Clinical Prompt
Coping imagery helps the child:
- see themselves handling an anxiety-arousing situation successfully
- prepare relaxation and cognitive coping strategies specifically tailored for this situation
- rehearse and refine their coping strategies at crucial anxiety-arousing points as the situation unfolds
- prepare for each step in the sequence that s/he will soon perform in real life
Step 1: Relaxation
Step 2: Narrative
- choose a real life situation
- write or tape the sequence of events that make up the problem situation from anticipation to resolution
- expand to include physical and emotional description
Step 3: Stress Points
- experience the situation through visualization
- probe through questioning
- identify stress points
Step 4: Plan Coping Strategies
- physical relaxation
- calming self talk
- planned actions
- re-record the narrative to include coping strategies at each stress point
Step 5: Rehearse
- listen to taped narrative while using the coping strategies
- revise coping strategies as necessary
Step 6: In Situ
- identify mild to moderate stressful situation
- make sure that cue-controlled relaxation is mastered
- test the coping strategies
- revise coping strategies as necessary
Materials
- Tape recorder
Introduction
Coping imagery (Freeman et al. 1990) is a blend of stress inoculation and covert modeling. It combines the best features of both to enhance performance in problematic situations while simultaneously lowering anxiety. The client should begin by identifying the detailed sequence of events that make up a problem situation – everything s/he does from beginning to end in the situation. Then note which elements of the sequence are the most anxiety evoking. Finally, have the child rehearse performing the entire sequence while using specific relaxation techniques and coping thoughts to lower anxiety at crucial junctures in the sequence.
Coping imagery helps the child:
- see themselves handling an anxiety-arousing situation successfully, perhaps one they have long avoided.
- prepare relaxation and cognitive coping strategies specifically tailored for this situation.
- rehearse and refine their coping strategies at crucial anxiety-arousing points as the situation unfolds. This builds confidence that s/he can reduce an anxiety response in vivo (in real life).
- prepare for each step in the sequence that s/he will soon perform in real life.
Coping imagery is outlined here in six simple steps that can be mastered with regular practice:
- Learning to relax.
- Writing the sequence of events that make up a problematic situation.
- Identifying the stress points in the sequence.
- Planning specific coping strategies for each stress point.
- Rehearsing the sequence in your mind using newly developed coping strategies.
- Applying coping imagery to real-life events.
Symptom Effectiveness
Coping imagery is most effective at reducing anxiety and avoidance symptoms associated with an existing problematic situation. It can be used to reduce avoidance behavior due to phobias and test anxiety, and to increase assertiveness. Coping imagery can also be helpful in reducing procrastination, resentment, and depression that often result when clients don’t cope successfully with specific anxiety-provoking situations.
Coping imagery relies on the ability to conceive clear and detailed images. If it is difficult for the child to achieve clear visual images, the alternative is to create a detailed image using auditory or physical impressions. If either approach enables the child to clearly imagine the scene, this technique may be used successfully.
Time for Mastery
A client may get results after as few as six to eight fifteen-minute sessions.
Instructions
Step 1: Learn to Relax.
The relaxation skills that the child will need to master – progressive relaxation, relaxation without tension, and cue-controlled relaxation are in Technique #04. Don’t proceed past Step 4 until the child has learned and practiced each of these relaxation procedures. We suggest that the child “overlearn” cue-controlled relaxation to the point that s/he can do it automatically. Eventually, s/he should be able to attain deep muscle relaxation in two minutes or less. The more s/he practices, the quicker and deeper the relaxation will be.
Step 2: Write a Narrative.
Even while learning relaxation skills, the child can still take additional steps to prepare for using coping imagery. S/he can choose a real-life situation that makes him/her anxious. Something s/he wants or needs to do, but tends also to avoid or struggle with. It can be anything from job interviews to presenting in class, from making a date to explaining his/her needs to an angry friend.
One of the first steps toward helping a client mobilize to cope with a difficult situation is to understand how and why it makes him/her anxious. What particular aspects of the situation are most difficult to deal with? What are the worst fears about what might happen? Which points feel most out of control emotionally? The answers to these questions are not always clear, particularly if the child is facing a complex situation. However, the more the child understands about the situation, the easier it will be to cope.
Have the child begin by writing out [or dictating to you to write] the sequence of events that make up the problematic situation. S/he should write it in the form of a narrative, using as much detail as possible. The sequence should start with the anticipation of the situation, then move on to describe the opening of the scene, and continue until the situation is resolved. The most important details to include are those aspects of the situation that make the child most anxious. Also, the child should include how s/he is specifically affected by the anxiety: what are the physical as well as emotional responses? How and why are these responses intensified by the scene?
This narrative may take some time to develop, not only because the child may have difficulty in the writing, but because you want to probe the child’s perception of the situation to develop as much detail as possible. It does not need to be done all in one session and may be revisited over time.
Step 3: Identify the Stress Points.
You can use this narrative to help the child identify the particular parts of the sequence that are acutely stressful. An effective way to do this is through visualization. The child can tape-record him/herself reading the narrative slowly. Later, when it is played back, the child can sit in a relaxed state, eyes closed, with all attention focused on building the scene in his/her mind. If the child finds it impossible to tape themselves, you might slowly read the sequence to them while they visualize the scene or record it for them.
