Mindfulness-Based Cognitive Therapy for Anxious Children A Manual for Treating Childhood Anxiety
RANDYE J. SEMPLE, PHD JENNIFER LEE, PHD New Harbinger Publications, Inc.
Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. “Anxiety Got the Best of Me” by Denis Kucharski, copyright © 2008 by Denis Kucharski. Used with permission. “So Just Be” copyright © 2007, “No Man’s Land” copyright © 2002, “Magic Show” copyright © 2005, “I Don’t Take Criticism Well” copyright © 2007, and “River of Feelings”copyright © 2005 by William Menza. Used with permission. Excerpt from MINDFULNESS-BASED COGNITIVE THERAPY FOR DEPRESSION by Zindel V. Segal, J. Mark Williams, and John D. Teasdale, copyright © 2002 by Guilford Press. Used by permission of Guilford Press. Distributed in Canada by Raincoast Books Copyright © 2011 by Randye J. Semple and Jennifer Lee New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com Illustrations copyright © Denise McMorrow Mahone, 2011 Cover design by Amy Shoup; Acquired by Catharine Meyers, Edited by Jean Blomquist All Rights Reserved Printed in the United States of America
Library of Congress Cataloging in Publication Data on file Semple, Randye J. Mindfulness-based cognitive therapy for anxious children : a manual for treating childhood anxiety / Randye J. Semple and Jennifer Lee. p. ; cm. Includes bibliographical references. ISBN 978-1-57224-719-2 (pbk.) -- ISBN 978-1-57224-720-8 (PDF e-book) 1. Anxiety in children. 2. Cognitive therapy for children. I. Lee, Jennifer, 1972- II. Title. [DNLM: 1. Anxiety Disorders--therapy. 2. Adolescent. 3. Child. 4. Cognitive Therapy-methods. 5. Psychotherapy, Group. WM 172] RJ506.A58S46 2011 618.92’8522--dc23 2011012685 13 12 11 10 9 8 7 6 5 4 3 2 1
First printing
Contents
Foreword
vii
Acknowledgments
xi
Introduction
1 Part 1
A Mindfulness-Based Approach to Treating Childhood Anxiety 1
Dancing Between Two Worlds: Buddhist Psychology and Cognitive Psychology
7
2
Understanding the Problem of Anxiety
25
3
Different Paradigms and Different Goals
40
4
Adapting Mindfulness-Based Cognitive Therapy for Children
60
Part 2
Mindfulness-Based Cognitive Therapy for Children 5
Overview of the Twelve-Session Program
77
vi
Mindfulness-Based Cognitive Therapy for Anxious Children
6 Introducing a New Way of Being in the World
104
7 Who Am I and Why Am I Doing This?
121
8 Mindfulness to Your Taste
146
9 Sound Experiences
157
10 Seeing Clearly
174
11 Being Touched by Mindfulness
191
12 Making Sense of Scents
201
13 Mindfulness as a Way of Life
211
Part 3
MBCT-C in Perspective 14 The Past and Future of MBCT-C
237
Epilogue
247
Appendix A: Information and Resources
249
Appendix B: Table of Contents for Mindfulness in Everyday Life Notebook
257
Appendix C: MBCT-C Session Handouts
261
Appendix D: Program Evaluations
335
References
347
Index
359
Introduction
In our work as clinical psychologists, we see the suffering experienced by many children with anxiety disorders. Suffering may be intensified when thoughts and feelings about the experiences are not differentiated from direct perceptions of the experiences. For many children, anxious thoughts and feelings can feel more real than the actual anxiety-provoking situation. When we taught mindful awareness practices to children, we found that some changed how they related to their own thoughts and feelings. Some children realized that what they infer is not necessarily true, what they fear is not necessarily real, and thoughts are just thoughts. We wrote this book to share with you a psychotherapy that may help children with anxiety experience less suffering. Mindfulness-based cognitive therapy for children (MBCT-C) is a twelve-session therapy developed for children between the ages of nine and twelve. With age-appropriate modifications, MBCT-C may be useful with children a few years older or younger. Initially developed as a group intervention, we also offer suggestions for conducting MBCT-C with a single child. This book, with its accompanying CD-ROM, provides detailed instructions for conducting each session and includes reproducible written materials and handouts. The session summaries and home practices found in appendix C should be read in conjunction with the instructions for each session. The structured program presented here is intended to help children become more aware, moment by moment, of their multifaceted journey through life.
