Chapter 6
The Taming Sneaky Fears Program:
Theoretical Framework, Requirements for Implementation, and Program
Overview
6.1.1 Adapting Traditional CBT for Young Children
6.1.1.1 Psychoeducation Component of Traditional CBT
In traditional CBT for anxiety disorders, therapists provide children, adolescents, and adults with information (psychoeducation) about what anxiety is, how to recognize anxiety symptoms and triggers, and how to manage and cope with anxiety symptoms.
When working with four- to seven-year-old children, information about anxiety, anxiety symptoms, triggers, and coping strategies needs to be conveyed in a simple, concrete, and young child-friendly manner. In Taming Sneaky Fears, the abstract concept of anxiety is made concrete by externalizinganxiety. In other words, and as suggested by others (e.g., Huebner,2006), young children and their parents learn to think of anxiety as an unwanted visitor that they are tired of hosting, a separate entity with its own name rather than an integral and unchangeable part of the child.
Young children and parents are encouraged to give this unwanted and bothersome visitor a name so they have a common language to refer to it. In the Taming Sneaky Fears program, Sneaky Fears is the name given to this unwanted visitor.
Albeit externalized, the concept of anxiety or Sneaky Fears is still abstract for four- to seven-year-old children. So to make the abstract concept of anxiety or Sneaky Fears even more concrete, two related strategies are used. First, the illustrated children’s story section ofTaming Sneaky Fears—Leo the Lion’s story of bravery & Inside Leo’s den: The workbook(Benoit & Monga,2018a,b) is used at each child session to bring to life Sneaky Fears, these two annoying jackal characters that continuously bother the main story character, Leo the Lion, by appearing throughout the story and saying worry thoughts (cognitive distortions) in a growling voice (creating fear and anxiety for Leo). Second, during the child group sessions, Sneaky Fears are portrayed by two full body, gray fox puppets that are referred to as jackals to match the children’s story characters. Externalizing anxiety and making the abstract concept of anxiety concrete and come to life in this way sets the stage for young children to be able to recognize that just like Leo the Lion, their own Sneaky Fears put worry thoughts in their brain that make them feel nervous and scared.
In the Taming Sneaky Fears program, young children are encouraged to give their own Sneaky Fears a pet name and draw a picture of what their own Sneaky Fears look like. This represents a first step towards young children learning that their previously intimidating Sneaky Fears are not so scary after all, and that they can exert control over their Sneaky Fears. Young children learn that they can choose to ignore Sneaky Fears or talk back to Sneaky Fears and tell Sneaky Fears to leave them alone and quit bothering them (as suggested by others, e.g., Huebner,2006). Young children learn that they can choose to Be the Boss of their Body and Be the Boss of their Brain and not let Sneaky Fears be the boss.
As with older children in traditional CBT, young children in the Sneaky Taming Fears program learn, in a step-wise manner, how to recognize their anxiety symp- toms, understand when their anxiety bothers them (triggers), and manage and cope with their anxiety symptoms. In a first step, they learn how to recognize anxiety symptoms by finding out How to Be a Feeling Catcher (by doing a Body Scan to figure out what emotion they are feeling and where they are feeling the emotion in their body, and by using the Feeling Thermometer to gauge how intensely they are feeling the emotion). Second, to manage and cope with anxiety symptoms, they learn How to Be the Boss of My Body by using relaxation strategies, including Spaghetti Arms and Toes (progressive muscle relaxation), Balloon Breathing (controlled or diaphragmatic breathing), and Imagery, to make their body relax and calm down even when their body does not want to calm down. Third, young anxious children learn How to Be the Boss of My Brain (or correct cognitive distortions and replace automatic, inaccurate, and unhelpful thoughts with thoughts that are more accurate and more helpful) by (1) using the relaxation strategies to be calm enough to think clearly; then (2) visualizing the Stop sign (to make their brain so busy thinking about the shape, color, and letters of the Stop sign that their brain has no time to think about the worry or scary thoughts that Sneaky Fears try to sneak into their brain);
then (3) being a Trick Catcher and catching the Tricks that Sneaky Fears play (i.e., cognitive distortions: Not Telling the Truth, Exaggerating, and Only Showing the Bad Things); and then (4) using the Trick Stoppers (or coping strategies to correct cognitive distortions: Ignore Sneaky Fears, Think Brave Thoughts, and Talk to an Adult). Fourth, young anxious children learn How to Climb Bravery Ladders (or progressive desensitization) to face and overcome their fears and show that they are becoming brave. Finally, young children learn to identify the triggers of their anxiety by recognizing situations in which their Sneaky Fears bother them the most. The ultimate goal is Taming Sneaky Fears!
