July 15, 2025 • 45 mins
In this week's chat about choices, psychologist/researcher Dr. Katharine Dahlsgaard and your host Dr. Whitehouse explore what we can do about the emotional side of food allergies, exploring when everyday anxiety crosses the line into specific phobia and how to address it. Dr. Dahlsgaard walks us through her research demonstrating that exposure therapy, including the proximity challenges, like smelling or being close to an allergen, to help recalibrate fear responses.
We discuss balancing safety with bravery through the healing lens of being “safe enough,” address the overlap of food allergies with Avoidant Restrictive Food Intake Disorder (ARFID), and unpack the essential life skill of functioning even while anxious.
-Dr. Katherine Dahlsgaard | Psychologist | CBT Therapist
-Instagram: @braveisbetter
-Scale of Food Allergy Anxiety (SOFAA) | Children's Hospital of Philadelphia
-Want to help your patients with food allergy anxiety? Do proximity challenges!
-Cognitive-behavioral intervention for anxiety associated with food allergy in a clinical sample of children: Feasibility, acceptability, and proof-of-concept in children - ScienceDirect
-Episode 4 with Kelly Chambers, discussing her experiences as a Food Allergy Bravery parent: https://www.buzzsprout.com/2371319/episodes/15580765
Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com
Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Katherine Dahlsgaard, PhD (00:00):
every time they get anxious, they try
(00:01):
and avoid feeling anxiety.
And that is no way to live.
It is an existential threat toyour child if they get to that
point, because part of humanlife is feeling anxious in
response to challenges.
Your kid is gonna have to asksomeone.
To marry him, your kid is gonnahave to apply for her first
(00:22):
mortgage, and they're gonna beanxious and they need to have
the confidence that they havebuilt up in childhood with you
as the parent that they can beanxious and function anyway.
Not perfectly, not happily, butfunction.
Amanda Whitehouse, PhD (00:39):
Welcome to the Don't Feed the Fear
podcast, where we dive into thecomplex world of food allergy
anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
Amanda Whitehouse, Phd (01:00):
this summer we are talking about
choices and where we have someaction and control over our
experiences, we may not be ableto control whether or not we
experience any anxiety aboutmanaging our allergies, but we
can take steps to mitigate that.
That is why I'm so excited foryou to meet today's guest, Dr.
Katherine Dahlsgaard..
She's a clinical psychologistand a researcher who's been
(01:22):
shaping the landscape of foodallergy anxiety with her work.
You may know of her from herwork at Children's Hospital of
Philadelphia where she createdthe Bravery program.
You might know about herdeveloping the SOFAA scales to
measure food allergy anxiety,and most recently, she
co-authored a paper on usingproximity challenges, like
smelling or being close to yourallergen as a deliberate anxiety
(01:45):
reducing tool in clinicalsettings.
So I asked Dr.
Dahlsgaard to join us so that wecould explore not only what she
discovered, but how these ideascan feel different, safer, and
braver for families managingfood allergies.
Trust me, you'll want to meether.
thank you so much for joining mehere on Don't Feed The Fear, Dr.
Dahlsgaard.
I am so excited to talk tosomeone on the podcast for the
(02:06):
first time in the same field asme, another psychologist Thank
you so much for taking the timeto join me.
It feels very special to haveyou here.
Katherine Dahlsgaard, P (02:13):
Amanda, I'm delighted.
Amanda Whitehouse, Phd (02:15):
Tell us how you got into this unique
combination that we both findourselves in, of being
psychologists, working with themental health side of food
allergies.
Katherine Dahlsgaard, PhD (02:26):
It is a long answer.
I will try to make it short.
I have been a specialist intreating pediatric anxiety
disorders for 20 years.
It is my passion and I startedat Children's Hospital of
Philadelphia.
I was the founder and directorof their anxiety clinic for kids
with anxiety disorders, childrenand adolescents, and I ran that
(02:48):
for a bit over 10 years.
And we treated all of theanxiety disorders that kids
present with, so things like OCDand all kinds of phobias and
separation, anxiety disorder,and selective mutism and PTSD
and as the director.
I was given appropriately whatwere considered very difficult
(03:11):
cases, and I started to see justa few in my clinic, these kids
who had bonafide IgE mediatedfood allergies, but they had too
much anxiety about them and theywere engaged in a ton of
medically unnecessary avoidance.
(03:31):
So in food allergy, we wannahave medically necessary
avoidance of ingesting theallergen.
But these were kids who wereterrorized by being in the
presence of their allergen orjust by the thought of being in
the presence of their allergen.
(03:53):
And not only that, but unusual,uh, unusual to my cases.
Their parents were terrorizedtoo.
So let me explain what I mean.
In the case of the dog phobia,the kid is terrified of dogs
over predicts.
If they see a dog, the dog'sgonna bite them and over
(04:14):
predicts the catastrophicconsequence.
Not only is the dog gonna biteme, it's gonna rip my throat
out, I'm gonna, I'm gonna die.
It's gonna be terrible.
But their parents know my kid isway over predicting negative
outcomes.
She's way too afraid of dogs.
In the case of food allergyanxiety, or what I came to call
(04:35):
specific phobia of anaphylaxis,the parents were just as
terrified as the kids, and myheart went out to these families
in a very profound way.
(04:58):
And also it turns out that thesewere not difficult cases to
treat like any phobia.
They were straightforward totreat.
We have a great treatment forphobias, and these kids and
their families got betterquickly with a very common and
strategic treatment.
(05:18):
So that's how I got into it.
Amanda Whitehouse, Phd (05:20):
So everyone's going to wanna know
immediately.
Then.
I think I'm familiar because ofyour work and my work, but tell
people what is the very specificand effective treatment that we
use for specific phobias.
Katherine Dahlsgaard, PhD (05:32):
It is called exposure therapy, and it
is a type of cognitivebehavioral therapy, so exposure
therapy.
For your listeners who haven'theard about it or maybe think
they might know what it is,exposure therapy.
Is the effective evidence-basedscientifically backed treatment
(05:53):
for pretty much all anxietydisorders, and the evidence is
especially strong for phobiasand exposure is gradual
strategic exposure to the safeenough thing that is avoided
unnecessarily.
(06:16):
So to take the instance of,again, dog phobia, the kid will
be avoiding dogs.
If I go over to my cousin'shouse, I, I get my mom to tell
their parent that the dog has togo in the basement.
But even so, even though the dogis in the basement, every time
it barks, I get really scared.
(06:37):
Because my brain is overpredicting the dog's gonna get
out.
It's gonna come right to me andit's going to bite me.
And so you have kids who havebeen avoiding play dates with
friends that have dogs, avoidinggoing to holidays with families
that have dogs, or familymembers that have dogs.
And you would think that allthis avoidance would make it so
(06:58):
that they're not anxious, butinstead they're anxious all the
time.
And that is because unnecessaryavoidance.
Means you're collecting baddata.
So I haven't been around a dogfor three years.
Yeah, I see all my friendspetting the neighborhood dogs
and loving dogs, but I haven'tbeen around dogs for three years
(07:21):
and I haven't been bitten thatentire time.
Therefore, the avoidance isworking and I better keep doing
it, and that means I better bevigilant every time I see a dog
so I can avoid it.
Amanda Whitehouse, Phd (07:34):
Right, and now that's the only coping
skill I have for managing thisanxiety is avoid everything at
all costs.
Right.
Katherine Dahlsgaard, PhD (07:40):
Yes, and it is the only coping skill,
but it isn't a coping skill
Amanda Whitehouse, Phd (07:45):
Right.
Katherine Dahlsgaard, P (07:46):
because what the child is not learning
is the relative safety of dogs.
They're also not getting achance to be, um, they're also
not getting a chance.
To develop the crucial lifeskill of functioning while they
are anxious.
(08:06):
So, so many of my anxious kids,when they come to me, they're
not just anxious about the doc,about temporary separations from
their parents, about getting upin front of other kids at school
and giving, um, a, a, a public,uh, speech.
They've gotten to the pointwhere every time they get
anxious, they try and avoidfeeling anxiety.
(08:30):
And that is no way to live.
It is an existential threat toyour child if they get to that
point, because part of humanlife is feeling anxious in
response to challenges.
Your kid is gonna have to asksomeone.
To marry him, your kid is gonnahave to apply for her first
mortgage, and they're gonna beanxious and they need to have
(08:52):
the confidence that they havebuilt up in childhood with you
as the parent that they can beanxious and function anyway.
Not perfectly, not happily, butfunction.
Amanda Whitehouse, Phd (09:05):
I talk about with my clients, how
there's this bell curve or anormal curve showing that a
little bit of anxiety motivatesus and enhances our performance,
right?
And so framing that as it'sactually a good and a productive
thing in certain circumstancesat a moderate or appropriate
level.
Katherine Dahlsgaard, PhD (09:20):
Yes, and just like with dogs, and
then I'll talk about foodallergens as well, we want our
children to have an appropriatelevel of anxiety around dogs.
I've never met this dog.
I don't run up to it and pet it.
I ask the owner, is it okay if Ipet your dog?
In the case of food allergy, wewant our kids to have enough
(09:40):
anxiety, right?
A good enough amount to keepthemselves safe.
We want our kids when they goover to a friend's house to be
cautious about what they eat, tolook at ingredient LA labels to
carry their EpiPen everywhere,right?
That's the appropriate level ofanxiety that we want for our
(10:01):
children.
What we don't want is too muchof a good thing because too much
of a good, good thing means Iavoid too much.
The bad thing doesn't happenthat my anxious brain was
predicting would happen.
So I think the avoidance isworking and then I turn around
(10:23):
and I'm the only kid who justgot to college in my college
class who's eating alone in mydorm room, rather than going in
the cafeteria and developingfriendships.
