When our children feel anxious or afraid, it can be difficult for parents to know exactly how they should respond. Many parents put pressure on themselves to solve or fix this problem for their child, which is often impossible and a less than ideal way to handle this tricky situation.
Joining me to talk about childhood anxiety and offer support for parents navigating this in their own family is the author of Goodbye, Anxiety: A Guided Journal for Overcoming Worry, Dr. Terri Bacow.
You’ll learn a framework you can use that will work toward helping your child learn to cope with their anxiety, rather than avoiding their fear, and factors to help you determine if and when it’s time to seek professional support.
Dr. Terri (00:00):
You realize this is okay, I can do this. Nothing bad is going to happen. I can tolerate the anxiety. The anxiety will come down.
Dr. Sarah (00:13):
When our children feel anxious. It’s normal for us as parents to wanna turn off their pain and make those feelings go away. But actually teaching our child coping skills to deal with their anxiety is a much more effective strategy. Joining me to help parents learn anxiety management techniques as well as the knowledge of when it’s time to call in some professional support is licensed clinical psychologist and the author of the new book, Goodbye, Anxiety: A Guided Journal for Overcoming Worry, Dr. Terri Bacow.
In order to know how to best support our child, it’s helpful to understand the difference between normative feelings of anxiety, a perfectly healthy emotion that we all experience and when it crosses into a disordered level. I hope this episode helps you feel empowered with solutions and tools along with reassurances that there is plenty of support to help you work through this with your child.
In this episode we’ll dive deep into the topic of childhood anxiety and one of the treatment modalities that we mention that as you’ll hear both Dr. Terri and I are big proponents of is SPACE. SPACE which stands for Supportive Parenting for Anxious Childhood Emotions is a parent-based treatment program for children and teens with anxiety, or OCD developed by Dr. Eli Lebowitz at the Yale Child Study Center. By utilizing the parent child relationship and our understanding of attachment theory to focus on our children’s most basic need to seek safety from their caregivers through space, parents are given tools and skills that they need to understand exactly how to respond to their child’s anxiety in a way that strengthens their child’s ability to cope with their discomfort and ultimately overcome their symptoms of anxiety. After this episode, if you’re interested in learning more about the work my clinical practice Upshur Bren Psychology Group is doing to treat childhood anxiety and OCD with SPACE, go to upshurben.com/space. Not only do we have trained and licensed therapists working one-on-one with parents, but we’ve also begun running four week virtual group programs to help parents develop a personalized roadmap with strategies for supporting your unique child focused entirely on your own behaviors, which you actually have control over. To learn more, go to 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.
Hi everyone. I’m so excited today to welcome Terri Bacow out to the podcast. She is a clinical psychologist. She wrote an amazing workbook called Goodbye Anxiety, for teens and tweens and she’s here today to talk to us all about anxiety in our kiddos and in ourselves. And ugh, I’m so glad that you are here.
Dr. Terri (03:39):
Thank you so much for having me. I am delighted to be here.
Dr. Sarah (03:44):
So one of the reasons that we talked about doing this episode was because you’ve really created a specialization in treating anxiety in adults and in teens and twins and also with younger children. And I get a lot of questions about anxiety too and I think there’s a lot of misunderstanding about anxiety and one, I’m just curious how you got into this work. But then maybe we could talk a little bit about clearing up some misconceptions about anxiety.
Dr. Terri (04:20):
Yes. So I think that people don’t understand, number one, that it’s an incredibly common experience. I think that there maybe a misunderstanding that anxiety is only experience by a few of us. One really every single person in the world has anxiety. It’s a common emotion, it’s universal, it’s actually also adaptive. I did the number one disorder and diagnosed by psychologist, a psychiatrist.
Dr. Sarah (04:53):
Interesting. Yes. It’s really like, it’s so funny, I was working with a nine year old yesterday and he has OCD, which is kind of a sort of, it’s on that anxiety spectrum and he was like, I feel like I’m the only one that has this. And I was a little heartbroken for him but also really encouraged to be able to help him understand this is so common.
Dr. Terri (05:18):
It is like many factors, every single one of my clients has, I mean part of that is selection bias, but it also reflects the general population.