6.1.1.2 Cognitive Triangle Component of Traditional CBT
Figure6.1illustrates the traditional cognitive triangle that shows the links among thought, feeling, and behavior. Older children, adolescents, and adults participating in traditional CBT typically learn to critically examine the automatic thought they generate when a given situation occurs and determine whether this thought is accurate (vs. inaccurate—or a cognitive distortion) and helpful (vs. unhelpful—or generating a negative feeling that negatively affects behavior). Over time, traditional CBT teaches older children, adolescents, and adults to challenge any automatic, inaccurate, and unhelpful thought and replace it with a thought that is more accurate and more helpful.
This, in turn, positively affects how they feel (feeling) and what they do (behavior) in a given situation.
Fig. 6.1 The traditional CBT cognitive triangle
Of course, the aforementioned terminology traditionally used to explain and illus- trate the interplay among thought, feeling, and behavior is quite cognitively sophis- ticated for four- to seven-year-old children to grasp. Nonetheless, young anxious children can learn to recognize how their thoughts, feelings, and behaviors are inter- related and how they can change the thought or feeling generated in a given situation to, in turn, affect what they do (behavior). In the Taming Sneaky Fears program, young children learn that when they feel shy, nervous, or scared (i.e., a negative feeling) at a high level on the Feeling Thermometer (i.e., 5 or above on the 10-point Feeling Thermometer), it usually means that their Sneaky Fears are playing their Tricks of Not Telling the Truth, Exaggerating, and/or Only Showing the Bad Things on their brain (i.e., putting one (or more) inaccurate and unhelpful thought(s) in their brain). Young children learn that by being a Feeling Catcher (and doing a Body Scan and using the Feeling Thermometer to figure out what they are feeling and how intense the feeling is) and getting their Feeling Thermometer down to a 1 or a 2 (by using their relaxation strategies, i.e., Spaghetti Arms and Toes, Balloon Breathing, and Imagery), they can Be the Boss of their Body. They learn that when their Feeling Thermometer is down to a 1 or a 2 on the 10-point Feeling Thermometer, they can think more clearly, which makes it easier for them to use the Stop sign, be a Trick Catcher to figure out what Trick their own Sneaky Fears are playing on their brain (i.e., what cognitive distortion is at play), and use the Trick Stoppers (Ignore Sneaky Fears, Think Brave Thoughts, and Talk to an Adult) to Be the Boss of their Brain (i.e., challenge the automatic thought or cognitive distortion). Children learn that when they make their brain Think Brave Thoughts or Ignore Sneaky Fears (i.e., when they generate a more accurate and helpful thought in a given situation), they feel less shy, nervous, and scared (i.e., positively affect feeling) and, in turn, they are better able to face and overcome the fears that they would otherwise have avoided (i.e., positively affect behavior). Young children also learn that when they are the Boss of their Body and the Boss of their Brain, they can Climb their Bravery Ladder to show that they are becoming brave, overcoming their fears, and taming their Sneaky Fears. The parents of young anxious children also learn how the cognitive triangle of traditional CBT and the Taming Sneaky Fears program overlap (Fig.6.2).
Fig. 6.2 Overlap between traditional CBT and the Taming Sneaky Fears program