Respectful Communication and Social Skills for Children

Session 7 of the RAINBOW treatment protocol focuses on helping the child develop communication skills to improve peer and family relationships (ingredient B: Be a good friend of RAINBOW), and the session is conducted primarily with the child. For various reasons, children with bipolar disorder often have poor communication skills. Like most other skills, however, social skills can be taught and learned. The therapist and the child practice ways of expressing feelings nonverbally (“Feelings Charades”) and other nonverbal communication skills (such as making eye contact, listening). In addition, respectful communication skills are developed and practiced, including instruction in “I Messages” for emotional expression.

Affect Regulation Skills for Parents

Session 3 of the RAINBOW treatment protocol focuses on developing routines (ingredient R: Routine of RAINBOW) and improving affect regulation (ingredient A: Affect regulation of RAINBOW), and is conducted individually with the parent/caregiver(s). After a review of the previous week’s work by the therapist and parents, the parents are first engaged in a task to help establish predictable routines at home to minimize their child’s emotional reactivity. Parents are then encouraged to share their own feelings surrounding parenting a child with bipolar disorder. Last, the therapist and the parents develop ways to improve the identification, communication, and management of difficult feelings.

Family Problem Solving

Session 9 of the RAINBOW treatment protocol focuses on improving family problem-solving and coping (ingredient O: Oh, how do we solve this problem? of RAINBOW), and is conducted with the parent/caregiver(s), child, and siblings. It is important for all family members to have opportunities to talk about their experiences and to have that experience respected by the family. The therapist works with the family to improve interactions at home by problem-solving difficult situations and developing a family plan to minimize behavioral escalation once it occurs. In addition, the session aims to foster affiliation among family members through emphasizing shared experiences, positive feelings, and common goals.

Affect Regulation Skills for Children

Session 4 of the RAINBOW treatment protocol is primarily conducted with the child and focuses on developing affect-regulation skills (ingredient A: Affect regulation of RAINBOW). Key skills developed in this session include recognizing and labeling emotions, identifying physiological cues of anger and other feelings, and recognizing triggers of anger. These skills are taught in order to help the child to normalize the experience of intense emotion, and to teach the child how to cope with intense negative emotion. In addition, the child’s completed mood charts are reviewed, and mood monitoring is assigned again as a between-session task for the child and the family.

Psychoeducation about Pediatric Bipolar Disorder

Session 2 of the RAINBOW treatment protocol focuses on providing psychoeducation about pediatric bipolar disorder to the child and family. The psychoeducation portion focuses on the incidence, prevalence, assessment, presentation, diagnosis, and course of pediatric bipolar disorder, given that most families enter treatment with either limited or inaccurate information about this complex diagnosis. The family’s thoughts and feelings related to psychotropic medication are also explored. In addition, the child and caregiver(s) are introduced to mood monitoring, which is a key component of RAINBOW treatment, and both the child and the parents are assigned to chart the child’s moods several times daily for the next week.

Introduction

The Introduction describes how the Rainbow Manual provides the user with the empirical foundation for RAINBOW and for each of the RAINBOW treatment components, as well as detailed session-by-session guides for delivering RAINBOW. Each of the 12 session guides includes the RAINBOW ingredient(s) covered in the session, the agenda, the objective(s) for the session, the conceptual background for treatment objectives, and specific instructions and language for each objective and related activities. Recommended time lengths for each session activity are provided. The conceptual manual is intended to be used by the practitioner as the background and training for learning how to deliver the RAINBOW manual to children and families.

Creating Pleasant Memories and Finding Support

Session 10 of the RAINBOW treatment protocol focuses on maximizing social support (ingredient W: Ways to find social support of RAINBOW), and it is conducted with the parent/caregivers and child. The therapist provides psychoeducation regarding the importance of social support for effective parenting and child affect regulation. Parents and therapist discuss and evaluate methods of widening and utilizing social support networks for parents and child, as well as strategies to work through barriers to increasing social contacts. In addition, the child is engaged in role-play to practice adaptive help-seeking behaviors. Last, parents and child create a “Support Tree” to help identify and recall those in their support network.

Promoting Social Skills and a Balanced Life for Parents

Session 8 of the RAINBOW treatment protocol focuses on promoting the child’s social skills as well as on enhancing parental self-care (ingredient B: Be a good friend and Balanced life for parents of RAINBOW), and it is conducted with the parent/caregiver(s). Parent(s) are provided with psychoeducation regarding the importance of friendships, and engaged in problem-solving to identify key opportunities to promote their child’s social skills as well as ways to minimize difficulties during stressful social situations. The session also focuses on parental well-being and how they can maximize their opportunities for parental self-care, via discussion and completion of a “balanced lifestyle” activity.

Coping and Positive Thinking for Parents

Session 6 of the RAINBOW treatment protocol focuses on promoting self-efficacy in the parent and child (ingredient I: I can do it! of RAINBOW) and developing coping skills in parents (ingredient N: No negative thoughts, live in the now of RAINBOW), and it is conducted with the parent/caregivers. Therapist and parents first work to identify the child’s positive qualities and ways these can be promoted and reinforced through positive language and mastery activities. Parents are then encouraged to develop their own positive scripts and self-talk to improve their feelings of self-efficacy. Last, parents are instructed in cognitive and mindfulness skills to learn ways to reframe negative thoughts and increase their focus on the present moment.

Introduction and Overview of RAINBOW Program

The RAINBOW program was developed through a review of the literature and clinical experience relevant to the developmental psychopathology and treatment of pediatric bipolar disorder (PBD). Session 1 is the first session of the RAINBOW treatment protocol, and it is conducted with child and parent/caregiver(s). The primary objective of this session is to orient the child and family to the RAINBOW program and engage them in the treatment process. The session agenda includes introductions and identification of goals for treatment, introducing the concept of RAINBOW treatment and the integral components, addressing issues that may affect the family’s engagement in treatment, and building rapport with the child.