An Effective At-Home Approach to Treating Your Child’s Anxiety and OCD

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re doing a follow-up to an episode from last year with Dr. Yara Shimshoni on a parent-focused approach to anxiety treatment called SPACE. So many of you expressed interest in this, we got feedback, we got comments, “I’ve never heard about this, I want to learn more!” And you were excited to understand how you can use new strategies to positively impact your child’s anxiety symptoms. Anxiety continues to be a leading mental health issue for children and teens, and even more so now with the pandemic situation that we’ve been living through over the last almost year. So we need new and innovative approaches to treatment and the great thing about a parent-focused approach is that parents can be in control of moving the process forward.

So today, I have the pleasure of having Dr. Eli Lebowitz on the show to talk with us specifically about his new book that he has written for parents, called ‘Breaking Free of Child Anxiety and OCD’. Now, this is a book focused on parents that’s going to allow you to understand your child’s anxiety and work on reducing it in some new ways, even if you don’t have access to trained professionals. So let me tell you a bit about him.
Professor Lebowitz studies and treats childhood and adolescent anxiety at the Yale School of Medicine, Child Study Center, where he directs the Program for Anxiety Disorders. His research focuses on the development, neurobiology, and treatment of anxiety and related disorders, with special emphasis on family dynamics and the role of parents in these disorders. Dr. Lebowitz is the lead investigator on multiple funded research projects, and is the author of research papers, books, and chapters on childhood and adolescent anxiety.

His work has been recognized by private and public organizations including the Brain and Behavior Foundation, the National Institute of Mental Health, and the National Center for Advancing Translational Science. He is also the father of three great boys, so he’s a parent, just like us. Dr. Lebowitz, welcome to the show. 

Dr. Eli Lebowitz:

Thank you for having me, it’s great to be here. 

Dr. Nicole Beurkens: 

So I’ve been wanting to ask you this: You and I have had interactions outside of doing the podcast. I had the great privilege of taking your practitioner training over the summer, so there’s a question I’ve been wanting to ask you, which is how you’ve developed an interest or a focus in studying and treating childhood anxiety disorders in the first place. Was this always an interest of yours? Were you doing something else and sort of stumbled on this? Tell us the story of that. 

Dr. Eli Lebowitz: 

I’ve actually been interested in child anxiety and obsessive-compulsive disorder for many years. But my interest in parent-based approaches actually stems in part from an experience that I’ve had many years ago when I was working in a large children’s hospital and I was actually working at the same time in two programs there. One of them was an anxiety and an OCD clinic where we did cognitive behavioral therapy with kids. The other program that I worked at was a parent-guidance unit or parents of youth with severe externalizing behavior problems, and there, as is often the case, we worked with parents because youth with really serious behavior problems are not always ideal candidates for direct therapy themselves. One of my jobs in the anxiety programs was actually to screen incoming new families and try to gauge how good of a fit they would be for our treatment program.

And one really big question that I would ask right away is, “Does your child want help? Is your child interested in therapy?” Because we know that cognitive behavioral therapy and exposure and response prevention for OCD require a high level of motivation and collaboration and engagement on the part of the child. So if the answer was “No”, I could already let them know that there wasn’t a great likelihood of this succeeding. But I really became increasingly frustrated, because on the same day, I might be having that conversation with the parents of a child with anxiety or OCD and telling them, “Look, if your child’s not interested in treatment, we may not be able to help you”, but on that very same day, I might meet with the parents of a child with behavior problems and tell them “We don’t need your child to be here, we can work with you. We’re going to give you the tools to overcome this problem.” And that just made me really frustrated and led me to think a lot about what we can be doing with and for parents of children who have anxiety or who have OCD where their child is maybe not going to benefit from cognitive behavioral therapy, and how do we not have anything to offer those parents? That really led me to think about what we could do to help those parents, which ultimately contributed to the development of this treatment, SPACE.

