The SPACE Program: A New Treatment Approach for Childhood Anxiety

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re talking about anxiety in children, and a newer parent-focused approach to treatment. You know anxiety is one of the most common mental health issues in children, but our standard approaches, individual therapy and/or medications tend not to be very effective for many children, especially when we look at long-term results. One of the newer approaches that research is showing can be very effective for reducing anxiety in children is called the SPACE program. SPACE stands for Supportive Parenting for Anxious Childhood Emotions, and it’s a group program focused on helping parents understand their child’s anxiety and manage their own behavior in ways that help children become less anxious and more resilient. Here to talk with us about this approach is Dr. Yaara Shimshoni. She is an associate research scientist at Yale School of Medicine. She has conducted research on anxiety disorders in children and new treatment approaches involving parents. She collaborates with Dr. Eli Lebowitz at the Yale Child Study Center on developing and researching the SPACE program for improving childhood anxiety. Thank you so much for being here today, welcome!

Dr. Yaara Shimshoni:

Thank you, Nicole. This is a great opportunity. I’m really happy to be here. 

Dr. Nicole Beurkens: 

I’m excited to share information about what you’re doing with parents because anxiety is so prevalent, whether kids have a diagnosis of anxiety, or maybe they have other kinds of issues and anxieties, a piece of that, this is something that a lot of families are dealing with. I want to start with having us talk about some of the common ways of treating anxiety and how the approach that the SPACE program takes is different. 

Dr. Yaara Shimshoni: 

Yeah. So SPACE is a treatment for child anxiety and OCD, but SPACE focuses on the parents and it works with the parents to reduce the anxiety. Most other treatments for anxiety, as you mentioned will work directly with the child on reducing their anxiety symptoms. One of the most common treatments that you’ve mentioned is cognitive behavioral therapy or CBT. In this case, we would usually work with a child on identifying and challenging maladaptive thought processes, and then we would gradually expose the child to the feared stimuli and situation. And as you have mentioned, CBT is effective in reducing child anxiety. It has been studied in numerous randomized controlled trials and has shown to reduce the anxiety levels. But it has been shown to be effective in around 50-60% of the children, which means that there are quite a lot of children who do not benefit from this traditional approach. And one of the main reasons is that CBT requires a good amount of motivation on the part of the child, who has to be willing to come into therapy, to meet a therapist and to do the things that you are most afraid of. And this is hard — not all children are willing to do that. 

Also, you mentioned that anxiety is the most common mental health concern for children. We know that around 30% of children will suffer from clinical levels of anxiety sometime throughout their childhood. Depending on the epidemiological study that you look at, between 5% and 15% of children suffer from anxiety at any given moment. These are a lot of children. So I think we owe it to these children to continuously develop effective treatments that can reach more children and have more families overcome this very prevalent problem. So why do we work with the parents specifically in SPACE, right? That’s the big question. And the answer to that lies in our mammalian biology. We are mammals. Humans are mammals. I assume this is not very big news to anybody. But one of the things that is unique about mammals is that our offspring come into this world ill-equipped for independent survival. A baby mammal without its parents’ protection, nourishment, regulation unfortunately is not going to survive very long. But luckily, mammals have solved this problem of infancy vulnerability by developing a signalling system between the offspring and the parents. The babies tell us that they need our help, and parents are hardwired to respond to these cues. For example, if a baby feels frightened, they’re not going to solve that on the individual level. A baby is not going to stand up suddenly and run away or stand up and fight whatever it is they are afraid of. They are going to communicate this to the parent. Usually they will cry and then parents will come and help. And so if we accept that premise that a fear response in a human child is primarily a social response, then it really makes a lot of sense that a disorder, a problem, anxiety, that is an effect — excessive and chronic activation of this fear system will manifest in chronic and an inappropriate activation of this signalling system. 

So if a child is signalling all the time to the parent, “I need you, I can’t do this on my own, I’m scared, help me!” It’s no wonder that parents are responding chronically — “I’m here, don’t worry, I got it, I’m going to help you.” And in this way, parents become increasingly involved in the child’s anxiety symptoms. Once you start to look at anxiety from this systemic perspective, it will never look the same to you, because you will always see how the anxiety is very much alive in the relationship between the parents and the children, and you will see how parents are inherently involved in this phenomenon, in the child’s anxiety. 