Dr. Sarah (05:30):
And this is where I think people have a lot of misunderstanding about it is when we treat anxiety, they have this belief that the goal of treatment is to make the anxiety go away when in fact treating anxiety actually means helping people tolerate the anxiety that exists.
Dr. Terri (05:49):
Exactly. There’s a valid attempt to suppress it, to eliminate it, and that could lead to a rebound effect. It’s actually the worst thing you can do is to try to shut down your feelings. In fact the opposite which is allowing yourself to feel your feelings will allow them to pass faster.
Dr. Sarah (06:10):
Yes. So can you help us understand a little bit what is anxiety exactly what’s going on?
Dr. Terri (06:19):
So anxiety is an uncomfortable feeling, typically not always comfortable. The way that I like to define it is that it is an overestimation of the likelihood of danger and an underestimation of our ability to cope. Meaning that anxiety typically definitive stress, tends to be out of proportion. It tends to be an overreaction. So stress tend to be temporary specific proportion, whereas anxiety is more chronic, it’s more ongoing, it’s more problematic at time.
Dr. Sarah (06:59):
That is such a great and condensed way to put it, an overestimation of the likelihood of danger and an underestimation of our ability to cope with that. And the reason why we’re overreacting isn’t because we’re irrational, it’s because our threat detector is hypersensitive.
Dr. Terri (07:19):
Yes. And this is where the biology comes in and some anxiety runs in family is highly genetic. Like Lady Gaga said, you’re just born that way. It’s really something that gets passed along and it’s neurobiological meaning that it originates in their brains and their bodies and people who have anxiety disorders tend to have more of active nervous system with sensitive nervous system, meaning the more likely or more phone to experiencing physiological sensations of anxiety to basic heart butterfly tension, those things tend to happen more. But we experience anxiety, especially if we are genetically drawn to it.
Dr. Sarah (08:08):
So interesting because it really shows that I think a lot of people have their self critical for their anxiety, they blame themselves, their shame around it. A lot of times they question their sense of reality and it it’s really, it’s something that when people have high levels of anxiety it might be completely outside of their control.
Dr. Terri (08:30):
Absolutely. I think this stigma is so misplaced. It is sort of like blaming yourself for having diabetes or a heart condition or a cold. This is really something that is neurochemical, which is why sometimes psychiatric medication could be a good choice, but therapy is also a really good choice.
Dr. Sarah (08:52):
Yes. What are some of the ways that therapy and behavioral interventions can help with anxiety disorders?
Dr. Terri (09:00):
Therapy is the best thing you could do if you have anxiety, particularly a specific kind of therapy that we call CBT, which stands for cognitive behavioral therapy. This is the gold standard when it comes to the treatment of anxiety disorders and it’s just a great fit because the therapy approach really teaches concrete coping focus, it’s action oriented, solution focused and it’s all really about what are some actionable strategies that you could use when you, they’re anxious and that’s what CBT does, the teacher, this strategy mind really does reframing behavioral changes, all of those strategies really can stop anxiety in its tracks.
Dr. Sarah (09:50):
And it kind of works. One of the reasons why I like CBT for anxiety and full disclosure, I’m a very psychodynamic relational therapist and I still use CBT when I work with people who have anxiety because when we have that sort of overactive amygdala or that hypervigilance that comes from the presence of that, that fear-based nervous system activation, we have to override that neurobiological response kind of manually. And CBT does a really good job of giving people sort of conscious manual override or like cheek codes to their nervous system responses.
Dr. Terri (10:37):
I completely agree and that’s why CBT and other evident based treatment approaches really are a good match. And I think that most of our anxious people want to feel in control and CBT can be empowering in that way because what we’re telling the client clients is try this, do this homework sheet, try this exercise, go out and speak to someone you don’t know. See what happens. It’s really concrete.
Dr. Sarah (11:09):
And that this go out and speak to someone you don’t know. Makes me think of ERP, which is exposure and response prevention, which is another type of treatment for anxiety and anxiety disorders, which is kind of under the umbrella of CBT. Can you talk a little bit about ERP?
