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Anxiety & Depression:

An evidence-based approach to teaching teachers, school psychologists,

and school psychology interns how to use evidence-based interventions
to help students in schools.
Gillian Adams
Jana Drummond
Marissa Malouf
Caroline Weishaupt

CHAPTER 2: WHAT IS DEPRESSION......................................................... 6

Introduction to Anxiety & Depression

Chapter 1
Anxiety is a stress-related response that is often characterized by worry, concern,
perceived threat or danger, and nervousness (Yang, 2010). It is triggered by a combination of
biochemical changes in the body, the students personal history and memory, and social
situations (Frey & Odle, 2011). There are many different types of anxiety, such as Generalized
Anxiety Disorder, Separation Anxiety Disorder, Test Anxiety, Social Phobia, Panic Disorder,
and Obsessive-Compulsive Disorder (National Institute of Mental Health, 2014). Many students
experience anxiety or anxiety-related symptoms at some time during their educational career.
For example, students often feel anxious when starting at a new school, some students worrying
about their grades, concerns related to their family, their relationships with peers, or their
performances in sports or other extracurricular activities. Anxiety-related behaviors vary and
manifest themselves differently depending on the individual and the type of anxiety the student is
presenting. Some students may cry frequently, have tantrums and have difficulty concentrating
(Ford-Martin & Mertz, 2009). Additionally it is common for students to be irritable, withdrawn,
seek easy tasks, fail to complete tasks, avoid particular situations or places, complain of
stomachaches or headaches, or experience sudden panic attacks (Ford-Martin & Mertz, 2009).

Frey, R. J., & Odle, T. G. (2011). Anxiety. In L. J. Fundukian (Ed.), The Gale Encyclopedia of
Medicine (4th ed., Vol. 1, pp. 426-430). Detroit: Gale. Retrieved from
Ford-Martin, P., & Mertz, L. (2009). Anxiety. In L. J. Fundukian (Ed.), The Gale Encyclopedia
of Alternative Medicine (3rd ed., Vol. 1, pp. 113-117). Detroit: Gale. Retrieved from
National Institute of Mental Health. (2014). Anxiety Disorders. Retrieved from
Yang, Y.-T. T. (2010). Anxiety. In C. S. Clauss-Ehlers (Ed.), Encyclopedia of Cross-Cultural
School Psychology (pp. 111-113). New York: Springer. Retrieved from

Chapter 2
Depression is a very serious health problem, which can affect people of all ages
throughout their lives or periods of time. Depression is generally defined as experiencing
sadness or irritability, and lack of energy and happiness in nearly all activities for a consistent
extended period of time (Cash, 2004). It affects the entire person, including a persons thoughts,
emotions, behavior, and physical health (University of Michigan Depression Center, 2014).
Youth and children with depression are unable to just snap out of it, treatment is required to help
change the behaviors and thoughts of the individual (Cash, 2004). The University of Michigan
Depression Center (2014) discusses the factors that contribute to depression symptoms, include
genetics, changes in hormone levels, certain medical conditions, stress, grief, and difficult life
circumstances. If untreated, threatening risks are heightened for the individual.
The prevalence of depression is rising in adolescences. According to Cash (2004),
depression is starting to occur in individuals lives earlier than in past years. Research has
shown that 28% of individuals between the ages thirteen and nineteen, experience at least one
onset period of depression. Of those young adolescents who experience major depression, up to
seven percent may eventually commit suicide (Cash, 2004). The need to provide safe

environments, resources, preventions and intervention strategies for schools is necessary due to
the prevalence among young adolescents.
Schools should be aware of the risks that relate to depression. They need to be aware that
there is a gender difference associated with depression and that female adolescents are twice as
likely to develop depressive disorders as their male peers (Cash, 2004). Students at greater risk
include adolescents from lower socioeconomic status backgrounds (Klein, Torpey, Bufferd, &
Dyson, 2008). Students who experience high stress or significant loss are at a higher risk. As
well as, students with behavioral problems, including attention difficulties, learning disorders,
conduct issues (Cash, 2004). Genetics from hormonal changes, medical issue, or family history
of depression are among other contributing factors (University of Michigan Depression Center,
2015). Adolescents who may become depressed also include risk factors of uncertainty with
sexual identity, poor academic performance, abuse, or neglect (Cash, 2004). Knowing about
depression is important for the school environment because the leading risk factor for youth
suicide is depression. Depression may lead to substance abuse, school dropouts, and unplanned
pregnancies (Klein, Torpey, Bufferd, & Dyson, 2008). Any student within the school may have
experienced these risk factors, and if school psychologists are aware they can provide the tools
and techniques to support these students.
Signs and Symptoms:
Recognizing the common signs and symptoms adolescents express will help to identify
these students in need of support. Symptoms of depression appear through physical, cognitive,
and behavioral signs. Desrochers and Houck (2013) compiled a handout, which includes
symptoms that are common within children and adolescents experiencing depression. Not all

