Cognitive Behavioral Therapy (CBT) is an approach with a strong 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 who are at least 8 years old. That recommended age is for good reason too. A lot of the concepts involved in CBT treatment are beyond the cognitive skills of young students. They aren't ready yet to make the connection between their thoughts, feelings, and actions, much less make a plan for how to change any component.

I was still hopeful that there was a way to integrate cognitive behavioral therapy with younger students and went searching for strategies to bring this effective approach down to our kindergarten and first grade students. I figure if there is a way to teach algebra to first graders, there was a way to use CBT.

Make It Concrete

The big issue with cognitive behavioral therapy for younger students is that they are not capable of some of the abstract thinking that is required. Getting a 6 year old to understand that they have thoughts and that those are different than feelings is not the most natural concept. So let's think of ways to make it less abstract and more concrete.

Thoughts

I define thoughts as words we say to ourselves that others can't hear. We talk about all the different thoughts we have all day and that we have lots of thoughts. Next, we discuss how our thoughts influence our feelings and actions.

String Test Activity: Hold a string with a small weight tied to it. Tell the student you can move the string by simply imagining that it will move. Allow the child to do the same. This introduces the concept of thoughts controlling our actions. This is a prerequirement for students to understand that they can “talk back” to their negative thoughts.

Thought Paths: Write down an event that could be perceived negatively or positively. Write down a positive thought you could have and a negative thought you could have. Follow the path from each thought so that a negative thought corresponds to a negative feeling and a negative action, while a positive thought leads to a positive feeling and action.

Feelings

Work on developing a student's emotional vocabulary. You can do this with feelings dictionaries or game.

Use Books: One of the best ways to discuss emotions is through books. While reading books, remark on how a character is feeling 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: When we teach students to observe others to determine how they feel, we talk about how they look. 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 that students understand their thoughts, feelings, and actions, how they connect, and how they can change any component for a better outcome. It is unreasonable to think we can teach even older students this all at the same time. For younger students break down each part and then help them connect each.

Special education teachers often teach new skills using chaining. This approach can be particularly helpful 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 that fluid and independent.

In CBT, think about focusing on a student understanding thoughts, feelings, and actions separately and fluidly. Then looking at how those connect. Then how they can make plans to change their thoughts, feelings, and actions. For example, I might create a checklist of skills that they student will become independent with in order.

• Identify a thought a character has in a story.
• Identify a thought they had in a neutral situation
• Identify a thought they had when upset.
• Identify a negative thought that led to a negative feeling or action.
• Change a negative thought to a positive thought.
• Use positive self-talk to combat negative thinking.

Bring the Concepts to Life

One really effective way to introduce CBT concepts to younger children is to develop characters that represent CBT 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. Last year, I developed The Helper Squad, a series of characters, games, and activities, that embody different skills I use often in CBT.

Other Ideas

• 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. For many of these skills to really take hold, children are going to require regular prompting and reinforcement.

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 key catch phrases to use (e.g., “That sounds like a Mean Brain thought.”) and steps to follow.

If you are working on student changing negative thinking, consider simple steps for parents to follow since they will need to do the heavy lifting as students are learning.

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

Understanding Feelings

Understanding how you are feeling is a key 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 emotions 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.

Managing Emotions

Teaching coping skills is a key part of CBT that often goes unmentioned. While students need to understand their thoughts, feelings, and actions, 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 coping skills, such a 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 so they are accessible, provide engaging practice opportunities, and involve parents and teachers.

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