Cognitive Behavioral Therapy and Self-Injury by Lauren Appel

People who self-injure tend to experience a significant amount of negative thinking. The concept behind Cognitive Behavioral Techniques is that if the negative thinking can be changed into something more productive, then the urge to self-injure will be minimized. Self-Injury comes from emotional pain and as most CBT practitioners believe, our emotions are tied closely to our thoughts. 

There are two key components for overcoming negative thinking. The first is “awareness” or recognizing that you are having a negative thought or a “thinking trap.” The second is “changing the thought” into something more useful.  Cognitive Behavioral techniques can help transform thoughts, which can, in turn, create a better mindset and reduce self-injury urges. Below are examples of typical thinking traps, which can facilitate awareness, along with additional strategies for dealing with negative thoughts.

Cognitive Distortions or “Thinking Traps” (Based on Trails’ Thinking Traps: Unhelpful Thinking Styles)

All or Nothing Thinking– Thinking in extremes without a middle ground. For example, “I’ve got to be the fastest on the track team, otherwise I’m no good.”

Jumping to Conclusions– Developing an opinion on something with little to no evidence.  This can look like “mind reading” (assuming you know what the other person is thinking) or “fortune telling” (predicting the future.) For example, “Everyone is going to laugh at me when I present my project.”

Emotional Reasoning– Using your feelings as the basis for facts. For example, “I feel miserable; therefore, I’m worthless.”

Overgeneralization– Creating a pattern based on a single event or episode. For example, “I stumbled over my words, so I must be awkward.”

Ignoring the Good– Focusing on the negative parts and leaving out the good things. For example, “I can’t do anything right.” Ignoring the good maybe omitting that they did make the football team, therefore something went right.

Creating awareness of these thinking traps makes a good start in halting negative thinking once the student realizes that the thoughts in their head are not true.

Strategies for Overcoming Thinking Traps

Be your own friend– This strategy is great for transforming negative thoughts into positive or encouraging thoughts. The concept is also simple enough for even elementary school children to understand.  Basically, you frame the scenario by asking what the student would say if their friend said a negative statement (i.e. I have no friends; I’m worthless, etc.) Most students who self-injure are much kinder to their friends than to themselves and teaching them in the context of becoming their own friend can help alter their way of thinking. The juxtaposition between how they talk to their friends versus how they talk to themselves can also help them become aware of the intensity of their own negative thinking.

Prove the thought wrong– Often our negative thoughts involve a scathing statement about ourselves, usually about something we have concluded based on a single event or an assumption of how we think other people view us. The key is to challenge the thought by coming up with evidence that proves the statement wrong.  For instance,  if I were to say, “I’m a terrible student,”  then I should challenge myself to come up with times where I was a good student.  Examples may include getting an A on a project or taking notes every class. The idea is that if you can come up with at least one example, then it contradicts the extreme of “I’m a terrible student.” This creates a new thought, “Well, I’m actually a pretty good student, I just made a bad grade,” to replace the old one. Help can also be given by providing these examples with the student to get them on the right track.

Write a positive reminder list– This strategy piggybacks off of the “prove the thought wrong” strategy. During emotional moments where things seem the bleakest, it feels impossible to think of anything good about yourself. It’s beneficial, when the student is feeling stable and reasonably well, to have them come up with reminder lists about their positive traits, what their talents are, etc. This can be tailored to the negative thoughts they have the most. For instance, if the thought is “I have no friends,” then have them come up with a list of friends. These friends can even participate by asking them to write down what the student means to them. These affirmations can be kept on a phone where it can be easily accessed and when the student feels down, they can read all the positive evidence that proves the thought wrong.

Not JUST

How often have you heard someone say something like the following:

“I am just a bus driver.”

“Joey is just going to community college first.”

“Sarah is just going to a state school, nothing prestigious.”

“She’s not planning to get a degree, she’s just going to be a florist.”

This has been a pet peeve of mine for a very long time. Once I dove into the research around self-injury and suicide and after I had the opportunity to watch “Race to Nowhere“, I became increasingly convinced of the need to change the narrative and shift the elitist mindset around conversations about education and careers society-wide and especially in education.

On a personal note:

  1. One of my eleven children self-injured (and was sometimes suicidal) specifically around her felt need to achieve at a high level. This, despite reassurance from myself and the rest of her adoptive family that it was not at all necessary.
  2. Only two of my eleven children began their college education at other than a community college.
  3. One of my eleven children is so impacted by mental illness, historical trauma, and related drug abuse, that she is unable to function without the support of inpatient staff.
  4. Another of my children is impacted with ADHD to the point that, at the age of 26, he has not yet been able to finish his college degree despite numerous attempts.

