Thinking About Thinking Webinar

Thinking About Thinking: Rare & Resilient Webinar 3

Rare & Resilient Webinar 3 – Thinking About Thinking


Tyler Bradley, Male Speaker, Walter Perez, Video Narrator, Caitlin Shneider, Melissa, Video Narrator #2, Emily Ventura


Emily Ventura  00:00

All right, well, I’m excited to see everybody for the third webinar in our series. And today, as you might remember, we are going to talk about thinking. And this is just a quick overview of what we’re going to cover today.

So we’ll start with a quick recap of what we talked about last week. I know many of us were here, but we’ll just sort of hit the highlights like we did last time. And then we’ll dive into thinking and we’ll talk specifically about the cognitive triangle, how it’s related to the way we feel and the way we behave. We’ll talk about some thinking traps, the ways in which our mind might fall into some some traps. We’ll talk specifically about one kind of thinking trap, which is called catastrophizing, which is really important for kids that experience chronic pain and chronic itching. And we’ll talk about some thinking related coping skills.

So just as a quick recap from last time, last time, we were talking about stress management and talking about what is stress. We think of stress as an event or an experience that expends the resources of a person. We talked about it kind of like a piggy bank that has tokens in it. And that when we have stress, that stress takes tokens out of our piggy bank. And so it could be that we have so many things that are stressful in our world that we are out of tokens. So the goal is to minimize the number of tokens that get taken out when we have stressful things happen, and therefore kind of reduce the impact of stress on our resources or our piggy bank. We know that living with a chronic disease is an ongoing stressor.

Parenting, a child with a chronic disease is an ongoing stressor. So it’s constantly taking tokens out and so we’re trying to think about ways to preserve the tokens that we have in there or add to them. And we talked about stress in the parent child relationship, and acknowledging that this is a two way streets, in that the way that a parent feels influences the way and the experience of the child. And the child’s experience then influences the parents and it’s a circle, and it happens over time. It can be the other way too, that a child’s experience then influences the way that parent feels. And it goes round and round.

We talked about that to highlight that it’s important for kids to learn stress management, but also for parents too. And that, especially for parents of younger kiddos, that are infants and toddlers that can’t learn a coping skill and practice it, it’s even more important for parents to be practicing stress management. So we talked about the foundation of stress management, kind of like adding tokens to our piggy bank, that way we have more.

And we thought about that in the context of that mind body connection we’ve been talking about. So to care for our mind, we have to care for our bodies, which means taking care of our bodies, treating illness symptoms, going to the doctor, making sure that we’re eating and drinking in a balanced way, that we’re sleeping in a balanced way. And also getting some physical activity throughout the day in a way that feels good to our bodies.

And we talked about what happens when we don’t do that, thinking about like being hangry of, you know, missing lunch, and then feeling not feeling so good. Or when you’re sitting all day long at work and then you’re not feeling so great at the end of the day. So we talked about how that can impact how we feel and our mood. Then we specifically talked about four different stress management skills, which target the biological aspects of stress, and the psychological aspects of stress. So the two skills we talked about for biological were diaphragmatic breathing, which we also called like belly breathing, if you remember that Elmo video. And then square breathing, and then progressive muscle relaxation, which we called PMR.

And both of them do the same thing, in that they’re trying to trick our body to think that we’re relaxed, so that we can turn off that fight or flight response, and therefore stop sending it signals to the brain. Then the two strategies we talked about for the psychological aspects of stress, were guided imagery, so trying to use our five senses to explore a certain part of our environment, or to go somewhere else to use our imagination, to be able to direct our attention away from something that’s more difficult or stressful. And mindfulness. Similarly, just being in control of where we’re giving our attention. 


Caitlin Shneider  04:38

So throughout the webinar series, we’ve been using this picture as a framework of what we’re talking about. So we’ve talked about pruritus as this process that happens in the body and one of the things that happens after that is we experience itch, which is the sensation in our skin. And that then leads us to scratch, which is the behavior.

We’ve talked about that there are these biological, psychological and behavioral parts that influence the impact of pruritus on Itch, and itch on scratching. So we’ve been working on learning different things that can help with this. And we’ve talked about it kind of like a light switch in that it’s not the on/off switch, but it’s making the itching, the itch, brighter, or dimmer, and we’re trying to learn strategies to make it dimmer.

So last week with stress management, we were really focused on biological and psychological factors. And this week, we’re going to focus on just the psychological factors, specifically thought patterns. So if you remember from the first series, we talked about the psychological factors that influence it, which were our thought patterns, the way we think, our affect, which is like our emotions, our awareness to the present moment, which is what we call mindfulness, and stress. And so if you look at this list, we talked about stress last week. We did that. We talked about mindfulness last week in the context of stress, so we’ve done that. You can’t change emotions, but we can change the way that we think. And that can influence this. 


Caitlin Shneider  06:19

And so that’s where we’re going to start. And so as we start to talk about thinking, it’s also important for us to consider child development and how children learn to think and where they are in terms of their thinking. So there was a psychologist named John Piaget, who has this theory about the way that kids learn to think over time and this picture just kind of represents that. But what we know is that younger kids, under the age of seven, have… their attention in terms of where their brain is developing, is really focused on learning about their environment.

They’re learning about different parts of their environment, and they’re using their senses to explore that. And they’re starting to understand that they’re separate from other people. They’re starting to understand that their thoughts are not everybody else’s thoughts. Whereas the older children that are seven and up, are starting to develop more advanced thinking skills. So they’re starting to think about being able to take another person’s perspective. And at the teenager level, are able to think more abstractly or reason or sort of notice certain patterns in the way that we think.