Dr. Nicole Beurkens: 

I love that story and it connects so much to my own experience of working with kids in the realm of more significant autism spectrum disorders, severe emotional and behavioral disorders, and being trained in and taking a very parent-based approach to that, and then noticing, like why aren’t we doing this everywhere? We’ve sort of just been doing that at our clinic, and then when I happened to come across an article about SPACE a while ago now, I was like, “Yes! That inherently makes perfect sense to me because why wouldn’t we work through the parents?” So I love that that’s how you came to that as well, and it’s so needed in the realm of anxiety and OCD. Because what you’re saying is so true that the typical approach of cognitive behavioral therapy really does require that the child be engaged and we’ve seen so many families at our clinic, where they’re like, “My child was exited from treatment/they said they couldn’t work with us/they said they were discounting because my child won’t engage, he won’t do the work, he doesn’t want to come to sessions”, so I think that’s such a powerful difference with what you’re offering here.

Dr. Eli Lebowitz: 

Yes, that’s exactly it. And even when a child is willing to engage in CBT, we know that the treatment is not going to be effective for everybody. Clinical trials show that approximately half of children who get cognitive behavioral therapy are really going to have very good responses. They’re going to be a lot better after treatment, and that’s fantastic. If you are a glass half-full kind of person, then that’s really good news when we think about how prevalent these problems are and they really are so prevalent in the population. But it also leaves another half of the glass empty. So, certainly for children who are not going to do CBT at all, but even for children who are, having another tool in our toolbox, another approach in our arsenal of how we can help these families is just tremendously important. 

Dr. Nicole Beurkens: 

I completely agree, and I’m of the mindset as a professional that we need to be aiming a lot higher than 50% in our outcomes with people, and if we’re not, let’s explore why we’re not and what else we can do, which is exactly what you and your team are doing in the realm of anxiety and OCD. I want to get into, in a minute, some of the really practical things that you talk about in the book, but before that I want to sort of pave the way for that by having you talk a bit about what you think parents need to understand about childhood anxiety and OCD. And maybe even touch on why the anxiety and the OCD are connected, why write a book about anxiety and OCD together? What do you think that parents need to understand about that that most parents don’t? Or maybe another way of looking at that is: What are we missing in how we typically approach this?

Dr. Eli Lebowitz: 

Yeah, it’s a really fantastic question, and I think there are some big points here that can be made and that are really important to understand. One of them is that the real heart of any anxiety disorder, the core of the problem is actually not entirely about being more anxious than somebody else. So often when we think about anxiety disorders, we think, well, that’s a child, or an adult, for that matter, who simply has more anxiety than someone else. And that is true, but it’s not the whole story. Most of the impairment of the real disabling, sometimes really crippling impact of an anxiety disorder actually stems from the fear of experiencing anxiety. From not wanting to feel anxious. That is what drives so much of the impairment in these very common problems.

So that may sound a little confusing, but think about it like this: You may have, say two children, who have a frightening experience. Maybe they’re walking home from school and a really big dog barks really loudly next to them, and they’re both scared at that moment. They will both be equally startled and afraid in that moment. But after a minute or two, they’re going to start calming down. And if one of those children walks away from that thinking, “Well, that was scary, but okay, it’s over.” And the other child walks away from it thinking, “That was horrible, I never want to feel like that again, that was so unpleasant and aversive for me that I just never want to have that experience,” That’s the child who is going to develop the anxiety disorder” because the next day, they’re going to cross the street when they go near that house. And the next day, they’re not going to want to walk down that street at all. And soon, they’re not going to want to leave the house at all because there could be a dog somewhere. Or maybe they won’t want to see a movie that has a dog because it reminds them of that horrible experience. 

