How To Tell the Difference Between the Blues and Symptoms of Depression: 6 Tell-Tale Signs

By Sunda Friedman Tebockhorst, PhD, LPC

“The opposite of depression is not happiness, but vitality.”
This quote from writer Andrew Solomon contains some important wisdom about the nature of the beast we call depression. It is normal to experience sadness, to have days of feeling grumpy or down. We all have days like this, sometimes a few in row. It is normal to feel sad in response to distressing life events – these are the bumps in the road of life, and for most of us, we navigate over the bumps and get on with the life we recognize as ours. However, when the obstacle is not the normal vicissitudes of daily life, but rather a run-in with depression, this can be altogether a different story. Life becomes a foreign and exhausting experience, where it feels like there is no respite and no hope for a more engaged tomorrow. Here are some things to look for if you aren’t sure whether or not you might benefit from help for depression. If you have found that, for more than two weeks or so:
1. Everything is exhausting: the tasks of daily living – getting the mail, taking out the trash, doing the dishes, talking to friends or family – are overwhelming and extraordinarily demanding. If it feels like doing the little things of everyday life is just too much to face, you may be dealing with depression.
2. Everything is annoying: for many people, and this can be especially true for men, who in our culture our discouraged from acknowledging that they feel down or sad, depression shows up as extreme irritability. If you find that you are responding to the other people and events of your life with intractable bouts of extreme irritability not in proportion to the events in question, you may be dealing with depression.
3. Everything is overwhelming: you used to find that life was a pretty comfortable place for you, but now find that even minimal levels of stimulation are overwhelming for you. People in your life talk too much or talk too loud, bright colors are intrusive, any change in plans or routine is unbearable, even music, books or movies you used to enjoy demand too much energy – if this sounds familiar, you may be dealing with depression.
4. Everything is un-interesting: you used to enjoy your hobbies, had activities or events in your life that predictably brought you pleasure, but now, nothing is pleasurable or enjoyable. If food tastes bland, jokes are never funny, you don’t look forward to things you used to, you can’t seem to care what’s going on around you, you may be dealing with depression.
5. Anything could provoke tears: if you find that you cry frequently, sometimes for reasons you don’t understand, or for no reason at all, you may be dealing with depression.
6. Nothing provides relief: if you have come to a place where you feel no hope that things will change or improve, and/or you feel helpless to gain traction and return to a place where life held some pleasures, if a sense of defeat and purposelessness has invaded your daily routine, you may be dealing with depression.
It’s important to note that, if several or all of these things ring true for you, you do not have to just suffer through it. There are effective tools for managing and resolving depression, most notably, therapy and medications. Statistically speaking, the best outcomes in terms of recovery happen when we use both of these approaches together; you will have to find the specific remedy that best suits your particular needs. What’s most important is that you know that you don’t have to keep struggling and you certainly don’t have to accept that this is just the way things are. Depression is an awful monster that can take over people’s lives, whisper horrible things in their ears, and prove a relentless and formidable burden. While you may not know what to do to get rid of this monster if it has invaded your life, you don’t have to do it alone. A skilled therapist can help you move back to a place of vitality and engagement in life. Please – if this describes you or a loved one – know that we as a community of experienced therapists would like to help you begin the work of taking back your life from this monster. There is hope, and there is help. Finding the right therapist can be a great first step.

Pet Loss: How to Help Your Child Cope with Grief

Pet Loss: How to Help Your Child Cope with Grief

By Jenny Key, LCSW

My earliest memories center on our lively, red-haired family member, Donovan. He was the star of our summer outings, ate too much birthday cake, and made holidays chaotic.  He was my constant companion and first adventure buddy.  I recall vividly, despite my young age of four, when I realized that Donavan was missing.  I walked into my mom’s room as she was making her bed and asked where Donovan had gone.  Like most moms, she struggled with how to tell her child the beloved family dog died.

Be Authentic

Coping with pet loss can be a difficult, yet cathartic time for families.  It is often a child’s first experience of death.  Parents struggle with if, when, and how to involve children in this process.  Instincts tell you to protect them from the pain of pet loss, while logic argues that they should understand that death is a part of life.  The grieving process is unique for each family member, but when approached with openness and patience, it provides an opportunity to become closer.