So too much anxiety leads to toomuch avoidance and too much
avoidance leads to a life thatis smaller than it needs to be.
(10:46):
And a food allergy is a chroniccondition for most people, but
it doesn't have to be a chroniccondition that makes your life
small.
And it shouldn't be.
People with food allergiesdeserve like the rest of us who
do not have food allergies.
To live as big a life aspossible, an adventurous a life
(11:09):
as possible.
Amanda Whitehouse, Phd (11:12):
I love that.
So that is the inspirationwanting these kids.
And their parents to have as bigof a life as possible and as
full of a life as possible.
Is that where you then movedfrom Directing this anxiety
clinic, then you created aspecific food allergy anxiety
clinic at the Children'sHospital Philadelphia.
Correct.
Katherine Dahlsgaard, PhD (11:30):
Yes, very much.
I, I can really say I put mymoney where my mouth was.
I put my money where my heartwas.
In that I, the director of theanxiety clinic at CHOP
Children's Hospital,Philadelphia, went over to the
food allergy center and startedup the first that I know of or
that we know of, specialtyAnxiety clinic embedded within a
(11:51):
food allergy center.
So if you can imagine, um, theDepartment of Child and
Adolescent Psychiatry allowingtheir director to go over to
another department to days aweek to start at this clinic,
you can bet I really, really,really wanted to start that
clinic and start doing the work.
Amanda Whitehouse, Phd (12:10):
And your time is precious, but certainly
there must have been anabundance of patients for both,
I would suspect.
Katherine Dahlsgaard, PhD (12:17):
Very much so.
It was a, it was a great thingto do.
I've had a lot of really, reallysatisfying experiences in my
career.
I love my job.
I love helping anxious kids.
I love the treatment, I loveeverything about it.
But starting up, the FoodAllergy Bravery Clinic, the FAB
Clinic.
In the food allergy center atCHOP is one of the jewel, one of
(12:39):
the jewels in my crown.
It was just great.
I loved it.
Amanda Whitehouse, Phd (12:44):
I've heard so many good things.
I know a lot of people who havebeen clients there.
I'll link for people listening.
I had a guest on the show whosedaughter, pulled out of some
really restrictive eating and,and concerning weight loss, due
to food allergies
Katherine Dahlsgaard, PhD (12:57):
So wait.
You've interviewed formerpatients of the FAB Clinic.
Amanda Whitehouse, Phd (13:00):
Uh, just, just one on the show.
Yeah.
Katherine Dahlsgaard, PhD (13:02):
Oh my goodness.
Oh, that's so great.
Alright.
Amanda Whitehouse, Phd (13:04):
her name was Kelly Chambers.
She came on the show and she,she gave a really great episode.
So I'll, I'll make sure to linkthat and just said the best
things about their experiencethere.
Katherine Dahlsgaard, PhD (13:13):
Oh, that's delightful to hear.
When I got there, the firstthing I did was I looked around
and I read all the literature.
Any person who's gonna start aspecialty treatment clinic, you
need to be very cognizant of theliterature.
And I, to some extent was, butthe first thing I did there,
actually, the first two things Idid there was I sat down and I.
(13:33):
Read every piece of literaturein the food allergy journals,
which are different from thepsychiatric journals.
So your listeners should know.
Oftentimes people who work inpsychology don't read medical
journals and vice versa.
And it's just because we getused to reading studies as they
come out in the journals thatwe're familiar with.
So I took a very, very deep diveinto that.
(13:55):
And then the other thing that Idid was I started going to the
oral food challenge or officefood challenge.
Clinic so that I was seeing kidscome in and ingesting their
allergen and for the most part,not having a reaction, but
sometimes having reactions andhow that was handled, what that
actually looked like.
So I got a very intimate look inboth the science and the
(14:18):
practice of treating kids withfood allergies.
And the first thing I noticedwas that there was no disease
specific validated questionnaireto measure food allergy anxiety.
Now, for all of your listenerswho have just fallen asleep,
trust me, this was fascinatingand very, very, very exciting.
And what's needed if you'regoing to design a treatment for
(14:42):
food allergy anxiety is you needto have a validated measure
questionnaire.
That is scientificallyvalidated.
So it measures what it'ssupposed to measure.
It has good reliability, it hasgood validity because you need
to use it as a pre and postmeasure, pre-treatment levels of
anxiety, post-treatment levelsof anxiety, and then if you do a
(15:03):
follow-up, follow up levels ofanxiety.
So the first thing I did was.
Developed that and wrote thatand got that validated, which is
a very long process, and that iscalled, I love it.
Every time I say it, I'm gonnasay it.
It's called the SOFAA, which isan acronym for scale of food
(15:26):
allergy anxiety.
So anyone who wants to take alook at the sofa, it is free for
use for clinicians andresearchers.
And it is housed atchop.edu/sofa, SOFAA.
So I developed that and it's achild measure and a parent
measure.
So children report on their ownfood allergy anxiety and parents
(15:49):
report on their perception oftheir kids food allergy anxiety.
So we have cross informantreports.
So that was number one.
And then number two is I startedto work on a treatment, and I
really like therapy that istargeted and focused.
I like treatments that areleaned down so they don't have a
(16:10):
lot of bells and whistles Andfortunately, I'm an exposure
therapist, and so exposuretherapy lends itself beautifully
to very brief and targetedtreatments.
So thank goodness that aspect ofmy personality fixed by my
choice of profession.
And I was already, to someextent, doing the treatment that
I ultimately developed as thefood allergy bravery treatment,
(16:33):
the FAB treatment.
And that was.
You come in, we assess yourlevel of food allergy anxiety,
specifically the amount ofmedically unnecessary avoidance
in which you're taking part,because again, it's the
avoidance that is driving theanxiety.
Not the other way around.
The more you avoidunnecessarily, the more anxious
you're gonna be.
(16:56):
And then we start a treatmentthat is exposure based and you
start getting exposures insession one.
Let me stop here.
Amanda Whitehouse, Phd (17:04):
Yeah, I think that's where a lot of
parents go.
What?
Because they're doing exposure,food allergy treatments, right?
OIT, where we're developing atolerance and perhaps ingesting
the allergen.
And
Katherine Dahlsgaard, PhD (17:14):
Yes.
Amanda Whitehouse, Phd (17:14):
not what you're talking about, good idea
to clarify.
Katherine Dahlsgaard, PhD (17:18):
Oh, absolutely.
Well, I've been doing this forso long exposure means something
very positive in anxietytreatment, in food allergy
exposure, typically, the way thelay public thinks about it is my
child was exposed to crosscontamination and then ingested
the allergen.
That's not what I'm talkingabout when I talk about exposure
(17:39):
in the context of treatment forexcessive food allergy anxiety,
or specific phobia ofanaphylaxis.
Exposure in this case is, Hey,let's have you practice engaging
in safe enough casual contactwith your allergens and all of
(18:00):
the exposures that we do, noneof them of course, are gonna
involve ingestion.
That's not a good exposure, butrather they are going to be s
trategic exposures that arecommon and common to all
exposure therapy, regardless ofwhat phobia you're treating, but
also they're going to beevidence backed that they are
safe.
(18:22):
So, for instance, typically insession one, we do the whiff
challenge.
The whiff challenge.
Oh, we love the Wif challenge,and that is if you're allergic
to peanuts, let's open up a jarof peanut butter and have you
sniff it.
And if you're super, superscared, which would make sense
because you're sitting in frontof me, we're gonna have you
sniff it from a ruler's lengthof away.
(18:42):
And if that's too scary, let'sstart with it being six feet
away.
Because often this is the firsttime the kids have been around
their allergen.
And then we bring it closer andhave you sniff, and I'm gonna
give you tons of positivefeedback.
Those are great, loud sniffs,good brave sniffing.
And the child is afraid.
And the parent is afraid.
(19:04):
And that is okay because guesswhat happens?
And what happens is they sniffand they get afraid.
But what doesn't happen is ananaphylactic reaction., And that
has real world implicationsbecause.
Your kid is gonna be aroundsomeone who is eating her
(19:25):
allergen, right?
Your kid is gonna be aroundsomeone who's eating a peanut
butter sandwich, and they'regonna be able to smell that
peanut butter sandwich, and wewant them to know, not because I
told them or you told them, butvia direct experiential proof,
oh, it's okay that I can smellthe peanut butter.
That doesn't cause an allergicreaction, but therapy through
(19:46):
telling works about as well asparenting through telling.
Exposure therapy works soefficiently and so powerfully
because the kids learn it ontheir own.
So that would be an example ofan exposure.
And then, I personally haveparents present in every
(20:06):
session.
I want parents to see what I'mdoing with their kid.
I want parents to see how Imanage when their kid gets very
anxious that when their kid getsanxious, the more anxious their
kid gets, the more relaxed Iget.
And the impression I wanna giveto the child, not by telling,
but by showing is it's okay ifyou're anxious.
Your anxiety doesn't make meanxious.
(20:27):
Let's keep going and do somemore good sniffs.
But also I want parents therebecause I want parents to have
firsthand knowledge that this issafe enough for their child.
And as I say to my students,when I train them to do
exposures, I say.
I really like having parentspresent in session because an
(20:49):
exposure for the child is anexposure for the parent too, and
it's, that is triple the casewith food allergy.
Parents really often don't knowwhat is safe enough.
It's hard to get really accurateinformation about what is safe
enough, and they really, reallyhave to trust a psychologist to
(21:11):
do these exposures, which Ialready know are safe enough
because I've read all theresearch papers and I consulted
with a ton of food allergistswhen I was developing this
treatment.
