Anxiety Treatment Plan
Anxiety disorder is amongst the most common disorders that affect people in society (Bandelow & Michaelis, 2015). While it was believed that anxiety only affects adults, it has been recently found that anxiety affects even children (Creswell, Waite, & Cooper, 2014). Due to anxiety, children can record poor performance in school, have stunted growth, and show reduced aggressiveness in various activities. To prevent the negative impacts of anxiety in children, it is essential for the parents to seek medical attention for their children. This paper displays the development of a treatment plan for James, a 3rd-grade student who suffers from an anxiety disorder.
The most effective intervention for correcting anxiety disorder among children is cognitive behavioral therapy (CBT) as it has no side effects or health hazards, and hence it becomes an ideal treatment plan for anxiety in children (Creswel et al., 2014). The therapy allows the children to develop tools to manage the tension on their own in the present age and the future (Lowenstein, 2017). Therefore, cognitive behavioral therapy becomes an effective intervention to treat anxiety disorder in children.
In the case study, the behaviors of James are indicators that he suffers from an anxiety disorder. The main trigger of James’s anxiety is his poor performance in school. In this case, therefore, it is necessary to restructure the perception of school performance as a basis of treating the disorder. James is able to undertake all his daily routines well except for his homework. When doing his homework, James becomes anxious. As such, to correct his disorder, it is important to restructure how he does his homework in incremental steps. Since James is still very young, the CBT intervention plan should be made as playful and fun as possible. Activities that are play based which are within the context of a therapeutic relationship enhance the effectiveness of CBT intervention among children.
The CBT plan that will be used for James will include key interventions which are psycho-education, somatic management skills, cognitive restructuring, gradual exposure, and relapse prevention (Lowenstein, 2017). Psycho-education serves a central role in CBT with the main purpose of informing both the child and the parents about anxiety, its sources, signs, reactions, and treatment approaches (Nehra et al., 2013). With this knowledge, the experience of the client with anxiety is normalized and the client is empowered to handle anxiety in an optimal way. During this process, the therapist will be able to give James and his mother factual information about James’ anxiety with his homework. Also, James and his mother will be made aware that other children have gone through a similar challenge and have been treated successfully. This way, James will be given a sense of hope and confidence.
The therapist can play the crumpled paper throw game with James to maintain his interest in the process of gathering information about his condition and to ensure that he understands what the therapy is all about (Lowenstein, 2017). This game entails crumpling papers into balls and throwing them towards a hoop. If James gets a crumpled paper, he will earn one point but if he misses he answers a question and gains two points for the questions he answers correctly. At the end of the game, the points will be traded for a prize (Lowenstein, 2017). The questions to ask include; what does anxiety feel like? How do you feel when you start doing your homework? Would you like the feeling to go away? What is cognitive behavior therapy? What is gradual exposure? Also, Juliet can play the game together with James so that they learn together. The client is not expected to know the answers to most of the questions but the therapist will read the correct responses aloud giving them an opportunity to learn. This approach encourages children to listen keenly facilitating learning and integration of the treatment plan.
Training of somatic management skills is also an integral part of CBT (Nehra et al., 2013). This aspect of CBT mainly deals with relaxation which helps anxious children to acknowledge and learn how to control their physiological and muscular responses to anxiety. Most children who have an anxiety disorder are often resistant to relaxation due to negative metal assessments such as this is not possible, I cannot manage this among others. In some case, extreme fears prevent children from relaxing, for instance, James’ anxiety is triggered by the fear of poor performance which gives him trouble doing his homework. The therapist will teach James how to relax using playful methods in order to penetrate the resistive barriers holding James back. The cookie breathing game can be used as an intervention to teach diaphragmic breathing (Lowenstein, 2017). The child is instructed to hold hands where the belly button is located in the tummy. The child is then asked to breathe in slowly through the nose for three seconds as the tummy moves out. Thereafter the child breathes out for four seconds through the mouth as the tummy moves in.