individuals with depression express every symptom, but may exhibit a variety of symptoms from
each category. The physical signs of depression include changes in sleep patterns, unusually low
energy with talking and activity, restlessness and agitation, changes in eating patterns, or
frequent vague complaints about headaches, stomachaches muscle cramps, and tiredness.
Cognitive signs of depression include, poor attention, increased sensitivity to failure, poor
memory, difficulty completing tasks, difficulty making decisions, pessimistic view on
circumstances, negative view of life and future, helplessness, low self-esteem, and thoughts of
suicide or death. Behavioral signs of depression include, withdrawing from social situations,
increased dependency, and excessive time alone, decreased ability to cope with social events,
and reducing participating in previously enjoyed activities. School behavior symptoms may be
misbehaving in a classroom, a decrease of school performance, and tardy or absent from school.
Other behavioral signs include, running away, substance abuse, lack of self-care, and crying
without apparent cause. With all of these signs and symptoms, it is important to take into account
that not everyone who exhibits these signs are depressed, but recognizing the circumstances, the
individual, and the environment is important to include when assessing the student.

Cash, R.E. (2004). Depression in children and adolescents: Information for parents and
educations. Social/emotional development. Maryland: NASP.
Desrochers, J.E., & Houck, G. (2013). Signs of depression in children and adolescents.
In Depression in children and adolescents: Guidelines for school practice. Maryland:
Klein, D.N., Torpey, D.C., Buffered, & S.J., Dyson, M.W. (2008). Depressive disorders. In T. P.
Beauchaine, & S. P. Hinshaw (eds.), Child and adolescent psychopathology. (pp. 447509). New Jersey: John Wiley & Sons.
The University of Michigan Depression Center. (2014). Depression. Regents of the University of
Michigan. Retrieved from:

Web Resources


Chapter 3
Website: www.my.happify.com
Mission: Happify contains resources for teachers, parents, students, and staff to use to improve
their happiness through mindfulness and cognitive behavioral therapy (CBT). The happify.com
website is scientifically researched and provides multiple science articles, data with graphs and
charts, and research to provide knowledge to users to learn more about the effectiveness and
research behind Happify.
About the Website:
This interactive website uses mindfulness and CBT to provide multiple tracks for users
to create an account and follow a daily track. The tracks include: Coping With Stress, Reducing
Negative Thoughts, Building Social Relationships, Feeling Less Lonely, Seeing the Good in Life,
Nurture the Body and Soul, and Boosting Happiness with Positivity. Within these tracks are
multiple activities, games, information and worksheets for users to engage in that relate to the
course they selected. For example, within Reducing Negative Thoughts, the first activity is a
worksheet that asks the user to identify three positive events that have occurred that day and to
write about these events and rate how the individual felt during them.

The next activity is a game where the individual must click on positive words that appear
quickly on the screen to identify the difference between positive and negative words. The
activity changes as the individual progresses along the track. The user is monitored to ensure
daily check-in and capability to complete tasks within a timeframe without overloading on tasks
in one day. This is to ensure that the user is not progressing too quickly through any given track.
These tracks listed are free for members who sign up.
Signing-up is quick and simple when first entering the website, since the instructions for
each step are provided. For those looking to become HappifyPlus members, you will be required
to pay a monthly fee. For one year, the price is $4.76 per month or two years the fee drops to
$3.16 per month. Becoming a HappifyPlus member expands the games, activities, some levels,
courses, and an in-depth progress-monitoring chart. Users signed in under the free membership
are able to complete free courses without paying but are limited to tracking their in-depth
progress and unlocking levels at an earlier time. Once an account is created, there is an
assessment to find out more about the individual user. Everything can remain private, unless the
user chooses to connect with other users on the website. These connections create a social bond
within Happify to track how other members are progressing and promote positive encouragement
between users. After gaining membership, you gain access to the Community blogs and forum
posts to receive social support through open communication about concerns and interests.
Members also receive access to Happify Daily, which provides news, updates, and motivational
articles about healthy living styles. Unfortunately, you need to be 18 years or older to be a
member, but these interactive courses can be tailored to young adolescents with parent or teacher
supervision due to lack of vocabulary knowledge and potential access to public forums. Happify


also provides a free mobile application to access daily activities throughout an individuals day.
All activities are family friendly and provide resourceful guidance to living a positive healthy life.


Chapter 4
PBIS World
Website: http://www.pbisworld.com
Mission: PBIS World was created by a school social worker who was the PBIS Coach for his
district. He created this website to enable and empower teachers and staff to implement and
carry out PBIS more autonomously. There are over 200 pages of content on this website and
hundreds of resources. While this website was designed to be used with PBIS Implementation, it
provides valuable information regarding different behaviors that might be seen in a school that
would negatively affect a students abilities to be successful in the classroom.
What is PBIS?
According to the website, PBIS (positive behavior interventions and supports) is an
architecture for addressing behavior through the prevention-oriented structuring of researchbased interventions and supports in a hierarchical and progressive manner. PBIS is a preventionoriented way for school personnel to (a) organize evidence-based practices, (b) improve their
implementation of those practices, and (c) maximize academic and social behavior outcomes for
all students. The purpose of this is to improve behavioral and academic outcomes (PBIS, 2015).

