Ep 194: Breaking Free of childhood Anxiety and OCD: A conversation about SPACE! with Dr Eli Liebowitz

Anxiety is the most common mental health challenge kids face—and it doesn’t just affect them, it impacts the whole family. In this episode, I talk with Dr. Eli Lebowitz, the clinical psychologist behind the SPACE program (Supportive Parenting for Anxious Childhood Emotions), about how parents can help reduce their child’s anxiety—not by changing their kids, but by changing their own responses. We discuss how accommodation and overprotection can backfire, what supportive parenting really looks like, and why this parent-based model is so empowering. Whether your child has a formal anxiety diagnosis or just tends to worry more than others, this episode offers research-backed tools that truly make a difference.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

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What you really realize when you stop trying to force your child to do all these things is that there's a whole lot that you can do that is going to be tremendously impactful, and that your child doesn't need to approve of. Hi everyone and welcome back to your child is normal. I'm Dr Jessica Hochman, your host and pediatrician, and I have to tell you that I am so excited about today's guest. His name is Dr Ellie Liebowitz, and he's a clinical psychologist at the Yale Child Study Center. He's the creator of the space program supportive parenting for anxious childhood emotions, and he's the author of the incredible book breaking free of child anxiety and OCD. I personally admire Dr Liebowitz his work for a long time, and what I love most about his approach is that it empowers parents. He doesn't just talk theory, he gives real, actionable strategies and even scripts that parents can use in the moment to help their child manage their anxiety more effectively. It's realistic, it's compassionate, and most importantly, it actually works. I'm incredibly grateful to have had the chance to speak with Dr Liebowitz, and if you're listening. Dr Liebowitz, thank you so much for saying yes, and I'm so excited to share his work with more parents. He's a fantastic resource, and I think you'll walk away from this episode feeling more equipped and with a clear, actionable path to support your child. Dr, Ellie Liebowitz, I'm so happy to have you here. Thank you so much for your time. Thanks for having me. Glad to be here, I have to tell you, I've been doing this podcast now for a few years, and because I talk often about anxiety and childhood anxiety, a few guests have referenced you and mentioned your name, and I feel like I'm talking to somebody famous. So thank you so much. Okay, well, flattery is never a bad idea. So thank you very much. I appreciate it. So tell me about yourself. I'd love to know what inspired you to do the work that you do. So I work at the Yale Child Study Center, where I co direct our anxiety and mood disorders program. Child Study Center is a really interesting place because it's part of our medical school and functions as child psychiatry, but it's a very interdisciplinary center, and so we have psychiatry, but also psychology and other disciplines social work. So it really makes for a kind of creative environment to work in. So I am a clinical researcher, and I do a lot of research, but my research tends to be driven by my experience working with families, and that actually did lead me to focus a lot on parents and on family systems. You know, it's kind of interesting. In our field, in mental health, there are some areas where people have naturally focused a lot on parents for one reason or another. For example, if you are primarily focused on children with really problematic behaviors, really defiant children, things like that, it's historically been very typical to have a strong parent focus, not least of all, because working directly with the child in those cases is often quite challenging. Not to say you can't or shouldn't do that, but it can be really challenging. And so people gravitate a lot toward work with parents. But then you look at what people like to call the internalizing problems, children with anxiety, children with depression, problems that are less maybe disruptive to the other people around them, and there's been much less of a focus on parents, but actually parents both really struggle A lot to help their children with anxiety, and also face a lot of challenges themselves in coping with the child's anxiety. And what's really striking is that, maybe more than any other problem, parents are actually such a big part of what it means for a child to even have anxiety, because we're so hard wired to rely on parents when we are anxious, and so parents get really sucked in to all these different ways of responding. And so it really drove me to try to think a lot about how we can harness that involvement that parents naturally have, and really create something that would be practical and also effective at being able to address those issues, both for children who maybe aren't ideal candidates for doing therapy themselves, but also, more generally, for all those families where parents just want tools to like, What can I do and how can I be more effective? And so, you know, there's a lot of different answers to the question, How did I end up doing what I do? But maybe that's one way of thinking about it. I really appreciate this approach to involving parents and to primarily focusing on parents and what parents can do. Yeah, for multiple reasons. One, I feel like as parents, we are the ones around our kids the most. We're witnessing the behaviors. We're impacted by the behaviors. And so if we can help our kids in real time, I think that's clearly going to be an effective modality. And also, what I love is the scripts that you give us, because I think in the moment, it's hard for us to know how to respond effectively to our children. It's easy to think about maybe how our parents talk to us, or it's easy to get frustrated. And so having a script to go to, I think, is for me, I'm definitely planning on using this in my own life. Yeah. Well, thanks. I think that is really key. You know, if you just kind of lay out an idea, but you can't translate it into some really practical and accessible, go to kind of strategy that a parent can use. Then it ends up falling flat a little bit because, you know, as parents, we're dealing with this, like you said, in real time, and not just in real time, but under a lot of stress, which is not an ideal moment for a lot of deep thinking, and so we do end up. I was amused when you were saying about what our parents said. I can't count the number of times that I've heard coming out of my mouth, things that maybe I heard growing up, and not because they were the most helpful things to me