So today, we’re going to talk about thinking skills. And so they’re really going to be more appropriate for older kids and teenagers and for you as caregivers. And so if you have a younger child, this will be something that’s great to save for when they get older, or to use for yourself as well. But that’s something just to keep in mind. So this is really who this will be most helpful for is these older kids. And so as we’re talking about thinking, we’re coming to this with the idea that changing our thoughts, or changing our relationship to our thoughts, might help us turn down the itch sensation.

And I’m gonna explain more about what I mean in terms of changing our relationship to our thoughts. But as you might remember, from the first webinar, we talked about two specific thought patterns that were related to the itch experience.

One of which was thoughts that emphasize the negative meaning of itch, specifically, worrying about itch, and feeling helpless in the context of itch. And the other one was more acceptance-based thinking, accepting our experience as it is and not not having a negative reaction to it in the moment. So what the data have shown, as you might remember, is that thoughts that emphasize this negative meaning we see is associated with increased itch, and increased scratch. And acceptance based thinking is associated with decreased itch and decreased scratch.


Caitlin Shneider  09:08

So let’s dive in and start start talking about what this means. So we know that as human beings, we have about 70,000 thoughts a day. That is a lot… a lot of thoughts. And the thoughts that can go through our mind are things that maybe don’t make sense, things we don’t want to have going through our mind, things that we’re actively thinking about. There’s a whole number of things that go through our mind. And sometimes we have thoughts that just pop into our mind that we’re not intentionally trying to think about. And we call that an automatic thought. It automatically pops into our head.

And these automatic thoughts can be positive, they can be neutral, and they can also be negative. And we know that having a lot of negative automatic thoughts can be really distressing and that negative thoughts in particular can be kind of sticky, in that they get…we get stuck in them. So that kind of raises the question of, well, why do we have negative thinking? Is this helpful for us in any way? And so I think this video can be a helpful way of understanding this a little bit more.


Video Narrator  10:15

Okay, so you got a new sweater. It looks great, and you’re getting tons of compliments. But then just one person said something snarky about it. And even though you got all that praise, you can’t help but stew over the negative comment. Why is that? Why does my mind seem to  dwell on the negative?


Video Narrator #2  10:37

A lot of my research focuses on how people tend to get stuck in particular ways of thinking and what enables them to get unstuck. 


Video Narrator  10:45

Allison Ledgerwood is a psychology professor at UC Davis.


Video Narrator #2  10:49

I got to study how humans think and how we could maybe think better.


Video Narrator  10:52

We all know the expression about seeing a glass half full or half empty. It isn’t just what you see, but how you see it. And the way you describe that glass to people can really change how they feel about it. Allison wanted to know what happens when you try to switch your way of thinking from the positive frame to the negative frame, or vice versa.Her research team brought two groups of people into the lab and told them about a new surgical procedure. Group one was told that the procedure has a 70% success rate. For group two, they framed it as a 30% failure rate. 


Video Narrator #2  11:31

It is the same exact procedure, and they’re giving you the exact same information, but one doctor is focusing on the part of the glass that’s full, and the other doctor is focusing on the part of the glass that’s empty. 


Video Narrator  11:40

So no surprise, people like the procedure when it’s described in positive terms, and they don’t like it when you focus on the failure rate. But then the researchers pointed out to the first group that you could also think of the procedure as failing 30% of the time. Suddenly, people didn’t like it anymore. And when they tried a similar thing with a group two, pointing out that the procedure had a 70% success rate, people didn’t change their mind. 


Video Narrator #2  12:06

And over and over again, in studies like that, we find that people seem to get stuck in the negative way of thinking about it and it’s hard for them to flip and focus on the positive. 


Video Narrator  12:16

So once you frame something negatively, it really sticks. 


Video Narrator #2  12:20

It makes sense from an evolutionary or functional perspective that our minds are built to look for negative information in the environment and to hold on to it once we find it.


Video Narrator  12:31

 Imagine your prehistoric ancestors. You don’t want to forget that there might be predators around


Video Narrator #2  12:37

In many situations, we want our minds to be grabbed by negative information so that we can fix problems when they’re there. 


Video Narrator  12:44

But then there are other situations, where we want to get over some small imperfection or a bit of bad news, when it’s not helpful to fixate on the negative. What do we do then?


Video Narrator #2  12:53

 What I really take away from this research for my own life is that it’s difficult to see the upside and that it takes work, literally, that we have to put some effort into looking at the bright side of things. We can’t assume that our mind is just going to do that automatically. And that it’s very easy to just keep tilting back towards the negatives.


Video Narrator  13:14

 And this is something you can counteract with practice, like spending a few minutes each day thinking about the things you’re grateful for. Doing this regularly can help it become a habit. And it turns out that this negative bias can change over time. Remember when you were younger, and any bad experience felt like the end of the world?


Video Narrator #2  13:33

So this kind of pervasive negativity bias starts to diminish. And so in our research, we we find that the stickiness of the negative frame seems to disappear entirely by the time people are in their 70s. And they seem to flow back and forth between negatives and positives much more easily.


Video Narrator  13:48

 So maybe that’s something we can all be grateful for, that there are actually some good things about getting older. How do you get out of negative ways of thinking? Okay.


Caitlin Shneider  14:01

So I think that just helps us understand a little bit more about the reasons why we have negative thinking and that it has a purpose in some ways, and that it can protect us in some ways, but that it takes practice to get unstuck from negative thoughts. And so when we’re talking about thinking, we also want to talk talk about the relationship between the way that we think and the way that we feel. So we know that there is a connection between the way that we think and both the way we feel and our behavior, what we do. And so this helps us be able to understand ways that we can not feel as bad.