In practice, this appears as 3 tiers of increasingly intensive and individualized behavior

interventions and supports as well as a system of data collection and analysis.
About the Website
This website provides valuable information regarding a wide variety of externalizing and
internalizing behaviors, including Anxiety and Depression. When first looking at the home page,
the user is directed to list of these behaviors and have an option to choose which behavior to look
at. When clicking on a link, the page then directs them to another page about the behavior they
are looking at. This page contains information about the behavior, such as characteristics about
the behavior and common symptoms that may be associated. At the bottom of the page, it then
asks if these characteristics describe the students behavior, and if it does the user is then brought
to a page with suggestions for Tier 1 interventions. From this page, it gives the user an option to
see all Tier 1 interventions, get data tracking forms and strategies, or see more supportive Tier 2
interventions. Tier 3 interventions are also provided if necessary.
For Parents
While this website is designed for school educators and those who work with children,
parents may also find the information provided on this website useful. The profile of the student
may be helpful for parents to narrow down the target behaviors that they are seeing in their child.
This information may be especially helpful for parents who think that are seeing Anxiety and
Depression in their child, and may provide them information as to whether or not their childs
behaviors are consistent with the criteria of the disorders and warrants a doctors visit. This
website also provides parents with additional information about the behaviors they are seeing
and helps them be more informed when speaking with educators or outside providers about their
childs actions. Some of the example Tier 1 interventions, such a positive praise and reward


systems, may be helpful for parents to know about and may improve the behaviors in the home
environment when implemented by the parents.
For School Psychologists and Educators
This website provides many great resources for school psychologists and educators alike.
The tiered interventions and data tracking forms are useful to school personnel who are looking
to implement interventions to reduce specific behaviors. This website also educates the users on
the typical profile of a student who exhibits these negative behaviors. This is helpful to see if an
intervention that is being used addresses the target behavior it is intended for. In addition to this,
this website is easily accessible and provides educators with interventions for a wide variety of
behaviors all on the same site. This website is also user friendly and provides teachers and
school psychologists with detailed data tracking sheets which is a valuable resource.

Positive Behavioral Interventions & Supports. (2015). Retrieved April 22, 2015,
from https://www.pbis.org/school/swpbis-for-beginners


Chapter 5
Canadian Mental Health Association (CMHA)
Website: http://www.cmha.ca/highschool/english.htm
Mission: The purpose of this website is to provide easily accessible and free mental health
advice and information to high school students, parents of high school students, and educators
(teachers and school staff) at the high school level. Designed in a user-friendly way, this website
seeks to make visitors feel welcome by normalizing the event of browsing the site and the
availability to read past experiences and stories of other teens, parents, and educators who have
faced similar experiences. Although all three sections have similar formatting (i.e. welcome,
introduction, recognition, high school information, personal stories and examples, and
resources/links), they are designed to gear the information toward the specific target audience.
Overall, it develops comfort in letting visitors know they are not alone.
About the Website:
The web resource provides an engaging introduction for student viewers. The site
provides easy access to issues related to a teens mental health. It offers avenues of access for
issues related to teen mental health and its affects on adolescent life and academics. The venue


offers ways to recover by providing examples of effective coping mechanisms as well as various
experiences of the readers peers. It presents students with basic information regarding the
differences between mental health problems and mental illnesses. The student section
concludes by providing cool links and resources to help the student get through high school
and transition to their next step.
The next segment of the site is directed at the parents of teenage adolescents. The site
provides examples and ways to assist parents in recognizing whether a child presents
characteristics of one whom might be in need of help. This webpage offers tools for parents to
assist them in identifying and understanding the means in which their children are being affected
by mental health related issues in both their general lives and the academic world. The site
provides input in the form of examples and experiences of other parents who have experienced
similar issues. It allows the reader the ability to recognize, provide support, and collaborate with
other parents. Children and school sharing personal experiences, which will assist the reader in
adapting responses to their own child. The site also supplies information regarding transition in
the post high school years to assist the parents in dealing with the tumultuous times of adolescent
development; physical, mental, and emotional changes. The site provides parents with the
critical information to allow them to recognize that the adolescent years between the ages of 16
and 24 have a higher risk for young adults to develop mental health problems including serious
mental illness than any other period in their lives. Parents are also given links and resources if
they are seeking extra supports.


Teachers and School Staff Members

Here also the site provides succinct information and access to pointed information as it
relates to teachers observations of students within the academic setting. Teachers are informed
that they are often the first persons to observe and hone in on early warning signs of mental
health issues in students. The site provides personnel with necessary tools and information to
become more aware of mental illness and mental health issues. The site supplies examples for
how these issues can impact a childs learning and provides support information that can be
integrated into lessons to facilitate increase levels of student learning once mental health issues
have been identified by the teacher or school staff member. The site as it relates to teachers, also
presents peer experiences that can facilitate a teachers adapting to situations that will assist the
student in the classroom environment.


Chapter 6
Creative Counseling
Website: www.creativecounseling101.com
Mission: This website provides a rich resource for creative counseling. The information
provided on the website focuses on play therapy as a means for providing students with the
counseling they need using fun, creative, and new techniques. The resources are intended for
school psychologists and other professionals in the mental health field (e.g. School Psychology
Interns). Their mission is to increase awareness and promote education about play therapy, the
various techniques that are evidence-based, how to apply these techniques in a counseling setting
and how to address various student needs.
What is Play Therapy?
Play therapy is therapeutic technique useful for School psychologists, teachers, and parents,
when counseling students. Play therapy has many benefits, some of which include, preparing for
social situations, learning to deal with negative feelings (e.g. anger and sadness), and helps
students work through challenging situations in a creative manner.


