By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Multimedia, Podcast

Topics: Anxiety

In this episode of Shrinking it Down: Mental Health Made Simple, Gene and Khadijah are joined by Dr. Kat Boger to explore what it’s like for families when one child is struggling with an anxiety disorder. They discuss how to explain anxiety in an age-appropriate way, unintended effects of family accommodation, and realistic strategies to support both the anxious child and their siblings.

Tune in for important and practical advice on supporting your child with anxiety!

Media List

• About (InStride Health)
• Anxiety Disorders (MGH Clay Center)
• Talking to Kids About a Sibling’s Mental Illness (MGH Clay Center)
• Growing Up With a Sibling With a Disability (MGH Clay Center)
• No Kings

Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH; Kat Boger, PhD

[INTRO MUSIC PLAYS]

Gene 00:29

Welcome Back to Shrinking it Down: Mental Health Made Simple. I’m Gene Beresin

Khadijah 00:33

And I’m Khadijah Booth Watkins,

Gene 00:35

and we’re two children and adolescent psychiatrist at the Clay Center for young healthy minds at the Massachusetts General Hospital. So, you know, facing a mental illness in a child can be one of the most challenging experiences of parenthood. Managing mood and behavioral symptoms and bearing a child’s suffering are compounded by navigating kind of an impossible health care system that treats psychiatric illness so differently than other serious illnesses that affect children and teens and young adults. For that matter, what’s more, attempting amid the stigma that still exists around psychiatric illness can leave parents feeling isolated in their struggle. On the other hand, unlike a broken mental health system or diminishing stigma, addressing a child’s mental illness with their siblings is one challenge that parents are fully equipped to handle. Though there’s, frankly, very, very little discussion about this in literature or online. It’s normal.

Khadijah 01:35

for parents who want to protect their children from a sibling’s illness, and that includes mental illness they want to protect their children from, you know, behaviors from news that might be scary or confusing, and parents usually feel torn from wanting to protect their child’s privacy, the child who might be struggling, especially, but not only if this child is a teenager, but you know, significant illness can’t be kept in a vacuum. It usually affects everyone in the family and so choosing not and so choosing not to discuss it can leave siblings feeling kind of confused, bewildered, frustrated. You know, we often tell parents. You know, when you leave kids with their own devices, they create a story that’s often scarier than reality. So, treating mental illness as something that is secret may actually promote stigma, isolation, shame and embarrassment. So we really want to help parents figure out and think about how to find ways to speak openly and honestly about what a sibling might be noticing or what a sibling might be struggling with at home, while at the same time setting a tone of, you know, compassion, patience and respect. We want to create this environment that supports healing and resilience in all of their children. And so, it can even become even more complicated when you know the sibling has to explain or stand up for sibling who’s struggling, who’s viewed maybe negatively by the peers or by their teachers or in the community. And so really, having these open conversations can really help everyone who’s involved.

Gene 03:02

Yeah, I might add that, you know, and we can talk about this with our with our guest, but, you know, kids with any form of disability, but, but psychiatric problems are often the subject of bullying, and they’re picked on at schools, and so siblings who are witnessing this, you know, don’t know really what to do, that, among many other things here to help us navigate this really difficult but important conversation for parents to have with their with their kids, is Dr Kat Boger. Dr Boger is a board-certified child and adolescent psychologist dedicated to helping youth with anxiety and OCD through innovative research-based care, she co-founded the McLean anxiety Mastery program, MAMP, a nationally recognized intensive treatment program, and served as an assistant professor at Harvard Medical School. She also published a variety of peer reviewed journal articles, delivered national talks, including a TEDx talk, and trained professionals across hospitals, schools and communities. She’s also co-founder and the Chief Clinical Officer for in stride health, which works to expand access to effective mental health treatment for young people with anxiety and OCD welcome cat.

Dr. Kat Boger 04:19

Thank you so much. Gene and Khadija. I’m really happy to be here today.