So we can’t change the way we feel, but we can change our thoughts and our behavior. And by doing those things, we can change the way that we feel. So an example of this, I’m sure this has happened to several of us, is let’s say we’re walking down the street. We pass somebody that we know, and you go to wave at them, and they look at you and they don’t wave back. So like, what would go through your mind if that were to happen? What are thoughts that could go through your mind? Or maybe like have if this has happened to you? And you can either put it in the chat or just unmute.


Emily Ventura  15:24

I mean, I would think that I have done something wrong.


Caitlin Shneider  15:27

Right. That might be one thing that many of us would think is like, “Oh, gosh, did I do something wrong? They didn’t wave back at me”. What else could go through your mind? It could be something..Sorry go ahead.


Tyler Bradley  15:52

I said that they don’t remember who you are. 


Caitlin Shneider  15:54

Yeah, “Maybe they don’t remember me?” Absolutely. Tyler. It could be “They didn’t see me.” Right, there are lots of different ways that we could think about this. And so we’re going to look at this in the context of that cognitive triangle, right. So if if we go with what Emily said, of, “Oh, gosh, I did something wrong.” If that was a thought that popped into our mind, how might you feel the next time that you saw that person?


Emily Ventura  16:22

I’d feel nervous or anxious.


Caitlin Shneider  16:31

Yeah. Like anxious, kind of worried. Absolutely. And that thinking about if you feel anxious or worried, what might you do the next time you see that person? 


Emily Ventura  16:50

Run the other way. 


Caitlin Shneider  16:51

Haha. Right. Like not even engage with them. You’re gonna do something totally different. Absolutely. What if we had the thought that they were busy or they were like, distracted and they didn’t see you? If we had that thought, wow do we think we would feel the next time we saw them? Yeah, haha we might be like, “Hello!!” haha. But how do you think you would feel if if that was the thought that popped into your mind? That they didn’t see you.


Tyler Bradley  17:22

 You wouldn’t feel so nervous.


Caitlin Shneider  17:25

Right. You might not have as strong of a negative response to them. You might feel not nervous, or you might feel like, you want to make sure they saw you, just like Emily was doing. And that might drive your behavior to make sure you go out of your way to make sure they see you. Right. And so I think this example illustrates that the way that we think influences the way that we feel, and that also influences how we respond. And so when we think about this, it’s important to acknowledge, as we did, that having some of these negative ways of thinking can be protective.

It’s, it has a purpose, from an evolutionary standpoint, right. There’s a reason that we have it. And in some ways, it can be protective. Kind of thinking about worst case scenario prevents us from getting hurt, or from having to experience negative things. But it’s also important to acknowledge that expecting the worst can be exhausting, and can keep us from doing things that are important. And so it’s important to acknowledge both of those things. 


Caitlin Shneider  18:30

And so we’ll talk about specifically, thinking traps, which are ways in which our thoughts are not giving us all of the information, or they’re kind of biasing the information that we’re getting. So when I think about thinking traps, I think about it kind of like this pair of glasses on the screen, in that our mind is adding something to what is not there and it’s shaping how we’re thinking about our environment, or experience. And what we want to do is to be able to say, “Oh, I have these glasses on And that’s why I’m seeing pink”, and be able to understand that.

And we’ll talk more specifically about that. So I’m going to talk about a number of thinking traps and just explaining them a little bit. And I’m going to go through these relatively quickly. One of the thinking traps that is very common is called “all or nothing thinking” or “black and white thinking”. So an example of this might be, “Well if I didn’t get 100% on this test, I’m a failure.” So it’s either perfect, or it’s failure. Or I did this completely right or I did this completely wrong. There are no shades of gray, there’s nothing that’s ambiguous. It’s all or none. That’s one thinking trap. Another one is called a “mental filter” in which our mind is only paying attention to certain types of evidence.

So we might only really pay attention to things that we did wrong, and not really pay attention to the things that we did right. And that’s related to this one, another thinking trap, which is “disqualifying the positive”, so automatically getting rid of things that have been positive or things that have happened to you potentially for another reason, but automatically throwing those out. Another one is “jumping to conclusions”. So particular two kinds of jumping to conclusions, one of which is “mind reading”, so imagining that you know what another person is thinking, and “fortune telling”, which is thinking that you know, what’s going to happen in the future. I think, probably many of us have done this before, where we have an interaction with someone just like that example we were talking about, of them walking down the street.

They didn’t wave at us, and we think, “Oh, they must be so mad.” That is trying to read their mind and there’s no way we would know that unless we actually ask them that. And fortune telling, predicting what’s going to happen in the future. Another one is “overgeneralizing”. So everything is horrible, or nothing good ever happens. There’s again, no degree of gray. And so it is taking one thing that’s happened and making it true about absolutely everything and making these big conclusions. So oftentimes, whenever I hear “everything” or “nothing”, there’s like a little flag that goes off in my in my mind.

Another one that I highlighted at the start of today was “catastrophizing”, which is also called “magnification”. And “minimization”, which we’re going to come back to and we’re going to talk more about this. I don’t really like the way that this is worded on here. I think of magnification and catastrophizing more like spiraling thoughts.

You have one thought that leads to another thought, which leads to another thought, which leads to another thought. So it’s… an example of that could be, “I missed three questions on my math test. So that means I got a C on my math test. Oh my gosh, if I got a C on my math test, well, that means that I’m gonna get a C in my math class. And then if I get a C in my math class, that means my GPA is going to drop. And then if my GPA is going to drop that I’m not going to get into college”.