What is Creative Counseling?

Creative Counseling is a modern spin on the traditional counseling experience for students. This
approach offers a creative way to educate and promote emotional wellbeing for students, using a
variety of therapeutic approaches.
About the Website:
For School Psychologists

Creative Counseling 101 provides school psychologists with a thorough understanding of

what creative counseling is all about.

The website aims at helping school psychologists better understand how to construct a
counseling plan, and incorporating play therapy, art therapy, sand tray therapy, music
therapy, movement therapy, social skills stories, and other creative mediums into each
counseling session.

The website provides many resources, sample intervention scripts and examples of
creative techniques that school psychologists can use to guide their learning and
implementation of creative counseling in the school.

Additionally, there are over eight hundred pages of free play therapy, sand tray therapy,
school counseling ideas and lesson plans, art therapy & counseling, and creative ideas for
all mental health professionals. This website is an incredible reference and useful tool for
all school psychologists.


Chapter 7
Students Against Depression
Website: http://studentsagainstdepression.org/
Mission: This website is a great resource for students, parents, teachers, and school
psychologists. The website is designed to help students spread awareness, while providing them
with useful resources to cope with and manage their depression. In addition, this website
provides additional references and websites that students can go to, to find more information
about stress, depression, suicide, and other student issues. Lastly, one of the greatest aspects of
this website is Take Action! Take action focuses on spreading awareness and educating your
own community about depression by providing access to free resources, modules to help students
take action in their own lives, and suggestions for how to help our peers or community members
work through challenging situations or issues, like depression.
About the Website:
For School Psychologists

A useful website for school psychologists to be aware of as they may be working with
students who have depressive symptoms or students have a medical diagnosis of


For Students

This website provides students with tips and suggestions for tackling depression, where
to start, how to develop a healthy daily routine, and changing attitudes to live better.

Another great aspect is that students can stay connected with Students Against
Depression on social media sites, such as Facebook and Twitter.


Intervention Resources


Chapter 9
What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a form of treatment that is used to treat a wide
variety of mental illnesses. This form of treatment is unique in that is focuses on examining the
relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that
lead to self-destructive actions and the beliefs that direct these thoughts, people with a mental
illness can modify their patterns of thinking to improve coping (NAMI, 2012). It is because of
this, that CBT is especially useful to treat Anxiety and Depression. Challenging the irrational
fears or beliefs associated with these disorders and replacing these negative feelings with
healthier patterns of thinking has proved to be very successful.
In terms of the therapy structure, CBT is a structured and goal-orientated evidence-based
therapy. CBT is time-limited, and it is assumed that the client will not be in continuous on-going
treatment; the average length of CBT is 16 sessions (NACBT, 2014). It is because of this time
limitation that each CBT session has a specific agenda and goals that need to be accomplished
during the time allotted. Homework is also an integral part of therapy so the concepts that are
discussed during the time limited therapy sessions can be practiced and ingrained for the client.
Since CBT is based on the idea that our thoughts cause our feelings and behaviors, not
external things, like people, situations, and events, it can be especially useful to use with client

who suffer from Anxiety or Depression. The benefit of CBT is that clients can change the way
they think or feel even if the situation does not change, which is helpful for people who have no
control over the external stimuli that may trigger their disorders. CBT encourages clients to
restructure their thinking to interpret their environment as less negative or dangerous, which
allows the clients to reduce the intensity of their Anxiety or Depression. Studies have shown that
CBT actually changes brain activity in people with mental illnesses who receive this treatment,
suggesting that the brain is actually improving its functioning as a result of engaging in this form
of therapy (NAMI, 2012). CBT has shown to be highly effective in treating mental illnesses, and
many interventions utilize strategies that come from this type of therapy.

National Alliance on Mental Illness (2012). Cognitive behavioral therapy? Retrieved April 29,
2015, from http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_
National Association of Cognitive-Behavioral Therapists (2014). What is CBT? Retrieved April
29, 2015, from http://www.nacbt.org/


Chapter 10
What is Dialectical Behavioral Therapy?
Dialectical Behavior Therapy (DBT; Linehan, 1993) is a cognitive behavioral treatment
approach initially developed to treat suicidal adults with borderline personality disorder (BPD),
which was subsequently adapted for suicidal adolescents. DBT is a skills-based approach that
targets emotional dysregulation, suicidal behavior, interpersonal deficits, and treatment
resistance. Research has shown that in addition to the above, DBT is effective in treating a
myriad of additional disorders such as depression, substance dependence, post-traumatic stress
disorder (PTSD), and eating disorders (Robins, Ivanoff and Linehan, 2001).
It was understood by Linehan that individual therapy was not sufficient for treating highrisk clients, rather, a multi-faceted approach was better suiting the needs of the targeted group.
The intervention consists of two modalities: Family Skills Training (conducted with individual
family units) and Individual DBT Therapy with the adolescent. In keeping with this strategy,
there are three main components of DBT: individual therapy, skills training group, and therapist
consultation team (Robins et. al., 2001). More specifically, DBT improves and maintains the
clients internal motivation to change their behaviors through effective collaboration with their
therapist, enhancement of both client and therapists motivation to continue therapy, the


