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Running head: ANXIETY AND DEPRESSION

Evidence-Based Interventions: Anxiety and Depression


Katie Viola, Michelle Powers, Deirdra Maguire, and Monica Azzaro
Marist College

ANXIETY AND DEPRESSION

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Table of Contents

Part I: Introduction to Anxiety and Depression

What is Anxiety?

What is Depression?

Part II: Anxiety and Depression Website Summaries

Website Summary: AnxietyBC

Website Summary: ASCD

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Website Summary: Worry Wise Kids

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Website Summary: School Psychiatry Program and MADI Resource Center

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Part III: Evidence-Based Anxiety and Depression Interventions

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What is Cognitive-Behavioral Therapy?

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Intervention Coach Card: Cognitive Coping Cards

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Intervention Coach Card: Graduated Exposure Therapy

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Intervention Coach Card: Cognitive Restructuring through Thought Records

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Intervention Coach Card: Talking Back to the Muck Monster

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Part IV: Appendices

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Appendix A: Sample Coping Card Statements

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Appendix B: Facing Fears Form

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Appendix C: Hopping Down the Worry Path - Fear Rating Form

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Appendix D: Sample Fear Ladder

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Appendix E: Fear Thermometer

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Appendix F: Instructions for Filling Out the Thought Record Form

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Appendix G: Thought Record Form

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Appendix H: Combating Negative Thoughts Form

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Appendix I: Common Irrational Negative Thoughts Form

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Part V: References

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Part I: Introduction to Anxiety and Depression

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What is Anxiety?
Anxiety can be defined as a feeling of worry, nervousness, or unease, typically about an
imminent event or something with an uncertain outcome (Huberty, 2008). There are many
different types of anxiety, such as Separation Anxiety, Specific Phobia, Social Phobia,
Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Post-Traumatic Stress
Disorder, among other forms of anxiety. Anxiety is a normal aspect of living and can be viewed
as an adaptive trait that exists within all humans, however, when anxiety begins to affect the
personal, social, or academic functioning of an individual, intervention may be warranted
(Huberty, 2008). In children and adolescents, some signs of anxiety might include concentration
problems, irritability, withdrawal, perfectionism, seeking easy tasks, failing to complete tasks,
fidgeting or restlessness, task avoidance, oversensitivity, persistent worry, or somatic complaints,
among other signs (Huberty, 2008).

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What is Depression?
Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a
mental illness that affects ones thoughts, feelings, behavior, mood and physical health. In
children and adolescents, signs of depression may include social withdrawal, lack of
participation in usual activities, decline in self-care or personal appearance, irritability,
uncooperativeness, inappropriate responses to events, somatic complaints, low energy or fatigue,
a decline in academic performance, negative affect, or attention problems, among other signs
(Huberty, 2008).

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Part II: Anxiety and Depression Website Summaries

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Summary of AnxietyBC

Website: http://www.anxietybc.com/
Mission: This website provides a rich resource of self-help information and programs, as well as
resources for parents and caregivers of individuals suffering from anxiety. Their mission is to
increase awareness, promote education and improve access to programs that work.
What it includes:
For Youth and Young Adults

Anxiety 101: provides information regarding what anxiety is, how to recognize the signs,
types of anxiety problems, when anxiety is a problem, and what can be done to address
anxiety problems

Facing fears: provides information regarding using exposure as a means of facing fears,
how to track progress, and how to utilize self-rewards

How to chill: provides information regarding anxiety reducing strategies, such as calm
breathing, tensing and releasing, visualizations, and mindfulness exercises

Common problems: provides information regarding common anxiety problems among


youth, such as social anxiety, perfectionism, trouble sleeping, panic attacks, test anxiety,
peer pressure, and disturbing thoughts

For Parents

Provides information regarding the ABCs of anxiety, subtypes of anxiety disorders that
commonly affect children, and how to recognize the signs of each subtype

Provides a complete home toolkit of simple step-by-step instructions on how to help


anxious children cope with specific issues, such as facing fears or using coping cards

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What is CBT?

Provides information regarding how CBT works, components of CBT that can be used as
self-help strategies, and how to seek help

Limitations: This website offers DVDs related to various anxiety problems, however, they come
at a cost. Further, the website is lacking a section specifically aimed at providing resources to
teachers or school staff. This website is geared toward parents and individuals experiencing
anxiety.

