Parenting Strategies for Young Children with Anxiety – The SPACE Method

0:04 Good evening and welcome. 0:06 Thank you so much for joining us for tonight’s webinar, Parenting Strategies for Young Children with Anxiety, The Space Method, presented by Ms. Giddy Gordon. 0:14 My name is Katie Delaney, and I’m the Family and Medical Outreach Coordinator for the New Jersey Center for Tourette Syndrome and Associated Disorders. 0:25 I will be your facilitator for this evening. Before I introduce our presenter, I want to go over some housekeeping notes. 0:32 the audience is muted. 0:34 If you’re attending the live webinar, questions can be submitted in the questions box at the bottom of your screen. 0:40 During the live Q &A, the audience will gain access to unmute themselves. We will stop recording right before this. 0:47 At the top right of your screen, you will see a paperclip icon. 0:50 There you will be able to find a copy of the presentation slides and upcoming events. At the bottom of your screen, you will see a react button. 0:57 To the right of it an arrow. 0:59 When you click the arrow you’ll see a few emojis appear such as a heart, thumbs up, etc. 1:04 Throughout the webinar, feel free to use this feature to let our presenter know how they’re doing. 1:09 Now if you guys have found that, can you give me a thumbs up or a heart just so I know you guys know where it is? Beautiful, thank you. 1:21 So for those viewing the webinar recording, you will not have access to these features. 1:25 However, any questions you have for the presenter can be submitted through the chat box to the left of your screen. 1:31 The presenter will answer those questions on our webinar blog located on our website njcts.org under the programs tab. 1:39 This blog will be monitored until Monday, December 23rd. 1:43 Any personal information will not be included in the post. 1:47 The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors and employees assume no responsibility for the accuracy, completeness, objectivity or usefulness of the information provided on our site. 1:59 We do not endorse any recommendation or opinion made by any member or physician, nor do we advocate any treatment. 2:06 You are responsible for your own medical decisions. 2:10 Now it is my pleasure to introduce our speaker for this evening, Miss Giddy Gordon. 2:15 Miss Gordon is an individual and family therapist at Central Therapy New Jersey and PhD candidate in clinical psychology at Long Island University, Brooklyn. 2:27 She specializes in treating anxiety, PTSD, OCD, depression, Tick’s and Tourette syndrome, ADHD, suicidality, and neurodevelopmental disorders. 2:40 Miss Gordon, the floor is all yours. 2:45 Great. Can everyone see my screen? Can you see my slides? 2:52 Perfect. Love the thumbs up. 2:55 Yes. Thank you, everybody. Thank you so much, Katie, for that lovely introduction. 3:02 I’m really glad to be here with you all tonight. Thank you, everybody, for joining me. 3:07 I’m really excited to be talking about this topic as somebody who works a lot with anxious children and their families, I have found that specifically, in general, I really enjoy talking about anxiety, specifically childhood anxiety, but I’ve also found this treatment program called SPACE, a parent-only treatment program that I’ll be talking about tonight to be super, super helpful and useful for the children and families that I work with. 3:36 And so I’m really excited to be sharing some of those insights with you all tonight. 3:41 All right. So let’s jump in. 3:45 Just a quick overview of what we’re going to cover tonight in this presentation. 3:52 First, I’m going to kind of talk a little bit more broadly about anxiety in general, understanding the difference between normative and clinical anxiety. 4:01 We’ll talk about some facts and myths about anxiety. 4:04 And finally, we’ll talk about kind of how identify anxious children and some signs and symptoms to look out for in childhood in children. 4:14 We’ll then talk about the theoretical model that the theoretical framework that the SPACE model is rooted in and which has to do with childhood attachment and attachment theory. 4:26 We’ll talk a little bit more about the caregivers and the parents role in both regulating their child’s anxiety and also in some cases exacerbating anxiety. 4:36 I’ll then go into the two big main pillars of the space treatment program. The first which has to do with increasing support. 4:44 The second that has to do with kind of gradually decreasing what we call family accommodations. 4:50 I’ll go over some strategies, some practical tips about how to implement some of these some of these programs and I’ll also provide you guys with some resources for those of you who are interested in learning more and we will have time towards the end for some questions as well. 5:08 All right. 5:10 Just a couple notes about anxiety, because I think these are, this is important to think about and to keep in mind as we go through this presentation. 5:19 So it’s really important to first understand what we mean when we’re talking about the concept of anxiety and to really understand anxiety as a normative response. 5:29 Anxiety is what stems, is the experience that we have where our body has been primed to stay alert and detect kind of any threats or dangers in our environment at any given point and mobilizes us to then do certain behaviors or engage in certain behaviors to keep us safe from those threats and dangers in our environment, environment. So in that sense, anxiety is a really important survival mechanism. 6:00 Also importantly, not only have we evolved with this ability to detect threats and respond to those threats to keep ourselves safe from potential dangers, we’ve also evolved with this really incredible power of imagination, which not only allows us to kind of respond to threats in real time, but also allows us to imagine potential dangers that might be upcoming in our environment and to take specific steps to preemptively avoid those potential dangers that we might encounter. 6:32 And so that’s a really important thing to kind of keep in mind when we’re talking about the anxiety system and individuals with anxiety. 6:40 Is this kind of this amazing gift that we’ve been given to kind of imagine dangers and take steps to protect ourselves from those dangers preemptively. 6:52 The issue with that is that while it’s an amazing gift that’s an enormous survival mechanism that’s helped us keep us safe throughout the years, it’s also kind of a double-edged sword because when we have this gift of imagination where we can imagine potential dangers, it also means that we have to be really and not only just accurately detecting threats that might kind of come up and accurately evaluating those threats, but we also have to be super good at kind of that risk kind of benefit analysis to be able to weigh potential risks against potential benefits. 7:29 When we’re thinking about upcoming potentially dangerous or harmful threats or things that we might encounter in our day-to-day life. 7:39 And I say that because when we think about individuals who struggle with anxiety disorders, I like to think about anxiety disorders as in some ways kind of like a disorder of the imagination. 7:52 Individuals as opposed to individuals who have normative anxiety, who do a really good job at detecting threats accurately in their environments, responding to them, kind of weighing the potential risks of certain things they might experience in the future against potential benefits, individuals with anxiety disorders do a couple of unique things in their minds that people without anxiety don’t do. 8:21 And these three, well, we can spend a lot of time talking about anxiety in general and what causes anxiety and what factors contribute to anxiety. 