Dr. Jeffrey Bernstein presented the final webinar of the FCP Fall 2021 Professional Education Workshop Series on December 1st entitled “Practical Counseling Strategies and Interventions for Children and Teens Struggling with Pandemic-Related Stressors.”

Topics addressed included generalized anxiety, avoidance-related problems, sadness and depression, schoolwork resistance, and shutdowns. This webinar also addressed effective strategies for anger management in children and teens. As in the past, Dr. Bernstein quickly engaged the attendees with his warm and congenial style. He told stories about his experience with clients, and his own life to illustrate his points. He used concrete examples and his sense of humor to maintain focus on each topic throughout the workshop.

Objectives for this workshop expected that participants would be able to

1. State the neuropsychological considerations for children and teens who have trouble regulating emotions and the related possible longer-term impacts of the pandemic.
2. Describe the advantages of combining mindfulness, Cognitive Behavioral Therapy, and positive psychology interventions for struggling children and teens.
3. List seven common distorted thoughts for teens and how they trigger anxiety, depression, and anger in a post pandemic era.
4. Discuss the advantages and disadvantages of online therapeutic approaches when working with children and teens (pre and post pandemic).

Dr. Bernstein met his objectives during his presentation. He also referenced his objectives throughout his talk, making it easier for the audience to attend to his remarks, rather than search for the objectives as he spoke.

The workshop began with reminders of the impact of the pandemic on the lives of children, youth, and families. Dr. Bernstein gave examples of increased anxiety in all areas of life, including home, work, and school during the past 20 months and continuing. He specifically discussed the impact of reduced structure with decreased academic expectations due to virtual learning, concern about job loss and working from home, fractured social contacts, and being cooped up at home. Dr. Bernstein said that all these impact emotional health, contributing to increased anxiety and depression, including suicidal ideation.

Dr. Bernstein provided a brief and simplistic description of what happens in the brain when overwhelmed by anxiety. He focused on three parts of the brain. The hindbrain at the top of the spinal cord which controls basic functions and is the most primitive part of the brain. The limbic system, including the amygdala, which stores strong feelings, and the prefrontal cortex which allows thinking and reasoning to regulate fear and anger. The hindbrain and the limbic system may react to overwhelming anxiety with an out-of-control, “Fight,” “Flight,” or “Freeze” response. Dr. Bernstein said that pressures from school, peers, or family stress and your worries may get the best of you. You may end up doing things you regret later unless the thinking prefrontal cortex kicks in to determine the extent of danger and regulate the emotions.

Two of the most important skills required for treatment to be effective with anxiety, according to Dr. Bernstein are 1. Calming down and 2. Problem solving. Without these skills it is difficult for the child or teen to effectively learn to manage emotions. He talked about the value of deep breathing, using belly breathes, and counting to 10 as examples of helping the prefrontal cortex to focus and gain control of negative emotions.

Dr. Bernstein talked about anxiety disorders, depression and anger as emotions that are being exacerbated during the Pandemic among children and adolescents.

Anxiety disorders cause extreme stress and worry that can interfere with daily living and development. Dr. Bernstein said that feelings of being ashamed, afraid and alone are not uncommon. Anxiety can change a child’s behavior, sleep, eating or mood. He said that anxiety disorders often coexist with other behavioral health problems such as depression, eating disorders, and ADHD. Different types of anxiety disorders include:

• Panic Disorder
• Phobia
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder

Dr. Bernstein provided an overview of depression with children and adolescents, He mentioned that about 2.5% of children and 8.3% of adolescents typically suffer from depression, with higher numbers occurring during the pandemic. Suicide rates are also increasing. He pointed out that children and young adolescents may have difficulty in properly identifying and describing their internal and emotional states when depressed. Instead, of communicating how bad they feel, they may act out toward others which is often seen as misbehavior or disobedience. They may also become socially isolated or have frequent physical complaints. Dr. Bernstein mentioned that depression may be associated with substance abuse.

Using the metaphor of a volcano, Dr. Bernstein talked about anger with children and adolescents. He said that anger usually doesn’t happen all be itself. Anger occurs when the volcano erupts because of underlying negative emotions. There are many emotions that can result in anger if left untreated, including frustration, fear, humiliation, and jealousy. He said that unmanaged anger can hurt the health of the child or adolescent. Left untreated, anger can lead to physiological changes causing high blood pressure, gastrointestinal distress, and chronic headaches.