It just it spirals down, from one thing to the next. That’s what catastrophizing is. And minimizing on the other hand, is just shrinking something to make it seem less important. Another one is, words that tell us that we are making a judgment about what is happening around us and that is therefore adding information to what is really happening in front of us.

So when I hear words like “should”, or “must”, or “it ought to be”, this is us adding a judgement about the world around us. And therefore we’re adding something to what is happening around us. And so putting that in can make us feel guilty or make us feel other negative emotions. So that is one way that our, our glasses might be distorting sort of what we’re seeing. And then the last one we’ll talk about is “personalization”, which is blaming yourself or taking responsibility for something that was not your fault. But there are other factors that are contributing to an outcome and kind of discounting those other factors and taking on more of the blame, then might actually be the case.

Or, on the other hand, blaming everybody else for a big part of what happened, when part of what you experienced was that part of it was your fault. And so by talking through these thinking traps, we talked about this idea that we’re adding something to our reality. We’re adding something to this experience. And so in acknowledging that, we acknowledge that the thoughts that go through our mind are not the facts, that we are seeing the world through these colored glasses that we talked about. 


Caitlin Shneider  24:08

And as I mentioned, we were specifically going to come back to catastrophizing, which is common for kids that experience chronic pain and chronic itching. And it really has three big parts, one of which is feeling helpless in the context of pain or itching, magnifying that experience, it gets bigger and then rumination, which is like a cycle.

It’s constant worry, getting stuck in a loop in negative thinking. And so that might be something like, “I worry all the time whether the pain will end. I feel like I can’t go on much longer with this pain. This is awful and it’s never going to get any better. I’m afraid the pain is going to keep getting worse”. Those are some examples of what pain catastrophizing would be like. And what we noticed is that as we talked about the, the thoughts that emphasize the negative part of itch, helplessness and the worry, are right here. So catastrophizing and specifically, catastrophizing related to itch is something that increases that itch sensation.

And as we’ve talked about, given the shared neural pathway between pain and itch, what we know about pain might also be helpful for kids that experience chronic itch. And we know that kids that experience chronic pain when they have pain catastrophizing, they have greater pain, so greater pain intensity, greater pain frequency. We know that they have more impairment in terms of what they’re able to do. So going to school is disrupted, sleeping is disrupted, being able to move around is disrupted. And then they also have worse quality of life as well.

And it kind of raises the question of, do kids with chronic itch also have catastrophizing specific to itch? So could we have something like itch catastrophizing? And people are only just starting to study this. So we they have just relatively recently published a measure that measures itch catastrophizing, and so it includes things like “The itch will never stop”, “There’s nothing that I can do about the itch.” So there’s the helpless. “I will scratch myself until I look horrible”. “This itch will get worse and worse and worse”. There’s the magnification. “I cannot stand the itch”. There’s the helpless again.

So this is a new area of research and we don’t yet have data on how this impacts outcomes. I would guess it would be similar to what we know from kids with chronic pain in that this does probably impact functioning and quality of life and it has been shown to be associated with increased itch sensation. And so the question is, how do we cope with having negative thoughts related to itch?


Caitlin Shneider  27:20

And there are two large evidence based treatment approaches that have been shown to be helpful. One is called Cognitive Behavioral Therapy, which we call CBT. And the other is called Acceptance and Commitment Therapy, which you would think would be called “ay-cee-tee.” It’s not. It’s “act”. So it’s CBT, and ACT. And so what are they? CBT is looking to change the thoughts that we have. So in the context of this cognitive triangle, we’re changing our thoughts, which then allows our feelings to change and we’re allowing our behaviors to change. And that, as we just said, allows feelings and behaviors to change and reduces itch sensation. But oftentimes, for kids that have a chronic disease, sometimes the thoughts that go through our mind are true. And it doesn’t make sense to change the thoughts because that is the reality.

So that kind of raises the question, “Well, what do you do, then if you can’t change the thoughts?” And that is often where we use ACT. And ACT is accepting the thoughts that go through our mind and distancing ourselves from the thoughts and continuing to engage in activities that are important to us. Again, by doing that, we’re then allowing our feelings to change, and allowing our behaviors to change and reducing that itch sensation.

And a key part of ACT is this idea of cognitive fusion, which is a fancy way of saying that the self, so who we are as a person, and what goes through our mind, the thoughts are fused. We sort of see them as one. We struggle to separate ourselves from our thoughts and then our thoughts become our reality. And it feels, by having that happen, we then feel removed from reality, and it gets very hard to pay attention to things that are outside of our head.

And what we strive to do in ACT, with an ACT framework, is to do cognitive defusion. So being able to separate ourselves from our thoughts, to take a step back from our mind, and to be able to observe our thoughts without getting caught up in them or getting lost in them. And so, whether we’re we’re using CBT or if we’re using ACT, the first thing that we want to do is to notice our thoughts, which is mindfulness, the skill that we’ve been talking about.

And one of the easiest ways to do that I have found, is simply adding this in front of whatever goes through your mind: “I am having the thought that…… that person is mad at me because they didn’t wave at me.” “I’m having the thought…….. that I’m worried for my presentation at work tomorrow”. I can also say, “The thought…..whatever…. is going through my mind right now.” Or you can simply describe what’s going through your mind. “These are thoughts. These are worries, I am daydreaming.”

Being able to describe what’s happening allows you to have distance between the thoughts going through your mind, and yourself. And that is the goal, to be able to distance yourself and notice the thoughts going through your mind. So that we can either change them, or accept them. Those are the two different ways in which we would respond. And I think this video is a really helpful way of thinking about this. So if you’ve ever been to a restaurant that has like, a sushi train, this is a helpful analogy. Or, if not, it’s still helpful, I think.


