Professor Robert Friedberg Hi,  everybody, Bob Friedberg again here,   talking about popular culture stories and  metaphors in cognitive behaviour therapy   with youth. In this first section  I’m going to talk a bit about the   literature on cognitive behaviour therapy  for multiple disorders, and then, why we   would want to include popular culture stories  and metaphors in our work with young people. So, as many of you know, cognitive therapy is  the first-line gold standard treatment for a   variety of disorders, including depression,  anxiety, autism spectrum, eating disorders,   disruptive behaviour disorders. Basically,  the whole gamut of DSM-5 problems. The   effect sizes are very, very promising,  that the theory is very robust. In fact,   one of the most interesting things is about  a decade ago, the Psychiatrist, John March,   predicted that in medical schools,  that cognitive therapy may be housed   in the Department of Neurosciences. So, all of  these type of things recommend CBT with youth. Despite its wonderful empirical support,  it doesn’t help everybody, and sometimes,   even the best things need a little bit  of a nudge. So, to tell you a first story   about popular culture, is one of my favourite  movies is Black Panther, and in Black Panther,   the movie of the superhero, there is a line  which is said, “Just because something works,   doesn’t mean it can’t be improved.”  And that’s the whole part of this talk. This is not to replace whatever we  do in cognitive therapy, but rather,   to augment what we’re already doing, and  that is – that approach is completely   consistent with the legendary Cognitive  Therapist, Phil Kendall’s idea that good   cognitive therapy practice should be done  with “flexibility within fidelity.” So,   all of these approaches are flexible, they’re  modifications of different cognitive techniques,   but they are all grounded in the theoretical  paradigm, the basic theoretical paradigm of CBT. So, let’s give a couple of  examples. In this section,   we’re going to talk about the use of metaphors,  popular culture heroes and stories. So,   here’s the first. Superhero stories, they  are so compelling. What’s so compelling about   superheroes? One thing that’s common among all  superheroes is they all have an origin story,   and most of the origin stories that superheroes  have, like Spiderman, Black Panther, Superman,   and my personal favourite, Batman, is they  all have trauma. That all of these – all of   their origin stories include some sort  of trauma, and these superheroes become   superheroes because they endure and persist and  thrive after their trauma, after their crises. So, I invoke superheroes almost all the time  in the stories in which I work with kids who   enjoy them, and sometimes, you can really,  really enhance and engage the kids by using   superhero stimuli, like the one I just used.  That oftentimes, I have these masks in session   and the kids can choose their favourite  mask, and I’ll choose my favourite mask,   which is typically Batman, and often, when we  try on the coping skills, we say, “Well, what   would Batman do?” And we put our Batman mask on  and apply the coping skills as Batman or Superman   or Wonder Woman, or any of those others, and then,  superheroes then become really nice covert models. The nice thing about Batman, for me, is that  Batman is a superhero who’s, ultimately,   human. He has no superpowers. The only powers  he has are the things we’re all endowed with   resiliency, flexibility, persistence, grit,   all of those things that are so important  to help kids learn and internalise. Here’s another metaphor type of approach, and  metaphors, like superheroes, very helpful,   that can engage kids, that can make our  approach much more experiential and memorable,   and this is a technique that I refer to as  “salt versus sugar.” And this technique is   really one of orienting kids to the idea that  they have to check out their assumptions rather   than believing them with complete faith, the most  blind thing. So, this is the way what – this is   the way I do it with a metaphor. I said, “Let’s do  a little experiment,” and let’s see how this is. I said, “I’m going to show you two bowls,” and I  have two plastic bowl – clear plastic bowls. In   one plastic bowl I have salt, put it and I fill  with salt, and the other plastic bowl I fill   with sugar. And I put them on, but naturally, the  child doesn’t see me do this, right? And I put the   two bowls in front of them, and I – they’re at a  distance from here to here, so they can’t smell or   taste it, right? And I said, “Which one is which?”  Now, as we all know, salt and sugar, from about   this far distance, you can’t tell the difference.  