Human evolution is incredible. We come out of the womb knowing that our greatest chance of survival is to attach to a primary caretaker who will keep us safe. And that innate wisdom is what motivates children to seek closeness and connection to their secure base.
When children suffer from an anxiety disorder the threat detector in their brain is on overdrive and more and more they rely on their parents to protect and soothe them. And while parents have the best intentions, this interpersonal dance can actually serve to increase the severity and frequency of anxiety in children.
Dr. Eli Lebowitz of the Yale Child Study Center has pioneered a new treatment that interrupts that dance! By altering the way parents respond to their child when they are in distress, rather than fueling the flames of anxiety, parents are able to lessen the symptoms, all without asking their child to change his or her behavior in any way.
SPACE has been a game changer in my private practice and I was delighted when Dr. Lebowitz agreed to come on the podcast to discuss the incredible work he is doing and the amazing results they are seeing
Dr. Eli (00:00):
There are no problems in all of mental health that have better response rates than child anxiety. There is nothing more treatable.
Dr. Sarah (00:15):
This is the second week of October, which means that it’s OCD Awareness Week. And this seems like the perfect time to have a conversation about a new treatment modality that we’ve been using in my private practice with Great Success. SPACE, an acronym for Supportive Parenting for Anxious Childhood Emotions is a parent-based treatment program for children and adolescents with anxiety, OCD, and related problems. And it was developed by Dr. Eli Lebowitz at the Yale Child Study Center. I am so thrilled to have Dr. Lebowitz here to talk about why this program is so different from any strategies that clinicians have used to treat children through parental involvement in the past. And we’re also gonna discuss the ways that anxiety often presents in children, why the parent-child relationship is a major component involved in childhood anxiety, both the maintenance of it and the treatment for it, and the results of the clinical trials that Dr. Lebowitz is doing and what we can learn from this research.
In this episode, you’ll hear about SPACE, a revolutionary treatment modality for childhood and adolescent anxiety and OCD from the creator himself, Dr. Eli Lebowitz. After listening to this episode, if you’re interested in learning more about SPACE, or if you are a parent in New York State and you think this treatment modality might be right for you and your own family, I encourage you to go to upshurbren.com/space where you can find more information about your options. One of the most accessible ways to get started is by joining our four week virtual group program. Capped at six families per group, you’ll gain a deeper understanding of childhood anxiety and OCD, you’ll learn strategies for supporting your child, focusing entirely on your own behavior, and you’ll develop a personalized framework for supporting your child to reduce their symptoms of anxiety and OCD. You can also use the contact form to schedule a complimentary 15 minute assessment call if you are interested in one-on-one support from one of our trained and licensed therapists. To learn more, go to upshurbren.com/space. That’s upshurbren.com/space.
Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.
Hello everyone. Today we are really, really lucky. We have a very special guest on the show today, Dr. Eli Lebowitz from the Yale Child Study Center. Thank you so much for being here today. I’m so happy you’re here.
Dr. Eli (03:22):
Thanks for having me.
Dr. Sarah (03:24):
So I, one of the reasons why I was super excited to have you on is because you have developed a treatment protocol through the Yale Child Study Center that is kind of changing a big part of my own practice. And I really wanted you to come on and talk about SPACE, the treatment SPACE (supportive parenting for anxious childhood emotions) today. But before we get into space, I just wonder if you wanted to like, share a little bit about, you know, how you got into this work, how this became a passion project, because like you are doing so much with this right now.
Dr. Eli (04:00):
Well, first thank you. How I got into this? You know, I’ve been interested in the area of child anxiety and related disorders like obsessive compulsive disorder really for a long time, kind of from the beginning of my professional career. And I think one of the really great things about working in this particular area is that anxiety is really relatable, right? Like we all feel anxious sometimes and some people struggle more and some people struggle less, but it’s something that affects all of us. But the other thing is that it’s an area where you can really make a difference and you can really see such significant meaningful improvement in children’s lives, in families’ lives and parents’ lives and often in a really brief amount of time. And that is just so rewarding and so gratifying when you see somebody’s life kind of turning around because they’re getting the help that they need. It is just the best feeling. And so I just love doing what I do.
Dr. Sarah (05:11):
Yeah, well if you can, I can feel like I’ve, I’ve attended a number of your trainings and I’m now actually the process of getting like formally certified in SPACE, which is not an easy feat. It’s gonna take probably a year or two, which is great cuz like the training I’m getting is really, really helpful. But you know, your passion for it comes through and the book, the book that you wrote, Breaking Free of Child Anxiety and OCD is something that I recommend when parents come into my practice for a child who has either anxiety or OCD or even like light features of those things. It’s typically the first book I recommend.
Dr. Eli (05:51):
Oh, well thank you. I, you know, it’s that book Breaking Free. It’s not the first book that I wrote, but it is my favorite.