Cognitive restructuring is the third phase of the selected CBT intervention for James. Anxious children often have negative thoughts and beliefs that escalate anxiety feelings. The therapist will have to assist James to understand how his thoughts and feelings are connected to his behaviors. Once this is understood, the client will be guided to replace the negativity with helpful and calming self-talks which are important for the success of CBT. The process of learning cognitive coping can be very dull for a young child like James. As such, the therapist will use helpful thoughts to help James. According to Lowenstein (2017), helping thoughts enables practitioners to use experiential and developmentally sensitive way of connecting cognitions and behaviors.
This method allows children to correct their maladaptive assumptions without feeling threatened. Also, the therapist can teach James this skill using YouTube videos which he will definitely find more interesting (Woods et al., 2017). When using cognitive behavioral therapy as an intervention plan to treat anxiety disorder, the client changes the negative thinking patterns which contribute to the disorder. The negative thoughts are then replaced with realistic positive thoughts (Smith et al., 2018). In the case study, James has negative feelings about his performance in school as he thinks he may not perform well. Consequently, there is a need for him to change his beliefs and start thinking of how well he will perform in school.
Gradual exposure is a CBT intervention which is specially designed to help the client to get over dysfunctional avoidance gradually allowing the child to regain optimal functioning. Since facing fears is a critical experience for children, most clients are always reluctant to proceed with this step in CBT. To engage James in the exposure phase, the therapist will prepare him by channelling his desires to recover into the actions he has to undergo to recover. Picture it Poster is an appropriate way of presenting exposure to children (Lowenstein, 2017). The activity involves building the readiness and motivation of the client to face his fears. The therapist will explain to James in a tone that is child-friendly the rationale and the significance of exposure, and initiating a reward system. Thereafter the child is guided to develop several graduated exposures. The development of the exposures will be done by the therapist, James and his mother. This way, the child will be empowered to overcome fears. The child then creates a poster with drawings of the exercises geared towards exposure making the plan more manageable. The therapist will provide Juliet with ample guidance on how she will support James during the exposure phase. After identifying the negative, distorted thoughts, the client can replace the thoughts with new realistic, accurate and positive thoughts (Smith et al., 2018).
Finally, relapse intervention is the last step of the selected therapy for this case study (Lowenstein, 2017). Relapse prevention prepares the child together with the parents to expect anxiety at any time and to emphasize that continuous practice and implementing the skills learned in therapy help in dealing with setbacks. In this phase, the therapist will present James with complicated homework and help him to find appropriate ways of tackling the homework. For cognitive behavioral therapy to succeed in children, the parents and the child must combine their efforts (Smith et al., 2018).
The usefulness of the Intervention Plan to the Client’s Problem
CBT is effective in treating anxiety disorders, more so, in cases where medication alone has not succeeded. Compared to other therapies, CBT can be completed in a relatively shorter time. Also, it focuses on restricting thoughts and reshaping behavior in order to change how the patient feels. Since CBT can be individualized as it will be for James, it can be offered in groups and can make use of self-help books and computer programs. The treatment plan enables the patient to participate positively in a variety of activities. In the case study, the therapy will allow James to do his homework with a positive mind of excelling in his school work. As a result, he shall do his homework effectively, hence improving his performance in school.
The skills which are learnt in CBT are life-changing and practical such that they can be incorporated in daily life to help the patient cope with future difficulties, even after completion of the treatment.
The intervention plan plays a crucial role in increasing the self-esteem of the patient. From the positive statements that the therapist recommends the patient to use when addressing issues, the client can develop higher self-esteem (Benefits and Drawbacks of Behavior Therapy, 2018). In this case, James will use the statements when handling the homework. As a result, strong confidence builds up in him, and he can do the assignments appropriately. As a result, his self-esteem increases as he believes in himself with time. Cognitive behavioral therapy improves performance at the school since replacing the negative thoughts of failure with the positive ones of success, the student is esteemed to work hard, and by believing in himself, he can improve his performance in school.
Limitations That May Hinder the Efficacy of the Treatment Plan
Cognitive behavioral therapy is an effective method of solving the challenges that affect individuals who suffer from an anxiety disorder. However, during the implementation of the treatment plan, there may arise situations that may hinder the application of the intervention plan. Firstly, the patient may struggle to adopt the thought challenging plan. The patient may have strong negative thoughts that may hinder the adoption of positive thoughts (Woods et al., 2017). In this case, James is a young child, and he may not understand the power of positive thoughts. Therefore, he may find it hard to replace the negative feelings about poor performance with positive feelings about the excellent performance in school. However, this challenge can be overcome by adding some more time for the patient to give him sufficient time to prepare and engage fully in the treatment and using playful techniques to make the process fun.
