Anxiety is the most common mental health challenge kids face—and it doesn’t just affect them, it impacts the whole family. In this episode, I talk with Dr. Eli Lebowitz, the clinical psychologist behind the SPACE program (Supportive Parenting for Anxious Childhood Emotions), about how parents can help reduce their child’s anxiety—not by changing their kids, but by changing their own responses. We discuss how accommodation and overprotection can backfire, what supportive parenting really looks like, and why this parent-based model is so empowering. Whether your child has a formal anxiety diagnosis or just tends to worry more than others, this episode offers research-backed tools that truly make a difference.
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
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Episode Transcript
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Unknown (00:00):
What you really realize when you stop trying to force
(00:03):
your child to do all thesethings is that there's a whole
lot that you can do that isgoing to be tremendously
impactful, and that your childdoesn't need to approve
of. Hi everyone and welcome backto your child is normal. I'm Dr
Jessica Hochman, your host andpediatrician, and I have to tell
you that I am so excited abouttoday's guest. His name is Dr
(00:24):
Ellie Liebowitz, and he's aclinical psychologist at the
Yale Child Study Center. He'sthe creator of the space program
supportive parenting for anxiouschildhood emotions, and he's the
author of the incredible bookbreaking free of child anxiety
and OCD. I personally admire DrLiebowitz his work for a long
time, and what I love most abouthis approach is that it empowers
parents. He doesn't just talktheory, he gives real,
(00:46):
actionable strategies and evenscripts that parents can use in
the moment to help their childmanage their anxiety more
effectively. It's realistic,it's compassionate, and most
importantly, it actually works.
I'm incredibly grateful to havehad the chance to speak with Dr
Liebowitz, and if you'relistening. Dr Liebowitz, thank
you so much for saying yes, andI'm so excited to share his work
with more parents. He's afantastic resource, and I think
you'll walk away from thisepisode feeling more equipped
(01:08):
and with a clear, actionablepath to support your child. Dr,
Ellie Liebowitz, I'm so happy tohave you here. Thank you so much
for your time. Thanks for havingme. Glad to be here, I have to
tell you, I've been doing thispodcast now for a few years, and
because I talk often aboutanxiety and childhood anxiety, a
few guests have referenced youand mentioned your name, and I
(01:30):
feel like I'm talking tosomebody famous. So thank you so
much.
Okay, well, flattery is never abad idea. So thank you very
much. I appreciate it.
So tell me about yourself. I'dlove to know what inspired you
to do the work that youdo. So I work at the Yale Child
Study Center, where I co directour anxiety and mood disorders
program. Child Study Center is areally interesting place because
(01:55):
it's part of our medical schooland functions as child
psychiatry, but it's a veryinterdisciplinary center, and so
we have psychiatry, but alsopsychology and other disciplines
social work. So it really makesfor a kind of creative
environment to work in. So I ama clinical researcher, and I do
a lot of research, but myresearch tends to be driven by
(02:17):
my experience working withfamilies, and that actually did
lead me to focus a lot onparents and on family systems.
You know, it's kind ofinteresting. In our field, in
mental health, there are someareas where people have
(02:38):
naturally focused a lot onparents for one reason or
another. For example, if you areprimarily focused on children
with really problematicbehaviors, really defiant
children, things like that, it'shistorically been very typical
to have a strong parent focus,not least of all, because
(03:02):
working directly with the childin those cases is often quite
challenging. Not to say youcan't or shouldn't do that, but
it can be really challenging.
And so people gravitate a lottoward work with parents. But
then you look at what peoplelike to call the internalizing
problems, children with anxiety,children with depression,
(03:23):
problems that are less maybedisruptive to the other people
around them, and there's beenmuch less of a focus on parents,
but actually parents both reallystruggle A lot to help their
children with anxiety, and alsoface a lot of challenges
(03:45):
themselves in coping with thechild's anxiety. And what's
really striking is that, maybemore than any other problem,
parents are actually such a bigpart of what it means for a
child to even have anxiety,because we're so hard wired to
(04:05):
rely on parents when we areanxious, and so parents get
really sucked in to all thesedifferent ways of responding.
And so it really drove me to tryto think a lot about how we can
harness that involvement thatparents naturally have, and
really create something thatwould be practical and also
(04:27):
effective at being able toaddress those issues, both for
children who maybe aren't idealcandidates for doing therapy
themselves, but also, moregenerally, for all those
families where parents just wanttools to like, What can I do and
how can I be more effective? Andso, you know, there's a lot of
different answers to thequestion, How did I end up doing
(04:48):
what I do? But maybe that's oneway of thinking about it.
I really appreciate thisapproach to involving parents
and to primarily focusing onparents and what parents can do.
Yeah, for multiple reasons. One,I feel like as parents, we are
the ones around our kids themost. We're witnessing the
behaviors. We're impacted by thebehaviors. And so if we can help
(05:09):
our kids in real time, I thinkthat's clearly going to be an
effective modality. And also,what I love is the scripts that
you give us, because I think inthe moment, it's hard for us to
know how to respond effectivelyto our children. It's easy to
think about maybe how ourparents talk to us, or it's easy
to get frustrated. And so havinga script to go to, I think, is
(05:30):
for me, I'm definitely planningon using this in my own life.
Yeah. Well, thanks. I think thatis really key. You know, if you
just kind of lay out an idea,but you can't translate it into
some really practical andaccessible, go to kind of
strategy that a parent can use.
Then it ends up falling flat alittle bit because, you know, as
(05:51):
parents, we're dealing withthis, like you said, in real
time, and not just in real time,but under a lot of stress, which
is not an ideal moment for a lotof deep thinking, and so we do
end up. I was amused when youwere saying about what our
parents said. I can't count thenumber of times that I've heard
coming out of my mouth, thingsthat maybe I heard growing up,
and not because they were themost helpful things to me when I
(06:15):
did to hear them, or because Ireally spent a lot of time
thinking about it and deciding,yup, that's the ideal way to
respond. But just because youdon't really have something
else, and you know, in theabsence of something else, and
when you're under stress, youkind of go with your built in
instinct, or what comes mostnaturally, which is not always
the most optimal thing to do. Ithink the other thing that's
(06:40):
really important for me in theway that I approach trying to
help parents to make somechanges is to try to move away
from trying to guide parents toimpose things on their children,
to force a change in your child.
(07:00):
You know I was talking about howtraditionally, there was less of
a focus on parent work and theanxiety world. But it's
interesting that even whenpeople did try to involve
parents, mostly what they endedup doing is trying to make the
parent kind of like function,like a therapist for their
child, right? Like, I'm going tobe your therapist. I'm going to
(07:23):
get you to do exposures. I'mgoing to get you to change your
thinking. Practice this scaleand and just as an example, so
you're saying, like, for kidsthat are afraid of bees, have
them put in a situation wherethey're exposed to be and that
might not be comfortable forevery kid, or every kid may not
be willing to do thatexactly. Well, you know that
(07:44):
kind of exposure, that's a greatidea, right? It actually is a
terrific idea if you have achild who wants to do that with
you. But if you don't happen tohave a child who's eager or
wants to do that with you, evenputting aside just how good your
clinical skill may be as aparent, but if you have a child
who doesn't really want to dothat with you, then not only can
(08:06):
it be ineffective, it actuallycan backfire quite a bit. But if
you are a therapist and yourpatient says, I don't want to do
exposures, you probably don'tyell at them, you probably don't
punish them, right? Not a lot oftherapists start yelling at
their patients and punishingthem, taking away their
(08:28):
privileges. But if you're aparent, and what you know is the
most important thing is that mykid go on this picnic and face
their fear of bees, and don'thide away and conquer their
fear. Well, you might startapplying the kind of pressures
that you're used to applying inother situations. When your kid
doesn't want to do what they'retold, right? They don't want to
(08:49):
do their homework, they don'twant to brush their teeth, they
don't want to go to school. Andwhat do you do? You start
pulling the levers that you'reused to pulling. Well, when you
try to do that as a therapist,were your child, that's not
going to end well,I imagine they'll dig their
heels in further.
They dig in further, and thenyou push even harder, and the
whole thing really kind of blowsup in your face. And so we don't
(09:13):
do that at all right, like inthe approach that I developed
this parent based treatment, Imake a very clear promise to
parents really early on, youknow, I'll just say to the
parent that no point in thiswhole process. Am I going to ask
you to make your child doanything or to make your child
not do anything because thosethings are hard and because you
(09:37):
don't need to. Because what youreally realize when you stop
trying to force your child to doall these things, is that
there's a whole lot that you cando that is going to be
tremendously impactful, and thatyour child doesn't need to
endorse or to approve of,because you're not asking
anything from them. You're justchanging your own behavior and.
(10:00):
It really frees, I think, thatwhole dynamic from a lot of
stress and pressure thatotherwise becomes a real
obstacle.
So first, just to back up alittle bit, the program that you
developed is specifically tohelp children with anxiety and
OCD Correct.
Well, I would say this, that isdefinitely where it started.
(10:20):
This began as a treatment forchildren, adolescents with
anxiety and OCD, we have, overtime, realized that we can apply
very similar principles to arange of other situations that
share some core features withanxiety and OCD situations where
(10:43):
parents are very involved andwhere parents tend to
accommodate the child'sdifficulty a lot. And so, for
example, we now use a version ofspace for parents of children
who are really picky eating,what the DSM likes to call
avoidant, restrictive foodintake disorder or arfid These
are really, really picky eaterswho often suffer a lot of
(11:08):
impairment because of thatproblem, not just nutritionally,
but even socially or at a familyfunctioning level. And we're
able to work with those parents.
Or another example, we can workwith parents of children with
chronic physical symptoms,chronic somatic physical
complaints, like aches andpains, the headache, the stomach
ache, etc. Again. Parents reallystruggle with this, right? Like,
(11:29):
on the one hand, I want my childto function, the other hand,
they are genuinely in pain. Sowhat do I do? And so we're able
to apply principles there, andwe've published research on
this, showing that you canactually have some really
meaningful improvement in thechild's functioning just by
changing how parents areresponding. We even have a
version of this that focuses onparents of adult children,
(11:53):
failure to launch. Failure toLaunch, it's great, exactly sad
that we need this. Very much.
Oh yes, we definitely do.
Failure to Launch, meaning adultchildren who are not really
functioning independently asadults. They're not in school,
they're not at work, they'rejust kind of stuck in life,
stuck at home, and often in theparents house, and just like not
really going anywhere. Well,that's another again, you have
(12:16):
this situation where parents areinevitably very involved in
facilitating this reality, butare also very helpless to change
it, like you can't really forceanything on your 30 year old,
and you can't even make them goto therapy, and there's very
little that you can make themdo. As hard as it is to make
your eight year old dosomething, well, it's a lot
(12:37):
harder to make your 28 year olddo anything. And so I think
really, although this did startas an anxiety and OCD treatment,
in a sense, maybe what it'sreally turning out to be is a
parent based approach to childdistress, to helping parents to
better navigate the situationwhere a child is experiencing
(12:59):
distress that is impairing in ameaningful way their function.
And, you know, we'll see. Is itapplicable for every condition?
Maybe not, not necessarily. Andas a researcher, I like to test
things before I'll go out andsay, Hey, this, this works. And
so in somatic symptoms andfailure to watch, we actually
have published clinical trialdata showing, yep, this can
work, and there may be otherproblem areas where we'll find
(13:23):
the sameit's amazing. It's such a useful
tool to know about. I'm soappreciative to know about other
tools that, because there areother existing models out there,
but this is a very uniqueapproach, and like you said,
it's very impressive thatthere's data showing that it's
actually effective. Okay, sopeople are probably wondering,
as we've been talking andsetting up about this idea of
space, I'd love to explain toeverybody what space actually
(13:46):
is. So first, before I ask youabout it, can you tell me who
made this mnemonic? I love it.
