Dr. Wilson: Yes. I don’t think there are more anxiety disorders necessarily, but I think that greater stimulus is around today. It’s the noise, the video games, the hovering parents who convey fear into the kids . . . all of that contributes to it.
Lynn: I get asked that question a lot. I think the obvious answer, as Reid stated, is “yes.” If you look at the statistics, it used to be that twenty kids would get diagnosed with anxiety disorder and now we’re looking at about one in eight kids—some research even states that it’s as high as one in five kids. I think there’s probably more awareness about it now, but I think that kids and adults have been anxious for a long time and it was just handled differently.
The level of anxiety has increased in families for a few reasons. One reason is that there’s so much more information and so much more awareness of things to be anxious about. So, I think that if you tended to be a worrier twenty years ago, you could keep it in check a little bit. Bad things still happened, but they weren’t so in-your-face. Since I’ve been a parent, the last fifteen years, the amount of information that we get about all the bad things that could possibly happen is just so much greater than it used to be. You worried before, but I think that now you have a lot more to really sink your teeth into. Worry loves a great imagination and with all the news and the constant deluge of information we have now, the imagination really gets to take over.
Dr. Ackerman: Speaking of the “hovering parent,” or the “helicopter parent” that Reid mentioned, do you think parents are more anxious today than perhaps in our day?
Dr. Wilson: Well, I don’t know if you remember, but in our day kids used to sit in the lap of their parent while they were driving the car! You were also sent out the back door to play, and you would come back in at supper-time. Your parent might be mad if you were late, but it wasn’t about “where have you been?” I think we’re such a global village now that we hear so much more about dangers in the rest of the world and the rest of the country, so it elevates our sense of danger. There are really two types of parents: the more protective, insecure parent, or the dominant, aggressive, “it’s my way or the highway” parent, and either one of those can instill in the child an external locus of control. They then learn that it’s more important to follow mom’s rules to stay safe, or that they need to watch out for dad because if he’s been drinking and he hits mom, then he might hit them too—either parenting style can lead to that external locus of control, and that causes kids to be more apprehensive.
Dr. Ackerman: I see, so both kinds of parents have the ability to inadvertently help instill anxiety in their kids. You make a comment in your book about how some of the anxiety in children can actually come from the parent wanting to do too much for the child. Can you expand on that?
Lynn: Parents can definitely contribute. I actually have this line that I use when I’m speaking to a room full of parents, I say “We all just have to recognize that if it’s ‘nature,’ it’s you, and if it’s ‘nurture,’ it’s you.” Our job as parents is to make our kids feel safe and cared for, but when we don’t allow them to feel uncomfortable, when we overprotect, when we don’t allow them to explore things . . . that’s where it becomes dangerous in terms of creating an anxious child. All the reassuring doesn’t give a child the opportunity to feel nervous or worried and move forward anyway. It’s a bad thing when a parent comes in and says to their child “The world is a dangerous place, you can’t handle it, let me step in and do it for you.”
Dr. Wilson: Well, almost everything the parents do for an anxious kid is understandable, makes sense, and is wrong!
Dr. Ackerman: Oh really!
Dr. Wilson: Yes! This is because our instinct is about trying to calm our kids down—I mean, my kids are in their twenties and I hate to find out that they have been crying, or that they are upset. Parents want to soothe and reassure children. They want to take away hurdles for them and that’s just bad form! You can’t take away a hurdle for a child, you have to help them learn to step over it; that’s where we’re going wrong. Plus, the anxiety disorders will run families because parents don’t know what to do. It gets to the point where backing up, avoiding, and reassuring are the only things that might get a child to go to sleep at night. Two things get parents to start showing up for treatment, sleep and school performance.
Dr. Ackerman: What has to happen within those two areas to get parents in treatment?
Dr. Wilson: With sleep it’s usually when the parents start sleeping in the bed with the child, or allowing the child to sleep with them, or when the child is having tantrums so that no one can sleep at night. That usually brings families in. In regards to school, it’s more about if the child doesn’t want to get out of bed in the morning, is avoiding school, or doing poorly in school.
Lynn: Most of the questions I get asked at workshops are about sleep. That’s the thing that gets parents’ attention the most. Anxiety just wreaks havoc at bedtime and it exhausts families. Parents have a hard time dealing with nighttime anxiety because a lot of times, as Reid mentioned, that’s when kids are the most demanding.
As Reid briefly mentioned, the other huge question that parents often ask is related to learning and anxiety. A lot of kids are diagnosed first with attention and focus problems and it presents all kinds of problems with homework and stepping into more challenging areas of school. The questions are usually “How do we deal with anxiety and its effect on learning?” It’s a big issue because kids with an anxious brain have a really difficult time learning. The brain just becomes so hypervigilant and protective that it can’t absorb new information really well.