So, the – their guess is just an estimate. Now, for all of you who are Clinicians  or experienced with CBT, you know what   the way to solve the problem is in telling  the difference, is that you have to check   it out. You have to taste what’s in what  bowl in order to decide accurately whether   it’s salt or whether it’s sugar. That  – and if – the other lesson of this is,   if you don’t test out accurately whether  it’s salt or it’s sugar, what’s the problem? The problem is that if you’re dipping into  the salt bowl and you’re expecting sugar,   it’s going to be a big disappointment  and a surprise to you. You’re going to   be unprepared. So, if you don’t know what’s  truly in those bowls, you’re very much prone   to inaccuracies. And that’s a way to, kind  of, make the idea of checking out assumptions,   of collecting data and making a accurate con –  forming an accurate conclusion can be memorable   for a kid, rather than just maybe reading  about it or simply hearing you explain it. Now, in the next section that I’m going to  talk about, I’m going to use some cognitive   restructuring and then, rational analysis  techniques that also are modifications   and improvements, perhaps, on some of the  traditional techniques [pause]. Howdie partners,   and welcome to thought prospector.  That’s me, I’m the thought prospector,   and I’ve been brought in to help you learn  to change some of y’all thinking. Now,   here’s some of – here’s some ideas of what  you can do. I get my ideas through mining,   and mining helps you discover what is there in the  mind that is true gold, rather than false gold. So, here’s what you do. First thing you do is you  write down your thought that you want to prospect,   and I have an idea right here in front of me, and  it is the thought that goes with maybe being a   little bit sad or depressed, and that thought is  “I’m a loser.” So, we got to mine this thought.   So, the way you mine this thought is you ask  yourself one question at a time, and that question   is, “What would a loser do that I would never  do?” and then, you write that down. Then, you ask   yourself the second question, which is, “What do  I do that a loser would never do?” and you write   down that. Then, you put these things together and  you mine gold with a new conclusion, and when you   come up with a new conclusion that’s better  than “I’m a loser,” you can then do a little   jig like I do and say, “I’ve found gold.” And  that is what you do with thought prospector. Hi, again, everybody. Here’s another fun technique  to help kids re-engineer their thinking. How many   out there, watching or listening, have heard  of Taylor Swift, the pop music star? Well,   she did a famous song, which is called “Shake  it Off,” and one of the things that I – myself   and my supervisees often do with kids, is this  exercise that’s based on Taylor Swift’s song,   Shake it Off [pause]. And here’s what you need  to do in your off – here’s the things you need   to do in your office. The first thing is you  have to access Taylor Swift’s song, either on   your computer or your phone, or however – whatever  device you use for music. Then, you ask the child,   “Do you like Taylor Swift? Are you familiar with  the Taylor Swift song, Shake it Off?” If they do,   there’s no explanation needed. If they don’t,  you just explain the song and its lyrics. The next step is that you take Post-it notes,  these little things that have sticky Post-it   things, and you and the child, or we have  done this in groups, so you and the children,   write down their troublesome automatic  thoughts on the Post-it notes. And so,   each of you then put the Post-it notes,  as many as you have, on your sleeves,   on wherever. So, all the automatic  thoughts, whether they be anxious   thoughts or depressogenic thoughts or angry  thoughts, doesn’t matter, and they’re all on,   and again, as many as the kids have. And then,  you explain to the kids what you’re going to do. So, we’re now going to listen to the Taylor Swift  song and we’re going to do what Taylor Swift says   to do when she says – when she sings it. And for  those of you who are unfamiliar with the song,   right, about 20 seconds in, Taylor’s song – Taylor  Swift sings, “Shake it Off, Shake it Off,” right?   As soon as that lyric comes on, you and the  child, or children if you’re doing the group,   jump feverishly and shake off the thoughts,  right? So, you could see they’re all shaken   off. Most of the time when we do this, the kids  are laughing. They think that is just so much fun,   both by just jumping around and shaking it off and  also, by seeing their Therapist do so, as well.  And then, you say, “Alright, so we shook off some  of those thoughts that walk around with our anger,   depression, scared feelings, but we can’t just  leave them there. We have to pick them back up.”   