improvement of client capabilities, and the restructuring of their internal and external
environment. For effective treatment to occur, inclusion of family members is crucial to ensure
collaboration of effective treatment in all environments (Linehan, 1987).
Within DBT there are also four sets of behavioral skills addressed to the client:
mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation (Robins et.
al., 2001). Throughout sessions these sets of behavioral skills are developed through effective
treatment and the collaboration of therapist and client. Because DBT clients typically have
multiple issues that require treatment, targets are prioritized through a triage style hierarchy to
determine the order that problems should be addressed, beginning with life-threatening behaviors
and matriculating to therapy-interfering behaviors, quality of life behaviors, and lastly, skills
acquisition (Robins et. al., 2001).

Dialectical Behavior Therapy for borderline personality disorder: Theory and method.
Linehan, Marsha M.Bulletin of the Menninger Clinic, Vol 51(3), May 1987, 261-276.
Linehan, M. M. (1993a). Cognitive Behavioral Treatment of Borderline Personality
Disorder. New York: Guilford Press.
Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality
Disorder. New York: Guilford Press.
Robins, C. J., Ivanoff, A. M., & Linehan, M. M. (2001). Dialectical behavior therapy. Handbook
of personality disorders: Theory, research, and treatment, 437-459.

Chapter 11
Through the Senses

Appropriate Grade Level: Elementary, Middle, and High School students working on being
present in the moment.
Brief Description: Mindfulness is a behavioral intervention, which incorporates techniques
using the Cognitive Behavioral Theory and Dialectical Behavioral Theory models.
Implementing Mindfulness within daily activities through multiple senses increases the students
ability to stay engaged in the present task at hand. Mindfulness can be used for a variety of
behaviors including concentration, controlling anger, testing anxiety, depression, emotion
regulation, and independence. Students learn multiple types of strategies to cope with their
emotions and bring their attention to the present moment through sight, smells, touch, taste, and
sound. Mindfulness is a calming intervention that varies between five to fifteen minutes
depending on the activity and can be administered to individuals, small groups, or class wide.
Intervention Goal: Provide students with the techniques and ability to manage emotions, have
awareness and attention in the present moment, and promote independent thinkers.
Progress Monitoring:
Before administering the intervention, the targeted behavior should be determined as well as the
target audience, whether its a student, multiple students or whole classroom. Duration and
frequency of the targeted behavior should be measured to gather baseline data. Mindfulness
incorporates multiple types of behaviors, so it is important to identify the specific behavior to
track over the course of the intervention.
Examples of behaviors that may be seen would include:
o Putting head on their desk in frustration,
o Eye contact is not being made with the teacher,
o Eye contact may be wandering around the classroom,


Sweating palms,
Foot tapping,
Biting nails,
A student who typically smiles but isn't smiling anymore in the classroom,
Pen tapping

Progress will be monitored through tracking frequency or duration of the behavior daily.
o Compare results to baseline data weekly throughout the intervention.

Though the use of Progress Monitoring we should be able to identify when the student
achieves the behavioral goal set by the teacher.

Materials Needed:

SeeingCalming pictures: Beach, sunrise/sunset, woods, snowcapped mountains,

clouds/sky, etc.

SmellIncense, flowers, tea, lavender

Touch Dryer sheets, felt pieces, feathers, rabbits foot, velvet cloth, stress ball

Taste Mint, hard candies, citrus flavor, tea, ginger

Sound rain, waterfalls, mindful bell, wind, nature/jungle noise

1. Identify the behavior of the student, students, or class.
2. Prepare the appropriate materials, needed for the session.
3. Introduce mindfulness to the class: what it is, how it can be used in the classroom, how it
applies to anxiety and stress, and how it can be applied to outside events.
a. To help explain mindfulness teachers may use:
Mindfulness can help us in our day-to-day lives. Over the next few weeks
we will be learning and practicing ways to be mindful in the classroom to
become mentally stronger. Mindfulness helps us calm our minds so that

we can be relaxed, refreshed, and more attentive. It is also a way of

building our inner strength and being more balanced. One of the
disadvantages of mindlessness is that we miss a lot of whats going on in
our lives. Lets learn ways to bring mindfulness into our daily lives.
Sometimes when we are asked to do something new or unusual, we may
feel awkward or uncomfortable. Its okay if these feelings occur. Try your
best to notice these feelings without acting on them and distracting
4. The first week, the teacher spends time with each sense explaining the sense and types of
strategies to incorporate mindfulness with the senses. Select a sense for each day of the
week to teach the students the different types of mindfulness and provide consistency
with the class schedule.
a. Smell: As we focus our attention on the smell of [scent] Id like you to focus your
attention on what the smell consists of. When emotions and thoughts arise, let the
smell refocus your mind let the thoughts and emotions just pass through. Notice
the sensations in your nose, mind, and body as you smell the scent.
b. Sound: recognize and notice the sounds you encounter within the classroom,
hallways, and outside the school. Notice sounds close to you and far away from
you. Notice how some sounds may disappear, while others may appear. As you
continue to listen to the sound playing, focus your attention on the different tones,
rhythms, and vibrations of the sounds
c. Touch: Id like you to focus on one of the objects as if youve never seen it
before. Imagine that youve arrived here from another planet and the object is