Dr. Terri (11:31):
Yes. So exposure therapy including the response prevention piece and really about the fears for OCD, for when we are avoiding the fear situation. When we avoid, we only reinforce the fear, we solidify it, we teach ourselves I can’t do this. So exposure offered the opposite. Try see what happened, see if it’s bad that you think it’s gonna be get used to it habituate when it comes to OCD there, the tendency to engage in rituals to prevent maybe something bad happening. And so if you sit on your hand and you prevent the response, you do not go check the event 100 time you explain from trying that light switch on and off, then you realize this is okay, I can do this. Nothing bad is going to happen. I can tolerate the anxiety. The anxiety or the anxiety will come back.
Dr. Sarah (12:31):
Exactly that slow and steady and sometimes subtle progression of tolerating a stressful stimulus so we can begin to cope with that fear or refraining from the rituals like you said in the case of OCD and learning to tolerate the anxious feelings that come with it. And I think this is the part that’s the most important part. We’re not eliminating anxiety by doing CBT or ERP, we’re increasing the tolerance for the feeling without having to engage in maladaptive behaviors that ultimately kind of keep it going.
Dr. Terri (13:05):
It’s makes you think about acceptance and commitment therapy, which is the third wave that CBT is another kind of evidence based approach and it’s all about experiential avoidant and really stop trying to shut down your feelings, really allow yourself to feel them and with is at least sit with the emotion but you try to cope with it effectively. There’s so much better that you’re trying to get it to go away.
Dr. Sarah (13:33):
And I think that’s part of the sort of psychoeducation I often give patients when I start working with them around anxiety. I think a lot of people come to therapy saying, make this anxiety go away, make my anxiety go away, make my child’s anxiety go away. And the sort of orientation to the therapy starts with, well that’s not gonna be the goal we’re gonna make the discomfort around the anxiety being present reduce. But it’s a feeling that is a human feeling that you’re gonna, we all will have.
Dr. Terri (14:13):
Absolutely. I think as the poet myself and someone who’s worked with parents, I could tell you that it’s really hard to see your child uncomfortable. And I think the parents have a particularly difficulty, especially in today’s parenting culture, tolerating child distress. When we see our kid distress, we want immediately to make it better immediately to sure whatever’s happening. And that’s not a reason but message to send. It’s understandable, we don’t want kids to be unhappy but they need to learn to experience this stress to the manager in order to be functioning adult.
Dr. Sarah (14:56):
And maybe this would be a good time to talk a little bit about in children, what does anxiety look like? Cause it doesn’t always look the same in kids as it does in grownups. There’s overlap but there’s like kids show anxiety in slightly different ways sometimes.
Dr. Terri (15:15):
Absolutely. The way that they come out fast as part have the younger kids you can see a little bit more tense and behavioral changes avoidant client ability. Well as the teenagers you’re going see more moodiness withdrawal, like a focus distraction really present differently depending on the age. And a lot of kids and teens don’t want to talk about it, but I think adults were more self aware, I don’t like this, I am going to talk about it was kids and teenagers don’t always know what’s happening to them and they’ll also embarrassed. So particularly teenagers do not necessarily go to hear about it from them. They just go to have to pack up on their bump, avoid them the tantrum.
Dr. Sarah (16:08):
And so I think sometimes parents can miss it and don’t see the anxiety underneath the grumpiness, the irritability, the moodiness, the tantrums. Especially in younger kids it can look like a very dysregulated child. Sometimes it even can get misdiagnosed as ADHD in very young kids, I think.
Dr. Terri (16:32):
A hundred percent. And it’s tricky since ADHD and anxiety can sometimes become more of a, sometimes it could co-occur but in the absence of ADHD, when it’s pure and anxiety disorder, you see lack of focus. We see distraction and so that can be ED as adhd, but but anxiety, you definitely gonna see misbehavior. You’re going to see protest resistance. I don’t wanna go to the sleepover, I don’t wanna go to this party. Then you might be so frustrated with your kid but really than just so anxious.
Dr. Sarah (17:09):
And it’s different. We were saying grownups, we have more self-awareness. We can say my body’s feeling uncomfortable, I’ve got a racing heart, I am having racing thoughts, I’m worrying about this thing. Kids, especially young kids, but even some teenagers don’t have the language or the self-awareness to be able to really reflect to their parents or to other people in their lives. I’m feeling anxious. They just show it. And so how can parents decipher some of these behavioral cues? What are ways that parents can maybe look under the surface of the behaviors to see if and check what should they be looking for to see if there’s really anxiety underneath those behaviors?