Dr. Sarah (06:01):
I have your other book right here.
Dr. Eli (06:04):
There you go. But Breaking Free really is my, it’s my favorite and it’s one that I wanted to do for a long time because it’s an opportunity to just talk directly to parents. And so it’s, you know, interestingly to me, because I didn’t, I guess fully envision it at the beginning, it ended up being a book that’s used by many professionals, many therapists to inform their treatment or sometimes as a workbook in, you know, in the work that they’re doing just kind of working through it together. But it’s really a book that’s written directly for a parent so that if you are a parent of a child who’s coping with anxiety, you can just pick it up and really walk step by step through things you can do to help them. And so and so I really like it and I love hearing from parents, which I do frequently, just hearing from parents about how this has helped them and it’s, it’s just a great feeling.
Dr. Sarah (07:02):
Yeah. And one of the things I like so much about it is it’s so validating for parents to read it. Like, I mean, I read it and I, my kids don’t actually have high levels of anxiety and I still felt validated as a parent, as a mom being like, ah, when I do things to accommodate my child’s behaviors, I am not doing that because I’m a bad parent. An accommodation in and of itself is not a bad thing. Understanding that doesn’t cause anxiety, but that it can inadvertently maintain the loop that kids get in when they have an anxiety disorder and giving them permission to say like, of course you’re doing this to help your kid and you didn’t cause their anxiety by doing it. Yet it’s worth kind of taking a second look at and seeing where we can make changes in those parental behaviors. You know, I think sometimes people think, Oh, you wanna change parental behaviors? Did I do something wrong? Am I messing up my kid by engaging these behaviors? And, and I think your booked does a very lovely job of, of reassuring parents, No, you’ve done nothing wrong. And also we can make it better through just changing your own behaviors.
Dr. Eli (08:08):
Exactly. You know, it’s interesting you mentioned your own kids and I have the advantage of being the parent of three boys and they’re all anxious some of the time, and one of them is anxious a lot of the time. And you know, you can’t judge a parent for how they respond to their child. We’re all out there trying to do our best and you know, I work with so many parents and so often I work with parents that I think, Wow, this is such a role model to me of how to be a parent parents that I work with where, you know, I’m the parenting or, or the doctor who’s telling them like the changes to make. But so often I’m so humbled because I think, Wow, you know, this person’s just such an amazing parent, but we get caught up in these traps, right?
Like our natural tendencies and our natural instincts that might even work well for lots of other kids sometimes don’t work well for this particular child if they need something else. I think, you know, I think the whole idea of like blaming parents for their kids’ problems, for their kids’ mental health problems or problems in general, I mean, it’s such a, unfortunately it’s such a big part of the history of our field. Because we have done that so much and so often, right? Like parents are to blame for schizophrenia, parents are to blame for autism, parents are to blame for eating disorders and it’s all nonsense. It’s all simply untrue. And, you know, so much empirical research proves that it’s not true. Yeah. But it also explains why I think it’s really easy for a parent to feel like they’re being blamed if you wanna talk to them about their parenting. So I love that you’re making that distinction, but it’s, it’s really not about, you know, how you’ve messed up this child. It’s about how you, as a loving parent who cares, can help this child to get better.
Dr. Sarah (10:14):
Yes, yes. It’s so empowering and I think maybe we can dive in a little bit and help clear up what we’re talking about when we’re talking about anxiety and we’re talking about accommodating behaviors. What are we talking about? Why is it different? First of all, what’s an accommodating behavior on the part of the parent? Why does that look different when a child has an anxiety disorder than maybe when your child is, you know, maybe developing more typically and doesn’t have that issue?
Dr. Eli (10:39):
Yeah, I think that’s a really important question just to even set the stage for, for this conversation. You know, every person is going to feel anxious sometimes, and that’s supposed to happen. Anxiety is not a disease, it’s not an illness, it’s a healthy normal part of our life, right? Like we are supposed to be anxious and that system is there to protect us. You know, if we didn’t feel anxious about dangerous things, well how would we know not to do them? And truth is you can have too much anxiety and many people do, but you can also have too little anxiety. And when you have too little anxiety, that’s at least as big a risk because you might have a shorter life or you might get into trouble in the life that you don’t have because our anxiety is there to keep us safe and to keep us out of trouble.
Now, when you’re a child, the natural way that you’re going to respond when you feel threatened, when you feel scared or or afraid, is to rely on your parents. Right? That’s built into our brains and it’s built into the brains of all mammals actually, because we’re born pretty helpless, right? Like, you know, baby isn’t able to defend themselves. A young child isn’t able to defend themselves well, and so what do we do? We look to our parents to protect us, right? And that’s natural, right?