Khadijah 04:23

to get started. How do we explain anxiety to siblings of different ages? You know specifically, what words do you use or not use? You know, what examples do you use? Do you focus on, or do you focus on? Or how do you even explain what they might be experiencing internally versus what we might see in terms of like behaviors or actions or what we might see externally. How do you begin these conversations around explaining anxiety?

Dr. Kat Boger 04:53

Yeah, you know, I think that’s a really important question, because how we talk about anxiety, can. Depending on the age and the developmental stage of the sibling. And so overall, the goal is to make the conversation understandable and non-scary. And what you want to do is you want to emphasize that anxiety is something their sibling is managing. It’s not who they are. So, for example, instead of saying Sara is anxious or Sara is an anxious person. I would say Sara is working on managing anxiety. And I think distinguishing the person from anxiety or the anxiety disorder is really important. And then I like to use the fire alarm analogy. You’ve probably heard of it. It’s simple, it’s concrete, and it’s one of your favorites. I know it tends to be a go to it tends to work well across ages, too. So I’ll say we all have an alarm system in our brains, and it’s meant to keep us safe, but sometimes that fire alarm, it’s more sensitive, and it’ll go off in situations when there’s really no danger, sort of like a smoke detector that goes off when you burn the pancakes, but there’s no real fire in the house. And so that’s sort of like the framework of the analogy I’ll use. And then I can tailor that by age. So, for thinking about younger kids, which would be like preschool, early elementary, I would keep it concrete and even go visual. So, I might say, like, your sister’s brain alarm goes off sometimes when it doesn’t need to, like, before school, or if she has to try something new, and this makes her body feel yucky. So she may say she can’t go or can’t do things, but she’s learning ways to calm down that alarm, and you could even bring that to life a little bit by drawing a picture of a little brain and an alarm, and kind of bring the child into it, and then for older kids, so that would be like late elementary middle school. You might go a little bit deeper, so you might say something like, her brain sends a false alarm and it tells her something bad’s going to happen, even though she’s actually safe, and this makes her feel really anxious, and sometimes she avoids things because she wants to feel better in the moment, but the more she avoids, the stronger the alarm gets. So, we as a family, we’re helping her practice doing hard things so that her brain can learn that she can handle it. And then lastly, for teens, I would be direct and collaborative. You might say something like, everyone has anxiety. It’s our built-in safety system. Your sister’s brain has a more sensitive alarm system right now, so we’re helping her retrain it through practice, as opposed to avoiding sometimes. You know, with a teen, you can ask them to reflect on times when they themselves have felt anxious. And I think this can help with normalizing and building empathy, as opposed to frustration like that. And then to touch on the other thing that you’ve said, I do like to connect the dots between the thoughts, the feelings and the behaviors. Behaviors are often what you can see, and the thoughts and the feelings could be more hidden. So, I might use language like her brain tells her she’s going to throw up at school, that’s the thought, and so she feels really scared, that’s the emotion, and then she asks to stay home. That’s the behavior. And I think that can help siblings understand that what they’re seeing is not stubborn or drama, it’s the anxiety doing its job just a little too well.

Gene 08:29

So, a couple questions in terms of your use of terms, do you get into the different behaviors of various anxiety disorders like phobias or separation anxiety or social phobia or generalized anxiety disorder, and where is that too much to have? I know this is probably a series of conversations, I would imagine, but do you get into the different kinds of anxiety that kids are seeing in their in the behavior of their siblings.

Dr. Kat Boger 09:04

It’s a good question. And I think again, the language I would use would depend on the age and developmental stage. So, for younger kids, I might paint a picture more just like what the behaviors look like. And so, I might say, and tie that to emotions and thoughts. So I might say, you know, your sister feels really scared in certain social situations, like when she’s talking to other people, and when she’s feeling scared, her brain is telling her other people are judging her, and so her behavior to try to leave those situations or not speak up or ask other people to speak for her, and then for someone who’s older, so for example, like a teen or young adult, I might put some you know, more descriptive language to it around you know your sibling is struggling with social anxiety, and what that means is a fear of being embarrassed or judged.