Amanda Whitehouse, Phd (21:19):
What I think is the biggest challenge
of working with phobias andanxiety is that even when our
logical brain knows this issafe, this is, very unlikely to
harm my child, the anxietyreaction and the fear in the
body just takes over.
So, aside from exposing andexperiencing that okayness, it's
really hard to shift.
Katherine Dahlsgaard, PhD (21:38):
Yes, and I think parents of kids with
food allergy, they get thedouble whammy because parents of
kids with other anxietydisorders, they know that the
dog is safe enough for the kid.
They know that a separation.
Is safe enough for their kid,meaning a temporary separation
to, you know, walk down the hallwith me and go get like a snack
(21:59):
from the fridge at my oldoffice.
But those parents are terrifiedof their kid being terrified
because they're afraid thatbeing afraid is gonna harm their
child because their experienceis, my child is being harmed by
being afraid all the time.
And what I say to them is,exposure therapy is so
(22:20):
efficient.
And so powerful that yes, theseexposures will have your child
be afraid, but the fear will beproductive because they're
learning a new skill and they'relearning that things that they
thought were dangerous weresafe.
So the anxiety is now productiveand therefore temporary versus
(22:41):
what's going on with your child,where the anxiety is feeding on
itself via the avoidance.
So the anxiety currently isunproductive and therefore
potentially endless With foodallergy parents, they're both
terrified.
I don't wanna see my kid be anymore anxious, so why do we have
to do exposures that'll make mykid anxious?
(23:02):
And then in the back of theirminds, even if I hand them the
papers.
Even if I hand them the handoutthat we created that gives them
sort of the breakdown of what issafe enough they have in the
back of their minds, what if mychild has a reaction during this
exposure?
So food allergy parents are myfavorite because they do have to
put up with a lot of fear topartake in this treatment, and
(23:28):
they get through it as well astheir kids do, and both parties
respond beautifully to thetreatment.
Because over and over and over,I thought this was gonna happen.
I thought my kid was gonna beanxious and it was gonna rip her
apart and maybe she'd have anallergic reaction.
And it turned out she did getanxious.
She didn't have an allergicreaction.
And when we went home and didthe whiff challenge for homework
(23:51):
every day we did the whiffchallenge for homework.
She got less and less and lessanxious.
And then I watched her get alittle exhilarated, like, oh my
gosh, I really am not like, ohmy gosh, I can sniff as much as
I want.
This is safe.
And then Dr.
Dahlsgaard, I found that she gotbored so that by session two,
the kid has come back and I'vetypically assigned the family.
(24:14):
This is session one homework,right?
You've met me and I'm, we'regonna get going.
I've assigned, okay.
Do the whiff challenge withdifferent forms of your child's
allergen in different rooms ofthe house.
So it's not just that I'm safeto sniff an open jar of peanut
butter on my kitchen counter.
Three times, it's that I'm, it'ssafe for me to sniff an open jar
(24:38):
of nuts, an open bag of, peanutm and ms in my bedroom, in the
living room, in the garage, inmy parents' car.
Because what I want is quickgeneralization and
generalization means it's notjust that this was safe enough
to do because I was with mytherapist, because now I'm doing
it at home.
It's not just that this was safeto do because it was a specific
(25:00):
allergen that didn't move.
As in the case of peanut butter,it is that it's safe to sniff an
allergen that is roomtemperature in all situations,
and that is very importantbecause I want your child to be
able to go to a friend's house,to be able to go to a picnic, to
be able to go to the schoolfield trip and be able to smell
(25:25):
peanut butter because people areeating it around her and be
very, very, very confident.
Oh my gosh.
Yeah.
Of course.
I've done this many times inmany situations, and I get to
enjoy that field trip.
I get to enjoy that picnic justas much as any kid that doesn't
have a food allergy.
Amanda Whitehouse, P (25:42):
Beautiful.
Katherine Dahlsgaard, Ph (25:43):
that's what I want.
Amanda Whitehouse, Phd (25:45):
Amazing.
So would you talk to us thenabout when the fear extends
beyond the specific allergen orproximity to the allergen and
into the concept of eating ingeneral?
Right.
A lot of food allergy parentsare becoming more aware of this
eating disorder diagnosis calledAFRID, which is restricted
eating.
So tell us about what yourthoughts are on that, what
(26:06):
you're seeing, and if yourapproach to that differs any
given the broader, fear thatshows up with kids who are
dealing with that.
Katherine Dahlsgaard, PhD (26:16):
Well, certainly.
So in the case of ARFID, ARFIDis an acronym that stands for
Avoidant Restrictive Food IntakeDisorder.
And the way for people tounderstand it is that ARFID is
the eating disorder where foodis restricted.
For any reason that is not dueto concerns about body size or
(26:37):
shape, that would be food isrestricted in the case of
anorexia.
So in ARFID, it's excessiverestriction of food, and there
are three broad subtypes ofARFID.
The first one is the pickyeating subtype, where food's a
restricted due to the sensoryqualities of the food, the
smell, the taste, the texture.
The second is the subtype.
Number two is The apparent lackof interest or enjoyment in
(26:59):
food.
That's the way it's written inthe DSM.
I prefer the, a relative lack ofinterest or enjoyment in food.
And these are the sort of lowappetite kids who just kind of
need to be reminded to eat.
They often also are, low weightkits.
They weigh lower than theyshould not, because again,
they're deliberatelyrestricting, but just their,
(27:21):
their brain isn't giving themstrong hunger cues and so they
don't take in enough calories.
And then the third subtype isthe type that you're talking
about.
And that is, food is restricteddue to excessive concerns about
the negative consequences ofeating.
And this is where an eatingdisorder and anxiety disorder
often overlap.
(27:42):
And I treat all three kinds ofarfid all day long.
And, when I was director of theanxiety clinic, chop.
I treated a lot of chokingphobia, vomit phobia, and then
ultimately food allergy phobiaor specific phobia of
anaphylaxis.
(28:04):
I keep using the term specificphobia anaphylaxis, and I'm
guessing that your listeners aresaying what everyone should have
a specific phobia ofanaphylaxis.
No.
Um, yes.
No.
So there is such a thing asspecific phobia of choking.
Right.
Everyone should have a fear ofchoking.
The issue is what makes for aphobia is it's an excessive fear
(28:27):
of choking, and it is maintained via all kinds of
unnecessary avoidance.
So when I treat specific phobiaof choking, people over chew
their food.
They chew and chew and chew, andchew and chew until it's a plum
in their mouth.
They'll restrict eating solids,only eating liquids.
They'll semi restrict solids, etcetera.
So when we do exposures forspecific phobia of choking the
(28:51):
exposure is not to choking,right?
That would make no sense.
The exposure is to good, fastswallows and racing up the
exposure hierarchy to eating,you know, the kind of easy soft
foods to the tippy top of thehierarchy, which is always
popcorn and steak withoutquestion.
So that is why specific phobiaof anaphylaxis.
Of course we wanna be afraid ofanaphylaxis, but we don't wanna
(29:11):
have that fear rule our lives.
So for all of you who are like,I don't think that's a good
name, I am gonna stick to thatname for what we're talking
about specifically ofanaphylaxis.
So I see kids with specificphobia of anaphylaxis, and if
they are not, underweight orweight compromised.
I treat it as a straightforwardphobia case and the food allergy
(29:35):
bravery treatment.
The FAB treatment is designedfor that presentation, meaning
it's a more straightforwardphobia case.
The kid is normal, weight is notweight compromised, and that
treatment is six sessions plus abooster.
And the second thing I did afterstarting the food allergy center
(29:55):
is I developed this treatmentand then I published the results
of this six session with a verysmall little sample.
10 patients.
And we got great results, whichis, we got not just significant
reductions in the SOFAA, but theeffect sizes were also large.
(30:19):
And they weren't only large preand post for the sofa, meaning
anxiety came down, but they werealso large.
On another measure, one I didnot write, which is called the
F-A-Q-L-Q, which is the FoodAllergy Quality of Life
questionnaire.
We got significant increases andthe effect sizes were quite
(30:40):
large, meaning that the kids gotless anxious and their disease
specific quality of life alsoimproved.
And we did that with bothinpatient, meaning patients
coming into the office and COVIDhit.
And so we finished out treatingsome of those kids via
(31:00):
telehealth.
Now that I'm in privatepractice, I treat only via
telehealth and many of mypatients come from.
Around the country, right?
And people often say.
Well wait, is it, is it a badidea to see kids with specific
phobia of anaphylaxis overtelehealth, over video?
And the answer is absolutelynot.
(31:20):
It can be hard to find aspecialist.
So my patients who live in otherstates.
It's good for them.
But the other is, is that theexposures from day one are
taking place in ecologicallyvalid settings, meaning in their
homes from day one For kids whopresent with both specific
phobia of anaphylaxis and ARFIDsubtype three, typically those
(31:41):
kids, they have a more severepresentation and they are often
weight suppressed, and thatmeans that just over time they
haven't gained weight as theynormally should.
And so they maybe if they were akid who the universe meant them
to be at the 50th percentile,they've now kind of drifted down
to the 30th percentile or 25thpercentile.
(32:03):
Often those kids are also pickyeaters, so they have a history
of picky eating and they havefood allergies, and now they
have specific phobia ofanaphylaxis, and now they're
also weight suppressed.
So those kids are a bit morecomplicated, but I treat them
all the time.
I would say 50% of the kids thatI treat for specific phobia of
(32:24):
anaphylaxis or excessive foodallergy anxiety also have ARFID
I, and in that case, typically Iwanna get the kid back up to a
therapeutic weight.
So initially the treatment isgonna focus on getting them to
eat a bit more and gain someweight.
Amanda Whitehouse, Phd (32:40):
So what do you think, is stopping more
clinics from popping up aroundthe country?