Dr. Nicole Beurkens: 

That’s a great way of describing what happens in that parent-child relationship, and I’m really glad you went through that because it’s important at the outset to say that programs that are focused on parents, as it relates to children’s behavior and their symptoms, are not insinuating that the parent is somehow to blame or the cause of the child’s symptoms. I’m sure you come up against that a lot. I do in my clinical work and in my research, people say, “Oh, you focus on the parents. You’re blaming the parent for the child’s….” No, that’s not the case. Can you comment on that?

Dr. Yaara Shimshoni: 

Yes. I’m very, very glad you brought that up. It is very important and we stress that in SPACE as much as we need to: Parents are not to blame for the child’s anxiety. We come from a field, mental health, with a very rich and long history for blaming parents for any problem a child may have. But in all these different cases, if you take eating disorders, ADHD, autism, schizophrenia and anxiety, research has failed to make a compelling case that parents are to blame. We work with parents because they hold a key to solving this problem. We mention this as much as we have to in treatment and make sure the parents don’t feel blamed. Many parents, just by their child having a problem, they already feel that it is their fault, and kind of building on this mammalian biology and the systemic view of anxiety makes it clearer that it’s the way you were wired. You are involved because you’re a good parent, because you are attuned and cued. One of the main ways in which parents are involved in a child’s anxiety is through a process that we call family accommodation. It stands at the core of the SPACE treatment. 

Dr. Nicole Beurkens: 

Yeah, and I want to get into that. I love what you said there about parents holding the key. As parents, it’s not our fault when our kids have these challenges, whether it’s anxiety or whatever else, but we do hold the key, we play a critical role because of that relationship that we have with our kids and because we are providing for them and their needs, we hold this key that can really transform how the child sees themselves, how they function — so I love that idea of the parent holding the key. Let’s get into this idea of family accommodation because this is at the core of what you do, and really, whether we are talking about the SPACE program or we’re talking about any approach that looks at family dynamics or using parents as sort of pivotal ways of changing things for kids, this idea of family accommodation is a big one, so describe what that is and how that plays out. 

Dr. Yaara Shimshoni: 

So, family accommodation very broadly refers to any changes the parents make in their behavior to help the child avoid feeling anxious. And there are endless examples of that. Parents can accommodate an anxious child by participating in the anxiety symptom. For example, by answering repeated worried questions a child may have, about, for example, being late to school. They can sit next to a child until they fall asleep when a child is anxious about sleeping alone. They can perform checks in the case of a child with obsessive-compulsive disorder. Parents can accommodate by modifying their schedules and routines. For example, always driving the child to school because the child is nervous about taking the school bus. Or being the parent who drives everybody everywhere because the child is anxious about driving with other parents. Or maintaining very rigid schedules because anytime we change the schedule, there is heightened anxiety. Or maybe we don’t go out as a couple anymore because our child is nervous about staying with a babysitter. 

Parents can accommodate by actively doing something, for example, ordering at a restaurant when a child is anxious to speak to the waiter. And they can accommodate by actively not doing something — for example, we’re not having company over because it makes our child uncomfortable that there are more people in the house. The point is that if you are a parent and you are listening to this and you are identifying yourself as accommodating, you’re not alone — quite the opposite. Research has shown that almost all parents of anxious children accommodate. Between 95-100%. This is a fairly new concept in child anxiety, it was introduced in 2013 by Eli Lebowitz in the first study on accommodation, and since then, the field is bursting with research. We’ve seen more than 100 peer-reviewed papers on this topic in the US and other countries. And they all keep coming up with that same number: 95, 98, 99% of parents accommodate. The other thing that they’re showing, these studies, is that accommodation, though very well-intentioned, is actually associated with more severe anxiety symptoms and functional impairment. And this is, in many cases, really heartbreaking because parents are pouring their time, their energy and sometimes money into these accommodations to try and help their child feel less anxious, but the outcome is the opposite of what they intended. The child is more anxious. 

Dr. Nicole Beurkens: 

I think that’s a slippery slope, right? I mean I’m even thinking about that for myself as a parent and families that I’ve worked with. These accommodations start sort of like, “Okay, this is how we’re handling this.” And then overtime, they just continue and then parents very often in the clinic will look back and they’ll go “You know, if you had asked me if I’d still be driving into McDonald’s for the same type of French fries every day because my child is scared to eat anything else, or if you told me that I’d still be driving my kid to school every day, if you told me 5 years ago that this would still be going on, I wouldn’t have believed it but here we are.” Time just goes and it’s easy to get locked into those habits or those parents of responding, right? 

