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← How to raise kids who can overcome anxiety

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Mostrar Revisión5 creada 05/27/2020 por Erin Gregory.

  1. As a child, I had many fears.
  2. I was afraid of lightning, insects,
  3. loud noises and costumed characters.
  4. I also had two very severe phobias
  5. of doctors and injections.
  6. During my struggles to escape
    from our family doctor,
  7. I would become so physically combative
  8. that he actually slapped me
    in the face to stun me.
  9. I was six.
  10. I was all fight-or-flight back then,
  11. and holding me down for a simple vaccine
    took three or four adults,
  12. including my parents.
  13. Later, our family moved
    from New York to Florida

  14. just as I was starting high school,
  15. and being the new kid
    at the parochial school,
  16. not knowing anyone
  17. and being worried about fitting in,
  18. on the very first day of school,
  19. a teacher takes roll and calls out
    "Anne Marie Albano,"
  20. to which I respond,
    [In a Staten Island accent] "Here!"
  21. She laughs and says,
    "Oh, precious, stand up.
  22. Say D-O-G."
  23. And I respond,
    [In a Staten Island accent] "Dog?"
  24. The class broke out in laughter
    along with the teacher.
  25. And so it went,
  26. because she had many more words
    to humiliate me with.
  27. I went home sobbing,

  28. distraught
  29. and begging to be sent back to New York
  30. or to some nunnery.
  31. I did not want to go back
    to that school again. No way.
  32. My parents listened

  33. and told me that they would investigate
    with the monsignor back in New York,
  34. but that I had to keep going in each day
    so I'd have the attendance record
  35. to transfer to ninth grade
    on Staten Island.
  36. All of this was before
    email and cell phones,
  37. so over the next several weeks,
  38. supposedly, there were letters being sent
    between the Archdiocese of Manhattan
  39. and Miami
  40. and with the Vatican,
  41. and each day, I'd go into school crying
    and come home crying,
  42. to which my mother would give me an update
    from some cardinal or bishop
  43. to "Keep her going to school
    while we find her a spot."
  44. Was I naive or what?

  45. (Laughter)

  46. Well, after a couple of weeks,
    one day, while waiting for the school bus,

  47. I met a girl named Debbie,
  48. and she introduced me to her friends.
  49. And they became my friends,
  50. and, well, the Pope was off the hook.
  51. (Laughter)

  52. I began to calm down and settle in.

  53. My past three decades
    of studying anxiety in children

  54. stems partly from my own search
    for self-understanding.
  55. And I've learned much.
  56. For young people, anxiety is the most
    common childhood psychiatric condition.
  57. These disorders start early, by age four,
  58. and by adolescence, one in 12 youths
    are severely impaired
  59. in their ability to function at home,
    in school and with peers.
  60. These kids are so frightened,
  61. worried,
  62. literally physically uncomfortable
    due to their anxiety.
  63. It's difficult for them
    to pay attention in school,
  64. relax and have fun,
  65. make friends
  66. and do all the things
    that kids should be doing.
  67. Anxiety can create misery for the child,
  68. and the parents are front and center
    in witnessing their child's distress.
  69. As I met more and more children
    with anxiety through my work,

  70. I had to go back to mom and dad
    and ask them a couple of questions.
  71. "Why did you hold me down
  72. when I was so frightened
    of getting injections
  73. and force them on me?
  74. And why tell me these tall tales
    to make me go to school
  75. when I was so worried
    about being embarrassed again?"
  76. They said, "Our hearts
    broke for you each time,
  77. but we knew that these were things
    that you had to do.
  78. We had to risk you becoming upset
  79. while we waited for you
    to get used to the situation
  80. with time and with more experience.
  81. You had to get vaccinated.
  82. You had to go to school."
  83. Little did my parents know,

  84. but they were doing more
    than inoculating me from the measles.
  85. They were also inoculating me
    from a lifetime of anxiety disorders.
  86. Excessive anxiety in a young child
    is like a superbug --
  87. and infectious, even multiplying,
  88. such that many of the youth that I see
  89. come in with more than one anxiety
    condition occurring at the same time.
  90. For example, they'll have specific phobia
  91. plus separation anxiety
    plus social anxiety all together.
  92. Left untreated,
  93. anxiety in early childhood
    can lead to depression by adolescence.
  94. It can also contribute
    to substance abuse and to suicidality.
  95. My parents were not therapists.