There are some of us therapistsworking individually, what do
you think needs to happen orwhat will open the door to more
of this
Katherine Dahlsgaard, PhD (32:52):
I think there's two things.
So the first is that.
It is very hard to find anexposure therapist generally,
particularly a pediatricexposure therapist.
I think exposure therapy stillhas a reputation among the lay
public of being an exotictherapy.
It is not, it is the stodgiest,most conservative, most evidence
(33:16):
backed therapy that there is.
It's been around, you know, 70years, so it's quite stodgy,
but.
It is the lucky student who getsa lot of training and exposure
when they're in a graduateprogram.
It can be hard to access.
So the first is sort of myfantasy, and that is that
there's a lot better and morepervasive treatment in this
(33:42):
incredibly evidence backedtechnique.
And then the second is one ofthe things that I'm working on
now, and that is.
Can people who are other thantherapists deliver exposure
therapy competently,particularly in the case of food
allergy.
(34:02):
So I love seeing patientsoutpatient.
I love my telehealth practice,et cetera, but it can be a
burden to find a therapist andgo to therapy.
Wouldn't it be nice if you couldgo and get this powerful
treatment at your foodallergist?
And not all food allergy centershave a dedicated psychologist.
(34:24):
And even if they do, often thatpsychologist is not trained in
exposure.
One of the big surprises for mewhen I, moved over to the food
allergy center and I read theliterature, is that the word
exposure was in none.
Zero of the, food allergy,articles written by
psychologists.
(34:44):
So these were psychologistswriting about food allergy
anxiety.
Typically an exposure was nevermentioned.
Interestingly, it was theallergists who had mentioned
exposure, but without knowingwhat they were doing.
So the, the, the granddaddypaper of them all, or the
grandmommy paper of them allreally was written in 2016 by UR
(35:05):
and roa, and I have forgottenthe third author, I'm sorry, but
it's called the TransformingPower of Proximity Challenges.
And these were allergists, um,an allergist, a physician and a
nurse practitioner.
And they were the originalpeople who said, well, when kids
are anxious, let's have themsniff their allergen during a
(35:26):
regular food allergy visit.
Let's have them touch theirallergen during a regular food
allergy visit.
And so exposure had been there,but the people who were doing it
didn't know.
Anyway, so I think that a greatway of accessing this would be
that we have this treatment begiven within food allergy
(35:50):
centers, and it can be deliveredby a psychologist or a therapist
like licensed, um, clinicalsocial worker, or by a nurse
practitioner.
And so the data that I'm lookingat now is from a, a quality.
Um, improvement study that thenurse practitioner, the
wonderful Megan Lewis at chop, Itrained her to do the treatment.
(36:15):
We did it together, and now I'min private practice.
She's still at CHOP and she nowdoes the treatment.
And I am analyzing the data from130 patients that she has
treated 130 and.
Um, preliminary results lookvery, very good.
(36:38):
So that would be my hope that atreatment like the fab treatment
or treatment like it efficient,focused, short, effective gets
into food allergy centers.
Amanda Whitehouse, Phd (36:52):
That would be amazing.
You said not very many allergistoffice have mental health
practitioner on staff, but Iwould argue that almost none of
them do.
I, I know of very few.
Practices that that operate thatway.
And it's difficult to understandwhy, because it just goes so
hand in hand so nicely, the wayyou're describing.
Katherine Dahlsgaard, PhD (37:09):
Yes.
You know, I, I was thinkingabout academic medical centers,
right?
That's where I've cut my teethand.
You know Penn, university ofMinnesota, NYU, and then CHOP.
So I'm used to in, you know, GIcenters or food allergy centers.
There is a pediatricpsychologist, but you raise a
(37:30):
really good career opportunityfor psychologists and
therapists, and that is what ifI embed myself in a food allergy
office?
Not full-time.
Wouldn't have to be, but itcould be.
Right.
So part-time, because you willget these patients and you will
be able to help them.
There's this, Megan and I justwrote a paper.
(37:52):
It was a review paper for Annalsof, uh, allergy, asthma, and
Immunology, and it was justpublished 2025.
And it was a review of usingexposure in the context of food
allergy and.
Megan wrote much of thediscussion I just thought it was
so beautiful and she said, forpeople who do this treatment, it
(38:16):
will be an incredibly satisfyingpart of your career.
So Megan.
Who had never done exposuretherapy.
Why would she?
She's a, decorated nursepractitioner now is saying, and
will say to me, this is one ofthe most satisfying aspects of
my career.
I love doing it.
So I think those of youtherapists who are listening.
(38:38):
Get ready to be very, veryhappy.
Amanda Whitehouse, P (38:41):
Wonderful.
What better outcome?
We can't make the allergies goaway, but to make that anxiety
go away and to help people livetheir lives more fully, like you
said earlier in theconversation, what could be more
rewarding
Katherine Dahlsgaard, PhD (38:51):
I think the thing I'd like to talk
about is the parents.
So parents come to me with theirchild and they are often.
And they acknowledge thissheepishly to me, I think I'm
more anxious than my child is.
And first off, parents, there'sno reason to be sheepish.
No one is gonna make fun of youfor having anxiety.
(39:13):
Your kid has a potentiallylethal medical condition.
Amanda Whitehouse, Phd (39:18):
Right, and they've been traumatized
usually by witnessing thatlife-threatening reaction.
That's often how things arediagnosed, unfortunately.
So
Katherine Dahlsgaard, PhD (39:26):
Yes.
Amanda Whitehouse, Phd (39:26):
real trauma.
Katherine Dahlsgaard, PhD (39:28):
Yes, definitely.
So I would like to address thebravery of the parents that I
see and say, good for you forpursuing treatment for your
child, recognizing that it wasalso going to be treatment for
you.
And yes, as a parent you areallowed To seek treatment on
(39:50):
your own if you have excessiveanxiety and your kid does not.
So I have seen parents wherethey come to me and I assess
their kid and I say, okay, Idon't think your kid actually
needs treatment, but I think youdo.
Will you allow me to treat youranxiety?
You will respond as beautifullyto an exposure protocol as your
(40:12):
kid would, but you need it.
They do not.
But I also have parents who havecome to me, particularly of
toddlers, who say, yep, I'mafraid to give my toddler.
I already know she's allergic topeanuts and I'm afraid to give
her any other new food.
I know that I am potentially,you know, limiting her life by,
by doing this, I feel terrible.
(40:34):
I'm anxious all the time.
Can I have treatment?
And the answer is yes.
You will respond just as well.
To an exposure based protocol asyour kid would.
The, radio station when thetreatment paper first came out
to one with just the, the 10kids, the local, public radio
station in Philadelphia did astory on us and they interviewed
(40:57):
some of the parents.
So some of the parents agreed tobe interviewed and.
There was a mom who I think onthe interview was crying and
saying, this has changed mykid's life, but it's also
changed our life.
And there is no greater gift toa psychologist than a parent who
(41:18):
is sobbing in happiness.
Amanda Whitehouse, Phd (41:21):
Yeah.
Thank you so much for that workthat you're doing, because I
know it's reaching so many andnow extending beyond with the
research and the tools thatyou're sharing.
The whole food allergy communityis excited about it and
appreciates it.
I think it's so important.
Katherine Dahlsgaard, PhD (41:33):
Thank you very much.
It is.
It is my pleasure.
Part of what's great about foodallergies is that your kid does
get some education in beingbrave.
And I wanna be clear about whatI mean.
So being brave is not goingthrough life and doing hard
things because you don't feelfear.
(41:55):
It is being afraid and gettingthe job done anyway.
And as much as I do not want anychild to suffer unnecessarily, I
do not want any child to beburdened by any Chronicle
medical condition.
But the reality is, is that somechildren are, and so my kids
(42:17):
with food allergies, they aregetting an early education in,
well, I gotta keep myself safeand this is how I'm gonna do it,
and this is how I'm going tofunction well at the level of my
peers.
I think the greatest gift thatwe can give our children,
(42:40):
particularly if we have kidswhose brain tilt a little hot,
as I call it, meaning tilt, alittle anxious, is multiple, as
many as possible as pervasive aspossible examples and practice
at functioning while anxious.
Yep.
I know you're anxious and yougotta go to school and I'm your
(43:01):
mom and I care about you and I'mnot fighting you.
I'm fighting anxiety.
I'm on your side againstanxiety.
Yep.
You gotta go to school.
Nope.
I'm not gonna ask for anaccommodation to get you out of
doing public talks at school.
Because I want you to learn youcan function while you're
anxious.
The more kids have thatexperience, the stronger they
are and the more confident youas a parent are going to be
(43:25):
about their ability to navigatelife when they're no longer
living with you.
Amanda Whitehouse, (43:29):
Beautifully said.
Thank you so much for sharingthat and everything that you
shared
Katherine Dahlsgaard, PhD (43:33):
Oh, my pleasure.
I, I, I just love your work aswell, so thank you so much.
Talking with Dr.
Dahlsgaard has been a goodreminder that food allergy
anxiety isn't just a feeling,it's measurable, it's
addressable, and it's eventransformable with empathy and
expertise.
So if you are ready to turndeeper awareness into meaningful
action, here are three stepsthat you can take to carry
(43:56):
forward today's insights.
If you want to dive deeper, youcan read her recent article and
learn more about the proximitychallenges that she told you
about today.
You can check out the SOFAAscale, S-O-F-A-A.
The link will be in the notes.
You can download the parent orthe child version from the
Children's Hospital ofPhiladelphia and notice what it
reveals to you about the anxietythat you're managing and.
(44:20):
Number three, I just want you tothink about this word bravery.
I want you to think about yourown bravery cues.