Video Narrator  31:13

So imagine that you’re sitting in front of a sushi train at one of those Japanese restaurants and there are all these dishes going past on the train. And in the center, there is the chef creating all of these dishes. The chef is like your mind, and the dishes are like all of those thoughts, ideas, memories that keep cropping up coming and going all day long. Some of the dishes on that sushi train may be very appealing. Some of the stuff on that sushi tray may be unappealing. And some of it may be neutral and take it or leave it. And it’s much the same with our thoughts, memories, ideas that pop up throughout the day.

Some of them are very pleasant. We really like them. We want them and we want to hold on to them. Some of them are very unpleasant, and we just want to turn away from them get rid of them. And a lot of them are kind of neutral. They’re neither positive nor negative. So all day long, the sushi chef of our mind is creating all these different dishes and the train keeps carrying them round and round. These thoughts keep cropping up throughout the day.

Now we can learn to step back and watch our thoughts coming and going in much the same way that we can step back and watch that sushi tray. An unpleasant dish pops up on the train, we don’t have to turn away in disgust and horror. A pleasant dish comes by, we don’t have to reach over and grab it and stuff it down our mouth. We can do the same with our own thoughts. We can step back with an attitude of openness and curiosity and watch them come and stay and go in their own good time.


Caitlin Shneider  33:05

So I think that’s a helpful way of just giving us context or an example for ways in which we might think about our thoughts. Another way that I often explain it is thinking about like clouds passing in the sky is watching your thoughts go by and just starting to notice them and observe them. So as we talked about that is the first step is noticing the thoughts that go through our mind. And that can be really challenging to notice what is going through your mind, especially if this is new.

Once we’re able to do that, we can start to use some specific coping skills or skills that allow us to either change our thoughts, or accept and distance ourselves from those thoughts. So we’ll start with the first one, which is a CBT skill, which for kids, I often call being a detective and sort of helping them think about what happened.

And so the first part of being a detective is this is one way of doing it, just figuring out the facts of what happened. So helping your your child identify the situation that we might be talking about, if there is a negative thought that’s going through their mind is, who was there? What happened? When was it? Just getting lots of specific details, and then helping your child understand what kinds of feelings were going through their mind. And really separating that from the thoughts that were going through their mind.

And rating the intensity of their emotion can be helpful, but not not necessary. So for example, if we’re using that idea of like, “I missed three questions on my math test, and now I’m gonna get a C and now I’m never gonna get into college”, we might start with talking about all of the specifics about what happened related to missing three questions on a test, helping them understand their feelings. So “I feel disappointed”, maybe “I feel worried”. And then the thoughts that were going through their mind, “I got to a C on my math test I’m such a failure” could be one. And once we’re able to identify some of the facts, the next part is spotting the thinking trap. So we just talked about a number of thinking traps and this is all of them sort of put together.

There’s a couple additional ones in here, but going through and saying, “Okay, where are there thinking traps? Where are there ways in which my thoughts might not be telling me the full truth of what’s happening or it’s adding something to the reality?” And then working with your child, to be able to identify information or clues that disprove that thought that goes through their mind. Helping them shift their attention to pieces of information that might go against their thought.

Because part of what we’re we’re talking about is that this negative thought is really focused on negative pieces of information, and it might be missing other positive things. So something that might be a clue to disprove this thought of, “I got a C so I’m a failure” is, “Wow, have you failed at everything in life? Are you the captain of the baseball team? Oh, that’s a clue that you’re not a failure”.

What else can we add here? “You got an A and a B, on your last two tests, that shows that you’re not a failure”. You’re just aggregating a bunch of clues that help them understand that this is not the reality and they’re in a thinking trap. And then working to create a thought that is more balanced, one in which that acknowledges their experience, and parts of their reality. So a more realistic or balanced thought could be something like, “I got a C on my test, and I feel disappointed.” “I got a C my test and next time, I’m going to spend more time studying, so I feel more prepared”.

Something like that, that honors their experience, while also more of the facts of the situation. And the emphasis is really on this more balanced thought. And the idea is that by having this more balanced thought, again, thinking of that cognitive triangle, we’re able to then change our negative emotional reaction. So what we just did in sort of the kid friendly version, is essentially this, which is the more adolescent and adult focused version, which is identifying what happened, identifying how our emotions responded, identifying the thoughts that went through our mind and then really digging into facts that support the unhelpful thought and facts that go against that, creating that balanced thought, and then rating our emotion after to notice if there are changes to our emotion.

And this is really a very simple way of looking at this. This takes a lot of time. And so I want you to understand that this is not a silver bullet of, “I’m having a negative thought and I feel really awful. Let me get out a thought record, if you will, and work through this and I’m magically going to feel better”. I would love for that to be true. That probably will not happen haha. This takes time. And I would often say like months of counseling and therapy to be able to start to shift the way that we think and this is a tool that we use.

But I want to acknowledge that this is a very simple way of thinking about this and it helps us understand this. But that changing some of the way we think takes time and it takes practice. So I just want to set that expectation that this is a tool that we can use, but it is not not the silver bullet that is automatically going to fix the way that we feel. So that is one CBT based tool. 


Caitlin Shneider  39:18

And we’ll switch gears and talk about some ACT tools, which again, are accepting our thoughts and trying to distance ourselves from those thoughts. And some sort of kid friendly ways of thinking about that, we’ll talk about our leaves on a stream, releasing balloons up into the sky, and being the pond. All of this again is coming from that idea of cognitive defusion, separating the self from our thoughts, trying not to to be to be our thoughts. So this is a little video that I think explains leaves on a stream, which can be helpful. 