There are many factors to consider when helping children cope with pet loss.  First, remember that you are working through this together. As the parent, you are the guide and model, but it is okay to admit your own feelings of grief.  Parents often want to hide their sadness in order to keep from burdening children.  In most cases, being transparent with your emotions will give them permission to share theirs.  Be mindful that your son or daughter may react differently to pet loss than you do, or even than other children of similar age.

Age Considerations

Parents seek to understand age-appropriate ways to incorporate children in the illness and death process.  Although developmental stages are helpful, your gut will tell you how much they are ready to know.  Most children from the age of two will have a sense of grief that comes with pet loss. While they may not be able to comprehend death as a permanent state until after the age of seven, you should be transparent and truthful.

Most of you can recall a story like Donovan’s: mom panicked and said the pet went to live on a farm.  Children sense that this explanation is not plausible, which causes them confusion or perhaps more distress.  Because they are learning about the permanence of death, they wonder why a part of the family was taken away.  They also may link their actions to the pet’s removal from the house.  Reassure your children they were not the cause of the pet’s death.  For younger ages, provide enough information so they understand their friend was sick.  With older children, give more details as necessary.

Children often react in ways that seem idiosyncratic or inappropriate, but this is especially true for teens.  Some may act out or express anger in situations not directly related to the loss.  Parents want them to confront their feelings directly by talking about the death. If your child is not ready, offering patience with their emotional ups and downs will better serve them.   Refrain from having a timeframe for grief resolution.

Create a Memorial

Make your home an accepting environment for all respectful reactions to grief.  Some children may accept death readily, having no reaction.  For others, reactions may come at a later time.  Involving your children in a memorial can help them find peace.  Ask them to do something in memory of the pet, like make a collage together or pick out picture frames for a pet corner in your home.  Invite them to write a letter to your pet saying goodbye as a way of helping them express their feelings.

Finally, when your family has suffered a pet loss, allow for extra time together.  Going for a drive, taking a walk, or similar activities promote conversation naturally.  Respond to their thoughts with validation, seeking to know more. If they choose to be silent, soak up the extra moments with your family, feeling gratitude for the time shared.  A pet enters into your life for a few precious moments and teaches your children about unconditional love, but their lessons stay in your family’s heart forever.

 

 

Hot Under the Collar

8 Common Anxiety Symptoms and a Few Ways to Begin to Cool Off

By Rachael Bonaiuto, LPC

When you have anxiety, it’s easy to feel like others don’t understand what you’re going through. Anxiety itself can make you feel as though you’re suffering from symptoms, worries and concerns that are not only pronounced – they also feel inherent. Despite how personal this anxiety is to you, the truth is that anxiety is surprisingly common. I witness anxiety symptoms in most people I encounter on a daily basis – clients, students, friends, and family – in the store, at the bank, even at a red light.  Anxiety is uncomfortable at best, and can become paralyzing and defeating.  And it is common…. so incredibly common.

You are at home, preparing to go to a dinner party with work colleagues. You don’t want to go, you dread it, you think of reasons not to go, fantasize about your favorite elastic-waisted pants and the flavor ice cream that would accompany the movie night you’d rather have. You finally surrender to going, but begin to notice tightness in your chest.  As you stare, hot and bothered, at your closet of ‘not quite right’ clothes, your neck begins to hurt and the pain causes even more fear. You snap at your partner, who gently reminds you that you need to get going. You ignore the texts from co-workers asking you if you’ve left your house yet. You can barely breath and you are frozen.  You are experiencing anxiety and it is profoundly challenging.

So, what are some common symptoms of anxiety? Below are eight typical symptoms of anxiety and a few ways to manage this persistent condition.

  1. You feel constantly worried, tense and on edge
  2. You are plagued by fears that you know are irrational but just can’t shake
  3. You avoid situations/activities because they cause you nervousness & stress
  4. You have difficulty thinking, speaking, and following conversations
  5. You experience pain, stiffness, tension, pressure, soreness, or immobility
  6. Your body temperature increases or decreases without external reason
  7. You feel chest tremors, pounding heart, and/or labored breathing
  8. You don’t feel like yourself, detached from loved ones, emotionally numb

Many common anxiety symptoms show up in your body. You may first experience a knot in your stomach, and then you realize you are totally freaked out about an upcoming presentation. You feel a rapid heartbeat and tightness in your chest and later notice that you are completely anxious to drive in snowy weather.  Your jaw is clenched and your breath is constricted just before you unleash the pent up worry and resulting irritability toward your child.  If you can begin to notice the signals from your body that suggest you are anxious, you may find opportunity to take pause, check in, and navigate what you need in the moment.