when I did to hear them, or because I really spent a lot of time thinking about it and deciding, yup, that's the ideal way to respond. But just because you don't really have something else, and you know, in the absence of something else, and when you're under stress, you kind of go with your built in instinct, or what comes most naturally, which is not always the most optimal thing to do. I think the other thing that's really important for me in the way that I approach trying to help parents to make some changes is to try to move away from trying to guide parents to impose things on their children, to force a change in your child. You know I was talking about how traditionally, there was less of a focus on parent work and the anxiety world. But it's interesting that even when people did try to involve parents, mostly what they ended up doing is trying to make the parent kind of like function, like a therapist for their child, right? Like, I'm going to be your therapist. I'm going to get you to do exposures. I'm going to get you to change your thinking. Practice this scale and and just as an example, so you're saying, like, for kids that are afraid of bees, have them put in a situation where they're exposed to be and that might not be comfortable for every kid, or every kid may not be willing to do that exactly. Well, you know that kind of exposure, that's a great idea, right? It actually is a terrific idea if you have a child who wants to do that with you. But if you don't happen to have a child who's eager or wants to do that with you, even putting aside just how good your clinical skill may be as a parent, but if you have a child who doesn't really want to do that with you, then not only can it be ineffective, it actually can backfire quite a bit. But if you are a therapist and your patient says, I don't want to do exposures, you probably don't yell at them, you probably don't punish them, right? Not a lot of therapists start yelling at their patients and punishing them, taking away their privileges. But if you're a parent, and what you know is the most important thing is that my kid go on this picnic and face their fear of bees, and don't hide away and conquer their fear. Well, you might start applying the kind of pressures that you're used to applying in other situations. When your kid doesn't want to do what they're told, right? They don't want to do their homework, they don't want to brush their teeth, they don't want to go to school. And what do you do? You start pulling the levers that you're used to pulling. Well, when you try to do that as a therapist, were your child, that's not going to end well, I imagine they'll dig their heels in further. They dig in further, and then you push even harder, and the whole thing really kind of blows up in your face. And so we don't do that at all right, like in the approach that I developed this parent based treatment, I make a very clear promise to parents really early on, you know, I'll just say to the parent that no point in this whole process. Am I going to ask you to make your child do anything or to make your child not do anything because those things are hard and because you don't need to. Because what you really realize when you stop trying to force your child to do all these things, is that there's a whole lot that you can do that is going to be tremendously impactful, and that your child doesn't need to endorse or to approve of, because you're not asking anything from them. You're just changing your own behavior and. It really frees, I think, that whole dynamic from a lot of stress and pressure that otherwise becomes a real obstacle. So first, just to back up a little bit, the program that you developed is specifically to help children with anxiety and OCD Correct. Well, I would say this, that is definitely where it started. This began as a treatment for children, adolescents with anxiety and OCD, we have, over time, realized that we can apply very similar principles to a range of other situations that share some core features with anxiety and OCD situations where parents are very involved and where parents tend to accommodate the child's difficulty a lot. And so, for example, we now use a version of space for parents of children who are really picky eating, what the DSM likes to call avoidant, restrictive food intake disorder or arfid These are really, really picky eaters who often suffer a lot of impairment because of that problem, not just nutritionally, but even socially or at a family functioning level. And we're able to work with those parents. Or another example, we can work with parents of children with chronic physical symptoms, chronic somatic physical complaints, like aches and pains, the headache, the stomach ache, etc. Again. Parents really struggle with this, right? Like, on the one hand, I want my child to function, the other hand, they are genuinely in pain. So what do I do? And so we're able to apply principles there, and we've published research on this, showing that you can actually have some really meaningful improvement in the child's functioning just by changing how parents are responding. We even have a version of this that focuses on parents of adult children, failure to launch. Failure to Launch, it's great, exactly sad that we need this. Very much. Oh yes, we definitely do. Failure to Launch, meaning adult children who are not really functioning independently as adults. They're not in school, they're not at work, they're just kind of stuck in life, stuck at home, and often in the parents house, and just like not really going anywhere. Well, that's another again, you have this situation where parents are inevitably very involved in facilitating this reality, but are also very helpless to change it, like you can't really force anything on your 30 year old, and you can't even make them go to therapy, and there's very little that you can make them do. As hard as it is to make your eight year old do something, well, it's a lot harder to make your 28 year old do anything. And so I think really, although this did start as an anxiety and OCD treatment, in a sense, maybe what it's really turning out to be is a parent based approach to child distress, to helping parents to better navigate the situation where a child is experiencing distress that is impairing in a meaningful way their function. And, you know, we'll see. Is it applicable for every condition? Maybe not, not necessarily. And as a researcher, I like to test things before I'll go out and say, Hey, this, this works. And so in somatic symptoms and failure to watch, we actually have published clinical trial data showing, yep, this can work, and there may be other problem areas where we'll find the same it's amazing. It's such a useful tool to know about. I'm so appreciative to know about other tools that, because