8:28 I think these three things are kind of really important to highlight when we’re thinking about these types of individuals. 8:36 The first thing that these individuals do differently is that just simply they come up when they’re thinking about an upcoming event, a potential, you know, situation they might encounter in their life, they first simply come up with a higher number of negative scenarios in their minds, possible situations that can kind of, that might happen in that scenario. 8:59 So, for example, if a child is invited to a birthday party, an anxious child might be about all sorts of negative things that can happen. 9:06 Things like I, you know, won’t have fun, to things like I might drown in the pool if it’s a pool party or I won’t know where the bathroom is and, you know, I might potentially have an accident and everybody’s gonna laugh at me, right? 9:19 So individuals with anxiety disorders, first and foremost, they’re thinking about a lot, they’re coming up in their imaginations with a lot more potentially negative scenarios. 9:28 The second thing that they, and the third thing they do differently, is not only do they come up with more of these negative scenarios in their minds. 9:36 But they also believe these scenarios to be much more likely to happen than is realistically true. 9:43 And not only do they think that these scenarios are much more likely to happen than is realistically true, but they also consider that if these things do happen, that the outcome would be much more disastrous than is realistically true. 9:58 So for example, if a child’s rate, you know, an anxious child and a non-anxious child might think, come up with the idea that there’s a possibility they might go to this birthday party and say, you know, make an embarrassing comment and say something that like might feel a little bit embarrassing. 10:14 But the anxious child is probably likely to think that that’s very probable, that that’s kind of pretty possible, you know, pretty realistic, pretty likely to happen. 10:24 And not only is it really likely to happen, it’s also if it does happen, and that’s gonna be a total disaster, right? 10:31 This is, if I make that embarrassing question, comment, then I’ll never have any friends and no one will ever talk to me again and that will be the last birthday party I’ll ever be invited to, right? 10:40 So, and that’s as opposed to an individual without an anxiety disorder, might consider the fact that that might happen, but will probably think that that’s less likely to happen than the anxious child. 10:50 And if it does happen, they’re more likely to think, okay, that might happen, but it will probably be okay if that does happen. 10:56 And so that’s an important, These are important kind of distinctions about the minds of individuals with anxiety disorders and the way that they think about kind of upcoming or experiences that might be coming up in their worlds differently than individuals without anxiety disorders. All right. 11:17 Just a couple like a couple facts about a couple statistics about anxiety. What do we know about anxiety disorders? 11:24 We first first of all, we know that anxiety disorders are the most common group of psychiatric disorders both in adulthood and in childhood We we also there’s you know, the research ranges in terms of how prevalent these Anxiety disorders are but anywhere between eight and twenty one percent of children in specific are diagnosed with an anxiety disorder at any given time I also know a lot of you in the audience might have children, might be parents of children with Tourette’s syndrome, or work with individuals with Tourette’s in your day-to-day life. 12:00 And so it’s also important to highlight the extreme comorbidity between Tourette’s syndrome and anxiety disorder. 12:07 There’s a huge amount of individuals with Tourette’s who also have comorbid anxiety, as well as comorbid OCD. 12:14 I’m not going to spend a huge amount of time talking about OCD tonight. 12:18 That deserves its own presentation, but the reason I highlighted that is because the space model that we’re going to be talking about has also been proven to be really highly effective in treating not only childhood anxiety, but also childhood OCD. 12:34 We also know that anxiety problems start early, individuals at the median age of onset of diagnosis is around age 11, there are many different types of anxiety disorders, we’re going to go into all of them but essentially the difference between the different anxiety disorders that we see have much to do with essentially just the type of fears or situations or objects that individuals are anxious about kind of the surrounding fear. All right. 13:06 In terms of these are when we talk about anxiety and specifically childhood anxiety I also like to highlight these two pretty pervasive myths that I see kind of, you know, as being pretty widespread, and I think it’s really important to talk about these myths and work on dispelling some of these two myths that I see as pretty pervasive. 13:28 The first one is that there’s this kind of idea that I don’t know, you know, what it’s, you know, this is rooted and there’s this idea about just children with all sorts of mental health disorders. 13:38 There’s this notion that parents are the cause of their children’s challenges. 13:42 But when we think about childhood anxiety in specifics, some people have this idea that parents are the cause of their child’s anxiety. 13:50 We really know the research is pretty convincing and showing us that that’s really not true. 13:58 Parenting alone contributes pretty minimally to a child’s anxiety symptoms. 14:04 We do know it’s certainly true that genetics play a role, that children with an anxiety disorder are very likely to have a parent that has an anxiety disorder. 14:15 But we also know that correlation is not causation. 14:19 And that just because they have a parent with anxiety disorder does not mean that the parents are the cause of that challenge. 14:27 That’s certainly true because we very often in families, we see that there might be an anxious parent and they might have one child with pretty clinical depilitating anxiety another child without anxiety at all. 14:41 And so at this point, right, the research shows us that there are a lot of, there’s a lot of really, there are a lot of contributing factors, temperament, which is certainly one of them that account for why individuals go on to develop anxiety disorders. 14:55 All right, and I want to highlight that, and I feel like that’s very important to emphasize specifically tonight, because we’re going to be spending so much time talking about about parenting strategies for anxiety. 15:07 I also really wanna overemphasize this notion that although we’ll be focusing on parent behaviors and shifts parents can make in their behaviors, parents are not the cause or the reason that their children have anxiety. 15:20 At the same time, right, we do also know that once we’re dealing with a child with an anxiety disorder, that there are certain parental behaviors that can exacerbate anxiety symptoms. 15:31 So we know that there are certain things that a parent can do that are more helpful for kids with anxiety and less helpful for kids once they already have those anxiety symptoms. 