In addition to these personal examples, much of my work is with individuals with significant disabilities whose access to a variety of job and career choices will be impacted by their disabilities. ADA requires that employers consider hiring individuals with disabilities to the point that reasonable accommodations can be made for the individual and they must be able to complete the core functions of the job. This may mean that many of the students I work with will be precluded from certain types of work.

I am sure you know personal examples or examples of other individuals you have met throughout your life and career that are similar to these scenarios. Today, I do not plan to write at great length on this topic. What I do want to do is provide one action point and pose some questions that I believe should help guide our thinking on this topic going forward.

Here is the action point:

Can you commit to removing the elitist “just from your vocabulary? I am asking that you begin to catch yourself before you say it. For example, “I am so excited! Our daughter is starting at our local community college in the Fall.” Here is another one, “Our son is attending hospitality training through Regional Center after he finishes the district’s Transition Program. It is such a great opportunity.” Or…”Yes, our daughter works for the city in the sanitation department. She drives the large trucks that pick up your trash every week. We are so proud of her!” You’ll notice…. no just.

Here are some questions I would ask you to reflect on:

  1. What percentage of a person’s value should be determined by their education and/or career?
  2. Do all people have intrinsic value, regardless of their education and/or career?
  3. If you had to rank the percentage of importance of character vs. education/career…. what would the percentages be? 50% character/50% education and career? 70/30? 30/70?
  4. In what way can you, personally, help to change the elitist narrative that devalues individuals and inappropriately overvalues specific types of education and careers?

Until next time-

Laura Mueller, Psy.D., LEP

Mindfulness Strategies

By Lauren Appel

“Mindfulness” has become a hot topic word and research has increased its fame.  Some benefits fall under the categories of emotional regulation, interpersonal (interactions with other people), and intrapersonal (interactions with yourself) (Davis & Hayes, 2011.)  All of these can reduce or eliminate emotional pain which can help overall functioning and remove these barriers to learning.

But what is mindfulness? The Oxford Dictionary defines it as “A mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.” Every definition that crops up highlights the same element which is focusing on the present. While traditional meditation brings us to the present, there are other more engaging ways to help our students reach this point. Below are some suggestions in guiding students to the present.

Breathing

Focusing on the breath is one of the most basic forms of mindfulness. Typically, you breathe in through your nose for 4 counts, hold for 4 counts, and breathe out through your mouth for 4 counts. The point is to slow down your breathing as much as possible. All of these strategies will take practice and may need prompts to engage in deep breathing.  Some key strategies to breathing are as follows:

Breathe in through your nose, out through your mouth- I often use the image that illustrates smelling the flower and blowing out the candle. This is especially helpful to younger students

Breathe from your belly– deep breathing can also be called belly breathing to emphasize the fact that your belly should rise and fall, not your chest. Breathing from your chest can create feelings of tension and panic. Sometimes it helps to put a hand on your stomach to feel it rise and fall. Younger children may like placing a stuffed animal on their stomachs to practice. This provides a great visual for understanding the belly breathing aspect

Five finger breathing– this serves as a visual reminder to breathe when other visual resources may not be available. You start by using your left finger to trace the line that goes up your right thumb. When you are slowly moving up a finger, you breathe in for 4 counts and when you slowly move down your finger to a “valley” between 2 fingers, you breathe out. The idea is to go through your fingers and return to the starting point for a total of 10 breaths. This can also be done subtly for self-conscious adolescents. No one has to know you are doing deep breathing exercises.

Timelines– This is just like 5 finger breathing except with a timeline labelled through 10. The student places his finger on the number one and breathes in and out for 4 counts then moves his finger to the number 2 and so on.

Being aware of your surroundings

This strategy is especially helpful for those suffering from trauma because it helps bring them back from the flashback to the present moment.

5-4-3-2-1– This is short for 5 things you see, 4 things you hear, 3 things you can touch, 2 things you can smell, and 1 thing you can taste. For younger children, it may be enough just to name the items. For older or more advanced students, ask them to describe each item without giving away the name of the particular thing they are experiencing. The more details they can put into it, the more engaged and present they become.

Progressive Muscle Relaxation

This involves purposefully tightening certain muscle groups, holding it for several seconds, then relaxing them, or as I call it “becoming a limp noodle.”  Different muscle groups include face, neck, shoulders and chest, arm and hand, stomach, hips, thigh, calf, feet. 

