Transcriber: Ūla Ivinskytė Reviewer: Vilma Veršylaitė
Theo was eight years old and was terrified of spiders
He was afraid that a black widow spider
would come into his bed at night and bite him, and he would
die. He left a light on. He searched his room for spiders at night.
He begged his parents to keep the windows closed, but Theo also had
another thought.
This was the belief that for him to be safe, the very last
thing.
That he saw or heard or even thought about
before falling asleep had to be his father saying to him
Good night, son, and I love.
You very much. That was the last thing. He would be safe.
Otherwise Spider would get him And he would die.
Now.
Admittedly.
This does not make a lot of rational sense.
All of our research indicates that spiders.
Do not care if your father loves you.
Very much or not.
It does, however, make.
A kind of emotional sense.
Because a parent saying to a child, I love you can make that child feel safe.
And so when Theo was going to sleep at night.
He called his father into the room and he said, Dad, can you say.
Good night, son and I love you very much?
And his father felt good and said, Of course, goodnight, son.
And I love you very much.
and he walked out. Theo tried to
hold on to that safe.
Feeling, but it takes time to fall asleep.
And soon.
Another thought came along to ruin it.
Maybe even a thought about the spider. And so he called his father
back into the room and he said, Dad, can you say it again?
And the father said.
It again and walked out. But then he called him back
said it again, walked
out, called him back. I directed the Child Anxiety program
at the Yale Child Study Center And when I
asked Theo’s dad, How many times are you actually saying.
Good night, son? And I love you very much
He averaged about.
120 times.
Per night.
That is a solid two or 3 hours of going In and out of
your kid’s room to say, Good
night, son, and I love you And let me tell you.
It might start out Good night, son.
And I love you very much.
When you’re at 120 times, it’s more like, Goodnight, son.
I wish I had a spider to throw on you.
These are 3 hours that you can't do anything else.
All right, let’s see. You have time for one one more.
Kelsey. Kelsey was very worried about health and illness.
Her mind obsessed over images of her dad having a heart attack.
Or her mom getting. COVID. Or she herself getting.
Pretty much anything.
And when she had asked her dad.
For the millionth time if.
He was sure he wasn't going to have a heart attack, he said, Of course not.
I'm healthy. I'm strong. I'm fit. Look, I can even do push ups.
And he did 1020.
Pushups just to show that he's in great shape.
But then Kelsey started wanting.
To see him do pushups every day.
This guy had not been this fit in his life. And when Kelsey’s mom
Got fed up with taking.
And retaking Kelsey’s temperature to prove she doesn’t have a
fever, she said, I’m a nurse. I can see that you’re fine.
I see the sparkle in your eye and it tells me that you're healthy.
And then Kelsey started coming to
her every day and saying,
Can you check for the sparkle in my eye? Do you see a sparkle in my eye?
What is happening in these families?
Why are so many parents
sucked in to their Children’s anxiety Symptoms?
In these ways it’s a phenomenon called family accommodation.
What it refers to are all of those changes
that parents make in their own behavior to help their child
not feel anxious. Family accommodation is present in almost
Every case of child anxiety.
But even though parents are accommodating to help the child not be anxious.
As they do, that more and more
Children tend to get more and more anxious over time.
So today I want to talk about
Why accommodation is so common.
How it maintains rather than reducing anxiety.
And how recognizing the role of accommodation opened.
The door to space An entirely
New treatment for child anxiety and obsessive.
Compulsive disorder. But first, why? Why do.
So many parents find themselves sleeping next to a child with
Separation anxiety or speaking in place of a
Child with social phobia, or washing Their own hands
compulsively because their child has OCD?
Or any one of the countless other examples that
I encounter almost every day.
Why is it so common?
I will tell you that one, It has to do with a critical aspect
of child anxiety, but one
which has been largely overlooked in how we think about, understand and treat.
These problems. You see, it turns out.
That human beings are mammals. I know
This is why you watch a TED talk.
So you can learn exciting new facts.
But actually, that’s simple
Fact of our mammalian nature has some key relevance here. Because mammals are born
Not really ready for life. They’re not able to protect themselves. They rely on
caregivers for protection. Look. Think about what would happen
if you were to walk up to an adult, a stranger, say, and you were to
frighten them.
They would have a fight or flight response.
They might confront you or they might get away from you.
But what about if you were to walk up to somebody, baby.
And scare them?
To be clear.
I am not. suggesting that you scare babies
In the name of science I have learned that this is not
a great way to make new friends
But if you did, that baby would do neither fight nor fight.
We're not equipped for it. We know what the baby would do.