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Summary of ASCD
Website: http://www.ascd.org
Mission: The Association for Supervision and Curriculum Development (ASCD) is a global
community dedicated to excellence in learning, teaching, and leading. ASCDs innovative
solutions promote the success of each child. ASCD works with educators and thought leaders
worldwide to implement innovative practices focused on the whole child and the success of each
learner.
What it includes:
Archives

This website provides information relative to various aspects of learning, but a search of
depression provides access to various archived articles relative to depression in
students

Responding to a Students Depression

This article provides information relative to the characteristics of depression in children


and adolescents and further provides information regarding the way depression presents
itself in school in both children and adolescents

The article also provides several classroom strategies that teachers can utilize in schools
to help children who display signs of depression. For example, schools should establish a
touchstone teacher, promote social interaction, communicate with the students family,
develop accommodations to respond to the students fluctuations in mood, etc.

The Shrink in the Classroom: Too Sad to Learn

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This article provides a thorough description of depression in students, methods for


treating depression, and advice for educators who work with depressed students

The Shrink in the Classroom: The Bipolar Child

This article provides a description of juvenile bipolar disorder, methods for treating
bipolar disorder, and tips for accommodating the bipolar childs needs within the
classroom

The Shrink in the Classroom: The Suicidal Student

This article explains how teachers can recognize suicide risk factors, how they can
address suicidal comments, and how schools can respond to a student suicide

Limitations: While this website provides several resources for teachers relative to depression in
students, the resources are not easy to find, as the website contains thousands of archived
articles.

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Summary of Worry Wise Kids


Website: http://worrywisekids.org/
Mission: The purpose of this website is to improve the quality of life for children with anxiety
and their families by offering comprehensive and accessible information on the full range of
anxiety disorders. The website provides resources that are designed to help children cope with
and overcome the stress, worry, and anxieties in their life to promote their health, social growth,
and academic performance.
What it includes:
Informational Pages

Information that helps parents and educators determine whether a childs anxiety is
developmentally appropriate or cause for concern by providing common red flags as well
as examples of normal anxiety

Presents possible causes of anxiety including genetics, learning/modeling, and


environmental factors

Dos and Donts for parenting an anxious child

Treatment

Step-by-step process for parents whose child needs help with anxiety issues

Detailed page on Cognitive-Behavioral Therapy and medications

Anxiety Types

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Descriptions of specific subtypes of anxiety disorders, red flags, and information on


treatment approaches that can help parents find the type that encompasses their childs
concerns

Information on Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Pediatric


Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS), Separation
Anxiety Disorder, Panic Disorder, Social Phobia, Selective Mutism, Specific Phobias,
and Post-Traumatic Reactions

Anxiety 101

Tips for explaining anxiety to kids that can be useful for parents and counselors
o Includes a script for younger children that involves a role play with puppets or a
silly voice
o Includes a script for school-aged children and teens

Resources for Schools

Sample accommodations for anxious students

Helpful tips for managing the classroom and school as a whole to create a supportive
environment for children with anxiety
o Examples: Seating within the classroom, cool down pass, suggestions for testing
conditions and class presentations

Limitations: While this website offers some practical suggestions for schools to help students
manage anxiety, much of the website is intended for use by parents and families.

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Summary of School Psychiatry Program and MADI Resource Center


Website: http://www2.massgeneral.org/schoolpsychiatry/index.asp
Mission: This website was created by the Massachusetts General Hospital School Psychiatry
Program. This site is designed to help educators, physicians, and students who are suffering
from mental health conditions. Some of the mental health issues that are mentioned on the site
include depression, bipolar disorder, obsessive-compulsive disorder, and anxiety disorders.
What it includes:
For educators, parents, and clinicians:

There are special links for educators, parents, and clinicians. Under these three links,
there are tabs for information about some of the mental health conditions, preliminary
screening, screening, and rating tools, and medications. For the informational tab, it
describes some symptoms that may be exhibited in the classroom or at home. The tab
also provides information about interventions that can take place at home, school, and
psychological and biological interventions.

For school psychologists:

With the informational tabs, we could direct parents to this site so they could have an
understanding of the condition. The interventions mentioned could also act as a starting
point to decide which is most appropriate for the student.

A positive aspect to the site is that it provides screenings for the different mental health
conditions. Some of the screenings provided are free. These screenings can be used for

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progress monitoring.

Limitation:
A limitation of this site is that it does not provide scripts for the interventions. It is a starting
point. When choosing an intervention from this website, we would have to do more research in
how to conduct the intervention.