Here are a few body-oriented tips for how to deal with anxiety:

1.     Pause:

  1. Find pause through breath. Inhale. Exhale. Feel your belly rise and fall. Notice the air come in through your nostrils and exit out your lips.
  2. Find pause through your senses. Pause to notice what you see. What do you hear and smell? Can you feel your clothes against your body? Experience your feet in your shoes, on the floor. Can you taste the salt on your lips or the flavor from your most recent meal?
  3. Find pause through movement. Go for a walk. Put on your favorite song and dance. Shake it out. Stretch your arms wide. Spread your legs and feel your feet rooted into the earth. Put your hands on your heart or give yourself a massage.

2.    Check In:

  1. Notice what is happening with your breath, senses, movements
  2. Notice, without judgment, what thoughts and feelings you have
  3. Simply observe what is happening in your inner landscape
  4. Scan your body for tension, tightness, fear, irritability, disorientation

3.    Take care:

  1. Ask yourself what you need? Remind yourself (or have someone else remind you) that it is okay to have needs.
  2. If you are having trouble accessing what you need, take another pause, a longer pause, lie on the earth and feel it beneath you.
  3. If you are in need of support, ask for help – from a friend, a loved one or a professional.

Anxiety can negatively impact your quality of life – the way you show up for others and for yourself. Knowing the common symptoms of anxiety can help you recognize when you or a loved one is experiencing unease. When you realize you feel anxious, it can be so valuable to pause, check in and take care of yourself in the moment. Building a deeper understanding of the symptoms and an awareness of what is happening in your body can provide access to your available resources through breath, sensation and movement. When you have access to your internal resources, you can also appreciate more deeply when you need additional support and when you are able to navigate your internal terrain on your own. This self-awareness provides empowerment, freedom and a deeper sense of compassion for self and other. Most importantly, if you are experiencing significant anxiety, seek professional help. Psychotherapy can be very effective in providing relief from the debilitating symptoms of anxiety.

Structured Activity Rewards: Clinical Case Studies

When I first introduce the idea of using a type of behavior modification, parents often dismiss it by saying, “We’ve already tried that and it doesn’t work; what else have you got?”  This is because there are several common pitfalls that will effectively sabotage a behavior modification approach with children.  These pitfalls include: using an overly complicated system (usually including grids and charts), choosing unmotivating “rewards”, not including the child in the creation of the plan, no plan for phasing out the system, lack of clarity regarding the behaviors themselves, expecting perfection, bribing versus reinforcing and poor parental follow through.

The Structured Activity Reward techniques used here are both simple and effective.  In fact, the results are often immediate and dramatic.  Chronic negative behaviors often improve within weeks!  In addition, the technique can be used with a wide variety of undesirable behaviors.  It is a structured approach that focuses the child on the desired behavior and provides fun activity rewards that are motivating to the child.  As a result, the child is also taught how to get parental attention in a more appropriate, positive fashion.  This is very important, as most undesirable child behaviors are actually fueled by the parent’s negative attention to those behaviors.  To better illustrate this approach, consider the following case examples.

Alex, Age 6

Alex was a feisty, highly intelligent boy who was diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) and was on related medication.  Children with ADHD display unusually high levels of inattention, impulsiveness, and hyperactivity for their age.  As is often the case with very bright children, Alex was very manipulative.  He had a history of aggressive behaviors which included biting others, as well as himself.  What better way to get immediate and consistent negative attention!  Alex’s parents were seeking assistance for his increasingly unmanageable behaviors in school.  His most recent exploit involved running out of the school building and climbing up a tree.  When the school staff attempted to talk him down, he growled loudly!

During my first session with Alex, he explained to me that he liked biting himself when he was “bored and hungry”.  He smilingly reported behaving well in school “unless someone antagonizes me.  Like if you antagonized me, I’ll bite you!”  Needless to say, I made every effort to stay on Alex’s good side, as I’m sure others in his life felt compelled to do.

