Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello. Welcome back to Beyond the Sessions segment of the Securely Attached podcast where me and Dr. Upshur are going to answer your parenting questions. Emily, thanks for being here.

Dr. Emily (00:57):

Hi, so good to be here as always.

Dr. Sarah (01:00):

So, okay, let’s get right into the question that we’re going to address today. So this parent writes in, hi, Dr. Sarah, loving the podcast. Thank you. Appreciate that. I was hoping you could help me with an issue. I’m dealing with my seven-year-old. She had a stomach bug last year and has been terrified of throwing up ever since then. I’m not sure what to do or tell her to help her get over this. Any tips would be greatly appreciated.

Dr. Emily (01:27):

Yeah.

Dr. Sarah (01:28):

I love a good phobia question I feel like. So let’s talk about this phobia a little bit. Fear of throwing up, which is also called emetophobia, but I also think a lot of what we talk about can be applied to any phobia. If your kid is afraid of spiders or they’re afraid of, I don’t know. I don’t know. What are some things your kids are afraid of? My kids have lots of things that they’re afraid of, but what point does it cross that threshold into what we would call a phobia and at what point does it cross a threshold in which we would say we need to be sort of strategic about how we’re responding as a parent? Some stuff is like we’re all going to be afraid of some stuff and some of it’s kind of worth just brushing off and if it’s starting to hit a threshold where it’s getting in the way. So I’ll let you jump in. What do you think?

Dr. Emily (02:21):

Yeah, I mean this parent, I would be curious to ask this parent a few more questions, which I’m sure we do a lot on this podcast, but I would really be curious to see where this is showing up on the day to day. Because from us, if this fear of throwing up is somehow showing up every day, we’d want to know a little bit more about that. Is it interfering with this child’s ability to do daily tasks, go to school, get in a car, maybe.

Dr. Sarah (02:50):

Food. A lot of times I see issues with emetophobia is that they start to avoid certain foods. Perhaps it could just be the time they got sick, but it also could start to expand out to, I don’t eat whole groups of types of food because I’m afraid it’s going to make me throw up.

(03:10):

If mealtime start to become a really big issue because of the want. The thing, when you have a phobia, you are going to want to avoid anything that makes you think about that phobia that makes you feel nervous. That’s the thing about anxiety, right? It’s a fear of being afraid and a phobia is a fear of being afraid. Feeling that feeling upon the introduction of this particular thing that we’re scared of have. When you have a weird burp and maybe it makes her think she’s going to throw up, that would be a trigger to then create a big wave of avoidant behaviors or the smells of certain foods, or like you said, riding in a car. Anything that’s going to remind her that she’s afraid, give her that sensation of anxiety, which is going to prompt an urge to avoid. So we kind of first have to get a sense, and obviously this parent didn’t share all this information, which is kind of nice because then we can generalize it to lots of different scenarios. But if this child is afraid of throwing up and is therefore avoiding restaurants, mealtimes, birthday parties where they’re going to serve a certain type of food that she doesn’t think she will be able to handle and it’s starting to get in the way of her day-to-day life, then we want to think about having a pretty strategic approach.

Dr. Emily (04:44):

Or I think the other thing you’re really aptly talking about things they might avoid, but it also might be things they’re asking the parent to do. So this parent might be thinking, oh, well now she won’t eat the dinner that I cooked, or now she won’t go into the car unless all the windows are down. So I often challenge parents to think how are they, what we call accommodating, which is kind of making it theoretically in your mind as a parent, making it easier for the child to get through these tough moments of being worried about something. We call that accommodation and we know that that actually feeds that anxiety a little bit more. It feeds that worry even more because we’re kind of tacitly saying, yeah, that’s a valid fear when in reality if we really talked parent to parent, you’d be like, it’s really not that she hasn’t thrown up since, or something along those lines. So I think the first thing I always want to try to figure out is exactly what said, one, how much is this interfering? But two, how much am I as a parent accommodating, changing what I would normally do in my day-to-day life to help this kid through these difficult moments? Then we can come up with a systematic plan to sort of reduce that, which in our world as we talk a lot about, would then reduce the anxiety and not have it be as sticky in lots of different places of your life.