Dr. Yaara Shimshoni: 

Absolutely. What we think is happening is that the child signals that they’re anxious and parents jump in. As we said, they are kind of wired to do so. And they are a little bit right because it does help in the moment. If my child is really anxious about ordering in a restaurant and I jump in and order for her, her anxiety will go down in the moment. She’ll get her food. If I sit next to my child until they fall asleep, they’ll fall asleep and feel better. If I answer all the questions that my child may have, that is also going to help them in the moment. But what’s going to happen tomorrow, right? Tomorrow night, is my child going to be less or more anxious about falling asleep on their own? Probably more. And so, over time, the accommodation maintains the anxiety, and we think that it promotes avoidance. So the child doesn’t get a chance to learn that they can handle it, and they become more and more reliant on these accommodations. And both parents and the child become more convinced that these accommodations are necessary for the child to function. And they grow and they extend like you said, they don’t just stay the same. They tend to expand, affecting more situations, and they take up more and more time. That’s what happens. 

Dr. Nicole Beurkens: 

It’s kind of like a snowball rolling down the hill, right? It starts out small, and then it gains momentum and then it gets bigger overtime. The more we accommodate, the more the child develops a sense of not being resilient, not being able to handle it themselves, dependent on the adult and then that just grows. I find especially, as they get older and life becomes more complex and the number of things they have to manage gets bigger and there are more fears and stressors, maybe what started out as just as a couple of lower-level things when they were young children, now can really expand. Suddenly parents, even in middle school and high school years can find that the number of accommodations, that the amount of reliance that the child has on them now is huge. 

Dr. Yaara Shimshoni: 

Yeah. And also, you know, the accommodation sends the message “We don’t think it’s okay for you to be anxious, so you shouldn’t feel that way.” The moment you start to feel anxious, we come and we take it away. So the child, as you mentioned before, doesn’t feel about themselves that they can handle it. We’ve also — I think this would be interesting to hear, we wanted to know what the children thought about the accommodation. I just told you what we think about the accommodation — how do they see it? So in one of the studies, we added 3 questions, kind of last-minute, we threw them in. We asked the children: “Are these accommodations helping you in the short run?”, “Are they helping you overcome your anxiety over time?”And “Should your parents reduce the accommodations?” And do you want to know what they said? 

Dr. Nicole Beurkens: 

Absolutely!

Dr. Yaara Shimshoni:

Okay. So they said, “Yeah! The accommodations are helping me in the short run, in the moment.” Are they helping you over time to overcome your anxiety problem? They said, “No.” I was amazed when I first saw this. Children know “It’s not really helping me!” So, “Should your parents reduce the accommodations?” What do you think they said?

Dr. Nicole Beurkens: 

They probably said “Yes” even though they realize that’s uncomfortable for them. 

Dr. Yaara Shimshoni: 

We wish. They said, “Absolutely not!” 

Dr. Nicole Beurkens: 

That’s right! Because it’s too scary!

Dr. Yaara Shimshoni:

Exactly. It’s really hard to face your fear. I haven’t yet met the child that came up to their parents and said, “Mom, dad, I want to thank you for so many years of accommodating my anxiety, but I have realized that it hasn’t really helped me overcome my problem. I suggest to you — stop doing that, and I will handle my fears on my own.” If there is a child out there who said that, I really want to meet them. But that hasn’t happened. And that also strengthens our point of working with the parents, because this change is not going to come from the parents. 

Dr. Nicole Beurkens: 

Yeah. The change won’t come from the child, right? Because they, even though they may recognize this isn’t helping me, it feels so uncomfortable for them at the moment, that they just want to soothe that, right? And I think that’s a piece of the dynamic too. You said, we show kids by accommodating that it’s not okay to feel anxious. That feeling anxious is a problem, is something to immediately make go away, when the reality is, anxiety is actually a normal, healthy part of life. We all experience anxiety at various times, and it can serve a purpose, so we don’t need to be afraid of our anxiety. But I think there is also this emotional dynamic that is meeting parents’ needs as well, right? So my child is distressed and anxious, that makes me uncomfortable and anxious to see my child distressed — so that accommodation, do you find that’s as much about soothing the child and helping the child feel better as it is then soothing the parents’ emotions too? 

Dr. Yaara Shimshoni: 

Definitely about that. And there’s another important motivation that we often see for accommodation. It’s not only about soothing everybody. It’s sometimes about getting through the day. 

Dr. Nicole Beurkens: 

Yes! Right! We have places to go, things to do. 