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Part III: Evidence-Based Anxiety and Depression


Interventions

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What is Cognitive-Behavioral Therapy?


Cognitive-Behavioral Therapy (CBT) is an evidence-based treatment that focuses on the
relationships between thoughts, feelings, and behaviors. Research currently supports the use of
CBT in the treatment of both depression and anxiety disorders (National Alliance on Mental
Illness, 2012). CBT is based on the idea that the way we perceive situations influences how we
feel emotionally and how we subsequently behave. This form of treatment is often focused on
the present, targets dysfunctional cognitions, affects, and behaviors, and helps the individual to
recognize the nature and extent of these problems. By changing belief systems and cognitions
through this form of therapy, children with anxiety and depression can begin to function more
appropriately and adequately in their environments (Huberty, 2008). The following evidencebased interventions are based upon cognitive-behavioral techniques.

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Intervention Coach Card


Cognitive Coping Cards
Target Problem: Anxiety
Brief Description: Cognitive coping cards are small index cards with short sentences or pictures
of some of the coping skills a student can use when experiencing anxiety. This intervention is
geared toward children between the ages of 6 and 15.
Location: School psychologists office; Individual session
Materials:

Plain white index cards

Writing utensil

Decoration materials (i.e. stickers, markers) - optional

Frequency: 1x weekly for 6 weeks; 30-minute sessions


Directions:
Step 1: First, the student must be able to recognize the signs of anxiety. Discuss with the student
how to recognize anxious thoughts and feelings. In collaboration with the student, create a list of
the anxious thoughts that the student frequently experiences.
Step 2: Explain to the student that his or her anxious thoughts can be changed to reflect more
relaxed and balanced thinking.
Step 3: Introduce the purpose of coping cards. Say, Coping cards are small index cards with
short sentences of some of the coping skills you can use when experiencing anxious thoughts.

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The cards are portable reminders to boss back anxiety! (Make sure the student is involved. The
student must feel that the coping statements will actually be personally helpful. Children and
teens are more likely to use them if they have been involved in developing them).
Step 6: Take out the index cards and a writing utensil. Model to the student how he or she might
create a coping card using one of the students anxious thoughts identified in Step 1. Provide the
student with examples of coping card statements (Appendix A). Pictures can be substituted for
words for very young children.
Step 7: Instruct the student to create the coping card(s). Say, On one side of the card, you will
write down one of your anxious thoughts. On the other side, you will write a replacement
thought, or write down an activity you can do when experiencing the anxious thought.
Step 8: Allow the student to decorate his or her card(s) with stickers or markers (optional).
Step 7: Practice using the coping card(s). Role-play different scenarios in which the student
might need to use his or her coping card(s). Instruct the student to refer to the card(s) whenever
he or she is feeling anxious.
Step 8: Follow up with the student once weekly for 6 weeks to discuss how the cards are
working, to add additional cards as needed, and to role-play various situations in which the cards
may be useful.
Progress Monitoring: Administer the Spence Childrens Anxiety Scale (SCAS) to children
between the ages of 8 and 15 prior to utilizing coping cards (http://www.scaswebsite.com).
Administer the SCAS at the beginning of each subsequent session to evaluate the effectiveness
of the cards. Use the SCAS- Parent Version for children as young as age 6.

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Citation:
AnxietyBC. (2014). Developing and using cognitive coping cards. Retrieved from http://www.
anxietybc.com/parenting/developing-and-using-cognitive-coping-cards
Wright, J. H., Ramirez-Basco, M., & Thase, M. E. (2006). Learning Cognitive-Behavior
Therapy: An illustrated guide. Arlington, VA: American Psychiatric Publishing, Inc.
Intervention Coach Card
Graduated Exposure Therapy
Target Problem: Anxiety or phobias/fears
Brief Description: Exposure is the process of facing fears. It involves the child being gradually
exposed to situations that they find fearful; over time this will allow the child to understand that
these fears are not actually scary and they will develop confidence in these situations. This
intervention can be done with children of all ages.
Location: School psychologists office; Individual session
Materials:

Plain white paper

Writing utensil

Fear Thermometer

Fear Ladder Form/ Hopping Down the Worry Path

Facing Fears Progress Monitoring form

Child chosen rewards

Frequency: 2x weekly until fear is phased out; 40-minute sessions


Directions:
Step 1: Understanding

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Help the child to understand the importance of facing fears

Provide example:

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Tim is afraid of the water, but really wants to spend time with his friends at the
swimming pool. What can he do to stop being afraid of the water?