The next week, I met with Alex and his father, who informed me that the school began a point system to provide the parents with daily feedback regarding Alex’s behavior.  He could earn up to four points a day.  We integrated this into our Structured Activity Rewards Contract (see Figure 1).  As soon as Alex accumulated eight good behavior points, he earned a fun activity with Mom or Dad.  To maximize motivation, we also included a “bonus for perfection”.  If Alex obtained four points every day in a school week, he got to choose an additional activity.  The next week, parent reports indicated a good week in school, earning three points most days.  This continued the following week and by the third week, Alex got his bonus for perfection.  Because structured activity rewards allow highly manipulative children to be manipulative in a positive way, it is often quite effective.  After five weeks, we increased the number of points required to twelve and eventually phased out the system completely.


Contract for Alex

When Alex gets 8 Good behavior points

Then he can choose a reward activity

 

Bonus!

If Alex has a perfect week

Then he can pick an extra activity.

Reward Activities

  • Go to the lake
  • Play a board game
  • Play a card game
  • Play Wiggle Bridge
  • Play math games

 

Monica, Age 8

Monica was a socially sensitive, needy child who easily got into conflicts with her mother.  Mom reported that Monica would experience anxieties/frustrations, take it out on her mother, who would then get angry at Monica.  Later, her mother would feel guilty and try to make up.  This scenario occurred repeatedly within their relationship.  Consider how this behavioral sequence would result in and was being reinforced by so much negative attention.

One area of specific difficulty common to so many families is getting homework done.  When it was homework time, Monica would engage in a variety of avoidant behaviors including: eating, fooling around, playing with her younger sister, etc. Her mother indicated that Monica would procrastinate until or through dinner and all the way up to and often past bedtime, requiring “hundreds” of reminders (or “yelling” according to Monica) to no avail.  Mom tried “everything” including rewards like playing video games, which Monica loved, but then she would just rush through her homework in a haphazard fashion.  Consequently, for the last year, Monica was not allowed to play video games during the week.  In addition, Monica wanted to play with her friends after school, but couldn’t due to this time consuming negative homework ritual.  This only compounded her social problems, by reducing her opportunities for needed socialization experiences.

We negotiated a Structured Activity Rewards Contract which addressed these issues (see Figure 2).  If Monica did her homework well after dinner and before bedtime with no more than 3 reminders, she could play video games and be with her friends the next day.  In addition, these good homework days would result in a fun activity with her mother or father.  A week later, her mother reported that the contract was working “really well”, and Monica indicated that Mom was yelling less.  While we addressed other therapeutic issues, homework continued to go well over the next 6 weeks at which time we were able to phase the contract out, as Monica had developed appropriate homework skills.

Contract for Monica

When Monica does her homework well after dinner and before 8:15pm (no more than 3 reminders)

Then the next day Monica can play video games (1/2 hour) and play with her friends after school

Also 3 good homework day results in one of these fun activities:

Reward Activities

  • Going out to ice cream
  • Going bowling with Dad
  • Dinner with Mom
  • Playing video games with Mom
  • Coffeehouse for tea and a muffin with Mom
  • Softball with Dad
  • Sleep over

 

____________________                       ___________________

Monica’s signature                                  Mom’s signature

 

Omar, Age 10

In our initial session, Omar presented as a respectful, well-mannered adolescent who was eager to please.  He was referred for a very common problem that had manifested into a variety of unusual behaviors.  His mother indicated that Omar was, “Scared of being alone and darkness.  He needs to have somebody with him at all times when it’s dark”.  Until age 3, Omar shared a room with his sister, who is one year older.  “Then he became scared to sleep by himself.”  This developed into a pattern of behavior in which Omar would initially fall asleep in his room and during the night, go into either his sister’s or parents’ room where he would remain until morning.  Another set of behaviors also developed around the fear of being alone.  Whenever Omar went to the bathroom or showered, one of his parents had to stand outside the door.  In addition, Omar was fearful of going upstairs alone or washing the dishes downstairs alone.  Keep in mind that these behaviors continued for many years.  What precipitated their finally seeking treatment was Omar’s recent desire to go on sleepovers.  It would have been awkward for Omar to ask his friend’s parents to stand outside the bathroom door!  Despite his being highly motivated to conquer his fears, he was unable to break these behavioral patterns.

