Navigating Childhood Anxiety: Insights from Eli Lebowitz

In today’s episode of The Self-Driven Child, I interview Eli Lebowitz, the creator of the concept SPACE, or Supportive Parenting of Anxious Childhood Emotions. He is helping parents and kids break the cycle of chronic stress. We discuss how to help our kids cope with uncertainty or a lack of control over situations. I’m so excited to share this conversation with you – Bill and I are huge fans of Eli’s work, and we feel so fortunate to spread the word about the SPACE concept. I hope you enjoy it!

Timestamps:
[2:48] Why he wrote Breaking Free of Child Anxiety and OCD
[4:35] The pandemic’s effect on childhood anxiety
[6:10] Is it regular anxiety or an anxiety disorder?
[10:50] The value of coping mechanisms
[11:15] The heart of anxiety disorders
[13:37] Helping with anxiety comes from a place of love
[17:24] Empathy helps parents with this process
[21:22] How anxiety can present in families
[23:44] The NUTS and bolts of anxiety
[25:27] Addressing anxiety widens a child’s world
[27:58] The traps parents fall into
[35:38] Accommodations for anxious kids
[38:56] Moving toward letting kids feel anxiety sometimes
[42:47] Teaching kids to be the hero of their anxiety story
[44:05] The problems of always accommodating kids’ anxieties
[47:51] Preventing learned helplessness
[50:23] The value of a plan & where to start
[58:00] Final thoughts

Resources:
Breaking Free from Child Anxiety and OCD: https://www.amazon.com/Breaking-Free-Child-Anxiety-Scientifically/dp/0190883529

More about the guest:
Professor Lebowitz is the Director of the Program for Anxiety Disorders at the Yale Child Study Center, where she researches and treats anxiety in children and adolescents. His work investigates the genetic and hereditary factors that have a role in the onset and maintenance of anxiety and associated diseases. Dr. Lebowitz has written extensively on child and adolescent anxiety and is the primary researcher on several grant-supported studies.

If you have a high school aged student and would like to talk about putting a tutoring or college plan together, reach out to Ned's company, PrepMatters at www.prepmatters.com

Transcript

Eli Lebowitz  00:00
I often say to parents, when it comes to anxiety problems, it's a little bit of a good news bad news story. And the good news is that in all of mental health, there is actually no problem more treatable than anxiety. There are so many problems where we wish we had solutions half as good as we have for anxiety. And so it's it is the most treatable problem. But the bad news side is that if you don't treat it, it doesn't tend to just go away on its own. And in fact, the opposite, it tends to get worse.

Ned Johnson  00:35
Welcome to the self driven child podcast. I'm your host, Ned Johnson, and co author with Dr. Williams pictured of the books, the self driven child the science and sense of giving your kids more control over their lives. And what do you say, how to talk with kids to build motivation, stress tolerance, and a happy home. As so many of us know, there are so many young people who are struggling with anxiety and depression and sometimes OCD and other stress related disorders. And of course, that stress is challenging not just for children, but for the parents as well. And oftentimes, parents get pulled into a dance of making accommodations of trying to soothe and protect their children, from the stresses of things that are well stressful. But when that goes on too much, we become enmeshed and can actually reinforce those various stressors and help kids feel stuck in a position to being stressed about things that we'd like them to feel less stressed about. So I'm really grateful to bring to this conversation with Dr. Le Liebowitz, who pioneered a concept called Space supportive parenting of anxious childhood emotions. It's a revolutionary approach to treating childhood anxiety and OCD without asking anything of children, but rather for us as parents, for adults, as educators as caregivers, to change our own dance steps in ways that break the cycle of kids feeling chronically stressed. It's really powerful stuff. I so enjoyed his book and this conversation, I think you will to take a listen. Thank you for being with us.

Eli Lebowitz  02:09
It's great to be here. Thanks for having me on.

Ned Johnson  02:12
As you may know, I my writing partner, Bill sticks are big fans of your work, we were delighted to become aware of your of your work before we wrote our book, what he's saying how to talk with kids develop motivation, stress tolerance, and a happy home. And so golly, people are listening to this probably have more familiarity with stress and anxiety and stress and anxiety in their kids. And they might like, but just to sort of frame things up. Can you just talk a little bit about why you wrote this book? And you know, kind of why now, given everything we know about anxiety?

Eli Lebowitz  02:48
Absolutely. First of all, I've been wanting to write this book for a while. And I'm really excited about it. Actually, it's it's been out for a year. And the feedback that I'm getting on it is exactly what I was hoping for when I wrote this book, as being able to speak directly to parents, to give them the tools to help their child is such a gratifying experience. And I think it's so empowering for parents, to be able to help your child. You know, having a child who's struggling, who's facing challenges like anxiety, like OCD, you can feel so helpless, you can feel so frustrated because you want to be able to help them and you don't always have the ability or the tools to be able to do that. And when you can, I think it's just the best experience. And I also think that from a child's perspective, that experience of I have a problem in my life. But I have parents who can help me to overcome that problem is just magnificent. I think it's, it's just great. And, you know, in terms of the why now, I like I said, I've wanted to do this for a while but but you know, even in the best of times, anxiety problems are so common. They are the most common mental health problem in children and adolescents. And actually in adulthood too. And let's face it, we actually haven't been living through the best of times. These have been years now that seem almost engineered to exacerbate to elevate or trigger anxiety in children. And the data that's coming out now from research that's happening during the pandemic is just staggering. We have essentially double the rates of anxiety as well as problems like depression relative to before the pandemic so We have taken the most common mental health problem and doubled it. And so I think there are just so many parents out there and so many families out there who really need tools to be able to cope with that challenge.