Dr. Yaara Shimshoni:

Exactly. We understand, maybe we even know that it’s better that the child now goes independently to the room and gets their stuff for school, but they’re really anxious and also, we really just have to get to work. So we accommodate. That’s another motivator for accommodation. 

Dr. Nicole Beurkens:

Absolutely 

Dr. Yaara Shimshoni:

Reducing this accommodation is the main focus of SPACE and it’s very hard to do. We want to make sure that we reduce the accommodation in a supportive and loving way. Maybe I can say a little bit about what we mean by support. 

Dr. Nicole Beurkens:

Yeah, I would love for you to get into that, because I think now we’ve helped people understand — okay, this is the dynamic that is going on here, this is how those accommodations are working. So yeah, how do you start to help families and help parents to approach this in a different way?

Dr. Yaara Shimshoni:

So we want to reduce these accommodations in a supportive way. What does that mean, in SPACE? So parents support an anxious child when they convey messages that combine validation and acceptance of the child’s anxiety and struggle with a vote of confidence that the child can handle their anxiety and be okay. So acceptance means that I acknowledge that my child is truly anxious. That they can’t just decide not to be, because I think they shouldn’t be or I wish they weren’t anxious, and that some things can be generally hard for them, even though they’re not hard for my other kids or for me. Maybe they seem silly, irrational and excessive. Confidence means that I show my child that I think that they’re strong and they can handle their anxiety. And so when we combine this validation with confidence, we create a supportive message. Maybe an example for that, a supportive statement that parents can actually say to an anxious child is, “I see how hard this is for you, but I’m 100% sure that you can handle it. You’ll be okay.” 

Dr. Nicole Beurkens:

Nice. 

Dr. Yaara Shimshoni:

For example, “I see you’re worried about who’s going to be at the birthday part and what cake they’re going to have and if you’re going to be late. I know that you can handle it. You’ll be okay!” Why do we think it’s so important to support an anxious child in this way? And the reason is that an anxious child today is going to be more sensitive to anxiety in the future. So it’s really importing that they feel that they can handle their anxiety. The goal of space is not that the child will never feel anxious. That is, as you mentioned, an unattainable goal, right? Nobody can do that, especially an anxious child — but rather we are hoping that they think about themselves — “Yeah, sometimes I get anxious, but that’s okay because I can handle it.”

And children will start to think about themselves in this way when parents start to look at them in this way. And this is true because parents are the mirror that children look into to see who they are. And if what I see reflecting back at me is “You’re too weak, this is too hard for you, you can’t handle it.” That’s what I’m going to think about myself. So the greatest gift parents can give an anxious child is a reflection of someone who can handle their anxiety, who doesn’t have to be afraid of being anxious. This will help them suffer less from their anxiety, and they will be more willing to experience it and put themselves in uncomfortable situations and learn that they can handle it. So in SPACE, we try to do those two things to reduce the accommodations and increase the support the parents provide the child. 

 

Dr. Nicole Beurkens:

It’s great that you gave an example of that, because I think a lot of times — and again, it’s very well-intentioned but parents say things to kids like, “Oh, you don’t need to worry about that!” Or “Don’t worry about that, that’s not going to happen!” or try to reassure in that way, but actually what that does is it just fuels that, right? And it doesn’t help them to accept and understand their feelings and realize that that’s okay and then also see that I can face it. We don’t want kids to only think that the way they can manage things is if nothing uncomfortable ever happens. So to say to a kid, “Don’t worry, that won’t happen.” Well, we don’t know. That’s the illusion of control, right? And I find that kids know that. They know when adults are saying, “Oh, that won’t happen” — well none of us has a crystal ball. None of us is in control. Things could happen, right? So that idea of how we communicate to kids in that way — that’s giving parents words to say and ways to approach that, I think is really important. 

Dr. Yaara Shimshoni:

Yeah, so really, SPACE takes these understandings of the systemic nature of anxiety and translates those into a practical and effective treatment. We help parents systematically understand how they are accommodating, and what they want to change. We make specific plans on how to do that and how they are going to be supportive, and who is going to help them — we kind of walk them through that. I think one additional important point about SPACE that also differentiates it from other treatments is that parents that work with us in SPACE accept the premise that when it comes down to it, we really can’t control what another person does. This could be sometimes frustrating for parents, but we can’t make an anxious child not be anxious, and we can’t make them face their fears. You can’t make a phobic child pet a dog if they’re terrified or order at a restaurant or present at school if they are very anxious about that. But this doesn’t mean that parents are helpless because they have a very powerful tool in their hand and that is their control over their own behavior. That’s the focus of SPACE. We’re going to work with parents on how we can change their behavior to be able to respond in a different way to the anxiety than they have before. 

