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July 3, 2019

Banishing Unicorns, Rainbows, and Glitter from Self-Talk in CBT with Kids

By Elisa Nebolsine, LCSW

Kids are smarter than we think. As a child therapist, I get to spend my days with them, and those I work with are usually brave, tough and strong – they just don’t always know that about themselves. As a specialist in the treatment of anxiety, my job is teaching kids to see their strengths, and helping them learn skills to manage their anxiety.

In Cognitive Behavior Therapy (CBT), we think about anxiety as an overestimation of the actual risk that exists in a given situation, and an underestimation of our ability to cope. For example, one of my child clients – let’s call her Karen – is terrified about going to summer camp. Karen is convinced that no one will like her, and that she will spend the whole week completely alone. If we look at the evidence, she actually has some friends and is reasonably good at forming and maintaining friendships. (If she weren’t, we’d need to do social skills training and resolving obstacles– both cognitive and practical– that could interfere.)

Karen knows that she has friends now, but her anxiety is telling her that she will not make any new friends at camp, and her anxiety is very convincing. Of course, there is always the small possibility that she won’t make new friends, but her anxiety is causing her to see this small chance as a likely outcome— overestimation of risk. Additionally, she thinks that if she doesn’t make any friends she will be all alone for the week. She isn’t problem-solving about what she would do in that situation; instead she is catastrophizing— underestimation of coping resources.

So how do we help Karen? One of the most basic skills that we teach kids is self-talk. This is an essential skill in CBT, which is of course all about our thoughts! Karen needs to learn ways to talk to herself and, ultimately, to respond effectively to her negative thoughts and beliefs. As we progress in therapy, we will go deeper into these cognitions, but one of the starting exercises we will use is realistic self-talk.

Realistic self-talk always reminds me of deep breathing. It’s one of these great skills that has been around forever and is consistently overlooked because it’s perceived as too simple or too obvious to be helpful. In fact, realistic self-talk can be enormously beneficial. The key is to help kids evaluate and modify their thinking, rather than provide them with what I call a “rainbow, unicorn, and glitter” intervention.

Too often self-talk is like a bright, shiny thing: too good, too positive, and too far removed from reality. For example, “rainbow unicorn” self-talk for Karen would involve coaching her to tell herself, “I will be the most popular girl at camp,” or “Everyone will love me!” It sounds far-fetched, right? In fact, many adults tend to use overly positive self-talk with kids. Karen, a smart child, knows those statements are too positive. At worst, “rainbow unicorn” reassurances can strengthen her fears. At best, she’ll simply disregard them.

Instead of “rainbow unicorn” self-talk, CBT clinicians strive to help clients learn realistic and helpful self-talk. “I may not be friends with everyone, but I’m likely to find a few people to spend time with,” or, “If I really am alone, I can talk to the counselor and ask for some help.” Self-talk is about helping people face difficult situations with a sense of courage that is grounded in reality.

To take this even further, psychologist Ethan Kross, PhD, of the University of Michigan has found that when we use our own names in self-talk, we hear statements differently— they are more effective at generating a positive emotional response. So if Karen is working on using self-talk, she may find it helpful to say to herself, “Karen, you can do this. You are capable of making good friends.” Dr. Kross has found that we hear the message, even from ourselves, in stronger language and respond more positively to the use of our own names.

Self-talk is a great starting skill in CBT work, and when used effectively, it can help kids begin to manage negative thoughts. As they begin to change their thoughts, we open the door to changing behaviors, and progress from there.