In our second session we discussed some basic cognitive-behavioral strategies to help cope with these fears.  Omar learned a deep breathing technique to foster relaxation and created a calming statement of reassurance that he could repeat to himself.   The following week we constructed a Structured Activity Rewards Contract (see Figure 3).  We were able to move quickly in large part due to Omar’s motivational level.  At his suggestion, we set a fairly challenging goal of 5 out of 7 “good” days.  In addition, we added a “bonus for perfection”.  Again, we utilized basic activity rewards with Mom or Dad.  Two weeks later we met again and to my amazement, Omar proudly reported being successful every day!  We revised the contract to 6 out of 7 days and one month later phased it out.  Each subsequent week resulted in 6 or 7 good days.  Once again consider the behavioral sequence.  Consider the inordinate amount of parental time and attention that Omar’s problem behaviors resulted in.  While it’s possible that the cognitive-behavioral techniques alone could have eventually gotten the same results, providing Omar with a way to earn positive parental attention insured rapid success.

 

Contract for Omar

When Omar

  • showers on his own (going upstairs with the door closed) 5 out of 7 days
  • bathroom on his own (again with the door shut) 5 out of 7 days
  • sleeps on his own (in own room and doesn’t call anyone) 5 out of 7 days

Then Omar can choose one activity on Sunday

 

***Activity***

-Lake with Mom                   -Go to mall with Mom

-Craft with Mom                   -Gardening with Mom

-Build model with Dad         -Fishing with Dad

-Lake with Dad                    -Bike ride with Dad

-Play catch with Dad            -Play a sport with Dad

***Bonus*** For a perfect week, Omar picks another activity

I have read and agree with this contract.

 

______________                 _____________          _____________

Omar’s signature                Mom’s signature          Dad’s signature

 

Ryan, Age 5

Initial parent reports indicated that Ryan was a, “Perfect child for the first five years.”  Four weeks earlier he had begun a new pre-kindergarten program.  Since the first day of school, Ryan had been having increasing difficulties adjusting.  It began with his dislike of a forty-five minute “sleepytime” toward the end of the school day.  Ryan was not a napper and probably found sleepytime to be tedious and boring.  His mother attempted to solve the problem by picking him up earlier, thus avoiding sleepytime altogether.  To the parents’ dismay, his adjustment problems worsened.  At this point Ryan resisted going to school at all, wanting only to be with his mother.  Despite a prior history of positive and frequent socialization experiences, Ryan was having tantrums every morning before being forced to go to school.

Let’s stop for a moment and consider the behavioral sequence.  Ryan’s initial adjustment difficulties result in leaving school early, to be with his mom.  In addition, there were certainly countless talks with Ryan regarding his concerns, trying to soothe his fears.  Not only do his adjustment problems increase, they now are unrelated to the initial issue of sleepytime.  All of the adjustment difficulties do, however, have one thing in common.  They all resulted in parental attention.  While the parents may not be yelling or punishing, it is still negative attention in that it fuels and even escalates the undesirable behaviors.

After sharing my negative attention theory, Ryan’s parents were doubtful that this could apply to their son based upon his very well adjusted first five years.  Despite this, they agreed to try utilizing structured activity rewards and we created a contract for Ryan (see below).  Ryan’s parents telephoned me prior to our two-week follow-up appointment.  They were pleasantly surprised to report that Ryan’s difficulties had dramatically improved and they would call back to reschedule if problems reoccurred.  I spoke with them sometime later on a different issue and was told that their son’s school adjustment problems were much more infrequent (i.e., normal).

Contract for Ryan

When Ryan has a good school morning (crying only in room, no grabbing Mom before school)

Then Ryan gets a Happy Point

2 Happy Points = 1 Reward Activity

Reward Activities

  • Go out for pizza with Dad
  • Go to grocery store with Dad
  • Play a game with Dad
  • Bike ride with Mom
  • Go out with Mom/Dad for ice cream
  • Go out with Mom/Dad for Chinese food

Bonus 5 Good Mornings = Clock

 

Jason, Age 11

Jason was also diagnosed with Attention-Deficit Hyperactivity Disorder.  Through prior therapeutic contacts and a good response to medication, his symptoms were kept under control.  Jason’s father had a variety of medical conditions that he had suffered with and, to his credit, learned to cope with fairly well.  Approximately three months earlier, Jason’s father had a sudden mysterious attack which left him temporarily paralyzed and seemingly, catatonic.  His family, who was with him at the time, feared he was dead.  While he completely recovered hours later, it was certainly a traumatic experience for everyone.  This was particularly true for Jason.  Ever since this incident, Jason insisted on constantly being with his father to make sure that he was all right.  As his father put it, “He just won’t leave me alone!”  It had gotten to the point where Jason insisted his dad sleep with him in his room every night.  Even the garage, which used to be Dad’s private sanctuary was now always shared with Jason.  While Jason and his dad previously always had a close relationship, he was driving his dad crazy!