Gene 10:00

Changed so and the other question is, it’s important to explain this to a child’s siblings, but who else should know? I mean, so, for example, grandparents, extended family, teachers. So that’s one question. And then, before you have conversations with anybody, how do you get permission or assent from a child with anxiety and so that they know that you’re actually having these discussions? Should they be or should they be present when you’re having these discussions?

Dr. Kat Boger 10:35

Yeah, you know, I think it depends on your family’s support network. I am a big believer that it takes a village. And so, if there are grandparents, teachers, coaches, any other adults who are part of your kids’ lives, I think it can be really helpful for them to understand what’s going on. And to your point, it needs to be in a way that feels respectful to your child. And so, I do recommend asking your child for permission first. And you could say something like, is it okay if we tell Grandma a little about your anxiety so that she can help when she comes to visit? And I think what this does is it gives your child some agency, and then they get to decide, you know how much they want to share and also whether they want to be present in the conversation. And I’ve seen it go both ways. I’ve seen some kids I absolutely want to be there, I want to do the talking, and others say I’d rather you have the conversation for me. But I think as parents, I’m a parent myself, and I’m a big believer too, and just leading with humility, and I love to just like, ask for feedback. And so, I think after you then had the conversation, I’d come back to your child and say, “How do you think that conversation went? Is there anything that I could do differently next time? And I think in addition to modeling humility and that we’re all fallible humans, it shows that you want to be collaborative, that you’re communicating, you’re showing respect, and I think all of those things are important in managing anxiety over the long term.

Khadijah 12:10

What if? What if your kid is like, no, no, no, no one can know this is not to be shared, and it’s really resistant to the idea of because I agree, like I think the more people that know and who you know are safe to understand are psychologically minded. It is better for the child to help them with their kind of progress through the challenges. But what if they’re, like, adamant that they don’t want to share it with anybody

Dr. Kat Boger 12:35

you know? I think the first thing I do is lead with validation. You may hear me say that a lot today, but, you know, I think that’s so critical in terms of we often think about validation is like the grease for the wheels of change, and so leaning into like, it’s understandable that you feel nervous about opening up to other people about this. This is new for you too. This is scary and overwhelming. And then I think after that, I would take more of like a curious stance and ask questions and wonder with them, what feel like the blockers to doing that, and what do they see as potential negatives or problems with sharing with other people, and be curious about whether they also see that There could be some positives too. And so again, I’m letting them drive, but I’m asking questions in a way that helps them expand their thinking.

Khadijah 13:32

And so and so we talk about at the beginning how you know the family is a unit. They’re all connected. And when a member of a family is struggling or impacted by something, anything, it doesn’t happen in isolation. So, when one child is struggling with anxiety, what kinds of ripple effects do you tend to see in their siblings?

Dr. Kat Boger 13:51

Yeah, you know, I see a few main patterns. One pattern that I see is just the emotional burden or toll. And here I see a range of reactions from siblings. So, one may be siblings feeling guilty, like, well, I shouldn’t complain. In this situation, my brother has it way worse than I do. Other situations see some jealousy over the attention that the child with anxiety, or even the time that the child with anxiety is getting. We also see fear and confusion. Sometimes you talk about it in the absence of information, kids will often create a story that’s scarier than reality. And I think when kids don’t have that information, it can feel really scary. And then sometimes we see resentment. Here it’s, you know, when families’ plans are changing repeatedly, it can feel frustrating and hard for a sibling. So, there’s that emotional piece. I think we also see shifts and roles within the family sometimes. So, some siblings will become the helper or the Peacekeeper in the family. Right, and then others will withdraw or act out more. And I think it’s really helpful to identify the roles as they’re starting to take shape, because these rules can get pretty sticky over time, and then modeling is a piece that we see. So, kids are natural observers. They pick up on how their parents and how their siblings are responding to fear, and how we talk about discomfort, and I think those are lessons that shape how they learn how to cope with emotions and challenging situations in the future. And then the final ripple effect that I’ll touch on is just disruptions to family life. And so, when a child’s anxiety starts driving decisions for them, but also for the whole family, it can really change the rhythms of family life. And so, you know, you might hear like, well, we can’t go to the restaurant tonight because it’ll upset your sister. And this can happen through something that’s called Family accommodation, and family members, so parents, but could also be siblings begin to do things, or sometimes even not do things to help their child avoid feeling anxious in the moment. So, this could be things like giving repeated reassurance, changing plans, staying nearby, or even stepping in to prevent distress in a given situation. And want to be clear, this all comes from love, and a child who has anxiety is often asking for these types of accommodations because their brain tells them that they’re not safe without them. The unfortunate part is here parents are, and family members are stepping in, and what they think is helpful behavior, but over time, it actually grows the anxiety, and it teaches the child I can’t handle this on my own.

