Goals

  • The child will understand the relationship between thinking and feeling
  • The child will be able to identify unrealistic negative thoughts
  • The child will learn to evaluate the evidence that supports or does not support the negative thoughts
  • The child will learn to generate more realistic thoughts

Materials

Child
Parent es
Other Materials
  • Sunglasses
  • Pens, pencils, markers

If Time is Tight

Make the connection between what we think and how we feel and help the child identify and change unrealistic negative thoughts.

In Session
Remember to start by setting an agenda together and reviewing any practice assignments.

Main Steps
Obtain Weekly Ratings If the main focus is traumatic stress or anxiety, use the 0 to 10 scale of the Fear Thermometer es to obtain Fear Ladder es ratings from both the child and his or her parent. If the main focus is depressed mood, use the Feelings Thermometer es to take a rating. If the main focus is disruptive behavior, take a parent rating with the Behavior Rating Scale.
Introduce Connection Between Thoughts and Feelings Explain to the child that today's session will focus on how our thinking can change our feelings, and on learning how to examine and change thoughts in order to feel better.

Example Script

Imagine that you get a bad grade on a test. How you think about this situation can affect how you will feel about it. One way of thinking about this might be "Oh no, I've failed. I'm always going to fail. This means I'll never get anywhere in life. I'm probably the biggest idiot in the whole school." Another way to view the situation is, "I'm sorry I made a bad grade, but I know I can study more next time and do better." How would you feel after having these thoughts? What would you do?
"B-L-U-E" Glasses
ACTIVITY		 Ask the child to imagine he or she is wearing dark sunglasses (better yet, provide sunglasses), and to describe how things appear to him or her. Are things clear or blurry? Are colors accurate? Do things appear as they really are?

Having negative thoughts can be like seeing the world through dark glasses. It makes it harder to see the world the way it really is (the colors, etc.), and it affects our mood (makes us feel more down/sad). Discuss what it is like to take off the dark glasses, and talk about the similarity between seeing more clearly and thinking more realistically.
Introduce B-L-U-E Introduce the child to the acronym B-L-U-E, looking at the Changing B-L-U-E Thoughts worksheet, and provide some examples of each type of thought, asking the child for suggestions.
B Blaming myself: Taking too much personal responsibility for negative events
L Looking for the bad news: Paying attention only to the negative information and ignoring the positive information.
U Unhappy guessing: Expecting bad outcomes when we don't really know how things will turn out.
E Exaggerating: Making a things seem worse than they really are
Relate B-L-U-E to the Child's Life Ask the child to give examples of some unrealistic negative thoughts he or she has had, and apply the correct B-L-U-E label to those thoughts. Be sure to come with your own examples of BLUE thoughts, in case the child can't think of any. (If the child does offer negative thoughts, but they don't fit one of the BLUE categories, don't worry about fitting them into BLUE; instead, just say something like, "Yes, that does sound like a pretty unrealistic thought")
Make a Connection between Thoughts and Feelings Explain that when thoughts are overly negative and unrealistic, they can result in bad moods or actions (like giving up or arguing). Discuss with the child the way that different thoughts can lead to different feelings and actions, using one of the examples on page 1 of the Changing B-L-U-E Thoughts worksheet.
Explain That Thoughts Can Be Untrue Ask the child if he or she has ever had thoughts that later turned out to be incorrect. Gather some examples, or offer some of your own. Point out that when we are in a bad mood, we are more likely to have negative thoughts, but just because we think it doesn't mean it's true.
Illustrate "Just Because I think it Doesn't Mean It's True" Go back to the example on page 1, and choose one of the B-L-U-E thoughts you and the child wrote there. How can we know whether that thought is accurate or not? One way is to evaluate the evidence. Are there are any other ways to think about the situation-ways of thinking that are more realistic and might improve feelings?

Example Script

So in this example, how does the kid know that [negative thought] is true? Is there any other way of looking at the situation? What would you tell someone in this situation who had this B-L-U-E thought?