completely new. Pick up the object and become aware of what you see, the shape,
the texture, color, size, temperature, hardness or softness. Recognize these
feelings and notice the sensations through your fingers and you become aware of
the object. Remember to let the outside thoughts pass through you mind and
remain attentive on the object in your hand.
d. Taste: Let us recognize the way our minds and body feel when we eat something.
Become aware of all the sensations as you place the [food item] in your mouth.
Take a bite and notice the taste, texture, and sensations occurring. Remain
focused on what youre tasting and feeling.
e. Sight: Looking at the [object], what is it that youre seeing? Notice the details of
the picture, notice the coloring, and notice the feelings that cross your mind when
you look at this picture. As thoughts arise, let them drift out as quickly as they
came. Maintain focused on what the actual image is youre looking at and what
details you can become aware of.
5. Practice the mindfulness senses three times throughout the day (beginning, middle, and
end), and spend five to fifteen minutes working on the techniques. The introduction days
will take longer to discuss but the more times the mindfulness occurs, the less
explanation needed.
6. Prompt students throughout the mindfulness session to remain attentive and focused on
the activity presented to them.
7. Implement this for 6-8 weeks and adjust length as needed for the behavioral goal to be


Burke, C. (2009). Mindfulness-based approaches with children and adolescents: A preliminary
review of current research in an emergent field. Journal of Family Studies. Springer
Science and Business Media, LLC.


Chapter 12
Comfort Kit

Target Problem: Anxiety Disorder

Brief Description: The purpose of this intervention is to facilitate children in learning selfsoothing strategies by providing them with a tactile approach to coping with fear in a healthy
way. The child is provided with a bag and fills it with self-care items that will be used to cope
when faced with a stressful/fearful situation. The overall objective is to assist the child in
changing their negative thoughts to positive and healthy thoughts by encouraging positive selftalk and self-care during times of need.
(Note: The child will select all materials; however the counselor will brainstorm with the child a
list of items that bring them comfort. Therefore, the following list is examples and suggestions
of items that may be used).

Large bag/shoebox to contain personal items of comfort.

Stress ball


Picture of a proud moment

Meaningful letter

Worry stone

Journal and a pen

Fabric (piece of a safe persons or loved ones clothing/ blanket

Favorite stuffed animal


Favorite book


Art supplies for decoration of bag/box (i.e. markers, crayons, stickers, etc.)

1. The counselor begins with educating the child (and, if possible, the parents/caregivers)
about the technique and the purpose it will serve when the child is faced with a
stressful/fearful situation.
2. Counselors then facilitate the child in brainstorming and creating their list of items that
bring them comfort and make them feel better. (Although the counselor guides the
process, it should be noted that the child chooses what will go inside of their bag or box.)
3. Children then select a container that will hold the items they have selected. (If it is to be
used within a school building it is better to advise the child to choose fewer items and a
smaller container for easier travel accommodations).
4. Next, the child can decorate the outside of the container.
5. The child can also develop directions on how to use the comfort kit and will be adhered
to the inside of the bag or box.
6. Counselor will then provide the child with a self-monitoring checklist that they will use
during the school day to track their anxiety in combination with their Comfort Kit to
reduce the anxious symptoms.

a. Make sure to go through the directions in detail (step by step) with the child so
they understand what is expected of them.
b. If needed, modify the self-monitoring sheet to the developmental level of the
Progress Monitoring:
Students will utilize a self-monitoring checklist throughout their school day to
monitor their anxiety levels. Older students at the middle and high school level will do this at the
beginning of each class period. For younger students, this will take place at the start of the day
and will continue at least 4 more times throughout the school day. This may include before
recess, before the start of a new activity, before lunch, and before the student goes home.
The idea of the daily journal in combination with the Comfort Kit will be to help
adolescents recognize their anxiety symptoms in hopes to reduce these feelings. The selfobservation and self-recording required of them will allow the child to become aware of their
symptoms and emotional states, internally and externally, and label their own behavior. School
psychologists and/or school staff will then be responsible for discussing the self-monitoring sheet
with the child and go over the directions in detail, making sure they understand what is expected
of them and the reasoning behind this method.
For younger students, journaling may be more difficult. It is suggested that when working
with elementary aged students, you have them create a drawing or verbally tell a story, as this
approach may be more appropriate. The drawing can be completed independently or overseen by
the teacher or school psychologist, and for a student who prefers to talk about their experiences,
feelings, and anxiety related symptoms, the teacher or school psychologist can scribe what the


student tells them. These alternative activities will help make self-monitoring appropriate for
students of various age groups.