Dr. Sarah (06:12):

Another way that it can show up accommodations that are not as obvious. There’s accommodating behaviors. I’m going to only serve you a certain type of food, or I’m going to pack you something different when you go to a birthday party or I’m going to drive with all the windows down, whatever. That’s a behavior that you’re engaging in to help your child avoid, but they’re also reassurance seeking dances that happen. So if a kid’s really anxious or nervous about throwing up, then they might be constantly asking you for reassurance. That’s not going to make me sick, right? I’m not going to throw up. If I throw up, we can go home. Making sure that they’re getting that soliciting, that reassurance from the parent and the parents constantly asking, answering questions over and over and over again.

Dr. Emily (07:05):

Yeah.

Dr. Sarah (07:05):

Good sign that is actually also kind of what we put into the bucket of an accommodating behavior that helps the child avoid, or what I like to say is it hits the snooze button on the child’s anxiety for them, but it’s not dismantling the alarm. The snooze button’s just going to come back in seven days.

Dr. Emily (07:24):

And I do think it’s really, these are things that we start doing and we might not even think about them as parents. You might not go out to dinner much anymore because going out to dinner is a really huge trigger for this kid. There’s a lot of things that you also might not do that becomes a part of your family routines that you do want to pay attention to as well. So I like that you say that those are the more sort of passive ways that we are like, oh, that was a bad experience for us. They were so upset. We’re not going to go to the restaurant anymore. And then I have families come because that can snowball a little, right? So I have families come who are like, but we used to do this all the time. We used to go out to the diner on Saturday mornings, and so again, that’s not just interfering with the child’s family, daily living and tasks, but the families as well. In younger children, we see that a lot where the family gets pulled in to sort of that pattern as well as well, excuse me.

Dr. Sarah (08:20):

So, okay, so one, we’re identifying the phobia, right? Two, we’re trying to get a read on how much is this interfering with my kid’s life. Simultaneously we’re looking at how much am I engaging in behaviors or avoiding behaviors that kind of rescue my kid from feeling the anxiety related to this phobia with aime phobia, like with throwing fear of throwing up. This is very often I’m helping them avoid certain foods or I’m helping them avoid certain places or activities where they think they will get sick or fear of throwing up might be I only would be okay if I’m afraid I’m going to throw up, I want to stay home because I want to throw up at home instead of going places. If I were to throw up outside of the home, that could be really overwhelming. That’s the fear. So you’re really doing an audit of where am I the parent engaging in behaviors that rescue my kid from feeling this feeling. So then this parent is saying she’s not sure what to do or tell her to help her get over this. So this is for the pre-work, right? We’re going to first decide if this is worth being systematic about. If it’s not, she’s really afraid of throwing up, but it doesn’t, every time she gets sick, she gets really upset. Well, that kind of makes sense and we’re not going to really be able to help her avoid that.

(09:52):

But when she’s not sick, she’s getting really afraid of throwing up and started. So we’re looking at how much is this interrupting? And then we’re looking at our accommodations and then we’re going to do something called the supportive statement. I’m literally pulling from the space playbook space is a therapy called supportive parenting for anxious childhood emotions. And it’s very helpful for these kinds of things because especially when you have younger kids, I don’t think you necessarily have to start with putting your child in weekly individual therapy to give them like CBT for phobias. You can obviously if it’s very severe and it’s really profoundly interrupting their life, but I still think doing a parental intervention first is where I’d start.

Dr. Emily (10:44):

Well, and mostly in younger children, and even in older children as well, you’re getting pulled in as the parent anyway. And as a parent, the way we talk about it in space is you have a more fully developed prefrontal cortex than your child. So the part of your brain that can regulate your emotions through these stressful times is more intact than your child. So we can really execute plans to stop doing this rescuing behavior. We call that reducing accommodations. We can do that with a little bit more oomph is what I say. We can do that better as the parent and support the child in tolerating those feelings more. So what Sarah’s talking about is the support statement is really validating, like you said, labeling, validating that fear like, oh, you feel like you’re going to get sick in this car after you ate this food and confidence. I know you can handle that. You’ve got this. Right. And sometimes, I mean a lot of, I actually do a lot of aime phobia more than I, as I was thinking about this episode, I was like, oh, I do this all the time. This happens a lot in treatment.