Dr. Ackerman: When you’re talking about parents inadvertently bolstering anxiety in their kids, you’re talking about well-intentioned parents, correct? The parents whose hearts are in the right place, but who don’t even realize that they are helping to produce an outcome they don’t want?
Dr. Wilson: That’s right. As we wrote in Anxious Kids, Anxious Parents, all parents of anxious kids are going to be anxious themselves because they don’t know what to do. In addition, the other breed of parent is the kind who already has a predisposition to anxiety. A lot of what we try to do with the book is saying “This is not just about Janey or Johnny, this is about how to clean up your act so that you don’t reinforce the worries.”
Dr. Ackerman: Early in the book, you go from addressing anxiety to addressing worry. What is the relationship between the two and why is worry emphasized much more?
Dr. Wilson: Worry is what drives anxiety. Obviously you can have anxiety that comes from trauma or something like that, but for a child who maintains a sense of avoidance, they must have thoughts inside their minds that interpret circumstances or their ability to cope with those circumstances. Those thoughts are what we define as “worry.” Anxiety relates more to the physical sensations that occur. They go hand-in-hand, but very quickly worry is what dominates the process. It’s a cognitive approach.
Lynn: I don’t think you can be anxious without worry! Worry is a natural thing that we do, it’s what comes up and says “Hey! Pay attention!” It’s what we do with that natural worry that determines whether we have anxiety. The worry is the process in your brain that is saying “what if this happens” or “what if that happens?” to induce problem-solving. When an anxious person can’t go from worrying to problem-solving . . . that’s where it becomes an issue.
Dr. Ackerman: Definitely, and there were a lot of places in your book that speak to that. I’ve been screaming back and forth about the dangers of “micromanager” parents and your book reinforces that idea. These people are stuck at the “worry wall,” where they can’t get to the problem-solving that should follow worry or anxiety. Sometimes I wonder if the best help that parents can give their kids is really just no help at all, to let them learn. What do you think are the common mistakes that parents make when they’re trying to help their child?
Lynn: General reassurance—you know, saying “There’s nothing to worry about” or “It’ll be fine” and things like that—and especially the reassurance about scheduling. Worry wants certainty and comfort, so when a child knows exactly what’s going to happen and a parent enables the idea that there aren’t supposed to be any glitches or bumps in the daily routine, that is a perfect environment for worry to grow. For example, a family will come in to see me and maybe they’ve already seen other therapists before. I’ll ask the mother, “So in all of your sessions and your reading, what have you learned?” and the mother will reply “Oh, well I know that the most important thing is to make sure my daughter knows exactly what’s going to be happening throughout the day. We give her the schedule and as long as she knows how everything is going to play out, everything goes well.” That is the exact opposite of what a child needs to learn how to do. Children need to learn to handle the unexpected, such as when there’s a substitute teacher at school, or the car breaks down, or a tree falls through a window during a storm, or even minor things like trying out for the basketball team and not making it. Anxious families have such strict schedules that it makes children feel like the world is just one big booby-trap.
Dr. Wilson: Our method is about leading with these cognitive and developmental approaches so parents can help their children and so families can get better. That’s where we want to start, with generic principles like learning to be okay with worry.
Dr. Ackerman: How does that make Anxious Kids, Anxious Parents different from other approaches to this issue?
Dr. Wilson: By keeping the information generic, Anxious Kids allows parents and schools to deal with the problem of anxiety as a whole, and teach it to their kids in that way. For example, when we were getting ready to publish HCI Books asked us if we wanted an index. We said we didn’t. We didn’t want parents looking up “dog phobia” or “fear of sleep.” It just gets too specific. When you keep things more general, it helps people understand how to be part of the solution and not part of the problem.
Dr. Ackerman: Right, that makes sense. One of the things I noticed about the book was that every chapter builds on the previous one. It isn’t meant to be read, like you said, as a reference that parents can skim through to find the specific issue they’re dealing with.
Dr. Wilson: Right. We did that on purpose and we framed it as seven puzzle pieces so that we can match the parenting book to the children’s book. It’s built as a logical system. You have to start working with “expecting to worry” and gradually move towards “talking to worry,” and so forth. There are some strange, unorthodox approaches in the book, so we needed to get them grounded first before just leaping into these crazy ideas.
Dr. Ackerman: You indicate in your work that a certain level of worry and anxiety is normal and that about 20 percent of children are diagnosed with an anxiety disorder. Do you think that, in some cases, what’s happening now might be because people are losing sight of what a normal level is?