Oh, I made the mnemonic. Itworked so well. Oh, thank you.
Well, that is very nice to hear.
I made the mnemonic sitting inthe Yale Medical School
cafeteria. This is like a decadeago or more, because one of my I
had actually done like a talkfor colleagues, describing the
(14:10):
approach and some very earlypreliminary findings from some
piloting of it, one of mycolleagues, a man by the name of
George Anderson, was a brilliantscientist here at our
department, said to me, after,you know, it's all really
interesting, but you really needto come up with a name for this.
Because I didn't, I wasn'tgiving it a name. I was just
(14:33):
describing the approach. And soI took it to heart and sat with
a coffee in the cafeteria andplayed with today, maybe I would
have, like, AI spit somethingout for me, but that was not an
option at the time, and so Iended up with with
space. I love it. Remindeverybody what is the mnemonic
stand forit stands for supportive
(14:54):
parenting, for anxious childhoodemotions. I. Yeah, which does
reflect the origins of it asvery focused on anxiety. And at
the time, actually, OCD was evenformally anxiety disorder per
the DSM. Today, it has graduatedinto its own chapter in the DSM,
along with some other relatedproblems, but actually still
(15:16):
makes sense to think of it as ananxiety disorder for most
purposes, and so we are a littlebit stuck with the word anxiety
in there, even when we talkabout space for arfid, or space
for failure to launch, or spacefor whatever. But like you said,
the mnemonic kind of works, sowe're sticking with it.
And anxiety is the most commonmental difficulty that children
(15:37):
experience. Itreally is. The prevalence rates
of anxiety are just staggering,and that was true like 10 years
ago and 20 years ago. But thenyou throw pandemic into the mix,
and the rates of anxiety that wesee today are even higher than
they were pre pandemic. I don'tknow how long it'll be before
the effects of living through apandemic, whether on the parent
(16:00):
side or on the child side, startto evaporate. Approximately one
in three kids is going toexperience an anxiety disorder
at some point before they areadults. Wow. So that is just
massive, and that's onlycounting the ones who actually
are going to meet likediagnostic criteria for a
clinical disorder, it's leavingout all the kids who are just
(16:23):
sometimes struggling withanxiety, right? Like there's a
lot of kids who are sometimesanxious and maybe at risk for
additional elevated anxiety, butmaybe aren't fully meeting
criteria. Well, we're not evencounting
Yes. And as you talk about inyour book, which I wholly agree
with, that some level and somedegree of anxiety is helpful.
(16:44):
You know, paying attention withwhat to potentially worry about
is protective at some degree,absolutely, it's not an accident
that so much of our brain isreally good at being anxious,
right? Like it's not anaccident, it's a feature. In a
sense, it's not a bug. Because,yeah, anxiety does help us to
stay alert to potential threats.
(17:06):
And the, you know, the kind ofspecial human capacity to
actually imagine potentialthreats in the future, or, you
know, hypotheticals, which maybe more of a human thing than at
least most other species, isalso really helpful, because we
don't have to wait to be facingthe danger in order to take some
(17:28):
precautions. So that's allreally useful. You can have too
much anxiety in your life. Youcan also have too little anxiety
in your life, and that's a riskas well. But that feature does
open us up to a lot of selftorment, to a lot of focus on
(17:48):
anxiety, even in places where itactually is not helping us to be
any safer, whether because thethreats we're worried about are
really not actual threats, orwhether because they're not
really likely to occur, or evenbecause there's just really
nothing we can do about them,and so it's not really useful.
(18:08):
And so we open ourselves up to aworld of being overly,
excessively, chronicallyanxious. And that's the price we
pay for being so good at beinganxious when we need to be
yes that the worries can play arole in our life to our
detriment. So I agree with that,but it's interesting. I'll tell
you, as a someone who lives inLos Angeles dealing with recent
(18:32):
fires, I have friends who worryto different degrees, and a good
friend of mine who tends to be aworrier. She was ready for the
fire, so when it was time toevacuate. She knew what to pack.
She knew what to do. She was incontrol. And I'm one of those
who's on the less worrying side.
I was so impressed with her, andI thought maybe I need to worry
a little bit more. Showed methat some worrying is very
(18:52):
beneficial.
Yeah, that's a really greatexample of the fact that anxiety
isn't your enemy, right? Like,no anxiety isn't your enemy.
It's not like we were justcursed with anxiety for no
reason. It does serve a purpose,but just like any other alarm
system, it's not always wellcalibrated, right? I mean, you
(19:13):
know, here's a game I've playedwith countless audiences, like,
imagine 200 people in a room.
I'll ask them, Have you everheard a car alarm go off? And
pretty much everybody will raisetheir hand. But if I ask them,
Have you ever heard a car alarmgo off because a car was being
stolen? Well, almost all thehands are going to go down.
Sometimes every single hand isgoing to go down because it's
(19:33):
not that alarms, you know, smokealarms, car alarms, etc. It's
not that they are bad, right?
Like they are useful for thepurpose they serve. However,
they're not always wellcalibrated, and not every time
an alarm goes off is actually anindication that a true danger is
(19:55):
present. Sometimes it's just anindication that an alarm is
Miss. Are firing. And the trickything with anxiety is that, just
like with your smoke alarm athome, you can't really figure
out whether it is going offbecause of a fire or whether it
is going off because of cooking,for example, you can't really
(20:16):
figure that out by how loud itis, right? Like if you try to go
by how loud it is, all that'sreally telling you is how close
you are to it. If you want tofigure out if it's going off for
the wrong reason, well, youactually need to do some
checking of the reality, andthat's true with our internal
alarm system as well. You mightfeel really strong anxiety. You
might have a panic attack,right? Like you might be in the
(20:38):
throes of very powerful anxiety.
That doesn't mean that becauseit's so strong, the risk is more
real. It just means you have areally strong reaction, and
that's something that is, youknow, sometimes a little hard
for us to wrap our heads around,because it feels so convincing.
Yes, I think about this line alot. Someone once said to me,
(20:59):
most of what you worry aboutnever ends up happening. And I
think about that because it's sotrue, we spend so much time
worrying, and most of what weworry about never becomes
realized in actuality. Yeah,true. Now about the space
program, there are two keycomponents that you talk about.
Will you tell everybody whatthose two components are?
(21:19):
Yes, the two key components ofspace and they're both changes
in the parent, like I saidbefore, right? Like, none of
this is like, here's how you'regoing to change your kid, but
the two key components aresupport and accommodation. What
we want to do in space isessentially to increase the
(21:40):
level of parental support and todecrease the level of parental
accommodation. But both of thosewords could probably use some
explaining or some defining.
Support in particular is trickybecause it's a word that, like a
lot of people could hear in alot of different ways, and many
parents might think, Well, I amsupportive of my child. And in
(22:02):
you know, based on a dictionary,maybe you are, but in space, we
have a very specific definitionof what is meant by support. And
it really comes down to a simplerecipe. It's like cooking a
really simple recipe, right?
Like you want to make mac andcheese, you need two things, but
(22:24):
you can't do it without both andthe mac and cheese of support
are acceptance and confidence,meaning you are being supportive
for your child who is currentlyexperiencing some distress,
maybe that's fear, anxiety,worry, etc, when you're
communicating to them these twomessages acceptance, meaning, I
(22:44):
get it right, like it's real,you genuinely are anxious. I'm
not dismissing it, I'm notdenying it, I'm not trivializing
it, or delegitimizing it orwhatever. I'm just accepting I'm
validating that. Yeah, you are,in fact, feeling this way. And
the other ingredient in thesupport recipe is confidence,
(23:04):
meaning I'm also communicatingto you that I actually believe
that you can handle feelinganxious. I'm not saying you're
not anxious, but I believe thatyou can actually cope with that,
meaning you can get through it,right? It's not confidence that
you're suddenly going to step upand do the thing you've been
(23:26):
scared of or face all yourfears. It's just my belief that
you are intrinsically able to beanxious right now and still get
through it and still be okay inthe end, you put both things
together. That's when you'rebeing supportive. So maybe it
sounds like saying to yourchild, I get it, this is really
(23:46):
scary for you, and I'm sure youcan handle it. I'm sure you can
get through it. You're going tobe okay.
I love this because I find it tobe honest, I think it feels very
good to be validated and to beseen, and also for a child to
feel that support that's goingto help them get to the other
end. As an example, I see a lotof kids in my office who are
(24:09):
fearful of their vaccinations, alot of parents, and I'm not
saying this is the wrong thingto do, but they'll say it's not
going to hurt. You've done itbefore. I like this statement,
because you're acknowledgingthat you see their fears. For
example, in this situation, youmight say, I understand that
you're nervous, I see thatyou're fearful, but I know you
(24:30):
can do it, as opposed to sayingit's not going to hurt, which
isn't really being honest. Butwhen you say, I know you can do
it, that is honest, and kidsunderstand
that I'm I'm with you. I'venever said it's not going to
hurt too manysame when I when I read your
book, I thought I've seen theerror in my ways. And these
statements are so helpful forme, I'm noting it, and hopefully
will use it and practice it inmy own life.
(24:53):
Yeah, I think the other trap inthe it's not going to hurt
model, whether that's a vaccine.
Nation, or whether it's anyother uncomfortable experience
that you're going through, isthat implicit in that is the
idea that if it were to hurt,you would not be able to handle
it, that if it is going to beuncomfortable, well then you
(25:15):
must avoid it. Well, then you'reprobably not able to cope with
that, because otherwise, why amI being so fixated on the idea
that it's fine and you can takethat to any number of
situations. I'm scared to get upin the dance recital and perform
in front of an audience? Well,if all I'm being told is no, it
(25:35):
won't bother you, like nobody'sgonna care nothing's it's gonna
be fine. You're not gonna beuncomfortable. You might think,
Okay now I'm gonna feel better.
But actually, what I'm hearingyou say is that's the only way
that I can cope. And I thinkprobably the most helpful thing
(25:56):
for an anxious child to learn isactually that it is okay to be
anxious, right? Like that. Youcan be anxious that it's fine,
not to say that it's notuncomfortable, but they can
handle it. You can handle it.
You can get through it. And thatis, I think, a much more
important message than Oh, let'ssee why it is not going to be
(26:16):
uncomfortable. Because, let'sface it, if your child is
vulnerable to anxiety, if theytend or they have some
predisposition toward elevatedanxiety, they are probably going
to experience a lot of anxietyin their lives. And probably the
best thing for them to know isthat that's okay, right? Like
that they can, in fact, handlethat, and that's why that
(26:38):
supportive message is soimportant, right? Because we
want them to be hearing Yes, Ido get it. Like you said, it
does feel good to be validated.
You know, sometimes we're insuch a rush to reassure and to
comfort that we actually skipover the validation where we end
(26:58):
up even like undermining it,right? Like, no big deal, no big
deal. No big deal, exactly. Orsometimes, you know, we lose our
temper a little bit, we getfrustrated, and we start to go
in the direction of, like, comeon, right. Like, come on. You're
a big boy. Don't be a baby.
Like, suck it up already, right?
Which is also, of course, notvery validating. And so starting
(27:20):
with that validating message ofI do get it, it like opens your
kid's ear to hear the secondpart of your message, which is
the confidence. Because if yourchild thinks you don't even
really understand that, it ishard. Why would they even care
what you have to say about it?
You obviously don't know whatyou're talking about, right?