Dr. Terri (17:54):
So I think parents might need to be direct and really just flat out ask. But if you’re going to ask, you need to do over a really sensitive way in a really non-judgmental, non-shaming way. And sometimes I encourage parents to tell the story about themselves and their own anxiety or time and their life that they will really fix that. And kids love hearing love stories about the parents say if you share, you disclose, you know what I would then third grade that I had to do the first day school, I remember that this was really hard for me. Did that sound like what’s go for you? And I think if you ask and you ask the non shaming nonjudgmental way, your kids will tell you what’s go for that.
Dr. Sarah (18:44):
Yeah, I think sometimes we have to give them the words, not in a priming kind of way, but a, I wonder if this might be what’s going on for you? The I wonder statement is a game changer in my family. I don’t know about you.
Dr. Terri (19:03):
I think given language, and modeling language could be really powerful. And I also think it’s not always up the parent to figure this out. If you see that your child is struggling, they seem to be having a hard time, they didn’t increase an irritability, a tan and you think something might be gone, do not hesitate to this A professional to find the therapist who can deal an assessment and the evaluation and who could tell you where they go again. Which leads to again the child end up getting the child to go, which is a whole separate topic. But I think that parents shouldn’t pressure on themselves to diagnose and to address it, to really leave it to dedicate to an expert.
Dr. Sarah (19:52):
Yeah and I think when you and I were talking about this episode, you made a really amazing point which is there’s so much information out there for parents today telling them do this, just teach your children mindfulness or teach them these strategies. And it’s kind of gets put on the parent to feel like it’s that my responsibility as a parent to be able to manage my child’s anxiety and you made a really important point that that’s not fair to parents and it isn’t their responsibility to manage their child’s anxiety. That’s a huge undertaking and you need to have help with that.
Dr. Terri (20:32):
Exactly. That is exactly my point of view on the matter, which is that I think that teachers especially will say to parents, your child is doing blah blah blah and then the parent, they punt it to them almost like a football, I’m handing this problem over to you. And then the parent gets so anxious, the teacher reports that my child is anxious, what do I do? And then the parenting culture within, we feel the pressure to fix it. And I think as parents we need to give ourselves permission to, I am not an expert on this topic. I don’t have a degree in psychology but in child psychology I am going to invest an expert to partner with me and to help me help my child.
Dr. Sarah (21:19):
And that partnership is key I think. In my practice sometimes we work exclusively with the parents. When a child has anxiety there’s a new type of therapy called space. Have you heard of SPACE?
Dr. Terri (21:35):
Yes I have heard of SPACE. I have. I’ve actually presented on, I’m really familiar with it.
Dr. Sarah (21:40):
Oh let’s talk about SPACE. So one of the ways that we help parents in our practice, sometimes we work with parents exclusively when a child has anxiety, but even when a child is the one going to therapy, we always bring the parents in to give to work kind of holistically with the family because you can’t treat a kid’s anxiety in a vacuum without the parents.
Dr. Terri (22:04):
And to think about SPACE is on the one hand with star you with the parents are not responsible for fixing. At the same time there are things the parents can do to certainly at minimum not make up worse of what SPACE does to teach’s parents some skills and some tools to not exacerbate the anxiety and to even help a little bit. So SPACE is really good, especially when the child refuses to attend therapy or is not able to, it’s really be distant. Then parent can learn some tools but again the parent wouldn’t be doing these strategies by themselves. The therapist will be working with the parent and teaching them these strategies and that’s the kind of beauty of it.
Dr. Sarah (22:53):
Yes, my practice, we’ve gotten so interested in SPACE, almost all of my clinicians have gone through the training for it in part because we work with a lot of parents of very young kids and I’ve found that that’s super helpful because space, the child is not involved in the therapy there. The interventions are all on the level of parental behavior, reducing our accommodations of the anxious rituals that occur in anxiety. I often describe it as we as parents, when our children are anxious, we end up inadvertently becoming the snooze button for their anxiety. We feel so compelled or pulled in by our child to hit that snooze button, turn off the uncomfortable feeling for them and they become really dependent on us to hit the snooze button. And what I like about SPACE is it helps the parent develop strategies to not hit that snooze button, support the child to hit, to dismantle that alarm on their own. But it’s great for really young kids who can’t really do therapy as well.