Ned Johnson  05:14
But I think the book is great. And part that it's, it's incredibly clear, it's incredibly actionable. And to your point, it's what parents can do to help kids, where I think so often, we try to control what our kids are doing to, quote unquote, make things better, which is then stressful to them. Because feeling like being someone's trying to control you is wildly stressful and stressful to parents, because they're trying to make other people do things when you can't necessarily do this. So I just I mean, in the book, I mean, it couldn't really have come at a better time, because as you said, anxiety has gotten through the roof and our access to mental health providers could be it could be better. If I may, I'd love to you make the point that you know, all of us are having more stress right now. But can you talk a little bit about sort of, quote unquote, garden variety, anxiety versus an anxiety disorder? You know, when can parents know? Ooh, this isn't just, you know, my kids are upset because they're upsetting things going on to this is we have a problem here.

Eli Lebowitz  06:19
Yeah, I think it's actually a really important question. Especially because we expect children to be anxious some of the time, right, we take it for granted, even without pandemics happening around them, children are going to be anxious some of the time we are expected to and we're supposed to, frankly, right? It's it's part of life. But when do we start thinking of anxiety as a disorder as a problem? Well, you know, like in every other area of mental health, we don't have X rays for this. We don't have blood tests for this. And so what do we do? We look at the level of impairment to a child's functioning, how much is this anxiety, impacting their ability to just function as you would expect for their age in their daily lives. And that might mean functioning in a school context. For example, being able to go to school being able to function at school to pay attention to a teacher tenure, along with friends, functioning in their social interactions, to make friendships, to maintain those friendships, to meet with other kids, things like that, to talk to them are functioning at home? How much is it disrupting daily life? Or even just the child's own personal well being? Are they able to be relaxed enough to go to sleep at night? Are they able to have a healthy appetite? Can they enjoy the things that they typically would like doing, and the more we see those areas of function being disrupted by anxiety, and the more that that's persistent, over some significant amount of time. So it's not just like one day or a couple of days, but this is becoming a feature of the child's life, the more those things start to mount up, the more we're going to consider the possibility that this might be an anxiety disorder. So the first time your child comes into your room at night and says, I think there's a monster under my bed, you don't have to give them Prozac. You don't have to get the therapists office. But when you see the anxiety, really impeding this child's ability to function normally and time is continuing to pass. That's when I would say talk to a professional, maybe we can maybe talk to your child's PD to definitely read the book. Oh, thank you.

Ned Johnson  08:42
What's your what and what and because one point that you make, I mean, when we'll talk about this a little bit about about kind of conventional protocols for treating anxiety, whether medication or CBT. That it's not an it's not an either or we don't we don't have to decide, do we do this and kind of get stuck back and forth that it's very much an and I have a I have a colleague who has a young child, then it was telling him about surveys that I picked this up. And I started to do with my child and I thought, you know, who doesn't benefit from having more tools in our parenting toolbox?

Eli Lebowitz  09:14
Yeah, I think that's great. And it makes a really good point, which is yes, it's important to be able to figure out when a child has an actual anxiety disorder and when they don't, but at the same time, your child doesn't have to have an anxiety disorder to be able to benefit from you're helping them to cope better with anxiety and sometimes if you're able to put some changes in place, if you're able to take some steps as a parent or teacher child some tools, you may be able to prevent a lower level of anxiety actually growing into a full anxiety disorder. The only people who think that you need to have a formal diagnosis in order to get treatment are people who work for insurance companies. else actually thinks that that makes sense. So if you're concerned about your child's anxiety, you could be taking steps to help them whether or not a formal evaluation would indicate the presence of a disorder.

Ned Johnson  10:11
What else like I also, like you make the point that we, you know, in terms of disorder, that it's really, we don't need to be finding the way that we don't have to be assigning blame, or, you know, certainly blaming ourselves or our partners, that the disorder is really just a description of, as you said earlier, have behaviors that are, you know, eroding the quality of life for our, you know, for our children or our families. And so, so well, it seems to me that the one of the outcomes we want for all of our children, is to have a high ability to cope with uncertainty with with anxiety with novelty, with a lower sense of control, because goodness knows we've all experienced those in the last couple of years. And I would imagine that this episode, studies have shown that the people who have come best through this are not the people who necessarily had the fewest headwinds, but people who had the highest coping mechanisms.

Eli Lebowitz  10:59
Yeah, I think that's very well said, and people don't always realize this. But I think you're, you're really making an excellent point, which is that the real root, the heart of having an anxiety disorder is not really about having more anxiety than another person. Yes, if you have an anxiety disorder, you will have more anxiety than another person. But what's the real problem, the real problem comes from your unwillingness to tolerate feeling anxious, from your determination, not to feel that way. And that's where the impairment really, really, really sets in, you might have two children, who are equally scared of something. But if one of them thinks, I'm never going to feel that way, again, that's the child who's going to be more impaired. And that's the child who will have a formal disorder, yeah, down down the line. And that means that the greatest gift you as a parent can give to your child who is vulnerable to anxiety is the belief that they actually can handle feeling anxious some of the time, that is the best inoculation imaginable against actually suffering from your anxiety excessively over the course of your life. And I think it's, it's just an incredibly impactful thing that a parent can teach a child. And I also, before I, before I let you say your next thing, I also want to just really underscore what you said about blame and the lack of blame. I think it's really easy. When we start talking about the role of parents in child anxiety, I think it's really easy to make that jump to well, if you think parents should be helping their children to overcome these problems, it doesn't really mean that they caused the problems in the first place. And the answer is definitely not. In fact, I strongly don't believe that parents are the cause of the vast vast majority of children's anxiety disorders. And I also think it just really doesn't make sense to think that parents should only be able to help their children with a problem that they cost. We should only when do we ever think like that, and we shouldn't think like that in mental health, either. But our field of mental health has unfortunately done a lot over the years of parents,

