Friday 27 April 2018

Dear David Coleman: My son has a fear of buttons - could CBT help treat this?

Clinical psychologist David Coleman offers parenting advice in his weekly column.
Clinical psychologist David Coleman offers parenting advice in his weekly column.
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Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. My now 13-year-old son has an irrational dislike/phobia of buttons. This fear began when he was two-and-a half. He was in a crèche at the time and I can only guess that perhaps something may have happened there that he associates with buttons. He's had to wear them during school term but just about tolerates them. Wearing them affects his normally pleasant manner negatively. He's thinking ahead now at careers, specifically ones that don't involve having to wear buttons - shirts being the worst offender. Would hypnosis/CBT be a good treatment for him?

David replies: I don't know enough about hypnosis to be able to comment about the relative merits of it as a treatment for phobias. Anecdotally, I have heard stories of people who have had great success and minor success with it, which is of little help to you.

I do have a lot of knowledge about CBT, or Cognitive Behaviour Therapy, as it is more fully known, and I am happy to comment on it as a potential treatment for a phobia.

I think CBT is the ideal treatment for phobias. As the name suggests, CBT aims to get people to look at, understand and then change the way they think about things (the cognitive part), and what they do (the behavioural part), in response to certain feelings.

So, with a phobia or extreme fear, we typically develop lots of avoidance strategies (behaviours) so that we don't come into contact with the feared thing, and we associate the feared thing with lots of negativity (thinking).

Sometimes our negative thinking about the feared object or situation, just reinforces and exacerbates our fear, such that it becomes a really negative cycle. We can convince ourselves that we are powerless to overcome the fear and the more we powerless we feel, the more fearful the thing can become.

CBT will help your son to understand his own negative thinking and how that thinking style may be adding to his phobia. Moreover, he will be taught how to use positive self-talk to reinforce a more positive thinking style that focuses on his ability, rather than his inability.

CBT for phobias also involves learning how to regulate your body's physical response to the anxiety that you feel. So your son can learn how to recognise the impact of adrenalin (the hormonal response to fear) and can learn relaxation strategies (like breathing, or muscular relaxation, or visualisation techniques) that can reduce or even eliminate the adrenalin, leaving him or her feeling more relaxed and feeling, physically, less anxious.

Once he has a successful relaxation strategy that can reduce his experience of anxiety, he can then begin a graded exposure to the feared object or situation. The first step, for example, for your son might be to imagine buttons while using relaxation techniques to reduce his anxiety.

Then he might see buttons, at a distance, again using relaxation to regulate his anxiety, to the point that he can think rationally enough to be able to use positive self-talk to remind himself of his ability to cope and so on.

Gradually, over time, he can challenge himself to come closer and closer to buttons, including holding them, using them and fastening clothes, while always regulating his anxiety such that it doesn't spiral out of control or threaten to overwhelm him.

Sometimes, a youngster might also do work with their therapist about the core beliefs they have, that underlie the anxiety. So, for example, if your son had witnessed a child choking on a button, then he may have come to believe that buttons can kill you if you're not careful.

So, once your son becomes aware of the specific core beliefs that underlie his fears he may be able to challenge, better, any core beliefs that are either irrational, or so unlikely as to make it almost impossible for the belief to be realised.

Naturally, the success of CBT for your son's phobia depends on the skill of the therapist and their experience working with teenagers, as well as your son's desire for, and commitment to, change.

With therapist skill and your son's effort, CBT may be the ideal way for him to challenge and overcome his fear of buttons.

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