Gene 16:51

And you know, another aspect of this that maybe you could comment on is given accommodation, given special needs of the anxious child, given all kinds of things that you just mentioned, looking at sibling rivalry. I mean, what about siblings who are not anxious? How are they? How do we help? How can parents help them not feel that their needs come second, that their needs can come equally well as in line with, with their anxious sibling?

Dr. Kat Boger 17:25

Yeah, I would start with honesty. Kids often know that something is going on, and so first you just want to acknowledge what is happening. So, you could say something like you may have noticed that your brother’s been having a hard time lately. Here’s what’s going on. Here’s what it means, and here’s what we as a family are doing to help. And then again, as I talked about before, I would lead with curiosity. I would ask the sibling questions and really listen to them so you might, you know, put your phone down and take some time and say, like, how has this been for you? And let them express their thoughts and their emotions. You may not want to hear some of the things they have to say, and it’s really important to sit with those things and make space for them and then also validate what they’re saying. So, you could say it’s understandable that you’ve been feeling a little jealous of the extra attention that your sibling has been getting lately. So, another thing that you can do is be intentional about one-on-one time with the sibling. I will acknowledge that this can be hard when you have a child who’s struggling with anxiety, who is taking up a lot of your time and attention. And when we think about this, it’s really quality over quantity. It doesn’t need to be fancy. It doesn’t need to be time consuming. Like a 10-minute walk with your child where you’re listening, you’re talking all of your attention is focused on them, or a game of UNO where they have your full attention. It sends a message about your matter too. And then the last thing I’d say is that you can also highlight what you’re noticing and appreciating in your child. So, you could say, like I noticed how patient you were when your brother was having a hard time, which can’t have been easy, and that makes the sibling feel seen and feel valued.

Khadijah 19:24

So, we’ve been talking a lot about, you know, conversations and open communication. And are there some ways that we can help parents foster open lines of communication between siblings about anxiety while still respecting, you know, boundaries and privacy? You know, we talked a little bit about that. We would want to probably include the child who might be struggling with anxiety, if, you know, in these initial conversations, before we open it up and have bigger conversations. But you know, is this going to be a big conversation held at a family meeting? Would this happen over multiple conversations, over the course of time? You know, I’d imagine at the core. Sure, I think you’ve mentioned, you know, it’s important to be honest and open and genuine and be compassionate and patient and make sure that we are not kind of falling into these traps of shaming and blaming and kind of promoting stigma. So, I just be curious to hear, how do you instruct parents to, kind of how to have these conversations at home? And then also I wonder, because the big thing I think, that they often struggle with is, how do they differentiate between what’s secret and what’s private? And so how to help them kind of strike that balance of maintaining privacy, but also not trying to make this feel like a secret? Secrets feel, you know, kind of yucky. They don’t feel good. And so how to help parents understand that difference?