Ned Johnson  13:34
long history of blaming, predict the moms, right,

Eli Lebowitz  13:37
especially moms, schizophrenia, autism, everything has been blamed on parents and moms in particular. And time. And again, actual research does not support those hypotheses. And that is certainly true for anxiety as well. So I'm not saying you can help your child because you cause their problem. I'm saying you can help your child because you love them, because you care about them. And because you want to

Ned Johnson  14:02
love it. I love it. And there's two points I'll make just add to that really quickly. I mean, it's so easy to think that parents cause anxiety and kids but it's just as likely to think that anxiety and kids causes the the response to the behaviors, even the anxiety and parents because, you know, as nurturing mammals, and we know that all stress, all emotions are contagious, right? If you're having a day of it, and I'm just in your presence, you know, particularly loving parents actually wanted to ask this, I was wondering whether is it a credible supposition that it may in fact, be the parents who are most loving who are even more attuned to their kids emotionally, or likely to react or perhaps overreact when they're if they have kids who are sort of neurologically more says that more more vulnerable, more anxious to the world around them?

Eli Lebowitz  14:53
It's a very credible supposition, and in fact, it is borne out in a lot of our research. We We look at these ways in which parents are responding to their child's anxiety. And we talk about accommodation. And we know that those kinds of protective accommodations, ultimately, they don't help the child to become less anxious, and they may be maintaining the problem rather than improving it. But actually, what you said is borne out in a lot of our data, which is, it's often the parents who have what you might think of as a lot of really positive parental attributes. And I don't like to say, who's a good parent, because I think there are tons of different ways to be a great great parenting like that. But if you think about things like being more sensitive, and being engaged with your child and praising them, and getting along with them, those are also often the parents who are also doing a lot of that kind of accommodation, I think it gets to exactly what you said, which is, yeah, we are mammals. And that means we are literally hard wired, when we're children, to look to our parents for help when we feel anxious, and we are equally hard wired. And I mean that literally in terms of our neural circuitry, we are equally hardwired as parents to notice when our kids are experiencing fear, distress, anxiety, and to step in, and to try to help them. And so of course, when you have a child who has a lot of anxiety in their life, that parent is going to get sucked in to responding to it, and you're going to have these patterns of entanglement and of accommodation. But that's not a parent being a bad parent. That is an anxiety, problem hijacking, and making really go wild, a very positive, healthy, and frankly, beautiful system of parental care.

Ned Johnson  16:53
I'm we're gonna get to obviously, the accommodations. But I wonder if you could talk for a minute, people who are anxious children who are anxious have a tendency to do a lot of if what about, you know, kind of dreaming up more scenarios, and then also attributing higher value and higher probability to Nick, can you can you walk us through this because I think it's a really useful framework for us them to think about the accommodations that we make, and how moving towards supportive parenting model can undo that tendency that our kids may have.

Eli Lebowitz  17:24
Absolutely, I try hard in the, throughout the book, but especially in the early chapters of the book, to help you as a parent, get it to just put yourself a little bit in the mind of your anxious child. And I do that through some explanations, and I do it through some metaphors. And the and the, the point that you were referencing is what I was explaining there is that we all are running constant simulations in our mind, right? Like, that's how we go through life, we're always thinking about various different scenarios, what might happen if I do this, what might happen if I do that, and we base our decisions, our reactions, our feelings, but also our decisions in terms of behavior, and the kinds of scenarios that we're imagining. Now, some of those scenarios are going to be more positive, and some of them are going to be more negative. Right? I, let's say there's a school trip. And I'm thinking as a child, should I go with my class on this school trip? Well, I might have some positive scenarios in mind. Like, it could be fun. It could be interesting. It'll be a nice memory, things like that. But I also might have some negative scenarios in my mind. Like, what if our bus goes off a cliff? What if burns down while I'm away? Memorable? What if I throw up on the bus in front of all the other kids and I'm just humiliated, and everybody teases me about it. So you have some positive scenarios, and you have some negative scenarios. And when you have a tendency to more anxiety, your brain is just going to come up with overwhelmingly more of those negative scenarios. So sure, yeah, of course, I might have a fun time. But I have these 10 Other ideas for all the ways in which it might go badly. And then there's the weights that I'm attributing to those things, what seems important and big versus what seems small. And so I might think, yeah, having a fun school trip, that's great, but it's not a huge deal. I don't give it a lot of weight. Whereas throwing up in front of everybody I give that seems like a massive thing. And so what do I end up doing? I ended up not going on the school trip, because it's just not worth it when you have so many more negative scenarios in your mind. And when those seems so much more weighty and more important than the positive ones. You're going to end up falling on the side of it. won't do it, I'll avoid it. Because it's just not worth

Ned Johnson  20:03
it. I know in mathematics, the time it makes me think about expected value where it writes the value then times the probability of event, and then you add them all up. And so, you know, I can imagine this as parents, you know, seeing it, you know, you meet new friends, it's enriching and blah, blah, blah. And, and the kid basically death, you know? I'm going out. Yeah, so thank you for that. Because I think for me, that's a really useful way to think about this. Because one thing that you made a point in the book, that, as parents, we picture, you know, a thrilling adventure, right, and our kid pitch pictures, the end of film movies, I mean, it's just, you know, Carnage. And we can have these very different movies playing in our heads. And we and we feel that our kid is, you know, air quotes, choosing to focus on the negative choosing to do this. And, you know, I've experienced this and like, Oh, my goodness, I mean, come on, really. And you make the point that we don't, we would do better not to think of it that way. Because if people really are religious, if they're really anxious about something, it's for legitimate reasons, it may not seem legitimate in us to in our heads, but to the child that it feels as real as you know.