Dr. Sarah (11:51):

I’ve had a lot of kids that I’ve seen that I’ve worked with a meta phobia. It’s not that uncommon and for very different reasons. And I will say a meta phobia is particularly tricky because if you have a fear of spiders, for example, which is like that’s probably not going to interfere with mealtime, whereas a meta phobia is often likely getting in the way of these, we have to eat multiple times a day and parents have a ton of baseline anxiety around feeding their kids because nourishing our children is such a core thing we feel so appropriately compelled to do, right? And there’s so much pressure around that. And when our kids start to avoid mealtimes or avoid certain foods or have a really tricky time with eating, that can create this trickle down effect that becomes way bigger than just a fear of throwing up. It’s just because it shows up in this very vulnerable spot in our kids’ lives.

Dr. Emily (12:51):

And I’ve had the same with transportation, so not food at all, just being car sick, having that feeling of nausea and being scared that you’re going to throw up often you have to get in a car often, frequently. That is something that…

Dr. Sarah (13:06):

This touches a lot of places, definitely. But the supportive statement is, one thing I like about it is a lot of times we don’t realize when we have a kid who’s wanting to avoid a lot of things and is seeking a lot of either accommodation behaviors or reassurance from us that we oftentimes will sort of reassure them, reassure them, reassure them, reassure them. So that’s the validation, validation, validation. And then flip over to like, oh my God, you are fine. This is not a big deal. Get over it because we’ve lost all of our patients’ bandwidth by constantly repeating ourselves, repeating ourselves, repeating ourselves until we lose it. And that’s so normal and common, and I think it kind of illustrates why a supportive statement is helpful because the supportive statement has both validation and confidence that you can cope. Just reassurance, just sort of validation doesn’t communicate that confidence that they can get through this and just that confidence without that validation can be a little demanding of our kids just, you can do this, it’s fine, because we just got frustrated with having to constantly be having to be back at the same spot every day.

Dr. Emily (14:32):

Well, what I love about a support statement as a tool from a parent side is if you can do a really good support statement, your job is pretty much done. I think you then very calmly move on. Even if your kid’s still having a hard time, even if they’re protesting even, there’s lots of noise and emotions you can feel confident and reassure yourself as a parent. These are really hard moments for parents. You can reassure yourself as a parent, I did what I was supposed to do. I’m doing, I validated. I saw them, I gave them confidence, and now I’m showing them with my behavior by not engaging in this anymore that I think they can do this. This is okay. And so I’m giving them this very subtle messaging that they’ve got this, I know they’ve got this so much that even if they’re still so scared and upset that I believe in them because I’m going to move forward with my behavior.

(15:28):

And I think it’s really reassuring as a parent to be like, all I had to do is a support statement and then have calm behavior and move forward. Great. It sounds so easy and it’s obviously very, very difficult to do that when your child is very upset and there’s a lot of big feelings, but it is really also reassuring as a parent to know that’s the boundary that you can set up. I’m going to give you this support statement. I’m here. I am going to move forward with you, but I don’t have to sit here and convince you to do the thing or convince you that this is not, that the thing isn’t scary or that it’s not going to happen because we can’t, right? I’m not trying to change my child’s behavior.

Dr. Sarah (16:08):

And that’s what’s so special about space I think so important because like you said, it’s easy because your job’s done when you say the thing and kind of model moving on, but just to really give parents a very accurate peek behind the curtain. When you do that, especially if you haven’t been and you start doing that, it’s not your job is done, meaning you have checked off the box of the most important thing you’re responsible for. It does not mean that your child is supposed to then say, oh, I can handle this feeling. Oh, nevermind, then I’ll just follow you along like a little duckling. They’re going to lose it. They will totally have a really hard time. It doesn’t mean that they’re going to not still be not just feeling anxiety but also railing against their belief that they can handle that anxiety. They do not believe they can handle feeling anxious about throwing up. And that’s the thing we’re trying to touch with this process. We’re trying to over time carefully and in a warm and supportive way, help them experience the anxiety, get to the other side and realize, oh, I survived that.

