CBT Interventions for Kids That Don’t Require Metacognition

When I hear or read “cognitive behavioral theory” or CBT, my brain immediately goes to cognitive distortions and thought changing. And that is absolutely a huge part of it, and maybe my favorite part. But…that’s only a piece of cognitive behavioral counseling! When we look at the theoretical model as a whole, there’s a lot more to it. The good news is that a lot of those other bits are things you are probably already doing with your students or the children you work with! Here are some other ideas for CBT interventions for kids:

Feelings

Did you know that research backs the labeling of emotions as an effective emotional regulation strategy? It turns out that labeling our feelings can help activate the prefrontal cortex while settling down our amygdala, getting our thinking brain back so we can process and move forward.⁣
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I think we’ve all believed in the power of identifying and naming our emotions in order to take care of them, and multiple journal articles I read about emotional regulation in children said that labeling feelings is important. It was only recently though that I read about actual studies that examined this (study 1, study 2, study 3).

And finally, CBT work with kids should include helping them to identify their triggers. Yes, knowledge is power, but it’s more than just that. When kiddos can identify their triggers, they can be more proactive with coping and you can be more targeted with your treatment. For example, if a student can say “I get angry when someone laughs at me,” then you can work together on creating helpful self-talk/affirmations to use in those situations. And, you can dive a little deeper to see if there are any beliefs underlying these triggers, like “I’m dumb.”

Relaxation Skills and Coping Skills

Inherent in almost all counseling we do with children is teach, model, and practice different ways to take care of our feelings. This explicit work around relaxation skills and coping skills is also a core component of cognitive behavioral theory. Two activities that are part of my CBT Group Curriculum around this area:

Relaxation BINGO: Repetition is important, especially since when we’re dysregulated, it’s harder to access and use coping skills we don’t have really cemented in our minds. A game like this allows for repeated practice when brains are calm! There are several different relaxation skills you could include, but these are what I use:

• BBB – Find something big, find something blue, and find something beautiful.
• Grounding – Right here in this moment, what do you hear, smell, touch, and see? (taste is left out because kiddos rarely can sense a taste in their mouth when they’re in my office unless it’s a lunch group!)
• Chair Push Ups – Pressing your hands against your chair (or the floor) when seated to nearly lift up your body, then relaxing your arms, can bring a sense of calm. I like to include this one in the mix because it’s the most physical strategy and some students are more invested in this than the others more traditionally calming.
• Star Breathing – Tracing your fingers as you inhale and exhale. True story: I use this one personally, including while panicking slightly at Disney World before getting on scary rides!

Finger Touch Affirmations: You tap each of your fingers to your thumb, take a deep breath, and then do the same thing in reverse. Once kids have mastered the coordination of this, you add in an affirmation. With each finger tap there’s a word (or sometimes two words strung together).

This is extra cool because it incorporates a few different components that help calm the brain. There’s deep breathing, there’s self-talk, there’s a mental re-focus, and there’s physical sensory.

Actions and Consequences

The behavior part of CBT is one we sometimes forget about but is still pretty important. One way to incorporate this into CBT work with kids is through examining with them how helpful (or unhelpful!) their behaviors are. Some question prompts you can use are:

• What happened next after you ___? Was that a good or bad thing?
• Do you think that helped you? Or did it hurt you?
• When you did that, how did you feel after? Did you feel better or worse?

Behavior Shaping/Reinforcement

Helping to improve a student’s behavior (decreasing harmful behaviors, increasing prosocial behaviors) is another CBT intervention with kids. Often times, this means creating a positive reinforcement system to reinforce behaviors you’ve taught, modeled, and practiced with them. Other times, it might be determining if a student has an unmet need impacting their behavior. This post is all about the lenses I use when conceptualizing student (mis)behavior.

For an easy grab-and-go tool in creating behavior interventions, I recommend this guide (linked below, just click the picture!).

Problem Solving

A core CBT intervention that doesn’t involve thoughts, feelings, or coping is problem solving. This can look like a lot of different things! It might mean reading a book that models a specific skill and then practicing it together. Julia Cook Books are great for skills-based stories Or it could involve role-playing different scenarios.

Here are some skills that might be part of your problem solving work with kids:

• I-Messages
• Identifying locus of control
• Asking for help
• Brainstorming solutions
• Conflict resolution

Depending on the student(s) you’re working with, you might focus on one or more specific skills. Or, you might do sessions focused on being a problem solver more generally. Either way, children are given a chance to practice taking helpful action steps while also developing more self-competence. The picture below shows a problem solving game I use with my resiliency groups.