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 here on the Securely Attached podcast. We’re going to answer your listener questions and we have Dr. Rebecca Hershberg here to lend her wisdom. Hi.

Dr. Rebecca (00:55):

Hi. It’s so great to be here. It’s been a little while.

Dr. Sarah (00:58):

I know I missed you. I missed you. So you ready for this listener’s question?

Dr. Rebecca (01:05):

I am ready.

Dr. Sarah (01:06):

Okay. So this person wrote in, my daughter had a traumatic health experience and surgeries after being misdiagnosed. Now she’s fearful and wants to go to the hospital every time she gets hurt, even minor cuts and bruises because she’s scared that we’re missing something serious. Giving her factual information doesn’t help. For example, it doesn’t look swollen or infected. How do I help her through these fears?

Dr. Rebecca (01:33):

Wow, this poor kid.

Dr. Sarah (01:35):

I know.

Dr. Rebecca (01:37):

I get it. Right. It sounds as though, I mean, not that we always need to get anxiety, it can be irrational, but in this case, of course, right? Of course. She’s missing some trust in the system because the system messed up.

Dr. Sarah (01:58):

Interestingly, the person who wrote in this question didn’t share the child’s age, so we kind of have to infer a few things here. But I do think that while this is hopefully a relatively rare situation, that we can extrapolate this to a lot of different things where a lot of kids at different ages have anxiety around something that no matter how much correct information that they’re being given, it’s not moving the anxiety, which I kind of think is the core current challenge that this parent is facing with their daughter. Right?

Dr. Rebecca (02:30):

Yeah. Well, it’s when we try it, it’s providing reassurance and the reassurance isn’t going to help. Even if you take something irrational. I’m terribly anxious that my peas are touching my chicken, and the mom is like, look, they’re not. I’ve moved them to the other side, the other side of the plate. It’s like that’s not help anxiety, and I think this gets to the core of so much of what we do, and I believe you’ve done an episode on space that we can link to Ellie Leibovitz’s treatment supportive parents for anxious children’s emotions. Anxiety is a feeling.

(03:13):

And it’s less often about providing the factual information, especially because a lot of times the factual information involves bind reading, so it’s less about that and more about teaching our kids that they can cope with the feeling of anxiety. So that might be where I would start with this child. The way that I do, it might depend on her age, but this idea of I see how worried you are, and then Norma, of course you’re worried, I remember what happened with your appendix. Or of course you’re worried, worried. I know you can handle that feeling. Let’s talk about what we do when we feel worried. And then maybe there’s some breathing exercises, maybe whatever other coping mechanisms there may be. It’s a focus on the coping and not the, let me tell you why. There’s nothing to be anxious about, which doesn’t help in situations, especially when you can’t say that a hundred percent.

Dr. Sarah (04:24):

Right.

Dr. Rebecca (04:25):

In this case, the mom might be able to, I can tell a hundred percent it’s not infected, but if your child is anxious that maybe inside of them, especially let’s say with this theme inside of them, there’s something medically dangerous and it just hasn’t come out yet. You can’t guarantee them that that’s not true.

Dr. Sarah (04:45):

And in anxiety sometimes in really trying to sort of convince, I’m using air quotes, convince the worry brain not to be worried as a parent being like, there is no problem here. It sometimes can backfire because it can actually do the opposite of what our intention is, which is kind of, it’s like doth protest too much. Oh, so wait, is there something I need to be worried about? It’s the example I often give is when a kid is scared of the dark and they want their parent to check under the bed for monsters and you check under the bed for monsters to show them that there’s no monsters there. You’re also kind of saying, well, there could be monsters and that’s why I have to check.

Dr. Rebecca (05:31):

Right, exactly.

Dr. Sarah (05:31):

So it’s in continuing to reassure the worry mind instead of the more whole picture of the child zooming out and saying, oh, you are a child who is feeling worried right now versus this bruise is not medically dangerous. So it’s like, who are you talking to? Are you talking to the worry thought or are you talking to the kid? And I think we can get, if we keep talking to the worry thought, we end up kind of convincing the worry thought that it should be there.

Dr. Rebecca (06:04):

Well, I think we do two things. I agree a hundred percent. We do that and we also convince the child that having a worry thought is so, is such a big deal that we have to spend all this time and energy with it, that it is as unpleasant as it feels or it is as dangerous as it feels. If I keep telling you there’s absolutely nothing to worry about the bruise on your hand, then I’m also implicitly saying, worrying about that is really, really awful. Please stop. Worry is the worst thing in the world. Worry is a really big deal that we have to get rid of as opposed to right sizing it like, oh, you’re a little bit worried. Of course you are. Look at what happened in your past or and normalizing it and being like, oh yeah, this is worry. This is called worry. Welcome to being human.