And by the way, what if some negative thoughts actually are true? How bad would that be? For example, maybe I won't ever be as good a skater as my sister. Is that a big deal? Not really!
Introduce and Practice Double Bubbles Use the Changing B-L-U-E Thoughts worksheet to practice evaluating B-L-U-E thoughts and generating more realistic TRUE thoughts (e.g., "If I practice hard I will improve," "The whole team made mistakes today, not just me."). Ask the child why the negative thought may be unrealistic, and to come up with more realistic TRUE thoughts.
Counter Your Own Thoughts Complete one copy of the Double Bubbles on My Own worksheet with examples from the child's own life, discussing with the child the evidence that supports or does not support the B-L-U-E thought, as well as alternative interpretations of events (i.e., TRUE thoughts).
Praise and Repeat Praise the child for his or her efforts in this exercise. If time allows, ask the child to work through another situation in which he or she might have negative B-L-U-E thoughts, and examine the evidence in order to come up with more realistic TRUE thoughts. Provide praise again.
Changing Thoughts at Home
PRACTICE ASSIGNMENT		 The child's practice assignment for the week is to fill in a second Double Bubbles on My Own worksheet, for a B-L-U-E thought he or she has during the upcoming week. Tell the child to write the B-L-U-E thought he or she had in the B-L-U-E bubble, and write a more realistic TRUE thought in the TRUE bubble, and to mark on the Feelings Thermometer ess how each thought made the child feel.

Tell the child that you will review the worksheet together the next time you meet.

Share with Parent
Consider Privacy Before bringing the parent into the room, it is important to ask the child if there is anything that he or she told you today that he or she does not want you to tell the parent. Be sure to honor the child's confidentiality within the appropriate limits of safety.
Review Concepts Have the child explain to the parent what concepts he or she has learned in the session. You can add information as necessary.
Encourage Monitoring and Praise Ask the parent to join the child in "detective work" by being on the lookout for examples of unrealistic negative thinking and successful counter-thinking over the upcoming week. Encourage him or her to praise and support the child in using this new tool!
Give Parent Handout In addition, give the parent the Changing B-L-U-E Thoughts es parent handout. The main goal of this part of the session is to familiarize the parent with the concepts (and provide a good review for the child), so the parent can assist the child in using his or her new coping skills.

Leave 'Em Laughing

End the session on a fun note, with a game, activity, or other exercise that will leave the child feeling really good about the work you have done together today.

Helpful Tips

  • If the child has not already been trained in the use of the Feelings Thermometer es, it will be important to introduce that skill before going through the activities in this session.
  • To make your discussion of thoughts less abstract and more concrete for the child, examples are very helpful. Such examples can involve thought bubbles attached to drawings or cartoons, stories of people thinking very negative thoughts, or illustrations that come to mind from television programs, movies, or books.
  • If the child is reluctant to discuss his or her own negative thoughts, or can't think of any, you can choose to discuss "another kid I know," or give appropriate examples from your own life.
  • Make sure the child understands that these 4 types of cognitive errors are only examples, and that there are other forms of negative, unrealistic thinking beyond those in the B-L-U-E list.
  • A variety of interactive games can be played to increase engagement in this session-indeed, to make it genuinely fun for the child. Some ideas include: asking the child to ring a bell (or say "beep") every time the therapist voices a B-L-U-E thought, and asking the child for a more realistic TRUE thought each time; if you do this, you will want to slip B-L-U-E thoughts into the conversation for the child to catch-e.g., "Oh, forgot to tell you something-I'm a terrible therapist!"). Or you might come up with hypothetical situations and ask the child to come up with as many realistic TRUE thoughts as possible in response to the therapist's negative B-L-U-E thoughts.
  • If the child enters the session in a bad mood, or seems tired, lethargic, or uninterested, this is an opportunity to introduce a "mood booster." Use the Feelings Thermometer es to take a brief mood rating, spend a few minutes engaging in a pleasant activity, then re-rate the mood. Be sure to highlight for the child this important point: what you do changes how you feel.
  • Check in on goals: Does the child feel that he or she is making progress? How does the material you covered today relate to the goals you set together?

How’s Your Style?

  • Did you praise often?
  • Did you review often, by asking questions?
  • Did you simplify the steps as needed?
  • Did your pace match that of the child or family?
  • Did you stay on track?