So a lot of the impairment actually stems from not wanting to feel anxious. And one thing that parents can really do that is so tremendously helpful for their children is convey to them the message and the idea that it’s actually okay to feel anxious some of the time. It is uncomfortable, but it is okay. It’s something that you can handle and it will pass, as opposed to “It’s a horrible experience that we should avoid at all costs.” Because then you’re going to really have the anxiety problem. And that’s one thing. I think that’s one really important message that it’s just so useful for parents to really get. You said something really interesting, which is “What have we been missing?” Actually, I think that’s a really great question to ask because SPACE, as a treatment, actually builds on a really important aspect of child anxiety that we have been missing for decades in how we conceptualize these problems and how we think about treatments for them. If you were to compare a treatment manual for cognitive behavioral therapy, for example. If you were to compare a treatment manual for children and a treatment manual for CBT for adults with anxiety, what you would see is that they are the same. They’re essentially the same thing.

Of course, we use a somewhat different language when we talk to a 7-year-old and we use other words. When we talk to a 47-year-old because they’re older and more mature, but the principles of the treatment are the same because we’re thinking about the anxiety in the same way. And here, there really is something missing because child anxiety is actually meaningfully different from adult anxiety. There’s a lot that’s the same, but there’s something special about child anxiety that is different. And that is children’s natural tendency to respond to fear by looking to their parents to protect them. Children know, instinctively, that they’re not able to protect themselves. We’re born not able to defend ourselves and protect ourselves. So in children, and this is different from adults, in children, we respond to fear by relying on our parents. What that means is that if a child has an anxiety disorder, they’re going to be looking to their parents all the time for reassurance, for protection, for soothing, and regulation.

What it means is that when a child has an anxiety disorder, it’s not only the child that has the anxiety disorder. It’s the family system, it’s the parents as well. Not because the parents are necessarily more anxious, but because they become involved in their children’s anxiety. Because they’re stepping in to try to provide that protection and that regulation and that soothing. This is a meaningful difference that hasn’t really been captured in our established typical treatments for anxiety, and it’s something that SPACE really does in a big way.

Dr. Nicole Beurkens: 

Absolutely. And I think to me, that’s such a great description of something that we have been missing across the board in our approach with that and probably explains a lot of why parents, even if their child has been through rounds of cognitive behavioral therapy, still end up feeling sort of frustrated, or sort of at least — we’ve had parents come in and say, “But what can I do? What do I do when my child is coming and repeatedly asking me these questions, other than tell them ‘Use your breathing strategies or try to distract yourself’” or whatever. So I think parents, a lot of them inherently realize, there’s some role that I am playing in this. I want to know how to do this differently. 

Dr. Eli Lebowitz: 

Right. That’s exactly it. You asked another important question, which I’ll just touch on briefly, and that was about “Why OCD? Why is OCD in there?” I mean, it’s in the title and it’s part of what the treatment is for. And even though we don’t formally classify OCD as an anxiety disorder anymore, although we did back until 2013, even in the DSM, the Merck Manual of Mental Health officially classified OCD as an anxiety disorder. Even though we don’t do that formally anymore, actually, in many ways, OCD is an anxiety disorder, and it goes to exactly what I was saying: Lots of people are going to have obsessive thoughts, intrusive thoughts, but the child who develops OCD is going to be that child who doesn’t want to have that experience, who thinks “This thought is so horrible to me, it’s so scary to me/embarrassing/strange/weird and frightening, that I never want to have that thought.”

And that child is then going to develop the compulsive rituals of OCD to try to banish those thoughts, to try to fix them and correct them, and they’re the ones who are going to be trapped in that loop of obsession and compulsion because it’s always fear that is the driver of OCD. Nobody has obsessions about winning the lottery. People are not scared about winning the lottery. Actually, this is maybe the most important thing for a parent of OCD to know about OCD is that a child’s OCD thoughts don’t tell us what that child secretly wants, they don’t tell us, “Here are some hidden truths about the child.” What they tell us is what the child fears, what they are afraid of. Anxiety and fear are the fuel that drive the engine of the OCD. So treatment for OCD is very similar to the treatment of other anxiety disorders. That’s true for cognitive behavioral therapy, it’s true for medications and it’s also true in this.