Dr. Sarah (07:00):

One thing too though, and I’m almost like whenever I answer questions, I hear the follow-up questions in my mind as though they’re coming in in real time. But because I get this question a lot when I talk to parents about reassurance seeking, which is what this mom is describing this child is she gets a cut. She has a feeling of worry that the cut means something dangerous to her that okay, the thought is we’re missing something serious. This could be worse than it looks, something bad could happen. Probably a sequence, a snowball of increasingly more scary thoughts. We call that catastrophizing. And then the child solicits the parents reassurance as a way of calming that anxiety. And if the parent does give that reassurance, which we’re very compelled to do because when we see our kid in distress, we want to help them turn that feeling off and we give the reassurance, no, it’s just a cut.

(08:03):

Don’t worry. You’re fine. And then they feel relief temporarily. I call that hitting the snooze button, not dismantling the alarm, right? It’s in seven minutes, that snooze button’s going to come right back on because some other thing or that thought came back or the cut stung again, some other thing is going to activate that attention on this worry and the whole cycle will start over again. They’ll feel that discomfort. They will seek out the parents’ help in turning that feeling off. The parent will offer the reassurance, which hits the SNOO button again, and we’re back in this cycle. So we call this sort of like this loop, but a lot of times when I’m explaining this to parents, they will say very reasonably, well, what is the difference between answering my kids’ worry thoughts with information like reassuring versus when am I just giving them information?

(09:01):

Sometimes I just do need to tell my kid what time I’m picking them up from school or what. That cut is not infected, but we can put a bandaid on it or whatever. And I guess the rule of thumb I tend to tell parents is the difference between information seeking and reassurance seeking is that if some kid is actually seeking information from you and you answer them, they’re done, then they have the information and have the information, they might come back a couple times, they want to make sure it’s right or whatever. But with reassurance seeking is when your child asks you a question and you answer it, no matter how many times you answer it, they keep asking the question because it’s not satisfying the lack of knowledge. It’s that receiving the answers actually serving a completely different function, which is hitting that snooze button, that discomfort, that physiological arousal from the anxiety, it’s hitting that snooze button, which gives them relief, and then they have to come back to you as soon as the anxiety comes back to hit the button again. And so if your child is repeatedly asking you the same question or the same kind of themes of questions, it’s a good chance you are engaged in a reassurance seeking feedback loop that is maintaining their anxiety, not actually, and it’s so hard, can get stuck in it.

Dr. Rebecca (10:25):

Parents, it’s interesting. That’s a very good rule of thumb, but I think also a rule of thumb is how does it feel to you? Most parents I know when they’re in a reassurance seeking loop or the accommodation cycle, it’s annoying. It’s like, I’ve already told you this 15 times, you’ve got to be kidding me that you’re asking me what time I’m picking you up. Again, if you feel like you’re a little bit rolling your eyes, a good question to ask yourself is, if my child wasn’t anxious, would I still be engaged in this conversation? And if the answer is no, then you know that you’re potentially what’s called accommodating their anxiety by providing the reassurance, which again, as much as it helps in the moment, just causes the anxiety to go up again once that momentary relief passes. The thing I want to make really clear is how incredibly understandable it is that we do this anxiety when our kids are anxious.

(11:27):

It’s real. And my first reaction to your reading the question was this poor kid, I’m sure she was tortured and as a parent to know, especially in this particular situation, that your kid was misdiagnosed and it led the guilt that this mom must feel. Even if we would say, don’t feel guilty, it happens. It’s like, so of course you want to provide reassurance. You don’t want your child to be suffering. You may feel guilty, whatever the thing is, and it really is helpful in the moment. And so you get that mom hit of like, oh, look, I comforted my kid.

Dr. Sarah (12:03):

And I think when people hear about this idea and then they hear us say, maybe stop. We’re going to phase out this reassurance that you’re offering their kid. They’re like, well, that’s not going to work because one, I can’t let them suffer. And also they’re like, my kid will absolutely never, they will not relent. I can’t just decide not to answer the question. They will bear down or lose their mind and it’ll all melt. So what I often will reassure parents when they are concerned about that is that one, you don’t pull all these accommodations at once because that’s just not really effective or sustainable, but you’re also not withholding reassurance when you’re going to sort of phase out reassuring. You don’t withhold it. It’s like you’re silent to them. You replace it with something else, which is in space. That therapy protocol you were talking about, Rebecca, you offer what they call a supportive statement, which is two parts, right?