Give the child an explanation as to why it is important to face their fears:


It is important for you to face your fears so that you can learn that those situations are
safe. Although it can be scary at first, with practice you will feel less anxious. You can
start with some things that are less scary and take small steps towards facing the things
that are scarier. Over time, you will feel better in those situations and may end up really
enjoying them.

Step 2: Make a List

Make a list with the child of things or places that they fear. Be sure to group similar fears
together, if there are many fears. Work with the child to come up with the list.

Have the child discuss possible rewards when goals are achieved.

Step 3: Build a Fear Ladder

Arrange the list from Least (0-No Fear) to Most scary (10- Tons of Fear).

Use the Fear Thermometer to help the child rate their fears (Appendix E).

Once each situation has been rated, use the Fear Ladder Form to make their final list
(Appendix D). Younger children may use the Hopping down my worry path Form
instead (Appendix C).

Note: Each ladder should include a whole range of situations. The ladder should identify some
things the child can do now with some anxiety, some things he or she can do now with moderate
anxiety and, finally, the things he or she finds too difficult to do now. It is important to start

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really small and take gradual steps.

Identify a specific goal; then list steps to achieve the goal. (If the child has more than one
fear, a separate ladder should be completed for each.)

Be sure to reward brave behavior.

Step 4: Facing Fears (Exposure)

Starting with the situation that causes the least anxiety, encourage the student to
repeatedly engage in that activity (e.g., repeatedly saying hi to an unfamiliar person)
until he or she starts to feel less anxious doing it.

If the situation is one that the student can remain in for a period of time (such as being
close to a dog), encourage him or her to stay in the situation long enough to see anxiety
lessen (e.g., standing next to a dog for 20-30 minutes).

Once your child is able to enter that situation without experiencing much anxiety, he or
she can move on to the next thing on the list.

Step 5: Practice

Practice the fear often. The more the child practices the quicker the fear will fade.
Homework should be given at the end of each session to provide practice with exposure.

Step 6: A Reward

Offer the child the pre-selected reward when a goal has been achieved.

Once the child has successfully faced their fear, rewards may be phased out. Be sure to
remember to praise.

Encourage the student to praise him or herself with positive talk.

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Progress Monitoring: The childs fear ratings on the Fear Ladder Form will serve as the
baseline data. Once exposure has begun, the school psychologist and the child can track the
progress together on the Facing Fears form (Appendix B). This helps the child to identify how
anxious they were prior to and after facing their fear. It also helps to determine what they have
learned after facing the situation.

Citation:
AnxietyBC. (2014). Helping your child face fears: Behavioral exposure. Retrieved from http://
www.anxietybc.com/parenting/helping-your-child-face-fears
Ollendick, T. H., & King, N. J. (1998). Empirically supported treatments for children with
phobic and anxiety disorders: Current status. Journal of Clinical Child Psychology, 27(2).

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Intervention Coach Card


Cognitive Restructuring through Thought Records
Target Problem: Depression, Anxiety
Brief Description: Cognitive restructuring helps students challenge their negative thoughts
about their environment and themselves and replaces the negative thoughts with positive
thoughts. With the thought record, the student and school psychologist can monitor and explore
the negative thoughts, look for evidence to support the negative thoughts, and explore alternative
solutions.
Location: School psychologists office; Group session
Materials:

Writing utensil

Thought record sheet

Frequency: 1x weekly for 6-8 weeks. If working in a school where the day is broken up into
periods, one session could last one period (i.e. 40 minutes). Depending on the group, the
sessions may need to last two periods.
Directions:
Initial Session:

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The school psychologist should explain why the students were chosen to be in the group.
He or she should also explain that the goal of the group is to help the students recognize
their negative thoughts and through the therapy sessions, the students will think of
alternative behaviors so the negative thoughts can become positive. The school
psychologist should also make the students aware of the agenda of each session. The
agenda is to review the homework assignment, come up with positive alternative
thoughts to the negative thoughts, and practice the steps to come to those positive
thoughts. During the initial session, the rules of the sessions should be explained along
with confidentiality.

After the explanations, the students will complete the Center for Epidemiological Studies
Depression Scale for Children (CES-DC). This scale can be used for baseline data. The
completion of the scale should take about five minutes.