Dr. Nicole Beurkens: 

Yeah. And I think that’s important to touch on the connection there. Really, how I think about this and explain this to parents and to kids, it’s all about managing uncertainty, right? We have different thresholds to that, there’s uncertainty in the world. But a parent is just going to say, “I just want my child not to be anxious.” It’s like, well that would be really weird, and actually a problem, right? If your kid was never anxious or if you were never anxious. The goal is that we increase our threshold, our tolerance level for being able to manage uncertainty in our lives, uncertain things that happen. To me, this is really about helping kids to better calibrate that. Some kids are just more prone to that, their tolerance for uncertainty is really low. So everything feels scary and they’re driven to avoid, whether that’s an anxiety disorder where it’s truly like more avoidance of it or ruminating about it, or it’s obsessive-compulsive disorder with the way that they’re trying to deal with managing that uncertainty and that fear is their rituals and their compulsions, it’s all aimed at the same thing. As human beings, we don’t like to feel uncertain, do we? 

Dr. Eli Lebowitz:

No, we don’t. We definitely don’t. We like predictability, we like control, we like certainty, these are things that are not always achievable, they’re not always there for us. So learning to live with lower levels of certainty is actually the best way to not go through your life suffering because of anxiety. The real goal of any treatment for an anxiety disorder is actually not entirely about just “I want to be less anxious.” It’s a lot about getting better at being anxious. If you can be anxious and handle that, you’re going to have less anxiety in your life and when you are anxious it’s not going to be as big a problem. When you feel like you can’t be anxious and you shouldn’t be anxious, that’s when you’re going to get more anxiety and more impairment to go along with it.

Dr. Nicole Beurkens:

That is the quote of the day right there for those of you who are listening, I want you to just really take that in, that the goal is to really get better at handling it and that’s our goal for our kids. It’s not to create a world where they don’t experience the discomfort of anxiety, it’s to help cultivate within them the sense of “I can feel anxious and I can handle it, and that’s it right there.” 

Dr. Eli Lebowitz: 

Yes, exactly. 

Dr. Nicole Beurkens: 

So, it occurs to me that we should, for people who maybe did not hear the previous episodes, I Want to have you say what SPACE stands for, and then I want to get into some of the things that you feel are most important to touch on with what parents will find in the book. What are some of the key things that you really wanted to impart to parents in writing this book, because obviously, you felt there was a need for this, there was something that drove you to say “I need to create this for parents and not just focus on training professionals.” So I want you to then talk about what the things that parents can take from it are. 

Dr. Eli Lebowitz:

Yes, so first of all, SPACE stands for Supportive Parenting for Anxious Childhood Emotions. The book is something that I have been really wanting to do for a long time. I am so excited that it is coming out and it will be available for parents, and that’s partly because I know that not every parent is going to be able to access a skilled, trained therapist. Sometimes there’s just not anybody in your area who is able to provide that help. Sometimes, it is too costly. Sometimes you do not have the resources to be able to devote the time, the money, the energy, etc. To actually go to therapy. There are so many people who are struggling and are just not going to be able to get the kind of care that you might get from a specialized, skilled therapist. So I’ve really been wanting to do this for a long time, and I’m really happy that it is going to be available now.
The book itself is a real guide to working your way through this treatment process in the way that you might do if you were working with a therapist and so it is not just about the principles, it’s not a theoretical book to just understand anxiety in principle, which is a great thing to do and certainly valuable and a useful thing, but it’s not enough. 

If I’m the parent of a child with anxiety, I am faced with endless specific challenges and questions and dilemmas every moment of every day. So just having a principle or an idea is often just not going to be enough. What I need is a systematic plan. Something that will really take me through this one step at a time. And that is the goal with this book, that parents will be able, if they take the time to read it and to work through the steps as they’re laid out in the book, to really be able to treat their child’s anxiety. That is an ambitious goal, but that is really the goal. 