2
Mindfulness-Based Cognitive Therapy for Anxious Children
A few important points are foundational for the material that follows. First, MBCT-C is not a spiritual practice. Second, it is not a conventional cognitive therapy. Third, MBCT-C integrates psychological models that may seem contradictory—because mindfulness promotes accepting things as they are, while cognitive therapy promotes changing things we don’t like. Fourth, it challenges us as therapists to abandon the desire for change in our clients, even though change is a time-honored goal of therapy. Finally, MBCT-C offers us opportunities to incorporate mindfulness into our own lives. Let’s look briefly now at each point.
MBCT-C is not a spiritual practice. Mindfulness-based therapies have grown quickly in acceptance and popularity. Several, including MBCT-C, integrate Buddhist meditative practices. Buddhist psychology describes a perspective about the world that is quite different from Western thought. It expresses clear ideas about how to be happy in the world, of which practicing mindful awareness is but one component. Mindfulness means paying careful, nonjudgmental attention—in the present moment—to our rich and complex inner and outer worlds. As therapists, we do not teach Buddhist religious precepts to children, but we adopt a mindfulness-based approach and encourage children to cultivate greater awareness because it is often helpful.
MBCT-C is not a conventional cognitive therapy. Cognitive therapy is effective in treating anxiety for many, but not for all. Many children (onethird to one-half) respond to it only partially or not at all. Cognitive therapy assumes that distorted thoughts can increase anxiety, so changing those thoughts can decrease anxiety. In short, cognitive therapy teaches children to change what they think. In contrast, MBCT-C assumes that how we relate to our thoughts, feelings, and body sensations can increase anxiety, so finding a different way to relate to these experiences can reduce anxiety. In other words, MBCT-C teaches children greater awareness and acceptance of the thoughts, feelings, and body sensations that contribute to their felt experiences.
MBCT-C and cognitive therapy are paradoxical models of acceptance and change. MBCT-C integrates successful elements of cognitive therapy into a complementary mindfulness-based paradigm. In many ways, these models work very well together. In other ways, they are paradoxical,
Introduction
3
because cognitive therapy is focused on change while mindfulness is focused on acceptance. As children cultivate greater awareness of their experiences, they can also cultivate compassionate acceptance of those experiences. In practice, as acceptance grows, profound changes may occur in thoughts and behaviors.
MBCT-C challenges us to abandon the desire for change. As therapists, our work involves offering interventions to help children. Because of the focus in MBCT-C on acceptance instead of change, the way its “interventions” are used may seem incongruous. Paradoxically, we seek to create change by accepting things just as they are. MBCT-C seeks to change not thoughts but how children relate to thoughts. In other words, we hope to cultivate acceptance from nonacceptance. In practicing mindful awareness and acceptance, children can learn to apprehend the world in different and perhaps more adaptive ways—and then intentionally choose to make changes. By enabling the child to accept herself and her life exactly as they are, we fertilize the ground from which changes can emerge spontaneously. The most difficult component of MBCT-C for a conventionally trained therapist may be to abandon the desire for change. In some ways, we offer instructions in how not to change. Letting go of the desire to change may in itself catalyze significant changes.
MBCT-C offers us opportunities to incorporate mindfulness into our own lives. You may be reading this book with a personal interest in incorporating mindfulness into your own life. The traditional way is to sit on a cushion and watch the breath. How can this simple activity effect meaningful life changes? Mindful awareness, in part, is simply paying attention to life as it is. This may sound easy, but it is not. For most, the practices themselves are not difficult. Remembering to practice can be more challenging. We believe that the only way to understand mindfulness is to practice bringing mindful awareness to your life. Your teachings must be grounded in an experiential understanding. We hope that your personal commitment to practice will bring about transformations as profound as those you hope to see in the children you serve.