That’s the basis of all attachment theory. Exactly. This is an evolutionary system that’s the there because it works and the parent is also part of that system, right? When your child feels scared, when your child feels threatened and they show you that, well, you feel a pretty strong urge to do something about it, to protect them, to deal with whatever is scaring or threatening them, and then to soothe them and calm them so that they can go back to feeling regulated and and, and just, okay.
And that’s a healthy system. Now, typically as children mature, as they get older, we’re gonna see a gradual shift so that they start relying less and less and less on parents to help deal with those scary situations. And they’re doing it more independently. And that happens over the course of years of maturation until you get to adulthood and you know, now you have an adult who can deal with their own threats and in fact could even be a caregiver for somebody else. But the thing is that anxiety disorders, meaning when you have not just normal appropriate anxiety levels about actual dangers, but anxiety disorders are when you feel anxious even when there isn’t an actual danger, right? Like your anxiety is being triggered all the time chronically and you’re feeling worried or scared or afraid or stressed so much of the time. Well, when that happens, it’s harder and harder for children to make that shift away from relying on the parent and more toward independent coping.
And so they get a little stuck on relying on their parent. And parents get really sucked into this dynamic, right? They get really pulled in because child’s scared a lot and I’m stepping in to help them child’s scared and I’m stepping in to help them. And that’s where we find these accommodations, right? When we talk about accommodation in the context of an anxious child, what we’re talking about are really all of the different changes that parents make in their own behaviors to help their child not feel anxious. And you could take any anxiety symptom almost in a child and see how a parent might end up accommodating it, right? Like maybe your child has separation anxiety and they’re really nervous when you’re not around. Well, maybe you are around all the time, maybe you don’t go out in the evening. Maybe you’re at work, but you have a zoom call going with your FaceTime call going with your kid all day so that they can walk by the iPad and just see mom.
Or maybe you’re sleeping next to them at night cuz they’re scared when you’re not there. Or maybe you have a child who’s has generalized anxiety, they’re worried all the time, their brain is just churning away with an endless stream of worried thoughts. What if this, what if this, what if that? And what do they do? They come to you because that’s what kids do when they’re anxious and you are accommodating and reassuring them again and again and again and answering their billion and one worried anxious questions. And you could go on with other examples, right? Like, you have a kid with social anxiety and you’re speaking in place of them because they’re too uncomfortable speaking to somebody on their own. So you step in and these are all examples of the kinds of accommodations that parents of anxious children find themselves doing day in and day out often quite intensely. So it feels like this anxiety is just really taking over our family.
Dr. Sarah (15:45):
Yeah. Yeah. I get a lot of parents cuz I’ve been working with some people with SPACE and in general in my practice with parents who have kids who have separation anxiety or social anxiety. And I think one of the reasons they even just come into therapy is actually because they’ve hit a tipping point where like, I can’t keep doing all this stuff anymore. I’m feeling exhausted. It’s like they, they sort of come in saying, my child is having a lot of trouble. But really once you like peel the layers back, they’re like, I’m having a lot of trouble. I can’t cope with this anymore because it’s so much work.
Dr. Eli (16:19):
Exactly. I mean this can really take over so that it becomes the center that like family life is, you know, organized around. Because really at a, at a kind of deep level anxiety problems in children are not just child disorders. You know, we think of them as child disorders cuz they’re the patient or they’re the one with the elevated anxiety. But intrinsically because children like other mammals respond to anxiety by relying on parents when a child has anxiety, it really is the family system that is. Coping with an anxiety disorder and not just the child. And so parents are often at wit’s end, they’re exhausted, they’re fed up, they’re frustrated, and they also feel guilty and bad about the times that they’re not able to help their child enough. Or am I doing it right or am I doing it wrong? And you know, there can even be financial burden to this.
You might be buying things because of your child’s anxiety and accommodating like that. Or you know, like one parent said, I could have had a promotion at my job and be earning significantly more income for our family, but that would’ve required me to travel or would’ve required me to work later in in the day. And my child is so anxious, I need to be there for them all the time. So I had to say no. And so now we have an accommodation that’s really dramatically impacting the whole family right. System, even at a financial level.
Dr. Sarah (17:50):
Right. And you bring up a really interesting point, which is that anxiety in kids, we need to sort of shift the way we conceptualize it to be significantly and materially different than the way we conceptualize anxiety in adults. Because the adult has and is operating off of a more mature internalized system where the child is actually working with an externalized system that includes the actual physical parents. And so when we’re treating anxiety and adults, we can usually work within their internalized system, which means basically they have their internalized objects inside of them that they have grown up and kind of their inner voices and their inner sense of self. That probably includes their parents, but like representations of them. So you could just work with the adult, but when you’ve got the child, you really actually need to involve the whole family because that is the system that we’re treating. And I think that’s one of the things that space really that shifts space, shifts the lens to that, to that in a way that I am like so excited by.