Like you obviously don'tunderstand it, and so probably
your opinion on the topic is notvery relevant, but if you can
(27:45):
show them that you do get it,you totally understand that it's
hard, and you believe they canhandle it well. Now you're
starting to hold up a mirror toyour child that shows them like
that reflection of themselves asa child who isn't all that weak
and helpless and vulnerable, butis actually okay, that they're
strong, that they're competent,they can handle things. And so
(28:07):
we put a lot of work into reallyjust training parents on using
these supportive statements. Andit doesn't always feel
completely natural at first,because nothing new feels
completely natural at first, butit starts to feel natural. And
you know, even if it doesn't, Ithink that's okay, your child is
still hearing a really importantmessage. And so that's the first
(28:30):
of those two big pictureelements.
So just to give an example forpeople, let's say they have a
child who's afraid of the darkand they want their parent to
lie down next to them everynight. What would a supportive
statement sound like? Asupportive statement might sound
like, I get it. It's reallyscary for you when you're in
your room by yourself, and Iknow you can handle that.
(28:52):
Feeling perfect. Yeah, reallysimple. We're not looking for
creative writing PhDs. We're notlooking for, you know, anything
very fancy. And so you need togo and lie in your room by
yourself, right? Like sometimes,in fact, not sometimes, pretty
much always, we will start usingthose supportive statements
before we even try to reduce anyof the accommodations, which is
(29:14):
the like second focus of thetreatment. And so even when
you're lying with your child inthe bed in the room at night,
you can say to them, you know, Iget it. Being by yourself would
be hard. It would be scary. Iactually think you could handle
that, and your child hears it.
(29:34):
And then only after we'vepracticed that for a while are
we going to start turning ourattention toward those
accommodations when we talkabout accommodation in the
context of a child's distress ortheir anxiety, what we're really
talking about is just all of thethings that you as a parent,
that you do differently becauseyour kid is anxious and you
(29:57):
don't want them to be sometimesyou're doing something too.
Lower the anxiety. Sometimesyou're doing it preemptively,
because you know it would makethem anxious, and so you're
taking steps to make sure theydon't get anxious, right? Like
maybe your child is scared ofbees, to use your example. And
so I plan my weekends to nothave bees, or I keep all the
(30:19):
windows in the house closed,because otherwise they freak
out, what if a bee comes in? Andso I never do open that window.
Or we don't go to the park whenwe're walking the dog, because
what if a bee shows up.
Or we take a long car rideinstead of a quick flight
because they're scared of anairplane, yeah. Or we only make
them mac and cheese becausethey're afraid to eat anything
(30:40):
else, and so we dominate them inthat way. There are so many
examples that come to mindExactly. It really goes like,
fear by fear, worry by worry.
You can see how parents might beaccommodating, right? Like,
maybe my child is sociallyanxious, and so we don't go to
the family events because otherpeople are there, or I don't
invite guests to the house whereI speak for them in social
(31:03):
situations, because they getawkward and uncomfortable and
feel shy and embarrassed, etc.
There is a ton of research outthere on accommodation of child
anxiety, and you look at like,hundreds of studies, and these
are from all around the world,really, all over the world, the
over, under, for the betters outthere on how many parents
(31:23):
actually accommodate theirchild's anxiety? Well, it's
around 97% Some studies havereported, like literally 100% of
parents of anxious kids saying,Yes, I regularly accommodate.
Some have gone as low as about95% it tends to average out at
around 97 8% so regardless ofthe exact number, what it really
(31:44):
means is that if you are theparent of an anxious child,
you're probably accommodating.
And to me it makes sense,because I feel like at the root
of accommodating, it comes froma loving place. It comes from a
place of wanting to protect yourchild, of wanting to care for
them, which I think is innate inmost of us parents. So it's
(32:05):
going to have to take somerewiring or some rethinking to
change thosebehaviors. Definitely, it comes
from a loving place. You don'twant to see your child in
distress. They're anxious, ofcourse, you want to help them.
And you know, accommodationactually works really well in
some other areas, right? Like,if your child has food
allergies, well, you're probablygoing to accommodate those food
(32:26):
allergies, right? Like you'renot going to say, well, I don't
care that you're allergic topeanuts, I'm just going to serve
you peanuts anyway, because,like, accommodation doesn't
sound like a good idea to me.
No, you're not going to servethem the peanuts because that
will kill them, and that makesreally good sense. There are
areas in which accommodation islike a really good idea, anxiety
(32:50):
turns out not to be one of them.
Because what all of thatresearch also shows, in addition
to just how prevalentaccommodation is, is that
actually, over the slightlylonger term, it is not helpful.
Higher levels of accommodationby parents end up predicting
more anxiety over time, not lessanxiety. And so now your kid is
(33:14):
even more anxious. And so whatdo you do? You accommodate even
more well. That just leads toeven more anxiety. So now you
accommodate even more, and itends up feeling like your whole
life is revolving around thiskid's anxiety. And you're
putting all of this effort,you're bending over backward,
which is really frustrating, andyet they get more anxious, and
it starts affecting the rest ofthe family, because if you're
(33:36):
putting a ton of energy and timeand resources, and sometimes
even money into accommodatingthis child. Well, that's going
to come at a cost to you, tosiblings, to your relationship
with your spouse, to youroverall work life, to your
leisure life, like it's going tocome at significant costs
(33:59):
and to the child, right? Youdeprive them of the opportunity
to grow and to improve in theirown life in that respect,
exactly, yeah. Because everytime what they're learning is,
well, yeah, I got through thismoment. Why? Because it was
accommodated, and I couldn't getthrough it any other way. And so
I'm re learning and reiteratingthat idea that I can't actually
(34:21):
handle my anxiety, right? Like,if you are always accommodating,
it's kind of like waving a flagthat says, I get it. You can't
handle anything.
I like the analogy that youoffered in your book about how
important it is to reduceaccommodations over time, where
you talked about how if a childwasn't that skilled in walking,
they just were behind in theirdevelopment of walking. Yes, you
(34:42):
could carry them around all day,and that would get you by, I
guess, but you can't expect themto improve their skill in
walking if you are doing it forthem. And a better method would
be to practice slowly butsurely, helping them do more,
helping them. Walk on their ownso that you could grow those
muscles. And you said verysimilar when it comes to
(35:05):
accommodating anxiety. You helpthem grow that muscle. You help
them learn to face thosechallenges, if slowly but
surely, little by little, youremove those accommodation
exactly that. You know that ideaof like, yeah, you're gonna let
your child struggle through thewalking, even though they're not
very good at it. And you knowwhat? You're going to have a kid
who falls over more, right?
Like, if you don't pick them up,if you don't rescue them, well,
(35:26):
they are going to fall overmore, and sometimes that's going
to hurt a little bit, but thereis some benefit to that, like,
moment of pain, right? Like,because they are strengthening
the muscle, and next week ornext month, they're going to be
walking just fine, and that'sgoing to set them up for a
lifetime of being able to walkaround. So, yeah, you could save
them the pain of a skinned knee.
(35:49):
It's like when you teach yourkid to ride a bike, right? Like,
yeah, you do take for grantedthat they may actually fall
over. Is that cruel? Is itterrible that parents put their
kids on bikes, even though theymight fall. Should we all go to
jail because we're torturingkids? No, because they're the
opposite. It's the opposite,right? Like if you said to your
kid, oh no, no, don't get on thebike, because, hey, do you know
(36:12):
that you might fall? You mightskin your knee, it might bleed,
you'll cry. It's gonna hurt.
Well, your kid definitelydoesn't want to get on that bike
anymore. But, yeah, you havesaved them that moment of pain.
You've also denied them alifetime of enjoying riding
bicycles. And so there's somecost, and it really rests on the
idea that you do believe thatyour kid is able to learn to
(36:34):
ride a bike, right like theyhave the capacity. Do they know
how to ride a bike, right now,no, and that's why they might
fall, but are they able to learnit? Yes, and that is the same
with the anxiety, right? Like,if you take a six month old baby
and put them on a bike, well,now you are a jerk. Now you are
a jerk because they're going tofall, they're going to get hurt,
(36:54):
and they're going to learnnothing. And so, yeah, that
parent is abusive, right? Like,that's horrible,
yes. And the second part of thestatement, believing that they
can do it that would befalse. That would be false
Exactly. But there's adifference between not knowing
something right now and notbeing able to learn it. Children
are able to regulate anxiety. Weare built with the capacity for
(37:19):
some regulation of our anxiety.
Sometimes we need to work atstrengthening that capacity,
just like you strengthen yourleg muscle, or just like you
learned to ridethe bike. So can you give an
example of what a reduction inaccommodations would look like
or sound like? For example, fora child who's struggling to have
(37:40):
their parent not lie next tothem before bedtime, what would
a reduction look like? So forexample, maybe my usual routine
is every night, as soon as it'stime for bed, I just go with
you, and I lie down next to youuntil you fall asleep, and then
I get up and, you know, goabout, yeah, it does happen.
Happens to the best of us. Itdefinitely does. What would a
(38:02):
reduction look like? Maybe wesay, look, let's start with a
gradual thing. Maybe we say,Look, when you go to bed for the
first few minutes that you're inbed, I'm actually not going to
lie there with you, like, I'mgoing to be outside, you know,
downstairs or in the kitchen,wherever, doing my stuff for 10
minutes, and then I am going tocome and I'm going to lie down
(38:23):
next to you, and you're going togo to sleep. And so I'm not
saying, hey, you need to bethere all night by yourself. In
fact, I'm not really saying whatyou need to do at all. What I'm
saying is I'm going to changethis. I'm not going to go right
away and lie down next to you.
And one really special thingthat happens when you do that is
(38:46):
that very often, your kid, inthat example, your kid, is
actually not that scared,because they know that you're
coming right, like they know youwill be there in a few minutes.
They're not thinking, Oh no, Ihave to lie here all night by
myself. What if the monsterscome out? Blah, blah, blah, and
so they're not actually all thatscared. And so you do that for a
few nights, and then, you know,maybe after a week you say,
(39:08):
like, hey, you know what thisweek we're gonna do 15 minutes.
And I tell you, when you get upto about 1520 minutes, most of
the time, that kid startsfalling asleep. Because if
you're tired and you're not thatscared, typically you end up
falling asleep, and eventuallyyou could just stop with the
whole thing, and you know, theyend up sleeping in their bed by
themselves. Or to take anotherexample, you know, maybe you
(39:31):
have a kid who is reallysocially anxious, and you always
speak for them, right? Like, yougo to the library, you're
talking to the librarian to getthem the book that they want.
You go to the diner, you'reordering for them, you get,
like, everything you're alwaysspeaking for them. So maybe you
say, starting tomorrow when wego to the restaurant, I'm not
(39:53):
going to be ordering dessert foryou. And if your child doesn't
get dessert that day, like,Okay. Not the end of the world,
I suppose, and it's a shame, butit's not the end of the world.
And you do that, but you're notsaying to them, you have to
order this, right? Like when itcomes time for dessert and your
kid wants the ice cream or thepie or whatever. You're not
saying you have to do it. You'rejust saying, Well, I'm sticking
(40:15):
to my plan not to do this foryou. And very often, you know,
maybe not the first time, maybeit's the second time, maybe it's
the third time, but your kidstarts to really realize that
you do actually believe thatthey're able to handle it, plus,
maybe they actually want somedessert, and maybe they end up
whispering to the waiter orpointing on the menu to the
(40:38):
waiter. Well, that's actually agiant step forward.
Yes, yes. And that's and I lovethat, because what you've
pointed out is that it doesn'ttake any work on the child's
part. It's all on the parent.
It's the change in our behavior.
Exactly, yeah, I never reallywant to put the onus the child.
If you have a child who doeswant to also practice some of
(41:01):
their own skills, that's great.