Dr. Nicole Beurkens: 

I’ve had a chance to look at the book ahead of time, and I think you really accomplished that. And I just want to say this for all of you parent listeners: Sometimes there are books about treatment protocols or things that you might pick up to read to try to help your child and it’s really dense and it’s hard to figure out how do I apply this? This book is really geared towards the practicalities of what you need to understand and here’s how to do this. I really firmly believe that any parent can walk away from this, even if you didn’t read the whole thing cover to cover, and you took pieces of it, it really does hit the nail on the head in terms of giving practical strategies and ways to think about the things that you can start doing differently with your child. I think it’s important to say that because some of you are thinking, “Oh, another book that I’m supposed to read.” But this really is a practical guide, so I really think you accomplished your goal with that.

Dr. Eli Lebowitz: 

Well, thank you. First of all, really, thank you because that is awesome feedback and it is certainly my goal and what I was going for, for that reason, the book is written in a very readable, relatable, I hope, language. I wrote it, yes, as a therapist and a doctor, but also as a parent and as a parent of a child who is often very anxious. I’m in the same boat as every other parent who deals with their children and with child anxiety. So that’s really where I’m writing from. That’s why it is written that way, why it is not longer than it has to be and not more expensive than it has to be, because the goal is really to try to make this as accessible as we possibly can.

In terms of the actual principles, what can parents really take from this? What are the real principles here? We can boil down everything that parents are going to learn to do through working through this book into two main things.
That then breaks down into a lot of very specific steps, but there are really two big picture things, two main goals: The first is to learn how to respond to your child when they’re anxious in a supportive manner. To be supportive. We have a very clear definition of exactly what is meant by a supportive response. Because ten people could have ten different ideas of what is supportive. But I have a really clear and specific definition. You’re being supportive when you show your anxious child two things: You show them first of all and this is so important, that you get it. That you believe them, that you understand it, that you accept and acknowledge it. You can not be supportive if you can’t accept that your child is genuinely struggling. Even if you don’t really understand why or even if you feel differently yourself or you wish that they felt differently. If you can’t accept that that’s their experience, then how can you really be supportive of them? And that’s one part of the supportive message. 

The other part and this is also so important is a message of confidence. The idea that I, as your parent, believe that you actually can tolerate and handle the stress. That you can be uncomfortable now and still be okay. So often, our responses to children when they’re anxious actually don’t convey that message. Very often we convey “I need to rescue you from this because you can’t be anxious/it’s not okay/it’s going to damage you in some way.” You think about it from a child’s perspective, it’s great if there is somebody to always rescue me, but it’s not great to feel like I always need to be rescued. That’s such a vulnerable feeling. So if you are vulnerable, it’s great to have someone there to rescue you, but it is better to know that you’re actually okay. Just like it’s great to have somebody always feed you, but actually it’s pretty good to be able to feed yourself and won’t need to always have somebody else step in and do it for you. When you put those two things together, the acceptance and the confidence, that’s when you’re being supportive. That can be a really simple thing, it can be as simple as saying something like, “I get it. This is really scary for you. And I believe that you can handle it.” I’m not asking the child to say that they believe it. I’m just telling you what I believe. And that’s one of those two big picture things that parents can really learn and there is a lot of very specific guidance for how you come up with those phrases and how you respond, etc.

The second thing is really about those accommodations. All of those changes that parents make in their own behavior because their child is anxious. And it’s the most natural thing in the world, it’s not — this is not like you are doing something bad and evil because you accommodate, it just means that you are a sensitive, loving parent who wants to help your child. It’s the most natural response in the world. So for example, your child is really worried, you want to reassure them, you want to tell them “It’s okay, that thing is not going to happen/you’re healthy/you’re not going to mess up.” Or maybe your child is socially anxious. You want to make it easier for them, you want to speak in place of them because they get awkward and uncomfortable. Maybe they have separation anxiety. You want to be close to them so they feel safe. Maybe you’re sleeping next to them at night so that they’re not scared when they are alone.

