Cognitive Behavioral Therapy (CBT) application used for children is a short-term (usually eight to twelve sessions) structured therapy method that aims to teach specific skills and coping methods to children/adolescents and parents. Cognitive Behavioral Therapy is a therapy approach that focuses on the relationship between thoughts, emotions, behaviors and these three components; how thoughts affect and direct emotions and behaviors. It is an evidence-based therapy protocol that is frequently used and proven effective in conditions such as depression, anxiety disorders, behavioral problems, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. It can be applied individually or in groups, especially for adolescents.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy states that in situations where emotional or behavioral difficulties are experienced, the relationship established between thought, emotion and behavior leads to some false beliefs and forces the individual to be conditioned in this direction. The individual may think that he/she is not loved, valued or unsuccessful because of these beliefs. Someone who thinks in this direction feels more negative emotionally and may withdraw.
Cognitive Behavioral Therapy aims to recognize the negative conditioning and the belief system that develops in relation to this and to show the person how this belief system is reflected in emotions and behaviors. As the most basic principle in the therapy process, dysfunctional and unfavorable thoughts are replaced with alternative/realistic thoughts . It states that the change created at the level of thought will also positively affect emotions and thus the desired behavioral change will be observed. Thanks to the methods used in the therapy process, the individual is taught various ways of coping. In this way, the aim is to change the unfavorable thought and behavior patterns in a positive way.
Trauma-Focused Cognitive Behavioral Therapy in Children
Trauma-Focused Cognitive Behavioral Therapy is one of the most common types of therapy used when working with children who have been exposed to traumatic life events. In addition to intervening in the traumatic experience, it also aims to deal with anxiety, depression, or similar maladaptive symptoms that arise due to the trauma. Interventions are planned to support the parents’ skills in this regard while working with the child’s distressing symptoms. In this way, the child is encouraged not only by the therapy process but also by the parents in the family environment, the parent-child relationship is strengthened, and the child’s coping skills are supported.
Cognitive Behavioral Therapy and Medication Use in Children
Considering the area of difficulty experienced by the child and the severity of this difficulty, medical treatment is also used in addition to the Cognitive Behavioral Therapy protocol. In cases accompanied by anxiety or depressive symptoms or in traumatic life events, drug treatment can be applied in addition to the psychotherapy process. When continued with psychotherapy, it is observed that the psychological well-being and functionality of children/adolescents increases significantly.
Cognitive Behavioral Therapy and Family Practices in Children
Family support is very important in Cognitive Behavioral Therapy applications conducted with children. Changes in family attitudes are very critical in changing maladaptive behaviors observed in children. Educating not only the child but also the parents in the process and developing problem-solving skills become a part of the therapy process. Behavioral methods used especially in applications conducted with young children are explained to families and recommended for use in the home environment.
For example, in cases such as Conduct Disorder, the aim is to reinforce the child’s positive and desired behaviors and thus increase the feeling of acceptance. The child, who is initially rewarded with concrete reinforcements (such as a sticker, a smiley face), also receives the approval of the parent during this time, and abstract reinforcements are in effect throughout the process (such as approval, well done, a smile). After a while, abstract reinforcements are paired with concrete ones and take their place. In this way, the aim is for the child to gain internal control and behavioral control. In this process, it is very important to cooperate with the parent and the school and to work in coordination in the therapy protocol.
Cognitive Behavioral Therapy Applications in Children
There are different methods used in behavioral problems (anger management problems, maladaptive destructive behaviors), emotional difficulties (such as depression, anxiety), phobias, peer bullying, obsessive compulsive disorder or trauma-related situations, taking into account the area of difficulty experienced by the child. Basically, problem-solving methods are taught to the child by establishing a connection between the event and thought, sharing with the child how these thoughts affect emotions and behaviors and how they are affected by each other.
In applications for children with emotional difficulties, the aim is to name the emotions and associate them with the event and the thoughts that are going through the mind at that moment. The child discovers that emotion, the effects of that emotion on the body, and how it is reflected in his/her thoughts and behaviors. The child is taught how to change thoughts in a functional way and how to think differently. Homework (such as thought recording, behavioral homework) aims to reinforce the connections established in the sessions. Breathing and relaxation exercises and coping cards adapted to the child’s age can be used. The child is helped to relax through games (sometimes with the support of play therapy). The child and the therapist work as a team to develop the child’s problem-solving skills. During this period, the child also works in cooperation with the parent and the school process.
Even if the psychotherapy process has ended, the child will have acquired the skills he or she can use to cope with similar situations, thanks to the Cognitive Behavioral Therapy protocol.