I'm not suggesting anybodyshould deny them a skill that
might be useful for them. Ifthey want to learn some relaxing
breathing exercises and do thatfor a minute and get themselves
in a better state, that'sperfect. But the beauty of doing
space is that you actually cando it, even if you have a child
who says I'm out right, like Idon't have a problem at all, or
(41:24):
I'm not interested in working onit, or I don't want any help,
the answer for that was just,well, I'm sorry, we can't help
you, right? If you called up atherapist and you said, My kid
is really anxious, and theysaid, Okay, bring them in. And
they said, No, they can't. Theywon't come in, I tried. They
refuse. The therapist would say,Well, what do you want from me?
You're stuck. Yeah, it'd belike, if you call your mechanic
(41:46):
and you say, my car won't start,and they bring it in, have it
towed in, and say, well, the carwon't come okay. How do you want
me to fix it? But what we can donow is say that's okay. That's
actually fine. You come in andwe're going to give you some
tools without making any demandsof your child, and you're still
going to have a really bigimpact our clinical research and
(42:06):
clinical research from otherteams, not by me, so just so
everybody doesn't think it'sjust because I want to say that
it works, but clinical trials,multiple clinical trials,
actually show that doing spaceis just as effective as working
directly with a child like incognitive behavioral therapy. So
(42:27):
it's not that we should stopdoing cognitive behavioral
therapy, which is a veryeffective treatment and has been
tested many more times thanspace, but it's great to have
another tool in the toolbox thatwe can use
absolutely and I actually thinkthere's a third component I want
to mention, and that is thatit's so important for parents to
(42:49):
be transparent about whatthey're doing.
Yes, I completely agree. I thinktransparency is really the way
to go. Don't tiptoe around it.
Don't trick your child. Youknow, sometimes parents say to
me, when we're doing space,like, won't they realize that
I'm seeing you or that I'm like,Yeah, of course. But why should
that be a secret? Yes.
(43:13):
I mean, I think it's beautifulexplain to them why you're doing
what you're doing, and thatyou're making these changes and
these accommodations because youlove them and you want them to
feel better,exactly right? Like I'm your
parent, I'm concerned, ofcourse, I'm going to do whatever
I can to help you, includingconsulting with whoever I think
can help you.
(43:33):
So I also want to ask you, youmentioned in your book a myth
that comes up a lot about thecause of anxiety, and if parents
are playing a role in theirchild's anxiety, can you explain
why that's not true? Because alot of parents will easily blame
themselves for their child'scondition. But I really like how
you explain that that's not thecase.
(43:54):
I think it's really an importantpoint. I'm glad you're bringing
it up, because parents have beenblamed for lots and lots of
problems, and pretty muchalways, when you actually test
those theories empirically, theyfall apart. They really do. So
here's the reality, yes, thereare correlations between certain
(44:16):
parent characteristics andcertain child characteristics,
and that includes for anxiety.
And so anxious children are morelikely than other children to
have parents who are alsoanxious. And anxious parents are
more likely than other parentswho are not anxious to have a
child who has anxiety. So thereis a correlational link there.
(44:37):
However, it's also important tobear in mind that finding as
well as other parentalcharacteristics that have been
linked to anxiety, like beingprotective or being critical or
things like that, those datacome from what is called cross
sectional study, meaning you'retesting the parent and the child
at the same time, and you'relooking is there. For a
(44:59):
connection. And as many peopleare already aware, correlation
is not the same as causation.
Two things going together doesnot mean that one is the cause
of the other, and if one is thecause of the other, it doesn't
tell you which is the cause ofwhich. Now is there a sense in
(45:23):
which, for example, genetics arecontributing? Yes, there is a
genetic contribution, but Ithink it makes more sense to
think of the genetics, not asthe parent, causing the child to
have anxiety by passing on thegenes. I think a more realistic
way to think about that is athird factor, meaning the gene
(45:44):
causing anxiety in both theparent and the child. I think
that's probably a more realisticway to look at it, because we
don't choose our genes, right,like we just get them. And so I
would think of the geneticsalmost as a third external
factor that is impacting boththere are also other external
factors, for example,environmental stressors. Maybe
(46:06):
we are both experiencinginstability in other aspects of
our lives, and those can becausing anxiety in both parent
and child.
I appreciate you saying this,because I find that so many
parents are riddled withparenting guilt when their kids
have difficulty. So this isgreat to learn
about. Well, i Far be it from meto deny any parent their God
(46:29):
given right to wallow in guilt,but I have to say that there
really is not a valid scientificbasis for the conclusion that
parents are the cause of anxietyin their children. And in fact,
I strongly believe, based on theresearch that is available, that
(46:51):
in the vast majority of cases,parents are not the cause of
anxiety in their children. Ifyou have a child who does not
have that predisposition toanxiety, I think there is a very
low likelihood of you givingthem an anxiety disorder,
regardless of what style ofparenting you happen to have,
right like, maybe you're a superprotective parent if your child
(47:13):
is not particularly prone toanxiety, I don't think you're
going to make them an anxiouskid. I do think you might
sometimes make them an irritatedkid, because it can be annoying
to have a really protectiveparent when you're not that
anxious, but I don't thinkyou're going to give them an
anxiety disorder. And the samegoes for your own anxiety level,
and the same goes for otherparental characteristics. And so
(47:33):
I would say you don't have to bethe cause of a problem in order
to be a solution to thatproblem, in order to be able to
help. By the way, we don't applythat logic in most areas. If
your kid came home from schoolwith a broken leg, I don't know
a lot of parents who would say,I didn't break it. You know,
that sounds like a you problem,because I didn't break your leg.
(47:55):
And if your kid has anxiety, youdon't have to say, Well, I only
want to treat it, or I only wantto help. And if I caused it,
that's absurd.
Yes. I mean, I can think myself,I have three kids, and they're
all very different when it comesto anxiety levels and what makes
each of them nervous. And Ithink we're the same parents. I
know they're technicallyseparated by a couple of years,
but I can see that in my ownlife to be absolutely the case,
(48:17):
different than 100 other waysthey are different than their
anxiety levels.
Yes. Now as we conclude, I'dlove to offer a message of hope
to parents that are listening.
Maybe they're feelingoverwhelmed by what to do. Maybe
they're feeling unsure aboutimplementing these changes. Can
you tell everybody, if they gothrough this program, how long
does it typically take, and whatwill they expect to find in the
(48:38):
end? In other words, do theseconditions get better from your
experience?
The answer to that last part isa resounding yes. These problems
can absolutely get better. Infact, while it's true that
anxiety is the most commonmental health problem, it is
probably also the most treatablemental health problem, there are
so many problems where we dreamof having the ability to
(49:01):
actually improve them to theextent that we can with anxiety.
I would say to any parentlistening that the world is just
chock full of kids who used tohave an anxiety disorder and now
they don't, because you canactually overcome these
problems. How long does it takea typical course of doing space,
assuming you're really doing itseriously working at it. You
(49:23):
know, it's not the kind oftreatment where you just go talk
to a therapist and then donothing for a week, come back
and talk again, you go to yourtherapy sessions of space so
that you know what to do athome. But at home is actually
where the treatment occurs,right? Like the sessions are
there to tell you how to do itwhen you're not there, but
assuming you're really puttingin the work a typical course of
space might run 10, 1215,sessions. 12 would be a
(49:47):
reasonable ballpark average,which means a few short months,
right? We're not talking aboutyears of therapy. We're talking
about a few short months. Isthat going to come? Completely
remove that predisposition toanxiety in your child. No,
because we don't change whohuman beings are, nor do I
(50:07):
really think we want to. Butwhat can it change? It can
change whether this is a problemthat is actually limiting your
child's experience. Is itimpairing their ability to
function, to go to school and tofunction there, socially,
academically, to live a normallife at home, to have social
relationships, to sleep at nightand eat during the day and feel
(50:29):
okay with themselves. That'swhat we're trying to change, to
make this not the problem thatis the focus of your kids life,
and that is very much possiblefor the big majority of kids.
And so I would say, if you'rereally doing this work, within
two months, you'll probablyalready be seeing really
(50:50):
significant change in yourchild. And within three months,
you might already be ready toactually end the treatment.
And I'm sure for parentslistening that do have kids that
are really impacted and impairedby their specific anxieties,
just learning that they can goabout their regular business and
their life without it impactingthem to such a large degree. I
think that must sound like adream.
(51:10):
I think so too, because, yeah,the anxiety is a huge burden on
the child, but it is also aburden on the parents and the
rest of the family. And thistreatment, while it does take
work, it should actually makeyour life easier, not harder.
And I'd like to point out it canalso help children that have
milder cases as well.
Yeah, yes, absolutely. I thinkeven if your child doesn't have
(51:30):
a clinically diagnosed anxietydisorder, you ask a parent who
has a child with some mild butnot all that severe anxiety,
would it be good if your childcould, like, do better with
this? They'll say, like, ofcourse, like, why not? Yes, only
insurance companies that thinkwe should ignore all of those
cases.
Yes, no. I'm someone who thinkslabels definitely have their
(51:52):
limits to how helpful they canbe for people, definitely. And
then, just to conclude, I wouldlove for everyone to know. Where
can they find you? You have aTED talk, you have a
documentary, where can peoplefind additional resources and
professional help if they wantsupport?
Yes, absolutely. Well, first ofall, apologies to everybody. I
am not on any social mediapersonally, and so don't look
(52:14):
for Ellie Liebowitz on good foryou, yeah. Well, I don't know if
good or not, but I've just, likecompletely sought that out. And
so I've never really joinedanything, but you can find a lot
of resources to learn more aboutthe treatment, to find the
therapist. The number one thingto do, I would say, is go to the
website. There is a website forspace. It is space treatment.net
(52:35):
and that has a ton of resources.
There's a list of therapistsnumbering in the 1000s who have
all done formal training indoing space, and there's at
least one in every single statein the US, as well as many other
countries. So you can go searchit, find somebody to work with.
There are other resources, linksto other podcasts or research
(52:58):
articles and other articles andvideos and things like that. You
can find that on the website. Ifyou're a therapist and you're
interested in becoming trainedin space, you can find where to
get information about thetraining. And so that is, I
would say, the number one placeto go. There is also a Facebook
(53:20):
page, so it's not me, but thereis a space Facebook page, which
is facebook.com/spacetreatments, in this case, a
plural. So space treatments. Andactually, through there, you can
join the discussion group ifyou're interested in
communicating with others. Thewebsite also has like a forum
that you can join. And there aremultiple books published. I
(53:42):
think if I had to recommend onebook in particular, I would say
it is the book called breakingfree of child anxiety and OCD.
That is a book really writtenfor any parent to pick up and
just work through to kind of dospace on their own. But even if
you are working with atherapist, it can be like a good
accompaniment for the treatment.
(54:05):
The book is great. I love theworksheets that are in there. I
think it's a great help forparents. I love all the examples
of supportive statements. Soanybody who's looking for a
place to get started, Idefinitely agree. I would get
that book, and you probably willfind that finding a therapist to
accompany the book would be themost effective way to treat your
(54:25):
child.
Yeah, I think so too. But I alsoacknowledge that not everybody
has easy access to a therapist,whether because of where you
live or other or other reasons,and so if you actually can't
work with a therapist, I wouldsay, then try to work through
the book by yourself. Teaser foranybody who is interested in the
arfid in particular, we do havea book coming out that will be
(54:46):
on kind of a similar book, butfor parents of these really,
really picky eaters. We alsohave another book coming out
which is really focused onschools and anxiety in the
school setting.
Amazing. Because I will say bothof those areas cause a lot of
distress for families,particularly arfid It's hard for
parents to know where to go,where to get treatment. So I'm
(55:08):
so happy to hear that you'recontinuing to do the good work
that you do. Dr Ali Liebowitz,I'm so proud of you, and I can't
wait to see what else youcontinue to do well. Thank you
so much. Thank you for all theimpact you've made, and thank
you for your time. Thanks. Thankyou for listening. And I hope
you enjoyed this week's episodeof your child is normal. Also,
if you could take a moment andleave a five star review,
(55:29):
wherever it is you listen topodcasts, I would greatly
appreciate it. It really makes adifference to help this podcast
grow. You can also follow me onInstagram at ask Dr Jessica, see
you next Monday. You.