About how you can tie that wordbrave into the actions that
you're already taking to manageyour anxiety, Weaving that word
and that concept and thephysical feeling of bravery into
everything you're doing canbring an extra power and shift
(44:40):
so thank you so much for joiningme for this courageous
exploration with Dr.
Dahlsgaard.
And as always, I ask that if youlike what you're hearing, please
subscribe to the podcast, sharewith another family who might
benefit from listening.
And if you really wanna help meout and spread the word, you can
leave a review wherever it isthat you listen to your
podcasts.
the content of this podcast isfor informational and
(45:01):
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda Whitehouse Thanks forjoining me.
And until we chat again,remember don't feed the fear.
every time they get anxious, they try
(00:01):
and avoid feeling anxiety.
And that is no way to live.
It is an existential threat toyour child if they get to that
point, because part of humanlife is feeling anxious in
response to challenges.
Your kid is gonna have to asksomeone.
To marry him, your kid is gonnahave to apply for her first
(00:22):
mortgage, and they're gonna beanxious and they need to have
the confidence that they havebuilt up in childhood with you
as the parent that they can beanxious and function anyway.
Not perfectly, not happily, butfunction.
Amanda Whitehouse, PhD (00:39):
Welcome to the Don't Feed the Fear
podcast, where we dive into thecomplex world of food allergy
anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
Amanda Whitehouse, Phd (01:00):
this summer we are talking about
choices and where we have someaction and control over our
experiences, we may not be ableto control whether or not we
experience any anxiety aboutmanaging our allergies, but we
can take steps to mitigate that.
That is why I'm so excited foryou to meet today's guest, Dr.
Katherine Dahlsgaard..
She's a clinical psychologistand a researcher who's been
(01:22):
shaping the landscape of foodallergy anxiety with her work.
You may know of her from herwork at Children's Hospital of
Philadelphia where she createdthe Bravery program.
You might know about herdeveloping the SOFAA scales to
measure food allergy anxiety,and most recently, she
co-authored a paper on usingproximity challenges, like
smelling or being close to yourallergen as a deliberate anxiety
(01:45):
reducing tool in clinicalsettings.
So I asked Dr.
Dahlsgaard to join us so that wecould explore not only what she
discovered, but how these ideascan feel different, safer, and
braver for families managingfood allergies.
Trust me, you'll want to meether.
thank you so much for joining mehere on Don't Feed The Fear, Dr.
Dahlsgaard.
I am so excited to talk tosomeone on the podcast for the
(02:06):
first time in the same field asme, another psychologist Thank
you so much for taking the timeto join me.
It feels very special to haveyou here.
Katherine Dahlsgaard, P (02:13):
Amanda, I'm delighted.
Amanda Whitehouse, Phd (02:15):
Tell us how you got into this unique
combination that we both findourselves in, of being
psychologists, working with themental health side of food
allergies.
Katherine Dahlsgaard, PhD (02:26):
It is a long answer.
I will try to make it short.
I have been a specialist intreating pediatric anxiety
disorders for 20 years.
It is my passion and I startedat Children's Hospital of
Philadelphia.
I was the founder and directorof their anxiety clinic for kids
with anxiety disorders, childrenand adolescents, and I ran that
(02:48):
for a bit over 10 years.
And we treated all of theanxiety disorders that kids
present with, so things like OCDand all kinds of phobias and
separation, anxiety disorder,and selective mutism and PTSD
and as the director.
I was given appropriately whatwere considered very difficult
(03:11):
cases, and I started to see justa few in my clinic, these kids
who had bonafide IgE mediatedfood allergies, but they had too
much anxiety about them and theywere engaged in a ton of
medically unnecessary avoidance.
(03:31):
So in food allergy, we wannahave medically necessary
avoidance of ingesting theallergen.
But these were kids who wereterrorized by being in the
presence of their allergen orjust by the thought of being in
the presence of their allergen.
(03:53):
And not only that, but unusual,uh, unusual to my cases.
Their parents were terrorizedtoo.
So let me explain what I mean.
In the case of the dog phobia,the kid is terrified of dogs
over predicts.
If they see a dog, the dog'sgonna bite them and over
(04:14):
predicts the catastrophicconsequence.
Not only is the dog gonna biteme, it's gonna rip my throat
out, I'm gonna, I'm gonna die.
It's gonna be terrible.
But their parents know my kid isway over predicting negative
outcomes.
She's way too afraid of dogs.
In the case of food allergyanxiety, or what I came to call
(04:35):
specific phobia of anaphylaxis,the parents were just as
terrified as the kids, and myheart went out to these families
in a very profound way.
(04:58):
And also it turns out that thesewere not difficult cases to
treat like any phobia.
They were straightforward totreat.
We have a great treatment forphobias, and these kids and
their families got betterquickly with a very common and
strategic treatment.
(05:18):
So that's how I got into it.
Amanda Whitehouse, Phd (05:20):
So everyone's going to wanna know
immediately.
Then.
I think I'm familiar because ofyour work and my work, but tell
people what is the very specificand effective treatment that we
use for specific phobias.
Katherine Dahlsgaard, PhD (05:32):
It is called exposure therapy, and it
is a type of cognitivebehavioral therapy, so exposure
therapy.
For your listeners who haven'theard about it or maybe think
they might know what it is,exposure therapy.
Is the effective evidence-basedscientifically backed treatment
(05:53):
for pretty much all anxietydisorders, and the evidence is
especially strong for phobiasand exposure is gradual
strategic exposure to the safeenough thing that is avoided
unnecessarily.
(06:16):
So to take the instance of,again, dog phobia, the kid will
be avoiding dogs.
If I go over to my cousin'shouse, I, I get my mom to tell
their parent that the dog has togo in the basement.
But even so, even though the dogis in the basement, every time
it barks, I get really scared.
(06:37):
Because my brain is overpredicting the dog's gonna get
out.
It's gonna come right to me andit's going to bite me.
And so you have kids who havebeen avoiding play dates with
friends that have dogs, avoidinggoing to holidays with families
that have dogs, or familymembers that have dogs.
And you would think that allthis avoidance would make it so
(06:58):
that they're not anxious, butinstead they're anxious all the
time.
And that is because unnecessaryavoidance.
Means you're collecting baddata.
So I haven't been around a dogfor three years.
Yeah, I see all my friendspetting the neighborhood dogs
and loving dogs, but I haven'tbeen around dogs for three years
(07:21):
and I haven't been bitten thatentire time.
Therefore, the avoidance isworking and I better keep doing
it, and that means I better bevigilant every time I see a dog
so I can avoid it.
Amanda Whitehouse, Phd (07:34):
Right, and now that's the only coping
skill I have for managing thisanxiety is avoid everything at
all costs.
Right.
Katherine Dahlsgaard, PhD (07:40):
Yes, and it is the only coping skill,
but it isn't a coping skill
Amanda Whitehouse, Phd (07:45):
Right.
Katherine Dahlsgaard, P (07:46):
because what the child is not learning
is the relative safety of dogs.
They're also not getting achance to be, um, they're also
not getting a chance.
To develop the crucial lifeskill of functioning while they
are anxious.
(08:06):
So, so many of my anxious kids,when they come to me, they're
not just anxious about the doc,about temporary separations from
their parents, about getting upin front of other kids at school
and giving, um, a, a, a public,uh, speech.
They've gotten to the pointwhere every time they get
anxious, they try and avoidfeeling anxiety.
(08:30):
And that is no way to live.
It is an existential threat toyour child if they get to that
point, because part of humanlife is feeling anxious in
response to challenges.
Your kid is gonna have to asksomeone.
To marry him, your kid is gonnahave to apply for her first
mortgage, and they're gonna beanxious and they need to have
(08:52):
the confidence that they havebuilt up in childhood with you
as the parent that they can beanxious and function anyway.
Not perfectly, not happily, butfunction.
Amanda Whitehouse, Phd (09:05):
I talk about with my clients, how
there's this bell curve or anormal curve showing that a
little bit of anxiety motivatesus and enhances our performance,
right?
And so framing that as it'sactually a good and a productive
thing in certain circumstancesat a moderate or appropriate
level.
Katherine Dahlsgaard, PhD (09:20):
Yes, and just like with dogs, and
then I'll talk about foodallergens as well, we want our
children to have an appropriatelevel of anxiety around dogs.
I've never met this dog.
I don't run up to it and pet it.
I ask the owner, is it okay if Ipet your dog?
In the case of food allergy, wewant our kids to have enough
(09:40):
anxiety, right?
A good enough amount to keepthemselves safe.
We want our kids when they goover to a friend's house to be
cautious about what they eat, tolook at ingredient LA labels to
carry their EpiPen everywhere,right?
That's the appropriate level ofanxiety that we want for our
(10:01):
children.
What we don't want is too muchof a good thing because too much
of a good, good thing means Iavoid too much.
The bad thing doesn't happenthat my anxious brain was
predicting would happen.
So I think the avoidance isworking and then I turn around
(10:23):
and I'm the only kid who justgot to college in my college
class who's eating alone in mydorm room, rather than going in
the cafeteria and developingfriendships.
So too much anxiety leads to toomuch avoidance and too much
avoidance leads to a life thatis smaller than it needs to be.
(10:46):
And a food allergy is a chroniccondition for most people, but
it doesn't have to be a chroniccondition that makes your life
small.
And it shouldn't be.
People with food allergiesdeserve like the rest of us who
do not have food allergies.
To live as big a life aspossible, an adventurous a life
(11:09):
as possible.
Amanda Whitehouse, Phd (11:12):
I love that.
So that is the inspirationwanting these kids.
And their parents to have as bigof a life as possible and as
full of a life as possible.