The possibility of a patient overindulging in the new behavior may hinder the effectiveness of CBT (Woods et al., 2017). In this case, James should be monitored not to overdo his homework and ignore other aspects of his life, for instance, he should be able to balance his homework and play time with his friends. Overdoing the homework may lead to tiresomeness that may make him inactive during the school hours. The inactivity may reduce his concentration in class work, and this may negatively affect his performance in school rendering the therapy useless. To address this concern, James’ mother will have to take charge of monitoring his son as he does his homework and as he practices.
Methods of the Treatment evaluation
Before starting the treatment plan, the therapist will provide James with a checklist for the symptoms of anxiety. Also, James and his mother will be required to observe, track, and report anxiety incidents and their triggers. Also, the CBT intervention plan will be evaluated by assessing the progress of James towards the desired objective which is to correct anxiety associated with his homework and poor performance. The progress will be measured through reduced symptoms of anxiety (Smith et al., 2018).
The effectiveness of CBT will also be realized when James realizes that the intervention plan which the therapist has settled on is sensible to him. Thereafter, he will understand what he is expected to do to overcome his anxiety and will have confidence in the treatment plan. At home, Juliet will realize improvement in his son’s mood and behavior. If she observes that James is engaging in activities that are associated with accomplishing the objective of the treatment, then it is a clear sign that the treatment plan is effective. The reports of James, his mother, and the therapist will be compared to determine if the therapy is effective.
Possible Treatment Alternatives.
Anxiety is not only treated using cognitive behavior therapy, but also other treatments are used to treat the disorder. Anxiolytics have proved to have a considerably greater reaction than a placebo drug (Creswell et al., 2014). Therefore, the clinicians tend to prescribe to the patients a dose of anxiolytic medicine. Moreover, the use of selective serotonin reuptake inhibitors (SSRIs) is another alternative handling of anxiety. SSRIs are viewed as the pharmacological treatment of choice in children with an anxiety disorder. This regard is derived from the effectiveness of the treatment and its safety profile. Finally, benzodiazepines can be used as another treatment for anxiety. However, the method is not recommended for children due to its side effects and the concerns about dependency.
Cognitive Behavior Therapy (CBT) is an effective method of anxiety treatment since it is cost-effective, simple and self-explanatory. James being a young child is at a sensitive stage that discourages him from using the other medications to control anxiety. The efficacy of the treatment plan is easily derived since the victim of anxiety can give direct reports about how he feels after being exposed to the therapy. Although it is the most effective treatment plan for anxiety in children, more research needs to be carried out to determine the different ways through which CBT can be carried out.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327-35.
Benefits and Drawbacks of Behavior Therapy. (2018). Retrieved from http://www.mychildwithoutlimits.org/plan/common-treatments-and-therapies/behavior-therapy/benefits-and-drawbacks-of-behavior-therapy/
Creswell, C., Waite, P., & Cooper, P. J. (2014). Assessment and management of anxiety disorders in children and adolescents. Archives of disease in childhood, 99(7), 674-678.
Lowenstein, L. (2017). Creative CBT Interventions for Children with Anxiety. Retrieved from www.lianalowenstein.com/articleAnxiety.pdf on 29th November 2018
Smith, M., Segal, R., & Segal, J. (2018). Therapy for Anxiety Disorders: Cognitive Behavioral Therapy (CBT), Exposure Therapy, and Other Anxiety Treatments. Retrieved from https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
Nehra, D., Sharma, K., L., & Kumar. (2013). Cognitive Behaviour Therapy: An Overview. Retrieved from https://www.researchgate.net/publication/237358832_Cognitive_Behaviour_Therapy_An_Overview on 29th November 2018
Woods, A. P., Stults, C. B., Terry, R. L., &Rego, S. A. (2017). Strengths and Limitations of Internet-Based Cognitive-Behavioral Treatments for Anxiety Disorders. Pragmatic Case Studies in Psychotherapy, 13(3), 271-283.
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