What you really realize when you stop trying to force
(00:03):
your child to do all thesethings is that there's a whole
lot that you can do that isgoing to be tremendously
impactful, and that your childdoesn't need to approve
of. Hi everyone and welcome backto your child is normal. I'm Dr
Jessica Hochman, your host andpediatrician, and I have to tell
you that I am so excited abouttoday's guest. His name is Dr
(00:24):
Ellie Liebowitz, and he's aclinical psychologist at the
Yale Child Study Center. He'sthe creator of the space program
supportive parenting for anxiouschildhood emotions, and he's the
author of the incredible bookbreaking free of child anxiety
and OCD. I personally admire DrLiebowitz his work for a long
time, and what I love most abouthis approach is that it empowers
parents. He doesn't just talktheory, he gives real,
(00:46):
actionable strategies and evenscripts that parents can use in
the moment to help their childmanage their anxiety more
effectively. It's realistic,it's compassionate, and most
importantly, it actually works.
I'm incredibly grateful to havehad the chance to speak with Dr
Liebowitz, and if you'relistening. Dr Liebowitz, thank
you so much for saying yes, andI'm so excited to share his work
with more parents. He's afantastic resource, and I think
you'll walk away from thisepisode feeling more equipped
(01:08):
and with a clear, actionablepath to support your child. Dr,
Ellie Liebowitz, I'm so happy tohave you here. Thank you so much
for your time. Thanks for havingme. Glad to be here, I have to
tell you, I've been doing thispodcast now for a few years, and
because I talk often aboutanxiety and childhood anxiety, a
few guests have referenced youand mentioned your name, and I
(01:30):
feel like I'm talking tosomebody famous. So thank you so
much.
Okay, well, flattery is never abad idea. So thank you very
much. I appreciate it.
So tell me about yourself. I'dlove to know what inspired you
to do the work that youdo. So I work at the Yale Child
Study Center, where I co directour anxiety and mood disorders
program. Child Study Center is areally interesting place because
(01:55):
it's part of our medical schooland functions as child
psychiatry, but it's a veryinterdisciplinary center, and so
we have psychiatry, but alsopsychology and other disciplines
social work. So it really makesfor a kind of creative
environment to work in. So I ama clinical researcher, and I do
a lot of research, but myresearch tends to be driven by
(02:17):
my experience working withfamilies, and that actually did
lead me to focus a lot onparents and on family systems.
You know, it's kind ofinteresting. In our field, in
mental health, there are someareas where people have
(02:38):
naturally focused a lot onparents for one reason or
another. For example, if you areprimarily focused on children
with really problematicbehaviors, really defiant
children, things like that, it'shistorically been very typical
to have a strong parent focus,not least of all, because
(03:02):
working directly with the childin those cases is often quite
challenging. Not to say youcan't or shouldn't do that, but
it can be really challenging.
And so people gravitate a lottoward work with parents. But
then you look at what peoplelike to call the internalizing
problems, children with anxiety,children with depression,
(03:23):
problems that are less maybedisruptive to the other people
around them, and there's beenmuch less of a focus on parents,
but actually parents both reallystruggle A lot to help their
children with anxiety, and alsoface a lot of challenges
(03:45):
themselves in coping with thechild's anxiety. And what's
really striking is that, maybemore than any other problem,
parents are actually such a bigpart of what it means for a
child to even have anxiety,because we're so hard wired to
(04:05):
rely on parents when we areanxious, and so parents get
really sucked in to all thesedifferent ways of responding.
And so it really drove me to tryto think a lot about how we can
harness that involvement thatparents naturally have, and
really create something thatwould be practical and also
(04:27):
effective at being able toaddress those issues, both for
children who maybe aren't idealcandidates for doing therapy
themselves, but also, moregenerally, for all those
families where parents just wanttools to like, What can I do and
how can I be more effective? Andso, you know, there's a lot of
different answers to thequestion, How did I end up doing
(04:48):
what I do? But maybe that's oneway of thinking about it.
I really appreciate thisapproach to involving parents
and to primarily focusing onparents and what parents can do.
Yeah, for multiple reasons. One,I feel like as parents, we are
the ones around our kids themost. We're witnessing the
behaviors. We're impacted by thebehaviors. And so if we can help
(05:09):
our kids in real time, I thinkthat's clearly going to be an
effective modality. And also,what I love is the scripts that
you give us, because I think inthe moment, it's hard for us to
know how to respond effectivelyto our children. It's easy to
think about maybe how ourparents talk to us, or it's easy
to get frustrated. And so havinga script to go to, I think, is
(05:30):
for me, I'm definitely planningon using this in my own life.
Yeah. Well, thanks. I think thatis really key. You know, if you
just kind of lay out an idea,but you can't translate it into
some really practical andaccessible, go to kind of
strategy that a parent can use.
Then it ends up falling flat alittle bit because, you know, as
(05:51):
parents, we're dealing withthis, like you said, in real
time, and not just in real time,but under a lot of stress, which
is not an ideal moment for a lotof deep thinking, and so we do
end up. I was amused when youwere saying about what our
parents said. I can't count thenumber of times that I've heard
coming out of my mouth, thingsthat maybe I heard growing up,
and not because they were themost helpful things to me when I
(06:15):
did to hear them, or because Ireally spent a lot of time
thinking about it and deciding,yup, that's the ideal way to
respond. But just because youdon't really have something
else, and you know, in theabsence of something else, and
when you're under stress, youkind of go with your built in
instinct, or what comes mostnaturally, which is not always
the most optimal thing to do. Ithink the other thing that's
(06:40):
really important for me in theway that I approach trying to
help parents to make somechanges is to try to move away
from trying to guide parents toimpose things on their children,
to force a change in your child.
(07:00):
You know I was talking about howtraditionally, there was less of
a focus on parent work and theanxiety world. But it's
interesting that even whenpeople did try to involve
parents, mostly what they endedup doing is trying to make the
parent kind of like function,like a therapist for their
child, right? Like, I'm going tobe your therapist. I'm going to
(07:23):
get you to do exposures. I'mgoing to get you to change your
thinking. Practice this scaleand and just as an example, so
you're saying, like, for kidsthat are afraid of bees, have
them put in a situation wherethey're exposed to be and that
might not be comfortable forevery kid, or every kid may not
be willing to do thatexactly. Well, you know that
(07:44):
kind of exposure, that's a greatidea, right? It actually is a
terrific idea if you have achild who wants to do that with
you. But if you don't happen tohave a child who's eager or
wants to do that with you, evenputting aside just how good your
clinical skill may be as aparent, but if you have a child
who doesn't really want to dothat with you, then not only can
(08:06):
it be ineffective, it actuallycan backfire quite a bit. But if
you are a therapist and yourpatient says, I don't want to do
exposures, you probably don'tyell at them, you probably don't
punish them, right? Not a lot oftherapists start yelling at
their patients and punishingthem, taking away their
(08:28):
privileges. But if you're aparent, and what you know is the
most important thing is that mykid go on this picnic and face
their fear of bees, and don'thide away and conquer their
fear. Well, you might startapplying the kind of pressures
that you're used to applying inother situations. When your kid
doesn't want to do what they'retold, right? They don't want to
(08:49):
do their homework, they don'twant to brush their teeth, they
don't want to go to school. Andwhat do you do? You start
pulling the levers that you'reused to pulling. Well, when you
try to do that as a therapist,were your child, that's not
going to end well,I imagine they'll dig their
heels in further.
They dig in further, and thenyou push even harder, and the
whole thing really kind of blowsup in your face. And so we don't
(09:13):
do that at all right, like inthe approach that I developed
this parent based treatment, Imake a very clear promise to
parents really early on, youknow, I'll just say to the
parent that no point in thiswhole process. Am I going to ask
you to make your child doanything or to make your child
not do anything because thosethings are hard and because you
(09:37):
don't need to. Because what youreally realize when you stop
trying to force your child to doall these things, is that
there's a whole lot that you cando that is going to be
tremendously impactful, and thatyour child doesn't need to
endorse or to approve of,because you're not asking
anything from them. You're justchanging your own behavior and.
(10:00):
It really frees, I think, thatwhole dynamic from a lot of
stress and pressure thatotherwise becomes a real
obstacle.
So first, just to back up alittle bit, the program that you
developed is specifically tohelp children with anxiety and
OCD Correct.
Well, I would say this, that isdefinitely where it started.
(10:20):
This began as a treatment forchildren, adolescents with
anxiety and OCD, we have, overtime, realized that we can apply
very similar principles to arange of other situations that
share some core features withanxiety and OCD situations where
(10:43):
parents are very involved andwhere parents tend to
accommodate the child'sdifficulty a lot. And so, for
example, we now use a version ofspace for parents of children
who are really picky eating,what the DSM likes to call
avoidant, restrictive foodintake disorder or arfid These
are really, really picky eaterswho often suffer a lot of
(11:08):
impairment because of thatproblem, not just nutritionally,
but even socially or at a familyfunctioning level. And we're
able to work with those parents.
Or another example, we can workwith parents of children with
chronic physical symptoms,chronic somatic physical
complaints, like aches andpains, the headache, the stomach
ache, etc. Again. Parents reallystruggle with this, right? Like,
(11:29):
on the one hand, I want my childto function, the other hand,
they are genuinely in pain. Sowhat do I do? And so we're able
to apply principles there, andwe've published research on
this, showing that you canactually have some really
meaningful improvement in thechild's functioning just by
changing how parents areresponding. We even have a
version of this that focuses onparents of adult children,
(11:53):
failure to launch. Failure toLaunch, it's great, exactly sad
that we need this. Very much.
Oh yes, we definitely do.
Failure to Launch, meaning adultchildren who are not really
functioning independently asadults. They're not in school,
they're not at work, they'rejust kind of stuck in life,
stuck at home, and often in theparents house, and just like not
really going anywhere. Well,that's another again, you have
(12:16):
this situation where parents areinevitably very involved in
facilitating this reality, butare also very helpless to change
it, like you can't really forceanything on your 30 year old,
and you can't even make them goto therapy, and there's very
little that you can make themdo. As hard as it is to make
your eight year old dosomething, well, it's a lot
(12:37):
harder to make your 28 year olddo anything. And so I think
really, although this did startas an anxiety and OCD treatment,
in a sense, maybe what it'sreally turning out to be is a
parent based approach to childdistress, to helping parents to
better navigate the situationwhere a child is experiencing
(12:59):
distress that is impairing in ameaningful way their function.
And, you know, we'll see. Is itapplicable for every condition?
Maybe not, not necessarily. Andas a researcher, I like to test
things before I'll go out andsay, Hey, this, this works. And
so in somatic symptoms andfailure to watch, we actually
have published clinical trialdata showing, yep, this can
work, and there may be otherproblem areas where we'll find
(13:23):
the sameit's amazing. It's such a useful
tool to know about. I'm soappreciative to know about other
tools that, because there areother existing models out there,
but this is a very uniqueapproach, and like you said,
it's very impressive thatthere's data showing that it's
actually effective. Okay, sopeople are probably wondering,
as we've been talking andsetting up about this idea of
space, I'd love to explain toeverybody what space actually
(13:46):
is. So first, before I ask youabout it, can you tell me who
made this mnemonic? I love it.
Oh, I made the mnemonic. Itworked so well. Oh, thank you.
Well, that is very nice to hear.