Video Narrator  39:59

Phase Three: leaves on a stream. The idea behind this exercise is to simply notice your thoughts coming and going without getting caught with them, without getting into a conversation with them, not trying to control them, not getting tangled up with them, just noticing them, and then letting them go. When you are ready, begin. Sit comfortably in your chair, with your feet on the ground if you can, and your back straight, but not too straight, sitting against the chair.

If you wish, close your eyes, or have a heavy lidded gaze, maybe looking at one spot on the ground. Now imagine you’re sitting on the bank of a stream and that there are leaves flowing past. The stream and the leaves can look any way you like to imagine. Notice a thought that comes into your mind and imagine placing it on a leaf and letting it flow on. Notice each thought, imagine placing it on a leaf and let it float on.

If your mind begins to wander, just notice that and return your focus to noticing the thoughts that come to mind. And imagine putting them on a leaf and let them float on. If your thoughts stop, just imagine watching the stream until the next one comes along. It doesn’t matter if they are good or bad thoughts. Just notice them and imagine placing them on a leaf and have them float away. 


Caitlin Shneider  41:49

I think having this example can be helpful because the idea of distancing ourselves from thoughts and letting them go is very abstract. And sometimes having an example like this is a little bit easier, particularly for kids but also for us as adults. It’s pretty abstract. And so I think this is a helpful way to illustrate it. Another example that I highlighted is this idea of release the balloons. 


Video Narrator  42:18

This type of mindfulness based therapy called acceptance. So if you’re still having trouble letting go of your thoughts, you can imagine yourself writing down each thought on a balloon, and then releasing that balloon up into the air and just allowing that thought to float from your mind as the balloon floats away. Now sometimes,


Caitlin Shneider  42:41

And the last example that I think can be helpful for kids, especially to understand is this idea of being the pond. That we have lots of thoughts and feelings that can exist within the pond, and that we are not any one fish in the pond. So this video will I think walk us through that.


Video Narrator  43:01

I’d like you to imagine that you and your mind is a big lovely pond. In that pond are lots of different kinds of fish. These are your feelings all swimming around together. There’s a happy fish. A sad fish. A sleepy fish. An excited fish. An angry fish. Worried fish. A playful fish. A calm fish. A kind of fish. A selfish fish. So many fish. So many feelings. All swimming around the pond. Your job here is just to be the pond. Be the pond. It’s wonderful being the pond because you can just watch all your different feelings just swimming by.

All of them are okay. Every feeling is welcome. You be the pond and let the fish be the fish. No need to do anything with those feelings except watch them, swimming around. See if you can be the pond now and just watch, seeing what kind of feelings you’re feeling. They just swim past.


Caitlin Shneider  44:56

So again, that’s another way of giving something to be, having something be a little bit more concrete, which I think can be helpful for kids. And for adults, given that this is a bit more abstract. So all of those are really trying to allow us to distance ourselves from our thought by using the idea of putting it on a leaf and letting it float down the stream, or tying it to a balloon and letting it float away. And as I mentioned, all of this takes time and practice.

And it can be really helpful to have a professional help with some of these things, because it can be challenging to start to notice our thought patterns and to start to shift them. So I think it’s helpful for us to have an understanding of our thinking, as well as some tools to be able to help with trying to shift some of our thinking. But it can be also helpful to have a professional to guide us through some of this. And so next week, will be the last week of the series. And so we’ll have two two webinars, one will be on Monday, which we’ll be talking about evidence based interventions from chronic itch.

So that will really be focusing on the more behavioral parts of factors that are associated with itch and scratch. And then on Thursday, we will talk about the process of finding a therapist. So that is what we have coming next week. But I…. that’s that’s what I have for today. So I figure we can pause there and talk about any questions that have come up or reactions or anything that is helpful. But I’ll pause my, my screen sharing and just open it up.


Emily Ventura  46:49

Hi, Caitlin, if I may…I have a few just reactions.


Caitlin Shneider  46:54



Emily Ventura  46:54

Thank you. First of all, I’ve shared with you and pretty openly that I’ve had a unique recent experience where my daughter is now older, and she’s started to experience itching again. And i is just very recently, so we’ve been creating this or I’ve been kind of working with you to create this series and then you know, this experience came up and I almost like I’m experienced it now. And then I also have this like…. I’m thinking about what I would have coached the younger me when I had the itching infant as well. And so I guess just sharing a little bit of my own reaction, and then some of my tips. 


Caitlin Shneider  47:36



Emily Ventura  47:38

You mentioned distancing. I think that that was one thing that was so important for me over the last few weeks. Again, I’ve worked with you as you’ve been creating this series, so I understand the tools that you’re putting out there and the value of those. But I found myself in the middle of her experiencing her itch, knowing the tools but not having just thinking like “How am I ever going to use these tools?”, this is… I’m terrified, I’m, you know, afraid…. I’m anxious. She’s itching. My heart rates up, you know, like I couldn’t get to that space of, you know, I just couldn’t get to that more therapeutic space. And so I had to step away.

And I mean, fortunately, I had, you know, support with me that was able to sit with her while I stepped away. But I think stepping away and just again, allowing yourself to feel like those videos you shared about the pond and the emotions and all those videos like allowing yourself to feel all the feelings because you need that. But you have to be distant to do it, because it’s just too traumatizing to do it in the moment. And then, only then, was I able to get to the point of like, “Okay, so what’s Caitlin been telling me? What has she been putting together? Like, how, how can I you know, put this into practice?” And it wasn’t easy. I appreciate you kind of validating, you know, it’s not easy.