Next, the school psychologist hands the students a thought record and explains that they
will be filling this out during the therapy sessions (Appendix G). The school psychologist
should explain that when he or she hears something that they believe is a negative
cognition, they are going to explore the cognition using the thought record form.
Instructions for filling out the thought record form are provided in Appendix F.

With the thought record form, the student describes the details of the situations, such as
who, what, where, when, and feelings experienced (Appendix G).

The school psychologist and the students think of alternative ways of looking at the
situation. The school psychologist and the students discuss that if we think of a situation
in a certain way that is how we are going to feel about it. For example, if we only have

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negative thoughts about a certain situation, then we are going to have negative feelings
about it.

The school psychologist can demonstrate ways to have more positive thoughts and
feelings about the situations and the students can practice those ideas.

The school psychologist and the students think of homework for the sessions. This could
be to fill out the record form when they are depressed or anxious and to practice the new
positive thoughts learned in the session.

At the end of the session, the students can practice some relaxation techniques (visit
http://www.healthiersf.org/resources/pubs/stressRed/StressReductionActivities.pdf for
examples of relaxation techniques). For this initial session, an icebreaker game can be
played if it was done so at the beginning of the session.

Following session:

The school psychologist will go over the homework assignment with the group. If the
child had difficulty filling out any of the sections in the chart, the school psychologist can
guide the student in completing it. If the students were practicing the new learned
behavior, the school psychologist can ask how it turned out. If further instruction is
needed, this would be the time to address those issues.

Next, the school psychologist will listen to more verbalizations and point out the negative
cognitions so the students can recognize them.

The process of filling out the record form is next.

With each weekly session, have the students fill out the CES-DC to monitor progress.

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At the end of the session, the school psychologist will assign the homework and practice
a relaxation technique with the students. The homework is to continue to fill out the
form. It could also be to practice the skills learned during the session.

Progress Monitoring: Administer the Center for Epidemiological Studies Depression Scale for
Children (CES-DC). This scale should be administered prior to the intervention then every week
that the intervention is implemented. While this scale might have been created for a pre/post
scale, using it every week can be beneficial to monitor the progress of the intervention. The
questions can be modified to serve the different populations where the intervention would be
implemented. The scale is appropriate for children between the ages of 6 and 17. It should take
the student about five minutes to complete.
Comments/Tip: The students can use a notebook if they are having difficulty writing within the
width of the columns.
Citation:
Cognitive Therapy Guide. (n.d.). How to write a thought record. Retrieved from http://www.
cognitivetherapyguide.org/thought-record-template.htm
DuPaul, G. J., & Lutz, J. G. (2002). School-based psychosocial interventions for childhood
depression: Acceptability of treatments among school psychologists. School Psychology
Quarterly, 17 (1). 78-99.

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Intervention Coach Card


Talking Back to the Muck Monster
Target Problem: Depression
Brief Description: This is a cognitive restructuring activity that aims to recognize and replace
cognitive distortions that are characteristic of children with depression through the use of a
simple drawing activity.
Location: School psychologists office; Individual or small group setting
Materials:

Paper

Coloring utensils

List of irrational negative thoughts

Cognitive Restructuring Handout

Frequency: 1x weekly for 6-8 weeks; 30-minute sessions


Directions:

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Step 1: Introduce the idea of cognitive restructuring to the child/group and give them the
cognitive restructuring handout (Appendix H).
An example script:
Sometimes we have negative thoughts about ourselves that make us feel bad. Many times,
these thoughts are untrue. When we have a hard time changing or letting go of these
thoughts, we get stuck in the negative muck. Our goal is to catch these thoughts and replace
them with more positive ones. In order to do this, we will combat negative thoughts using
the two questions on your handout.

Step 2: Introduce the idea of the Muck Monster to the child or group.
An example script:
The Muck Monster is a creature that will try to get you stuck in the muck by filling your
head with negative thoughts. Close your eyes and picture what he might look like.
Step 3: Ask the student to draw their own Muck Monster using the paper and coloring utensils.
Step 4: Collect the students drawing of the Muck Monster and explain the rest of the activity.
An example script:
To defeat him, we are going to talk back to the Muck Monster using the two what
questions on your handout to guide us. You can argue with the Muck Monsters negative
thoughts by being a thought detective and providing him with more realistic, positive
thoughts.
Step 5: The school psychologist will use the list of irrational negative thoughts to project
negative statements through the students Muck Monster (Appendix I).