15:41 And in that sense, parents can be a really important agents of change. 15:47 And we’re gonna emphasize and talk about that tonight. 15:52 There’s also this pretty widespread idea that I hear from parents a lot also that kids with anxiety are just kind of going through a phase that kids with anxiety will generally outgrow their symptoms. 16:03 So I wanna talk about that too, because there’s some truth to the fact that there is such a thing as a developmentally appropriate fear or a normative fear, right? 16:12 For example, like all preschoolers that some in that phase of life are gonna have some degree of separation anxiety that’s very developmentally appropriate to get to kindergarten and be scared of kind of leaving their parents and separating from their parents. 16:27 And something like that, when it’s more of a normative fear, or developmentally appropriate fear, those types of fears tend to kind of phase in and out over time. 16:37 But when we’re talking about individuals with clinical anxiety or individuals with anxiety symptoms that are more severe than what’s normative for a certain developmental stage, kids with anxiety with those types of symptoms definitely don’t outgrow their symptoms. 16:53 If anything, we know that these are kids that go on to become adults with anxiety disorders. 16:59 And that, you know, not intervening at a young age is likely to make these anxiety symptoms worse. 17:07 So in that sense, early identification and treatment of these anxiety symptoms is really important for reducing kind of long-term complications. 17:17 The great news is that anxiety is the most treatable of all mental health disorders. 17:22 We know that. 17:23 There are some really effective treatments for anxiety that really, really work. 17:27 space is one of them, but there are others too, and it’s, we see really good results in terms of treating anxiety. All right. 17:41 I just, before we move on to talking more specifically about space, I also want to go over a couple things to look out for when we’re thinking about children who might be struggling with anxiety. 17:53 So some symptoms, some signs, some things to kind of look out for when we wanna identify these individuals. 17:59 So in terms of just some physical signs, some things that we might see in terms of the body, we’ll certainly, we wanna be looking out for kids who definitely have more of that kind of sympathetic nervous system activation. 18:12 So that general of those fear responses when kids are just more fearful, their heart is pumping, more of their rapid breathing, things like that, right? 18:21 We wanna definitely be looking out for that fear response. 18:24 But we also want to be thinking about kids who might be complaining about physical symptoms, like things like headaches and stomach aches, certainly with kids who have what’s called generalized anxiety and tend to worry about a lot of different things in that when we’re dealing with that population, in some ways, the anxiety actually physically makes them sick. 18:47 Right? 18:47 And we see kids like that coming with a lot of complaints of different types of physical problem. 18:53 So if we see a kid who is who we if we encounter a child like that we always want to be thinking about right is there a reason is there some anxiety problem that they’re struggling with. 19:05 We also want also want to look out for appetite changes kids who have anxiety you know when we’re nervous it’s kids you know might not be have as high an appetite. 19:17 We also want to look out for disrupted sleep patterns so nervous kids kids whose anxiety symptoms are activated at any given point, often have difficulty falling asleep, staying asleep, they might have more nightmares than other kids. 19:31 So we certainly want to look out for things like that as well. All right. 19:36 In terms of the cognitive kind of things to look out for in terms of the mind thinking, so certainly those things that we talked about before, we want to look out for individuals who are generally coming, considering and thinking about upcoming situations and coming up with a higher number of negative scenarios that might exist. 19:57 And thinking about these things is very likely to happen and very detrimental if they do happen. 20:02 These are individuals who also generally have what’s called an attentional bias towards threats. 20:08 So they’re just more preoccupied and attentive to kind of threats and potential dangers in their environments. 20:17 There’s some really interesting research about that. 20:20 We also want to be looking out for things like difficulty concentrating and inattentiveness. 20:26 And I think this is also really important to highlight because often when we see kids in a school setting at home who are having difficulty focusing, we jump right away to thinking about, does this kid have ADHD? 20:39 But there might be a lot of reasons why a kid is having trouble focusing. 20:43 And anxiety is certainly one of those things. 20:45 If a kid is worried all the time and preoccupied with anxiety in their minds, it’s going to be really hard for them to focus kind of on the day-to-day tasks for things that are going on in the here and now. So definitely if we see focus issues, we want to wonder about those. 21:02 Emotionally, we certainly want to look out for anxiety and fearfulness, right? 21:05 Those are pretty apparent, but we also want to think about things like irritability, anger, crankiness, intense emotional reactions. 21:14 So when we think about that fight or flight reaction to anxiety, we see a lot that fight reaction in kids. So often anxious kids can look like they have behavioral challenges. 21:24 But we always want to ask ourselves, like, what is the root of those? 21:28 What are the root of those challenges? Is it possible that they might be struggling with an anxiety disorder? 21:33 And that’s why they’re acting out. That’s why they’re cranky. That’s why they’re irritable. 21:38 They might also be more sensitive to criticism. 21:42 Behaviorally, we certainly want to look out for avoidance behaviors, like what we call that avoidance creep. 21:48 So if we see a child who is slowly avoiding whatever that might be, whether it’s not wanting to go to school, not wanting to go to social situations, play dates, not wanting to take the school bus. 22:00 So anything, whenever we’re seeing a kid kind of engaging in these types of avoidant behaviors, especially if they are gradually avoiding more and more over time, we definitely wanna be thinking about anxiety. 22:14 We also wanna be thinking about kids who are kind of more reassurance seeking. 22:18 So often anxious kids treat their parents like they’re human Alexis. 22:23 They’re constantly asking them questions about where are you going? 22:26 When are you gonna pick me up? 22:28 Right, what happens if the bridge collapses when we’re driving over it, right? 22:34 What happens to uncle Harry after he dies? 22:38 Just a lot of questioning about what’s coming up. 22:40 What’s gonna happen? 22:41 am I okay? Am I sick? Am I going to get cancer? Right? 22:45 A lot of kids who are asked, when kids are asking a lot of questions, we also want to be thinking about anxiety. 22:51 Perfectionism is a big trait we see in anxious children and anxious adults. 22:57 So always thinking about that, which is hard because I know we’re a society that tends to reinforce perfectionism, but we certainly want to be wondering about when we see a child who’s overly perfectionistic. 