This case is a good example of a very common behavioral process.  Jason’s initial concerns and behaviors were completely appropriate and understandable.  The unanticipated consequence, however, of a significant increase in parental attention inadvertently fueled the behavior to a more dysfunctional level.

We agreed to utilize a Structured Activity Rewards Contract, but given the dynamics of the case, all of the reward activities were with his father (see below).  In our two-week follow-up, his father was ecstatic to report eight good days.  One month after initiating the contract, their relationship was returning to normal and both were forgetting to monitor the contract.  In this case the system was successfully phased out “naturally”.

Contract for Jason

When Jason gives Dad his space for a day

  • Not  bother Dad in Garage after 8:00pm
  • Dad sleeps in his own room

One warning per day for first week only!

Then Jason earns 1 Point

3 Points =  1 Activity Reward

Activity Rewards

-Buy a model                        -Work on a model

-Go fishing                           -Rent a video game

-Go mineral mining          -Play a board game

-Work on a project in garage

-Go to park, throw ball around

-Fly/work on a model plane

I read and agree with this contract

_____________________            __________________________

Dad’s signature                              Jason’s signature

 

Taylor, Age 8

According to Taylor’s parents, he “always” had a problem complying with their requests.  They described him as, “very impulsive”, “overemotional” and stated that he “tantrums whenever we discipline him”.  Even when he did comply it usually required at least 6 reminders and often, endless debates.

A review of Taylor’s school records and early developmental history indicate that at age three he was diagnosed with speech/language delays and had a history of frequent ear infections.  A pre-kindergarten screening noted specific weaknesses in auditory memory (remembering what you hear) and receptive language (understanding what is said to you).  Taylor benefited from ongoing speech/language therapy and was reported to currently be within the normal range  for his age.  While “not listening” is easily one of the most common child disciplinary issues, it is quite possible that Taylor’s noncompliance was initially a function, at least in part, of his real language difficulties.  I hoped that an effective structured activity rewards contract would give him the extra motivation needed to break these very early habits and foster new skill development.

We negotiated our Structured Activity Rewards Contract (see Figure 6).  For each parental request, Taylor was allowed one reminder.  Three good days would earn him an activity reward.  At our two week update session, Taylor had earned eleven good days out of fourteen.  I was pleasantly surprised with his progress.  Considering his developmental history, his parents were also very pleased with his progress, but did mention that he often waits for his one reminder.  To address this issue, Taylor and his parents added a bonus reward of money, which reportedly Taylor wanted more than anything, for needing no reminders.  Preferring activity over monetary rewards, I reluctantly agreed to this revision (see below).  The following week Taylor had accumulated six more good days, three of which were bonus days of no reminders.  Mom confided that the days without reminders took so much effort on Taylor’s part that she had succumbed to the fact that he just needs a reminder or two.  His success continued and we phased out the contract after five weeks.

Contract for Taylor

When Taylor does what is parents ask him to do all day

Then Taylor will earn one (1) point

Reminders!Taylor is allowed one (1) reminder for each request

Three (3) points = one(1) activity reward

Bonus!! 1 Day no reminders = 25cents/3 in a row = $1 

Activity Rewards

  • Go for a drive to see a relocated friend
  • Draw or paint with Mom
  • Build something with Dad, like racetrack
  • Go to a movie with Mom or Dad
  • Play Monopoly with Dad
  • Go to Blockbuster to rent a movie or game
  • Go out to eat with Mom or Dad
  • Go out for ice cream/frozen yogurt

 

I have read and agree with this contract

________________    ________________    _______________

Taylor’s signature                   Mom’s signature          Dad’s signature

 

Matthew, age 6

In 1992,  a significant earthquake rocked southern California at approximately 5:30 in the morning, waking most of us.  Matthew, like most children (and adults!) became quite frightened.  To help Matthew feel more secure, his parents allowed him to spend the remainder of the night with them in their bed.  In my opinion, this was a completely appropriate response.  The next night, Matthew awoke at 2:00 am and asked to sleep with his parents again due to his continuing earthquake fears.  As you may have guessed, this pattern continued for days that turned into weeks.  Consider the behavioral sequence that, of course, culminates in enormous parental attention.  Attention which, while initially quite appropriate, was now fueling Matthew’s earthquake anxiety behaviors.  Keep in mind that Matthew’s fears were also initially appropriate.  Inadvertently fueled by parental contact/attention, his fears became more severe and maladaptive.