I made the mnemonic sitting inthe Yale Medical School
cafeteria. This is like a decadeago or more, because one of my I
had actually done like a talkfor colleagues, describing the
(14:10):
approach and some very earlypreliminary findings from some
piloting of it, one of mycolleagues, a man by the name of
George Anderson, was a brilliantscientist here at our
department, said to me, after,you know, it's all really
interesting, but you really needto come up with a name for this.
Because I didn't, I wasn'tgiving it a name. I was just
(14:33):
describing the approach. And soI took it to heart and sat with
a coffee in the cafeteria andplayed with today, maybe I would
have, like, AI spit somethingout for me, but that was not an
option at the time, and so Iended up with with
space. I love it. Remindeverybody what is the mnemonic
stand forit stands for supportive
(14:54):
parenting, for anxious childhoodemotions. I. Yeah, which does
reflect the origins of it asvery focused on anxiety. And at
the time, actually, OCD was evenformally anxiety disorder per
the DSM. Today, it has graduatedinto its own chapter in the DSM,
along with some other relatedproblems, but actually still
(15:16):
makes sense to think of it as ananxiety disorder for most
purposes, and so we are a littlebit stuck with the word anxiety
in there, even when we talkabout space for arfid, or space
for failure to launch, or spacefor whatever. But like you said,
the mnemonic kind of works, sowe're sticking with it.
And anxiety is the most commonmental difficulty that children
(15:37):
experience. Itreally is. The prevalence rates
of anxiety are just staggering,and that was true like 10 years
ago and 20 years ago. But thenyou throw pandemic into the mix,
and the rates of anxiety that wesee today are even higher than
they were pre pandemic. I don'tknow how long it'll be before
the effects of living through apandemic, whether on the parent
(16:00):
side or on the child side, startto evaporate. Approximately one
in three kids is going toexperience an anxiety disorder
at some point before they areadults. Wow. So that is just
massive, and that's onlycounting the ones who actually
are going to meet likediagnostic criteria for a
clinical disorder, it's leavingout all the kids who are just
(16:23):
sometimes struggling withanxiety, right? Like there's a
lot of kids who are sometimesanxious and maybe at risk for
additional elevated anxiety, butmaybe aren't fully meeting
criteria. Well, we're not evencounting
Yes. And as you talk about inyour book, which I wholly agree
with, that some level and somedegree of anxiety is helpful.
(16:44):
You know, paying attention withwhat to potentially worry about
is protective at some degree,absolutely, it's not an accident
that so much of our brain isreally good at being anxious,
right? Like it's not anaccident, it's a feature. In a
sense, it's not a bug. Because,yeah, anxiety does help us to
stay alert to potential threats.
(17:06):
And the, you know, the kind ofspecial human capacity to
actually imagine potentialthreats in the future, or, you
know, hypotheticals, which maybe more of a human thing than at
least most other species, isalso really helpful, because we
don't have to wait to be facingthe danger in order to take some
(17:28):
precautions. So that's allreally useful. You can have too
much anxiety in your life. Youcan also have too little anxiety
in your life, and that's a riskas well. But that feature does
open us up to a lot of selftorment, to a lot of focus on
(17:48):
anxiety, even in places where itactually is not helping us to be
any safer, whether because thethreats we're worried about are
really not actual threats, orwhether because they're not
really likely to occur, or evenbecause there's just really
nothing we can do about them,and so it's not really useful.
(18:08):
And so we open ourselves up to aworld of being overly,
excessively, chronicallyanxious. And that's the price we
pay for being so good at beinganxious when we need to be
yes that the worries can play arole in our life to our
detriment. So I agree with that,but it's interesting. I'll tell
you, as a someone who lives inLos Angeles dealing with recent
(18:32):
fires, I have friends who worryto different degrees, and a good
friend of mine who tends to be aworrier. She was ready for the
fire, so when it was time toevacuate. She knew what to pack.
She knew what to do. She was incontrol. And I'm one of those
who's on the less worrying side.
I was so impressed with her, andI thought maybe I need to worry
a little bit more. Showed methat some worrying is very
(18:52):
beneficial.
Yeah, that's a really greatexample of the fact that anxiety
isn't your enemy, right? Like,no anxiety isn't your enemy.
It's not like we were justcursed with anxiety for no
reason. It does serve a purpose,but just like any other alarm
system, it's not always wellcalibrated, right? I mean, you
(19:13):
know, here's a game I've playedwith countless audiences, like,
imagine 200 people in a room.
I'll ask them, Have you everheard a car alarm go off? And
pretty much everybody will raisetheir hand. But if I ask them,
Have you ever heard a car alarmgo off because a car was being
stolen? Well, almost all thehands are going to go down.
Sometimes every single hand isgoing to go down because it's
(19:33):
not that alarms, you know, smokealarms, car alarms, etc. It's
not that they are bad, right?
Like they are useful for thepurpose they serve. However,
they're not always wellcalibrated, and not every time
an alarm goes off is actually anindication that a true danger is
(19:55):
present. Sometimes it's just anindication that an alarm is
Miss. Are firing. And the trickything with anxiety is that, just
like with your smoke alarm athome, you can't really figure
out whether it is going offbecause of a fire or whether it
is going off because of cooking,for example, you can't really
(20:16):
figure that out by how loud itis, right? Like if you try to go
by how loud it is, all that'sreally telling you is how close
you are to it. If you want tofigure out if it's going off for
the wrong reason, well, youactually need to do some
checking of the reality, andthat's true with our internal
alarm system as well. You mightfeel really strong anxiety. You
might have a panic attack,right? Like you might be in the
(20:38):
throes of very powerful anxiety.
That doesn't mean that becauseit's so strong, the risk is more
real. It just means you have areally strong reaction, and
that's something that is, youknow, sometimes a little hard
for us to wrap our heads around,because it feels so convincing.
Yes, I think about this line alot. Someone once said to me,
(20:59):
most of what you worry aboutnever ends up happening. And I
think about that because it's sotrue, we spend so much time
worrying, and most of what weworry about never becomes
realized in actuality. Yeah,true. Now about the space
program, there are two keycomponents that you talk about.
Will you tell everybody whatthose two components are?
(21:19):
Yes, the two key components ofspace and they're both changes
in the parent, like I saidbefore, right? Like, none of
this is like, here's how you'regoing to change your kid, but
the two key components aresupport and accommodation. What
we want to do in space isessentially to increase the
(21:40):
level of parental support and todecrease the level of parental
accommodation. But both of thosewords could probably use some
explaining or some defining.
Support in particular is trickybecause it's a word that, like a
lot of people could hear in alot of different ways, and many
parents might think, Well, I amsupportive of my child. And in
(22:02):
you know, based on a dictionary,maybe you are, but in space, we
have a very specific definitionof what is meant by support. And
it really comes down to a simplerecipe. It's like cooking a
really simple recipe, right?
Like you want to make mac andcheese, you need two things, but
(22:24):
you can't do it without both andthe mac and cheese of support
are acceptance and confidence,meaning you are being supportive
for your child who is currentlyexperiencing some distress,
maybe that's fear, anxiety,worry, etc, when you're
communicating to them these twomessages acceptance, meaning, I
(22:44):
get it right, like it's real,you genuinely are anxious. I'm
not dismissing it, I'm notdenying it, I'm not trivializing
it, or delegitimizing it orwhatever. I'm just accepting I'm
validating that. Yeah, you are,in fact, feeling this way. And
the other ingredient in thesupport recipe is confidence,
(23:04):
meaning I'm also communicatingto you that I actually believe
that you can handle feelinganxious. I'm not saying you're
not anxious, but I believe thatyou can actually cope with that,
meaning you can get through it,right? It's not confidence that
you're suddenly going to step upand do the thing you've been
(23:26):
scared of or face all yourfears. It's just my belief that
you are intrinsically able to beanxious right now and still get
through it and still be okay inthe end, you put both things
together. That's when you'rebeing supportive. So maybe it
sounds like saying to yourchild, I get it, this is really
(23:46):
scary for you, and I'm sure youcan handle it. I'm sure you can
get through it. You're going tobe okay.
I love this because I find it tobe honest, I think it feels very
good to be validated and to beseen, and also for a child to
feel that support that's goingto help them get to the other
end. As an example, I see a lotof kids in my office who are
(24:09):
fearful of their vaccinations, alot of parents, and I'm not
saying this is the wrong thingto do, but they'll say it's not
going to hurt. You've done itbefore. I like this statement,
because you're acknowledgingthat you see their fears. For
example, in this situation, youmight say, I understand that
you're nervous, I see thatyou're fearful, but I know you
(24:30):
can do it, as opposed to sayingit's not going to hurt, which
isn't really being honest. Butwhen you say, I know you can do
it, that is honest, and kidsunderstand
that I'm I'm with you. I'venever said it's not going to
hurt too manysame when I when I read your
book, I thought I've seen theerror in my ways. And these
statements are so helpful forme, I'm noting it, and hopefully
will use it and practice it inmy own life.
(24:53):
Yeah, I think the other trap inthe it's not going to hurt
model, whether that's a vaccine.
Nation, or whether it's anyother uncomfortable experience
that you're going through, isthat implicit in that is the
idea that if it were to hurt,you would not be able to handle
it, that if it is going to beuncomfortable, well then you
(25:15):
must avoid it. Well, then you'reprobably not able to cope with
that, because otherwise, why amI being so fixated on the idea
that it's fine and you can takethat to any number of
situations. I'm scared to get upin the dance recital and perform
in front of an audience? Well,if all I'm being told is no, it
(25:35):
won't bother you, like nobody'sgonna care nothing's it's gonna
be fine. You're not gonna beuncomfortable. You might think,
Okay now I'm gonna feel better.
But actually, what I'm hearingyou say is that's the only way
that I can cope. And I thinkprobably the most helpful thing
(25:56):
for an anxious child to learn isactually that it is okay to be
anxious, right? Like that. Youcan be anxious that it's fine,
not to say that it's notuncomfortable, but they can
handle it. You can handle it.
You can get through it. And thatis, I think, a much more
important message than Oh, let'ssee why it is not going to be
(26:16):
uncomfortable. Because, let'sface it, if your child is
vulnerable to anxiety, if theytend or they have some
predisposition toward elevatedanxiety, they are probably going
to experience a lot of anxietyin their lives. And probably the
best thing for them to know isthat that's okay, right? Like
that they can, in fact, handlethat, and that's why that
(26:38):
supportive message is soimportant, right? Because we
want them to be hearing Yes, Ido get it. Like you said, it
does feel good to be validated.
You know, sometimes we're insuch a rush to reassure and to
comfort that we actually skipover the validation where we end
(26:58):
up even like undermining it,right? Like, no big deal, no big
deal. No big deal, exactly. Orsometimes, you know, we lose our
temper a little bit, we getfrustrated, and we start to go
in the direction of, like, comeon, right. Like, come on. You're
a big boy. Don't be a baby.
Like, suck it up already, right?
Which is also, of course, notvery validating. And so starting
(27:20):
with that validating message ofI do get it, it like opens your
kid's ear to hear the secondpart of your message, which is
the confidence. Because if yourchild thinks you don't even
really understand that, it ishard. Why would they even care
what you have to say about it?
You obviously don't know whatyou're talking about, right?
Like you obviously don'tunderstand it, and so probably
your opinion on the topic is notvery relevant, but if you can
(27:45):
show them that you do get it,you totally understand that it's
hard, and you believe they canhandle it well. Now you're
starting to hold up a mirror toyour child that shows them like
that reflection of themselves asa child who isn't all that weak
and helpless and vulnerable, butis actually okay, that they're
strong, that they're competent,they can handle things. And so
(28:07):
we put a lot of work into reallyjust training parents on using
these supportive statements. Andit doesn't always feel
completely natural at first,because nothing new feels
completely natural at first, butit starts to feel natural. And
you know, even if it doesn't, Ithink that's okay, your child is
still hearing a really importantmessage. And so that's the first
(28:30):
of those two big pictureelements.