Dr. Nicole Beurkens:

You gave a great example of some language to use, that support — how to acknowledge: I see that you’re feeling really worried about this, I know that you can handle it. I’m confident that you can handle your anxiety. Can you give an example of how you would work with a parent in your program around changing and accommodating behavior? Maybe we could just pick a common one and how you help them think about that. 

Dr. Yaara Shimshoni:

Sure, is there one that you would specifically like us to work on? 

Dr. Nicole Beurkens:

Let’s pick maybe a child who is, let’s say, fearful of going over to somebody’s house or fearful of being away from mom or dad. 

Dr. Yaara Shimshoni:

Okay. So maybe we are talking about a child with separation anxiety. Maybe parents accompany the child to different rooms of the house. So every time the child wants to go to their bedroom to get something: “Mom, I need you to come with me, I have to go get something!” or to the bathroom and other places. Okay? So what we would do is that we would, after giving all that background of what accommodations are, what anxiety is, we want to make sure they understand all these things. What we mean by support — we would very thoroughly map out all their accommodations. So we would go through their day from the morning. How does the child wake up? How do they get out of the house? Do you come early from work? All these things. And we try to map out what are all the accommodations the parents are doing to help the child avoid feeling anxious? And then together, we will pick one we want to choose. 

Dr. Nicole Beurkens:

Just one, right? To start.

Dr. Yaara Shimshoni:

Just one, to start. For example, maybe these parents will decide: When we’re at home, after school, we are not going to accompany you to different rooms in the house. We’re going to pick — accommodation is always a parent behavior. So parents are going to decide how they are going to change their own behavior. So they make a very detailed plan about that. When are we going to do this? How are we going to do this? What are we going to do instead? What are we going to say when the child wants us to go with him anyway? Then we communicate that to the child. We tell them ahead of time about our plans. The target, again, is what we’re going to be differently. So they tell the child, “We are not going to be accompanying you to different rooms in the house.” Then they start implementing that and we are with them. We meet and we talk, and if we need to make changes and support them, we do that.

 Dr. Nicole Beurkens:

That’s great. I think that’s just helpful for people to get a big picture view of how to go through that. And I think what you said there is important, that you start with one thing, because I find that again, sometimes, parents with the best intentions, they hear about a new way of doing something, and they’re like okay — we’re going to make all these changes, and that is very overwhelming and anxiety-provoking for the child and for them, right?

Dr. Yaara Shimshoni:

Yeah, it’s hard. It’s very hard to work on many fronts at the same time. But still, we’ve seen through the SPACE — usually 10-12 sessions of SPACE, we are able to go through maybe two rounds of targets, and even though there are many things that we’re not directly working on, they improve. This experience of parents taking a stand and sending messages of support and not accommodating in one area can kind of reach other areas indirectly. And suddenly, parents start to come back and they report, “Oh, and this is down, and this is down, and we’re not doing this anymore and that anymore and the child is okay.” I think the child experiences themselves as more capable of handling their anxiety. So I don’t think you need to work on everything. 

Dr. Nicole Beurkens:

No, and that’s the great thing. I always think of that saying, “If you give a person a fish, they’ll eat for a day, teach a person to fish, they’ll eat for a lifetime.” That’s really how I view parent-focused intervention as once when we help parents to have the understanding and the tools, then they’re empowered to start to change things and that all carries over, and things can really shift and it doesn’t have to take a long time. They don’t have to continue to have the child every week coming in to do something because they are now empowered on a daily and even moment-to-moment basis to start to shift some of these things. That is effective. It also is a good use of time, it’s an efficient way of doing treatment, I think. 

Dr. Yaara Shimshoni:

Yes. Definitely parents don’t need to continue to come to SPACE forever. They get the tools and they go and do it on their own. 

Dr. Nicole Beurkens:

Can you talk a little bit just about the logistics? So you mentioned 10-12 sessions. So SPACE is done with small groups of parents, right? Can you just describe how it works? Groups or individuals? About how many sessions do you typically see people working with?

Dr. Yaara Shimshoni:

We usually do SPACE on an individual level. So we work individually with pairs of parents or single parents and we work for about 10, 12, 14, 16 sessions, but it’s a short-term process.