Eli Lebowitz  21:22
Exactly. You know, you remind me of a family that I that I worked with a number of years ago, and they went on vacation, they had a little girl who was very anxious little girl, she was about nine years old, and they went on vacation. And they went somewhere, some town in Europe, I don't remember the town was like one of these picturesque, quaint little towns with cobblestone streets and all the old churches. And when they came back, the father was describing this trip to man, he said, you know, we, every day, we would get up and leave our hotel and just lose ourselves in these quaint little streets and was a great time, we were all having a great time, except for the little girl. She was not having a great time, because her mind was full of all the what ifs. Wait, we're losing ourselves. That sounds terrifying. What if we don't find their way back? And we don't really know the language. And they said that dinner at the hotel is between this hour and that hour? And what if we don't make it? And if we get lost? And what if we lose our passports or we get mugged. And all of those negative scenarios meant that for her, this wasn't fun at all, you know, that kind of let's lose control a little bit. Because we're on being vacation, we don't need to be in control, we can lose track of time. But when you are anxious, when you are scared, that loss of control feels horrible. It doesn't feel like fun. It feels like losing yourself on the way to the most important job interview you've ever had. Does that sound like fun to anybody? I don't think so. Because when you are under stress, when you see a world full of risks, you want to be in control. And that means that you're going to sometimes seem to other people in your family, a little irritating, a little

Ned Johnson  23:07
controlling, bossy, you talked about the Bossy child. Yeah. Right. Because of

Eli Lebowitz  23:13
course you will be of course, you're going to be trying to keep being to be keeping everything on track and make sure everybody's doing everything right and not taking risks. And that can be a source of a lot of irritation. And I think helping parents do understand that and have a little bit of empathy for what is driving that behavior in their child can defuse some of that friction, and help them to maintain a more supportive stance, rather than just seeing this child as the, you know, the the one who spoils the vacation.

Ned Johnson  23:44
A good a good point. I mean, it's that that loss of control, I think, is a very important thing that we're building are big fans of the work of Sonya Lupien, who talks about the acronym nuts of novelty, unpredictability and the perceived threatened and that's a low sense of control, and that she maintains that I think the research suggests that that's, that's the most stressful thing that people can experience. And so I think a lot of what looks well is, you know, a lot of what looks like kind of unreasonable behavior, simply people are trying to feel and I guess that's really what's behind OCD is the, the perception, right? Of a sense of control, even though it you know, superstition doesn't actually make your team win, but they should feel better.

Eli Lebowitz  24:23
Right? And if that feeling is so strong inside of you, even if half your brain notes, that it's totally irrational, you're still going to be so compelled to avoid the risk anyway. Right? Like you talk to children with OCD. And almost all of them know that at least some of their thoughts or some of their behaviors, they don't really make sense. They're not really rational taught tapping this three times, it's not truly going to prevent a meteor from striking the earth. I know that but I also feel like it might and you don't really want to take the risk. And so I will do it anyway. And that can lead, of course, to a tremendous amount of those little decisions, adding up into a whole lot of impairment in your day to day life.

Ned Johnson  25:10
But the point that I think is really worth making is that left untreated, anxiety grows, right, that the number of things that kids are anxious about grows and grows, and really the world that they feel comfortable to operate in, gets smaller and smaller and smaller. Is that about right?

Eli Lebowitz  25:27
Yeah, that is about right. You know, I often say to parents, when it comes to anxiety problems, it's a little bit of a good news, bad news story. And the good news is that in all of mental health, there is actually no problem more treatable than anxiety. And that's a really important thing to know, there are so many problems in our field of psychiatry, psychology and mental health, there are so many problems where we wish we had solutions half as good as we have for anxiety. And so it's it is the most treatable problem. But the bad news side is that if you don't treat it, it doesn't tend to just go away on its own. And in fact, the opposite, it tends to get worse, being anxious about one thing just Prime's you to become anxious about other things as well. And so the problems tend to accumulate. And in fact, in every clinical sample, it is more common for a child to have more than one anxiety disorder than it is for them to have only one anxiety disorder, because these problems really accumulate. And because underlying those different problems is really some shared issues of anxiety manifesting in different domains. But it means that if it's not likely to go away on its own, but it is so treatable, it means we should be treating it. And, and we actually don't do enough, in our society today, to detect anxiety early and to intervene to address it, the amount of time that children with anxiety problems, wait for their first clinical contact is measured in months, and sometimes in years. And that means that a lot is accumulating a lot of additional problems and a lot of impairment are accumulating, we should be doing a whole lot more to detect anxiety and harnessing the systems that we have, like the primary care system in the school system, and of course, educating families and parents as well, so that we can intervene.

Ned Johnson  27:32
Now, you mentioned that you use the language into a shared problem. And that's a point that you talk about in the book that I mean, we wouldn't be should we let's dig in now, right? That that, you know, a child problem really typically becomes apparent problem and a family problem. So, you know, and you talk specifically about the two things that parents often try to do, that don't really help, you know, protecting in demand. And can you can you unpack that for us?