Is that where you then movedfrom Directing this anxiety
clinic, then you created aspecific food allergy anxiety
clinic at the Children'sHospital Philadelphia.
Correct.
Katherine Dahlsgaard, PhD (11:30):
Yes, very much.
I, I can really say I put mymoney where my mouth was.
I put my money where my heartwas.
In that I, the director of theanxiety clinic at CHOP
Children's Hospital,Philadelphia, went over to the
food allergy center and startedup the first that I know of or
that we know of, specialtyAnxiety clinic embedded within a
(11:51):
food allergy center.
So if you can imagine, um, theDepartment of Child and
Adolescent Psychiatry allowingtheir director to go over to
another department to days aweek to start at this clinic,
you can bet I really, really,really wanted to start that
clinic and start doing the work.
Amanda Whitehouse, Phd (12:10):
And your time is precious, but certainly
there must have been anabundance of patients for both,
I would suspect.
Katherine Dahlsgaard, PhD (12:17):
Very much so.
It was a, it was a great thingto do.
I've had a lot of really, reallysatisfying experiences in my
career.
I love my job.
I love helping anxious kids.
I love the treatment, I loveeverything about it.
But starting up, the FoodAllergy Bravery Clinic, the FAB
Clinic.
In the food allergy center atCHOP is one of the jewel, one of
(12:39):
the jewels in my crown.
It was just great.
I loved it.
Amanda Whitehouse, Phd (12:44):
I've heard so many good things.
I know a lot of people who havebeen clients there.
I'll link for people listening.
I had a guest on the show whosedaughter, pulled out of some
really restrictive eating and,and concerning weight loss, due
to food allergies
Katherine Dahlsgaard, PhD (12:57):
So wait.
You've interviewed formerpatients of the FAB Clinic.
Amanda Whitehouse, Phd (13:00):
Uh, just, just one on the show.
Yeah.
Katherine Dahlsgaard, PhD (13:02):
Oh my goodness.
Oh, that's so great.
Alright.
Amanda Whitehouse, Phd (13:04):
her name was Kelly Chambers.
She came on the show and she,she gave a really great episode.
So I'll, I'll make sure to linkthat and just said the best
things about their experiencethere.
Katherine Dahlsgaard, PhD (13:13):
Oh, that's delightful to hear.
When I got there, the firstthing I did was I looked around
and I read all the literature.
Any person who's gonna start aspecialty treatment clinic, you
need to be very cognizant of theliterature.
And I, to some extent was, butthe first thing I did there,
actually, the first two things Idid there was I sat down and I.
(13:33):
Read every piece of literaturein the food allergy journals,
which are different from thepsychiatric journals.
So your listeners should know.
Oftentimes people who work inpsychology don't read medical
journals and vice versa.
And it's just because we getused to reading studies as they
come out in the journals thatwe're familiar with.
So I took a very, very deep diveinto that.
(13:55):
And then the other thing that Idid was I started going to the
oral food challenge or officefood challenge.
Clinic so that I was seeing kidscome in and ingesting their
allergen and for the most part,not having a reaction, but
sometimes having reactions andhow that was handled, what that
actually looked like.
So I got a very intimate look inboth the science and the
(14:18):
practice of treating kids withfood allergies.
And the first thing I noticedwas that there was no disease
specific validated questionnaireto measure food allergy anxiety.
Now, for all of your listenerswho have just fallen asleep,
trust me, this was fascinatingand very, very, very exciting.
And what's needed if you'regoing to design a treatment for
(14:42):
food allergy anxiety is you needto have a validated measure
questionnaire.
That is scientificallyvalidated.
So it measures what it'ssupposed to measure.
It has good reliability, it hasgood validity because you need
to use it as a pre and postmeasure, pre-treatment levels of
anxiety, post-treatment levelsof anxiety, and then if you do a
(15:03):
follow-up, follow up levels ofanxiety.
So the first thing I did was.
Developed that and wrote thatand got that validated, which is
a very long process, and that iscalled, I love it.
Every time I say it, I'm gonnasay it.
It's called the SOFAA, which isan acronym for scale of food
(15:26):
allergy anxiety.
So anyone who wants to take alook at the sofa, it is free for
use for clinicians andresearchers.
And it is housed atchop.edu/sofa, SOFAA.
So I developed that and it's achild measure and a parent
measure.
So children report on their ownfood allergy anxiety and parents
(15:49):
report on their perception oftheir kids food allergy anxiety.
So we have cross informantreports.
So that was number one.
And then number two is I startedto work on a treatment, and I
really like therapy that istargeted and focused.
I like treatments that areleaned down so they don't have a
(16:10):
lot of bells and whistles Andfortunately, I'm an exposure
therapist, and so exposuretherapy lends itself beautifully
to very brief and targetedtreatments.
So thank goodness that aspect ofmy personality fixed by my
choice of profession.
And I was already, to someextent, doing the treatment that
I ultimately developed as thefood allergy bravery treatment,
(16:33):
the FAB treatment.
And that was.
You come in, we assess yourlevel of food allergy anxiety,
specifically the amount ofmedically unnecessary avoidance
in which you're taking part,because again, it's the
avoidance that is driving theanxiety.
Not the other way around.
The more you avoidunnecessarily, the more anxious
you're gonna be.
(16:56):
And then we start a treatmentthat is exposure based and you
start getting exposures insession one.
Let me stop here.
Amanda Whitehouse, Phd (17:04):
Yeah, I think that's where a lot of
parents go.
What?
Because they're doing exposure,food allergy treatments, right?
OIT, where we're developing atolerance and perhaps ingesting
the allergen.
And
Katherine Dahlsgaard, PhD (17:14):
Yes.
Amanda Whitehouse, Phd (17:14):
not what you're talking about, good idea
to clarify.
Katherine Dahlsgaard, PhD (17:18):
Oh, absolutely.
Well, I've been doing this forso long exposure means something
very positive in anxietytreatment, in food allergy
exposure, typically, the way thelay public thinks about it is my
child was exposed to crosscontamination and then ingested
the allergen.
That's not what I'm talkingabout when I talk about exposure
(17:39):
in the context of treatment forexcessive food allergy anxiety,
or specific phobia ofanaphylaxis.
Exposure in this case is, Hey,let's have you practice engaging
in safe enough casual contactwith your allergens and all of
(18:00):
the exposures that we do, noneof them of course, are gonna
involve ingestion.
That's not a good exposure, butrather they are going to be s
trategic exposures that arecommon and common to all
exposure therapy, regardless ofwhat phobia you're treating, but
also they're going to beevidence backed that they are
safe.
(18:22):
So, for instance, typically insession one, we do the whiff
challenge.
The whiff challenge.
Oh, we love the Wif challenge,and that is if you're allergic
to peanuts, let's open up a jarof peanut butter and have you
sniff it.
And if you're super, superscared, which would make sense
because you're sitting in frontof me, we're gonna have you
sniff it from a ruler's lengthof away.
(18:42):
And if that's too scary, let'sstart with it being six feet
away.
Because often this is the firsttime the kids have been around
their allergen.
And then we bring it closer andhave you sniff, and I'm gonna
give you tons of positivefeedback.
Those are great, loud sniffs,good brave sniffing.
And the child is afraid.
And the parent is afraid.
(19:04):
And that is okay because guesswhat happens?
And what happens is they sniffand they get afraid.
But what doesn't happen is ananaphylactic reaction., And that
has real world implicationsbecause.
Your kid is gonna be aroundsomeone who is eating her
(19:25):
allergen, right?
Your kid is gonna be aroundsomeone who's eating a peanut
butter sandwich, and they'regonna be able to smell that
peanut butter sandwich, and wewant them to know, not because I
told them or you told them, butvia direct experiential proof,
oh, it's okay that I can smellthe peanut butter.
That doesn't cause an allergicreaction, but therapy through
(19:46):
telling works about as well asparenting through telling.
Exposure therapy works soefficiently and so powerfully
because the kids learn it ontheir own.
So that would be an example ofan exposure.
And then, I personally haveparents present in every
(20:06):
session.
I want parents to see what I'mdoing with their kid.
I want parents to see how Imanage when their kid gets very
anxious that when their kid getsanxious, the more anxious their
kid gets, the more relaxed Iget.
And the impression I wanna giveto the child, not by telling,
but by showing is it's okay ifyou're anxious.
Your anxiety doesn't make meanxious.
(20:27):
Let's keep going and do somemore good sniffs.
But also I want parents therebecause I want parents to have
firsthand knowledge that this issafe enough for their child.
And as I say to my students,when I train them to do
exposures, I say.
I really like having parentspresent in session because an
(20:49):
exposure for the child is anexposure for the parent too, and
it's, that is triple the casewith food allergy.
Parents really often don't knowwhat is safe enough.
It's hard to get really accurateinformation about what is safe
enough, and they really, reallyhave to trust a psychologist to
(21:11):
do these exposures, which Ialready know are safe enough
because I've read all theresearch papers and I consulted
with a ton of food allergistswhen I was developing this
treatment.
Amanda Whitehouse, Phd (21:19):
What I think is the biggest challenge
of working with phobias andanxiety is that even when our
logical brain knows this issafe, this is, very unlikely to
harm my child, the anxietyreaction and the fear in the
body just takes over.
So, aside from exposing andexperiencing that okayness, it's
really hard to shift.
Katherine Dahlsgaard, PhD (21:38):
Yes, and I think parents of kids with
food allergy, they get thedouble whammy because parents of
kids with other anxietydisorders, they know that the
dog is safe enough for the kid.
They know that a separation.
Is safe enough for their kid,meaning a temporary separation
to, you know, walk down the hallwith me and go get like a snack
(21:59):
from the fridge at my oldoffice.