there are other existing models out there, but this is a very unique approach, and like you said, it's very impressive that there's data showing that it's actually effective. Okay, so people are probably wondering, as we've been talking and setting up about this idea of space, I'd love to explain to everybody what space actually is. So first, before I ask you about it, can you tell me who made this mnemonic? I love it. Oh, I made the mnemonic. It worked so well. Oh, thank you. Well, that is very nice to hear. I made the mnemonic sitting in the Yale Medical School cafeteria. This is like a decade ago or more, because one of my I had actually done like a talk for colleagues, describing the approach and some very early preliminary findings from some piloting of it, one of my colleagues, a man by the name of George Anderson, was a brilliant scientist here at our department, said to me, after, you know, it's all really interesting, but you really need to come up with a name for this. Because I didn't, I wasn't giving it a name. I was just describing the approach. And so I took it to heart and sat with a coffee in the cafeteria and played with today, maybe I would have, like, AI spit something out for me, but that was not an option at the time, and so I ended up with with space. I love it. Remind everybody what is the mnemonic stand for it stands for supportive parenting, for anxious childhood emotions. I. Yeah, which does reflect the origins of it as very focused on anxiety. And at the time, actually, OCD was even formally anxiety disorder per the DSM. Today, it has graduated into its own chapter in the DSM, along with some other related problems, but actually still makes sense to think of it as an anxiety disorder for most purposes, and so we are a little bit stuck with the word anxiety in there, even when we talk about space for arfid, or space for failure to launch, or space for whatever. But like you said, the mnemonic kind of works, so we're sticking with it. And anxiety is the most common mental difficulty that children experience. It really is. The prevalence rates of anxiety are just staggering, and that was true like 10 years ago and 20 years ago. But then you throw pandemic into the mix, and the rates of anxiety that we see today are even higher than they were pre pandemic. I don't know how long it'll be before the effects of living through a pandemic, whether on the parent side or on the child side, start to evaporate. Approximately one in three kids is going to experience an anxiety disorder at some point before they are adults. Wow. So that is just massive, and that's only counting the ones who actually are going to meet like diagnostic criteria for a clinical disorder, it's leaving out all the kids who are just sometimes struggling with anxiety, right? Like there's a lot of kids who are sometimes anxious and maybe at risk for additional elevated anxiety, but maybe aren't fully meeting criteria. Well, we're not even counting Yes. And as you talk about in your book, which I wholly agree with, that some level and some degree of anxiety is helpful. You know, paying attention with what to potentially worry about is protective at some degree, absolutely, it's not an accident that so much of our brain is really good at being anxious, right? Like it's not an accident, it's a feature. In a sense, it's not a bug. Because, yeah, anxiety does help us to stay alert to potential threats. And the, you know, the kind of special human capacity to actually imagine potential threats in the future, or, you know, hypotheticals, which may be more of a human thing than at least most other species, is also really helpful, because we don't have to wait to be facing the danger in order to take some precautions. So that's all really useful. You can have too much anxiety in your life. You can also have too little anxiety in your life, and that's a risk as well. But that feature does open us up to a lot of self torment, to a lot of focus on anxiety, even in places where it actually is not helping us to be any safer, whether because the threats we're worried about are really not actual threats, or whether because they're not really likely to occur, or even because there's just really nothing we can do about them, and so it's not really useful. And so we open ourselves up to a world of being overly, excessively, chronically anxious. And that's the price we pay for being so good at being anxious when we need to be yes that the worries can play a role in our life to our detriment. So I agree with that, but it's interesting. I'll tell you, as a someone who lives in Los Angeles dealing with recent fires, I have friends who worry to different degrees, and a good friend of mine who tends to be a worrier. She was ready for the fire, so when it was time to evacuate. She knew what to pack. She knew what to do. She was in control. And I'm one of those who's on the less worrying side. I was so impressed with her, and I thought maybe I need to worry a little bit more. Showed me that some worrying is very beneficial. Yeah, that's a really great example of the fact that anxiety isn't your enemy, right? Like, no anxiety isn't your enemy. It's not like we were just cursed with anxiety for no reason. It does serve a purpose, but just like any other alarm system, it's not always well calibrated, right? I mean, you know, here's a game I've played with countless audiences, like, imagine 200 people in a room. I'll ask them, Have you ever heard a car alarm go off? And pretty much everybody will raise their hand. But if I ask them, Have you ever heard a car alarm go off because a car was being stolen? Well, almost all the hands are going to go down. Sometimes every single hand is going to go down because it's not that alarms, you know, smoke alarms, car alarms, etc. It's not that they are bad, right? Like they are useful for the purpose they serve. However, they're not always well calibrated, and not every time an alarm goes off is actually an indication that a true danger is present. Sometimes it's just an indication that an alarm is Miss. Are firing. And the tricky thing with anxiety is that, just like with your smoke alarm at home, you can't really figure out whether it is going off because of a fire or whether it is going off because of cooking, for example, you can't really figure that out by how loud it is, right? Like if you try to go by how loud it is, all that's really telling you is how close you are to it. If you want to figure out if it's going off for the wrong reason, well, you actually need to do some checking of the reality, and that's true with our internal alarm system as well. You might feel really strong anxiety. You might have a panic attack, right? Like you might be in the throes of very powerful anxiety. That doesn't mean that because it's so strong, the risk