Matthew’s parents reported that he was always a worrier.  He was even easily startled  as an infant.  Consequently, Matthew may have also been more predisposed to having anxiety difficulties.

As our initial session was ending, I began to feel somewhat anxious myself as I was going away on a two-week vacation the next day and Matthew’s parents were desperate.  With great reluctance, I agreed to meet with Matthew later that day and quickly formulated a Structured Activity Rewards Contract with the family.  I like to work quickly, but not that fast!  We were, however, able to complete our contract later that day.  The system encouraged staying in his bed, but even if he came in once, he was still rewarded (see figure 7).  If he came in more than once, his parent’s would simply help him back to bed.  He could not, however, stay in his parents’ room.  Right before the family left, Matthew looked up at me and his eyes watered up.  He then quietly said, “I don’t think this is going to work.”  At that moment I was afraid that because I had moved too quickly, he would be right.  At our two week follow-up session, we reviewed Matthew’s progress.  During the first five days, Matthew visited his parents repeatedly on three nights and only once on two nights (thus earning two points).  Then to everyone’s amazement, Matthew remained in his room the following nine nights!  Matthew proudly indicated that he did wake up on some of those nights but was able to deal with it on his own.  We then proceeded to revise/phase out the contract (see below).

I met with the family two years later about some compliance difficulties and was told that there was no reoccurrence of these earthquake anxiety/behaviors.
                                                

Contract for Matthew 

When Matthew stays in his bed all night

Then he will get 3 smiley faces

 

If Matthew only gets out of bed one time

Then he will get 1 smiley face

 Activity Rewards (5 Smiley faces)

  • Wild Animal Park
  • Sea World
  • Zoo
  • Ice skating
  • Buy and play with bow and arrow
  • Marine Museum

 

New Contract for Matthew

When Matthew stays in his bed all night

Then he will get 1 star 

Activity Rewards (5 Stars)

  • Wild Animal Park
  • Sea World
  • Zoo
  • Ice skating
  • Buy and play with bow and arrow
  • Marine Museum
  • Go to a movie
  • Stay up ½ hour late
  • Bowling
  • Go to tide pool

 

Cindy, Age 7

Cindy presented as a sweet, friendly child whose eyes sparkled when she smiled.  In reviewing her case history with her parents, she seemed to almost be the perfect child.  Cindy adjusted “extremely well” to school, which she still “loves”.  Her interactions with peers were observed to be “excellent”.  Her parents also indicated that she was “very responsible” and she even willfully helped with chores! You may ask, “Why bring her to a psychologist?”

Cindy was referred for chronic bed-wetting.  She was toilet trained at age two and had no accidents until age five.  For the last two years, however, she wet her bed almost every night. Cindy’s father left very early each morning for work.  Prior to leaving, he would check on Cindy.  If she wet her bed he would wake her up, change her sheets, and put her back to bed.  Her medical history indicated frequent urinary tract infections, which were probably a contributing factor.  At age six, Cindy went to a urologist for a comprehensive medical evaluation and was even placed on medication for a year.  Despite this, however, her frequent bedwetting continued.  Not sure what else to do, the urologist sent her to me.

At that time the most effective treatment for bedwetting was a device called a “Pad and Bell”.  To use the device, the pad is placed under the bed sheet and is attached to a bell next to the bed.  Any moisture that touches the pad completes a circuit, which activates a loud bell.  The theory is that this trains children who are usually heavy sleepers, to be more aware of the body sensations that wake us up when we have to go to the bathroom at night.  (I’ve always wondered how this classical conditioning tool affects its subjects later in life.  When they hear a door bell, do they get the urge to go to the bathroom?)  I discussed this approach with Cindy’s parents and located a pharmacy, which sold the pad and bell device.