Dr. Kat Boger 20:42

Yeah, no, I agree that these kinds of open conversations are critical in reducing confusion and stigma and that like yucky feeling that you talked about and so similar to what we talked about in terms of extended families and bringing them in, I would start by talking with the child who’s experiencing anxiety and ask them, you know, would it be okay if we talked together as a family about what’s been going on? Siblings can have different types of relationships. So, this is a really important first step. You want to talk with them about what’s okay to share and what they would rather you not share, or they not share in the conversation. And maybe it’s just as simple as like, sometimes I get really nervous and my brain tells me things that aren’t true, and so this is what I tend to do in those situations. But I think planning ahead like that builds the trust and it builds ownership in the child who is experiencing anxiety, and then when the family comes together for that family meeting, as you alluded to, I would keep it concrete, keep it hopeful. You could talk about what anxiety looks like, what helps, also what doesn’t help. I’ve worked with a lot of kids who relish the opportunity to tell their families what doesn’t help. It feels empowering to actually say, you know, you may think that asking me a lot of questions when I’m feeling anxious is helpful, but it actually makes me feel more anxious, and then focusing on what can the sibling do to be helpful? Sometimes families want to have this conversation on their own, and other times, a therapist can help to facilitate the conversation, but I would say it’s not a one-shot deal. Instead, it’s important to keep revisiting this, because kids understand and their needs are going to evolve over time as they mature.

Gene 22:32

So, you mentioned previously about modeling and how. How does learning through modeling impact siblings own coping with the situation.

Dr. Kat Boger 22:44

Modeling is huge, and kids often learn more from what we do than what we say. And they are watching us. So, they’re watching their family members, their siblings, their parents, in terms of how they handle stress, fear, frustration, and in those situations, they’re learning a lot. And so, I think about, for example, emotional modeling. If parents or siblings respond to fear by shutting down or trying to make feelings go away, then kids learn that anxiety is dangerous, and anxiety needs to be avoided. On the other hand, when we respond with calm curiosity, like, okay, I noticed my heart is racing, but that’s just my body’s alarm going off. Kids can see that anxiety can feel uncomfortable and it’s tolerable. And then there’s the behavioral modeling piece, so if family members are avoiding challenges. So, if, like the sibling, is repeatedly avoiding things in the face of anxiety or backing away when they feel discomfort, then kids learn that avoidance is the safest and the best route. And so, it’s all about facing those challenges and even just small steps, so that kids can see the value in doing hard things or doing things that feel scary.

Gene 24:04

And do you ever suggest that parent’s kind of talk about their own experiences when they were anxious, when their alarms went off, like, for example, we’ve had hurricanes. Here. We’ve had, you know, wildfires, we’ve had all kinds of horrible natural events. And there, I’m sure there are a lot of family narratives that that that parents could use. Do you think that those narratives about how members of the family have helped real situations that cause anxiety, and also imagine situations that they were anticipating, anticipating something terrible happening and it just didn’t occur?

Dr. Kat Boger 24:41

Yeah, I think it can be helpful to a certain extent. And so, for example, I’ll encourage families to narrate their own bravery and how they’re responding to feelings of anxiety out loud. So even for myself, let’s say I have a big meeting, and I might just say out loud. Out. I’m feeling really nervous about my meeting today. I’m worried I’m going to mess up, and so I’m noticing that, and I am slowing down my breathing, and I’m reminding myself that I can handle this. And I think that that kind of like self-talk. It normalizes fear, but it also shows what coping can look like. And then I’ll circle back to the end of the day and say, oh, I was really nervous about that meeting this morning, and I’m so glad I did it, because I learned X, Y and Z.

Khadijah 25:31

You know, you alluded to this or actually spoke on this earlier. And I often tell parents similarly, you know that knowing how to best support your child who’s anxious can be tricky, because often, you know, our natural reaction response is, you know, what comes intuitive to us as parents can sometimes be counterproductive and that we, you know, sometimes can over accommodate and make the anxiety worse. You know, inadvertently, all through, you know, wanting to love and protect our children is this similar when we’re thinking about how parents are supporting siblings. You know, siblings, as you mentioned, sometimes step into different roles. They may step into the role of, you know, the parent or the protector, or they may be so frustrated and resentful that they maybe are avoiding their siblings. What are some of the best ways that parents can support the sibling of a child with anxiety? You know, are there specific situations that we can kind of give them guidance and instruction on how to manage when they’re, you know, again in the community or on the playground or hanging even with each other? What do you say to parents?