is more real. It just means you have a really strong reaction, and that's something that is, you know, sometimes a little hard for us to wrap our heads around, because it feels so convincing. Yes, I think about this line a lot. Someone once said to me, most of what you worry about never ends up happening. And I think about that because it's so true, we spend so much time worrying, and most of what we worry about never becomes realized in actuality. Yeah, true. Now about the space program, there are two key components that you talk about. Will you tell everybody what those two components are? Yes, the two key components of space and they're both changes in the parent, like I said before, right? Like, none of this is like, here's how you're going to change your kid, but the two key components are support and accommodation. What we want to do in space is essentially to increase the level of parental support and to decrease the level of parental accommodation. But both of those words could probably use some explaining or some defining. Support in particular is tricky because it's a word that, like a lot of people could hear in a lot of different ways, and many parents might think, Well, I am supportive of my child. And in you know, based on a dictionary, maybe you are, but in space, we have a very specific definition of what is meant by support. And it really comes down to a simple recipe. It's like cooking a really simple recipe, right? Like you want to make mac and cheese, you need two things, but you can't do it without both and the mac and cheese of support are acceptance and confidence, meaning you are being supportive for your child who is currently experiencing some distress, maybe that's fear, anxiety, worry, etc, when you're communicating to them these two messages acceptance, meaning, I get it right, like it's real, you genuinely are anxious. I'm not dismissing it, I'm not denying it, I'm not trivializing it, or delegitimizing it or whatever. I'm just accepting I'm validating that. Yeah, you are, in fact, feeling this way. And the other ingredient in the support recipe is confidence, meaning I'm also communicating to you that I actually believe that you can handle feeling anxious. I'm not saying you're not anxious, but I believe that you can actually cope with that, meaning you can get through it, right? It's not confidence that you're suddenly going to step up and do the thing you've been scared of or face all your fears. It's just my belief that you are intrinsically able to be anxious right now and still get through it and still be okay in the end, you put both things together. That's when you're being supportive. So maybe it sounds like saying to your child, I get it, this is really scary for you, and I'm sure you can handle it. I'm sure you can get through it. You're going to be okay. I love this because I find it to be honest, I think it feels very good to be validated and to be seen, and also for a child to feel that support that's going to help them get to the other end. As an example, I see a lot of kids in my office who are fearful of their vaccinations, a lot of parents, and I'm not saying this is the wrong thing to do, but they'll say it's not going to hurt. You've done it before. I like this statement, because you're acknowledging that you see their fears. For example, in this situation, you might say, I understand that you're nervous, I see that you're fearful, but I know you can do it, as opposed to saying it's not going to hurt, which isn't really being honest. But when you say, I know you can do it, that is honest, and kids understand that I'm I'm with you. I've never said it's not going to hurt too many same when I when I read your book, I thought I've seen the error in my ways. And these statements are so helpful for me, I'm noting it, and hopefully will use it and practice it in my own life. Yeah, I think the other trap in the it's not going to hurt model, whether that's a vaccine. Nation, or whether it's any other uncomfortable experience that you're going through, is that implicit in that is the idea that if it were to hurt, you would not be able to handle it, that if it is going to be uncomfortable, well then you must avoid it. Well, then you're probably not able to cope with that, because otherwise, why am I being so fixated on the idea that it's fine and you can take that to any number of situations. I'm scared to get up in the dance recital and perform in front of an audience? Well, if all I'm being told is no, it won't bother you, like nobody's gonna care nothing's it's gonna be fine. You're not gonna be uncomfortable. You might think, Okay now I'm gonna feel better. But actually, what I'm hearing you say is that's the only way that I can cope. And I think probably the most helpful thing for an anxious child to learn is actually that it is okay to be anxious, right? Like that. You can be anxious that it's fine, not to say that it's not uncomfortable, but they can handle it. You can handle it. You can get through it. And that is, I think, a much more important message than Oh, let's see why it is not going to be uncomfortable. Because, let's face it, if your child is vulnerable to anxiety, if they tend or they have some predisposition toward elevated anxiety, they are probably going to experience a lot of anxiety in their lives. And probably the best thing for them to know is that that's okay, right? Like that they can, in fact, handle that, and that's why that supportive message is so important, right? Because we want them to be hearing Yes, I do get it. Like you said, it does feel good to be validated. You know, sometimes we're in such a rush to reassure and to comfort that we actually skip over the validation where we end up even like undermining it, right? Like, no big deal, no big deal. No big deal, exactly. Or sometimes, you know, we lose our temper a little bit, we get frustrated, and we start to go in the direction of, like, come on, right. Like, come on. You're a big boy. Don't be a baby. Like, suck it up already, right? Which is also, of course, not very validating. And so starting with that validating message of I do get it, it like opens your kid's ear to hear the second part of your message, which is the confidence. Because if your child thinks you don't even really understand that, it is hard. Why would they even care what you have to say about it? You obviously don't know what you're talking about, right? Like you obviously don't understand it, and so probably your opinion on the topic is not very relevant, but if you can show them that you do get it, you totally understand that it's hard, and you believe they can handle it well. Now you're starting to hold up a mirror to your child that shows them like that reflection of themselves as a child who isn't all that weak and helpless and vulnerable, but