Dr. Eli (18:53):
Yeah, that is so well said. That’s exactly right. Anxiety is inherently a systemic phenomenon in children or child anxiety, I should say is inherently a systemic phenomenon. And it really is the aspect of child anxiety that most differentiates it from adult anxiety because in many ways they’re similar, right? A lot of things about adult anxiety are really very much the same in child anxiety. You know, our physiological responses, your racing heart and all of that, that’s pretty much the same whether you’re an adult or a child. A lot of the cognitions, the thoughts that you might have, the way your brain gets stuck on these worried scared thoughts and just obsesses over them, that’s pretty similar in children and adults. But this interpersonal aspect, the way that it involves the parents inherently and plays out at the family level is really the thing most differentiating it and it’s really an aspect that for a long time didn’t really inform how we treat these problems. Even when parents were involved in treating child anxiety, even when there were efforts to like bring parents into the treatment, this understanding of the role of parents and this interpersonal aspect didn’t really inform how that was done in the past.
Dr. Sarah (20:20):
Right? So how were, how were previous treatments involving parents and what were the outcomes and then how does space do it a little bit differently and what are the shifts that we’re seeing in the outcomes?
Dr. Eli (20:31):
Yeah. Well, you know, there’s actually a whole lot of research that occurred over decades, right? Like 30 years of studies that tried to involve parents in child anxiety treatment and pretty much all of them, with some exceptions, I shouldn’t say all of them. But by and large the approach was to train a parent to do treatment for their child. And usually that was cognitive behavioral therapy, which is kind of the frontline evidence based child based treatment. So what does it mean? It means that there’s a therapist who’s doing this CBT with the child and they’re teaching them about exposures and not to avoid things. And they’re teaching them cognitive tools, like how to change their thinking. Maybe they’re teaching them relaxation skills like breathing and then you say, Oh, let’s involve the parent and what do you do?
You train the parent to do the same things with the child at home. So maybe the parent tries to get the kid to do exposures at home. Maybe the parent tries to do the relaxation with the child at home. Basically, this is what’s called a lay CBT therapist. Now there are a few big problems with that approach. One problem is that very often children aren’t all that willing to do the work with the parent. You know, it’s hard enough for a therapist who’s not mom or dad to get children to do things like exposures, which are literally facing the thing you fear most. You know, that’s a big challenge even for a doctor. In many cases, kids are not going to do it with the parent. Another problem is it didn’t work. Meaning so many studies looked at this and asked, Well, if we add this piece of having the parent do the CBT with the child at home, in addition to the therapist doing it in the office, would these kids get better to a greater degree?
Would they have better outcomes? And the jury is in now, because again, we have like, you know, dozens of studies and the answer has been no, the kids, they didn’t get worse, but they also didn’t really do much better than if you just did the CBT in the office with the child. And a third problem is that if you are adding the parent to the child’s treatment, well you still need to have a child in treatment, right? Right. Like it means if you always think of the parents as like this added on extra little boost piece as opposed to the actual treatment. Well, what about kids who maybe aren’t able or aren’t willing to do the work with a therapist themselves? You can’t add something if it’s not, if you don’t have the basis. And so for all of those reasons, I think it’s clear at this point that we need a different approach.
And SPACE really takes a dramatically different approach because if you are conceptualizing the problem of child anxiety as a systemic phenomenon, well the downside of that is parents are also struggling, parents are also suffering and everybody’s impacted. But the upside of a systemic problem is that you have multiple ports of entry to intervention. Yes. Right? You don’t need to think of the parent as just another person who happens to spend a lot of time around this kid and might be able to do some CBT while they’re there. Right? As though you went out and hired a therapist to just walk around near your kid and sort of throw CBT ideas at them, that ignores the very special role that parents play in the context of child anxiety. All of this, what we’ve been talking about, about how they’re drawn in to accommodate about how this attachment system drives children to rely on their parents when they’re anxious. And so in SPACE, rather than trying to get a parent to change what their child is doing, like start practicing exposures or start doing relaxation or stop avoiding things, we focus entirely on changing what the parent themself is doing, their own responses to that child’s anxiety. Because in a system, if you change one thing, other things tend to change too. And so the whole treatment just focuses on how are you responding to your child and making some really important key changes. And you can do that even if the child is not in therapy at all, which is a huge game changer.
Dr. Sarah (25:29):
That is one of the reasons I love SPACE as much as I do, because in my practice I tend to work with parents of very young children, children who may be not impossible to do CBT with, but who are either potentially developmentally just a little bit too young or are resistant to the idea of like, they’re, they just don’t wanna, you know, it’s very hard to get a young kid to do something that they don’t want to do. It’s a lot easier for parents who are motivated and invested and cognitively much more developed to push themselves to do something different on their end.