But those parents are terrifiedof their kid being terrified
because they're afraid thatbeing afraid is gonna harm their
child because their experienceis, my child is being harmed by
being afraid all the time.
And what I say to them is,exposure therapy is so
(22:20):
efficient.
And so powerful that yes, theseexposures will have your child
be afraid, but the fear will beproductive because they're
learning a new skill and they'relearning that things that they
thought were dangerous weresafe.
So the anxiety is now productiveand therefore temporary versus
(22:41):
what's going on with your child,where the anxiety is feeding on
itself via the avoidance.
So the anxiety currently isunproductive and therefore
potentially endless With foodallergy parents, they're both
terrified.
I don't wanna see my kid be anymore anxious, so why do we have
to do exposures that'll make mykid anxious?
(23:02):
And then in the back of theirminds, even if I hand them the
papers.
Even if I hand them the handoutthat we created that gives them
sort of the breakdown of what issafe enough they have in the
back of their minds, what if mychild has a reaction during this
exposure?
So food allergy parents are myfavorite because they do have to
put up with a lot of fear topartake in this treatment, and
(23:28):
they get through it as well astheir kids do, and both parties
respond beautifully to thetreatment.
Because over and over and over,I thought this was gonna happen.
I thought my kid was gonna beanxious and it was gonna rip her
apart and maybe she'd have anallergic reaction.
And it turned out she did getanxious.
She didn't have an allergicreaction.
And when we went home and didthe whiff challenge for homework
(23:51):
every day we did the whiffchallenge for homework.
She got less and less and lessanxious.
And then I watched her get alittle exhilarated, like, oh my
gosh, I really am not like, ohmy gosh, I can sniff as much as
I want.
This is safe.
And then Dr.
Dahlsgaard, I found that she gotbored so that by session two,
the kid has come back and I'vetypically assigned the family.
(24:14):
This is session one homework,right?
You've met me and I'm, we'regonna get going.
I've assigned, okay.
Do the whiff challenge withdifferent forms of your child's
allergen in different rooms ofthe house.
So it's not just that I'm safeto sniff an open jar of peanut
butter on my kitchen counter.
Three times, it's that I'm, it'ssafe for me to sniff an open jar
(24:38):
of nuts, an open bag of, peanutm and ms in my bedroom, in the
living room, in the garage, inmy parents' car.
Because what I want is quickgeneralization and
generalization means it's notjust that this was safe enough
to do because I was with mytherapist, because now I'm doing
it at home.
It's not just that this was safeto do because it was a specific
(25:00):
allergen that didn't move.
As in the case of peanut butter,it is that it's safe to sniff an
allergen that is roomtemperature in all situations,
and that is very importantbecause I want your child to be
able to go to a friend's house,to be able to go to a picnic, to
be able to go to the schoolfield trip and be able to smell
(25:25):
peanut butter because people areeating it around her and be
very, very, very confident.
Oh my gosh.
Yeah.
Of course.
I've done this many times inmany situations, and I get to
enjoy that field trip.
I get to enjoy that picnic justas much as any kid that doesn't
have a food allergy.
Amanda Whitehouse, P (25:42):
Beautiful.
Katherine Dahlsgaard, Ph (25:43):
that's what I want.
Amanda Whitehouse, Phd (25:45):
Amazing.
So would you talk to us thenabout when the fear extends
beyond the specific allergen orproximity to the allergen and
into the concept of eating ingeneral?
Right.
A lot of food allergy parentsare becoming more aware of this
eating disorder diagnosis calledAFRID, which is restricted
eating.
So tell us about what yourthoughts are on that, what
(26:06):
you're seeing, and if yourapproach to that differs any
given the broader, fear thatshows up with kids who are
dealing with that.
Katherine Dahlsgaard, PhD (26:16):
Well, certainly.
So in the case of ARFID, ARFIDis an acronym that stands for
Avoidant Restrictive Food IntakeDisorder.
And the way for people tounderstand it is that ARFID is
the eating disorder where foodis restricted.
For any reason that is not dueto concerns about body size or
(26:37):
shape, that would be food isrestricted in the case of
anorexia.
So in ARFID, it's excessiverestriction of food, and there
are three broad subtypes ofARFID.
The first one is the pickyeating subtype, where food's a
restricted due to the sensoryqualities of the food, the
smell, the taste, the texture.
The second is the subtype.
Number two is The apparent lackof interest or enjoyment in
(26:59):
food.
That's the way it's written inthe DSM.
I prefer the, a relative lack ofinterest or enjoyment in food.
And these are the sort of lowappetite kids who just kind of
need to be reminded to eat.
They often also are, low weightkits.
They weigh lower than theyshould not, because again,
they're deliberatelyrestricting, but just their,
(27:21):
their brain isn't giving themstrong hunger cues and so they
don't take in enough calories.
And then the third subtype isthe type that you're talking
about.
And that is, food is restricteddue to excessive concerns about
the negative consequences ofeating.
And this is where an eatingdisorder and anxiety disorder
often overlap.
(27:42):
And I treat all three kinds ofarfid all day long.
And, when I was director of theanxiety clinic, chop.
I treated a lot of chokingphobia, vomit phobia, and then
ultimately food allergy phobiaor specific phobia of
anaphylaxis.
(28:04):
I keep using the term specificphobia anaphylaxis, and I'm
guessing that your listeners aresaying what everyone should have
a specific phobia ofanaphylaxis.
No.
Um, yes.
No.
So there is such a thing asspecific phobia of choking.
Right.
Everyone should have a fear ofchoking.
The issue is what makes for aphobia is it's an excessive fear
(28:27):
of choking, and it is maintained via all kinds of
unnecessary avoidance.
So when I treat specific phobiaof choking, people over chew
their food.
They chew and chew and chew, andchew and chew until it's a plum
in their mouth.
They'll restrict eating solids,only eating liquids.
They'll semi restrict solids, etcetera.
So when we do exposures forspecific phobia of choking the
(28:51):
exposure is not to choking,right?
That would make no sense.
The exposure is to good, fastswallows and racing up the
exposure hierarchy to eating,you know, the kind of easy soft
foods to the tippy top of thehierarchy, which is always
popcorn and steak withoutquestion.
So that is why specific phobiaof anaphylaxis.
Of course we wanna be afraid ofanaphylaxis, but we don't wanna
(29:11):
have that fear rule our lives.
So for all of you who are like,I don't think that's a good
name, I am gonna stick to thatname for what we're talking
about specifically ofanaphylaxis.
So I see kids with specificphobia of anaphylaxis, and if
they are not, underweight orweight compromised.
I treat it as a straightforwardphobia case and the food allergy
(29:35):
bravery treatment.
The FAB treatment is designedfor that presentation, meaning
it's a more straightforwardphobia case.
The kid is normal, weight is notweight compromised, and that
treatment is six sessions plus abooster.
And the second thing I did afterstarting the food allergy center
(29:55):
is I developed this treatmentand then I published the results
of this six session with a verysmall little sample.
10 patients.
And we got great results, whichis, we got not just significant
reductions in the SOFAA, but theeffect sizes were also large.
(30:19):
And they weren't only large preand post for the sofa, meaning
anxiety came down, but they werealso large.
On another measure, one I didnot write, which is called the
F-A-Q-L-Q, which is the FoodAllergy Quality of Life
questionnaire.
We got significant increases andthe effect sizes were quite
(30:40):
large, meaning that the kids gotless anxious and their disease
specific quality of life alsoimproved.
And we did that with bothinpatient, meaning patients
coming into the office and COVIDhit.
And so we finished out treatingsome of those kids via
(31:00):
telehealth.
Now that I'm in privatepractice, I treat only via
telehealth and many of mypatients come from.
Around the country, right?
And people often say.
Well wait, is it, is it a badidea to see kids with specific
phobia of anaphylaxis overtelehealth, over video?
And the answer is absolutelynot.
(31:20):
It can be hard to find aspecialist.
So my patients who live in otherstates.
It's good for them.
But the other is, is that theexposures from day one are
taking place in ecologicallyvalid settings, meaning in their
homes from day one For kids whopresent with both specific
phobia of anaphylaxis and ARFIDsubtype three, typically those
(31:41):
kids, they have a more severepresentation and they are often
weight suppressed, and thatmeans that just over time they
haven't gained weight as theynormally should.
And so they maybe if they were akid who the universe meant them
to be at the 50th percentile,they've now kind of drifted down
to the 30th percentile or 25thpercentile.
(32:03):
Often those kids are also pickyeaters, so they have a history
of picky eating and they havefood allergies, and now they
have specific phobia ofanaphylaxis, and now they're
also weight suppressed.
So those kids are a bit morecomplicated, but I treat them
all the time.
I would say 50% of the kids thatI treat for specific phobia of
(32:24):
anaphylaxis or excessive foodallergy anxiety also have ARFID
I, and in that case, typically Iwanna get the kid back up to a
therapeutic weight.
So initially the treatment isgonna focus on getting them to
eat a bit more and gain someweight.
Amanda Whitehouse, Phd (32:40):
So what do you think, is stopping more
clinics from popping up aroundthe country?
There are some of us therapistsworking individually, what do
you think needs to happen orwhat will open the door to more
of this
Katherine Dahlsgaard, PhD (32:52):
I think there's two things.
So the first is that.
It is very hard to find anexposure therapist generally,
particularly a pediatricexposure therapist.
I think exposure therapy stillhas a reputation among the lay
public of being an exotictherapy.
It is not, it is the stodgiest,most conservative, most evidence
(33:16):
backed therapy that there is.
It's been around, you know, 70years, so it's quite stodgy,
but.
It is the lucky student who getsa lot of training and exposure
when they're in a graduateprogram.
It can be hard to access.
