

feelings, and anxiety related symptoms, the teacher or school psychologist can scribe what the

37

student tells them. These alternative activities will help make self-monitoring appropriate for

students of various age groups.

References:

Craske, M. G., & Tsao, J. C. (1999). Self-monitoring with panic andanxiety

disorders. Psychological Assessment, 11(4), 466.

Lowenstein, L. (2006). Creative Interventions for Children of Divorce. Toronto: Champion

Press.

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Chapter 13 I Think, I am, I Feel

Target Problem:

This intervention can be used for Anxiety or Depression.

Brief Description:

I Think, I Feel, I Am cards are a specially designed therapeutic tool for practitioners working

with children or adults. This CBT based intervention helps clients to be able to express and

recognize their thoughts and feelings. The statements on the cards allow both the client and the

therapist to hone in on beliefs and feelings that best resonate for the client. The illustrations on

the cards were selectively chosen for their emotional impact and unique perspectives (I Think, I

Feel, I Am, 2009). These cards can be used during a counseling session to elaborate on topics

that have been previously discussed and/or to clarify how the client is feeling about an event.

This intervention is especially good for children who may not have strong verbal skills. Giving

them these cards with different feeling words on them may help the child recognize their own

feelings about a situation using the specified feelings on one of the cards, which then helps the

therapist understand how the client is feeling and better tailor their counseling session. Each

deck of cards includes almost 50 different feelings or thoughts from 6 different categories.

These categories include: mixed-up thoughts and comfortable thoughts (cognitions), mixed-up

feelings and comfortable feelings (emotions), body feelings (somatic responses) and resource

39

development (resourcing and strengthening). These different categories ensure that there in a

feeling or thought card to address a wide variety of potential scenarios.

Materials Needed:

Deck of “I Think, I Feel, I am” cards

Directions:

1. The school psychologist should begin the intervention by talking with the student about

their Anxiety or Depression during a counseling session.

2. When talking about a time they feel anxious or depressed, the cards can be given to the

student to help them identify their thoughts and feelings during that time. The body

feeling cards may be especially helpful with a student who has these disorders to help

them recognize that their somatic symptoms are associated with their Anxiety or

Depression.

3. The student, with the help of the school psychologist, then elaborates on those feelings

based on the card(s) that they chose.

4. The school psychologist then gives the student a different set of cards (comfortable

thoughts or feelings cards), and tells the student to pick which feeling they would have

rather felt during that time.

5. The school psychologist then continues the counseling session with the student

discussing the student’s original feelings about the situation and then how they could

replace those thoughts or feelings with more positive and comfortable thoughts or

feelings.

References:

I Think I Feel I Am. (2009). Retrieved April 29, 2015, from http://www.ithinkifeeliam.com/

40

Chapter 14 Bubble Breaths

Target Problem: Anxiety

Brief Description: This CBT based intervention is designed for students to learn how to use

breathing as a coping instrument when faced with anxiety or other stressors. The bubble breaths

intervention is a mindfulness technique used to help students to practice slow, deep breathing,

while aiding in relaxation. This technique, while most suitable for younger students, can be used

with individuals of any age. Additionally, bubble breaths can be implemented in an individual or

group format. Bubble breaths teaches relaxation using short and deep breathing techniques,

similar to those used when blowing small and large bubbles. This is a fun intervention for

students to use in school with the school psychologist and/or teachers and at home with

parents/guardians.

Materials Needed:

• Bottle of bubbles (can be bought or homemade)

Directions:

1. The school psychologist or teacher should begin the intervention by filling the room with

bubbles; most students will immediately begin to pop them as they fall.

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2. After a few minutes, the student(s) should be instructed not to pop the bubbles, but rather

use the bubbles to blow one big bubble.

3. The school psychologist or teacher should teach the student(s) how to take deep breaths

from the stomach and slowly exhale.

4. Next, they should explain to the student(s) that when they become anxious or stressed,

the brain wants more air, but the lungs are working too hard being upset to provide the

brain with air. However, if they breathe deeply, their brain will tell their heart to slow and

the lungs will work better.

5. The school psychologist or teacher should then instruct the student(s) that if they take

bubble breaths when they start to become anxious, nervous, stressed, or tense, they can

often prevent negative or unwanted behaviors from happening.

6. Students should practice bubble breaths daily or weekly with the school psychologist or

teacher, as well as at home with their parent/guardian, until the child is comfortable doing

this on his/her own.

7. The school psychologist or teacher should also help students implement this intervention

when a student experiences an anxious or stressful situation. This will help students

understand how to apply the intervention with or without bubbles during a time of need.

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My Bubble Breathing Chart

1. Please fill out these questions daily. If the answer to question 1 is NO, do not fill out the rest of the sheet. If the answer is YES, go on to the other questions. For questions 2 and 3, rate your level of anxiety from 1 (no anxiety) to 5 (high anxiety), or with a happy or sad face. *Note: Select which chart to use (numbers or faces) based on the developmental level of the child.

References:

AnxietyBC. (2014). How to Teach Your Child Calm Breathing. Retrieved from

http://www.anxietybc.com/parenting/how-teach-your-child-calm-breathing

Hall, T., Kaduson, H., & Schaefer, C. (2002). Fifteen Effective Play Therapy Techniques.

Professional Psychology: Research and Practice, 33(6), 515-522.