So just to give an example forpeople, let's say they have a
child who's afraid of the darkand they want their parent to
lie down next to them everynight. What would a supportive
statement sound like? Asupportive statement might sound
like, I get it. It's reallyscary for you when you're in
your room by yourself, and Iknow you can handle that.
(28:52):
Feeling perfect. Yeah, reallysimple. We're not looking for
creative writing PhDs. We're notlooking for, you know, anything
very fancy. And so you need togo and lie in your room by
yourself, right? Like sometimes,in fact, not sometimes, pretty
much always, we will start usingthose supportive statements
before we even try to reduce anyof the accommodations, which is
(29:14):
the like second focus of thetreatment. And so even when
you're lying with your child inthe bed in the room at night,
you can say to them, you know, Iget it. Being by yourself would
be hard. It would be scary. Iactually think you could handle
that, and your child hears it.
(29:34):
And then only after we'vepracticed that for a while are
we going to start turning ourattention toward those
accommodations when we talkabout accommodation in the
context of a child's distress ortheir anxiety, what we're really
talking about is just all of thethings that you as a parent,
that you do differently becauseyour kid is anxious and you
(29:57):
don't want them to be sometimesyou're doing something too.
Lower the anxiety. Sometimesyou're doing it preemptively,
because you know it would makethem anxious, and so you're
taking steps to make sure theydon't get anxious, right? Like
maybe your child is scared ofbees, to use your example. And
so I plan my weekends to nothave bees, or I keep all the
(30:19):
windows in the house closed,because otherwise they freak
out, what if a bee comes in? Andso I never do open that window.
Or we don't go to the park whenwe're walking the dog, because
what if a bee shows up.
Or we take a long car rideinstead of a quick flight
because they're scared of anairplane, yeah. Or we only make
them mac and cheese becausethey're afraid to eat anything
(30:40):
else, and so we dominate them inthat way. There are so many
examples that come to mindExactly. It really goes like,
fear by fear, worry by worry.
You can see how parents might beaccommodating, right? Like,
maybe my child is sociallyanxious, and so we don't go to
the family events because otherpeople are there, or I don't
invite guests to the house whereI speak for them in social
(31:03):
situations, because they getawkward and uncomfortable and
feel shy and embarrassed, etc.
There is a ton of research outthere on accommodation of child
anxiety, and you look at like,hundreds of studies, and these
are from all around the world,really, all over the world, the
over, under, for the betters outthere on how many parents
(31:23):
actually accommodate theirchild's anxiety? Well, it's
around 97% Some studies havereported, like literally 100% of
parents of anxious kids saying,Yes, I regularly accommodate.
Some have gone as low as about95% it tends to average out at
around 97 8% so regardless ofthe exact number, what it really
(31:44):
means is that if you are theparent of an anxious child,
you're probably accommodating.
And to me it makes sense,because I feel like at the root
of accommodating, it comes froma loving place. It comes from a
place of wanting to protect yourchild, of wanting to care for
them, which I think is innate inmost of us parents. So it's
(32:05):
going to have to take somerewiring or some rethinking to
change thosebehaviors. Definitely, it comes
from a loving place. You don'twant to see your child in
distress. They're anxious, ofcourse, you want to help them.
And you know, accommodationactually works really well in
some other areas, right? Like,if your child has food
allergies, well, you're probablygoing to accommodate those food
(32:26):
allergies, right? Like you'renot going to say, well, I don't
care that you're allergic topeanuts, I'm just going to serve
you peanuts anyway, because,like, accommodation doesn't
sound like a good idea to me.
No, you're not going to servethem the peanuts because that
will kill them, and that makesreally good sense. There are
areas in which accommodation islike a really good idea, anxiety
(32:50):
turns out not to be one of them.
Because what all of thatresearch also shows, in addition
to just how prevalentaccommodation is, is that
actually, over the slightlylonger term, it is not helpful.
Higher levels of accommodationby parents end up predicting
more anxiety over time, not lessanxiety. And so now your kid is
(33:14):
even more anxious. And so whatdo you do? You accommodate even
more well. That just leads toeven more anxiety. So now you
accommodate even more, and itends up feeling like your whole
life is revolving around thiskid's anxiety. And you're
putting all of this effort,you're bending over backward,
which is really frustrating, andyet they get more anxious, and
it starts affecting the rest ofthe family, because if you're
(33:36):
putting a ton of energy and timeand resources, and sometimes
even money into accommodatingthis child. Well, that's going
to come at a cost to you, tosiblings, to your relationship
with your spouse, to youroverall work life, to your
leisure life, like it's going tocome at significant costs
(33:59):
and to the child, right? Youdeprive them of the opportunity
to grow and to improve in theirown life in that respect,
exactly, yeah. Because everytime what they're learning is,
well, yeah, I got through thismoment. Why? Because it was
accommodated, and I couldn't getthrough it any other way. And so
I'm re learning and reiteratingthat idea that I can't actually
(34:21):
handle my anxiety, right? Like,if you are always accommodating,
it's kind of like waving a flagthat says, I get it. You can't
handle anything.
I like the analogy that youoffered in your book about how
important it is to reduceaccommodations over time, where
you talked about how if a childwasn't that skilled in walking,
they just were behind in theirdevelopment of walking. Yes, you
(34:42):
could carry them around all day,and that would get you by, I
guess, but you can't expect themto improve their skill in
walking if you are doing it forthem. And a better method would
be to practice slowly butsurely, helping them do more,
helping them. Walk on their ownso that you could grow those
muscles. And you said verysimilar when it comes to
(35:05):
accommodating anxiety. You helpthem grow that muscle. You help
them learn to face thosechallenges, if slowly but
surely, little by little, youremove those accommodation
exactly that. You know that ideaof like, yeah, you're gonna let
your child struggle through thewalking, even though they're not
very good at it. And you knowwhat? You're going to have a kid
who falls over more, right?
Like, if you don't pick them up,if you don't rescue them, well,
(35:26):
they are going to fall overmore, and sometimes that's going
to hurt a little bit, but thereis some benefit to that, like,
moment of pain, right? Like,because they are strengthening
the muscle, and next week ornext month, they're going to be
walking just fine, and that'sgoing to set them up for a
lifetime of being able to walkaround. So, yeah, you could save
them the pain of a skinned knee.
(35:49):
It's like when you teach yourkid to ride a bike, right? Like,
yeah, you do take for grantedthat they may actually fall
over. Is that cruel? Is itterrible that parents put their
kids on bikes, even though theymight fall. Should we all go to
jail because we're torturingkids? No, because they're the
opposite. It's the opposite,right? Like if you said to your
kid, oh no, no, don't get on thebike, because, hey, do you know
(36:12):
that you might fall? You mightskin your knee, it might bleed,
you'll cry. It's gonna hurt.
Well, your kid definitelydoesn't want to get on that bike
anymore. But, yeah, you havesaved them that moment of pain.
You've also denied them alifetime of enjoying riding
bicycles. And so there's somecost, and it really rests on the
idea that you do believe thatyour kid is able to learn to
(36:34):
ride a bike, right like theyhave the capacity. Do they know
how to ride a bike, right now,no, and that's why they might
fall, but are they able to learnit? Yes, and that is the same
with the anxiety, right? Like,if you take a six month old baby
and put them on a bike, well,now you are a jerk. Now you are
a jerk because they're going tofall, they're going to get hurt,
(36:54):
and they're going to learnnothing. And so, yeah, that
parent is abusive, right? Like,that's horrible,
yes. And the second part of thestatement, believing that they
can do it that would befalse. That would be false
Exactly. But there's adifference between not knowing
something right now and notbeing able to learn it. Children
are able to regulate anxiety. Weare built with the capacity for
(37:19):
some regulation of our anxiety.
Sometimes we need to work atstrengthening that capacity,
just like you strengthen yourleg muscle, or just like you
learned to ridethe bike. So can you give an
example of what a reduction inaccommodations would look like
or sound like? For example, fora child who's struggling to have
(37:40):
their parent not lie next tothem before bedtime, what would
a reduction look like? So forexample, maybe my usual routine
is every night, as soon as it'stime for bed, I just go with
you, and I lie down next to youuntil you fall asleep, and then
I get up and, you know, goabout, yeah, it does happen.
Happens to the best of us. Itdefinitely does. What would a
(38:02):
reduction look like? Maybe wesay, look, let's start with a
gradual thing. Maybe we say,Look, when you go to bed for the
first few minutes that you're inbed, I'm actually not going to
lie there with you, like, I'mgoing to be outside, you know,
downstairs or in the kitchen,wherever, doing my stuff for 10
minutes, and then I am going tocome and I'm going to lie down
(38:23):
next to you, and you're going togo to sleep. And so I'm not
saying, hey, you need to bethere all night by yourself. In
fact, I'm not really saying whatyou need to do at all. What I'm
saying is I'm going to changethis. I'm not going to go right
away and lie down next to you.
And one really special thingthat happens when you do that is
(38:46):
that very often, your kid, inthat example, your kid, is
actually not that scared,because they know that you're
coming right, like they know youwill be there in a few minutes.
They're not thinking, Oh no, Ihave to lie here all night by
myself. What if the monsterscome out? Blah, blah, blah, and
so they're not actually all thatscared. And so you do that for a
few nights, and then, you know,maybe after a week you say,
(39:08):
like, hey, you know what thisweek we're gonna do 15 minutes.
And I tell you, when you get upto about 1520 minutes, most of
the time, that kid startsfalling asleep. Because if
you're tired and you're not thatscared, typically you end up
falling asleep, and eventuallyyou could just stop with the
whole thing, and you know, theyend up sleeping in their bed by
themselves. Or to take anotherexample, you know, maybe you
(39:31):
have a kid who is reallysocially anxious, and you always
speak for them, right? Like, yougo to the library, you're
talking to the librarian to getthem the book that they want.
You go to the diner, you'reordering for them, you get,
like, everything you're alwaysspeaking for them. So maybe you
say, starting tomorrow when wego to the restaurant, I'm not
(39:53):
going to be ordering dessert foryou. And if your child doesn't
get dessert that day, like,Okay. Not the end of the world,
I suppose, and it's a shame, butit's not the end of the world.
And you do that, but you're notsaying to them, you have to
order this, right? Like when itcomes time for dessert and your
kid wants the ice cream or thepie or whatever. You're not
saying you have to do it. You'rejust saying, Well, I'm sticking
(40:15):
to my plan not to do this foryou. And very often, you know,
maybe not the first time, maybeit's the second time, maybe it's
the third time, but your kidstarts to really realize that
you do actually believe thatthey're able to handle it, plus,
maybe they actually want somedessert, and maybe they end up
whispering to the waiter orpointing on the menu to the
(40:38):
waiter. Well, that's actually agiant step forward.
Yes, yes. And that's and I lovethat, because what you've
pointed out is that it doesn'ttake any work on the child's
part. It's all on the parent.
It's the change in our behavior.
Exactly, yeah, I never reallywant to put the onus the child.
If you have a child who doeswant to also practice some of
(41:01):
their own skills, that's great.
I'm not suggesting anybodyshould deny them a skill that
might be useful for them. Ifthey want to learn some relaxing
breathing exercises and do thatfor a minute and get themselves
in a better state, that'sperfect. But the beauty of doing
space is that you actually cando it, even if you have a child
who says I'm out right, like Idon't have a problem at all, or
(41:24):
I'm not interested in working onit, or I don't want any help,
the answer for that was just,well, I'm sorry, we can't help
you, right? If you called up atherapist and you said, My kid
is really anxious, and theysaid, Okay, bring them in. And
they said, No, they can't. Theywon't come in, I tried. They
refuse. The therapist would say,Well, what do you want from me?
