From Timid to Tiger is an excellent guide for clinicians working with parents of anxious children. It aims to teach parents, in a collaborative and encouraging way, about anxiety and how to help them change the maintenance cycles of anxiety for their children in easy to follow steps. The book targets mental health clinicians working with parents of children between 3 and 9 years old with a primary diagnosis of generalized anxiety, panic disorder, agoraphobia, separation anxiety, social anxiety and specific phobias. Whilst some guides can come across as patronizing, this book is empowering for clinicians and parents alike, and provides clear assurance to parents that they can be the best placed people to help their children overcome anxiety.
The book begins with a basic description of CBT - clearly intended to introduce the parent reader to the therapy and covers the fundamentals of CBT concepts in a clear, easy to understand way. Examples are used to help illustrate how CBT can be used in the treatment of the anxiety disorders. For the mental health clinician, helpful notes are provided on how to deliver CBT in a group format. There are tips on engaging parents and helpful practicalities, such as room set-up for groups and the structure of individual sessions.
The CBT course is divided into 10 sessions, with valuable handouts for parents at the end of each session chapter. There are also specific session guides and checklists for the therapist leading the session. The first session introduces CBT and the links between thoughts, feelings and behaviours, illustrated by some straightforward examples. Session two introduces “special play” for parents and children: this aims to improve the relationship between parents and children and to help children build confidence by feeling in control of their world. Session three is about understanding anxiety and the fight and flight response. Sessions four and five teach the use of positive reinforcement by using praise and rewards to elicit changes in behaviour and improve motivation. Session six focuses on setting limits on a child's behaviour. The challenge this can present for parents is recognized, particularly when a child is distressed and the next session coaches parents to ignore unhelpful behaviours. Session eight is about managing children's worry through a variety of cognitive challenges and behavioural techniques such as “worry time”. Session nine helps parents manage difficult behaviour and set consequences for such behaviour. The final session is about summarizing the treatment, reviewing positive gains in treatment and giving out certificates.
It is worthwhile noting that there is a paper in press by the authors that is an evaluation of this treatment protocol. However, it has not been evaluated for children with OCD and PTSD, which is understandable given that these two disorders have their own specific treatment protocols. If anything, I think this book is being too modest in its targeted age range. I think parents of older children and younger adults would benefit from this programme. It uses well understood concepts of behaviour change in an uncomplicated and fun format, whilst giving parents the confidence to try new parenting strategies, and places emphasis on the importance of the parent-child bond. This book should be found in the library of every community and school based clinician working in children services.
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