We Still Love John

October 15, 2009

Discovery & Reporting

Filed under: #3: discovery and reporting — welovejohn @ 1:16 am

During this PBL, we have researched on how to include Cognitive Behavioural Therapy (CBT) in rehabilitating John and helping him to assimilate back into school and family life with a positive attitude.

There is an urgency to nip John’s antagonistic tendencies in the bud because there is a high chance that John may feel a reluctance to attend school if his anti-social behaviour perpetuates. School refusal can contribute to a greater set of problems including a child’s academic, social, and psychological problems; these in turn impact a child’s chances for future educational, financial, and personal success, and significantly affect family functioning especially when he becomes a parent himself. The possible reasons for refusal that we have found out include the avoidance of negative social or evaluative situations at school, and for John it could be to avoid his teacher who constantly picks on him, to ignore the impending exams and also avoid his friends who have been shunning him in return.

To help John to cope especially when family support is almost negligible for him, positive support at school – to provide him with at least one environment where he will feel safe. Our group has decided to address this by teaching him some coping strategies using CBT. This includes training in positive thinking and resilience. We hope that this will help him to focus on solving his problems one at a time, starting with an attitude makeover.

Resilience is an amoral quality that refers to an individual’s capacity to withstand stressors and not manifest psychology dysfunction, such as mental illness or persistent negative mood. These stressors could include traumatic experiences such as abuse, a death in the family of someone dear or in John’s case, it is instability in the home due to divorce. It is interesting to note that resilience is a dynamic quality that gets reinforced through each conscious decision to remain positive. If a person does not “practise” this quality, it can be lost and individuals find themselves increasingly being worn down from the stressors that they face. Resilient people tend to bounce back and recover faster from trials they face as compared to pessimistic people. Through CBT, we hope to help John realize that while he is going through a rough patch, having a positive attitude (or the ability to see opportunities through problems) will tide him over this difficult period in his life.

It is important to incorporate the idea of resilience especially for John since he has to be aware of the detrimental nature of his own negative thoughts (through mislabeling, overgeneralizations and jumping to conclusion) before he can attempt to change them to positive ones. Resilient children are also better able to understand their emotions and control them better than children who are not – a characteristic that John has to learn because it seems that he gets into rather destructive behaviour when he is angry.

Contrary to popular belief that resilience is a quality that is “caught and not taught”, the University of Pennsylvania conducted their pilot resiliency programme in the early ‘90s where children were taught to tell the difference between productive and self-defeating thoughts for 12 weeks. Additionally, they learnt to analyze a problem and elicit different possible solutions, in that way they learnt that what they were going through “may not be that bad after all”. Two years after the programme, the results were astonishing. The children who took part were all at risk for depression because of conflict or instability in their homes. When they were interviewed again two years later, it was found that only 22% of the children in the programme still felt depressed, compared to 44% of kids from similar backgrounds in a control group. If resiliency is a quality that can be taught to children and the benefits observed so quickly, we are indeed inspired by the convincing results to begin CBT on John in order that he may break away from his depression and return to the cheerful and high-achieving child that he was.

A salient feature of positive thinking is Seligman’s positive psychology where the merits of a more positive way of life are scientifically proven to be good for health. It is therefore not something merely idealistic because it can actually help John paint a more realistic picture of his current situation: he has many negative factors in his life that are not within his control, but he also has strengths and values that he can positively tap on to deal with his situation and change his worldview to a more balanced one. Another name for this is Seligman’s balanced psychology, where, to use an analogy, the glass is both half empty and half full. This perspective is crucial for John because he can be taught to realise that he is not entirely helpless, that he has potential and agency which he can learn how to effectively utilise for the advantage of his well-being. In other words, John’s situation will ameliorate with learned optimism. To aid him in that, CBT and its metacognitive strands of being aware of one’s own perception and situational interpretation will be employed to ensure that John will reach his optimal functioning.

We think that CBT will be useful in managing John’s behaviour because it will help him to regulate his own thoughts and process his emotions. This will break him out of his pessimistic, circular thinking that he is bad at his studies and that is the cause of his parent’s breakup. CBT sieves out the erroneous thought process and allows John to recognize his automatic response when something bad happens. The teacher/therapist can then take him through the cognitive distortion and discuss some coping strategies to dispel the negative thoughts before they even begin.

In addition, John has to be aware of what his “pressure points” are, what are the things that set him off so that he will know when and what coping strategy to apply. He should also learn to see things from other people’s perspective, this will make him more sensitive to other people’s feelings when he gets angry and lashes out at them.

October 13, 2009

When Children Refuse School

Filed under: #2: problem analysis, #3: discovery and reporting — Elizabeth Hope @ 4:30 pm

Looking at John, it struck me that he could possibly be at the start of a more serious set of problems of school refusal, if it gets worse.