Meditation

Most meditations help bring the focus to your breath or other sensations in your body.  There are guided meditations that narrate through the process and others that may have a gong or natural sounds and are more up to the meditator to make the most of it. The later should be used for advanced groups only. The length of the meditation should be based on both the age and experience of the student. Sometimes a couple minutes is more than enough. Both of these types of meditations can be found on YouTube as well as other apps like Insight Timer.

 Reference

Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, 48(2), 198–208. https://doi.org/10.1037/a0022062

And….. we’re back!

Welcome back to the Educators and Self-Injury Blog! I hope this update finds you and yours safely making your way through this wildly challenging year. It is more important than ever to focus in on mental health and meaningful and effective social-emotional learning (SEL) and effective coping strategies for ourselves and our students. In this “welcome back” blog, I wanted to share a brief training I provided for families in my school district and introduce you to a new collaborator for this website.

Social Emotional Learning for Parents and Families

Lauren Appel, School Counselor and Behavior Specialist

When preparing for a recent presentation (on Zoom of course!) for the San Diego Office of Education, I came across a wonderful article about responding to Non-Suicidal Self Injury in schools by a school counselor from North Carolina. I was so impressed that I reached out to her and she has agreed to become a collaborator on future blog posts! I am so grateful to have met her. Here’s a short bio:

Lauren Appel attended The College of William and Mary where she received her bachelor’s in psychology and the University of Virginia where she received her master’s degree in Counselor Education. She worked three years as a school counselor in an elementary school in Martinsville, Virginia. Lauren currently works as a Behavior Specialist in a school district in Yanceyville. North Carolina.   

I am so excited to begin our collaboration together! Look for an upcoming post authored by Lauren next week.

Until then, take care and stay well!- Dr. Laura Mueller

An Occupational Therapist’s Perspective on the Silent (or not-so-silent from where I sit) Tragedy Affecting Today’s Children

When I saw this short article posted on Facebook, I was super excited that this important message was again getting out to so many people. Occupational Therapist Victoria Prooday hits the nail on the head in her blog post “The Silent Tragedy Affecting Today’s Children.”  In this article, Ms. Prooday states:

It is scientifically proven that the brain has the capacity to rewire itself through the environment. Unfortunately, with the environment and parenting styles that we are providing to our children, we are rewiring their brains in a wrong direction and contributing to their challenges in everyday life.

She goes on to give very specific examples of what is going wrong and how we can parent differently. You will find it is very much in keeping with my past posts while also providing some very practical ways that we can re-tool what we are doing as parents. Please read this article and share with your friends as well!

The Overachievement Culture- A perspective from the UK

I have been passionate about speaking and writing on the overachievement culture here in the U.S. for almost 10 years. I find it abhorrent that our educational system does not recognize the undo pressures placed on children from the moment they enter the public school system. Pair this with parents who may unconsciously or consciously live vicariously through their children and/or find all their esteem from their high-achieving children and you have a recipe for children with high anxiety and stress and at a high risk for depression, self-injury, and even suicide. Children need free time, time spent reading alone or with their parents for pleasure, time spent walking or playing out of doors, time away from all pressures and all electronics. They can and should be encouraged to do their best. The do not need to be harangued with unobtainable (for many) standards and expectations every moment of every day of their lives.

I will admit that I had not thought about this same problem occurring across the Atlantic. Click this link to read a timely blog post by a teacher from the UK. Please take the time to read this and share it with others. Awareness must occur before change- please join me in spreading that awareness!

Mindfulness

Mindfulness is an idea that is becoming more and more known in educational circles. There is a growing body of research that demonstrates that its use can lead to improvement in problem behavior, including self-injury and feelings of depression. When we focus solely on academic success alone, we can often lose what is even more important- mental health and happiness. In a 2013 article by By Patricia C. Broderick, PhD, she states,

“There is little doubt that in addition to academic success, we also want our youth to be happy and well.”

While many educators have lost site of the importance of happiness and wellness, others have discovered the amazing benefits of mindfulness for our school youth. The amazing thing is that as youth feel better, they do better academically as well! When I am working with a school site to support a student with severe problem behavior, it is often recommended that academic demands be reduced. This is no “let them get out of it” approach- it has everything to do with creating academic success from a place of less stress.