Dr. Wilson: Absolutely. I think that’s a confusing thing for everyone. We definitely want to normalize it because part of what’s happening is that parents want to say “Don’t be scared,” and that’s not the message you want to give your kids. You don’t want to have dad look under the bed and say “Look, there’s no monster. Go to sleep, don’t be scared.” That’s going to just double-down on those kids who already have low self-esteem and who are insecure. What we want to be saying is “You’re right to be scared, given how you’re framing up this problem and your ability to face it.”
Dr. Ackerman: So what kinds of worries are normal?
Lynn: Well, worry and anxiety in general are normal. Whenever you’re stepping into a new situation, or facing something challenging, or taking part in something that is meaningful for you and you want to perform well, anxiety and worry are going to be present at those moments—and that’s what’s supposed to happen. For example, I was at a conference once with one of my mentors, a very important mentor for me, and he said “I’m going to come and listen to you when you present.” Then he said it again later and I said “You know, that makes me feel really nervous,” and he said “Yeah, it should!” It was important for me to do well in front of him; he was my teacher and such a valuable mentor, of course I was going to feel nervous.
Dr. Ackerman: So I have a question for you now, Lynn. For moms and dads, are there differences perhaps in gender when it comes to what people worry about?
Lynn: There are some gender differences, but one of the things we mention in the book is that the content of worry doesn’t matter as much. Most of the differences are somewhat stereotypical things, such as mothers worrying about what other parents think of them. I have two boys of my own and it was a little funny when I was writing this book because I was seeing these families come in and their sons were dressed so perfectly. I remember one of my boys wore a superhero costume every day for nineteen months! I would just think to myself “Gosh, how do these moms do it?” Then it dawned on me that these were anxious mothers who were so concerned about looking perfect to others. Dads tend to worry about harm coming to their children, being good dads, making mistakes, achievement, success, and things of that nature.
Dr. Ackerman: I think something that occurs with fathers especially is looking for indicators that their son or daughter will be able to take care of themselves. Our middle child was quiet and shy, so I worried about him a little bit. He was out playing Little League baseball one day and he got a hit and ran to first base. Then the next kid hit, my son Bobby ran to the next base, and a kid from the other team was standing on the bag at third base. When it was time for him to run, Bobby almost knocked him over to get to the base and said “You can’t stand on the bag!” That was the moment when I realized that perhaps I didn’t have to worry about him so much. The same kind of thing happened with my daughter as well. So, in relation to gender differences and kids, are there things that perhaps girls worry about more than boys? Or does it blend together when they’re adolescents?
Lynn: It blends together, I think, but Reid and I really emphasize in our work that content really doesn’t matter. A lot of times parents get sucked into the content of what they’re worrying about. People are going to worry about what’s developmentally appropriate for them. A kid will come to see me when he’s six and he’s worried about clowns and monsters. For example, I then had a kid, who I hadn’t seen in some time, come back into my office because he had his first girlfriend. It really is a developmental issue. We know that when kids are very young they’re mostly scared about bad things getting them, and when kids grow into adolescents it becomes more about performance issues and the social stuff. Both male and female teenagers worry about those things.
Dr. Ackerman: So it becomes a face-saving behavior.
Lynn: Yes, absolutely.
Dr. Ackerman: The reason I mention that is because it seems as though there’s a lot more focus now on female adolescents and relational aggression. You addressed that in your last comment, but I think it’s still very hard for them out there.
Lynn: Of course, and I was just about to say that the hard part about anxiety in teens—especially if you have an anxious parent or the whole family is anxious—is that anxiety is all about avoidance, as Reid mentioned earlier. The teenage stage of life is really about developing autonomy, so you end up with these two opposing forces; the need to develop independence and autonomy while you’re in a family that is afraid of taking any risks and moving forward. That causes a lot of conflict.
Dr. Ackerman: Now Reid, I know you recently spoke in Canada to educators; can you tell me how that went?
Dr. Wilson: It’s interesting because not only did we see an overwhelming turnout of teachers to those workshops, but about 80 percent of the teachers were also dealing with an anxious child at home.
Dr. Ackerman: Oh, so they were coming as professionals and leaving as consumers!
Dr. Wilson: Well, I think they were actually coming as consumers and getting paid as professionals. The teachers were definitely getting their CEUs and addressing problems in the classroom, but they were also realizing that everything they were doing at home with their own children was wrong. They were lining up to talk about their personal experiences. Anxiety is a widespread problem.
Dr. Ackerman: That sounds like a great indicator of how well your message has been received.