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Step 6: Encourage the group/individual to dispute the Muck Monster with the what questions
and positive statements (see appendix H).
Step 7: At the end of the activity, students are given homework to record any irrational negative
thoughts they experience during the week. At the next session, these thoughts will be projected
through the Muck Monster and students will practice disputing these thoughts.
Progress Monitoring: Progress monitoring can be conducted using the Childrens Depression
Inventory (CDI). This can be administered at the beginning of the initial session, and at the end
of each subsequent session.

Citation:
Nolen-Hoeksema, S., & Hilt, L. M. (Eds.). (2009). Handbook of depression in adolescents. New
York, NY: Taylor & Francis Group.
Stephan, S. H., & Marciante, W. (2007). Quick guide to clinical techniques for common child
and adolescent mental health problems. Retrieved from http://www.schoolmental
health.org/Resources/Clin/QuickGuide.pdf
Wright-Strawderman, C. (1996). Depression in students with disabilities: Recognition and
intervention strategies. Intervention in School and Clinic, 31, 261-75.

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Part IV: Appendices


Appendix A: Sample Coping Card Statements

Anxious Thoughts
I am going to fail this test.
Other people dont like me. Social situations
make me nervous.
I am so nervous I cant do this presentation.
I dont want to say the answer out loud
because it might be wrong.

Somatic Sensations
I feel like I cant breathe.
My stomach hurts.

My heart is racing.
My palms are getting sweaty.

Coping Card Statements


I am prepared for this test and I am going to
do really well.
I am a likeable person. Other people get
nervous too.
I rehearsed for this presentation and I am
prepared. I am going to do really well.
Everyone gets an answer wrong sometimes.
No one will care if I get the answer wrong.

Coping Card Statements


I can count to 10.
My stomach just hurts because I am feeling
anxious. This is normal and it wont last
forever.
My heart is racing because of my anxiety. I
can take 10 deep breaths.
My palms are getting sweaty because I am
feeling anxious. I can color or practice my
muscle relaxation.

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Appendix B: Facing Fears Form

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Appendix C: Hopping Down the Worry Path - Fear Rating Form

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Appendix D: Sample Fear Ladder

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Appendix E: Fear Thermometer

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Appendix F: Instructions for filling out the Thought Record Form

1. The situation. Briefly describe the situation that led to your unpleasant feelings. This will
help you remember it later if you want to review your notes.
2. Initial thought. What thought first crossed your mind? This was probably a subconscious or
automatic thought that you have had before.
3. Negative thinking. Identify the negative thinking behind your initial thought.
4. Source of negative belief. Can you trace your thinking back to a situation or person? Is there
a deep belief or fear driving your thinking? Search your heart.
5. Challenge your thinking. Look at the evidence both for and against your thinking. Have you
been in a similar situation before? What did you learn from it? What strengths do you bring to
this situation? Make sure you see the whole picture.
6. Consider the consequences. What are the short-term and long-term consequences if you
continue to think like this? Look at the physical, psychological, professional, and emotional
consequences.
7. Alternative thinking. The previous steps of the thought record helped you understand your
thinking and lower your defenses. Now that you've considered the facts, write down a healthier
way of thinking.

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Appendix G: Thought Record Form

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Appendix H: Combating Negative Thoughts Form

Combating
Negative Thoughts!
1) Whats the
evidence?
- Use this when you think
the truth will not
support the negative thought.

2) Whats another way to


think about it?
- Use this to create some replacement,
positive thoughts that make more sense.

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Appendix I: Common Irrational Negative Thoughts Form

Common Irrational Negative Thoughts


I cant do anything well.
There is no point in trying.
Im useless.
Things never work out for me.
Nobody likes me.
Im dumb.
Somethings wrong with me.
I cant make any friends.
Im worthless.

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Part V: References

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References
AnxietyBC. (2014a). AnxietyBC: Resources, results, relief. Retrieved from http://anxietybc.com/
AnxietyBC. (2014b). Developing and using cognitive coping cards. Retrieved from http://www.
anxietybc.com/parenting/developing-and-using-cognitive-coping-cards
AnxietyBC. (2014c). Helping your child face fears: Behavioral exposure. Retrieved from http://
www.anxietybc.com/parenting/helping-your-child-face-fears
Association for Supervision and Curriculum Development. (2014). ASCD: Learn, teach, lead.
Retrieved from http://www.ascd.org
Bailey, V. (2001). Cognitive-behavioural therapies for children and adolescents. Advances in
Psychiatric Treatment, 7. 224-232.
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