The object is for the child to experience the scene with as much vividness and detail as possible. Probe with this type of question – Where are you? Who is present there? Is it warm? Cool? What sounds can you hear in the distance? What smells surround you? Have the child engage as many senses as s/he can to create the scene in his/her mind. Continue through the sequence. Make sure that the child pays close attention to the physical and emotional reactions that s/he experiences. Tense muscles with increased heart rate and quickened respiration are some common signs of anxiety.
When the child comes to a segment of the sequence where s/he experiences elevated anxiety, s/he should make a raise her hand or otherwise notify you, so that you can make mental note of it. After s/he has finished, mark each of these points with an asterisk on the narrative. The places marked with an asterisk are the stress points. Later, as the child visualizes the sequence, these will be points where s/he will pause to do special relaxation and coping exercises.
Step 4: Plan Coping Strategies.
Most anxiety provoking situations are made up of several combined stresses. One of the main goals in writing out a narrative and identifying the stress points is to demystify the sources of anxiety. If the child can see the situation as a combination of smaller stresses, his/her anxiety will be much easier to understand and manage.
Anxiety reactions have two basic components: a physiological stress response, and thoughts that interpret a situation as dangerous. Coping imagery, therefore, must include a method for physical relaxation, as well as a set of statements that are calming and reassuring to you.
Relaxation
As the child visualizes the sequence, s/he will use cue-controlled relaxation with deep breathing at each stress point.
Cognitive Coping Statements
S/he will also need to develop cognitive coping statements for each stress point in the sequence. Effective coping statements will remind him/her that s/he has the ability to handle the situation and may offer specific strategies to deal with problems. Some examples of effective statements are: “There’s no need to panic…. I can get through this…. It doesn’t need to be perfect – my best is good enough”; “It’ll be over in a few minutes”; “I have a plan if there’s a problem”; “I know how to do this.” You’ll find that each stress point carries its own set of worries. Try to find statements for each that really address and relieve the worry in that moment.
The following are some important functions that cognitive coping statements can serve:
- Emphasize that you have a plan to cope, and specify what the plan is in that situation.
- Reassure that there’s no need to panic, that you have the skills to cope with the situation.
- Remind yourself just to relax away stress.
- Assert that a catastrophic fear isn’t true, and that the worst that could happen is ________________________.
- Lower unreasonably high expectations – i.e, “I’ll get through this; it doesn’t have to be great.”
- Instruct yourself to stop the crazy, catastrophic thoughts and get down to meeting the challenge.
Re-record the narrative so that it now includes instruction for cue-controlled relaxation and specific coping thoughts at each stress point. On the tape, make sure that the child gives time at the stress points to relax and let the coping thoughts sink in.
Step 5: Rehearse Your Sequence.
Now it’s time for the child to listen to the taped narrative while using the coping strategies.
The goal of this step is for the child to keep practicing the sequence until the anxiety is below 4 on a 10-point scale. The scale should range from 0, no anxiety at all, to 10, the highest level of anxiety ever experienced. It’s not necessary for the child to bring the anxiety level down to 0, but to reduce it. Keep in mind that some stress points in the narrative may be more difficult to cope with than others. The key word here is practice. As the child hones his/her coping skills and gets more familiar with the procedure, the coping strategies will become more and more effective.
If after a few repetitions the child doesn’t feel any reduction in anxiety, you may need to help them revise the coping strategy:
- Practice more deep breathing. Relaxation is critical to the effectiveness of the coping efforts. Make sure that the cue-controlled relaxation is, in fact, helping the child to relax. If not, you may need to have the child practice it alone for a period of time.
- Review coping statements. Sometimes it’s hard to pinpoint what the real source of anxiety is at each stress point. It’s possible that some of the coping statements are not addressing the main elements that are making the child anxious. Practicing the sequence will help identify which statements need to be rewritten, and what needs to be added to make them more effective.
Step 6: Cope In Vivo.
The final step in mastering coping imagery is applying it to real-life situations. When the child can visualize the entire sequence while successfully reducing levels of anxiety at each stress point, s/he is ready to approach the situation in vivo. Of course, s/he will have less control over the environment in real situations than s/he had during visualizations, but s/he need not feel out of control. One of the most important skills learned from this technique is how to stay in control of emotional and physical reactions. Feelings and tension that used to trigger fear can now be seen as cues to relax and encourage yourself with coping statements.
If possible, have the child use the new coping strategies with a mildly to moderately stressful situation at first. Because real life situations are usually more difficult to cope with than visualizations, one of the priorities should be to avoid the child feeling overwhelmed. Allow sufficient time for practice, and expect a few setbacks before the coping strategies feel totally comfortable and effective. It is helpful to point out to the child that such setbacks are common, but that the technique will work.
As with each of the prior steps in this technique, practice is the key to success. As the child becomes more adept at using coping imagery, it may become a significant resource for them in dealing with many different sources of stress.