Dr. Wilson: There really is a need. People are being dominated by the disorder and they’ve got to do something.
Dr. Ackerman: There’s a particular section in your book that deals with guidelines, perhaps we can go over one of them. This one is about how worrying can control a child and in turn negatively affect the whole family.
Dr. Wilson: The primary message of worrying that gets to the kid is “you can’t handle it.” You can fill in any topic, any specific area, and the main message that they take away is still the same. When a child feels as though they can’t handle something, they are going to enlist family members to manage the issue. The parents then come in and have to pacify the child’s needs, or the child will keep them up until three in the morning. At that point, the parent feels the same “I can’t handle this” that came from the child. Everyone ends up having to worship at the altar of worry because if they don’t they will be punished. What the family needs to learn is how to step forward instead of backing away.
Lynn: As Reid mentioned, when a child is worrying, they are commanding the adults around them to create an environment where worry is eliminated. The way I describe it is that anxiety is like a cult leader; it’s calling the shots, it’s dictating the way things need to be. It determines what has to happen in order for the family to continue functioning, for mom and dad to get to work on time, for everyone to get sleep. The accommodations that families make to satisfy the needs of anxiety and worry are still surprising to me sometimes. Anxiety has a really good way of getting people’s attention.
Dr. Ackerman: Let’s move on to the chapter about facilitating courage. Can you talk a little bit about the importance of courage in dealing with worry?
Lynn: Sure. One of the big areas where parents and even therapists make mistakes is that they think the only way to move forward is to have mastered something or you have to feel calm and comfortable. The real focus of our book is to be uncomfortable, be nervous on purpose, and be able to step into something new even when you have that anxiety. That’s where the courage comes from. In our book, courage is about moving forward even though you feel unsure. For example, there are a lot of programs in schools now for anxious kids that allow them to leave a classroom when they feel anxious and go to a guidance counselor or the library. They’re told that when they “feel comfortable enough,” they can go back to class. That’s not going to help children become courageous in the face of their worries.
Dr. Wilson: The issue of courage partially has to do with what I mentioned earlier about helping children over their hurdles, not removing the hurdles from their path. We’re not trying to get rid of anxiety; like what Lynn said about ‘stepping into something new’ despite the worry, we’re trying to learn how to perform with anxiety. We know this with children who are athletic and who get nervous at the starting line. They think that’s wrong. We have to teach them that it’s fine to have that kind of arousal. It’s all about being scared and doing it anyway. The problem happens when these kids, or any other kinds of kids, decide that the fear outweighs the enjoyment of the activity. When they start saying “I don’t care about that anymore,” that’s when it becomes a real problem.
Dr. Ackerman: What you’re saying there about the “I don’t care about that anymore” response to worry could be similar to the face-saving behavior of adolescents that we spoke about earlier.
Dr. Wilson: Definitely. Sometimes that’s why adolescents come into our practices. For example, if you’re seven years old at school and you have a teacher come get you before the fire drill goes off so that you won’t be scared, what happens when you still need that teacher and that treatment when you’re twelve? That kid is going to lose face with the other kids. A lot of times it’s a motivating factor for them to start examining these worry issues.
Dr. Ackerman: I want to go back to what you said about the classroom, Lynn. So if I was a child who had anxiety in the classroom, you would be telling me that my anxiety is fairly normal, is that correct?
Lynn: Absolutely. Even when it gets to the range where it’s not normal, we still have to give you the experience of retraining your brain, of feeling the anxiety and getting through it. Normally what anxious people do is they feel the anxiety, they retreat, they feel better, so they think “Oh, that must be the solution.” They end up learning that the “solution” is to get away from a situation that causes anxiety in order to feel better. The real goal is to provoke the anxiety and give kids the skills to handle it.
Dr. Ackerman: I was reading your book and thinking that there were so many people that I was trying to help who were just like that. The ones with the most problems were the ones who were constantly trying to alter the environment or the situation.
Lynn: Yes, they are just so focused on changing the external environment to meet their internal needs. It really has to be the other way around.
Dr. Ackerman: That’s an excellent way to put it. So am I correct in thinking that parents are going about this in entirely the wrong way? You seem to be saying that handling this isn’t about an absence of anxiety, it’s about being able to handle the anxiety when it surfaces.
Dr. Wilson: Yes, it’s the same thing as worry. We want to put it outside of them. I think it’s a very useful thing to do because when a child starts to worry, they start to pose all those questions to the parents. It’s a lot more difficult for a parent to answer questions about what might happen, but when they externalize it and say “Oh, that sounds like your Worry talking. How do you want to respond to it?” it’s a way of deflecting the question so the child learns to deal with and face the worry and anxiety.