23:09 Clinginess, that’s pretty common in younger children, and like we were talking about with the emotional responses, so behaviorally when we’re seeing things like temper tantrum, fighting, we also want to be thinking about kind of that fight reaction to fear. 23:24 All right. 23:25 And then finally, I have parents often describe their anxious children in these types of ways well and when we think about the mind of an anxious child, we can understand why this might be. 23:34 Very often these kids are talked about as kind of controlling or bossy, right? 23:39 They’re, these are kids. 23:41 And when we think about that and we understand what it feels like to be in the mind of an anxious child who is thinking about all these negative potential things that might happen in their environment that are very likely to happen and be super disastrous if they do happen, right? 23:53 It only makes sense that they’ll wanna do everything they can to control their environments, to maintain that sort of, to make sure that everything goes in the way that they want it to. 24:02 In a similar way, these kids are also described as pretty inflexible or rigid. 24:07 And we can also understand why that might be, right? 24:10 For an anxious child, things that change equals the unknown and the unknown is often very scary and very dangerous. 24:19 So these are kids who can be super resistant to change and anxious about change. 24:28 All right. 24:29 So I know I threw a lot of questions of a lot of information at you. 24:34 We talked a little bit about anxiety in general how to spot and symptoms of anxiety, how to identify anxiety in children. 24:43 I wanna shift gears now to talking about one, a really important feature of childhood anxiety that really makes childhood anxiety very fundamentally different from adult anxiety and is gonna be very important in that reason for treatment. 25:01 Thank you, Katie. 25:03 And really matters for how we approach childhood anxiety in a different way than we do adults. 25:09 So I put up, Katie just put up a poll question. 25:12 Can everybody see that? 25:17 Can I hear- I threw it up a little fast. 25:20 Okay. 25:22 Okay, I see people are already kind of responding. 25:25 So what do you guys think is a key feature that distinguishes childhood anxiety from adult anxiety? 25:31 And you can take a guess at this one for sure, but curious what people have to say. 25:40 So I’ll give people a couple moments to answer this. 25:57 All right, I see a couple responses. 26:00 Take another couple seconds. 26:05 All right, this is a trick question. 26:07 I don’t expect you guys to all know the answer to this. 26:12 But whoever answered, whoever chose the answer that childhood anxiety is an interpersonal phenomenon is correct. 26:22 And that’s a really important feature and distinguishing factor and thing that we to bring attention to when we’re thinking about childhood anxiety that really matters in terms of how we are approaching and responding to childhood anxiety. 26:42 And so essentially, right, and this is the core of this space treatment model and where we and the ways in which we intervene, stands from this understanding of anxiety as a social experience in children specifically. 27:02 And we know this, and this is based on what’s called attachment theory, which stems from this idea that understands the way that anxiety that child children with anxiety, sorry, the way that human children, and all mammalian children really are born very different than other animal species in the sense that when humans are born, they’re not born self-sufficient, they’re not born able to fend off dangers and fend for themselves, as opposed to some other species who are born totally ready for life and very prepared to protect themselves and to deal with the kind of threats in their environment. 27:42 children and other mammals are born essentially totally unprepared for life, they’re not able to self-regulate and they cannot protect themselves. 27:51 And for those reasons, as opposed to an adult who encounters anxiety and fear and might respond to anxiety and fear in a more self-defense kind of way, children respond to fear in a social way. 28:06 So if you ever, I don’t recommend this, but if you ever try to scare a younger child and try to observe how they respond to being scared. 28:20 What we often see is a child starting to cry, right? Starting to cry. 28:25 Maybe if their caregiver is nearby, they might go run to their parent, cling to them. 28:31 But what we see is that when they experience anxiety, they send out these signals and these cues to their caregivers that signal to them, hey, I’m in distress, I’m feeling unsafe, and I’m in need of your protection and reassurance and nurturing. 28:49 And just like those children are hardwired to respond to fear by sending out those social signals, parents, too, are hardwired to respond to those signals in their children. 29:04 And so to notice their hardwired to very carefully attend to their children’s fear cues and to respond to them by helping their child, essentially if there’s a threat, protecting themselves, their children from danger, but then jumping in to reassure them to minimize their distress and help them essentially regulate. 29:26 And that’s a really important thing to think about and to understand when we’re talking about anxiety in children. 29:37 Does that make sense to people? 29:38 Can I get a thumbs up if that’s something that people understand? Okay. Amazing. Okay. So great. 29:47 So, you know, this is when we’re thinking about that social fear system, right, and kids who are not, who don’t have anxiety disorders, that’s a really adaptive system. 29:58 The kid kind of signals out their distress, the parent comes in, rescues them from a real threat, or helps them regulate. 30:03 And eventually this is a child who then kind of learns to accurately detect dangers and threat and learns to kind of eventually translate those regulation skills into the ability to self-regulate on their own. 30:18 The problem becomes when we’re dealing with individuals who have chronic anxiety or clinical anxiety symptoms. 30:27 And if we think back to what we were talking about with individuals with anxiety disorders, we now know that individuals with anxiety disorders are very quick to perceive threats or dangers in their environment when they’re not actually present, right? 30:44 So children like this are constantly sending out those fear signals. 30:48 they’re constantly communicating to the adults in their environment, hey, I’m in distress, I feel unsafe. 30:56 And because of that, the parents are very often constantly responding to their child with reassurance, with support, with protection. 31:06 And the problem becomes, though, while that’s a very, again, we’re hardwired to do these things, so it’s a super normative reaction, a super adaptive reaction to a child who doesn’t have an anxiety disorder. 31:18 When we do this, when our child is actually not really in danger, while that’s a well-intentioned thing to do, this can be a really problematic behavior that can slowly over time actually exacerbate our children’s anxiety symptoms. 31:34 So what that does, right, when we respond to our anxious children constantly to help them regulate or to reassure them in these moments is it actually reinforces the perception and that the threats that they see in their environment are real and actually dangerous and actually harmful, that they’re really at risk and which only makes them feel much more safe, much less safe and much more vulnerable over time. 32:01 It also teaches them that they can’t deal with and cope with anxiety independently. 