These are well-intentioned accommodations, but a huge amount of research now shows that when you do these accommodations, even if your child is feeling better in that moment, actually, over time, they’re not getting less anxious. They’re getting more and more anxious over time, and so you’re just pouring tons of time and energy and reserves, sometimes even money into trying to accommodate, but your child is not getting less anxious. And the second thing parents will learn to do in a very clear and systematic way is first of all figure out: What accommodations am I doing? Maybe I’m not even aware. So there’s real guidance on “How do I identify accommodations?”

And then, how do I pick one thing to focus on, we’re not just going to say, “Okay, never accommodate anything at all”, that would be overwhelming for your child, and you probably could do it anyway. So how do I pick one specific thing. How do I make really clear plans for reducing that accommodation? And crucially, how do I cope with my child’s response to me reducing the accommodation? Maybe my child gets upset, maybe they get angry at me. Maybe they say something really painful for me to hear like, “Don’t you care about me anymore?” These are hard things. So there are a lot of very clear tools for coping with those responses in a supportive and loving way while continuing to reduce that accommodation to help your child get better.

The last thing, I know this is a long answer to your question, but the last thing I really want to emphasize because I think it’s so important for parents to know is a promise that I make to parents, and that promise is, at no point in this treatment am I going to ask you to make your child do anything. You’re not going to have to make them practice a skill, you’re not going to have to make them not do anything, because it turns out, oftentimes, you can’t. I can give you great advice like, “You’ve got to make your child practice this wonderful skill.” Then you go home, your child says, “I’m not interested. I don’t want to do it.” Now you’re stuck! That’s my fault as a therapist, because if I told you you have —“ How do I make them do anything! So throughout this entire process, this is my promise: You will not be asked to make your child do something or to make your child stop doing something. It’s all going to be about your own behavior, about the one person that you actually do have some control over, and that’s yourself. 

Dr. Nicole Beurkens: 

Which is such a freeing and important thing because so many parents, especially if they have been through a lot of other treatments, it’s like they want to get involved in power struggles like they want a hole in their head. It’s like you can tell me all these things, but how do I do this? And I think that that’s really the empowering part of that and the flip side of that that I want you touch on: Sometimes parents take that and say, “Oh, so you’re saying that it’s my fault that my kid is anxious or has an anxiety disorder”, which is not the case, but I want to have you touch on that. 

Dr. Eli Lebowitz:

And I’m glad that you raised that, because nothing could be further from the truth. Not only am I not suggesting that parents are to blame for their child’s anxiety, it is factually not true. It’s just not right. Our whole field, mental health, psychology, psychiatry, social work: We have done so much harm in the world by blaming parents for children’s mental health problems. Parents have been blamed for everything: Schizophrenia, autism, eating disorders, anxiety problems, everything! And time and again, empirical research shows that it is simply not true. Not only is it hurtful and unhelpful, it’s also just wrong. In the vast majority of cases, a child has an anxiety disorder because they were born with a predisposition, a vulnerability to anxiety, not because you did too much of this or not enough of the other thing. It is of course possible to behave so atrociously as a parent that you could damage your child’s mental health, yes that is possible if you severely neglect your child, if you abuse them physically and emotionally, you’re going to do harm.

But that is not the story for almost all the cases of child anxiety. So I think it’s so easy to make that leap from, well, you’re saying treat the parents and so you’re probably blaming the parents. And I cannot say emphatically enough that it’s simply not true. Just like if your child has a physical illness, you’re going to have to help them to overcome that. You’re going to have to do things different because your child is sick. That doesn’t mean you made them sick. It just means you care about them. You love them, you want to help them. So the message here is parents can be a solution to their child’s anxiety problem, but they’re not the cause of the child’s anxiety problem in the first place. 

