Counselling children: Panic attack (Part 2)
Updated: Nov 22, 2019
A child faces past trauma that raises its head in the classroom
Robert Davies © 2018
“Hello, Charlie, I am happy to see you. I want to apologize about last time. I think I went a little strong. ”
“Mr. Jenkins, I agreed to the deal. My Daddy always says ‘a deal is a deal’.
“Are you ready to do some work today?” “More of the same?” “No, No. We are working more on your thoughts this time with a Mood Log. I will show you.
Mr. Jenkins reached for a large binder and pulled out a sheet of paper.
“This is a mood log, Charlene. We use it to write down your feelings and thoughts.”
Mr. Jenkins placed it in front of Charlie with it attached to a clipboard.
“So write down the problem. What is it again.”
“About getting nervous and thinking I am going to throw up. I mean ‘vomit’.”
Charlie smiled at the use of the word 'vomit'.
Mr. Jenkins smiled back. Charlene knew she had done great work last time.
“Well, would Being Nervous in Class work?”
“Charlene, I will help you write it down. I will do mine, and you can copy it from me okay. That is if you want to. I know some grade ones can be pretty good at writing.”
Charlene copied Mr. Jenkins’ sheet. She wrote: Being Nervous in Class.
Being Nervous in School
Then Mr. Jenkins helped her remember the specific event with all the details: students present, date, time of day.
"Now lets circle the names of feelings. You can circle ‘nervous’ for sure. Let me read them and you circle them.”
Charlene circled, ‘unhappy, panicky, inferior, lonely, foolish, self-conscious, hopeless, defeated, irritated, overwhelmed and ashamed’.
“Now, how strong between 0% and 100% were they? Look at that line and circle how strong it might be.”
Charlie circled the relative strengths of the emotions with most being close to 100%.
Writing Out Charlene’s Thoughts
Then Mr. Jenkins asked her about her thoughts when she was feeling that way. It was a kind of backwards approach. It was Charlene’s thoughts that were causing her feelings.
“Charlene, when you are feeling ‘foolish’ what are you thinking to yourself or telling yourself?”
“I am thinking, ‘If I get sick, everyone will laugh at me.”
“Good. That’s a good thought. Write it down.”
Mr. Jenkins wrote it on his Mood Log and then he showed Charlie so she could copy it.
“How about ‘ashamed’. Why would you feel ashamed? What might you tell yourself?”
“I will look terrible with getting sick and having the stuff on my clothes or on the floor or maybe on my desk or even on somebody.”
“Okay, are you telling yourself that you will look stupid or everyone will look down on you?”
“Everyone will look down on me.”
“Okay, I will write that down.”
Mr. Jenkins did, and Charlene copied it under ‘thought number two’.
Mr. Jenkins continued going through the feelings and writing down NOT feelings but Charlie’s thoughts.
Another one was:
“My friends will laugh at me.” And
“Nobody will want to be my friend anymore.”
All together Mr. Jenkins and Charlie had four good thoughts.
1. If I get sick, everyone will laugh at me.
2. Everyone will look down on me.
3. My friends will laugh at me.
4. Nobody will want to be my friend.
Checking the Thoughts for Cognitive Distortions or Mind Traps
Mr. Jenkins then explained that when something upsetting happens such as a panic attack, most people have negative thoughts, at least, to start. It is those negative thoughts that give us those negative emotions. Usually those negative thoughts seem to be maybe a 100% true; however, on closer examination, we find that those thoughts often have twists in them or distortions that we call ‘mind traps’ or ‘cognitive distortions’. There are at least 10 common cognitive distortions.
“Which thought did we want to check first, Charlie?”
“My friends will laugh at me,” said Charlie.
“Let me ask you, how your would react if your friend got sick and made a mess all over the floor and desk and on somebody, too?”
“I would want to help my friend. I would run to the toilet and get paper towel and help her clean up.”
“What would you be thinking if your friend made a mess?”
“I’d want to make sure they were all right, and if there was anything that I could do to help.”
“Well, Charlie. If you would act like that and think like that how would you feel? I’d feel worried about my friend.”
“Well, why wouldn’t you laugh?”
“I wouldn’t want to laugh. There wouldn’t be anything to laugh at. It wouldn’t be funny. I would be worried.”
“So, let me ask you, ‘Why would you worry about your friends laughing at you when you certainly wouldn’t laugh at them.”
“Oh, I see. I understand. I guess my friends wouldn’t. They would want to help.”
“Well, who would laugh?”
“I don’t know. Some of the boys?”
“When people laugh, Charlie, they don’t always laugh at funny stuff; they laugh when they are nervous or embarrassed. Do you think that some of your classmates might be nervous or embarrassed and then laugh?”
“I don’t know.”
“Well, if they did. What would you think?”