Eli Lebowitz  27:58
Yeah, we think of these as, as traps really have as traps that you might fall into in your response to an anxious child. And these are traps that can ensnare even a smart, savvy and well intentioned parent. And so what are those traps? Well, the two most common patterns that we'll often observe are, on the one hand, being overly protective. What do I mean by that? What I mean is that you are when you're being protective, you're guided by the principle that says, I need to shield my child from distress, I need to help them to not feel uncomfortable to not experience anxiety, maybe you believe anxiety is harmful. Maybe you just don't like to see them upset. And of course, protecting your child from harm is so important. Right? Like, who doesn't want to protect your child from harm? I'm a parent. Yeah. And I see protecting them from harm as probably the number one, you know, most important job that I have, as a parent, there's lots of jobs that you have, but I definitely want to be protecting them from heart. But, but when you apply that thinking, to any experience of anxiety, that's when it becomes a trap. Partly because anxiety is not actually harmful. You can experience anxiety and still be okay. But also, because when you do that, what's the message that your child is getting? The message is, anxiety is something I need to avoid? Look, even my parent is working so hard to make sure I never feel anxious, it must be really bad. And so if you go back to what we said before about the root of the impairment being in that feeling of I shouldn't feel anxious and I don't want to you're strengthening that by giving that message. And if I can jump in right there.

Ned Johnson  29:55
So if we thought about as an anxious kid, you talked about and lock right Another dad putting a lock on the front door that that is an anxious kid, I assign a high probability to this thing happening and a really high negative value to it happening. So if my mom and dad, or the caregiver helps me avoid that thing, they are reinforcing to me the message that oh, yeah, you're not just you have to avoid this, we, as the whole family have to make sure that you don't experience that. Which, which, if then if a parent then tries to say it's not such a big deal, it's completely inconsistent, because my my words might be that but my actions are, avoid this.

Eli Lebowitz  30:32
Exactly. Yeah, that's exactly right. Or to give another example, from another kid that I that I worked with, who had panic symptoms, or racing heart, she would suddenly have her heart racing, and she'd feel out of breath. And she'd think there's something really wrong with her body, and she might die. And it was so scary for her. And when she would come to her parents, and be out of breath, and be so scared. What would they do they take her to the hospital, to the emergency room, because they were so overwhelmed by her anxiety and wanted to protect her from it. And it didn't matter how many times the doctors at the hospital said, Look, she's fine, stop bringing her in, you don't need to do this. But if you think about it from that child's perspective, if I think something's really, really wrong, and I feel like I might be dying, and you're rushing me to the ER, I mean, what stronger confirmation is there that this is an emergency than literally visiting the emergency room, right. And so, sometimes, our protective behaviors can actually get in the way of helping a child to learn that they can be okay that they can cope. Now, that other trap, the second one is the one that we call demanding. And what do I mean by that? I mean, the parent whose guiding principle here is, I need to raise a an independent, strong, mature child. And what that derives is that when you do feel anxious, I don't accept it. Either I demand of you that you not feel the way you are feeling. And that never goes well. You can't tell people how to feel,

Ned Johnson  32:11
and or you're not old. Yeah.

Eli Lebowitz  32:17
If you're making that demand, you're losing that. That trust because if I feel what I feel, and you're telling me that's wrong, or that's false, or it's fake, or you're telling me that I shouldn't be feeling it, it's babyish. You're being a sissy, you're being a was grew up, get a grip, those kinds of demands, a child can't write, like, if they could choose to just turn off their anxiety, they would choose it without your advice, right? It's not like they enjoy feeling this way. And so I can't feel that way. And what do I feel, I feel rejected, I feel misunderstood, or I feel ashamed of the way that the way that I actually do feel around the anxiety. Now, I say this can happen even to a really well intentioned parent, because sometimes, it just is intuitive to us. It doesn't have to be so harsh, like you're being a baby. Sometimes a child says, you know, this is scary. And you say, oh, no, it's not. Right, and you don't mean to say to them, something demanding or something harsh, you probably mean something like, you know, I don't think it's scary, or I wish you weren't scared of it, or you don't be scared of it. But what you're actually telling them is what you are, what you feel is wrong. And so those are both traps, sometimes you'll have one parent who falls very heavily on the protective side, and maybe another parent in the same house who falls very heavily on the demanding side. But also sometimes even within one parent, you might find yourself flip flopping a little bit between these two positions, right? Maybe you start out the morning when there's plenty of time and you're really protective. But then time gets short, and you need to get to work and your kid needs to get to school. And suddenly you flip into that much more demanding mode.

Ned Johnson  34:18
And if I can, if I just want to emphasize a point that I think is so important you make so well in the book, that for children to learn to, in order to undo anxiety disorders, the goal is not to lower the perceived pressure on them, but really to increase their capacity to cope. And when we as parents either try to run around protect them, or demand that they don't feel this way. In both of those situations. We're telling them that these hard foods that you have are not okay, I'm either going to remove the stress or you don't feel these things or tell you you're not allowed to feel this because it's it's not okay. And if we're trying to increase the kid His capacity for anxiety, we're increasing the confidence that the Yeah, this is hard. And and we will talk about this in some depth, you know, increase in our belief that they can handle heart failures.

Eli Lebowitz  35:12
Yes, exactly.

Ned Johnson  35:14
So let's talk about the accommodations. Because back to that point, anxiety, a childhood anxiety is not a child that ends up typically being the child and family problem. So what do you talk about two important two kind of big categories of accommodations? What we, as parents do, thinking that we're, you know, obviously out of love and support and wanting to protect our kids. But what do we do? And why is that a problem? Yeah.