All of the serious emotional disorders presented above are treatable. Dr. Bernstein said that their many advantages to combining mindfulness, Cognitive Behavioral Therapy, and positive psychology as treatments to reduce or eliminate these disorders. He stressed a referral for medication and/or other specific treatment modalities are required when appropriate.

Dr. Bernstein said that mindfulness sets the stage for treatment. He presented several techniques such as floating on a cloud or a body scan to help children and adolescents “stay in the moment.”

He discussed the “Mind Body Connection” showing that anxious thoughts can quicken breathing or pains in the body so that the mind focuses on the body’s response which causes increased anticipation of getting more anxious, which causes more anxiety.

The 3 core parts of mindfulness include.

• Intention: Intending to be aware of the present moment.
• Attention: Focusing on different parts of what you are experiencing.
• Attitude of a beginner’s mind. Experience things as if the very first time.

Dr. Bernstein pointed out that:

Mindfulness is about:

• Noticing your thoughts and sensations:
• Awareness of your breath, body and mind.
• Reacting to emotions in a different way.
• Noticing what is going on in the moment.
• Re-centering yourself to cope.

Mindfulness is not about:

• Your mind becoming a blank slate.
• A mysterious hard-to-learn techniques.
• Having to meditate for hours.
• Sitting in emptiness or misery.
• Learning never to get angry in the first place.

Dr. Bernstein stated that that mindfulness can be integrated in Cognitive Behavioral Therapy. His workshop provided several activities that showed how mindfulness can help the person shift from emotional reaction to a cognitive thought process. He also said that mindfulness promotes the acceptance of intrusive thoughts to challenge them and then let them go.

CBT is often described as the cyclical description of thoughts, feelings, and behaviors. An anxious or distorted thought can lead to negative feelings which can cause problematic behaviors. Dr. Bernstein provided seven common distorted thoughts among teenagers.

These are:

1. All or nothing thinking
2. Jumping to conclusions
3. Negative Filtering
4. Catastrophizing
5. “Should” thinking
6. Negative Labeling
7. Negative comparisons

Dr. Bernstein presented several strategies to help the child and adolescent identify, challenge and reframe these unrealistic thoughts. He said that positive psychology should also be combined with Mindfulness and CBT for effective treatment with children and adolescents.

Dr. Bernstein said that positive psychology includes:

• Getting to know your strengths
• Using optimism
• Showing gratitude
• Experiencing a flow
• Having Grit

He gave examples of each of these attributes throughout his presentation.

During his workshop, Dr. Bernstein discussed 40 proven anger reduction strategies with teens or children. These ranged from mindfulness activities to variations of CBT strategies.

Dr. Bernstein presented a variety of techniques to engage with the angry child or teen. Similar to those discussed in a previous workshop, they included:

• A “Calm, Firm, non-controlling” mindset is essential, regardless of the techniques used in therapy.
• Be humble, acknowledge that you do not have all the answers and invite the clients to teach you.
• Be transparent. Show empathy, “I get that you would rather be playing a video game, but I appreciate your participation so far.”

Finally, Dr. Bernstein presented some general tips for counseling children and teens online. He said that the clinician must be a combination of therapist, teacher, comedian, and puppeteer. He also, be flexible, monitor the parent participation, praise cooperation in the session and give breaks when needed.

The advantages of online counseling include:

• Stretch us to be more creative,
• Allows us to see the home setting.
• Provides a unique sense of safety for the child.
• Opportunity to see others in the home.
• Can involve parents more.

The challenges of online counseling for therapists include:

• Being mindful of your performance anxiety
• Pressuring yourself too much to “make things happen”
• Staying feeling therapeutically connected.
• KYV – Know Your Value
• Losing a sense of your own special place and creating a sense of comfort
• Need to monitor role of the parents and collaboratively discuss expectations.

Once again, the pandemic has forced FCP to use a Webinar Format for this workshop. I thought Dr. Bernstein did a nice job with this. He acknowledged his own anxiety with the format, but it was a very professional presentation. There were few questions. Most comments were from educators. I thought the material was a great introduction to treatment of children and teens for educators, and a good refresher for the experienced mental health professionals in the audience, with some nice innovative techniques provided. In general, an informative and pleasant 3 hours today.

Any other thoughts?