I found this very good book about the reasons children begin to refuse school, or display disinterest in learning, and possible solutions we can employ to help them in such a situation.

The author covers four reasons for school refusal: to avoid negative social or evaluative situations at school, to receive attention from a parent or a significant other, and to obtain tangible rewards outside of school. Positive support at school for John would therefore be very important, because school refusal can contribute to a child’s academic, social, and psychological problems, impact a child’s chances for future educational, financial, and personal success, and significantly affect family functioning.

Fortunately, the recommended solution is in line with our project — CBT!

“This manual includes tools for assessing a child’s reasons for school refusal behavior and is based on a functional, prescriptive model. It presents well-tested techniques arranged by function to tailor treatment to a child’s particular characteristics. Each treatment package also contains a detailed discussion of special topics pertinent to treating youths with school refusal behavior, such as medication, panic attacks, and being teased. A corresponding workbook is also available for parents, who often play an important part in a child’s recovery. This comprehensive program is an invaluable resource for clinicians treating school refusal behavior.”

It’s recommended for use with children who are completely absent from school, who attend but then leave school during the day, who go to school following intense morning behavioral problems, or who display unusual distress during school days leading to pleas to parents or others for future non-attendance.

The book is: When Children Refuse School: A Cognitive-Behavioral Therapy Approach Therapist Guide (Treatments That Work), by  Christopher A. Kearney and Anne Marie Albano.


Christopher A. Kearney
Christopher A. Kearney (Author)
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(Author), Anne Marie Albano

Revisiting Resilience

Filed under: #3: discovery and reporting — welovejohn @ 1:46 pm

(http://wilderdom.com/psychology/resilience/PsychologicalResilience.html)

Definition of Psychological Resilience: An individual’s capacity to withstand stressors and not manifest psychology dysfunction, such as mental illness or persistent negative mood.

Risk factors: Major acute or chronic stress such as death of someone else, chronic illness, physical or emotional abuse, fear, unemployment, community violence and instability in the family.

Resilience is a dynamic quality, not a permanent capacity.  In other words, resilient individuals demonstrate dynamic self-renewal, whereas less resilient individuals find themselves worn down and negatively impacted by life stressors.

Characteristics of resilient people:

  • Ability to “bounce back” and “recover from almost anything”
  • Have a “where there’s a will, there’s a way” attitude
  • Tendency to see problems as opportunities
  • Ability to “hang tough” which things are difficult
  • Capacity for seeing small windows of opportunity and making the most of them
  • Have deep-rooted faith in a system of meaning
  • Have a healthy social support network
  • Has the ability to competently handle most different kinds of situations and manage strong emotions
  • Has a wide comfort zone
  • Able to recover from experiences of a traumatic nature

Formula for resilience???

growth = challenge + support

“Any level of challenge can be provided if the support is corresponding. But even a small amount of challenge may be too much and lead to traumatic experience if the person isn’t well supported.”

The Penn Resiliency Programme – An inspiration for John

Filed under: #3: discovery and reporting — welovejohn @ 1:41 pm

(http://www.webmd.com/balance/features/teach-resilience)

In a 1990 pilot program, Penn graduate psychology students showed 70 children ages 6 to 12 how to back off from pessimistic or habitually negative assumptions.

For 12 weeks the Penn researchers taught the kids how to tell the difference between productive and self-defeating thinking.

Researchers then instructed the children to look at their own fears and ask, “What’s the worst that can happen?” and “How likely is it that this will pan out?” “The kids had to test their expectations and see if they were realistic,” Shatte says.

In one exercise, students examined the case of Tim C., a ten-year-old who believed that people didn’t like him, that he wasn’t very good in school, and that he would never get decent grades. The students looked for evidence supporting or refuting Tim’s assumptions.

The group also learned how to analyze a difficult situation, then make a list of options and alternatives. Says Shatte, “We taught them the basic skills of problem-solving.”

All the kids were at risk for depression because of conflict or instability in their homes. Two years later, Shatte and his colleagues found only 22% of the kids in the program still felt depressed, compared to 44% of kids from similar backgrounds in a control group.

Some interesting findings from the Penn Resiliency Programme:

  • Girls tend to become resilient by building strong, caring relationships, while boys usually bounce back by learning how to problem-solve.
  • Kids can learn how to be more resilient, regardless of their IQ.
  • Children learn resilience from their parents up to the age of 11; after that, they learn from their peers.
  • Parents and caregivers find it easy to teach resilience when a child is young, vulnerable, and helpless, yet they find it difficult when dealing with rebellious kids.
  • Affluence doesn’t seem to matter. Parents in developing nations teach resilience as often as those in affluent countries.
  • Punishment and blame are counterproductive.