Craske, M. G., & Tsao, J. C. (1999). Self-monitoring with panic andanxiety
disorders. Psychological Assessment, 11(4), 466.
Lowenstein, L. (2006). Creative Interventions for Children of Divorce. Toronto: Champion


Chapter 13
I Think, I am, I Feel

Target Problem:
This intervention can be used for Anxiety or Depression.
Brief Description:
I Think, I Feel, I Am cards are a specially designed therapeutic tool for practitioners working
with children or adults. This CBT based intervention helps clients to be able to express and
recognize their thoughts and feelings. The statements on the cards allow both the client and the
therapist to hone in on beliefs and feelings that best resonate for the client. The illustrations on
the cards were selectively chosen for their emotional impact and unique perspectives (I Think, I
Feel, I Am, 2009). These cards can be used during a counseling session to elaborate on topics
that have been previously discussed and/or to clarify how the client is feeling about an event.
This intervention is especially good for children who may not have strong verbal skills. Giving
them these cards with different feeling words on them may help the child recognize their own
feelings about a situation using the specified feelings on one of the cards, which then helps the
therapist understand how the client is feeling and better tailor their counseling session. Each
deck of cards includes almost 50 different feelings or thoughts from 6 different categories.
These categories include: mixed-up thoughts and comfortable thoughts (cognitions), mixed-up
feelings and comfortable feelings (emotions), body feelings (somatic responses) and resource

development (resourcing and strengthening). These different categories ensure that there in a
feeling or thought card to address a wide variety of potential scenarios.
Materials Needed:
Deck of I Think, I Feel, I am cards
1. The school psychologist should begin the intervention by talking with the student about
their Anxiety or Depression during a counseling session.
2. When talking about a time they feel anxious or depressed, the cards can be given to the
student to help them identify their thoughts and feelings during that time. The body
feeling cards may be especially helpful with a student who has these disorders to help
them recognize that their somatic symptoms are associated with their Anxiety or
3. The student, with the help of the school psychologist, then elaborates on those feelings
based on the card(s) that they chose.
4. The school psychologist then gives the student a different set of cards (comfortable
thoughts or feelings cards), and tells the student to pick which feeling they would have
rather felt during that time.
5. The school psychologist then continues the counseling session with the student
discussing the students original feelings about the situation and then how they could
replace those thoughts or feelings with more positive and comfortable thoughts or
I Think I Feel I Am. (2009). Retrieved April 29, 2015, from http://www.ithinkifeeliam.com/

Chapter 14
Bubble Breaths

Target Problem: Anxiety

Brief Description: This CBT based intervention is designed for students to learn how to use
breathing as a coping instrument when faced with anxiety or other stressors. The bubble breaths
intervention is a mindfulness technique used to help students to practice slow, deep breathing,
while aiding in relaxation. This technique, while most suitable for younger students, can be used
with individuals of any age. Additionally, bubble breaths can be implemented in an individual or
group format. Bubble breaths teaches relaxation using short and deep breathing techniques,
similar to those used when blowing small and large bubbles. This is a fun intervention for
students to use in school with the school psychologist and/or teachers and at home with
Materials Needed:

Bottle of bubbles (can be bought or homemade)

1. The school psychologist or teacher should begin the intervention by filling the room with
bubbles; most students will immediately begin to pop them as they fall.


2. After a few minutes, the student(s) should be instructed not to pop the bubbles, but rather
use the bubbles to blow one big bubble.
3. The school psychologist or teacher should teach the student(s) how to take deep breaths
from the stomach and slowly exhale.
4. Next, they should explain to the student(s) that when they become anxious or stressed,
the brain wants more air, but the lungs are working too hard being upset to provide the
brain with air. However, if they breathe deeply, their brain will tell their heart to slow and
the lungs will work better.
5. The school psychologist or teacher should then instruct the student(s) that if they take
bubble breaths when they start to become anxious, nervous, stressed, or tense, they can
often prevent negative or unwanted behaviors from happening.
6. Students should practice bubble breaths daily or weekly with the school psychologist or
teacher, as well as at home with their parent/guardian, until the child is comfortable doing
this on his/her own.
7. The school psychologist or teacher should also help students implement this intervention
when a student experiences an anxious or stressful situation. This will help students
understand how to apply the intervention with or without bubbles during a time of need.


Progress Monitoring:
My Bubble Breathing Chart
1. Please fill out these questions daily. If the answer to question 1 is NO, do not fill out the
rest of the sheet. If the answer is YES, go on to the other questions. For questions 2 and 3,
rate your level of anxiety from 1 (no anxiety) to 5 (high anxiety), or with a happy or sad
face. *Note: Select which chart to use (numbers or faces) based on the developmental
level of the child.

1. I needed to use my bubble breathing today.



2. Before I did my bubble breathes, my anxiety level was: 1 2 3 4 5

3. After I did my bubble breathes, my anxiety level was: 1 2 3 4 5

1. I needed to use my bubble breathing today.



2. Before I did my bubble breathes, I felt:

3. After I did my bubble breathes, I felt:

AnxietyBC. (2014). How to Teach Your Child Calm Breathing. Retrieved from
Hall, T., Kaduson, H., & Schaefer, C. (2002). Fifteen Effective Play Therapy Techniques.
Professional Psychology: Research and Practice, 33(6), 515-522.

Chapter 15
Party Hats on Monsters

Target Problem: Anxiety Disorder

Application: Preschool School-aged children
Brief Description: This intervention is implemented through a drawing exercise that has been
designed specifically to enable children to gradually face their fears in a nonthreatening and
satisfying manner. It is understood that most children find more comfort when expressing their
fears through drawing as opposed to verbalizing them. In addition, many children find
reassurance when they are not required to face their worst fear or anxiety immediately. By
experiencing success in a gradual process when facing the feared object, the childs confidence
level and sense of mastery is said to improve.
Materials Needed:


Drawing Instruments (i.e. crayons, markers, paints, chalk, stickers, etc.)