Dr. Terri (24:06):
Correct. And I think one of the most powerful intervention within SPACE for parents is to not allow the child to avoid the feared situation. Now this is where accommodation comes in. We’re tempted to, oh you don’t have to go to school today. You could stay home from camp today. Oh I’ll call the mom and you don’t have to go with the sleepover. When we do that, we make it worse completely unintentionally and instead of over accommodation, but the science shows it better is to say to the child with empathy, I know this is hard but you don’t wanna go to camp today and you are going goodbye and I will see you later. And that’s really hard for parents. But once you do it, you really see the impact and you don’t deal with the ab avoidance.
Dr. Sarah (25:05):
And I think that piece of the validation is critical. You have to let the child feel seen in their distress. You have to name it, you have to acknowledge it, you have to give it validity. It is so hard to do this, it’s hard to say goodbye. It’s hard to spend the day at camp. It’s hard to be xyz. Whatever the fearful the fear is, right? Or the avoidant thing is, and I know you can handle this feeling and I know that you can give this a go. And so that emotional support without necessarily adjusting the schedule or the plan or making a big change. And sometimes kids can’t go to camp, it’s too much. Maybe we have to scaffold, maybe we have to work our way up. Sometimes you need to know your kid and you gotta know how far I always talk about it. Can we bend but not break? Can we stretch them just far enough so that they’re not so distressed that we’ve missed the window of change?
Dr. Terri (26:13):
Absolutely. And if you think about psychological sciences, about expression therapy, we create hierarchy. If we take it done and incremental baby steps, you would not just put your child in the deep end of the pool, you will start out the shallow end of the pool and you would incrementally work your way towards. So yes, you need to start as small and also firm that this is gonna be okay. To your earlier point about validation, I think the trick is to blend the validation with the firmness. So you start with the validation, you start with a reflective statement. When you acknowledge the child’s feeling and know this is hard for you and you follow that up with the limit and you are going to go to camp today and you could book on that but it’s going to be fine. You could do that something encourage to offer another praise that’s really helpful. But I think the parents sometimes forget to do that praise, to praise the brave behavior. A lot of time we over attend to the anxious avoidant behavior, but when a child does something really great without always remember to call them out and to give them a compliment. And that’s really important.
Dr. Sarah (27:32):
Yes, I agree. I think, and it’s interesting, I think praise, praise is tricky for parents these days. Like praise is confusing cuz you hear a lot of people being out in the parenting world saying don’t praise your kids. It will make them, it inhibit their intrinsic motivation or which to some degree we know is true. But I don’t think the antidote is to not praise our kids. It’s just to be mindful of the way that we praise our kids.
Dr. Terri (28:05):
Precisely. I think they can never be assure. So my person independent is you cannot praise your child too much. But like you said, the way you praise or how you praise can make a difference without maybe the effort, not the to be acknowledged how hard you’re broken, how hard you try, love how you did that rather than great painting.
Dr. Sarah (28:34):
Yes a hundred percent.
Dr. Terri (28:36):
But it is a great painting. That’s fine too.
Dr. Sarah (28:38):
It’s totally fine and we all do it. I definitely say good job to my kids. But I do try to be mindful of that, of balancing that out with the effort, the resilience, the grit, how hard you worked on something I spend when it comes to anxiety, I think that part’s actually really critical because if we just praise a child for going to camp when they’re anxious, we make camp potentially a little bigger than it is. It can put camp on a pedestal, it can create pressure around maybe today they could and tomorrow they might not be able to. And now then if they got praised for going to camp, they might feel like if they can’t the next time they’ve failed. Versus if your child’s really anxious about going to camp and they make it one day without any issues going to camp and they say goodbye, a drop off and you say it was so hard to say goodbye this morning and you were able to do it today.
You push through that uncomfortable feeling and you got yourself in with your friends and you made it. That focus puts the focus on the work that they did to get there and not camp itself. Which I think is when you have a child who has anxiety, like you were saying, we were saying at the beginning and attuned to things that feel scary. And so when we give weight a lot of weight to something like an outcome or a job well done or what a behavior we want them to engage in, sometimes it can make that pressure, that thing feel very pressurized, which can actually increase anxiety.