Dr. Emily (17:31):

And I can handle it.

Dr. Sarah (17:32):

You didn’t rescue me, you didn’t give me a different meal or drive with the windows down and I was anxious the whole way, but we got there and I didn’t throw up. And now I realize that I can feel anxious about throwing in this one instance. It’s not going to be generalizable yet, but this one instance and I was okay, and then you might need to help your child later after they’ve survived the event and gotten kind of back to baseline to help them connect those dots, right? To say that was really hard to sit in the car with the windows up and you really didn’t like that and you were really anxious or nervous or worried, whatever language you use. And when we got there, and this is the key, you didn’t throw up, see it’s, and even though you were nervous, that whole ride when we got there, eventually that feeling went away. We’re not talking about nausea, we’re talking about the anxiety went away because here’s the beautiful thing about anxiety and whether it’s a phobia of throwing up or a phobia of any other thing, what we’re trying to help a child realize is that the feeling comes and goes, the fear comes and goes.

(18:49):

The uncomfortable physiological sensation of being anxious comes and goes. And what their system is saying to them initially is, I cannot survive that feeling. So I have to do everything in my power to avoid having that feeling. It’s been attached to said phobia, it’s been attached to throwing up for this child, but it’s really not about throwing up, it’s about wanting to avoid that anxious feeling. And so if we can over time help them experience that feeling and then look back and say that feeling it didn’t last forever and you are okay, you can handle that feeling, not falling into the trap of constantly convincing them you didn’t throw up in the car ride, you didn’t throw up here, you didn’t throw up there. Then we’re also, it’s like checking for monsters under the bed. It’s like you’re afraid of monsters. I’ll check under the bed to prove they’re not there. We’re sort of feeding the worry bug though and saying there could be monsters, and if I don’t check, you never know. Whereas now we’re not talking about the throwing up so much. We’re talking about tolerating the anxiety and realizing that that feeling comes and goes. That’s why this can be sort of approach can be very applicable to any kind of anxiety, whether it’s a phobia of throwing up or something else.

Dr. Emily (20:02):

I mean, I think what you’re touching upon is so important, which is the task here, the goal, the parenting goal here is helping your child get more comfortable with discomfort or tolerating discomfort. And that yes, that can be applied to so many different quote phobias, something very specific or just worries in general, which is life has a lot of discomforts. I always say to parents, it would be such a gift to give your child that ability to have tolerance. It doesn’t mean they have to love it, they don’t have to live in that place, but that they can do hard things. It can be hard and they can still do it. They can tolerate that. And I think that’s such an important skill and I think that’s something, something we talk about a lot is you can learn that, right? Parents are always saying, what can I do? How can I help get my child to be more resilient? And this is one of those things to me is building your child’s tolerance and capacity to manage difficult feelings in themselves. And that’s really any, it can be applied to any situation. So just like your point, it’s not about throwing up or not throwing, it’s about approaching challenging situations and being able to handle it.

Dr. Sarah (21:14):

And one thing I’ll add too that I think is important because if you’re listening to this episode and you’re like, oh, I’m doing all these accommodating behaviors, or I’m doing all this reassurance seeking and all these different places around this phobia around whatever’s going on with my kid’s anxiety, Sarah and Emily say, don’t accommodate, give a supportive statement and instead, and so then they go, and I see this a lot, then parents will go and they’ll try to stop all of their accommodations things. And the problem with that is it’s really hard to maintain. It’s hard to have a plan because you are going to be playing whack-a-mole with accommodations. It’s overwhelming for the kid because all of a sudden all of their sort of structures that keep them, help them avoid are taken away at once. So they become really reactive and then also it lasts for maybe a week or two before you burn out and just stop all of it and go back to accommodating.