  96. They didn't know any psychologists.
  97. All they knew is that these situations
    may have been uncomfortable for me,
  98. but they were not harmful.
  99. My excessive anxiety would harm me
    more over the long term
  100. if they let me avoid
    and escape these situations
  101. and not learn how to tolerate
    occasional distress.
  102. So in essence, mom and dad were doing
    their own homegrown version
  103. of exposure therapy,
  104. which is the central and key component
  105. of cognitive behavioral
    treatment for anxiety.
  106. My colleagues and I conducted
    the largest randomized controlled study

  107. of the treatments of anxiety
    in children ages seven to 17.
  108. We found that child-focused
    cognitive behavioral exposure therapy
  109. or medication with a selective
    serotonin reuptake inhibitor
  110. are effective for
    60 percent of treated youth.
  111. And their combination gets 80 percent
    of kids well within three months.
  112. This is all good news.
  113. And if they stay on the medication
  114. or do monthly exposure treatments
    as we did in the length of the study,
  115. they could stay well
    for upwards of a year.
  116. However, after this treatment study ended,
  117. we went back and a did
    a follow-up study of the participants,
  118. and we found that many of these kids
    relapsed over time.
  119. And, despite the best
    of evidence-based treatments,
  120. we also found that for about
    40 percent of the kids with anxiety,
  121. they remained ill throughout
    the course of the time.
  122. We've thought a lot about these results.

  123. What were we missing?
  124. We've hypothesized that because
    we were focusing
  125. on just child-focused intervention,
  126. perhaps there's something important
    about addressing the parents
  127. and involving them in treatment, too.
  128. Studies from my own lab
    and from colleagues around the world

  129. have shown a consistent trend:
  130. well-meaning parents
    are often inadvertently drawn into
  131. the cycle of anxiety.
  132. They give in, and they make
    too many accommodations for their child,
  133. and they let their children
    escape challenging situations.
  134. I want you to think about it like this:
  135. Your child comes into the house
    to you crying, in tears.
  136. They're five or six years of age.
  137. "Nobody at school likes me!
    These kids are mean.
  138. No one would play with me."
  139. How do you feel seeing
    your child so upset?
  140. What do you do?
  141. The natural parenting instinct
    is to comfort that child, soothe them,
  142. protect them and fix the situation.
  143. Calling the teacher to intervene
    or the other parents to arrange playdates,
  144. that may be fine at age five.
  145. But what do you do if your child
    keeps coming home day after day in tears?
  146. Do you still fix things for them
    at age eight, 10, 14?
  147. For children, as they are developing,
  148. they invariably are going to be
    encountering challenging situations:
  149. sleepovers, oral reports,
  150. a challenging test that pops up,
  151. trying out for a sports team
    or a spot in the school play,
  152. conflicts with peers ...
  153. All these situations involve risk:
  154. risk of not doing well,
    not getting what they want,
  155. risk of maybe making mistakes
  156. or being embarrassed.
  157. For kids with anxiety

  158. who don't take risks and engage,
  159. they then don't learn how to manage
    these types of situations.
  160. Right?
  161. Because skills develop
    with exposure over time,
  162. repeated exposure to everyday
    situations that kids encounter:
  163. self-soothing skills
  164. or the ability to calm
    oneself down when upset;
  165. problem-solving skills,
  166. including the ability
    to resolve conflicts with others;
  167. delay of gratification,
  168. or the ability to keep your efforts going
  169. despite the fact that you have
    to wait over time to see what happens.
  170. These and many other skills
    are developing in children
  171. who take risks and engage.
  172. And self-efficacy takes shape,
  173. which, simply put,
    is the belief in oneself
  174. that you can overcome
    challenging situations.
  175. For kids with anxiety
    who escape and avoid these situations

