Using Cognitive Behavioral Therapy with Younger Students 

Cognitive Behavioral Therapy (CBT) is an approach with a solid research base that is easy to implement in a school setting. The problem for us in elementary schools is that it is meant for students at least eight years old. Many of the concepts involved in CBT treatment can be beyond the cognitive skills of young students. 

I was still hopeful that there was a way to integrate CBT concepts with younger students. I searched for strategies to bring this practical approach to our kindergarten and first-grade students. If there was a way to teach algebra to first graders, there was a way to use CBT.

Make It Concrete

The big issue with CBT for younger students is some of the required abstract thinking. Getting a six-year-old to understand that they have thoughts that are different from their feelings is tough.

Let's think of ways to make it more concrete.

Thoughts

Thoughts as words we say to ourselves that others can't hear. We have lots of different thoughts all day. How and what we think will impact how and what we think and do.

String Test Activity

Hold a string with a small weight tied to it.

Tell the student you can move the string by thinking about it moving.

This introduces the concept of thoughts controlling actions.

Thought Paths

Write down an event that could be perceived negatively or positively. Something like the first day of school or going on a roller coaster.

Write down a possible positive and negative thought people could have.

Follow each thought and show how it changes how you think and feel.

Feelings

Work on developing a student's emotional vocabulary. You can do this with books, games, and simple activities..

Use Books

One of the best ways to discuss feelings is through books. While reading a book, remark on how a character feels and how you know that.

• Do they look a certain way? 
• Did something happen?
• Did they say something that told you how they felt?

Teach students to observe to figure out how someone feels.

Feelings Inspectors

Shows students how to observe others to figure out their feelings.

• What does their body language tell you? 
• What does their face tell you?
• How about their voice?

Break It Down

The end goal of CBT is a students understand their thoughts, feelings, and actions, how they connect, and how they can change any part for a better outcome. For younger and older students, break down each part and then help them chain it together.

Special education teachers often teach new skills using chaining. This approach can be constructive when introducing CBT to younger students. In chaining, you work on each small step until it is independent. Then, you work on connecting the steps and making them fluid and independent.

Bring the Concepts to Life

One effective way to introduce CBT concepts to younger children is to use characters that represent different skills, desired behaviors, or behaviors to change.

For example, when discussing negative/positive thinking, you can use characters such as the Inner Critic or Inner Coach. Mean Brain might be a helpful character for students who are hard on themselves.

I developed The Helper Squad, a series of characters that embody different skills you teach in counseling. 

Other Ways to Personify Skills

• A volcano inside you when you are angry
• A butterfly belly when you are nervous.
• Thunderstorms as increasing anger.

Parent and Teacher Carryover

Recent studies using cognitive behavioral therapy with younger students focus heavily on a strong parent component. Children will require regular prompting and reinforcement for many of these skills to take hold.

Provide parents with information about CBT. More specifically, the skills they can reinforce and how to reinforce them. In my experience, parents respond well to phrases to use (e.g., "That sounds like a Mean Brain thought.") and steps to follow.

If you are working with students to change unhelpful thinking, consider simple steps for parents to follow since they will need to do the heavy lifting as students learn.

1. Spot the negative thought.
2. Challenge the thinking with kid-friendly language.
3. Flip the thought to a positive one.
4. Toss away the negative thinking.
5. Praise effort.

Understanding Feelings

Understanding your feelings is a foundational skill needed to access CBT. I already mentioned developing an emotional vocabulary with students as a first step. It is also essential that students begin to understand the intensity of emotions.

Some emotions are big, and some are small. When someone is angry, they can be annoyed, or they can be furious. Strategies a student should use will depend on how intense the emotions are.

Young students respond well to simplified emotional thermometers or metaphors that show something going from big to small. Consider a hands-on demonstration like a balloon blowing up until it is ready to pop. You can show how a needle won't pop a partially inflated balloon, but an overly full balloon will pop with a light touch.

Teaching Strategies

Teaching strategies is next up. Students need to understand their thoughts, feelings, and actions. And they need to know what to do when they have strong feelings and thoughts.

Before students can make that connection, they can work on developing strategies, such as deep breathing, taking a break, or positive self-talk.

The most important thing when using cognitive behavioral therapy with younger students is to break down the skills, provide engaging practice, and involve parents and teachers.

Do you use CBT with younger students? What are your techniques and tips?