UP-C Session 10: Facing Our Emotions—Part 1

Chapter 20 reviews the topic of situational emotion exposures (presented to children as experiments for facing emotions and getting used to them) and allows the children to complete their first situational emotion exposure in the group context. The best group exposures are ones that are relevant in some way to all participants, but are not too emotionally intense for any one child. The session concludes with initial planning for a first at-home exposure. The parent session prepares parents for facilitating and supporting exposures. The concept of safety behaviors is introduced, and parents are encouraged to identify any safety behaviors their children may be using and to make a plan for eliminating these.

UP-C Session 3: Using Science Experiments to Change Our Emotions and Behavior

Chapter 13 teaches children the skill of “acting opposite” to what their emotion may be telling them to do, and then applying this skill in a “science experiment” focused on sadness. Sadness is the primary focus of this session because children can often relate to the experience of feeling bored or sad at some point, and it is relatively easy for them to see how changing their behavior changes this emotion. This session also helps set the stage for situational emotion exposures. The parent session introduces the concept of using science experiments to see what happens when we take different “opposite” actions from those that have been maladaptive during emotional states. Parents learn how to support their children as they begin to engage in a series of opposite action science experiments for sadness and withdrawal.

UP-A Group and UP-C Individual Therapy Variations, Other Adaptations

Chapter 23 highlights the flexibility and adaptability of this transdiagnostic, unified approach to treating emotional disorders in children and adolescents. These treatments target a common set of underlying features of emotional disorders (e.g., high levels of intense emotions, distress reactions to intense emotions, unhelpful behavioral choices when experiencing intense emotions). Thus, the skills detailed in these treatments are applicable to disorders or problem area sharing these core features. These include anxiety and depressive disorders and obsessive-compulsive (OC) spectrum disorders, tic disorders, stress-related disorders, somatic symptom disorders, and potentially even some eating disorders. This chapter reviews some of the most common modifications that may be needed for using the UP-C and UP-A under different conditions and with different types of symptom presentations.

UP-C Sessions 11 Through 14: Facing Our Emotions—Part 2

Chapter 21 covers Sessions 11 through 14 of the Emotion Detectives program. The goal is to have each child complete several successful situational emotion exposures that reflect increasingly challenging items. Initial exposures allow the children to become accustomed to situational emotion exposures, as well as exposure planning, and allow therapists to assess children’s responses to various emotion triggers. Later sessions provide extensive time to further challenge children and parents as they attempt increasingly difficult items. There is no formal parent group for these sessions. Instead, parents should be directed to review workbook and home learning exercises in the companion materials and assist with exposure activities, as appropriate..

UP-C Session 7: Problem Solving and Conflict Management

Chapter 17 teaches “Problem Solving,” a strategy for generating and evaluating multiple solutions to a problem. Problem Solving skills can help children to manage situations where they feel “stuck” or unable to come to a good solution initially. This is an extension of “flexible thinking,” as children are encouraged to use their powers of observation and flexible thinking strategies to generate possible actions that they can take in difficult circumstances. These strategies are applied to emotional situations, including those in which there is a high degree of interpersonal conflict. The parent session continues to promote the goal of flexible thinking. Parents learn the steps of Problem Solving and how to support their child in using them.

UP-C Session 5: Look at My Thoughts

Chapter 15 introduces the idea of flexible thinking. This session teaches children to recognize that their initial negative or threatening interpretation of an ambiguous situation may not be realistic or accurate. The parent session introduces the concept of cognitive flexibility, emphasizing that their child’s first interpretation of a situation may not be the most realistic or accurate. Parents learn about the four thinking traps covered in the child component of the session (jumping to conclusions, mind reading, thinking the worst, and ignoring the positive) so that they can help their children identify thinking distortions. This session also covers an additional emotional parenting behavior (inconsistency) and its opposite parenting behavior (consistent reinforcement and discipline).

UP-C Session 2: Getting to Know Your Emotions

Chapter 12 provides education about the structure and function of emotions. Child group members begin to practice identifying and rating the intensity of their emotions, as well as breaking emotions down into their component parts (thoughts, body clues, behaviors). Children also learn to understand the course of their emotional experiences by examining what happens “Before, During, and After” a given emotion. The cycle of avoidance and other emotional behaviors are also covered. The parent session introduces the idea that parenting behaviors used in response to a child’s strong emotions may accidentally maintain or amplify the child’s distress. An overview of one common emotional parenting behavior (criticism) and its opposite parenting behavior (praise/positive reinforcement) is presented.

Module-P: Parenting the Emotional Adolescent

Chapter 9 introduces parents to the idea that the parenting behaviors they use in response to their adolescent’s strong emotions may actually maintain or amplify them. Many of the difficulties demonstrated by parents of emotional adolescents result from a normal, appropriate desire to lessen their adolescent’s distress. The problem is that such strategies typically operate to unintentionally limit the adolescent’s interaction with upsetting situations or stimuli, thereby accidentally reinforcing the adolescent’s emotional disorder symptoms over time. Parents are encouraged to identify their own emotional responses to their adolescent’s strong emotions, as well as the parenting behaviors they use to manage both their own and their adolescent’s distress. Parents are introduced to four parenting behaviors or “pitfalls” common to families of children and adolescents with emotional disorders, as well as “opposite parenting behaviors” that may be more effective in helping their adolescent to manage strong emotions.

Core Module 6: Awareness of Emotional Experiences

Chapter 6 first teaches adolescents to increase awareness of their experiences more broadly, and then helps adolescents use the same strategies to increase awareness during emotionally evocative situations. Awareness training is an important step in the treatment process. This module will assist the adolescent in adopting a practice of present-moment awareness and nonjudgmental awareness in different situations and across varying triggers of increasing intensity. This may in turn eventually reduce attempts to avoid uncomfortable emotional experiences. The adolescent will use awareness strategies during generalized emotional exposure practice at the end of the module, and the therapist should identify and process any subtle avoidance behaviors observed with the client.

Core Module 4: Awareness of Physical Sensations

Chapter 4 gives adolescent clients a greater awareness of the body’s reactions during intense and/or distressing emotion states. Principles of interoceptive or “sensational” exposure are introduced and practiced to build the adolescent’s ability to tolerate strong physical sensations. Taking this approach, which involves an acceptance-oriented stance toward uncomfortable physical sensations, is incompatible with taking actions to avoid or suppress these sensations prematurely. The interoceptive exposure techniques in this module were originally developed with panic disorder symptoms in mind. However, the body drawing and body scanning techniques, as well as interoceptive strategies, are presented in a manner broadly applicable to a range of concerns and are especially relevant for adolescents with poor distress tolerance or high reactivity to sensations in their bodies.