You're stuck. Yeah, it'd belike, if you call your mechanic
(41:46):
and you say, my car won't start,and they bring it in, have it
towed in, and say, well, the carwon't come okay. How do you want
me to fix it? But what we can donow is say that's okay. That's
actually fine. You come in andwe're going to give you some
tools without making any demandsof your child, and you're still
going to have a really bigimpact our clinical research and
(42:06):
clinical research from otherteams, not by me, so just so
everybody doesn't think it'sjust because I want to say that
it works, but clinical trials,multiple clinical trials,
actually show that doing spaceis just as effective as working
directly with a child like incognitive behavioral therapy. So
(42:27):
it's not that we should stopdoing cognitive behavioral
therapy, which is a veryeffective treatment and has been
tested many more times thanspace, but it's great to have
another tool in the toolbox thatwe can use
absolutely and I actually thinkthere's a third component I want
to mention, and that is thatit's so important for parents to
(42:49):
be transparent about whatthey're doing.
Yes, I completely agree. I thinktransparency is really the way
to go. Don't tiptoe around it.
Don't trick your child. Youknow, sometimes parents say to
me, when we're doing space,like, won't they realize that
I'm seeing you or that I'm like,Yeah, of course. But why should
that be a secret? Yes.
(43:13):
I mean, I think it's beautifulexplain to them why you're doing
what you're doing, and thatyou're making these changes and
these accommodations because youlove them and you want them to
feel better,exactly right? Like I'm your
parent, I'm concerned, ofcourse, I'm going to do whatever
I can to help you, includingconsulting with whoever I think
can help you.
(43:33):
So I also want to ask you, youmentioned in your book a myth
that comes up a lot about thecause of anxiety, and if parents
are playing a role in theirchild's anxiety, can you explain
why that's not true? Because alot of parents will easily blame
themselves for their child'scondition. But I really like how
you explain that that's not thecase.
(43:54):
I think it's really an importantpoint. I'm glad you're bringing
it up, because parents have beenblamed for lots and lots of
problems, and pretty muchalways, when you actually test
those theories empirically, theyfall apart. They really do. So
here's the reality, yes, thereare correlations between certain
(44:16):
parent characteristics andcertain child characteristics,
and that includes for anxiety.
And so anxious children are morelikely than other children to
have parents who are alsoanxious. And anxious parents are
more likely than other parentswho are not anxious to have a
child who has anxiety. So thereis a correlational link there.
(44:37):
However, it's also important tobear in mind that finding as
well as other parentalcharacteristics that have been
linked to anxiety, like beingprotective or being critical or
things like that, those datacome from what is called cross
sectional study, meaning you'retesting the parent and the child
at the same time, and you'relooking is there. For a
(44:59):
connection. And as many peopleare already aware, correlation
is not the same as causation.
Two things going together doesnot mean that one is the cause
of the other, and if one is thecause of the other, it doesn't
tell you which is the cause ofwhich. Now is there a sense in
(45:23):
which, for example, genetics arecontributing? Yes, there is a
genetic contribution, but Ithink it makes more sense to
think of the genetics, not asthe parent, causing the child to
have anxiety by passing on thegenes. I think a more realistic
way to think about that is athird factor, meaning the gene
(45:44):
causing anxiety in both theparent and the child. I think
that's probably a more realisticway to look at it, because we
don't choose our genes, right,like we just get them. And so I
would think of the geneticsalmost as a third external
factor that is impacting boththere are also other external
factors, for example,environmental stressors. Maybe
(46:06):
we are both experiencinginstability in other aspects of
our lives, and those can becausing anxiety in both parent
and child.
I appreciate you saying this,because I find that so many
parents are riddled withparenting guilt when their kids
have difficulty. So this isgreat to learn
about. Well, i Far be it from meto deny any parent their God
(46:29):
given right to wallow in guilt,but I have to say that there
really is not a valid scientificbasis for the conclusion that
parents are the cause of anxietyin their children. And in fact,
I strongly believe, based on theresearch that is available, that
(46:51):
in the vast majority of cases,parents are not the cause of
anxiety in their children. Ifyou have a child who does not
have that predisposition toanxiety, I think there is a very
low likelihood of you givingthem an anxiety disorder,
regardless of what style ofparenting you happen to have,
right like, maybe you're a superprotective parent if your child
(47:13):
is not particularly prone toanxiety, I don't think you're
going to make them an anxiouskid. I do think you might
sometimes make them an irritatedkid, because it can be annoying
to have a really protectiveparent when you're not that
anxious, but I don't thinkyou're going to give them an
anxiety disorder. And the samegoes for your own anxiety level,
and the same goes for otherparental characteristics. And so
(47:33):
I would say you don't have to bethe cause of a problem in order
to be a solution to thatproblem, in order to be able to
help. By the way, we don't applythat logic in most areas. If
your kid came home from schoolwith a broken leg, I don't know
a lot of parents who would say,I didn't break it. You know,
that sounds like a you problem,because I didn't break your leg.
(47:55):
And if your kid has anxiety, youdon't have to say, Well, I only
want to treat it, or I only wantto help. And if I caused it,
that's absurd.
Yes. I mean, I can think myself,I have three kids, and they're
all very different when it comesto anxiety levels and what makes
each of them nervous. And Ithink we're the same parents. I
know they're technicallyseparated by a couple of years,
but I can see that in my ownlife to be absolutely the case,
(48:17):
different than 100 other waysthey are different than their
anxiety levels.
Yes. Now as we conclude, I'dlove to offer a message of hope
to parents that are listening.
Maybe they're feelingoverwhelmed by what to do. Maybe
they're feeling unsure aboutimplementing these changes. Can
you tell everybody, if they gothrough this program, how long
does it typically take, and whatwill they expect to find in the
(48:38):
end? In other words, do theseconditions get better from your
experience?
The answer to that last part isa resounding yes. These problems
can absolutely get better. Infact, while it's true that
anxiety is the most commonmental health problem, it is
probably also the most treatablemental health problem, there are
so many problems where we dreamof having the ability to
(49:01):
actually improve them to theextent that we can with anxiety.
I would say to any parentlistening that the world is just
chock full of kids who used tohave an anxiety disorder and now
they don't, because you canactually overcome these
problems. How long does it takea typical course of doing space,
assuming you're really doing itseriously working at it. You
(49:23):
know, it's not the kind oftreatment where you just go talk
to a therapist and then donothing for a week, come back
and talk again, you go to yourtherapy sessions of space so
that you know what to do athome. But at home is actually
where the treatment occurs,right? Like the sessions are
there to tell you how to do itwhen you're not there, but
assuming you're really puttingin the work a typical course of
space might run 10, 1215,sessions. 12 would be a
(49:47):
reasonable ballpark average,which means a few short months,
right? We're not talking aboutyears of therapy. We're talking
about a few short months. Isthat going to come? Completely
remove that predisposition toanxiety in your child. No,
because we don't change whohuman beings are, nor do I
(50:07):
really think we want to. Butwhat can it change? It can
change whether this is a problemthat is actually limiting your
child's experience. Is itimpairing their ability to
function, to go to school and tofunction there, socially,
academically, to live a normallife at home, to have social
relationships, to sleep at nightand eat during the day and feel
(50:29):
okay with themselves. That'swhat we're trying to change, to
make this not the problem thatis the focus of your kids life,
and that is very much possiblefor the big majority of kids.
And so I would say, if you'rereally doing this work, within
two months, you'll probablyalready be seeing really
(50:50):
significant change in yourchild. And within three months,
you might already be ready toactually end the treatment.
And I'm sure for parentslistening that do have kids that
are really impacted and impairedby their specific anxieties,
just learning that they can goabout their regular business and
their life without it impactingthem to such a large degree. I
think that must sound like adream.
(51:10):
I think so too, because, yeah,the anxiety is a huge burden on
the child, but it is also aburden on the parents and the
rest of the family. And thistreatment, while it does take
work, it should actually makeyour life easier, not harder.
And I'd like to point out it canalso help children that have
milder cases as well.
Yeah, yes, absolutely. I thinkeven if your child doesn't have
(51:30):
a clinically diagnosed anxietydisorder, you ask a parent who
has a child with some mild butnot all that severe anxiety,
would it be good if your childcould, like, do better with
this? They'll say, like, ofcourse, like, why not? Yes, only
insurance companies that thinkwe should ignore all of those
cases.
Yes, no. I'm someone who thinkslabels definitely have their
(51:52):
limits to how helpful they canbe for people, definitely. And
then, just to conclude, I wouldlove for everyone to know. Where
can they find you? You have aTED talk, you have a
documentary, where can peoplefind additional resources and
professional help if they wantsupport?
Yes, absolutely. Well, first ofall, apologies to everybody. I
am not on any social mediapersonally, and so don't look
(52:14):
for Ellie Liebowitz on good foryou, yeah. Well, I don't know if
good or not, but I've just, likecompletely sought that out. And
so I've never really joinedanything, but you can find a lot
of resources to learn more aboutthe treatment, to find the
therapist. The number one thingto do, I would say, is go to the
website. There is a website forspace. It is space treatment.net
(52:35):
and that has a ton of resources.
There's a list of therapistsnumbering in the 1000s who have
all done formal training indoing space, and there's at
least one in every single statein the US, as well as many other
countries. So you can go searchit, find somebody to work with.
There are other resources, linksto other podcasts or research
(52:58):
articles and other articles andvideos and things like that. You
can find that on the website. Ifyou're a therapist and you're
interested in becoming trainedin space, you can find where to
get information about thetraining. And so that is, I
would say, the number one placeto go. There is also a Facebook
(53:20):
page, so it's not me, but thereis a space Facebook page, which
is facebook.com/spacetreatments, in this case, a
plural. So space treatments. Andactually, through there, you can
join the discussion group ifyou're interested in
communicating with others. Thewebsite also has like a forum
that you can join. And there aremultiple books published. I
(53:42):
think if I had to recommend onebook in particular, I would say
it is the book called breakingfree of child anxiety and OCD.
That is a book really writtenfor any parent to pick up and
just work through to kind of dospace on their own. But even if
you are working with atherapist, it can be like a good
accompaniment for the treatment.
(54:05):
The book is great. I love theworksheets that are in there. I
think it's a great help forparents. I love all the examples
of supportive statements. Soanybody who's looking for a
place to get started, Idefinitely agree. I would get
that book, and you probably willfind that finding a therapist to
accompany the book would be themost effective way to treat your
(54:25):
child.
Yeah, I think so too. But I alsoacknowledge that not everybody
has easy access to a therapist,whether because of where you
live or other or other reasons,and so if you actually can't
work with a therapist, I wouldsay, then try to work through
the book by yourself. Teaser foranybody who is interested in the
arfid in particular, we do havea book coming out that will be
(54:46):
on kind of a similar book, butfor parents of these really,
really picky eaters. We alsohave another book coming out
which is really focused onschools and anxiety in the
school setting.
Amazing. Because I will say bothof those areas cause a lot of
distress for families,particularly arfid It's hard for
parents to know where to go,where to get treatment. So I'm
(55:08):
so happy to hear that you'recontinuing to do the good work
that you do. Dr Ali Liebowitz,I'm so proud of you, and I can't
wait to see what else youcontinue to do well. Thank you
so much. Thank you for all theimpact you've made, and thank
you for your time. Thanks. Thankyou for listening. And I hope
you enjoyed this week's episodeof your child is normal. Also,
if you could take a moment andleave a five star review,
(55:29):
wherever it is you listen topodcasts, I would greatly
appreciate it. It really makes adifference to help this podcast
grow. You can also follow me onInstagram at ask Dr Jessica, see
you next Monday. You.
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