is actually okay, that they're strong, that they're competent, they can handle things. And so we put a lot of work into really just training parents on using these supportive statements. And it doesn't always feel completely natural at first, because nothing new feels completely natural at first, but it starts to feel natural. And you know, even if it doesn't, I think that's okay, your child is still hearing a really important message. And so that's the first of those two big picture elements. So just to give an example for people, let's say they have a child who's afraid of the dark and they want their parent to lie down next to them every night. What would a supportive statement sound like? A supportive statement might sound like, I get it. It's really scary for you when you're in your room by yourself, and I know you can handle that. Feeling perfect. Yeah, really simple. We're not looking for creative writing PhDs. We're not looking for, you know, anything very fancy. And so you need to go and lie in your room by yourself, right? Like sometimes, in fact, not sometimes, pretty much always, we will start using those supportive statements before we even try to reduce any of the accommodations, which is the like second focus of the treatment. And so even when you're lying with your child in the bed in the room at night, you can say to them, you know, I get it. Being by yourself would be hard. It would be scary. I actually think you could handle that, and your child hears it. And then only after we've practiced that for a while are we going to start turning our attention toward those accommodations when we talk about accommodation in the context of a child's distress or their anxiety, what we're really talking about is just all of the things that you as a parent, that you do differently because your kid is anxious and you don't want them to be sometimes you're doing something too. Lower the anxiety. Sometimes you're doing it preemptively, because you know it would make them anxious, and so you're taking steps to make sure they don't get anxious, right? Like maybe your child is scared of bees, to use your example. And so I plan my weekends to not have bees, or I keep all the windows in the house closed, because otherwise they freak out, what if a bee comes in? And so I never do open that window. Or we don't go to the park when we're walking the dog, because what if a bee shows up. Or we take a long car ride instead of a quick flight because they're scared of an airplane, yeah. Or we only make them mac and cheese because they're afraid to eat anything else, and so we dominate them in that way. There are so many examples that come to mind Exactly. It really goes like, fear by fear, worry by worry. You can see how parents might be accommodating, right? Like, maybe my child is socially anxious, and so we don't go to the family events because other people are there, or I don't invite guests to the house where I speak for them in social situations, because they get awkward and uncomfortable and feel shy and embarrassed, etc. There is a ton of research out there on accommodation of child anxiety, and you look at like, hundreds of studies, and these are from all around the world, really, all over the world, the over, under, for the betters out there on how many parents actually accommodate their child's anxiety? Well, it's around 97% Some studies have reported, like literally 100% of parents of anxious kids saying, Yes, I regularly accommodate. Some have gone as low as about 95% it tends to average out at around 97 8% so regardless of the exact number, what it really means is that if you are the parent of an anxious child, you're probably accommodating. And to me it makes sense, because I feel like at the root of accommodating, it comes from a loving place. It comes from a place of wanting to protect your child, of wanting to care for them, which I think is innate in most of us parents. So it's going to have to take some rewiring or some rethinking to change those behaviors. Definitely, it comes from a loving place. You don't want to see your child in distress. They're anxious, of course, you want to help them. And you know, accommodation actually works really well in some other areas, right? Like, if your child has food allergies, well, you're probably going to accommodate those food allergies, right? Like you're not going to say, well, I don't care that you're allergic to peanuts, I'm just going to serve you peanuts anyway, because, like, accommodation doesn't sound like a good idea to me. No, you're not going to serve them the peanuts because that will kill them, and that makes really good sense. There are areas in which accommodation is like a really good idea, anxiety turns out not to be one of them. Because what all of that research also shows, in addition to just how prevalent accommodation is, is that actually, over the slightly longer term, it is not helpful. Higher levels of accommodation by parents end up predicting more anxiety over time, not less anxiety. And so now your kid is even more anxious. And so what do you do? You accommodate even more well. That just leads to even more anxiety. So now you accommodate even more, and it ends up feeling like your whole life is revolving around this kid's anxiety. And you're putting all of this effort, you're bending over backward, which is really frustrating, and yet they get more anxious, and it starts affecting the rest of the family, because if you're putting a ton of energy and time and resources, and sometimes even money into accommodating this child. Well, that's going to come at a cost to you, to siblings, to your relationship with your spouse, to your overall work life, to your leisure life, like it's going to come at significant costs and to the child, right? You deprive them of the opportunity to grow and to improve in their own life in that respect, exactly, yeah. Because every time what they're learning is, well, yeah, I got through this moment. Why? Because it was accommodated, and I couldn't get through it any other way. And so I'm re learning and reiterating that idea that I can't actually handle my anxiety, right? Like, if you are always accommodating, it's kind of like waving a flag that says, I get it. You can't handle anything. I like the analogy that you offered in your book about how important it is to reduce accommodations over time, where you talked about how if a child wasn't that skilled in walking, they just were behind in their development of walking. Yes, you could carry them around all day, and that would get you by, I guess, but you can't expect them to improve their skill in walking if you are doing it for them. And a better method would be to practice slowly but surely, helping them do more, helping them. Walk on their own so that you could grow those muscles. And