Dr. Nicole Beurkens:

Such an important thing for parents to understand, and I think what’s been interesting, both in just treating families and working with parents for a long time but also specific to doing SPACE treatment with families. While the emphasis is on parents changing the way that they’re managing things to support the child in better managing their anxious feelings, there is also this synergistic effect where parents who tend to have more anxiety about things and to recognize that for themselves have some new awareness and some improvement that they discover in themselves as well through going through the process. And I’m curious if that’s something you’ve seen in your treatment. 

Dr. Eli Lebowitz:

It’s 100% something we have seen in treatment and in fact, we’ve even studied that empirically through research. So we’ve done randomized control trials of SPACE treatment, and the main goal there is to assess: Is this treatment making the child less anxious? But we assess parent anxiety as well. And what we see is that parents are reporting lower anxiety levels following space. Even though the treatment is all about the child, we’re not trying to directly treat the parents anxiety, but they’re reporting less anxiety. We’re also seeing other beneficial impacts. Maybe this is an important one to highlight: We’re seeing improved parent-child relationships. And I stress that because sometimes parents are concerned, like “I”m going to start removing these accommodations and maybe my child is going to get upset with me, is this going to damage the relationship? Are they going to feel abandoned or neglected or rejected?” Or something like that. What we see is the opposite. Both parents and children report better parent-child relationships following SPACE treatment, even if there are some difficult moments along the way. Maybe in that first week or two, your child is a little bit more upset with you, and if we ask them right then, “How are you feeling about what your mom and dad are doing right now?”, they may say, “It sucks, I don’t like it.” But when we do it in a supportive way, A: They see that we’re acting out of love and care, B: They’re getting better and their anxiety is going down. And what we see at the end of treatment is actually improvement. We shouldn’t forget that the burden of accommodation actually takes a toll on the relationship. It’s exasperating, it’s frustrating, there can be resentment and anger and that takes a real toll on the parent-child relationship. So It’s actually wonderful to see that relationship improving. 

Dr. Nicole Beurkens:

To me, it’s just one of the many benefits of doing parent-focused treatment is not just the direct benefits to the child but the benefits that everybody in the family system get, and even we could touch on siblings here as well while the treatment may be directed towards the child who is struggling with managing their anxiety, there are all kinds of dynamics that emerge in families where parents are accommodating a child’s anxiety, and then siblings get dragged into it, so I would go so far as to say that when parents are working through the steps that you outlined in the book, this has a very positive benefit for the entire family system. 

Dr. Eli Lebowitz:

Yes, that is 100% true. Siblings are very much impacted by their siblings’ anxiety. Sometimes really directly. So maybe I have a child with an anxiety disorder, the whole family can’t do certain things, and the sibling is paying a price: They can’t have playdates/we can’t go to your baseball game because we have to be with the other child who has the anxiety.” The burden is shared and everybody is impacted. So one reason that siblings benefit is that the sibling is getting less anxious and the impact on me is improving. Another reason is often siblings also have anxiety. By treating the parents rather than the child, it means that they’re learning tools that they can apply for their other children as well. And finally, I think it’s a really positive thing, even if you are not the child with the anxiety, being in a family and seeing, “My sibling has a problem, my parents help them. My parents knew how to step in and help them to get better.” That’s a wonderful thing for me to observe as a sibling as well, because these are my parents too. When I have a problem, they’re going to help me. And so I think you’re absolutely right. Working with parents gives us an opportunity to really have a beneficial impact on the whole family: The child with anxiety, the parents, and the siblings as well. 

Dr. Nicole Beurkens:

Fantastic. So many more things we could talk about. I know we’re running low on time. Obviously, everybody listening to this is going to be ordering the book right away. We’ll tell them how in a moment, but I want to give people something to latch onto in the meantime. It’s going to take a few days to get the book in their hands. If there was one thing that you would encourage our listeners to start with, something that you know, they get done listening to this, they’re like man, this makes sense, I want to start working with this: What would be something that everybody could begin with? 