It takes practice to do these things. But it is possible and it is helpful. So if I could give just one piece of advice, you know, for those who are just starting the practice, like just taking that moment to step away and experience these things as you just so mentioned, and then allowing yourself to take a deep breath and say, “Okay, maybe there’s just one thing I can do when I go back”. For me it was controlling my reaction. You know, like, I’m…. watching her itch was stressful to me. But when I went back into her room and was able to just say, “Okay, well she’s itching” and I took a deep breath and my heart rate was slowed, the entire experience just felt more manageable. 


Caitlin Shneider  49:47

Thank you so much for sharing that. I think it’s so helpful to hear your experience as a parent and I’m sorry, that has it’s been more stressful for you more recently. And it sounds like….. I want to validate that it is really challenging and that we’re presenting some new ideas. And I mean, it would be fantastic if we could present all of these, and you could immediately implement them and be like “This is this is, this is fixed.”

And I think it’s going to, as we’ve talked about take time, but what I’m hearing you say is that it sounds like in the moment, you are able to acknowledge this is this is exactly what we’re talking about. “I’m noticing that I feel stressed. I’m noticing that I’m having a reaction to watching my daughter scratch and I’m noticing that my heart rate is going up.” And that is actually using some of the skills we have been talking about.

It sounds like you were very mindful in the moment of what your internal experience was. And I think I would love to hear your perspective on whether you think the the former version of you would have have noticed that or not. But it sounds like you were able to notice that. You might have preferred to have implemented a number of these skills in the moment and that would have blown my mind if you could have done that the first time. But I think it’s really I think that’s the first step is noticing, that “I’m I’m having a reaction. I’m noticing what’s going through my mind.” And as we’ve talked about having the awareness allows us to be able to then understand and then to be able to change.

So it sounds like you were you were using some of the skills we’ve been talking about. And that allowed you to, as you said, take some deep breaths. So maybe maybe you didn’t do diaphragmatic breathing, but you were able to slow your breath down and use some of those stress management skills. So I think that I would be curious about whether the former you was able to respond in the way that you’ve done more recently.


Emily Ventura  51:54

Well, my immediate response is no. Haha. The 26 year old Emily who had the infant child, who was still just grieving kind of the diagnosis, no. But…but I would like to tell myself, essentially telling anybody who’s kind of in that phase and the current self, I guess, that it is….. I don’t know….those are like, acknowledging there’s not much we can change, as you’re saying, right? We can’t change the biology. We can’t change the fact that she’s itching. Hang on….I totally lost my train of thought. I had something better to say….Standby…Oh, no….. it’s just you feel suffocated by the gravity of the diagnosis, for one.

You feel suffocated by the fact that you can actually do anything. Suffocated by the fact that you haven’t slept in days or weeks or months, and your child hasn’t slept. And so those are really hard things to get through. Well I think….I mean, I probably did feel that in my younger self, but I probably didn’t normalize it at all, you know. I wouldn’t have felt those things and felt like “This is real for what you’re experiencing and this is what it is.’ I, you know, probably tried to get through it in a different way. i tried to fix it, if you will.

I think the simple fact of acknowledging it is so important, because then you can acknowledge kind of, as you say, like, “Okay, this is my this is, this is an appropriate reaction to what’s happening And I need to feel all these things, and I am feeling all of these things. what is an appropriate way that I can get through this? I’m not going to fix it.” Maybe eventually, there’s some fixes, But yeah know, the younger the younger, 10 years ago, Emily probably didn’t acknowledge those feelings in the same way that I can now. 


Caitlin Shneider  53:55

And acknowledging your role in her experience too right, is noticing that “I’m feeling stressed and overwhelmed and I’m going to take a minute to have my feelings and process my stress and I’m going to come back to this”, I think is also really skillful, because as we’ve talked about, your stress ,she will feed off of.


Emily Ventura  54:15

Absolutely. Yeah.


Caitlin Shneider  54:18

Thank you so much for sharing that.


Melissa  54:21

I have a question. I think it’s really brought up the point about switching frames and how when you say, you know, when you’re speaking of, you know, the 70% success rate versus a 30% failure rate. And it’s funny, because I’m actually reading a book right now, related to like Don Juan, the teaching of Don Juan with Carlos Castaneda, and he brings up this point. And he used the analogy of when you say, to someone, “Don’t forget the keys” as opposed to “Remember the keys”, reframing can, I guess, function in the form of empowerment.

So I guess from the like, perspective of someone who like, isn’t a patient myself, but is supporting or wants to be there for someone, you know, and not wanting to use phrases like, you know, “This will pass”, you know, because that’s negating their experience, like, you know, are there alternatives, you know, as someone who’s a little separated that that someone could use to empower someone who is managing stress?


Caitlin Shneider  55:30

Sure, sure. I think that you’re highlighting something that’s very important that that language does play such a big role in our experience. I think that ties so nicely to what we talked about is that the words that go through our mind or the words we say out loud, directly influence how we feel. And that can be one way to support caregivers is to use our language to empower them and the same for patients directly. And I think there, there is lots of of data to show that impact, that we call a positive psychology empowering, and more strengths based approach can be really helpful in in helping and reducing stress.


Melissa  56:21

Do you have like, I guess this might be asking too much, but do you happen to have like concrete examples of like, what that would look like from like, a person trying to empower someone dealing with stress or like things you could say?


Caitlin Shneider  56:33

Hmmm sorry, I misunderstood your question. Sure. Ways to empower someone that is feeling stressed? Yeah. What what One example could be is, “Of course, you feel stressed. It makes a lot of sense, you feel stressed. You have a child with a chronic disease. You’re watching someone you love continuously scratch to the point that they are not able to sleep, and you’re not able to sleep. So no wonder you’re stressed. This is a lot for anyone to handle. And what I know about you is that you get through hard things. You’ve gotten through hard things in the past.

