**2.4. Importance of rewarding**

introduction of the therapy program to be used, discussion on parenting attitudes that trigger or alleviate internalizing symptoms, a short training on effective parenting methods, debriefing on effective reinforcement and punishment techniques, conversation on intrafamily communication skills and ways to strengthen them, debriefing about how should the parents help their children during the process of doing homework given through the

Another issue to be covered during parent meetings is the expectations. Some parents have great expectations from the treatment, such as CBT will change all the behaviors of child; there will not be any problems while he/she is doing his/her homework; there will be less conflicts with the siblings; or his/her room will always be tidy. At this point, it is quite important to underline which behaviors this therapy program will specifically focus on while informing the family about the content of program. Similarly, some parents who cannot observe the improvement, they have expected during the first few sessions may not bring the child to sessions at the very important point of therapy. While talking about contents of sessions during family meetings, emphasizing that the child will mostly learn about techniques developed to effectively cope with the symptoms in the first sessions, so they will be more theoretical, and the change will occur when the child starts to use these acquired skills in his/her own life will positively affect the rate

One of the essential components of the program for CBT is homework. Thanks to homework, clients might practice the skills they have learned in sessions in their daily life, and might gain the chance to apply the coping techniques taught by the therapist when they encounter with problems in life [69]. Another advantage of homework is the opportunity it provides for the therapist to understand which techniques the child has earned and which he/she has not [70]. While using homework actively is important, the way homework is presented to children also matters. Firstly, it is required to precisely distinguish homework given at schools from the homework given in therapy to be done between sessions. By this way, prejudice of the child toward these tasks will be prevented, and performance anxiety will be triggered as little as possible for cases with anxiety disorder. When examining the therapy programs, it is seen that various names are given to break down the "homework" perception that the child might

Especially, if the academic skills of the child fall short in this aspect, it is important not to focus too much on writing skills and grammar, and structure some of the activities and homework verbally, if required, thus enable the child to feel more comfortable and happy. Another point to take into consideration about homework is informing the parents about homework every week. Therapist should talk to the parents in advance to advice them to encourage and help

When literature is examined, it is seen that homework given to children with anxiety disorder mostly includes self-monitoring of anxiety, relaxation exercises, keeping records of thoughts,

have: "Show That I Can" or "Take Home Projects" are two examples [50, 71].

the child, especially in tasks that are difficult to perform.

therapy, and practice of techniques in daily life [50, 68].

6 Cognitive Behavioral Therapy and Clinical Applications

of attendance to sessions.

**2.3. Importance of homework**

In treatment of all the mental disorders seen in childhood, rewarding that is based on operant conditioning is one of the essential therapy components of CBT. Unlike other techniques, the focus in rewarding is not reducing the internalizing symptoms; the primary aim of rewards is to enable the child to maintain the motivation and attendance to sessions, encourage him/ her to do the homework given, as well as to create a factor that facilitates application of techniques such as exposure or social skills training. Behavior shaping, positive reinforcement, fading, and negative reinforcement are the most commonly used rewarding techniques in the treatment of internalizing disorders [20, 73].

There are some points that must be taken into consideration while using rewarding techniques in children. Firstly, it is quite important to create a reward pool that suits the needs and interests of each child. Besides, it should be known that social reinforcers are effective on children as much as the physical reinforcers. Therefore, the role of social reinforcers in the treatment must be noted; they should be used frequently during or between sessions, and the family must be informed about the matter [20]. Secondary reinforcement such as collection of coupons or points are considered as a main rewarding technique just as the spontaneous and short-term rewards [73]. Therefore, it is quite important to establish a rewarding system to be maintained throughout the program in childhood CBT, and integrate this planned system into structured therapy.

Teaching the child to reward himself/herself will increase the motivation of child about techniques and change in the long-term as much as being rewarded by the therapist or family. For this reason, if the child learns self-reinforcement during the sessions, symptoms of children with internalizing disorder such as negative mood, low self-esteem, and social withdrawal will be affected positively.