Dr. Kat Boger 26:35

Yeah, I think these situations come up all the time, and often in the context of that anxiety and avoidance cycle, and it can be really tough for siblings. So, you imagine the whole family has an outing on a Saturday, and they’re all supposed to go together. Everyone’s excited, but then one of the children’s anxieties derails the plan for the sibling. That can be confusing. It can be disappointing, frustrating, and so I think acknowledging that, as I know this is frustrating, you were looking forward to this. It’s okay if you’re feeling upset that it’s again. It’s that validation that I said I’d come back to and it’s really powerful. And it tells the siblings that their feelings matter too. I think also, parents can plan ahead and give the sibling concrete ways to respond if and when anxiety shows up for the sibling. So, for example, if the whole family is going to a party, a parent might say, if your sister gets anxious at the party today, remember, it’s her anxiety talking. It’s not her, and what we’re going to do, and in that situation is we’re going to acknowledge her fear, and then we’re going to coach her to take small steps, to enter that party and to start engaging in other people. And I think this helps both separate the person from the symptoms and then helps the sibling understand what’s going to happen and how the family is going to respond. And then I think it’s also important to ensure to the degree that it’s possible logistically, that the siblings don’t lose out on their own experiences. So if, for example, the whole family was supposed to go to a party and the child with anxiety is not able to go that day, see if you can find a way for the sibling to still get to go to that party, and that sends a message that their matter, their needs matter too, although recognize sometimes logistically that can be tough. Do you?

Khadijah 28:30

ever, do you ever just not discourage but you know, sometimes I’ve, I’ve had siblings, you know, speak for other siblings, or order for us, like, do you get involved in coaching the parents to coach the siblings in the same way you would coach the parent to, kind of, you know, gently encourage the child to, kind of, do these things on their own. Do you give that same instruction to the parents to coach the siblings?

Dr. Kat Boger 28:54

It’s a really good question. So, family accommodation is equal opportunity, and kids will ask their parents for various accommodations. They’ll also ask their siblings. And it’s super tricky when you’re a sibling and you think you’re being helpful in the moment, because you think you’re alleviating the distress of your sibling, and really, you’re actually, unfortunately feeding that anxiety avoidance cycle. And so, in situations like that, we’re seeing that family accommodation is really targeting the whole family. We’ll sit down often and have a conversation with everyone, and we’ll talk about what family accommodation is, what it looks like in the family, and the role that it serves in that anxiety cycle. And then we’ll make a plan. So sometimes the families will say the first step in the plan is when you hear your sibling ask for that specific accommodation. So, when they say, will you order for me at the restaurant? We’re just going to say, that sounds like your anxiety talking. And then maybe the next level up, after we’ve done that a bunch, is that we’re just going to give a thumbs up, and then we’ll do that a bunch of times. Then eventually we’re just not going to respond, because the more we respond in those moments, the more we say yes, I will do that. I’ll speak to you again. The bigger the anxiety gets, and we’re robbing the child of the opportunity to see that they themselves can handle the situation.

Gene 30:16

And you know, another thing that comes up frequently, and I and many parents and young people who are listening one at one specific tips. So, for example, what strategies do you recommend helping all members of the family develop coping skills? So, for tolerating behavior that’s really, really difficult, learning how to let it go and not and not intervene and Wendy and when and when do you recommend that parents were siblings’ step in and provide support? I mean, how can the family learn these kinds of skills and enable them?