Eli Lebowitz  35:38
So this term accommodation, which has really become a very central term in the way that we now understand child anxiety. So in the same way that you might say, part of having anxiety is a certain level of distortion in your thinking, or part of having anxiety is a certain level of dysregulation in your body responses? Well, part of having anxiety as a child is a certain level of accommodation by parents, it's just part of the picture. And what we mean by accommodation is really all of the changes that parents make in their own behavior, to help their child either avoid or alleviate, the distress relating to their anxiety. And there are endless examples of some really common ones might be, let's say, you have a child with generalized anxiety, chronic worry. And so what do they do? They come to you with their worrying thoughts, and they ask you questions about it. And that's their symptom. But what do you do? Well, you're constantly answering those questions. And that's the accommodation, you're reassuring them again, and again, and again, sometimes endlessly. Or maybe you have a child with social anxiety. And for them speaking to other people is really uncomfortable, because they're so preoccupied with saying the wrong thing, etc. That's their symptom. But what do you do, you might be speaking in place of that, when you're around? That is your accommodation, because you're intervening so that they don't have to experience that distress? Maybe you're at

Ned Johnson  37:19
work, and we as parents don't have to be stressed. So often wonder how much we do that. Because when they're stressed, we're stressed. So we're less stressed, we just kick the can down the road, right? You know, we make that accommodation, oftentimes much for ourselves. Because it's hard when our kids are upset, right?

Eli Lebowitz  37:36
Definitely, I think the two, the two really big drivers of accommodation are one, it's really hard to see your child in distress. And that's natural. Of course, it's hard. Nobody wants to like that. And we shouldn't like that. And the other is you need to keep function going. You need to keep the family's life moving forward, you need to get to sleep on time, you need to get showers on time, you need to get to work on time, you need to get through the day, and you may have other children that you're also trying to get through the day. So it's not even just this child. And most parents of an anxious child are also the parents of another child who may or may not have an anxiety issue. And so you're really busy, and you're dealing with stuff you have to get through the day. And sometimes the accommodation is the way to just get through this moment, so that you can move in. And together, those two things drive a massive amount of accommodation by parents, this has been studied all around the world. And in many studies, without exaggeration, 100% of parents of anxious children reported frequently accommodating the anxiety. And I don't know how easy it is to think of something that 100% of parents you know, we don't agree,

Ned Johnson  38:56
is a staggering statistic that is really well. And I think that points up that emphasize the point you make throughout the book, that it can't be that you know, these parents are to blame that you know, that that these are patterns that we buy our human wiring fall into because we we were born to we're wired to protect and nurture our children. And so this is you make the point. I mean, it's a completely normal and mostly healthy until, you know, anxiety becomes a disorder, you don't need a medium, you know, pervasive and problem problematic. So, so we shouldn't be beating ourselves up. But we want to move in the direction of not doing it all the time.

Eli Lebowitz  39:40
Yes, that's exactly right. I mean, if 100% of parents do this, or you know, the studies that don't say 100% Say like 97% So we're still talking about every parent. And if all parents of anxious children do this, then it just means it really is the most natural thing in in the in the world so we shouldn't be beating ourselves up about it and And you know, this is true of anxiety across the board. Everything about anxiety is healthy and adaptive, when it is triggered by the right things and becomes problematic when it's triggered by the wrong things. The difference between an anxiety like healthy anxiety and anxiety disorder is really in what is triggering it, it's not in how the response looks, we don't have separate anxiety systems for healthy anxiety. And for maladaptive anxiety, we just have one anxiety system, and it's triggered, sometimes appropriately and sometimes inappropriately. But the reason that we want to be actually reducing those accommodations, even though they can be helpful in that moment, they might help your child feel better in the moment. But the reason we want to be reducing them is that the other thing that a lot of research has taught us at this point is that over time, they're not helpful, meaning you might be accommodating, and in this moment of the day, your child feels relieved, but tomorrow, they're going to be more anxious and not less anxious. And as parents accommodate more and more and more, their children tend to get more and more and more anxious. And that is.

Ned Johnson  41:18
And that may seem counterintuitive to folks, right? I mean, and if I understand that, am I correct that the probably two reasons for that one, that we're reinforcing the untrue belief that this thing is, you know, perilous to them when it's it's an unhappy feeling, not not a dangerous situation. And we're adding to that to that mistaken belief, and we're depriving them of the opportunity to learn to cope, right, because the only way you learn to deal with difficult things, right is doing difficult things. Yeah, I

Eli Lebowitz  41:50
think what you're, what you're learning is, in fact, the only way I can cope is by having my parent rescue me. That is my one way of getting through this kind of difficulty is by having my parent rescue me. And look, having somebody rescue you when when you're in danger. That's a good thing. Yeah. But it is such a vulnerable place to be if you need to be rescued all the time, then that's an incredibly vulnerable existence. And you're never

Ned Johnson  42:21
the superhero, right? You're always You're always the damsel in distress tied tied to the trashy police.

Eli Lebowitz  42:27
Who wants to always be the damsel in distress and strong you want to be able to, you know, to save yourself, in the same way that if, you know, if, if if your child believed that the only way that they could eat was if you fed them the food, like spoon feeding them the food, then how vulnerable would they feel? How could they ever go anywhere, because they always need you to be there. What if I get hungry. And it's kind of similar, if I feel like the only way that I can cope with anxiety is by having you rescue me, then I feel incredibly vulnerable. And I'm going to have more anxiety in my life. I say to parents, a lot of times, you as a parent, you're like a mirror that your child looks into to see themselves. And if what they see reflected back to them is a child who is vulnerable and weak and helpless. That is what they're going to believe about themselves. And they're going to be more anxious as a result. But if you can show them a reflection of themselves as somebody who may have an anxiety issue, but is strong, but as capable, but as competent and can deal with that, then they're going to believe that about themselves, and they're going to be so much stronger, and they will have less anxiety. And by the way, by the way, it's not only that, higher, higher levels of accommodation, predict more severe anxiety and more impairment for the child and the whole family. But it's really important to know that they also predict worst treatment outcomes, both for therapy like cognitive behavioral therapy, and even for medications. And so children who are more accommodated by parents, not only does their anxiety tend to get worse in general, but they're also less likely to benefit from a lot of the well established treatments that we usually use for treating those problems.