So, you then pick them back up from where they  fell and you give the child another Post-it note,   where they have to come up with a counterthought,  or a coping thought. Once they do that,   they paste their automatic thought to the coping  thought and they have a coping card that they can   keep in a deck or wherever they might store them,  and that’s called shaking it off. Very fun to do,   totally consistent with the idea of  cognitive restructuring, and again,   aligns very nicely with Kendall’s notion  of “flexibility within fidelity” [pause]. Hi, I am, as you recall, Lieutenant [inaudible –  16: 42] and I am a Private Eye, and what I’m going   to teach you to do with kids and adolescents is  to be a thought detective. And in Private Eye,   we look for proof, we search for clues, and  this is what we do. We take a thought record   and I literally take a magnifying glass and give  my kids a magnifying glass, and we look at their   thought records through these magnifying glasses  as a way to find clues. And the idea on being a   thought detective is looking for evidence,  finding proof. So, as thought detectives,   we go through this stage. We look closely at our  suspect clue, and we say, “What is the facts, what   is the evidence that supports this belief?” and we  write those type of things down. Then, we use the   magnifying glass again to find, sometimes, more  hidden clues, like, “What’s the proof, or what’s   the evidence that this thought is not 100% true or  accurate?” And we write those type of things down. Then, we have a third phase, which is we  go back to those facts that we listed as   confirming our thought or our conclusion,  and we walk, once again, very closely,   and ask, “What’s an alternative explanation for  these facts that support my belief?” And then,   the final stage is to make a conclusion, looking  at what the facts that support the belief is,   what the facts that disconfirm  the thought are, and what are some   alternative explanations for the confirming  thoughts? And then, forming that conclusion. Now, often, with young children when I do this, I  often have a set of mini, mini magnifying glasses   that I actually give to kids during this exercise  as a reminder of how to be a thought detective.   So, a simple, kind of, reminder that we have  to always be looking closely at the evidence   of our thoughts, and that is a test of evidence by  being a Private Eye or thought detective [pause]. This exercise is another more advanced  modification of some rational analysis   techniques. Like Shake it Off, this is also based  on a popular culture hero from Sesame Street,   which is an American TV show that probably  is worldwide, as well. And in Sesame Street   there is a famous character called The Count,  and The Count teaches kids how to count. Well,   in this modification I use the idea of The  Count as a way to help kids change some of   their thinking. Oftentimes, we’ll either draw  a Count or sometimes, I will don this costume.   In the era of remote work, you can even make  this as a psychoeducational video to teach   the rational analysis skills, with yourself  playing The Count. So, I’ll show you how I do. One minute as I – wait, one second as I  get into role. You can watch me [pause].   Ha, ha, ha, ha, welcome everyone, I am Count  Dracula. I help kids work with their thoughts   and feelings so that they can come up with  different ways to view the same situation. So,   here’s what you do. One thing is you write  down the situation that is bothering you. Then,   you write how you’re feeling, and you  may have many different feelings. You   may have feelings like being sad, or you  may have feelings like being worried,   or you might have worries about school, or  you might just be a little bit angry. And so,   you write down your feelings and then say  how strong they are, and you count them, ha,   ha, ha. You count them on scale from one, all the  way up to ten, the highest level they can be, and   then, you ask yourself, “What is going through my  mind right now?” and you write down your thoughts. And then, the next thing is you use The Count’s  questions, and these are the questions that you   might ask yourself to come up with different ways  of thinking. First, you may ask yourself, “Am I   confusing what is likely with what might happen?”  Another question that you may ask yourself might   be, “Are there things about me that I’m paying too  much attention to? Are there things about myself   that I’m paying too little attention to?” Here’s  another question that might be helpful for you,   “Am I being too hard on myself?” And here’s  yet another one from The Count, which is,   “Am I being too hard on other people?” All of these questions help you think in a   different way. That’s why The Count helps you, ha,  ha, ha. Here’s yet another question that may be   helpful, “Am I holding too many rules for myself?  Am I holding too many rules for other people?” All   of them good questions to ask when you have  thoughts and feelings that may be disturbing   you. I hope you see this as helpful from The  Count, and of course, as we end this series,   the key things is to remember to “keep calm and  learn CBT.” See you in another time. Goodbye. Well, you’ve all seen a couple  of different ways to use popular   culture stories and metaphors in CBT. I  hope they’re useful. I hope they augment   what you’re doing with kids. One of the  great things about working with children,   adolescents and families is it allows you to  have fun and be creative. So, I hope in some   way that some of these techniques ignite your  creativity and help you find your particular   voice in the work you do with children. So, thank  you and once again, “keep calm and learn CBT.”