Dr. Eli (26:09):
Dr. Sarah (26:10):
And I think it’s better for family harmony because then I think one of the other problems that maybe didn’t get mentioned in the problem with parents being the CBT therapist, is that that’s not the parent’s role, you know, in, that’s not the job of the parent in real life. You know, the job of the parent is to see a child, to sue the child, to be this sort of emotional support for the child. And while in space we do shift some of their behaviors, I think space maintains that role for the parent. They’re not some, they’re not making the child change and constantly creating this friction between them and the child. And you use something called supportive statements, which I think are amazing to help parents be an emotional support for a child, communicate a lot of confidence in their ability to cope with something, sort of really communicate to them, You can do this and I’m here for you without necessarily continuing to do the same behaviors that we’re maintaining that anxiety loop.
Dr. Eli (27:16):
Exactly. Yeah. No, that’s, that’s exactly right. By the way, it’s really interesting you said about the family harmony because it is so true. I mean, the accommodation itself places a lot of burden on the family system and can often lead to a lot of tension, a lot of stress. Parents are doing all these accommodations, but they’re not always doing them happily. And that leads to you know, a, a strain on the relation on the relationships. And then, like we were saying, asking parents to try to control and modify what their child is doing is just inviting more conflict and more stress into that situation. And, you know, anybody who has kids knows, and anybody who was a kid also knows that you can’t always just, you know, even if you have a great idea, it doesn’t mean your kid is going to go along with it.
But it’s interesting to me because, you know, we study this very carefully in our research and our clinical trials of of SPACE. One of the things we look at in addition to our children getting better is the anxiety getting better. Another thing we look at is actually what impact is this having on the family relationships, on the family atmosphere, on the parenting stress. And we see improvement in those things, which is important for parents to know. Sometimes parents are a little a little anxious that if I don’t accommodate my child when they’re anxious, well maybe they’re gonna feel unloved. Maybe they’re going to get mad at me, or maybe our relationship will deteriorate. And what we actually see is an improvement in parent child relationships and in parenting stress when parents are able to do the treatment. So yeah, the, the the supportive statements, I mean, that’s really one of the two biggest parts of this treatment, this communicating support to your child, which really means showing your child that you get it, that they are genuinely anxious, that they’re not just making it up or being a baby or immature, or attention seeking or manipulative or all these other thoughts and ideas that can sometimes cross our mind showing them that regardless of how rational it is for them in this moment, this is hard.
They’re anxious, they’re scared, they’re stressed, they’re worried, whatever it is that they’re feeling, just communicating that you get it. But combining that with a message of confidence, meaning that you, the parent, believe that your child actually can handle feeling anxious some of the time that they can get through that, that they can be okay. And that is a critically important message for an anxious child to hear. Cause our whole anxiety system is set up to drive avoidance, right? It’s set up to be uncomfortable in the same way that nobody designs smoke alarms to sound really beautiful and melodious and harmonious. Like nobody makes a smoke alarm that you wanna sit around and listen to because you want it to be uncomfortable. You want it to call attention and say, Uhoh, this is a problem. Right. And our anxiety system is the same way. It is uncomfortable. It it’s intended to be. And a lot of
Dr. Sarah (30:30):
Right, it’s a smoke alarm. It’s a, I often call it a fire alarm, you know, it’s…
Dr. Eli (30:34):
Yeah, exactly. That’s exactly right. And, and just like a fire alarm, it’s really unpleasant. And a lot of children really grow to believe that those sensations, those experiences of anxiety, they’re just intolerable. They can’t handle them, they can’t deal with them. And sometimes that message is reinforced by the way that we as parents are responding to them. You know, lots of anxious kids will grow up hearing themselves described as a child who can’t handle anxiety, right? Like, my kid can’t deal with stress, my kid goes to pieces and can’t handle anxiety. And that’s what a child believes. And if you believe that about yourself, well you’re doomed to a lot more anxiety. Right. If you believe I can’t handle anxiety, you’re gonna have a lot of anxiety in your life because every time anything triggers your anxiety, it’s gonna feel like a disaster. And so this message of confidence combined with accepting that for you, it is hard right now, it’s just holding up a mirror to this child and saying, Look, this is how I see you. I see you as Yes. Able to handle it as capable and strong and able to deal with things. And that really can shift how a child sees themselves as well.
Dr. Sarah (31:48):
Yeah. Yeah. And so if people wanna learn more about SPACE, like if they’re like, Oh, this is a treatment that I’ve never heard. Cause I, I mean truthfully, it’s new. I mean, this is, this is, it’s, you’ve been studying it for a long time, but it’s been out kind of in the world and you’ve been training other clinicians to provide this type of treatment, not for that very long. So I think people are, it’s just starting to percolate on the scene in a more mainstream way. And by the way, the research that you are doing is showing that the efficacy of this treatment is in line with CBT alone for children, right?
