How does Cognitive Behaviour Therapy (CBT) help highly-anxious pupils?

Julia Sharman

Julia has over 30 years’ experience working in the education sector as a specialist and advisory teacher for SEND and mental health. Previously a Local Authority Coordinator leading on educational projects and community learning in the public, private and voluntary sectors and freelance writer. She is a specialist teacher for children with dyslexia and an Advisory Teacher for children with mental health issues and medical and health needs.

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“There is nothing either good or bad, but thinking makes it so” - William Shakespeare

At some point in our lives most of us, for one reason or another, will suffer from anxiety, which affects our ability to function as we usually would. For some young people, anxiety-based problems can be long term, debilitating and leaving them in need of outside intervention. The National Institute for Clinical Excellence (2012) estimates that as many as one in 33 children and one in eight adolescents are suffering from depression at any one time. Young people often find it helpful to talk through problems with a friend or family member, but sometimes talking to a trained professional may be a more appropriate course of action.

In my work I see many referrals and pupils on our caseload who suffer from high levels of anxiety or depression. High levels of support, in conjunction with other support services, are offered to these pupils to help make the transition and reintegration back to school as smooth as possible. One of the interventions offered is Cognitive Behaviour Therapy (CBT).

CBT was developed by Aaron T. Beck at the University of Pennsylvania in the early 1960s as a structured short-term present-oriented psychotherapy for depression. The focus is to solve current problems and to modify dysfunctional thinking and behaviour. Distorted or dysfunctional thinking influences the mood and behaviour of sufferers, greatly affecting day-to-day living and their ability to cope in educational settings. CBT is described by the NHS as a “talking therapy that can help individuals manage their problems by changing the way they manage them - by changing the way they think and behave. It is most commonly used to treat anxiety and depression although it has been found to be beneficial "Distorted or dysfunctional thinking influences the mood and behaviour of sufferers."for other mental and physical conditions”.

A paper, following research, published by Oxford University in 2014 suggests that anxiety prevention programmes given to year 5 pupils in school significantly reduced anxiety symptoms and highlights that such lessons benefit all children regardless of their initial anxiety level.

CBT is learning how to stop the cycle of negative thinking and help individuals develop their problem-solving skills to better confront and cope with anxiety-provoking situations and events – a psychological approach that helps individuals understand and explain their behaviour. It is a structured intervention that provides a framework for changing ways in which they think and behave by guiding them to understand the relationship between thinking and feeling and how their actions affect them. Like other types of therapy it may not always completely solve problems, but can go a long way to developing coping strategies. CBT deals with current problems rather than issues from the past and is particularly helpful at helping to combat anxiety, depression, eating disorders and drug misuse by improving state of mind on a daily basis. For deep-rooted issues or difficulties other types of treatments may be offered. CBT is not usually suitable for dealing with more complex mental health issues or learning difficulties.

CBT sessions are generally offered once a week or once a fortnight, by specially trained clinicians, and typically last from six weeks to six months. They are usually offered in a clinic setting although for more intensive intervention (time permitting) may be offered at home. Individuals do need to co-operate and commit to the whole number of sessions offered. Intermittent attendance can greatly impair progress and sessions may be withdrawn.

In 2008 Dr CJ Williams suggested a five area approach by focusing on: 1) Life situations / relationships and practical problems (environment), 2) Altered thinking, 3) Altered feelings, 4) Altered physical symptoms and 5) Altered behaviour. The key aims are to think about are: self, world (environment) and future. The effect of changing negative thinking makes an individual feel better and gives them coping strategies. By describing what is going on in their head and how that makes them feel can help them to notice any patterns which it may be helpful to bring about change. Understanding this can help them to make positive changes by thinking and acting differently and therefore take greater control of their lives and improve confidence.

What can schools do to help?

Schools are the place where changes in children are observed. The adults identify and manage mental health matters, and there are the opportunities to reach pupils directly, or indirectly by supportive key adults or indirectly by influencing policy and practice. Although CBT is usually delivered by trained psychologists or therapists, there are courses available for educational personnel, school counsellors or members of the pastoral team so keep an eye out for what’s available. There are long waiting lists for specialist targeted support so the key benefits of having trained members of staff in-house would be early intervention, developing on the spot and timely provision, and offering support to those pupils who do not attend Child and Adolescent Mental Health Service (CAMHS).

Teachers and support staff know their students well. Be mindful of changes in behaviour, particularly if the student becomes atypically disengaged with friends or activities for sustained periods of time or if they present as being unusually angry, frustrated or sad. If these episodes last for more than a few days, make some time to speak to the individual about your concerns. It’s important to consider the nature, intensity, severity and duration of these changes. Talk to other members of staff and find out if they have noticed anything out of character.

Here are some things that you may notice about changes in behaviour:

  • Changes in energy levels – students may appear constantly tired, lethargic or not eating.
  • Problems with concentration, memory or attention.
  • Decreasing and poor school attendance.
  • Decrease in performance in lessons or homework.
  • Unusual or adverse behaviour – aggression, non-compliance or verbally abusive.
  • Neglect of personal appearance, hygiene.
  • Physical symptoms – headaches, stomach aches, tearful, etc.
  • Isolated from peers and friends.

    Other students may also have noticed these changes and be worried too. They may also express their concerns. Listen to what they have to say. They may also need some reassurance.

CBT can be delivered to groups of pupils or to individuals. During training, attendees will be asked to identify an appropriate group or individual to work with. Once training is complete, try to make sure you have a regular and designated area. If the venue / meeting place keeps changing this will add to the already high levels of anxiety. At all times remain non-judgemental, listen, try not to interrupt and use a calm voice. There may be more than one answer to solve a problem. Explain that you might need to ask advice if you are unsure. Also inform them that anything they say is confidential, unless they are in danger or at risk of harm. In this case follow the usual guidelines for safeguarding.

Start questions in a way that explains why you’re are asking, eg: “I’ve noticed that…” or “I can’t help but notice…” Try not to use closed type questions where you are likely to get a yes or no answer.

It can be difficult to tell the difference between mental illness and normal teenage behaviour, but sometimes you need to go with your ‘gut’ feeling that things aren’t quite right. Trust your instincts. If you are worried that the student may be suffering in silence you may, with permission, want to talk to the student’s parents."Once training is complete, try to make sure you have a regular and designated area." Parents may have noticed a change in behaviour at home too.

Being able to offer CBT to students in school means being able to offer swift support. Early intervention is key to success; prolonging the problem may lead to more difficulties. Professor Harry Daniels of Oxford University said of the aforementioned research, “…intervention offers an affordable and practical response to the challenges of promoting emotional health in school. The need to improve the mental health of children is being increasingly recognised as a global priority given the associated health risks, and the economic and social costs, is such anxieties are not dealt with early on.”

Do you employ CBT in your school? Let us know below.

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