Dr. Nicole Beurkens:

Okay, great. I think that’s helpful for people to know because especially for families whose child maybe has been in therapy ongoing for a long time, it’s helpful to know that there can be time-limited interventions that can be effective. I think sometimes people just think of therapy and they think, “Oh that’s the rest of my life.” Right? And you’re saying no, actually we can accomplish these things in some pretty set periods of time. 

Dr. Yaara Shimshoni:

Yeah. It’s pretty short, I think.

Dr. Nicole Beurkens:

Yeah, and you’ve got some good research to support this too. I want to point that out. This isn’t just an idea that you had and you’re saying, oh this works. You’ve actually done some studies, and I’m curious, maybe you have some studies in the works now, even. 

Dr. Yaara Shimshoni:

Yes, we do. So, SPACE has been studied in two open trials. One for OCD and one for anxiety, but more recently, we finished a large, randomized control trial, in which we compared SPACE to Cognitive Behavioral Therapy. We randomized 124 children to either receiving CBT or SPACE. And children in the CBT came themselves to therapy, they met with a therapist and they worked like we mentioned earlier in this conversation about gradual exposures and all these cognitive changes. Children in the SPACE condition did not come in. Their parents came into treatment and worked for 12 sessions on accommodation and support. The results were, I think, remarkable. They showed no differences between these two approaches. And I say this is remarkable for two reasons. One is that SPACE is a fairly new approach, and it did as good as CBT, which has been studied multiple times. The second one is that children in SPACE did not come in at all. They didn’t see a therapist even once, and still, they got better to the same degree as children who did come in 12 times for therapy. So that was one study.

We are now in the middle of a second randomized control trial of SPACE and this is an FMRI study. So here we are interested in the brain mechanisms of family accommodation. So we scan anxious children and we look at brain areas that are responsible for fear, which is the amygdala, and regulation — areas in the medial prefrontal cortex. We show them neutral faces and scary faces. Very naturally, when you show an anxious child a scary face, their amygdala has a strong reaction. Stronger than when you show them neutral faces. But what we do is we scan them twice. So once they’re alone in the scanner, and this is how it usually is done, and another time, mom is standing next to the scanner and is holding their hands as they look at these faces. What we found was that when mom was there, the amygdala had a weaker response and the prefrontal cortex had a stronger connectivity to the amygdala. So there was more regulation going on. And interestingly, we found that the impact of mom’s presence on the brain was associated with how much she accommodates in real life. So for children who are heavily accommodated, the presence of mom was more impactful on their brain. So we’re starting to see in the brain what we see in real life in terms of the regulatory function of accommodation. But this is still ongoing, so we don’t have definitive final results yet, we hope to have them soon.

Dr. Nicole Beurkens:

Yeah, I look forward to seeing the final published version of that. That’s a really fascinating way of approaching that, and I think that that’s important. Those are more of the kinds of studies that we need to look at the how and the why things work. It’s one thing to say, okay, this is the result that we get from doing this type of intervention, but that doesn’t really tell us anything about what’s actually going on in the brain — why that might be important. So I love that you’re delving into that and looking at that. So fascinating. And I know that you’ve done some work. You mentioned OCD, also picky eating, those kinds of issues, and how the family accommodation plays into — so many interesting things that you all have going on. I want to make sure that people know where they can find more information about the SPACE program, about what you all are doing. I know you mentioned there is a book that’s coming out soon. Give us all the details, where can people get more info? 

Dr. Yaara Shimshoni:

So there is a website, spacetreatment.net there is a clinician community there, a parent forum, resources including books that Eli Lebowitz has written. That’s also where we talk about upcoming trainings if clinicians are interested to learn how to do SPACE. And there is a book for parents that is going to come out, called Breaking Free of Childhood Anxiety and OCD. It’s not out yet, but you can probably preorder it on Amazon. And this book can really help parents, step-by-step do the things that we talked about today. 

Dr. Nicole Beurkens:

Awesome. And I believe on the website also there is a resource directory of practitioners so that if parents want to try to find somebody maybe in their area that they could work there, there is a listing there, right? 

Dr. Yaara Shimshoni:

Correct.

Dr. Nicole Beurkens:

Fantastic. Such a great resource on that website. Really, so much wonderful information that you shared today. I really thank you for taking the time to be with us and to talk with us about what I think is one of the most interesting and exciting things that has come about for the treatment of anxiety in kids, so thank you so much for being here.

Dr. Yaara Shimshoni:

Thank you, Nicole. 

Dr. Nicole Beurkens:

And thank you to all of you for tuning in and listening. We’ll see you back here next week for our next episode of The Better Behavior show.