Dr. Eli (32:22):
Absolutely. Absolutely. Yes. It’s completely equivalent or, or as we would say, non-inferior to doing direct cognitive behavioral therapy with, with a child, right?
Dr. Sarah (32:33):
Yes. And sometimes that’s the right path. And sometimes, I think like sometimes I’ll do intakes and I’ll be like, Let’s figure it out through the intake process. Let’s feel it out. People often come to me, most people have never heard of SPACE. And so they come to me, they say, My child’s anxious, can you treat them? And I say, Yes. And also, or really, I say, Yes, here are the different ways we can do individual child therapy or we can try space. Which I actually think in many ways is a better frontline treatment because it’s short, it’s time limited. It’s like, you know, anywhere between, between 12 to 18 sessions usually. What is that in line with what you’re seeing time wise?
Dr. Eli (33:10):
Yeah, no, absolutely. I would say a typical course of space is give or take 12 sessions might be a little bit more. Sometimes it’ll even be a little bit less. So we’re talking about something that’s relatively that’s relatively brief,
Dr. Sarah (33:26):
Right? And it doesn’t require your child to get on board and do all these things. It’s really, it’s very simple actually. It’s elegantly simple. It’s like, you know, it’s sophisticated, but it’s presented in a very simple, systematic way where you basically, you know, work with the family to map out the accommodations that they are doing, figure out which one feels like a good one to address you share with the child. It’s very transparent, which I think is also really important. Share directly with the child why you are gonna stop doing this behavior and why you believe that they’re gonna be able to handle this and help them understand what they can expect. You know, so you’re really laying out a lot of transparency with the child and involving it in that piece. And then you stop doing the behavior and you really focus for a little while and just pulling that one behavior.
So it’s not overwhelming. It’s not like, Oh my God, I’m gonna stop doing every single thing I do in my child’s just gonna like turn to a puddle and I am gonna turn into a puddle. It’s like we do one thing at a time in the idea, and then we do a second and maybe a third. And the idea is in doing these sort of systematic pulling of specific accommodations, the child learns to generalize that effect, that like, Oh, I can ha I can survive this. Okay, oh, I can survive this too. Now maybe I can survive more things, more anxiety in general. And like really, I think what you’re trying to teach the whole family is not, you don’t ever need accommodations. You’re trying to teach the child and the parents anxiety’s safe. The, the feeling, the experience of anxiety is not inherently dangerous. You can survive this. And so we are going to systematically expose you to a little bit of anxiety and help you feel like you can survive that doing it multiple times throughout the course of the treatment. And then the ideal situation is the child then says, Oh, you know what? I’m actually okay feeling this, feeling I’m more okay than I was before. Feel feeling this feeling,
Dr. Eli (35:29):
Right? Yes. Reducing those accommodations. It is really that, that the second of those two big changes, right? Like we’re, we’re increasing those supportive responses that show acceptance and confidence. And we are exactly like you said, reducing those accommodations, but in a systematic way, in a gradual way. We’re not overwhelming the this system, right? We’re taking one thing and we’re focusing and we’re doing that. And when you do that one thing as a parent, when you, when you take that first step, it’s such a meaningful thing because you actually get to see that your child can handle it. You know, it’s a big deal for them because we’re starting to shift them away from like, I can’t handle anything, I just need you to rescue me all the time. And we starting to build up their confidence. But it also is a really big moment for parents because they see, you know, I didn’t think my kid could handle things.
One of my absolute favorite things to hear from parents at the end of SPACE treatment, and it’s something that I hear so often, but I love it every time, is when they say, We didn’t realize how strong our child is. We underestimated what they’re capable of. We thought they were so fragile, so vulnerable, so helpless. And we realize actually they’re kind of tougher than we thought. They’re stronger than we thought. And I just love that because it means that we’ve been able to really make that shift away from, you know, like you said, anxiety is, you know, dangerous and to be avoided at all costs to anxieties uncomfortable, right? We don’t like it necessarily, but it’s something that we can handle. And I think giving that sense to your child that I can handle things even that are uncomfortable, I think it’s the biggest gift you could give any anxious child and just sets them on a course for such a better life for like so many years.
Dr. Sarah (37:22):
Yes. And I’m curious what you think about this, cuz I’ve found too, you know, we know anxiety is genetically, you know, predetermined in some ways or there’s a genetic component to it. So a lot of times I get parents who also have anxiety and it’s usually some type of an anxiety dance oftentimes where there’s a parent who’s so anxious about their child feeling anxious that that is why they are kind of stuck in this accommodation loops. And actually I feel like space does a really nice job of kind treating both the child and the parent because the child is having to sort of experience the uncomfortable anxiety because you’re no longer taking it away from them. But the parents often having to experience their uncomfortable anxiety of not turning off their child’s anxiety. And so there’s like a dual exposure that’s kind of happening in these moments for both the child and the anxious parent if that happens to be one of the reasons why the accommodations are kind of happening, are being maintained.