1. I needed to use my bubble breathing today.

Yes

No

2. Before I did my bubble breathes, my anxiety level was: 1 2 3 4 5

3. After I did my bubble breathes, my anxiety level was: 1 2 3 4 5

1. I needed to use my bubble breathing today.

Yes

No

2. Before I did my bubble breathes, I felt: J L

3. After I did my bubble breathes, I felt: J L

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Chapter 15 Party Hats on Monsters

Target Problem: Anxiety Disorder

Application: Preschool – School-aged children

Brief Description: This intervention is implemented through a drawing exercise that has been

designed specifically to enable children to gradually face their fears in a nonthreatening and

satisfying manner. It is understood that most children find more comfort when expressing their

fears through drawing as opposed to verbalizing them. In addition, many children find

reassurance when they are not required to face their worst fear or anxiety immediately. By

experiencing success in a gradual process when facing the feared object, the child’s confidence

level and sense of mastery is said to improve.

Materials Needed:

• Paper

• Drawing Instruments (i.e. crayons, markers, paints, chalk, stickers, etc.)

Directions:

1. The instructor begins by directing the child to draw something that makes him or her

feel happy or safe, such as a favorite activity or friend.

2. After the child completes the drawing, the instructor engages the child in a relaxing

conversation about what he/she has drawn.

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3. Next, the instructor asks the child to draw something that scares him or her

(dependent upon the age of the child it is suggested to tell them to draw something

that scares them “just a little”).

4. The instructor then tells the child to modify the drawing in a way that will make the

feared object (e.g., a monster, animal, insect) seem less scary. For example, the child

could shrink the monster, put a party hat on him, draw a superhero who turns the

monster from mean to nice, and so on.

• Either while the child is modifying the drawing or after, the instructor engages

in a discussion with the child that assists them in the realization that when

they change the picture on paper to make it less scary, they also begin to

change the picture in their head so that they are no longer frightened by the

object they fear. It is important for the child to discuss with the instructor how

they are feeling after the activity takes place.

5. The instructor continues over time creating a scale of the child’s fear.


1. Prior to implementation, students will fill out the “How am I feeling today” pre-

assessment form. This form will be used to identify the student’s feelings and anxiety

level prior to the intervention. It will also allow the school psychologist monitor the

student’s progress throughout and at the end of intervention implementation.

2. Students will utilize a daily journal and/or daily feeling chart (How do I feel today) to

monitor their anxiety on a daily basis. The concept behind the daily journal/feeling

chart will be to assist the adolescent in recognizing their anxiety symptoms in hopes

of reduce these feelings. It will also assist the school psychologist in monitoring

45

progress, to see if the adolescent is experiencing success or if the intervention needs

to be modified.

3. School psychologists and/or school staff will discuss the daily journal sheets/daily

feeling chart with the child and go over the directions in detail, making sure the

student understands what is expected of them and identifying the purpose of the

activity.

4. To conclude the intervention and measure progress made, the school psychologist

will give the student the post-assessment form to complete. This form will allow the

instructor to attain the necessary information regarding the specific intervention and

measure the individual student’s progression throughout the intervention.

References:

Crenshaw, D.A. (2001b). Party hats on monsters. In H. G. Kaduson & C. E. Scharfer (eds.),

101 more favorite play therapy techniques (pp. 124-127). Northvale, NJ: Jason

Aronson. http://pegasus.cc.ucf.edu/~drbryce/Play%20Therapy%20Techniques.pdf

46

PART IV:

Additional Resources

47

Massachusetts General Hospital

Website: http://www2.massgeneral.org/schoolpsychiatry/ Mission: This website provides resources for parents, educators, and clinicians related to mental

health issues that many of our students may experience.

About the Website:

For Parents

• Parents have access to this website and information about child mental health, screening,

and medications. The site helps parents navigate through the various informational tools,

and is helpful for parents who are in the early stages of exploring possible causes of their

child’s difficulties, as well as for parents whose child has already received a diagnosis

from a trained clinician.

For School Psychologists & Educators

• Like parents, school psychologists and other educators have access to information

relation to child mental health, screening tools, medications, mental health within the

classroom, which include; educational evaluations, school-based interventions, creating

safe school climates, and curriculum for teaching emotional regulation skills.

48

For Clinicians

• This website is also useful for clinicians looking for further information about child

mental health issues, medications, screening tools, etc.

Useful Tools:

Child/Adolescent Mental Health Information

Medical conditions described:

• Anxiety (Generalized Anxiety Disorder)

• Separation Anxiety Disorder

• Social Phobia (Social Anxiety Disorder)

• Panic Disorder

• Obsessive-Compulsive Disorder

• Depression

• Bipolar Disorder (Manic Depression)

• Attention Deficit/Hyperactivity Disorder (ADHD)

• Autism Spectrum Disorders

Checklists for Preliminary Screening

• Checklists include but are not limited to the Child Behavior Checklists (CBCL), BASC-2,

Conners 3, Home Situations Questionnaire (HSQ), and the School Situations

Questionnaire (SSQ).

Screening Tools and Rating Scales

• Screening tools and rating scales are used to assess various medical conditions. These

tools and scales are categorized and individualized into tables for each medical condition.

49

Mental Health in the Classroom

• Some of the questions addressed in the Educational Evaluation section include, when

might an evaluation be necessary, what is an initial educational evaluation, and how does

an initial educational evaluation get underway.

• School-based interventions are broken down for each of the medical conditions discussed

on the website, as well as include additional interventions for medical concerns like

eating disorders, conduct disorder and oppositional behavior, and suicide.

• Creating safe school climates is an important topic addressed on this website. The

website aims at providing parents and educators with information surrounding incidents

of targeted school violence, how to build a “connected” school culture, and how to assess

threats in students of concern.

• This website provides users with resources and tools for implementing curriculum based

on improving or teaching emotional regulation skills. Among these resources are PDF

documents related to emotional regulation, self-calming methods, reframing feelings, and

conflict resolution.

Medications

• Information pertaining to the medications used to address medical conditions is provided

for parents, educators, and clinicians to identify possible side effects that their children,

students or clients may be experiencing. This information is useful for clinicians and

parents, to adjust medications to better meet the medical needs of the child.

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