Not Helping your Child with Anxiety or OCD: When Helping Only Hurts and What You Can Do Instead
By Ferdinando “Ferd” Palumbo, MSW, LCSW
In my previous blog, I discussed the relationship between avoidance and escape and maintaining anxiety. Although avoidance and escape are only natural desires when faced with discomfort, for people suffering from Anxiety and OCD this often leads to a problematic overreliance on escape and avoidance which over time worsens anxiety. We have amazing, evidence-based treatments for Anxiety, OCD, Phobias, and Panic that work well as individual treatments for children, teens, and adults. However, when your child or teen is not interested in engaging in individual therapy this is a more complicated matter. But we do have options!
Parents often ask me “Ferd, my kid is anxious, what can I do?” Or “My son doesn’t want to do therapy, is there something I can do?” The answer to both questions is parents can actually do quite a lot to help their anxious child! Dr. Eli Lebowitz, a Psychologist at Yale, wrote an excellent book where he spells out the integral role parents can play in treating their children suffering from Anxiety and OCD. In fact, he runs a clinic at Yale where he works exclusively with parents on reducing their participation in what he terms “family accommodation” which is a term he uses to describe the things parents do or avoid doing in relation to their child’s anxiety and OCD symptoms. This treatment is called SPACE which stands for Supportive Parenting for Anxious Childhood Emotions and has been shown in research to be effective for helping children with Anxiety.
It seems only natural to help an anxious person. Moreso when we’re talking about helping a child suffering from anxiety or OCD. Parents, grandparents, uncles and aunts, teachers and others (subsequently referred to as loved ones) often encounter children suffering from anxiety, OCD, panic attacks and other challenges. Typically, children going through these types of challenges are experiencing intense discomfort and do what they do any other time they’re uncomfortable—they go to a trusted adult to seek out relief.
This pursuit of relief may often entail loved ones doing things and/or avoiding doing things in relation to whatever is prompting anxiety, OCD, and panic symptoms. We call this generically in the field of anxiety disorder treatment “family accommodation.” This can be misleading as schools and teachers can be the ones accommodating. It can even be adults accommodating other adults as is often the case in romantic relationships. It can further be confusing because most of us have a positive association with the word “accommodation.” I prefer to call this behavior “problematic accommodation” to be clearer that we are targeting the accommodations which end up worsening anxiety.
Let’s look very quickly at how accommodations can worsen anxiety. Let’s suppose a child with OCD had a compulsion around saying goodnight to the parents and demands the parents respond each time with “good night, I love you” until it feels “just right.” This might start out briefly with saying it 2-3 times but the parents’ continued participation in this ritual reifies what the OCD is telling the child that they “must” get the ritual right. Also the child is learning that they need to resolve uncomfortable feelings when that really isn’t the case. Through simply not engaging in the ritual the parent can teach the child that they can tolerate the discomfort and that the discomfort doesn’t last forever. This can only be learned though if the child stays in the discomfort. The well-intentioned parent ends up feeding their child’s obsessive thoughts in this scenario.
The parents in this scenario in a SPACE approach would sit the child down, explain how the accommodations end up worsening the anxiety in the long run and lay out a plan for not engaging in the problematic accommodations. A parent could say “I know we have been spending time with you until you get the good night routine right, but it turns out that when we stay there engaging in the routine, we’re actually making it worse. Going forward we will only say ‘good night, I love you’ once each night.” We can couple this with validating their anxious experience while simultaneously expressing full confidence that they can tolerate the discomfort. Dr. Lebowitz calls these type of statements supportive statements. The parents in the above paragraph could say to their child “we know this is probably really uncomfortable for you, but we know you can handle it.”
Initially, just like we discussed in my previous blog post discussing exposure therapy for anxiety, OCD, and panic, the child may protest and experience more heightened anxiety. But after repeatedly facing their fear without parental accommodation, the child learns they can tolerate the discomfort and ends up not needing the accommodations any longer.
Let’s look at some composite case vignettes and see how the anxiety, OCD, or panic symptoms were improved by steps the parents took to reduce problematic accommodations.
Obsessive Compulsive Disorder
A teenager is very disgusted by the possibility that his bed could become contaminated, and he could be “laying in filth.” His parents were purchasing fabric sanitizer so the teen could disinfect his bed before bed. Slowly the sanitizing rituals become more complex using more sanitizer each day. The parents use a SPACE approach and explain to the teen they will no longer be purchasing fabric sanitizer as it is making the child more fixated on disinfecting his bed. After the teen runs out of fabric sanitizer he initially is very anxious but a week later without the fabric sanitizer he has accepted not sanitizing his bed each evening.
A young girl experiences chest discomfort, shortness of breath, racing thoughts, and intense crying while driving with her parents. Her parents begin choosing alternate routes to drive which escalates to not driving certain distances. Her father will often sit in the back seat patting her back, reassuring her that she will be okay. The parents slowly start reintroducing avoided routes and instead of offering effusive comfort, they express confidence to her that she can tolerate it. Slowly, her panic attacks decrease in frequency and duration. She learns that panic attacks do not last forever, and she can deal with them.
Social Anxiety Disorder/Social Phobia
A teenage boy is afraid of making social errors when speaking to strangers. When he goes to a restaurant with his family, they place an order for him. His parents have asked his teachers to not call on him for fear of him experiencing social anxiety. As his parents learn this approach, they begin to not order for their son at restaurants. Their son realizes he can tolerate the discomfort of ordering food and it isn’t as scary as he thought. Eventually his parents rescinded their request that teachers refrain from calling on their son and over time he became less afraid of being called on unexpectedly.
Generalized Anxiety Disorder
An elementary school aged boy experiences many different types of worry. His worry seems to focus on his mother potentially arriving late to pick him up from school. She has never been late but this worry persists. The mother reassures him daily she will be on time, she leaves work early every day to ensure she will be on time, she even asks for a school employee to escort her son to the front of the school to show him she is on time. After learning SPACE principles, the mother reduces and then eliminates her verbal reassurances. Her child learns he can tolerate the uncertainty and eventually learns he doesn’t need to be the first person picked up. The mother and child are both able to approach school pick up with less stress.
In each of these cases, the work was either improved or completely facilitated by the parents only focusing on changing their behaviors. In each of these scenarios, the children weren’t asked to do anything different, they were just pushed to a place where they could adapt and learn they can tolerate distress. SPACE can be an excellent treatment adjunct or standalone treatment to help children experiencing anxiety, which is why I am excited to announce that next month Northern NJ CBT will be offering a SPACE group for parents! Please click here to fill out the contact sheet if you are interested