you said very similar when it comes to accommodating anxiety. You help them grow that muscle. You help them learn to face those challenges, if slowly but surely, little by little, you remove those accommodation exactly that. You know that idea of like, yeah, you're gonna let your child struggle through the walking, even though they're not very good at it. And you know what? You're going to have a kid who falls over more, right? Like, if you don't pick them up, if you don't rescue them, well, they are going to fall over more, and sometimes that's going to hurt a little bit, but there is some benefit to that, like, moment of pain, right? Like, because they are strengthening the muscle, and next week or next month, they're going to be walking just fine, and that's going to set them up for a lifetime of being able to walk around. So, yeah, you could save them the pain of a skinned knee. It's like when you teach your kid to ride a bike, right? Like, yeah, you do take for granted that they may actually fall over. Is that cruel? Is it terrible that parents put their kids on bikes, even though they might fall. Should we all go to jail because we're torturing kids? No, because they're the opposite. It's the opposite, right? Like if you said to your kid, oh no, no, don't get on the bike, because, hey, do you know that you might fall? You might skin your knee, it might bleed, you'll cry. It's gonna hurt. Well, your kid definitely doesn't want to get on that bike anymore. But, yeah, you have saved them that moment of pain. You've also denied them a lifetime of enjoying riding bicycles. And so there's some cost, and it really rests on the idea that you do believe that your kid is able to learn to ride a bike, right like they have the capacity. Do they know how to ride a bike, right now, no, and that's why they might fall, but are they able to learn it? Yes, and that is the same with the anxiety, right? Like, if you take a six month old baby and put them on a bike, well, now you are a jerk. Now you are a jerk because they're going to fall, they're going to get hurt, and they're going to learn nothing. And so, yeah, that parent is abusive, right? Like, that's horrible, yes. And the second part of the statement, believing that they can do it that would be false. That would be false Exactly. But there's a difference between not knowing something right now and not being able to learn it. Children are able to regulate anxiety. We are built with the capacity for some regulation of our anxiety. Sometimes we need to work at strengthening that capacity, just like you strengthen your leg muscle, or just like you learned to ride the bike. So can you give an example of what a reduction in accommodations would look like or sound like? For example, for a child who's struggling to have their parent not lie next to them before bedtime, what would a reduction look like? So for example, maybe my usual routine is every night, as soon as it's time for bed, I just go with you, and I lie down next to you until you fall asleep, and then I get up and, you know, go about, yeah, it does happen. Happens to the best of us. It definitely does. What would a reduction look like? Maybe we say, look, let's start with a gradual thing. Maybe we say, Look, when you go to bed for the first few minutes that you're in bed, I'm actually not going to lie there with you, like, I'm going to be outside, you know, downstairs or in the kitchen, wherever, doing my stuff for 10 minutes, and then I am going to come and I'm going to lie down next to you, and you're going to go to sleep. And so I'm not saying, hey, you need to be there all night by yourself. In fact, I'm not really saying what you need to do at all. What I'm saying is I'm going to change this. I'm not going to go right away and lie down next to you. And one really special thing that happens when you do that is that very often, your kid, in that example, your kid, is actually not that scared, because they know that you're coming right, like they know you will be there in a few minutes. They're not thinking, Oh no, I have to lie here all night by myself. What if the monsters come out? Blah, blah, blah, and so they're not actually all that scared. And so you do that for a few nights, and then, you know, maybe after a week you say, like, hey, you know what this week we're gonna do 15 minutes. And I tell you, when you get up to about 1520 minutes, most of the time, that kid starts falling asleep. Because if you're tired and you're not that scared, typically you end up falling asleep, and eventually you could just stop with the whole thing, and you know, they end up sleeping in their bed by themselves. Or to take another example, you know, maybe you have a kid who is really socially anxious, and you always speak for them, right? Like, you go to the library, you're talking to the librarian to get them the book that they want. You go to the diner, you're ordering for them, you get, like, everything you're always speaking for them. So maybe you say, starting tomorrow when we go to the restaurant, I'm not going to be ordering dessert for you. And if your child doesn't get dessert that day, like, Okay. Not the end of the world, I suppose, and it's a shame, but it's not the end of the world. And you do that, but you're not saying to them, you have to order this, right? Like when it comes time for dessert and your kid wants the ice cream or the pie or whatever. You're not saying you have to do it. You're just saying, Well, I'm sticking to my plan not to do this for you. And very often, you know, maybe not the first time, maybe it's the second time, maybe it's the third time, but your kid starts to really realize that you do actually believe that they're able to handle it, plus, maybe they actually want some dessert, and maybe they end up whispering to the waiter or pointing on the menu to the waiter. Well, that's actually a giant step forward. Yes, yes. And that's and I love that, because what you've pointed out is that it doesn't take any work on the child's part. It's all on the parent. It's the change in our behavior. Exactly, yeah, I never really want to put the onus the child. If you have a child who does want to also practice some of their own skills, that's great. I'm not suggesting anybody should deny them a skill that might be useful for them. If they want to learn some relaxing breathing exercises and do that for a minute and get themselves in a better state, that's perfect. But the beauty of doing space is that you actually can do it, even if you have a child who says I'm out right, like I don't have a problem at all, or I'm not interested in working on it, or I don't want any help, the answer for that was just, well, I'm sorry, we can't help you, right? If you called up a therapist and you said, My kid is really anxious, and they