32:07 It makes them much more reliant on the parents for self-regulation. 32:11 And over time, right, this, what it ends up doing is limits the development of distress tolerance skills, helped, it makes them less confident and less independent in their ability to manage their emotions and their feelings over time. 32:27 And so this kind of problem is kind of really important to talk about it. 32:33 I’m gonna spend some time talking about this concept of family accommodation in a second, But what that term generally refers to are the changes or the things that parents do in reaction to their children’s anxiety or distress that helps their child essentially either lessen feelings of anxiety or avoid them altogether. 32:55 So when parents kind of jump in when a child is in distress and saying, hey, you know, I’m scared to take the bus and they come in and sit with them and they buckle them up and they reassure them and they answer their questions about why they’ll stay safe, right? That can be an example of an accommodation. 33:13 And another accommodation can also be the parent, the kid is in distress, doesn’t want to take the school bus, they’re scared of the school bus and the parent then drives them to school, right? They don’t want their child to have to experience that much distress. 33:25 And so they, they, they shift the way that they respond to their child to help kind of help them avoid that experience. 33:32 What we now know about these behaviors or what we call accommodation is that over time, accommodation behaviors only increase the intensity of a child’s anxiety symptoms over time. All right. And so that’s where the space model comes in. 33:51 And that’s kind of essentially the problem or the reality that space has jumped in and tried to an area that we then try to intervene. 34:05 So SPACE, SPACE is a wonderful acronym that stands for Supported Parenting for Anxious Childhood Emotions. 34:14 It is a parent-only treatment. 34:18 It’s an entire treatment program that has been shown to be really effective in not just treating childhood anxiety disorders, but also OCD by entirely focusing on shifting the parents behavior and giving the parent tools to respond differently to their child’s anxiety symptoms. 34:38 So what’s really amazing about space is that we don’t actually require the child to buy into anything. We don’t need them to do anything differently. 34:46 The treatment in itself works by just simply shifting the way the parents respond or the things that they do in response to their child’s anxiety. All right. 34:58 This was a program who this treatment was developed by a psychologist named Dr. 35:02 Ellie Leibowitz, and essentially there are two main interventions in space. 35:10 The first that has to do with increasing what we call supportive responses, and we’ll go over that in a second, and the second that has to do with gradually reducing accommodation behaviors. 35:22 All right, and we’re going to go into depth into both these things and what that looks like. 35:29 All right, so the first step, that first space pillar, supportive responses. 35:36 So this is the first thing we encourage parents to really to hone in and really be thinking about. Dr. Lebowitz has this wonderful equation that I love. 35:47 He says that support equals acceptance or validation plus confidence. 35:54 And so what we wanna really be doing with children with anxiety symptoms is two things. 36:00 And we wanna be doing these two things equally and really both kind of simultaneously and really well. 36:07 The first thing that we wanna do is we want to be able to convey to our child that we understand that they’re really in distress, that their feelings are really, that things are really hard for them, right, that they’re not like a kid who doesn’t have an anxiety disorder. 36:22 Things feel much scary for them, scarier for them, that this is really hard, right, that they’re really experiencing real fear. 36:30 We want to empathize with their feeling. We want to validate that feeling. 36:34 At the same time, we also want to be communicating confidence in their ability to handle their anxiety. 36:42 So we’re trying to really help kids learn to both understand that their anxiety is real, but that they can cope with anxiety and distress. 36:52 And so this is like this is a really important kind of framework. 36:58 We need to do both of these things and we need to do both of these things equally well to be really supportive for a child with anxiety. 37:06 again we’re like when with our children we’re kind of like mirrors and so whatever we show them and whatever we communicate to them helps them understand their self and their capabilities and we really want to mirror that both that their feelings are valid and that they and and that their feelings make sense um and also that they can handle that distress they can handle and cope with that anxiety all right so for example a supportive response might be something like I see that this is hard for you, right? 37:37 I really see that this is super hard, but I’m 100% sure that you can handle it. 37:42 I also know you can get through this. 37:44 This is hard, but you can do it. 37:46 All right? 37:47 And so that’s the first thing that we try to focus on. 37:52 A quick exercise. 37:54 I wanna, maybe we can all kind of think about this type of scenario. 37:59 And I want you to think about with that equation, right? 38:03 understanding that support equals acceptance plus confidence. 38:08 I want you to consider a child who might be coming to you expressing fear about going to a new summer camp. 38:16 And Katie, if you can help me launch this poll question. 38:20 I want you to think about potential reactions or responses, things, ways that we can respond to our child and which of these responses might be a really good example of a supportive response. 38:33 Which of these is really conveys kind of support in the way the space model talks about. 38:44 All right, so take a moment. 39:06 All right, I’ll give everyone like 30 more seconds to put in an answer. 39:12 And so far, you’re all amazing. 39:14 Most people got this one. 39:22 All right, so great. 39:25 So almost everybody really got this and really chose whoever answered number three. 39:33 That’s correct, right? 39:34 I know going to a new campus hard for you, but I’m sure you got this, right? 39:39 I know that this is real. 39:40 This is a real fear. 39:41 This really feels hard, but I also believe that you can handle this. 39:45 You got this, right? 39:47 So I just wanna go through those other examples and kind of quickly highlight, right? 39:51 What is wrong with these other responses? 39:54 And again, no judgment if these are the reactions that we sometimes have to our children with anxiety. 39:59 The first one, right, there’s nothing to be afraid of, you’ll be fine, right? 40:03 That might be an example of a parent who’s conveying confidence, right? 40:07 You’ll probably be fine, right? 40:08 Maybe we’re conveying to them that they can handle it, but we’re also really not validating their real anxiety. 40:14 When we’re saying things like there’s nothing to be scared of, that’s not really the case with these children, right? 40:20 The fear is really real, and we don’t want to be communicating things that will make them distrust their feelings or not understand their emotions. 40:29 The second one, it’s okay. 40:31 You don’t have to go if it makes you anxious. 