Ned Johnson  44:21
Wow, that's concerning. Let me pivot towards how do we get ourselves out of the traps, right that folks may be in. And the first point that you talk about when we start when we're when we're going to transition from from, from making many accommodations to making fewer is we first start with support and you have a very specific way of defining support, which I think is powerful for frankly, every parent whoever was whether you have a kid who is anxious or not, I can Can you can you walk us through that?

Eli Lebowitz  44:54
Definitely. We define support in space as Any response that you're giving your child that shows them two key messages. And it only becomes supportive when you have both of those messages. And neither one of them is necessarily all that intuitive, or is all that common in the way that we are actually responding to anxious children. So what are these two messages that we want to give in order to be supportive? The first is a message of acceptance. It's a validation and an acknowledgement of the child's genuine distress. That might be a really simple thing, like saying to your child, I get it, this is hard for you, or I get it, this scares you, or worries you, or makes you uncomfortable, simply validating and accepting what they experience. That's the opposite of the No, it's not scary, or those kinds of messages that are dismissive of the child's anxiety. Here we are the opposite of dismissive, we're accepting and validating. But it becomes supportive. When we combine that with the second ingredient, we call this the mac and cheese of support, because you need two ingredients. And you can't make mac and cheese without both. And just like in the same way in support, you can't do it without both. So what's the second ingredients, ingredients, in addition to acceptance, it's confidence. And by that I mean, me showing you that I have confidence that you can handle anxiety, that you can tolerate it that you can cope with it, which can be as simple also as saying, I know you can handle it. And when you put the two things together, you get a statement that sounds something like I get that this is really hard for you. And I believe that you can handle it. And you'll notice, we're not asking parents express confidence about what the child is going to actually do. We're not saying I know you will step up, or I know you will ace your past or I know you will, I don't know that you might do it, you might not do it. But what I do know what I can say with confidence is that I believe you can handle the distress, I believe you can cope with it, tolerate it, get through it, and be okay in the end. And when you put those two things together, that's when you're being supportive. And it has such a powerful impact on children. I'm not promising any parent that the first time you say this to your child, they're gonna give you a big hug and say thank you for totally curing my anxiety problem. But as you start to make this the way that you're responding so that when they are anxious, when they're upset, when you see them having a problem, you're showing them that support, you're starting to shift their whole view of themselves in relation to the anxiety that has a tremendous impact.

Ned Johnson  47:51
That's really cool. So if we go back to parents have a tendency to protect or demand with the acceptance, where it's the anti demanding not say, you know, buck up stuff in such a wuss about this is and I accept that this is really hard for you, I can see for whatever reason, this is pretty intense for you. And we're not falling into the protecting trap, as you described, saying, I have confidence that you can handle this. And I think that just to emphasize it again, that the whole goal of this is to increase kids ability to and competence in their ability to cope with with not feeling great all the time. And you know, I think some parents will love if I made sure he was tutored enough and got an answer anything that they wouldn't be stressed about. Not true, right? It's Oh, man, I love it. Yeah. You know, at the very end of the book, I mean, well, actually, I was gonna say really quickly as your your work makes me think a little bit about Steve Mayer and Martin Seligman about learned helplessness. And they had that paradigm paper and learn helplessness at 50. Were kind of what we got right and what we got wrong. And if I remember correctly, Mayor said something like, it wasn't that these animals that they were being mistreated, learn to be helpless, but that they failed to learn a sense of control. And so your, your metaphor about us as parents being a mirror to kids, that we've we're constantly showing them that they can't do us do it without us. How do they learn? As opposed to I know this is hard, and you can handle it?

Eli Lebowitz  49:27
Yeah. Yeah. That's exactly that's exactly.

Ned Johnson  49:31
And then thereafter, we won't you know, I've taken up so much of your time and I'm grateful for it. But I also want people to pick up the book because after we talk about we start those the that supportive language for a week or two or three, depending on how kind of entrenched you are. And then very, in a very specific, you know, all the appendices in the back of the book of how you make a concrete specific plan. Identifying accommodations, ways is problematic what we as parents Due to bit by bit, you need to make a plan on how to stop making that accommodation, how to communicate it to a child in a way that supportive and clear, it doesn't get in the weeds, and bit by bit with support decreased the accommodation, because you as you make the point, if you just stop accommodating, without increasing the support your your kids, things will go well.

Eli Lebowitz  50:23
Right? Yes, I think having a system, a set of steps that you can follow in a practical way is absolutely critical. It's not enough to say to parents look, accommodation maintains anxiety over time. So try not to accommodate that is not going to lead to the kind of change that is necessary in the same way that if you're a cognitive behavioral therapist, and a child comes to you for treatment, or adult comes to you for treatment, you don't just say to them, Look, avoidance maintains anxiety. So I think you should do less avoidance, and you're welcome. Now you've had CBT, right? Like, that's not enough, you need to walk through a series of steps. And that's what this book lays out. And that's what we do when we're working with parents in treatment. And in space. We start with, let's, let's just identify what are the accommodations that we're doing. And very often, when you go through that, you'll notice that there are a lot more than you may have even realized. And then let's pick one thing to start on. Because you can't just stop everything at once. And you shouldn't even really try, it's not going to go very well. So pick one thing, and the book has some guidelines for where should I start? I mean, if there are a lot of accommodations, then how do I know what to pick? And it lays out how do you make that choice? And then let's make a clear plan. And that is so critical. It's not even enough to say I'm going to reduce this accommodation. I need to say when how much and what will I do when my child gets upset because I'm not doing the accommodation? What if they get mad at me What if they say Oh, you don't care about me anymore. And you make a really detailed plan. And even then we take another important step, which is let your child know about this. Go ahead and start reducing the accommodation because you don't know what they'll understand from that. Maybe they'll think, Oh mom, or dad, they're just fed up with me. No, you want them to understand that I'm doing this, even though I know it's hard. I'm doing this because this is how I'm going to help you. Because I care about you. And I don't think that what I've done so far is the best way to help you. So I'm taking responsibility on my own behavior and choices. And I'm saying I'm going to do differently, because that's how I'm going to help you. And then you work through the actual implementation of the plan. And the book really tries to guide the parents step by step by step, so that you can do this entire treatment process, even if you're not working with a therapist, and a lot of therapists are actually using it as a workbook in their treatment with parents. Totally envisioned when I wrote it, but I think is really cool is that you can actually use it as a guide to working in therapy, even with a professional, which is kind of nice as well.