Dr. Eli (38:14):
Yeah. And here by the way, your perspective or intuition are backed up by empirical research too. Because another thing that we look at in our clinical trials is parent anxiety. And of course lots of parents of anxious kids are gonna have a lot of anxiety themselves, both because of the genetics and also just because anxiety is really common. And so lots of kids are gonna have anxious parents, but we actually see a significant reduction in parent anxiety following the treatment, even though at no point are we saying like, we’re gonna try to treat your anxiety. Right. That’s not what the treatment is about, but they’re going through this together and they’re learning about anxiety and they’re learning to cope with it. And you know, if you say to your child again and again, you can handle anxiety, that’s gonna have an effect on you too. Totally. And absolutely. And so we actually do see significant reduction in parent anxiety following the treatment with just a, it’s like an added perk for the parent.
Dr. Sarah (39:13):
It’s a twofer.
Dr. Eli (39:15):
Dr. Sarah (39:17):
That’s really funny. And so you also have a documentary that just came out all about space. Like if parents are like, What is this treatment? I wanna learn more about it, they can, obviously, they can read your book Breaking Free of Child Anxiety and OCD, but they tell us about the documentary.
Dr. Eli (39:31):
Yeah. So this is really exciting for, for me because it’s, and it’s such a beautiful, such a beautiful project, which I will say was actually done with support from a very generous donor who wanted to find a way to bring this treatment to the awareness of more people. And what it is is really a, it’s a brief film, like 20 minutes or so, it’s called I like the breaking free theme. And so, it’s called Breaking Free of Anxiety: A Journey Through Space. And it, it tells the story of two families who are coping with children with anxiety, one of them actively going through the treatment during the time we were making the film. And so you can actually see like part of sessions of like, I’m meeting with the parent, I’m planning for how she’s going to go home and talk to her child about the reducing an accommodation.
You could sort of actually see it happening. And the other family is one that had already completed treatment, but their story really brought to life very nicely as well. And I think it’s just a great way to to learn about the, the, the, the treatment and just, you know, kind of get a sense of what it might be, what it might be like. I would recommend people who do want to learn more about SPACE whether through the documentary or lots and lots of other resources that exist can visit the website that’s dedicated to SPACE. It is spacetreatment.net. And there’s a lot of things there. For example, there is a list of therapists who have trained in this treatment. And so if you’re a parent, you wanna find somebody who knows this treatment, you can go there and just search for somebody in your state or country and find someone to work with. And there’s also a section devoted to resources where you can find videos like the documentary film that we just talked about. You can find podcasts like the one we’re doing and also many, many articles. Some of them were research kind of articles, but also lots of just general media kind of articles like, like an article in the Atlantic or, or CNN or things like, like that. So that’s a great place to just learn more about the treatment.
Dr. Sarah (41:58):
Yeah. And for the, we have a good amount of people who listen to this podcast who are clinicians and I will highly recommend going and reading some of the research that cuz you share all of your research on there. And I’ve, it’s so helpful to, you know, to see that stuff I think too from a clinical perspective.
Dr. Eli (42:16):
Dr. Sarah (42:17):
And then of course, you know, if you wanna get heady, anybody can go read that, but it’s really good.
Dr. Eli (42:25):
Absolutely. You know, when I write, when I write even research articles, I do try to actually write them so that anybody can pick them up and read them. And some of those articles, even the like researching ones are, are case studies where yeah, you know, you can read the story of a family that got this treatment and maybe you’ll see a little bit of data like comparing their anxiety scores before and after. But it’s really a narrative and it’s telling the story. And if you are a clinician visiting the website, you can also find information about training. So if you want to get trained in how to do this treatment and then be listed on that list of space providers that’s on the same website, you can find information about that as well.
Dr. Sarah (43:07):
Yeah. And I can’t recommend the trainings enough. I have had clinicians do also your supplemental trainings for the RFID, avoidant restrictive food intake disorders treatment and also the failure to launch training, which I think is really amazing because if you or anyone you know has that’s listening has a family member or is working with someone who’s having a difficult time, you know, launching or has a child who’s having a difficult time launch, an adult child’s having a difficult time launching SPACE has actually been shown to be efficacious for treating that as well.
Dr. Eli (43:43):
Yeah, that is such a huge problem. The whole, you know, this whole problem of failure to launch is a massive problem. And vastly underdressed under addressed, understudied. There’s very little research. You know, we, we recently conducted the first ever epidemiological study. So just a survey with a nationally representative sample to determine how many people are actually in this boat of I’m an adult, I’m physically able, I’m not disabled by like a physical disability or a serious mental illness that might be really incapacitating. And yet I’m not functioning independently as an adult. I’m stuck in my parents’ home. I’m not going to school or to work or doing something productive with my life. And we haven’t published these findings yet because we’re still pouring through the data, but what I can already say just from what we’ve already seen in that data is that we’re talking about a problem that affects something like 3 million households in the United States alone, which is truly enormous.