Dr. Terri (30:27):
I love how you said that and I really love how you faced it. That was spot up. That’s exactly right. Which is to trace the attempt at the fact that you had hard feelings and you persevered. That’s the part we’re praising.
Dr. Sarah (30:46):
Mhmm. Cause that’s the part that we really wanna help build up in our kids when they having all kids. But when you have a child who has anxiety, part of it, like you were saying, the two components you talked about, one of them was underestimating their ability to cope with something. So we’ve gotta increase that confidence that they can cope. And we do that by helping them notice when they’re doing it and logging that. It’s like I’m capable, look I did this thing. I’m rewriting the blueprint or the narrative that I have in my mind of my abilities.
Dr. Terri (31:20):
Yes, exactly. The coping and the ability to get through is the part that we really want to call them out for. Which is you have skills, you could do this, you did this yesterday, what was that like for you? Do you think you could try get tomorrow?
Dr. Sarah (31:38):
Yeah, I think that’s so empowering and it’s empowering for parents because that’s doable. Parents often feel overwhelmed when their kids have anxiety, they feel very helpless. They’re like, I don’t know how to respond to this. But giving them these really concrete frameworks, we validate the feeling but we encourage them to see themselves as capable. We communicate that confidence and then when they are able to do something, even if it’s incremental, we really notice the effort that they put into the thing and work with them to rewrite their narrative of their abilities. Like that’s doable for parents. It doesn’t mean the anxiety disorder is gonna clear up just cuz you do that takes time and work. But that’s much different than saying mom and dad, make this kid not anxious anymore. It’s on you.
Dr. Terri (32:31):
It’s definitely doable and it’s part of the work of parenter because parents are get really hard all the time. We’re trying to get them to do things they don’t really do day after day, morning after morning. So it’s sort of the power of persuasion and again the validation part is key. The refraining from allowing them to avoid is key. And the power can also keep in mind to model for your kids. If you as a parent are anxious, I have to say it’s really best to not we show it. We definitely want to communicate to kids that it’s okay they have feeling that as parent we have feelings too, but we don’t want to model freaking out for them because they might copy that. So by I with encourage parents to really adopt a poker base, if you are afraid of go got the rollercoaster, maybe try to demonstrate that this is really hard for me and I’m going to go on the rollercoaster.
Dr. Sarah (33:36):
Right. And I think poker face about the be belief that I can’t do this, but maybe also saying I am feeling anxious, I’m just going to push myself to do the thing. So it’s like we wanna model not avoidance, we wanna model pushing ourselves out of our comfort zone. But I also think it’s okay for us to acknowledge when we feel anxious. Like you were saying, kids feel kind of seen when their parents say, I’ve had this feeling too. I know what this feels like.
Dr. Terri (34:14):
Exactly. So this is sort of, well the blend comes in, well you’ve stayed feeling, you feel the come way to demonstrate to your child and it’s okay to have feelings. It’s okay to have negative emotion and this is how we try to cope with this negative emotion without, by the way we try to get through this is me, mom, dad, this is me doing good.
Dr. Sarah (34:41):
Yeah, yeah. Narrating that whole process I think is gonna be so powerful for kids. So I’m curious what you think about this cuz this is a sort of slightly different topic, but I think related, I have a lot of kids and parents in my practice who experience anxiety about things that are objectively scary. It’s not, oh I’m scared of a rollercoaster cause I’m scared the whole thing will fall apart. But the pandemic, climate change, gun violence, things that are happening and are objectively scary, how do we help people who have anxiety when the things they’re are afraid of are not in their heads? They’re also in reality.
Dr. Terri (35:28):
Great question. Because the world will live. It’s insane. And so that is an incredibly relevant question. I’m so glad you asked that. So I would stop by reiterate my earlier point about validation. I think we first need to validate for a client that is understandable, you’re feeling this way. It’s hard because it’s hard. The reason that you’re having this feeling is this situation is legitimately frightened after that, after you offer that support to maybe talk about some distress tolerance skills, what are some strategies for managing distress? The distress tolerance piece is really important, but what do we do? But there’s a circumstance that we hate but that we can’t change. I’m thinking about a shooting that happened earlier this summer that was just horrifying. And I think that this is, well, acceptance based method can be helpful and that always have to be really acceptance doesn’t mean approval.