Dr. Kat Boger 30:59

I love this question, because I think these are skills that can benefit everyone in the family, not just the child who has anxiety. And so, one of my favorite strategies as a parent myself, but also as a professional working with other parents, is just pausing. It sounds simple, it’s really powerful. And so, the idea is that you take a moment to check in with yourself as parents, we’re tired, we’re really busy, and it’s easy to just operate on autopilot. I know for me, it is anyway and so taking that pause allows us to choose how we want to show up in this situation. I think it’s particularly important in moments that challenge us. So, for example, when anxiety is really big or emotions are strong, our instincts as parents, even as siblings, is to jump in and solve problems. It’s to fix, and unfortunately, that sometimes can just make the situation worse. And so, what we want to do in the situation is just pause, maybe slow down our breathing a little bit. And this gives everyone a chance to just notice what’s happening and then decide what we want to do, instead of just reacting automatically. And then I think we can help kids in noticing and naming and responding to emotions. So, you might say it seems like you have butterflies in your stomach right now, what emotion Do you think you might be feeling? So again, leading with that curiosity, and I think just the act of naming it can make the emotion feel less overwhelming and more manageable. You’ve probably heard the expression name it to tame it, but I think it’s the difference between being in the wave and observing the wave, and then after naming the emotion, you can work with the child on how they want to respond. So maybe they want to take a break, or maybe they want to take a slow breath, or maybe they want to take a brave small step forward. And then lastly, you want to validate again, keep coming back to it, but it’s so important leaning into how they’re feeling in the situation. And it doesn’t necessarily mean agreeing with their behavior. You’re just instead showing that their emotions are real and okay. And I think when kids feel understood in a certain situation, they’re much more open to coping, as opposed to like shutting down.

Khadijah 33:29

To wrap up, let me ask you, what is one thing you wish all parents knew about raising a child with anxiety?

Dr. Kat Boger 33:38

I would say that parenting a child who has anxiety is completely counterintuitive. Every instinct scream, protects them, protects them, but protection in this situation actually feeds fear. And so, the best thing that we can do is show our love, validate feelings, and then encourage brave steps forward. And so, every time your child is facing a fear, no matter how small that fear is, they are teaching their brain. I can handle this, and that is what will shrink anxiety down to size over time.

Khadijah 34:14

I feel like, when I tell parents that you see like this, their shoulders like the weight lift a little bit, because it feels like it’s, it’s tricky, like it feels like you’re almost, sometimes in a hamster wheel, and you’re doing all these things that are just so natural. But really, you know, I think it’s a work, it’s an active, deliberate process to not do the thing that feels so natural often when you’re working with your young person who has anxiety, but I think knowing that as a parent is so helpful and I think so empowering and just so validating, really. And I think it just allows them to be able to do the other work that can be hard. It’s hard for the whole family. It is often a family project, if you will.

Dr. Kat Boger 34:59

That’s very true. And I have worked with families over the years, who said we have been stuck on that sort of like hamster wheel, as you refer to it, for years, thinking that what we were doing was actually making the situation better, and now we’re realizing it was growing the anxiety, and on the one hand, that’s hard to recognize, on the other hand, it’s empowering, because now the family has a roadmap, and they have strategies and skills that they can start to employ to help again, shrink that anxiety over time.

Gene 35:34

Well, this has really been helpful. And I’d like to wrap up with something we do in all of our podcasts, and that is kind of have a round robin. So, let’s talk. Let’s, let’s give examples of our own anxieties and how we cope with them. Not that we have anxiety disorders, though those. Anxiety is natural, but anxiety is really natural. So, so, um, but, but how? How do you what’s, what’s something that makes you anxious?

 

Khadijah 36:01

Khadija, I’m gonna tell you two things. One of the things that makes me anxious is having an email that I haven’t respond to. And so instead of just going, I know it’s been two days, three days, instead of just going in and responded, then I started delaying, like, oh, it’s been long time. How they are going to feel that it’s taking me so long to respond. So that makes me anxious. And the other thing that makes me anxious is talking to people that I that I don’t know in social settings. That makes me anxious. I just push through it. But that does make me feel that kind of what am I going to say? What if I sound silly? What if they think I don’t sound smart? Those are the two biggest things, I think.

Gene 36:41

But how do you cope with it? How do you cope with it? How do you cope with it? What do you do to see your way through it?