And Ori, who’s a postdoc who works with me likes to say, if all of those people with failure to launch were to suddenly move out of their home to some new city that we established, it would be the fourth largest city in the United States.
Dr. Sarah (45:08):
Dr. Eli (45:09):
That’s how big of a problem. And it’s one where there really aren’t a lot of solutions, honestly. There’s not evidence based treatments. There’s not a lot of like randomized control trials for this area. And parents are really so frustrated and so stuck in this situation. And so having a treatment that can work through them, because as much as young kids don’t always wanna do therapy, adults with failure to launch often really don’t wanna do therapy. Yeah. And if you’re able to avoid work and college and every other aspect, you’re also pretty able to avoid therapy as well. Yeah. And so having a parent based treatment for that is really, really, really, I think, important as well.
Dr. Sarah (45:51):
Yeah, totally. So that’s, we can put links to all these resources in the show notes because I think this is all like, so helpful for the trainings and for if parents wanna learn more about the documentary, the book, the treatments our clinic offers it, you know, our group practice offers SPACE therapy. We’re thinking of trying to put together like a psychoeducational group too, so that parents can like get a flavor for aspects of it, you know, while they’re waiting to get seen or to decide if that’s something that they wanna pursue. So we can put links to all this stuff on the show notes. Is there anything, I’m just curious, like, as a sort of concluding thought, like is there anything you really want parents to know if they’re, if they’re listening to this and they’re like, Wow, you know, I, my my child’s anxiety really is something that I wanna address or that I’ve been maybe not totally sure how to really address or I’m feeling burnt out about it. Is there anything that you have to share with those parents that might be a source of like comfort?
Dr. Eli (46:55):
Well, I would say if you’re the parent of a child with anxiety, first of all, it’s not your fault. I, I think it’s, you know, you can’t say it. I know we said it before, but you can’t say it enough. It’s not your fault if your child has anxiety, but there’s really a good news, bad news story when it comes to child anxiety problems. And the bad news is that these aren’t problems that tend to just go away on their own. There’s not a lot of what we call spontaneous remission, meaning your child is anxious today, but you just wait and they outgrow it and now they’re fine. I’m not saying it couldn’t happen, but it doesn’t tend to happen. In fact, the opposite tends to happen, which is a chronic course with growing severity. And that’s sort of the bad news part.
The good news though, about child anxiety is that in all of psychopathology, in all of mental health problems, there is nothing more treatable. There are no problems in all of mental health that have better response rates than child anxiety. And the world is simply chock full of people who used to have an anxiety disorder and now they don’t. And so if you put those two things together, if it’s not going to go away on its own, but it really can improve if you do get help, I think you get a really strong argument for taking action, for doing something about it. You know, you start with just having a conversation with your kid about how they’re feeling and what they’re coping with, and you reach out to your pediatrician, you reach out to the teacher and you get some referrals and you meet with a counselor or a therapist and you get to work on this because you might in assured amount of time, you know, if we’re talking about 12, 15 weeks, we’re talking about a few months, you might have a child who is so much freer of their anxiety and a whole family that is functioning so much better.
So I think it’s an area with tremendous hope.
Dr. Sarah (49:00):
Yeah, hope that is totally the way that I see this. Like it feels very hopeful. Yeah. So thank you so much for coming on, for sharing all this with us. You, the work you’re doing is amazing and just grateful you took some time out of your day to talk with us.
Dr. Eli (49:17):
Well, thank you for having me on. It’s been a great conversation.
Dr. Sarah (49:25):You can probably hear from this episode just how passionate I am about this topic. If you are recognizing yourself or your child in our conversation, I encourage you to seek professional support, whether through SPACE or different modality, treating anxiety in children can have a massive impact on the way they grow up to see themselves and the world around them. If you are interested in learning more about the work that my clinical practice Upshur Bren Psychology Group is doing to treat childhood anxiety and OCD with SPACE, go to upshurbren.com/space. Not only do we have trained and licensed therapists working one on one with parents, but we’ve also begun running intimate virtual groups with no more than six families per group. This four week program can help you to gain a deeper understanding of childhood anxiety and OCD and develop a personalized roadmap with strategies for supporting your unique child, but focusing entirely on your own behavior, which you actually have control over. Because of licensing restrictions to do therapeutic services at Upshur Bren Psychology Group, you gotta be a resident of New York State to be eligible. So to learn more about the work we are doing, go to upshurbren.com/space, or to find a local practitioner in your area, you can go to spacetreatment.net to see a fullest of space providers. Until next Tuesday, don’t be a stranger.