40:32 It’s a really good example of a parent that’s communicating acceptance, but not confidence, right? 40:39 They’re showing them, okay, I understand, right? 40:41 Like I get that you’re anxious. 40:42 But also by telling them they don’t have to go, we’re not mirroring their ability to handle this, right? 40:51 And that their capability of getting through this on their own. 40:55 Number four, new camps can be scary. 40:58 I’ll stay all day to help you just in case. 41:05 An example of also a response that we’re not communicating to them that they can handle it, their ability to handle it. 41:15 And the last one, ignoring them to encourage independence. 41:18 That’s a really good example of neither of those things. 41:21 we’re not encouraging confidence or acceptings. 41:25 All right, so those are some other examples. 41:27 In the interest of time, I’m just looking at the clock. 41:29 I’m gonna skip over this, but I’ll share a resource for people to kind of learn a little bit more about this, but there are main traps that parents sometimes fall into with anxious children that kind of map on to these kind of acceptance, confidence questions to their parents who are more protective and parents who are kind of more demanding of their child to kind of not feel anxious and these are problematic for different reasons. 41:58 I’ll give you, you guys can read up about this on your own and I’ll share some resources for learning a little bit more. 42:04 But we want to also be thoughtful about are we falling into any of these traps with our children and really making sure that we’re doing a good job at communicating both acceptance and confidence, right? 42:16 We want to be that mirror that can show them that they can handle hard things, that they can handle distress. 42:23 All right, so that’s the first kind of intervention, really shifting the way that we communicate to our children, showing them both that their feelings are valid and also that they can cope with anxiety. 42:38 The second thing that we do in space is we gradually work on decreasing what we call family accommodation behaviors. 42:45 And so I mentioned this briefly before, but accommodation behaviors refer to any of the things that parents do, changes that they make in their behaviors to help their child avoid or lessen feelings of anxiety. 42:59 So this can look like a whole lot of different things. 43:01 It can be if a kid has separation anxiety that we sleep next to them every night. 43:05 It can be if a kid has anxiety-related stomach aches every morning that we let them skip school. 43:10 It can be we answer their constant questioning. 43:12 It can be a whole bunch of different things, but we do know that these types of behaviors are super common. 43:19 And like we said earlier, the more accommodations behaviors we engage in with our children, the more severe their anxiety symptoms are over time. 43:29 And this just causes a lot more impairment for children and their families. 43:35 All right, and so the second thing, okay, I’ll just highlight this quickly, but there are different types of accommodation behaviors. 43:41 there are accommodation behaviors that have to do with participation. 43:46 So these are behaviors where we’re actively engaging in behaviors that allow the child to feel, to avoid anxiety. 43:53 Whereas modification has to do with accommodations that revolve around kind of changing family routines or expectations to minimize a child’s anxiety. 44:03 So, and the slide you can see, I put a couple of different examples of different types of anxiety problems and ways that parents might respond, different types of accommodation behaviors they might engage in. 44:14 So for example, right, with a kid who, social anxiety, who’s kind of scared about meeting new people, talking to strangers, they don’t feel comfortable with guests coming over. 44:24 So this might be a good example of a modification. 44:27 We change our routine, we do something differently as a family, the parents decide they’re gonna stop inviting guests over to their house, right? 44:33 That’s one example of a modification type accommodation. 44:38 Let me choose an example quickly about OCD, because this is also important, even though we haven’t been talking about OCD so much. 44:46 For example, there are often kids who have a fear or an obsession with odd numbers. 44:51 And so if a child with that type of kind of obsessional fear, they might be, I feel like this has come up with a couple of different children I’ve been working with with OCD, that they needed their parents to kind of give them even number of kisses on the cheek before bedtime. Otherwise, they would feel really scared. 45:09 So a parent who engages in that and make sure to always give them an even number of kisses, right, that’s an example of participating in the anxiety symptoms, right, or doing something to help them at to participating in the anxiety behavior, the avoidance behavior, doing something actively to help them kind of avoid or lessen their anxiety. 45:28 Okay, so there are a whole bunch of different accommodation behaviors that parents might engage in. 45:33 So if you’re a parent of an anxious child, almost all parents do some of these things. 45:40 So we wanna always be thinking about what are some of these things that we might be doing in our day-to-day life? 45:47 Just in terms of what do we do with those accommodations? 45:50 What are the steps to kind of reducing these accommodation behaviors? 45:54 And so we talked about those first two steps of the space treatment, which has to do with kind of just increasing support and just psychoeducation about anxiety. 46:03 But what we would encourage parents to do next is then to create a map of all of the potential accommodations that they engage in at any given point. 46:12 From morning till evening, what are the things that I do differently to make my child experience less anxiety? 46:18 Then we essentially, that’s just kind of for information gathering, but then we choose one target accommodation at a time. 46:24 We think about, well, what is one Accommodation behavior that I engage in that I want to reduce or I want to do a little bit less of And often I encourage parents to choose a behavior. 46:35 That’s maybe happening pretty consistently And that is is causing some sort of like functional impairment. 46:40 It’s really getting in the way of their day-to-day life And so whatever it is at the parents are then encouraged to work on just choose one accommodation and one at a time to reduce We then get super detailed about thinking about well What are we going to do when we reduce this accommodation behavior? 47:00 And so for some parents, this can look like all sorts of different things. 47:05 For some parents, it can be, I get rid of this accommodation entirely. 47:09 I just don’t do it at all anymore. 47:12 So for example, if a child comes to me and they have health anxiety, they want me to check their temperature a million times to make sure they’re not sick, I just stop taking their temperature. 47:22 It can also be, I reduce this accommodation kind of incrementally. 47:27 So I tell them, okay, you can only do one temperature check a day. 47:31 Whatever it might be, there’s no right or wrong way to approach this. 47:34 But we want to be thinking about really, really specifically, what are we doing? 47:38 How are we doing it? 47:39 Who’s involved in this process? 47:41 When is this starting? 47:42 When are we stopping this accommodation? 