  176. and get other people to do them for them,
  177. they become more and more
    anxious with time
  178. while less confident in themselves.
  179. Contrary to their peers
    who don't suffer with anxiety,
  180. they come to believe that they are
    incapable of managing these situations.
  181. They think that they need someone,
    someone like their parents,
  182. to do things for them.
  183. Now, while the natural parenting instinct
    is to comfort and protect

  184. and reassure kids,
  185. in 1930, the psychiatrist Alfred Adler
  186. had already cautioned parents
  187. that we can love a child
    as much as we wish,
  188. but we must not make that child dependent.
  189. He advised parents to begin training kids
    from the very beginning
  190. to stand on their own two feet.
  191. He also cautioned
    that if children get the impression
  192. that their parents have nothing better
    to do than be at their beck and call,
  193. they would gain a false idea of love.
  194. For children with anxiety
    in this day and age,

  195. they are always calling their parents
  196. or texting distress calls
    at all hours of the day and night.
  197. So if children with anxiety don't learn
    the proper coping mechanisms when young,
  198. what happens to them when they grow up?
  199. I run groups for parents
    of young adults with anxiety disorders.

  200. These youth are between
    the ages of 18 and 28.
  201. They are mostly living at home,
  202. dependent on their parents.
  203. Many of them may have
    attended school and college.
  204. Some have graduated.
  205. Almost all are not working,
  206. just staying at home
    and not doing much of anything.
  207. They don't have meaningful
    relationships with others,
  208. and they are very,
    very dependent on their parents
  209. to do all sort of things for them.
  210. Their parents still make
    their doctors appointments for them.
  211. They call the kids' old friends
    and beg them to come visit.
  212. They do the kids' laundry
    and cook for them.
  213. And they are in great conflict
    with their young adult,
  214. because the anxiety has flourished
    but the youth has not.
  215. These parents feel enormous guilt,
  216. but then resentment,
  217. and then more guilt.
  218. OK, how about some good news?

  219. If parents and key figures
    in a child's life
  220. can help the child, assist them
    to confront their fears
  221. and learn how to problem-solve,
  222. then it is more likely that the children
    are going to develop
  223. their own internal coping mechanisms
    for managing their anxiety.
  224. We teach parents now
    to be mindful in the moment
  225. and think about their reaction
    to their child's anxiety.
  226. We ask them,
  227. "Look at the situation and ask,
    'What is this situation at hand?
  228. How threatening is it to my child?
  229. And what do I ultimately
    want them to learn from it?'"
  230. Now of course, we want parents
    to listen very carefully,

  231. because if a child is being bullied
    seriously or put in harm's way,
  232. we want parents to intervene,
  233. absolutely.
  234. But in typical, everyday
    anxiety-producing situations,
  235. parents can be
    most helpful to their child
  236. if they remain calm
    and matter-of-fact and warm,
  237. if they validate the child's feelings
  238. but then help the child,
  239. assist them in planning how the child
    is going to manage the situation.
  240. And then -- this is key --
  241. to actually have the child
    deal with the situation themselves.
  242. Of course, it is heartbreaking
    to watch a child suffer,

  243. as my parents told me years later.
  244. When you see your child suffering
  245. but you think you could swoop in
    and save them from the pain of it,
  246. that's everything, right?
  247. That's what we want to do.
  248. But whether we are young or old,
  249. excessive anxiety leads us
    to overestimate risk and distress
  250. while underestimating our ability to cope.
  251. We know that repeated exposure
    to what we fear weakens anxiety,
  252. while building resources and resilience.
  253. My parents were on to something.

  254. Today's hyper-anxious youth
    are not being helped
  255. by overly protective parenting.
  256. Calmness and confidence
    are not just emotions.
  257. They are coping skills
    that parents and children can learn.
  258. Thank you.

  259. (Applause)