And you will continue to get through hard things.” And so in that way I’m validating their experience, while connecting it to what I know about them that they have gone. I could personalize it if I knew that person more in some of the challenges they’ve been through, but drawing on their strengths and saying, “You’ve been able to get through things in the past. And I know that you will be able to get through hard things like this.” You might also connect them to social support or offer, you know, “Are there ways in which I can support you?” I think having a partner, being able to share some of the load is helpful. But that’s one example. Is that sort of what you were thinking Melissa? Okay.


Melissa  58:03

Yeah, thank you.


Walter Perez  58:13

I just wanted to say,


Male Speaker  58:14

Oh, sorry, go ahead.


Walter Perez  58:16

No, no, go ahead. Go ahead. 


Male Speaker  58:17

Please. Go ahead. 


Walter Perez  58:18

No, no, no, please.


Male Speaker  58:21

Hello, everybody. I have a baby with the PFIC 6. So we are new to this. We are just learning. He was diagnosed a couple of months ago. Obviously, he is one year and four months, so he doesn’t even speak. But my question is, when can you start negotiating or put a kid in therapy to help? Like, when can you start using these techniques with with a baby? How young is too young? So that is my question.


Caitlin Shneider  58:49

That’s a great question. I think part of what will be helpful for a younger baby will come next week. And it will also be some of what we talked about last week, which is stress management for the parents. And a lot of what you’re going to do right now is going to be focused on you and the way that you respond to your baby. This stuff will be more relevant for your baby once they are 7, 8, 9. So a little bit a ways away. Right now your baby is processing all the information in their environment. And they are not able to think about the way that they’re thinking and learn a coping skill and implement it.

So it falls more on you as the parent to be able to manage stress to be able to respond to them in different ways. And what we’ll talk about next week is you as the parent are able to shift and shape some of the behavior because you can positively reinforce behaviors you want to continue. And you can not give attention to and try to shift behavior away from things that we don’t want to continue. We’re going to talk more about that next week. But I would say for this specific set of skills that are more thinking based it would be more 7, 8,9 around then. Great question. 


Male Speaker  1:00:08

Thank you. 


Caitlin Shneider  1:00:09

Thank you for joining today. 


Male Speaker  1:00:11

Of course, I will join next week for sure. 


Caitlin Shneider  1:00:13

Great! We are excited to have you.


Walter Perez  1:00:15

Oh, yeah, I just want to say thank you for your presentation today. Very solid. And just to piggyback on what you just said, there, from our experience, 100% that when our child was so young, and it started with us on how we were going to attend to him, how we were going to talk to him, what we were going to do.

So I, from experience, I will say that 100%, that’s been very helpful. And then by example, that kind of ends up trickling in and impacting them. I wanted to say that I really appreciate your your thinking traps. It is so cool to see that because to really identify that, I can probably see how that would have been a little bit more helpful even in the past, even though we probably did do some of those. But to be able to identify it, it’s a really good starting point to know, “Hey, what am I supposed to be focusing on?” or “How should I be changing that?” Right.

And I also wanted to point out that one comment you made in your slide there about that it takes time and practice. I, I have to say that’s so true, right. Because, you know, you can’t go to the gym one day and expect to be buff and have a six pack, like it has to… you have to work at it. And I think I’m speaking to myself on this, but I think as an encouragement everybody else, that we do need to practice it. And then one day, you arrive and you feel like “Oh, wow, it is working”. So I guess I’m just saying give it a chance.


Caitlin Shneider  1:01:46

I think that’s beautifully said, Walter. I think that’s exactly right. And I think it connects to that analogy we talked about last time too, of like getting ready to run a marathon, right. It’s that exact point of we have to build those muscles to be able to run 26.2 miles. And going out tomorrow to run a 26.2 mile run,  I don’t know about you haha, but it’s not gonna go well for me. So it does take time. And I think, I think to your point, the idea of and I think it connects to what Emily said, the first part is noticing it right. It’s being able to say “Oh that is a thinking trap that I fall into.

That one is mine. Like that is something I do!” and being able to notice it in the moment, as it’s happening and saying, “Oh, there there is a judgment” or “Oh, I’m discounting the positive”. That is the first step. And it will take time to be able to then shift it. But it is the first step. And I think if you’re able to do that, that’s fantastic. I think that is a is a great first goal is to be able to start to notice patterns in your own thinking and to catch it as it’s happening.


Walter Perez  1:02:54

Well, thank you for bringing clarity to that. Well done and it’s very helpful.


Caitlin Shneider  1:02:59

Thank you. Thank you so much for sharing. I really appreciate that. I appreciate all the cameras being on too.  It makes it much more more personable.

For Rare Disease Day 2023, we offered a webinar series called “Rare & Resilient Resources: A New Perspective On Coping With Pruritus”. This is the third webinar in the series. This installment discusses how we can work to change the way we think and use the power of our thoughts to cope with stressors.

Webinar Overview

This session  focuses on one of the primary psychological factors that influences itch: thought patterns. The way we think influences how we feel and behave. By changing our thoughts, or changing our relationship to our thoughts, we can help to “turn down”  itch. In this webinar, we identify negative thought patterns, such as thinking traps and catastrophizing. These can contribute to heightened sensation of itch. We also explore two coping methods for negative thoughts related to itch – Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) – and how to practice them at home. 

Host: Caitlin Shneider

Caitlin is a Clinical Psychology Doctoral student at Georgia State University. Caitlin studies the influence of child pain catastrophizing and parent response to pain on psychosocial and functional outcomes for youth. This gives her a unique perspective on dealing with pruritus.