The baby would cry really loud and that crying would serve as a signal
to the baby’s parents
to say, I’m in danger, I’m scared. You need to step
in and get this creep away from it.
And it's not only children who are hardwired to respond to fear by signaling
caregivers. It’s also parents who are hard
Wired and powerfully motivated
to detect the cues of fear in their children and
to step in and provide that protection and ultimately regulation and soothing
And what this means is that when we're thinking about children,
anxiety is actually
Not a one person phenomenon. It's an. Interpersonal system.
Happening between child and parent and so it’s not
That surprising that if a child has a disorder, like an anxiety disorder,
where they chronically feel anxious, of course.
Parents are going to get sucked in to responding to that anxiety.
Through all of those accommodations.
But how is it that even though they are bending over backward and working
so hard to accommodate so the child won't be anxious as they do it,
children get more anxious rather than the opposite?
Well, think about the message that a child is.
Learning through those accommodations.
Are they learning? Anxiety is
uncomfortable, but it passes and I can deal with it. No.
The message is more like
I cannot handle my anxiety on my own.
I need my parent to rescue me from it.
You know, it's kind of a funny word, rescue.
We we usually associate it with really positive things like bravery and heroism.
But it's always the rescuer who is brave and heroic.
Not the one being rescued.
You only need to be rescued because.
You're facing a danger you cannot cope with on your own.
It is great to always have someone to
rescue you. But two always need to be rescued.
That is a really scary way to live.
And parents can have a.
Big impact.
On this kind of thinking. In a sense, a.
Parent is a lot like a mirror that their child
looks into.
To see who they are and when they look in that mirror
And what they see reflected to them is a child who is helpless.
And weak and Vulnerable in the face of
anxiety. Well, that’s what they believe.
And their anxiety gets worse.
Think about how you would talk to a child who had a physical illness.
Let's say something like diabetes. You would never sit that child.
Down for a conversation and.
Say, what a shame that you of all.
Children have diabetes.
Because let's face it, you kind of suck at diabetes.
You’re just not really good at coping with it.
You would never say that. You know, they have to cope with this situation,
with this illness, and you want them to believe they can.
And when parents can show.
Their child a reflection.
Of themselves as strong and.
Capable and able to handle.
Anxiety, well, that's what the child believes and their anxiety can get better.
And that is not.
Just wishful.
Thinking.
This paradigm shift.
In understanding.
Anxiety as an.
Interpersonal system.
And the pioneering research on the role of family accommodation.
Led me to develop space or supportive.
Parenting for anxious.
Childhood emotions. Space is a completely parent based.
Treatment for anxiety.
And OCD. What that means is, rather than a child going to sessions,
parents go to sessions and learn how to change their behavior
and how they are responding to that child's anxiety.
Everything that happens in space is about The parents behavior
and in fact, I make a simple promise to parents early on
I say at no point in this whole treatment
are you going to be asked to make your kid to anything.
Nor will you be asked to stop them.
From doing anything. But we're going to.
Focus on how you are responding. And in
Particular, parents learn to make two critical changes.
To be more supportive.
And less accommodating.
Supportive in space.
Means that you’re responding to
your child in a way that shows
Them Both acceptance of their genuine distress
Along with confidence in that.
Child's ability to tolerate that distress.
For Theo.
That might mean his dad saying.
I get how scared you are about spiders.
And I'm 100% sure you can handle that fear . Or Kelsey's mom could say.
I know how worried you are.
About getting sick, and I'm sure you can handle that worry.
The second change that parents learn to make is to reduce those.
Accommodations not all at once.
But bit by bit, gradually, step by step with careful planning. They can reduce.
The accommodation and move from that role.
Of rescuer of their child to a more supportive role.
And as they do, children get better. For Kelsie.
That meant her mom Gradually limiting
the number of times she would take her temperature. And believing
that Kelsey would be okay, even if she really.
Really wanted her.
To check again.
Findings from clinical.
Trials show that space is as effective as working directly with
a child in therapy. And of course, for some children.
Who can't or maybe won't.
Work directly in therapy themselves, it can be.
Pretty much the only option. When Theo's.
Dad stopped going.
In and out of his room and.
Limited his I love you.
To one per night. They had some difficult nights.
But Theo came to see that he could handle that fear.
And once he believed that he was well.
On the way to overcoming it.
So that is how changing our
Understanding of how anxiety
works in children and acknowledging the.
Role of accommodation opened the door.
To a new treatment.
That is changing the lives of children.
And parents affected by anxiety. And if you are the parent of.
A child who struggles with anxiety, you may be able to help.
Them to overcome it. Because remember.
The world is full of children
who used to have an anxiety disorder.
Thank you.