It does not mean that you come by then. I mean that is an understatement. It’s more that you accept this is a really difficult circumstance, it’s really upsetting and there is nothing necessarily that I can do about it at this moment. And that’s okay. But at the same time, always covered client to focus on really distinguishing between what you can and cannot control. If there’s a circumstance where you just can control a substance is perfect, if there’s something that can be done, then you should do it if there is an action that you can take. But I think that focusing on what you can control it, taking some small steps is another really waste strategy. But one anxiety is legitimate.
Dr. Sarah (37:29):
Absolutely. That is such a helpful and simple four step process to keep in mind. Not that it’s always easy to, but it’s important to validate. Yes, it is scary practice distress tolerance skills. So I have my strategies for managing distress that I know what I can do in these moments that it’s hard and scary. Three is an acceptance based model. So I have to sort of accept on my own that there’s some things that I cannot control. And then four is take actions on the things that we can do these small steps one thing at a time. And this strategy is true for grownups and it can be tailored for kids too. Because I think kids in general, they live in a world where they’re pretty helpless. They don’t have a ton of agency. And so when things that are objectively scary happen in their world, it really compounds that sense of helplessness potentially.
Because even when scary things aren’t happening, kids can tend to feel of helpless. A lot of things just happen to them and they have to just find their way through it. So this idea of finding, helping kids understand what they can’t control and helping kids understand what they can control and really as the parent or the therapist creating awareness of tangible control in a child’s life. And sometimes it’s not about the thing that’s scary. I think it’s important to note sometimes control, tangible control in a scary situation can look like I can control what game I play with my brother today. I can control which shoes I wear to school today. I can control what pair of pajamas I wear. But as parents who wanna give that authentic, these opportunities for a lot of authentic control to our children who feel anxious because it helps them of balance out that sense of helplessness that comes with anxiety sometimes it doesn’t always have to be related to the thing that they’re afraid of.
Dr. Terri (39:35):
Anxiety really is about control. It’s a really common theme in anxiety disorders. And other times I will ask the people that I work with know what’s really, go again, what is this really about? About are you truly afraid of this situation or are you more concerned that it going to be out of control? I mean that’s maybe an attempt to get control. We see that and that with generalized anxiety disorder with things like overplanning overcompensating, which is really just an attempt to have control.
Dr. Sarah (40:14):
So I think helping kids both have control when they feel out of control, but also tolerating the lack of control that comes with life is also, it’s like a tightrope. We have to walk not always obvious what is gonna work. And so I think that’s where it’s always helpful too, to have help from a professional to come up with a game plan.
Dr. Terri (40:39):
Yes, I always say let’s delegate to the professionals. Really take the pressure off of yourself as a parent. And to find someone, especially who does CBT with kids, I think that is a really great fit for younger ages. I mean it’s a place for all ages, but younger kids, we use a lot of child funding metaphors.
Dr. Sarah (41:05):
Yeah, I agree. So this book that you wrote, Goodbye Anxiety, which is a guided journal, it’s full of prompts to help you really think about anxiety in a way that helps you feel like you’ve got control, you have a sort of roadmap. How did you end up thinking to write this book? How did this book come about?
Dr. Terri (41:25):
That’s a great question. So I have to be completely honest that I lucked out. I got really lucky because a colleague of mine introduced me to the publisher and it was actually the spring of 2020. So I was massively stressed with the lockdown part of the pandemic. And I think this is a good example that yes, because I took the car just to find out more and I really connected with the publisher. They were really looking for someone who was an expert at CBT who could offer really create this resource for teenagers and tweens, but the best of us on how to manage anxiety. So it was kind of serendipitous.
Dr. Sarah (42:16):
That’s amazing. And it’s really, I mean it’s really great. I think this is something that I certainly think teens and twins in my practice would like. But I also think some of these things that are in here can be translated for younger kids.
Dr. Terri (42:31):
So the audience of the book, as I would say the best age range for this book would be 14 to 24.