So the first is sort of myfantasy, and that is that
there's a lot better and morepervasive treatment in this
(33:42):
incredibly evidence backedtechnique.
And then the second is one ofthe things that I'm working on
now, and that is.
Can people who are other thantherapists deliver exposure
therapy competently,particularly in the case of food
allergy.
(34:02):
So I love seeing patientsoutpatient.
I love my telehealth practice,et cetera, but it can be a
burden to find a therapist andgo to therapy.
Wouldn't it be nice if you couldgo and get this powerful
treatment at your foodallergist?
And not all food allergy centershave a dedicated psychologist.
(34:24):
And even if they do, often thatpsychologist is not trained in
exposure.
One of the big surprises for mewhen I, moved over to the food
allergy center and I read theliterature, is that the word
exposure was in none.
Zero of the, food allergy,articles written by
psychologists.
(34:44):
So these were psychologistswriting about food allergy
anxiety.
Typically an exposure was nevermentioned.
Interestingly, it was theallergists who had mentioned
exposure, but without knowingwhat they were doing.
So the, the, the granddaddypaper of them all, or the
grandmommy paper of them allreally was written in 2016 by UR
(35:05):
and roa, and I have forgottenthe third author, I'm sorry, but
it's called the TransformingPower of Proximity Challenges.
And these were allergists, um,an allergist, a physician and a
nurse practitioner.
And they were the originalpeople who said, well, when kids
are anxious, let's have themsniff their allergen during a
(35:26):
regular food allergy visit.
Let's have them touch theirallergen during a regular food
allergy visit.
And so exposure had been there,but the people who were doing it
didn't know.
Anyway, so I think that a greatway of accessing this would be
that we have this treatment begiven within food allergy
(35:50):
centers, and it can be deliveredby a psychologist or a therapist
like licensed, um, clinicalsocial worker, or by a nurse
practitioner.
And so the data that I'm lookingat now is from a, a quality.
Um, improvement study that thenurse practitioner, the
wonderful Megan Lewis at chop, Itrained her to do the treatment.
(36:15):
We did it together, and now I'min private practice.
She's still at CHOP and she nowdoes the treatment.
And I am analyzing the data from130 patients that she has
treated 130 and.
Um, preliminary results lookvery, very good.
(36:38):
So that would be my hope that atreatment like the fab treatment
or treatment like it efficient,focused, short, effective gets
into food allergy centers.
Amanda Whitehouse, Phd (36:52):
That would be amazing.
You said not very many allergistoffice have mental health
practitioner on staff, but Iwould argue that almost none of
them do.
I, I know of very few.
Practices that that operate thatway.
And it's difficult to understandwhy, because it just goes so
hand in hand so nicely, the wayyou're describing.
Katherine Dahlsgaard, PhD (37:09):
Yes.
You know, I, I was thinkingabout academic medical centers,
right?
That's where I've cut my teethand.
You know Penn, university ofMinnesota, NYU, and then CHOP.
So I'm used to in, you know, GIcenters or food allergy centers.
There is a pediatricpsychologist, but you raise a
(37:30):
really good career opportunityfor psychologists and
therapists, and that is what ifI embed myself in a food allergy
office?
Not full-time.
Wouldn't have to be, but itcould be.
Right.
So part-time, because you willget these patients and you will
be able to help them.
There's this, Megan and I justwrote a paper.
(37:52):
It was a review paper for Annalsof, uh, allergy, asthma, and
Immunology, and it was justpublished 2025.
And it was a review of usingexposure in the context of food
allergy and.
Megan wrote much of thediscussion I just thought it was
so beautiful and she said, forpeople who do this treatment, it
(38:16):
will be an incredibly satisfyingpart of your career.
So Megan.
Who had never done exposuretherapy.
Why would she?
She's a, decorated nursepractitioner now is saying, and
will say to me, this is one ofthe most satisfying aspects of
my career.
I love doing it.
So I think those of youtherapists who are listening.
(38:38):
Get ready to be very, veryhappy.
Amanda Whitehouse, P (38:41):
Wonderful.
What better outcome?
We can't make the allergies goaway, but to make that anxiety
go away and to help people livetheir lives more fully, like you
said earlier in theconversation, what could be more
rewarding
Katherine Dahlsgaard, PhD (38:51):
I think the thing I'd like to talk
about is the parents.
So parents come to me with theirchild and they are often.
And they acknowledge thissheepishly to me, I think I'm
more anxious than my child is.
And first off, parents, there'sno reason to be sheepish.
No one is gonna make fun of youfor having anxiety.
(39:13):
Your kid has a potentiallylethal medical condition.
Amanda Whitehouse, Phd (39:18):
Right, and they've been traumatized
usually by witnessing thatlife-threatening reaction.
That's often how things arediagnosed, unfortunately.
So
Katherine Dahlsgaard, PhD (39:26):
Yes.
Amanda Whitehouse, Phd (39:26):
real trauma.
Katherine Dahlsgaard, PhD (39:28):
Yes, definitely.
So I would like to address thebravery of the parents that I
see and say, good for you forpursuing treatment for your
child, recognizing that it wasalso going to be treatment for
you.
And yes, as a parent you areallowed To seek treatment on
(39:50):
your own if you have excessiveanxiety and your kid does not.
So I have seen parents wherethey come to me and I assess
their kid and I say, okay, Idon't think your kid actually
needs treatment, but I think youdo.
Will you allow me to treat youranxiety?
You will respond as beautifullyto an exposure protocol as your
(40:12):
kid would, but you need it.
They do not.
But I also have parents who havecome to me, particularly of
toddlers, who say, yep, I'mafraid to give my toddler.
I already know she's allergic topeanuts and I'm afraid to give
her any other new food.
I know that I am potentially,you know, limiting her life by,
by doing this, I feel terrible.
(40:34):
I'm anxious all the time.
Can I have treatment?
And the answer is yes.
You will respond just as well.
To an exposure based protocol asyour kid would.
The, radio station when thetreatment paper first came out
to one with just the, the 10kids, the local, public radio
station in Philadelphia did astory on us and they interviewed
(40:57):
some of the parents.
So some of the parents agreed tobe interviewed and.
There was a mom who I think onthe interview was crying and
saying, this has changed mykid's life, but it's also
changed our life.
And there is no greater gift toa psychologist than a parent who
(41:18):
is sobbing in happiness.
Amanda Whitehouse, Phd (41:21):
Yeah.
Thank you so much for that workthat you're doing, because I
know it's reaching so many andnow extending beyond with the
research and the tools thatyou're sharing.
The whole food allergy communityis excited about it and
appreciates it.
I think it's so important.
Katherine Dahlsgaard, PhD (41:33):
Thank you very much.
It is.
It is my pleasure.
Part of what's great about foodallergies is that your kid does
get some education in beingbrave.
And I wanna be clear about whatI mean.
So being brave is not goingthrough life and doing hard
things because you don't feelfear.
(41:55):
It is being afraid and gettingthe job done anyway.
And as much as I do not want anychild to suffer unnecessarily, I
do not want any child to beburdened by any Chronicle
medical condition.
But the reality is, is that somechildren are, and so my kids
(42:17):
with food allergies, they aregetting an early education in,
well, I gotta keep myself safeand this is how I'm gonna do it,
and this is how I'm going tofunction well at the level of my
peers.
I think the greatest gift thatwe can give our children,
(42:40):
particularly if we have kidswhose brain tilt a little hot,
as I call it, meaning tilt, alittle anxious, is multiple, as
many as possible as pervasive aspossible examples and practice
at functioning while anxious.
Yep.
I know you're anxious and yougotta go to school and I'm your
(43:01):
mom and I care about you and I'mnot fighting you.
I'm fighting anxiety.
I'm on your side againstanxiety.
Yep.
You gotta go to school.
Nope.
I'm not gonna ask for anaccommodation to get you out of
doing public talks at school.
Because I want you to learn youcan function while you're
anxious.
The more kids have thatexperience, the stronger they
are and the more confident youas a parent are going to be
(43:25):
about their ability to navigatelife when they're no longer
living with you.
Amanda Whitehouse, (43:29):
Beautifully said.
Thank you so much for sharingthat and everything that you
shared
Katherine Dahlsgaard, PhD (43:33):
Oh, my pleasure.
I, I, I just love your work aswell, so thank you so much.
Talking with Dr.
Dahlsgaard has been a goodreminder that food allergy
anxiety isn't just a feeling,it's measurable, it's
addressable, and it's eventransformable with empathy and
expertise.
So if you are ready to turndeeper awareness into meaningful
action, here are three stepsthat you can take to carry
(43:56):
forward today's insights.
If you want to dive deeper, youcan read her recent article and
learn more about the proximitychallenges that she told you
about today.
You can check out the SOFAAscale, S-O-F-A-A.
The link will be in the notes.
You can download the parent orthe child version from the
Children's Hospital ofPhiladelphia and notice what it
reveals to you about the anxietythat you're managing and.
(44:20):
Number three, I just want you tothink about this word bravery.
I want you to think about yourown bravery cues.
About how you can tie that wordbrave into the actions that
you're already taking to manageyour anxiety, Weaving that word
and that concept and thephysical feeling of bravery into
everything you're doing canbring an extra power and shift
(44:40):
so thank you so much for joiningme for this courageous
exploration with Dr.
Dahlsgaard.
And as always, I ask that if youlike what you're hearing, please
subscribe to the podcast, sharewith another family who might
benefit from listening.
And if you really wanna help meout and spread the word, you can
leave a review wherever it isthat you listen to your
podcasts.
the content of this podcast isfor informational and
(45:01):
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda Whitehouse Thanks forjoining me.
And until we chat again,remember don't feed the fear.
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