1. The instructor begins by directing the child to draw something that makes him or her
feel happy or safe, such as a favorite activity or friend.
2. After the child completes the drawing, the instructor engages the child in a relaxing
conversation about what he/she has drawn.

3. Next, the instructor asks the child to draw something that scares him or her
(dependent upon the age of the child it is suggested to tell them to draw something
that scares them just a little).
4. The instructor then tells the child to modify the drawing in a way that will make the
feared object (e.g., a monster, animal, insect) seem less scary. For example, the child
could shrink the monster, put a party hat on him, draw a superhero who turns the
monster from mean to nice, and so on.

Either while the child is modifying the drawing or after, the instructor engages
in a discussion with the child that assists them in the realization that when
they change the picture on paper to make it less scary, they also begin to
change the picture in their head so that they are no longer frightened by the
object they fear. It is important for the child to discuss with the instructor how
they are feeling after the activity takes place.

5. The instructor continues over time creating a scale of the childs fear.
Progress Monitoring:
1. Prior to implementation, students will fill out the How am I feeling today preassessment form. This form will be used to identify the students feelings and anxiety
level prior to the intervention. It will also allow the school psychologist monitor the
students progress throughout and at the end of intervention implementation.
2. Students will utilize a daily journal and/or daily feeling chart (How do I feel today) to
monitor their anxiety on a daily basis. The concept behind the daily journal/feeling
chart will be to assist the adolescent in recognizing their anxiety symptoms in hopes
of reduce these feelings. It will also assist the school psychologist in monitoring


progress, to see if the adolescent is experiencing success or if the intervention needs

to be modified.
3. School psychologists and/or school staff will discuss the daily journal sheets/daily
feeling chart with the child and go over the directions in detail, making sure the
student understands what is expected of them and identifying the purpose of the
4. To conclude the intervention and measure progress made, the school psychologist
will give the student the post-assessment form to complete. This form will allow the
instructor to attain the necessary information regarding the specific intervention and
measure the individual students progression throughout the intervention.

Crenshaw, D.A. (2001b). Party hats on monsters. In H. G. Kaduson & C. E. Scharfer (eds.),
101 more favorite play therapy techniques (pp. 124-127). Northvale, NJ: Jason
Aronson. http://pegasus.cc.ucf.edu/~drbryce/Play%20Therapy%20Techniques.pdf


Additional Resources


Massachusetts General Hospital

Website: http://www2.massgeneral.org/schoolpsychiatry/
Mission: This website provides resources for parents, educators, and clinicians related to mental
health issues that many of our students may experience.
About the Website:
For Parents

Parents have access to this website and information about child mental health, screening,
and medications. The site helps parents navigate through the various informational tools,
and is helpful for parents who are in the early stages of exploring possible causes of their
childs difficulties, as well as for parents whose child has already received a diagnosis
from a trained clinician.

For School Psychologists & Educators

Like parents, school psychologists and other educators have access to information
relation to child mental health, screening tools, medications, mental health within the
classroom, which include; educational evaluations, school-based interventions, creating
safe school climates, and curriculum for teaching emotional regulation skills.


For Clinicians

This website is also useful for clinicians looking for further information about child
mental health issues, medications, screening tools, etc.

Useful Tools:
Child/Adolescent Mental Health Information
Medical conditions described:

Anxiety (Generalized Anxiety Disorder)

Separation Anxiety Disorder

Social Phobia (Social Anxiety Disorder)

Panic Disorder

Obsessive-Compulsive Disorder


Bipolar Disorder (Manic Depression)

Attention Deficit/Hyperactivity Disorder (ADHD)

Autism Spectrum Disorders

Checklists for Preliminary Screening

Checklists include but are not limited to the Child Behavior Checklists (CBCL), BASC-2,
Conners 3, Home Situations Questionnaire (HSQ), and the School Situations
Questionnaire (SSQ).

Screening Tools and Rating Scales

Screening tools and rating scales are used to assess various medical conditions. These
tools and scales are categorized and individualized into tables for each medical condition.


Mental Health in the Classroom

Some of the questions addressed in the Educational Evaluation section include, when
might an evaluation be necessary, what is an initial educational evaluation, and how does
an initial educational evaluation get underway.

School-based interventions are broken down for each of the medical conditions discussed
on the website, as well as include additional interventions for medical concerns like
eating disorders, conduct disorder and oppositional behavior, and suicide.

Creating safe school climates is an important topic addressed on this website. The
website aims at providing parents and educators with information surrounding incidents
of targeted school violence, how to build a connected school culture, and how to assess
threats in students of concern.

This website provides users with resources and tools for implementing curriculum based
on improving or teaching emotional regulation skills. Among these resources are PDF
documents related to emotional regulation, self-calming methods, reframing feelings, and
conflict resolution.


Information pertaining to the medications used to address medical conditions is provided

for parents, educators, and clinicians to identify possible side effects that their children,
students or clients may be experiencing. This information is useful for clinicians and
parents, to adjust medications to better meet the medical needs of the child.