said, Okay, bring them in. And they said, No, they can't. They won't come in, I tried. They refuse. The therapist would say, Well, what do you want from me? You're stuck. Yeah, it'd be like, if you call your mechanic and you say, my car won't start, and they bring it in, have it towed in, and say, well, the car won't come okay. How do you want me to fix it? But what we can do now is say that's okay. That's actually fine. You come in and we're going to give you some tools without making any demands of your child, and you're still going to have a really big impact our clinical research and clinical research from other teams, not by me, so just so everybody doesn't think it's just because I want to say that it works, but clinical trials, multiple clinical trials, actually show that doing space is just as effective as working directly with a child like in cognitive behavioral therapy. So it's not that we should stop doing cognitive behavioral therapy, which is a very effective treatment and has been tested many more times than space, but it's great to have another tool in the toolbox that we can use absolutely and I actually think there's a third component I want to mention, and that is that it's so important for parents to be transparent about what they're doing. Yes, I completely agree. I think transparency is really the way to go. Don't tiptoe around it. Don't trick your child. You know, sometimes parents say to me, when we're doing space, like, won't they realize that I'm seeing you or that I'm like, Yeah, of course. But why should that be a secret? Yes. I mean, I think it's beautiful explain to them why you're doing what you're doing, and that you're making these changes and these accommodations because you love them and you want them to feel better, exactly right? Like I'm your parent, I'm concerned, of course, I'm going to do whatever I can to help you, including consulting with whoever I think can help you. So I also want to ask you, you mentioned in your book a myth that comes up a lot about the cause of anxiety, and if parents are playing a role in their child's anxiety, can you explain why that's not true? Because a lot of parents will easily blame themselves for their child's condition. But I really like how you explain that that's not the case. I think it's really an important point. I'm glad you're bringing it up, because parents have been blamed for lots and lots of problems, and pretty much always, when you actually test those theories empirically, they fall apart. They really do. So here's the reality, yes, there are correlations between certain parent characteristics and certain child characteristics, and that includes for anxiety. And so anxious children are more likely than other children to have parents who are also anxious. And anxious parents are more likely than other parents who are not anxious to have a child who has anxiety. So there is a correlational link there. However, it's also important to bear in mind that finding as well as other parental characteristics that have been linked to anxiety, like being protective or being critical or things like that, those data come from what is called cross sectional study, meaning you're testing the parent and the child at the same time, and you're looking is there. For a connection. And as many people are already aware, correlation is not the same as causation. Two things going together does not mean that one is the cause of the other, and if one is the cause of the other, it doesn't tell you which is the cause of which. Now is there a sense in which, for example, genetics are contributing? Yes, there is a genetic contribution, but I think it makes more sense to think of the genetics, not as the parent, causing the child to have anxiety by passing on the genes. I think a more realistic way to think about that is a third factor, meaning the gene causing anxiety in both the parent and the child. I think that's probably a more realistic way to look at it, because we don't choose our genes, right, like we just get them. And so I would think of the genetics almost as a third external factor that is impacting both there are also other external factors, for example, environmental stressors. Maybe we are both experiencing instability in other aspects of our lives, and those can be causing anxiety in both parent and child. I appreciate you saying this, because I find that so many parents are riddled with parenting guilt when their kids have difficulty. So this is great to learn about. Well, i Far be it from me to deny any parent their God given right to wallow in guilt, but I have to say that there really is not a valid scientific basis for the conclusion that parents are the cause of anxiety in their children. And in fact, I strongly believe, based on the research that is available, that in the vast majority of cases, parents are not the cause of anxiety in their children. If you have a child who does not have that predisposition to anxiety, I think there is a very low likelihood of you giving them an anxiety disorder, regardless of what style of parenting you happen to have, right like, maybe you're a super protective parent if your child is not particularly prone to anxiety, I don't think you're going to make them an anxious kid. I do think you might sometimes make them an irritated kid, because it can be annoying to have a really protective parent when you're not that anxious, but I don't think you're going to give them an anxiety disorder. And the same goes for your own anxiety level, and the same goes for other parental characteristics. And so I would say you don't have to be the cause of a problem in order to be a solution to that problem, in order to be able to help. By the way, we don't apply that logic in most areas. If your kid came home from school with a broken leg, I don't know a lot of parents who would say, I didn't break it. You know, that sounds like a you problem, because I didn't break your leg. And if your kid has anxiety, you don't have to say, Well, I only want to treat it, or I only want to help. And if I caused it, that's absurd. Yes. I mean, I can think myself, I have three kids, and they're all very different when it comes to anxiety levels and what makes each of them nervous. And I think we're the same parents. I know they're technically separated by a couple of years, but I can see that in my own life to be absolutely the case, different than 100 other ways they are different than their anxiety levels. Yes. Now as we conclude, I'd love to offer a message of hope to parents that are listening. Maybe they're feeling overwhelmed by what to do. Maybe they're feeling unsure about implementing these changes. Can you tell everybody, if they go through this program, how long does it typically take, and what will they expect to find in the end? In other words, do these