(22:11):

So don’t do that, please. The way that we do it with space and in general, my approach whenever I’m working with a parent to kind shift a dynamic in the family, whether it’s accommodating anxiety behaviors or walking on eggshells to avoid meltdowns if you’ve got more of an explosive kiddo or whatever, when we’re working on changing something that is systemic in the makeup of the family dynamic right now, you pick one thing to focus on one issue that comes up regularly. And so it’s helpful to do a bit of an audit over the next week and say like, okay, where are all the places that I am accommodating this phobia?

(22:55):

Is it every time we go out to a restaurant? Is it every time we sit down at the table? Is it every time we get in the car? Is it kind of look at the big range and then kind of pick one place where you are seeing it regularly come up where your child is sort of seeking your help and avoiding the fear and then you want to just address that one thing for now and kind of ignore the rest, continue accommodating in the other places you might be accommodating and just pull one accommodation at a time and let your kid know that you’re going to do it. Give him a heads up in space. You actually write a letter to your kid and you read it to them. That says something along the lines of like, Hey, I realize that every time I make you a completely different meal from everyone else in the family, I’m really not helping you to feel more confident that you can handle this worry you have about throwing up.

(23:53):

And so one of the things I’m going to do differently from now on is I’m going to start serving you the same food that we’re going to eat as a family, and I’ll make sure there’s at least one thing on the table that I know you are going to feel safe with, and everything else is going to be what everyone else is eating. And I know that that might make you feel nervous, and I know that you can handle that feeling. You got this, I love you. And then immediately after that, you are going to stop doing that thing and you are going to tolerate that when you first stop doing it, you’ve done your job and your kid is going to do their job, which is communicate to you just how freaked out they are that they are now being asked to tolerate something they believe they cannot handle.

(24:32):

And we’re going to move through it over and over and over again with consistency, because you only have to be consistent with this one thing instead of 50 million things. And then over time, your kid’s going to get used to that thing and then you can kind of look at another spot that you could adjust your behavior. You’re only focusing on what your behavior is. I’m not going to serve this food differently anymore. Not you need to eat these foods, right? So we’re looking at our behavior, we’re focusing on one thing, we’re giving the kid a heads up, we’re framing it in a way that helps ’em understand that this is a behavior we had been doing that makes us feel like we’re not really actually helping them feel less anxious, and that we think that this new behavior we’re going to do is going to help them to feel more brave. And now we’re going to do it. We’re going to be consistent, we’re going to tolerate their feelings, and eventually we’re going to get through that hump of they’re protesting it and we’re going to move on to some other accommodation as needed. That’s kind of space in a nutshell.

Dr. Emily (25:38):

I think the last thing I’ll say is I think that it’s so important that you’re saying pick one, right? That’s a big piece of this, but I will say you can also practice support statements without doing anything else. You can continue to accommodate, but practicing support statements is super important. So I would say give that a try. That’s one of the lower hanging fruits that it takes a little while to get used to. So give it a try. You can still accommodate, but make sure you’re validating and giving confidence.

Dr. Sarah (26:09):

I love that. If you are interested in learning more about SPACE, because this is a very helpful treatment for phobias, especially kids, phobias, especially little kids, definitely check out our website, br.com. There’s a whole space section on that website. We have groups, we do it individually, we also have resources there just to help you get information about it. There’s a great book. So Eli Lebowitz developed space at the Yale Child Study Center, and he wrote a book called Breaking Free of Childhood Anxiety and OCD. It’s a great book, so that’s a great place to start. But there’s a lot of resources out there about learning about space, and we have other episodes we’ve done where we talk about it, so I’ll make sure that we add those to the show notes and show descriptions, so you can just go and listen to more episodes. We actually have an episode with Eli Lebowitz talking about space, so definitely listen to that if you’re curious about the treatment modality.

Dr. Emily (27:14):

Yeah.

Dr. Sarah (27:16):

All right, talk to you soon. Bye.

(27:19):Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.