47:45 And we get very detailed about what we’re going to do differently instead, right? 47:48 If our kid comes to us and says, mommy, take my temperature, right? 47:51 how am I gonna respond differently? 47:53 What am I gonna do instead of accommodating? 47:56 And most, and maybe very importantly, with reducing accommodation, we’re super transparent with our kids about this process. 48:04 If anybody knows anything about an anxious child, we know that children don’t like random surprises or changes in their life. 48:12 And so we don’t wanna just kind of throw this stuff at them and change, shift these behaviors kind of without warning. 48:19 we’re very open with our children about what we’re doing. 48:24 And we share the plan with our kids. 48:26 We’re very transparent about what we’re gonna do and why we’re gonna do it. 48:31 Again, like we talked about before, what’s amazing about space is that we don’t actually expect anything from kids. 48:38 We’re simply doing something that involves a shift in our own behavior, but we do, right? 48:44 So we don’t expect anything from them in the moment. 48:46 We’re just doing something differently on our end. 48:49 But it is important to be open and honest and transparent with our children about what we’re doing. 48:54 Right? 48:54 And so we choose that behavior. 48:55 We come up with a plan for reducing the behavior, we implement it, and then we see how it goes. 49:01 Usually what happens is in the beginning, the child experiences a lot of distress when we’re getting rid of that accommodation, but over time, they learn to handle it. 49:11 They learn that they can cope and things kind of get better as time goes on. 49:14 And once we are effectively, we are able to effectively eliminate that anxiety, then we start over and we do this kind of with something new. 49:23 And so I’m gonna give you guys all a book. 49:25 I know I’m just talking about this super quickly, a wonderful book to read if people are interested in learning more and understanding this process a little bit more about and kind of what that might look like in real time. 49:38 Because it’s tricky and things might kind of come up in the process that we might not anticipate, Ooh, I really wanted to share this with you, but we don’t have time. 49:47 But this is a really great example of a written accommodation plan that one of the parents I’ve been working with had written out to address accommodations that they were engaging in around bedtime. 50:01 Yeah, go ahead. 50:02 You can share it if you want. 50:04 It’s okay. 50:05 Okay. 50:06 All right. 50:06 Yeah, no, you’re good. 50:08 I think people can also read this in their own time, but thank you, Katie. 50:12 I, yeah, I guess you can see, so right, just to give an overview of what they did over here, right? 50:20 This was a family that wanted to address some accommodations they were engaging in with their child around bedtime. 50:27 This was a kid who had a lot of fears around kind of going to sleep on his own and things related to the nighttime. 50:35 And so this family had a whole bunch of like really elaborate ways of helping the kid not feel distressed in the nighttime. 50:43 So they would sit outside the room for a half an hour, and then they would check on the child to make sure they were sleeping, and they would check multiple times. 50:49 They would answer a lot of questions, reassurance-seeking questions from that child. 50:54 And they felt like this was really disruptive of their routine, and this was an area they wanted to target. So this was the behavior that they chose. 51:02 And you can see how they talked about it. I love what they did. 51:06 I think they did a really good job just in the beginning of showing, conveying both support and acceptance, right, as showing to them, right, we know that you’re strong, that you’re brave, that you can handle this. 51:17 We recognize that you’re also really experiencing a lot of really intense fears, right, this is really scary for you. 51:24 But we also know you can, you’re capable of getting through this stuff, right. 51:29 They also took kind of responsibility for and explained to them, you know, why they did the things that they they did and why they’re going to stop doing this. 51:37 In this sense, right, they said, we realized that we tried to do these things at night because we thought they would help you feel less anxious, but now when we think about it and we realize that that’s actually not helping you, it’s actually causing you, it’s actually getting in the way of you being able to be independent, right? 51:53 So they were very transparent about just communicating what we’re doing and why we’re doing it. 51:58 And that this is a family who wanted to do to do this more gradually, so their first steps with, they were kind of not gonna eliminate the accommodation behaviors entirely, but they wanted to start off kind of just doing this a little bit less in a little less intense way than they were before, which is a super valid way to approach this. 52:14 There’s no, there’s really no right or wrong way to kind of address, to approach to reducing these accommodation behaviors. 52:25 All right, and just finally, this is a hard, this is a hard process. 52:29 You know, it’s not easy to stop these behaviors. 52:33 It’s gonna make our kids really anxious, really upset in the beginning. 52:37 So just some tips to get through this process, right? 52:40 Don’t forget to be supportive. 52:42 Praise them when they do things well. 52:44 Give them a written copy so they know what to expect so they can remember, oh, okay, my parents not doing that for that reason, right? 52:49 We talked about this. 52:51 Try to keep your eye focused on the mission in those moments. 52:54 And the mission in this sense is to just simply not do, You know the thing that you don’t want to do right and for your child to get through it It doesn’t matter. 53:03 It’s very like it’s very it’s probably very probably probable that they might become upset aggressive Even to some extent try to ignore those behaviors understand that they’re coming from an anxious place The anxiety might get worse before it gets better Um, but try to really focus on kind of what’s my mission my mission here is to be able to help my kid learn And that they can cope with anxiety. 53:25 That’s that’s really that’s really the goal All right. 53:29 I know I just like went through that like super fast, flooded you guys with information. There’s a lot more to think about, to talk about with this stuff. 53:39 The good news is Dr. 53:40 Leibowitz has published an amazing book that I highly recommend to all parents of anxious children that you can read, you can read more. 53:49 And in his book, he really provides a detailed kind of overview of how to do this process with children. 53:54 So you can definitely opt to engage, to work alongside a therapist in just, in this process of working through the space program. 54:05 But for parents that maybe don’t have those resources, have those times, have that time in their schedule, you can also really effectively do this on your own. 54:13 And that this book that he, that Dr. 54:16 Leibowitz wrote as a really good kind of reference for that process of working through, working through these stages with our children. 54:26 All right. 54:28 Just, I put up a slide, just if anyone is interested and wants to stay in touch, I have my contact information over here. 54:36 Feel free to text me to send any emails. 54:39 We’ll have a couple of minutes for questions now, but you’re definitely welcome to get in touch with any other questions. 