conditions get better from your experience? The answer to that last part is a resounding yes. These problems can absolutely get better. In fact, while it's true that anxiety is the most common mental health problem, it is probably also the most treatable mental health problem, there are so many problems where we dream of having the ability to actually improve them to the extent that we can with anxiety. I would say to any parent listening that the world is just chock full of kids who used to have an anxiety disorder and now they don't, because you can actually overcome these problems. How long does it take a typical course of doing space, assuming you're really doing it seriously working at it. You know, it's not the kind of treatment where you just go talk to a therapist and then do nothing for a week, come back and talk again, you go to your therapy sessions of space so that you know what to do at home. But at home is actually where the treatment occurs, right? Like the sessions are there to tell you how to do it when you're not there, but assuming you're really putting in the work a typical course of space might run 10, 1215, sessions. 12 would be a reasonable ballpark average, which means a few short months, right? We're not talking about years of therapy. We're talking about a few short months. Is that going to come? Completely remove that predisposition to anxiety in your child. No, because we don't change who human beings are, nor do I really think we want to. But what can it change? It can change whether this is a problem that is actually limiting your child's experience. Is it impairing their ability to function, to go to school and to function there, socially, academically, to live a normal life at home, to have social relationships, to sleep at night and eat during the day and feel okay with themselves. That's what we're trying to change, to make this not the problem that is the focus of your kids life, and that is very much possible for the big majority of kids. And so I would say, if you're really doing this work, within two months, you'll probably already be seeing really significant change in your child. And within three months, you might already be ready to actually end the treatment. And I'm sure for parents listening that do have kids that are really impacted and impaired by their specific anxieties, just learning that they can go about their regular business and their life without it impacting them to such a large degree. I think that must sound like a dream. I think so too, because, yeah, the anxiety is a huge burden on the child, but it is also a burden on the parents and the rest of the family. And this treatment, while it does take work, it should actually make your life easier, not harder. And I'd like to point out it can also help children that have milder cases as well. Yeah, yes, absolutely. I think even if your child doesn't have a clinically diagnosed anxiety disorder, you ask a parent who has a child with some mild but not all that severe anxiety, would it be good if your child could, like, do better with this? They'll say, like, of course, like, why not? Yes, only insurance companies that think we should ignore all of those cases. Yes, no. I'm someone who thinks labels definitely have their limits to how helpful they can be for people, definitely. And then, just to conclude, I would love for everyone to know. Where can they find you? You have a TED talk, you have a documentary, where can people find additional resources and professional help if they want support? Yes, absolutely. Well, first of all, apologies to everybody. I am not on any social media personally, and so don't look for Ellie Liebowitz on good for you, yeah. Well, I don't know if good or not, but I've just, like completely sought that out. And so I've never really joined anything, but you can find a lot of resources to learn more about the treatment, to find the therapist. The number one thing to do, I would say, is go to the website. There is a website for space. It is space treatment.net and that has a ton of resources. There's a list of therapists numbering in the 1000s who have all done formal training in doing space, and there's at least one in every single state in the US, as well as many other countries. So you can go search it, find somebody to work with. There are other resources, links to other podcasts or research articles and other articles and videos and things like that. You can find that on the website. If you're a therapist and you're interested in becoming trained in space, you can find where to get information about the training. And so that is, I would say, the number one place to go. There is also a Facebook page, so it's not me, but there is a space Facebook page, which is facebook.com/space treatments, in this case, a plural. So space treatments. And actually, through there, you can join the discussion group if you're interested in communicating with others. The website also has like a forum that you can join. And there are multiple books published. I think if I had to recommend one book in particular, I would say it is the book called breaking free of child anxiety and OCD. That is a book really written for any parent to pick up and just work through to kind of do space on their own. But even if you are working with a therapist, it can be like a good accompaniment for the treatment. The book is great. I love the worksheets that are in there. I think it's a great help for parents. I love all the examples of supportive statements. So anybody who's looking for a place to get started, I definitely agree. I would get that book, and you probably will find that finding a therapist to accompany the book would be the most effective way to treat your child. Yeah, I think so too. But I also acknowledge that not everybody has easy access to a therapist, whether because of where you live or other or other reasons, and so if you actually can't work with a therapist, I would say, then try to work through the book by yourself. Teaser for anybody who is interested in the arfid in particular, we do have a book coming out that will be on kind of a similar book, but for parents of these really, really picky eaters. We also have another book coming out which is really focused on schools and anxiety in the school setting. Amazing. Because I will say both of those areas cause a lot of distress for families, particularly arfid It's hard for parents to know where to go, where to get treatment. So I'm so happy to hear that you're continuing to do the good work that you do. Dr Ali Liebowitz, I'm so proud of you, and I can't wait to see what else you continue to do well. Thank you so much. Thank you for all the impact you've made, and thank you for your time. Thanks. Thank you for listening. And I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. You.