And in that it is dying to be youth funding. It’s dying to be relatable, to really take psychological science and make a fun. I have another pop culture reference it in the book. I make reference the music and movies. I had to do a lot of Googling, by the way, because I’m old and I had to kind of really pretend to be hip. But the book is really designed to appeal to young people, young adults, tweens, teens. It’s also meant to be giftable, understanding that parents, one parent teachers, educators can really pick it up and give it as a gift to someone that they think is with anxiety and is kind of discerning. It has pretty colors and graphics and pictures. So I think that it’s really youth funding and can be given quite easily as a gift. I also think parent could pack up a copy and deducted them more about C B T and some of the strategies and principles that are involved in this treatment of it.
Dr. Sarah (43:48):
Yeah, no, I think it’s a really great resource. What’s one of your favorite strategies from the book that maybe if you are a parent of a younger kid you could pull and use with a child?
Dr. Terri (44:01):
By far, my favorite is the idea of taking a breathing break.
Dr. Sarah (44:07):
Okay. Yeah, talk about a breathing break.
Dr. Terri (44:10):
I’ll tell you about the breathing break. The breathing break is the idea of just stopping for a moment to take a breath, get think about breath again. You can’t lose your breath and you can’t leave it at home. You always have your breath. But it could be done anytime, anywhere, any place. And no one even needs to know that you’re doing it about a breathing break. How it differs from this regular breathing that it deliver slower. We talk about something called square breathing, which is just, I take the number, only number, I tend to use the number four and you inhale to the counter four, pause, pause. And then you exhale for, and this is lower breath, really engaging the diaphragm and it’s really relaxing but also and sued the nervous system because you’re getting more oxygen to the entire part of the body, but you’ve got more oxygen body parts really kind of activate the power sympathetic nervous system, which is really good for common. And I think parents can quite easily teach this. You can really demonstrate it.
Dr. Sarah (45:28):
Yeah, no, I love that. And I think it’s also really helpful to teach these skills in fun playful ways and calm connected moments. Not in the midst of a moment of intense panic and anxiety, but to kind of build these into life. And then after that way they’re more accessible in that moment when things are hot.
Dr. Terri (45:54):
I completely agree and I think that a time be made fun. And sometimes we use metaphor like pretend that you have a book on your stomach and you want the books to go up and down, but pretend like the blow up a balloon, what would that look like? That still together. And maybe we could even have a breath contest.
Dr. Sarah (46:14):
Yeah, yeah. We can make it playful. Cause I think nobody wants to take, be told, take a breath when they’re in stressed out. We have to build the comfort with breath work in outside of those moments. Cuz otherwise it’s, it can be, I feel like if I’m really upset or anxious or stressed out and someone tells me to take a breath, I find that I’m like, you take a breath. We have to build that into the relational aspect of things outside of those moments. So it’s an accessible tool.
Dr. Terri (46:52):
Dr. Sarah (46:54):
Well this is amazing. Thank you so much for coming on the show. And if people wanna learn more about your book or learn more about the work you’re doing in your practice, how can people find you and learn more about you?
Dr. Terri (47:07):
Dr. Sarah (47:14):
Dr. Terri (47:15):
Which is super exciting. There’s a Barnes and Noble three blocks from my house. So I usually go to like, I enjoy stopping by to check on my book.
Dr. Sarah (47:24):
Dr. Terri (47:25):
So you could get it in stores at Barnes and Noble, but you could certainly get that on Amazon and independent booksellers that are online. And if books would like to learn more about my practice, certainly my website would be a great resource is drterribacwo.com. And I could also be found on Instagram, which is @drterribacow. And the Instagram had a lot of information about the book and the data of excerpt from it.
Dr. Sarah (48:00):
Dr. Terri (48:00):
First of all, I encourage everyone to buy it, but if that’s not a possibility, if you go to my Instagram going to see images from it and quotes from it. And I really encourage people to do that because social media is so accessible.
Dr. Sarah (48:18):
That’s amazing. So there’s a lot of ways that people can get access to the resources that you provide, which is awesome. And we’ll link all of these links in the show notes. So if you’re listening and you wanna reach out to Terri, you can find her easily.
Dr. Terri (48:31):
Dr. Sarah (48:33):
Thank you so much for coming on. It was so great talking to you.
Dr. Terri (48:37):
Thank you so much for having me. This was wonderful.
Dr. Sarah (48:45):
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