“Well, they wouldn’t be true friends, and I wouldn’t want them to be my friends if they acted like that.”
“Are you telling me that you would act differently from your friends?”
“I guess no one would really laugh. Maybe somebody nervous but probably not.”
Let’s check the mind traps, Charlene. If there are mind traps in your thoughts, then that means that the thought can’t be as true as you thought.
Negative Thought: My friends will laugh at me
“Is this an example of All or Nothing Thinking - Mind Trap #1. Does ‘my friends will laugh at me’ mean all your friends? Why not just one friend or two? Could they smile or could they turn their faces away? Is this an example of all your friends doing something negative? Then that would be a mind trap? Think about it Charlie.”
Is the thought ‘my friends will laugh at me’ an example of the mind trap, Jumping to Conclusions – Mind Trap #5. You conclude something without any facts. Is it fortune-telling, where you predict what will happen. Can you tell the future? NO! So how do you know your friends will laugh at you? Would this be an example of the mind trap, Jumping to Conclusions, using Fortune Telling. Think about it.
Is the thought ‘my friends will laugh at me’ an example of the mind trap or cognitive distortion, Negative Filter – Mind Trap #3, where you only think of your friends in a negative way and you don’t think of them in both a negative and a positive way. That wouldn’t be balanced and realistic. If you only think of your friends negatively, that is a mind trap, it isn’t realistic, and it isn’t positive. Friends have both qualities but mostly positive, I would think or they wouldn’t be your friends. Charlie, are you using a mind trap here?
In the thought, ‘my friends will laugh at me’, are you ignoring the positive because that would be the mind trap or cognitive distortion, Discounting Reality- Mind Trap #4. If these are your friends, it doesn’t make sense to only think of their behaviour in a negative way. After all, these are your friends! What about the fact that friends care for one another and help one another if possible? Are you using a mind trap here, Charlie?”
“In the thought, ‘ my friends will laugh at me’, are you ‘labeling’ them in your mind, maybe ‘untrustworthy’, maybe ‘poor friends’. Labeling – Mind Trap # 9. Maybe yes, maybe no – only you know, Charlie, if this mind trap is there. People can’t be ‘labeled’ as ‘untrustworthy’ because you know that your friends have lots of good qualities. You can define your friends by painting them as “untrustworthy’. They can be silly, wise, happy, sad, grumpy, fun-to-be-with, great company and lots of mixed pro’s and con’s. You can look at all the other mind traps to see if there are others, but certainly you have some. What ones do you think, Charlie?”
Charlie agrees that the negative thought My Friends Will Laugh at Me has the cognitive distortions or mind traps #1, # 3, #4, #5. & #9.
“So Charlie what thought would be more true than My Friends Will Laugh at Me because that thought has at least 5 mind traps or distortions or twists. It can’t be 100% true as you had thought. What would be more true?
“Well, I think that my friends will not laugh at me’.
“Okay, Charlie, I can’t use ‘will’ because that would be fortune telling. Try to use something more positive and realistic. What can you count on your real friends doing?
“ Good friends stand by their friends and help them.”
“Good, Charlie, why don’t you write that down, or I will and you copy. Is it 100% true?
Yes. How about ‘my friends will laugh at me’? You had 100% true before.”
“It is not true at all’.
Charlie went back to class after she had examined all her negative thoughts for mind traps. All together Mr. Jenkins and Charlie had four good thoughts.
If I get sick, everyone will laugh at me BECAME Friends care about each other.
Everyone will look down on me BECAME True friends accept their friends
My friends will laugh at me BECAME Good friends stand by their friends and help them.
Nobody will want to be my friend BECAME Good friends stick together.
Charlie did another assessment of her feelings and the negative feelings all dropped to 0%. When one can defeat the negative thoughts with realistic and positive thoughts then it makes the original My Friends Will Laugh at Me a lie.
She returned to class and at least once a year from grade 1 to grade 6, Charlie would catch Mr. Jenkins' attention and say, “Mr. Jenkins, I’m still okay.” When she went on to middle school, she gave Mr. Jenkins a note which read, “Thank you for helping me get over my fear. I will never forget you. I will miss you. You are my hero!”
Bob-the-counsellor remembers all the students he has had the opportunity to help. He can’t help everyone, but he can help many. He treasures his job, and he will always treasure Charlie's note.
Most people like stories, and therapy is all about stories. Telling stories about powerful techniques used in TEAM CBT therapy demystify this therapy one story at a time.
Yet, confidentiality is a cornerstone of all counselling. Without confidentiality, clients wouldn’t feel safe going to therapy to divulge the most painful areas of their lives. To safeguard clients while illustrating TEAM CBT techniques, confidentiality is kept by either having the client’s consent or by distorting the facts, making the client unrecognizable .