Please consider the following resources in your quest to support your students and children:

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The Importance of *FACE* time

About fifteen years ago, when my then-husband and I made the decision to adopt a sibling group of five young girls (ages 4-11 years) in addition to our four biological children  (ages 18 months- 11 years), I made the commitment to spend one on one time with each of my children. I did not want them to feel like they were only a group and I did not want them to feel that our whole relationship consisted of me telling them what to do and what not to do. Thus began “30 minutes.” That was the amount of one-on-one time I promised each of my kids on their “day.” These two things became an institution over the ensuing years (my kids are now ages 16-26). On your “day” you got to pick your seat in our 15-seater van, sit where you wanted to at the dinner table, have first choice when anything came up, and spend “30 minutes” of one on one time with Mom. Some of the many things we did for “30 minutes” included: lay outside and look at the stars, take a walk, create a movie (back in the days when we had to use a big bulky VHS movie camera), go out to eat, and make a special food to eat together. Rarely was the time only 30 minutes. The time that I spent with each of my kids was a wonderful gift for me and I treasure each and every memory.

One of the things I emphasize when talking to parents is this need to spend one on one time with their children. Even though most parents aren’t dealing with a group of nine kids, one on one time – talking and interacting face to face- is still incredibly important . At a recent presentation a dad asked, “If you don’t count watching TV or playing video games, what do you suggest we do together?” This dad reflected an all-too prevalent phenomenon in our society. As Dr. Bruce Perry puts it, we have developed technology at a pace that has outstripped our ability to adapt and cope with it in a way that best meets the true needs of humans. The human race was designed (or has evolved, if you prefer) to interact, face to face with other humans. From the advent of television, to the invention of VCRs and early video games to today’s ever-present social media we have been in previously uncharted territory that has resulted in less and less time spent face to face. Humans do not thrive in the absence of rich social relationships.

Research indicates that when a high number of rich social interactions and social-emotional support are present in a child’s life, trauma and other adverse events have a far lesser impact on the child’s overall development and life outcomes. Other research has pointed to the value and efficacy of strong relationships for adolescents in intervention for self injury. One of many research articles on the topic of the importance of social relationships and its impact on every aspect of health is available here. Further, I would encourage you to take an hour of your time to watch this presentation by Dr. Perry.

With this in mind, I want to use this article to encourage you to 1) Spend more face time with your children and loved ones (maybe it could be your New Year’s resolution);  2) Make hard decisions about limiting your own screen time and that of your children; and… 3) If you are in a position where you can share this need with others, please spread this information- it is vitally important to our future as a society. More and more children are growing up on a starvation diet in terms of relationships and therefore social-emotional development – and this has very scary implications in terms of developing empathy and other very important pro-social skills.

Meanwhile…here are some ideas of things to do with your friends, loved ones, and/or children to interact and really get to know each other better. Although the list was created by Megan Gladwell with younger kids in mind, there is not one thing on here you couldn’t enjoy with your adolescent, spouse, or adult friend!

1. Write a silly story

Sit down together with some paper and pencil. Ask your child to choose a specific location , a main character, a situation or conflict, and let the story unfold. Draw and color two or three pictures to illustrate your tale.

2. Have a story and craft hour

Invite a small group of your kid’s friends or neighbors to your home and read a story to the kids. Then create a craft that coordinates with the story’s theme. Have your child help plan and teach the craft and serve treats that go with the theme, too.

3. Break out a board game

Go back to the basics. Play checkers, Uno or Monopoly.

4. Build a Fort in your house or in your backyard!

Use cardboard boxes, blankets, bricks, or whatever materials you have to construct a cool fort.

5. Fill a donation box

Encourage your child to gather his gently-used, outgrown clothes and toys and deliver them to a needy friend or shelter.

6. Zoom around

Grab your helmets and ride bikes, scooters or skateboards together at a park.

7. Walk a dog

If you don’t have one, this idea is even more of a novelty. Offer to walk a neighbor’s dog for an hour.

8. Make homemade ice cream or popsicles OR bake a cake.

Invest in an ice cream maker and create yummy concoctions. Or, buy the cheap, plastic Popsicle molds and fill them with juice or soda and fruit pieces. Buy a box cake and look up a fun frosting recipe. Decorate your cake with cool colors!

9. Visit a pet store

For non-pet families, it’s always a treat to see the reptiles, birds, hamsters, kittens and puppies at your local pet store. Stress that you’re just window shopping.

10. Read a book together– choose an old favorite of yours or one your child is interested in.

Find a nice, long book that will stretch through a month or so, and read a chapter to your kids each day. Charlotte’s Web, Matilda and The Secret of Nimh are fun reads. Great book series include: The Chronicles of Narnia, Wrinkle in Time, and of course… Harry Potter!

This list is taken from a longer list created by Megan Gladwell.

I hope this has encouraged you to spend more face to face time with your loved ones and to spread the word to others as well! Now… I better get off this screen!