Karen Levine, Ph.D. is a Psychologist in Lexington MA, Lecturer on Psychiatry
Harvard Medical School, treating young children with Autism, Anxiety or Selective Mutism. With her colleague Naomi Chedd, LMHC, she authored 3 books including Attacking Anxiety (Jessica Kingsley Publishers, 2015). http://drkarenlevine.com
Humor is a useful tool that can be readily used together with gradual exposure / CBT in treating children’s phobias. By “humor” I mean playfulness used by the adult, collaboratively with the child, in an individualized manner that the child finds funny, and that is consistent with the culture of the child and setting. For instance, together with a preschooler terrified of bugs, adult and child can initially make their Lego figures stomp on plastic bugs, ‘tossing them away’ in a clean waste basket. The goal is to get the child to smile, to laugh, feel supported by the adult, share playful emotions, as they play with feared bugs. Note this is different from performance humor such as telling jokes or wearing funny hats.
Humor can be readily incorporated throughout the process of gradual exposure. With my colleague Naomi Chedd, LMHC, I wrote about this regarding children with anxiety and developmental challenges such as ASD in our book Attacking Anxiety (Jessica Kingsley Publishers, 2015). This approach, combining gradual exposure with playful engagement, is also helpful with typically developing children.
While there has been very little research to date on the impact of humor, clinically we see that playful, socially engaging, child-attuned humor, often has the following benefits:
1. Building rapport and maximizing motivation: Playful interaction makes relationships related to gradual exposure more fun, motivating and rewarding for children.
2. Decreasing anxiety: Getting a child into a playful state before and during situations that are likely to cause anxiety, including planned gradual exposure, can often be effective in reducing anxiety, hence helping the child tolerate increasing exposure to the fear trigger.
3. Flexibility: Playfulness and humor can be incorporated across environments including home and school, with children of various ages, and with various developmental profiles. Parents, teachers and clinicians can readily collaborate regarding the child’s humor.
There are some circumstances and ways in which we should not use humor:
1. Never use humor to tease the child in a way that insults or belittles them or anyone else or makes anyone uncomfortable. Something is only funny when everyone involved thinks its funny.
2. Do not use humor when a child is experiencing distress, sadness or anger.
3. Do not use humor in a way that overwhelms the child so the child becomes giddy or frightened. Consider reducing your emotional intensity, and involving the child more.
4. Some children seem to simply not have much of a sense of humor at some points in their development. Don’t force it. But don’t be afraid to introduce small amounts, teaching enjoyment of humor.
5. What is funny in one culture may be taboo, or simply not funny, in another. Be sure the humor you are using is culturally consistent with the child’s family, school or other contexts. Clinicians can draw from family humor.
In conclusion, using playful, attuned, child-specific, culturally sensitive, interactive humor can be an effective treatment tool, integrated with gradual exposure to phobia triggers. Treatment can be fun for all involved!