(13:13):

It’s one part validation that is a really hard feeling to have. I know you’re feeling worried, plus confidence that you can cope, which is exactly what you were saying earlier, which is this feeling, this worry you’re feeling. I know you can handle this feeling or some version of those two pieces. So we’re not responding to them, we’re just not responding to them with the facts anymore. We’re not answering the content of the worry. We’re just speaking more. I always say, don’t speak to the worry, don’t answer that question, but zoom out and up and answer the bigger question they’re asking you without asking it with words, which is, am I okay? Was this feeling ever going to go away?

Dr. Rebecca (14:02):

Yeah. And I think I just want to bring it back to this question. So kind of what that would look like here, what I might have a conversation with this parent in my office, let’s say. It would be something like I first giving the child some warning about this. This is also not the type of thing. We change our approach and we don’t give them a heads up. It’s not like they’ve been looking to us for reassurance all the time, and then suddenly we replace it with this thing without telling them. We tell them that’s what we’re going to do. So in this case, it might be sitting down with your daughter on the rare occasion that she doesn’t have a cut or a scrape and just saying, Hey, one thing I’ve noticed is that because of what happened with your appendix or whatever it is, we’re imagining, you get so worried again, presumably depending on the age of the kid, you might have to explain what worry is, but you get so worried when you have something that I know you have a cut or an injury that I know is safe or dad knows is safe, your teachers.

(15:07):

And so I notice you ask me about it a lot when that happens, and I’m going to start doing something different that I think is going to help you, that’s going to feel a little yucky. And I’m going to say, when you come to me with a cut, I’m not going to tell you that it’s safe or that it’s okay or that I know we don’t need to go to the hospital. Instead, I’m going to tell you that I get how hard it is, what you’ve been through and this feeling, and I know you can handle this feeling. And so you’re giving them a heads up and then you start shifting the script when your kid comes to you and says, oh, look, I have this little scrape. We need to go to the hospital. And you might, I mean, again, that’s the other thing.

(15:47):

It’s not bad to the first time you see the scrapes to be like, oh no, it looks just minor. It’s not infected. But then the second time, the third time, I really think we have to go to the doctor. It really looks infected to me. How do you know it’s not infected? What if there’s something more serious there, sweetie, this again, I know you want me to say all the things we’ve talked about. I’m not going to say them. I love you so much. I see how worried you are, and I’m right here with you As you handle that feeling and as that feeling hangs out with you until it goes away because it realizes it doesn’t have power anymore.

Dr. Sarah (16:23):

Yeah, feelings come and go. That’s what I always say to make kids.

Dr. Rebecca (16:27):

Riding the wave.

Dr. Sarah (16:28):

Yeah, this feeling is hard right now, and eventually it will go because feelings come and go. I feel like that’s so helpful too, because when parents are being, especially with a situation like this, if it’s like, I think there’s a monster under the bed, will you please check? Or I’m really worried you’re not going to pick me up at school when this is the routine and there’s no reason that you really are going to have to deviate from it. Versus these situations where it’s like there’s a little bit of gray here because a child, this exact child could be truly injured. Let’s say it’s not a cut or a bruise and she broke a finger or whatever. In those situations, I see this a lot. I’m not this kid. It sounds like this anxiety is really, it’s really an organic response to something really scary happening to her. But I see this a lot with OCD, and I’m curious if you, Rebecca, because where it’s like I’ll be working with a kid who’s really scared of contamination fears, for example. And she might say to me, I’m really worried that if I touch that doorknob and if I’m sick and I cough and I touch that doorknob with my hand, and then an immunocompromised person comes and touches that doorknob, they’re going to get sick and they could die and it could be my fault. Again, and so if I’m like, that is not likely to happen, and she will come back and be like, but it could happen.

Dr. Rebecca (18:15):

Yeah.

Dr. Sarah (18:15):

And I’m like, you’re right. That could happen. Yeah, it could. And then you get stuck, which I think is the big problem with reassurance is that it ends in a dead end usually because take you all the way down to the end where you have no longer have an answer.

Dr. Rebecca (18:31):

And that’s where I think it’s really important to have this approach of we can’t predict the future. You’re right. I can’t tell you that that’s a hundred percent for sure not going to happen. We can look for evidence, we can talk about the percent likelihood.