Prior to purchasing the pad and bell, I suggested that we assess motivational factors by setting up a Structured Activity Rewards Contract.  I explained to Cindy’s parents that I didn’t expect the contract to help much, but I wanted to see if increasing her motivation would have any effect at all.  We also explained to Cindy that we’d try it and if it didn’t work, it was no big deal.  We constructed a contract that included daily rewards and bonus rewards for multiple dry nights (see below).  We met a week later and to everyone’s surprise, Cindy was dry five out of seven nights!  The following week she was dry seven nights straight!  During the next week, Cindy only had one wet night.  At this point we began phasing out by modifying the contract (see Figure 10).  Cindy was also required now to change her own sheets.  Approximately six weeks after initiating the contract, we phased it out completely.  One month later, Cindy continued to have all dry nights.  I couldn’t help but wonder if the daily one-on-one attention from Dad each morning inadvertently fueled the behavior.  Interestingly enough, her parents began to notice an increase in attention seeking /defiant behaviors from this seemingly “perfect” child. While she was staying dry at night, she was getting more “pissed-off” during the day!  We addressed these issues in subsequent family therapy sessions.

 

Contract for Cindy

If Cindy has a dry night

Then she can choose 1 daily reward

Daily Rewards

-Lunch at school                  -Time alone with Mom or Dad

-Later bedtime                      -15 minutes in parents’ bed

-Dad’s seat for dinner           -Sleeping on the floor

 

Bonus!      2 Dry nights = 1 Bonus

3 Dry nights = 2 Bonuses

4 Dry nights = 3 Bonuses

Bonus Rewards

-Nails with Mom                               -New notebook

-Mom cleans her room                   -New markers

-Front car seat on weekend           -New book

-Bath with Mom                               -Mermaid cards

-Ice cream with Dad                      -Having a friend over

I have read and agree to this contract

_____________________            _______________________

Parents’ signatures                                        Cindy’s signature

 

New Contract for Cindy

When Cindy has two dry nights

Then she can choose 1 special reward

Special Rewards

-Lunch at school                   -Time alone with Mom or Dad

-Later bedtime                      -15 minutes in parents’ bed

-Dad’s seat for dinner           -Sleeping on the floor

Bonus!      3 Dry nights = 1 Bonus

4 Dry nights = 2 Bonuses

5 Dry nights = 3 Bonuses

Bonus Rewards

-Nails with Mom                           -New notebook

-Mom cleans her room                 -New markers

-Front car seat on weekend         -New book

-Bath with Mom                            -Mermaid cards

-Ice cream with Dad                    -Having a friend over

 

I have read and agree to this contract

_____________________            _______________________

Paarent’s signatures                              Cindy’s signature

 

These case histories attest to the powerful impact of systematically shifting parental attention from negative to positive.  It is important to point out, however, that these seemingly simple contracts were carefully constructed to maximize their chances of success.  The next chapter will provide you with everything you need to know to construct an effective Activity Rewards Contract for your child.  The key element to this system is the use of parental attention that fuels the child’s motivation to practice the desirable behavior(s). To get your own step-by-step instructions on creating your own Structured Activity Rewards Contract, download Dr. Hittelman’s free report: “Change Your Child’s Behavior in 30 Days” by clicking HERE .

Strategic Parenting for a Successful School Year

A new school year presents a new opportunity to develop a game plan for the academic year that yields positive results for your student(s) as well as your family. Quite often, a stressor for one family member tends to have an impact on everyone; a parent’s new job, a family member struggling with emotional challenges, a sibling leaving home for college, and yes, a child starting the school year. More than many of us realize, children often feel apprehensive regarding the increased expectations that come with a new grade level, getting back into the habit of getting up early, studying for tests, and doing homework. The best way to deal with an impending stressor is preemptively. Consider these strategies:

• Instead of waiting for the inevitable meltdown, create an opportunity for the family to discuss the challenges the school year brings and how family members can support each other.
• Model checking-in at the dinner table regarding your week (trying to focus on accomplishments as well as challenges) and encourage other family members to do so as well. Just being able to vent about school stress can help your child reduce it.
• Frequently acknowledge what’s going right. Remember that it’s human nature to focus on the negative and take the positive for granted.
• Practice good self-care: Find healthy ways to reduce your own stress. Otherwise, you won’t have much patience for anyone else’s.
• Clarify your priorities: School is very important, but not as important as the parent-child relationship. Don’t let school conflicts create a rift between you and your child.
• Have a few laughs! Never underestimate the many benefits of making the time to have fun as a family. In our busy world, it may not happen if we don’t plan on it.
• If your child seems to be struggling academically, consider ruling out underlying emotional/learning issues before assuming it’s all about motivation. A good place to start is with your child’s classroom teacher.