Khadijah 36:48

So, with the emails, I have to psych myself up and say, the longer you wait, the worse it’s going to get. Like, if you keep putting it off, then they’re really going to feel like, why did you respond to it? So, I have to give myself a pep talk. Different strategies, you know, I use with social situations. Sometimes it’s just kind of, again, a pep talk. Like, you know, it’s fine, you’re going to be okay. These are nice people. They’re not, they’re not going to ridicule you. Like, people are kind sometimes, you know, in the I don’t know, cat, if you think this is a bad thing, sometimes I just, like, have a person, like, I try to go to things with someone, and then I kind of venture out on my own, so that initial step of going together with a friend or family member, and then I kind of make myself kind of have conversations again, just, you know, go over and just say hello, and then you could just walk away. Like I kind of give myself small little projects, many exposures, many exposures for been doing it for life. Love it.

Dr. Kat Boger 37:41

We often say, actually, in our program, exposure is life, and so it sounds like you are making exposure life. So that’s great. I can jump in because I share the email fear. When my inbox gets to approximately like six or seven emails, it makes me feel uncomfortable. I like to be one to two. I don’t have to be zero inbox. I like to be one to two. And so, every once in a while, I will give myself exposure of just tolerating that the inbox has gotten larger, and I just have to sit with it. And yeah, but the other thing I’ll add is, for me, it’s my real trigger is when my kids are struggling, and anyway, that’s when my anxiety goes up. And so, I think it’s sometimes it’s hard to practice what you preach. And so, I find myself having the urge to do exactly the opposite of what I coach parents to do. And so, I really have to then capitalize on that pause and kind of reflect on the situation and then make deliberate decisions, and how I show up. And I think also just, you know, learning on my support systems, so my husband, my friends, and I think what I find is helpful is actually telling them how they can be helpful. Is, I think sometimes people think they’re being helpful, but they’re not really sure how to navigate it. And so, sharing what you need in a given situation, I think, can help equip people to support best.

Khadijah 39:08

What about you? Gene,

Gene 39:10

well, you know, I’m anxious about email, but I want, and I’ve got, I’ve got, like, 27,000 literally, 27,000 emails. Not, I go to about five or six countries a day, but, but many of them are, I can just delete but, but most recently I have been anxious about two things. One is, I have a cat with chronic kidney disease. And, you know, I I’ve always had a dog, any cat and, and this cat was a feral cat from South Boston, my daughter picked this cat up, you know, and as a feral cat, she never was all that friendly, you know. I mean, she would like, literally turn in and scratch. She would scratch our dogs. But what I realized, and I would and I anxious, because. So virtually every cat over 16 will get chronic kidney disease, and then they become picky eaters and oh, it’s just, it’s like having a sick kid, but it’s, but it’s you can’t control, you can’t take care of it like a sick kid. So, I’ve been anxious about that, but what’s made me, what’s worked for me, is just kind of helping to, kind of, like, treat the cat, you know, in a more kind and friendly way. And she’s never purred more or played more. So that’s one thing. The other thing most recently is I’ve been very anxious about what’s going on in our country politically. And I haven’t I, it’s been a long time. I mean, I was in college during the 60s and 70s medical school and went to lots and lots and lots of rallies, but I went to, I went to the first rally in many years. I went to the No King’s Rally. And I was terribly anxious about going, because so many people are angry and fearful and marginalized, and I was really kind of anxious about going. And to my surprise and pleasure, it was so much fun. The people were in costumes. They were the signs were hysterical. I took so many pictures of the I mean, it was in the face of real fear and hate and rage that a lot of people are feeling. And I think that happened all over the country, which was kind of paradoxical, but what I learned was that there’s no better help for anxiety than being with other people and using humor to deal with adversity.

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So that’s that was. That was a great, great learning experience. And now, for those of you at home, if you like what you’ve heard, consider sending us a review. And as always, we hope that our conversation will help you have yours. I’m Gene Beresin

Khadijah 42:14

And I’m Khadijah Booth Watkins, until next time you.

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Episode music by Gene Beresin

Episode produced by Spenser Egnatz