The importance of taking temperatures.

We have had a lot of feelings around here for the last two years.  Feelings of loss, feelings of anger, feelings of relief from time to time. 

In that time, two of my kids have been diagnosed with disorders that bear the names of feelings:  one with anxiety, one with depression.  I've become very caught up in all things "feeling."  There are medications for these conditions, of course, but those don't get you there on their own; therapy is part of it too, sometimes for the individual kids, sometimes including one or both of us parents; occasionally Mark and I have had a session with the child's therapists and without the child. 

Therapy means lots of talk about feelings.

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One of my young people, the anxious one, has been given a diagram called a "feelings thermometer."  I'm told that it goes by other names, with the most clinical-buzzword-sounding being SUDS:  the Subjective Units of Distress Scale (Wikipedia).   

One version of the emotional temperature scale for a younger child.

It's basically a form of "On a scale of one to ten (or zero to ten), how anxious are you feeling right now?" 

You would think that something this simple would not be very helpful, but I've been amazed at how much it's helped. The more reading I do about ways that clinicians use the scale, the more I try to use it in everyday conversations. 

I suspect that one of the reasons it's helpful in our family is just that it yields a number within a number range, which even if it is entirely subjective, is a landscape that...certain people in the family... find to be comforting and reliable, like a well-blazed hiking trail.  

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Notwithstanding the quirks of our comfort zones:  it also gives us a low-impact way to inquire about the well-being of the anxious young person. 

All types of measurement change the value being measured, but some do it more than others.  At the beginning of our journey from "this kid is a worrier" to "we need help if we are going to help this kid" to "this kid is in treatment for an anxiety disorder", any attempt to ask about anxiety tended to create more anxiety. 

Take a seemingly simple question like "How are you doing today" (yes, I know that in many circumstances this question is not perceived as simple).  Sometimes asking it would precipitate a complete meltdown; I think the act of self-examination itself triggered anxiety.   But the number is somehow less weighty, maybe because it doesn't force much engagement with language. 

At first it was difficult for the child in question to nail down the part of the scale, and there was some hemming and hawing, and prompting from us.  But with practice it became a very quick way to check in:  "What's your emotional temperature right now?" gets a numerical response almost right away, with only a few "um"s.

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One thing I found really helpful as I went on reading about how people use the thermometer:   Different parts of the scale call for different kinds of support. 

At the very top of the scale—let's say betwen 8 and 10—the anxious person may be incapable of language-based reasoning.  There's no point in, say, insisting that they just get back to their schoolwork, or that they explain what set them off.  There may not even be a point in trying to talk them down, or reassure them with language.   Instead, depending on what works best with this particular person, it may be time for a cuddle or a hand lightly stroking the back; or an invitation to go to a quiet place and rest, with another or in private; or a suggestion to engage in vigorous activity or in some self-soothing behavior that the young person has practiced and found to work for them in the past.  (more on that below.)

Towards the bottom of the scale—say below 5—even if the anxious person is not totally at peace, they can reason and think and perform tasks, independently or with others.  They can engage in therapy, they can be encouraged to stay on task, they can consciously choose behaviors.  They can also practice deeper relaxation techniques to bring the number lower still.

In the middle, when a moderate amount of stress is being experienced, there is an opportunity to develop self-regulation.  Here is where the young person (as well as their parents!) can learn to notice when the temperature is rising and then do something about it.  Take a break, switch to another task, practice breathing exercises, get up and stretch, try a visualization, get up and fetch something to use as a fidget... all these things are behaviors that have to be learned.  It is here, in the zone of moderate stress, where they can be tried, tested, and practiced; later when the emotional temperature goes through the roof, they can call on these techniques to help bring them down.

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One of the things I have learned by using the emotional temperature scale is that what a kid looks like on the outside is not necessarily a great indicator of what distress level they would report on the inside.  And yes, if you had asked me about this before we were using the scale, I would have said "of course that makes sense, everyone exhibits distress differently." 

But I did not have, then, so much personal experience with how the same person can exhibit distress differently at different times.  A child who appears to be quietly playing a favorite computer game may be, in fact, calm and happy, and often they are.  But a child who appears to be quietly playing a favorite computer game may also be trying desperately to use the computer game to distract from intense internal distress.  A child who is flailing around in the playroom or, grunting with effort, whacking the hanging punching bag with a stick, not answering when called, may be physically expressing anger and distress.  Or they may be absorbed in an imaginary game of swordfighting.   

I often tell the kids, "I can't read your mind; you have to tell me."  I regularly need to remind myself of that as well.

Comments

[Melanie B]

So much of this is familiar and so much rings true and yeah these have been some very trying years. But the more language I have to label the anxiety, and the more we work with therapists, the easier it's getting. Still hard, but easier. Marginally.

I like the thermometer image and might need to print one off for our use. I have a certain anxious child who likes numbers and certainty and this might appeal. We previously had a color-coded system, a couple of years ago, but it was just red-yellow-green and I think not as useful. We got some mileage out of it, but then moved on.

We're still in the process of identifying what kinds of help/interventions/self-regulation are appropriate when. Maybe we can work on tying different ones to specific numbers on the scale. That's worth experimenting with.

[bearing]

There are a lot of examples of wording for the tick marks online, appropriate for different ages. It could be a fun project to make personalized versions for every kid.