54:46 If anybody could use a therapist, both for support with their anxious child, but we have a lot of therapists at our practice that do all sorts of other things, feel free to get in touch. 54:59 And I know we don’t have so much time now for questions, Katie, but I do. 55:03 No, that’s OK. 55:05 If it’s all right with you, we can go over a couple of minutes. 55:08 So no worries with that. 55:10 So I’m just going to jump in right now. 55:13 First and foremost, we’re going to hop into Q &A. 55:18 As you guys know, first I’ll ask the submitted questions, and then I’ll switch to the verbal Q &A, which is when I’ll stop the recording. 55:25 So our first question is, do you feel that when parents work on their own anxiety, it helps children with their anxiety disorders? 55:34 Hmm, that’s a really good question. 55:40 Yeah, I’d say that like, that’s a good question. 55:43 I’d say it depends. 55:45 I think sometimes, sometimes very often parents who are anxious themselves are more likely to engage in these like protective parenting behaviors that we hadn’t totally touched on but like to be those parents that are maybe rescuing their children a little bit more from anxiety because maybe they experience that distress in their body a little bit more it’s much harder for them to see their kids kind of go through that anxiety experience or that distress so they have kind of maybe anxiety about their child’s anxiety. 56:19 So I can say, I can see that to some extent, if a parent kind of works through their own anxiety, that maybe they’ll be able to be a little bit more mindful of, you know, how to respond to their child’s, you know, anxiety in a way that’s not like rescuing in a way that’s kind of thoughtful. 56:37 But I don’t know that that’s totally, that’s totally a fix. 56:41 I think that these kind of strategies or these ways of approaching our children are probably more important in terms of helping our children who have anxiety. 56:51 So just generally, you know, and I can imagine a situation where those things might become natural to a parent who has worked on their own anxiety, but I don’t know that that’s totally for sure the case. 57:03 And so I don’t know if I fully answered that, but I can see that being helpful, but I don’t know that that’s the treatment in itself, if that makes sense. 57:12 Yes, no, definitely. Another question we have is, my kids often don’t want to go to school. 57:18 What should I say? 57:22 That’s a great question. I mean, we always want to know why. Right? 57:27 So that’s, you know, I don’t want to answer if we’re talking about an anxious child, right? That’s one thing. 57:33 But we always want to wonder about why. 57:34 Just be curious in general about our children’s behaviors and what that’s about. Maybe they’re being bullied at school. 57:40 Maybe school’s really for them. 57:41 They have a learning disability and that’s, you know, they’re not getting the support they need. They’re not feeling like they excel. 57:46 So there’s a lot of reasons why a kid might not want to go to school. 57:49 But if it’s anxiety, right, which is often, very often the case that we see kids who have anxiety about going to school, I would highly recommend thinking about those, that supportive kind of, those supportive response, that model of supportive responding, right? 58:05 So really just doing your best. 58:08 The worst thing that we can do for kids that are anxious about to school is to actually let them not go to school. 58:14 We really want to get them to school, essentially not just because we want kids to go to school, but because for that reason of that confidence piece that we’ve been talking about, we really want the kid to learn that it might feel scary, but that they can handle it and they can get through this. 58:29 And we don’t want to get into that avoidance creep where they just continue to avoid their anxiety-provoking situations But I would say, depends on why, what’s going on with your child and why that is, if that makes sense. 58:46 Yeah, no, of course. 58:48 Another question we have is, this individual said, this was great and really informative. 58:54 Is there a recommended minimum age for using this method, just thinking about younger kids and not being able to read a letter? 59:01 Ooh, okay. 59:02 Yeah, I’m glad you brought that up. 59:03 That’s a really good point and something that I’d say, yes, definitely something to consider in terms of just how do we adapt this model to much younger children. 59:13 I’d say this is a framework that has been shown to be effective for all ages. 59:19 So from like really, really young kids to also young adults, even to some extent, we have these children that we call it with this experience called Failure to Launch when we have these older adults that kind of are more anxious and the parents are engaging in these accommodation behaviors that are not helping them kind of learn be independent. 59:39 So this can really be and the research shows that this is effective for a lot of different ages. 59:45 So you know I’d say there’s not a minimum age and if anything I think young children are actually probably the best target for this type of treatment because when kids, these are the kids that are hard to get into individual therapy and so for kids that you know can get in when we have like a three, four-year-old who’s showing signs of anxiety, we probably want to lean towards a parent-based treatment model, if that makes sense. 1:00:14 And certainly, this is a great treatment model for children who might resist going to therapy or might not want to go to individual therapy, a great way to intervene. 1:00:30 But I’d say it definitely makes sense to think about developmental stages and what’s appropriate in those moments. 1:00:35 And that’s a great point about the written letter, right? 1:00:39 For a kid like this, we want to really get down to their level. 1:00:42 We want to really stick with these same kind of core concepts and core the things, the communication is the same, the behavior is the same. 1:00:52 But definitely, we don’t want to print it out and make them read it on their own. 1:00:56 We’ll probably want to sit down and have a discussion about it. 1:00:59 Maybe we want to put it in visual images. 1:01:01 you know, whatever that might be. 1:01:03 But, you know, this is definitely not a model that doesn’t work for younger children. 1:01:06 If anything, this is probably a really great framework for much younger children, as long as we can shift to kind of to make this more appropriate for their developmental stage. But good question. So I’m going to stop here. 1:01:23 So we leave some time for verbal questions. 1:01:26 The remaining submitted questions will be posted to our blog at www.njcts.org under the programs tab for Ms. Gordon to answer. 1:01:36 To those watching the recorded version, thank you so much for attending. Please complete the exit survey. 1:01:40 Our next presentation will be Cannabis and Tourette Syndrome, the Evidence, the Promise, and the Perils presented by Dr. Elia Abidjaoud. 1:01:49 It’s scheduled for Wednesday, January 29th at 7 p.m. EST with the recording the following day, Thursday, January 30th at 2 p.m. EST. 1:01:58 We offer professional development certificates for school professionals and school nurses that attend the live or recording of the webinar. 1:02:05 To register for either time, please visit njcts.org slash webinars. 1:02:09 And with that, we are going to stop the recording.