October 12, 2009

So what do you have to do to find happiness? – Times Online

Filed under: #3: discovery and reporting — welovejohn @ 4:45 pm

So what do you have to do to find happiness? – Times Online

Shared via AddThis

October 8, 2009

Resources on Positive and Cognitive psychology

Filed under: #3: discovery and reporting — ingenuity @ 2:33 am

Stuff on Positive Psychology:

http://www.ppc.sas.upenn.edu/publications.htm

Good summary of Cognitive Therapy- to the point

http://www.nacbt.org/whatiscbt.htm

September 26, 2009

Solution for John *updated*

Filed under: #3: discovery and reporting — qi @ 5:26 am

John’s Belief: Thoughts -> Emotions -> Behaviour -> Belief (Vicious Cycle)

(Argh…Diagram failed to load..its in ur emails (=)

Suggested Therapy for John: Cognitive Approach

To help him cope by changing his reaction (behavior) towards external stimuli, through correcting of his faulty cognitive thoughts towards external stimuli.

Consist of 2 parts.

1) Counselling (focused on changing his defective cognitive thought patterns)

2) Derive a Coping plan for John to practice in his daily lives.


Diagnosis of John from the Case:

Identify John’s internal mental processes towards stimuli (his environment) which led him to behave in an extreme manner.

Stimuli Response (Behaviour) Automatic thoughts and beliefs (Internal Process)
His divorced parents are engaged in a heated quarrel in the living room. (sound of quarreling and head banging)

[Act 1- Scene 2]

In his bedroom, John bangs his bead against the wall repeatedly. No one loves me. There is no one I can talk to.
Failing Chinese Spelling since Primary Two

[Act 1: Scene 1]

He gives up even before he tries. I am Stupid. My Brain has been damaged. It is impossible for me to pass Chinese. I am a Failure.

They don’t want to work with me. They say that I always give the wrong answer. They say I am stupid. Who cares, anyway?

[Act 1- Scene 3]

Unmotivated and disengaged from the group work

Drifts in class and appears to be preoccupied with his thoughts. He seems to be daydreaming all the time.

I am very bad at percentage. I am Stupid. No one wants to work with me. No one loves me.

Teacher complained to his Parents.

Caned by his mother’s Boyfriend

Recalls his P1 and P2 days when he topped his class and parents beamed with pride at his achievements

[Act 1 – Scene 4]

When all is asleep, he is in front of the computer screen, gaming his stress away… Escape from Reality by playing the computer. No one loves me. There is no one I can talk to. Nobody can help me. I am Confused.

John is rejected by Meng Chong who doesn’t want to be in his team.

[Act 1 Scene 6]

He is angry and distraught by the rejection. He reacts with Aggression.

John Reacts: Big deal! Go Then! (Shoves Meng Chong hard) and they engage in a short scuffle.

You are such a bully to everyone-my dad says you are just like your dad when he was in school!

At least my dad isn’t a sissy!

Everyone bullies me. Others are mean to me, so I should be mean to them too.

John’s Core Belief:

I am Stupid. My Brain has been damaged. It is impossible for me to pass Chinese. I am bad at percentage. I am a Failure. There is no one I can talk to. Nobody can help me. I am Confused. Everyone bullies me. Others are mean to me, so I should be mean to them too. I am Stupid. No one wants to work with me. No one loves me.


Our Solution: Resilence through Cognitive psychology

Step 1: Teacher talks to John by counselling to change his defective Cognitive Patterns to improve on his resilence

– Positive Automatic Thoughts:

– Positive Emotions: Depression

– Positive response to Situational Factors

– Positive Core Belief

– Positive Behaviour

Step 2: A Plan for John to Follow:

1) Assertive Training – Role Play Pg 342 (Aileen’s Texkbook)

2) Activity Scheduling – Restrict his computer behaviour so as to let him regain control of his life.

September 24, 2009

Submittion to Tutor (15th October Week)

Filed under: #3: discovery and reporting — qi @ 3:39 am

Group Portfolio: Powerpoint Slides + Notes (Presentation Speech)

Individual Reflection: Our Blog Page (Print a copy)

Martin Seligman’s Why Is Psychology Good

Filed under: #3: discovery and reporting — welovejohn @ 1:36 am

Resilience

Filed under: #3: discovery and reporting — welovejohn @ 1:34 am

Valerie Andrews’ Can We Teach Resilience: http://www.webmd.com/balance/features/teach-resilience

James Neill’s What is Psychological Resilience: http://wilderdom.com/psychology/resilience/PsychologicalResilience.html

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