Dr. Eli Lebowitz:

The very first thing is to start practicing being supportive. Come up with your own supportive phrase, just have those two ingredients: Acceptance and confidence. I see it’s hard for you and I believe that you can cope. Start using those words. Maybe just saying that one time is not going to erase your child’s anxiety disorder completely, but you’re starting to show them a vision of themselves as someone who is both understood and accepted, but also someone who can cope and you’re starting to introduce that language into your interactions with a child. So number one, just start practicing being supportive. And learn more about SPACE.
You can visit, even before you have the book, there is so much more information, you can visit the website which is spacetreatment.net, I’m sure you’ll have a link. There are so many resources there for parents and for therapists to learn more about these treatments. There are videos that you can watch, some longer and some shorter. There are many articles, those research articles, case studies so you can read about the treatment of another family and many media articles like in The Atlantic or NPR or CNN and just those are really written for the general public reader. There are podcasts like this one and others! There are even forums so that you can interact with other parents who may be coping with the same issues and that’s such a supportive and strengthening experience just to be able to say, “Yeah, I’m working on this too and this is how it’s going for me.“ and just sharing that. So there is a forum where you can have those conversations, you can do it anonymously if you prefer. You don’t need to give your name or your child’s name. So I think that’s a good resource in the meantime and throughout.

Dr. Nicole Beurkens:

Absolutely. I’m glad that you brought up the professional piece because for those of you who are in our professional community who are listening to this, I’ve mentioned earlier in the show: I’ve been through the professional training with Eli and his staff, can’t recommend it enough. Go on there and look. Even right now you’re doing the virtual trainings because it can’t be in person, there’s a wealth of resources there if you are a professional in a variety of fields who is interested in bringing this information and these strategies into your work with kids and with families, great resources there as well. I believe there is also a directory. Obviously the book is a resource for parents to sort of do the do it yourself mode, but for families who are interested in seeing if there is someone in their area, there is a directory on the website too. 

Dr. Eli Lebowitz:

Yes. And thanks for mentioning it. Absolutely, there is a directory of therapists who are trained in SPACE with their contact information, it’s searchable by state within the United States, we now have at least one person in almost every state, not the full 50, but we’re getting there, we’re close. And if you’re in another country, increasingly more and more countries are represented as well, we don’t have the whole globe covered yet, but we’re working on that too. So you can find somebody to work with and so many people today are doing tele-treatment that even someone further away may be able to work with you as well. 

Dr. Nicole Beurkens:

Right, so if you are getting the book and you say I’m going to start working with this myself and you hit some patches where you are like, “I’m not sure how to work from this”, it’s a great combo. I think it’s great, and if you are already a parent who is working with a practitioner doing SPACE, having the book is a great resource for you to have to refer to at home, so those dovetail well. The book is out right now and let’s tell people where they can go to get it. 

Dr. Eli Lebowitz:

Yeah, the book is out. It’s called Breaking Free of Child Anxiety and OCD. I’m the author, Eli Lebowitz and you can get it where you get your books. You can get it on Amazon, probably lots of people are getting it on Amazon, you can get it in bookstores and even directly from Oxford Press, who is the publisher. 

Dr. Nicole Beurkens:

Yeah and we’ll have the links as always in the show notes, highly, highly encourage all of you to go and check that out. We will be referencing it and recommending it widely here in our clinic, so I recommend it for all of you. Eli, thank you so much for taking the time out of your very busy schedule, especially with the new book launching to be here with us to talk to our community about this. Such impactful information, so important that we’re spreading the word about this, so really appreciate your time. 

Dr. Eli Lebowitz:

Well thank you so much for having me, it was really a pleasure being here. 

Dr. Nicole Beurkens:

And as always, thanks to all of you for being here with us and listening, we’ll catch you back here next week for our next episode of The Better Behavior Show.