Ned Johnson  53:09
I love it. One thing that I really appreciate about the book is all of the kinds of scripts or the scenarios of you know, I can't remember that I can't remember the details of it, but a statements the parents made to a child that on the surface of it, it's very loving, it's very warm and warm, it feels very kind of, you know, classically supportive, like, gosh, you know, you can do this kind of kiddo. But you really then sort of pull it apart and go back to if support in this model, it has these two components, mac and cheese of acceptance and confidence. How in the subtle ways, you know, what looks on the surface great as actually undermining both of those, and then what to do instead. So for parents who might think how do I even do this? It's it's not quite a do it yourself workbook. But it's kind of like that, in that it gives templates. I think a lot to your point, a lot of kind of pain points and a lot of scenarios that I think are hard in families. And so I think it'd be very I could I was picturing myself taking some of the things that in my experience with my children. And soon if I tweak this, and here's how I would say that. And so I'd really appreciate it must be based on the conversations you've had supporting other families walking through this, this process because it really, it really rang so true. It's really great.

Eli Lebowitz  54:29
Well, thank you very, very much for everything you said. And yes, definitely having worked with parents and families for many years. Now what I do have is a very deep reservoir of example. And I've heard so many families describing you know, the traps they fall into and the challenges that they face and also what has worked and what hasn't worked for them and that makes it easy for me to try to bring it to life in the book with a lot of very real life examples, obviously mess for identity, but with a lot of very real life examples of what happens when you do it like this, and what happens when you do it like that and try to help parents to figure out, what am I going to do? Right? What how am I going to make this mine and implement this with my own child?

Ned Johnson  55:16
Before I love to hear if you have any last thoughts, but but I'll jump in first. And just kind of echo two things. One, the point you made before that anxiety is just wildly more prevalent, certainly then, you know, in children than it was for all of us as their loving parents. But also that it is the most treatable disorder is a psychological disorder people face and that is such a good thing. And some appointed didn't make before but everyone who's you know, thrown praise, you know, left, right and center as your terrific book is that this book helps reduce checking. This book helps reduce anxiety in children, as much as does cognitive behavioral therapy, which is the gold standard for treating anxiety and children. And the idea that we as parents, simply by changing our steps, simply by changing our approach, we don't have to ask anything of our children, which is great, because we can focus on a relationship and to, we have a greater sense of control, because the kid doesn't have to do anything. But simply by employing the step by step methods that you have in your book. We as parents, even if we're not responsible for causing the problem, we can be the solution as much as if those kids engaged in therapy themselves.

Eli Lebowitz  56:30
Yeah, that's exactly it. And it's, I mean, it's such a powerful thing we've done. And this is based on rigorous clinical trial research published in very rigorous peer reviewed journals. And so this is not just wishful thinking. But clinical trial research indicates that this treatment, which as you emphasize doesn't require that you make your child do anything at all. And it doesn't require that you stop your child from doing anything at all, it's all about the things that you have control over as a parent that you can decide yourself, which means you don't have to fight with your kid about it. That this treatment can be as effective as having a child engage in direct cognitive behavioral therapy with a skilled therapist with weekly sessions. And that is simply amazing for us as a field, to have another tool in our toolbox that doesn't rely on the same constraints that that are imposed on having a child directly being in therapy, I think is fantastic. And I think I guess my last thought is just going to pick up on what you said about anxiety being so treatable, I would say to all the parents, who might be listening, that the world is full of children who used to have an anxiety disorder. And that can be your child as well. And I really say it as a message of hope. Because yes, this is a daunting and difficult challenge. But you can have hope, because it is a challenge that can also be overcome.

Ned Johnson  58:00
Breaking free of child anxiety and OCD, a scientifically proven program for parents and compared to go and take into kids a therapist, carbon neutral, Dr. Le Leibowitz. I am I'm so grateful for your time, more so for for the work that you've done in developing space, the space program and putting this in a just a terrific book in a way that's accessible to anyone. Once, as you said another tool in the toolbox to help their kids get to a better place and where they may be right now with some of those typical anxieties of childhood that we want to help them learn to cope in a healthy way. Hey, folks, Ned here. Over the past 25 years, I've talked with 1000s of parents of high school students, parents who care deeply about their kids education and how they deal with stress and the pressure to succeed. But these parents need to work with a team they trust won't just pile on more pressure to achieve better grades and scores. This is why I started prep matters in 1997 to create a different kind of experience for test preparation, tutoring in college admissions planning. This podcast and my books reflect our company's philosophy and approach to helping students if you have a high school student and we'd like to talk about putting in place a plan, please get in touch with us, visit our website at prep matters.com or call 301-951-0350. That's 301-951-0350 Thanks