(18:50):

What we can do is talk about how we would handle that if it did happen. How many wonderful doctors there are out there for immunocompromised people, how many, you know what I mean? You can sort of talk about if it were to happen, not the dying part, but the person gets, there’s a lot of steps, and is there a chance that they might ultimately, after all those things, that they might die? Yes. And let’s just sit here and feel that that’s the feeling again. And I mean, that’s exposure therapy. I mean, I remember working with a girl a long time ago on internship at NYU, and she was terrified of germs. And so we built up to her final exposure, which was sitting in the er in just hanging out in the er. And the truth part didn’t matter. It was like, I might get sick. It was like, you might, yeah, you’re sitting in the er. It’s not a great way not to get sick.

Dr. Sarah (19:52):

Right. Because the thing is when you’re working with anxiety, you’re not treating her immune system was the thing that she was scared about. You’re not treating this child’s case. We’re not treating the cut or the bruise. We’re treating the anxiety. And the anxiety is really, I don’t believe I will be able to tolerate the feelings that will come if something bad happens.

Dr. Rebecca (20:15):

Exactly.

Dr. Sarah (20:16):

What we’re really having to reorient ourselves to in these moments as a parent or as a therapist, is to say, I’m not going to get into the weeds about the content of the worry. It could be true. It could be not true. It could be possible. It could be impossible. It could be probable or improbable. That’s a red herring. Don’t chase that distraction. But really, if we can remember, this is anxiety that I’m actually addressing here, and I’m going to stick to that. Oh, this is a really hard feeling.

Dr. Rebecca (20:48):

Anxiety gets worse when you avoid it. If you leave the emergency room because you’re so scared you might get sick, you’re never going to see that you have the ability to sit here and not feel anxious because your body can only sustain an anxious response, faster heartbeat, vasovagal constriction, all that stuff for a limited amount of time. And once that bodily response passes, you feel less anxious, but you have to go through it for that to happen.

Dr. Sarah (21:18):

You got to get to the other side and look back and say, oh, that wasn’t fun, but I’m still here. I can handle this. I am actually not going to be annihilated. And that I think is really the fear. So I hope this gives families, anybody who’s going through child anxiety, some sort of not just scripts. I think we actually give a couple really helpful ways to say things about this, but really like a framework.

Dr. Rebecca (21:47):

I think a framework is so important. And so I don’t want to say counterintuitive, but it’s not intuitive.

Dr. Sarah (21:54):

It is. I actually think in this case, a lot of anxiety stuff is counterintuitive to a lot of people, it was to me.

Dr. Rebecca (22:03):

You want to rescue your kid. You don’t want your kid to feel upset if your kid is miserable about a lot of things. Your goal as a parent is to take away their misery and the idea that you would kind of allow them to feel that way and potentially even encourage it, you’re right. It’s counterintuitive because in these approaches we’re saying, oh, we will not only let you suffer, we might even encourage you to suffer a little bit because you have to have the experience of getting through it to know that it’s not as dangerous as you feel it is. It’s hard. It’s really hard.

Dr. Sarah (22:35):

It is. And I think there are ways, I think also, I think the pendulum can swing in the other direction where it’s almost like I need to help them get over it. And so it’s more about like, no, you’re fine. You’re fine. Or very much almost.

Dr. Rebecca (22:54):

It’s not a big deal. It’s not a big deal.

Dr. Sarah (22:55):

Right? And I think, so there’s two camps like, oh, I am afraid to not reassure because I don’t want them to suffer. Or I, why are they not over this? This is not a big deal. And how do I convince them it’s not a big deal? And I think the answer is actually neither of those things. It’s like you can be with your kid and emotionally supportive of them and not rescue them from the feeling. And the emotional support part is kind of an important part to validate, oh, this is real. This does not feel good. But I’m not talking about the cut and the bruise. I’m talking about the fear, the worry, and just staying on topic. If you take one thing away from this, if your kid is engaging in reassurance, seeking behavior from you, and you notice you’re stuck in this loop, stay on topic. The topic will not be the thing the child is bringing to you. That’s like distracting content. The topic is, Ooh, you’re feeling worried.

Dr. Rebecca (23:59):

Yeah.

Dr. Sarah (24:00):

That’ll be a guiding compass I think. I’m glad that this parent wrote in. Thank you for writing in this question. I hope this was helpful. And everyone keep writing in questions. We love getting a chance to answer these. So have a great day and we’ll see you soon, Rebecca.

Dr. Rebecca (24:15):

Thanks, Sarah. Bye everyone.

Dr. Sarah (24:18):

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.