Exploring Feelings: Cognitive Behaviour Therapy to Manage Anxiety

The Cognitive Behaviour Therapy program Exploring Feelings was designed by the author to be highly structured, interesting and successful in encouraging the cognitive control of emotions. Every child participating in the program has a workbook for the six two-hour sessions that includes activities and information to explore the specific feelings of being happy, relaxed, anxious or angry. There are sections in the workbook to record individual comments and responses to questions. At the end of each session, a project is explained to the child, which is to be completed before the next session. At the start of the next session the project is discussed with the person implementing the program or the group of participants using the program. A metaphor was created of the child being an astronaut or scientist exploring a new planet, as the author has noted that children with Asperger syndrome are often interested in exploration of the physical world, science and science fiction.

The Exploring Feelings program is designed to explore the mental world from a scientific perspective. There are two Exploring Feelings programs, one is designed to explore and manage anxiety, the other to explore and manage anger. The original program was designed for small groups of two to five children between the ages of 9 and 12 years, with two adults conducting the program. However, the Exploring Feelings program can easily be modified so that it can be used with just one child. The activities can also be modified to be age appropriate for an adolescent or adult.

The program was designed as a treatment for an anxiety disorder or anger management problem in children with Asperger’s syndrome but the program can be equally applied to children with High Functioning Autism and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). The author also designed the program so that it does not have to be implemented by a qualified psychologist. A teacher, speech pathologist, occupational therapist or parent could implement the program without having training in Cognitive Behaviour Therapy.

Reviewed by Maureen Bennie Director, Autism Awareness Centre Inc.

World renowned clinical psychologist Dr. Tony Attwood has written two excellent programs for managing two common emotions that are frequently out of control in people with autism spectrum disorders – anger and anxiety. Uncontrolled anger and anxiety can cause people with ASD’s to experience isolation, frustration, interruption of learning and bullying. Attwood’s programs teach cognitive control of emotions.
There are six two-hour sessions that include activities and information to explore the specific feelings of being happy, relaxed, anxious or angry. There are sections within each session to record individual comments and responses to questions. At the end of each session, a project is explained to the child and is to be completed before the next session.

Although designed for small groups of 2 -5 people ages 9 – 12 years with two adults conducting the program, the program can be modified for one child and activities can be adapted to use with adolescents or young adults. Exploring Feelings is designed for people with Asperger Syndrome but it can be used with individuals with High Functioning Autism or PDD-NOS. It doesn’t have to be implemented by a psychologist – teachers, speech pathologists, occupational therapists, or parents can administer the program.

Before the session workbook begins, an overview of the program concepts is given: background to Cognitive Behavioural Therapy (CBT), how to use Comic Strip Conversations – a cartooning method developed by Carol Gray, developing the Emotional Toolbox, and using Social Stories effectively. Results of two recent studies completed in Australia provide evidence of the effectiveness of these programs. Papers from these studies will be published in 2005.

Session 1 explores the two positive emotions – happy and relaxation. There is a range of activities to measure, experience, and compare positive emotions in specific situations. Session 2 investigates feelings of anxiety or anger and recognition of those changes that occur in physiology, thinking, behaviour and speech during these emotions. The concept of the Emotional Toolbox is introduced, which is different types of tools to fix feelings. The focus is on physical tools that provide a constructive release of emotional energy such as running or bouncing on a trampoline and relaxation tools that lower the heart rate such as reading a book or listening to music.

Session 3 develops the Emotional Toolbox, which is comprised of social tools, thinking tools, additional/potential tools, and inappropriate tools. Social tools are using other people as a means of managing feelings. The goal is to find someone who can help change mood. The thinking tools involve self-talk, putting an event in perspective, using the individual’s motivation to acquire knowledge to change feelings about something, achieving academic success, and cue controlled relaxation which can be an object on hand that is associated with relaxation. The additional/potential tools can be special interests, medications, rewards, enjoyable activities, or reading autobiographies of people with Asperger Syndrome.

The Thermometer Concept in Session 4 provides a visual tool for measuring emotions using a thermometer as the yardstick. In Session 5, Carol Gray’s Social Stories are adapted and used as a means of improving social/emotional knowledge and providing social strategies for emotional management. Session 6 allows the individual to design their own Cognitive Behavioural Therapy program.

A before and after program test demonstrates the child’s increase in knowledge and ability to manage emotions. The last section of the book is for the adult trainers. An overview of central themes, suggestions for group cohesion – rules to establish with the group, a timing breakdown for each activity within a session, and materials needed to make preparation for the programs are given. The pages are perforated so they can be torn out and used with the children.

Dr. Attwood has created two programs to use at home, school or in the therapist’s office that effectively provide tools to control anger or anxiety in people with ASD’s. Attwood takes the guesswork out of how to teach emotional cognition and provides us with a program that is user friendly.