Dr. Ackerman: That really seems to feed into what you said many times in the book about your “Take Action” message to the parents. Can you comment on that?
Dr. Wilson: Of course. Everything is based around the cognitive principle of “Take Action.” If you don’t take action, you won’t ever do anything! As you know, Anxious Kids is the parenting book and we also have an accompanying book for children. We start slow so parents can warm their kids up to this frame of reference for getting better, and once they do start improving it’s important to begin taking risks related to the specific topic they are struggling with. So everything is related to getting that action going.
Dr. Ackerman: So when you talk about kids in your book, you specifically mention kids from ages eight to eighteen. I’m curious as to why you selected that specific age group.
Dr. Wilson: Because the publisher thought that was a cute way to do it! “Eight to eighteen” just sounded good.
Dr. Ackerman: Oh, is that so! In many of your examples, I think you refer to children younger than eight.
Dr. Wilson: We do; sometimes we work with children as young as three years old with this kind of stuff. Obviously they won’t be reading the children’s book that goes along with Anxious Kids, but their parents will start working with them on the principles. We actually have a very nice clip that we play in our workshops of a six-year-old girl who has learned these skills in about eight sessions of working with Lynn. You can see that she’s totally got it—she’s not regurgitating anything, she’s pretty clear about the principles. Technically adults can use and understand the book too; the concepts don’t just stop at eighteen years old.
Dr. Ackerman: Yes, and I realized that a lot of the time that when kids grow up and the reach that age, the worry doesn’t stop. They’re just adults now and for us parents, there’s a certain level of concern that happens as a result.
Lynn: Definitely, and we have to pay attention to kids with anxiety that isn’t being treated. A huge problem that we often see is that a child whose anxiety hasn’t been treated ends up becoming an adult who has anxiety and depression.
Dr. Wilson: Of course, and additionally the reason that we stop at eighteen is because they are still under the influence of these parents who can be inadvertently helping along the worry and the anxiety. When 65 percent of children who have an anxiety disorder have a parent at home who is diagnosable . . . that’s the reason we’re writing a book for the parents and having a kind of “trickle-down” effect to the kids. We wrote the book for the children too so that they could be independent and work on these issues on their own as well. We wanted to focus on children particularly because if we don’t help these kids now, we’re going to be paying for it for a long time. Lynn already mentioned that anxiety disorders in children lead to depression, but it can also lead to potential drug abuse, and difficulty applying and going to college—there are just so many things that will continue to cause havoc in a child’s life as they grow into adolescents and young adults.
Dr. Ackerman: As we’re winding this interview down, I’m sure you know that there are many clinicians who are going to be reading this interview. What do you think they should be looking for in their clients in order to effectively combat the growing problem of anxiety?
Dr. Wilson: Well if a family is seeking treatment because of anxiety-related issues, it’s going to be fairly obvious. The family will be restricted and the world of the child is going to be made very small in order for him or her to feel comfortable. I think what’s most important for the clinician is the question of “Now what do I do?” Counselors need to be thinking about how they can collaborate with the family and, by the end of the session, create a homework assignment that helps the child and the family become somewhat doubtful about the theme of the worrisome issue at hand. They need to come up with ways that the child can tolerate not knowing, tolerate the physical sensations of anxiety, and still step forward. They can take as small of a step as they want, but there has to be a step. That’s where we think counselors should focus their attention.
Dr. Ackerman: What are the things that you hope parents will take away from your book and really learn to do with their children?
Lynn: The first thing is this; giving children the tools to help them tolerate uncertainty, to problem-solve, to be able to move forward despite worry and anxiety, that’s what we need to do as parents. If we as parents have anxiety about letting our children be uncomfortable, we’re not giving them long-term life skills. Kids who aren’t good problem-solvers don’t move forward very well.
Additionally, if parents have anxiety themselves, they need to really take a look at how they are talking to their children. There’s a really good chance they might be catastrophizing situations and projecting their own low risk tolerance onto their child. Anxious parents have a tendency to talk about the world as a dangerous place. Expressing fears in front of the children really teaches them that the world is dangerous and that they need to be careful. That really hampers their growth.
Dr. Ackerman: Throughout this interview, Reid, you’ve mentioned the children’s book quite often. What’s the exact title?
Dr. Wilson: The title is Playing with Anxiety: Casey’s Guide for Teens and Kids. It’s actually a pretty substantial book, probably about forty-five thousand words. It’s written through the voice of Casey, a fourteen-year-old girl who has had anxiety beginning from kindergarten. The book is narrated by Casey and she tells kids what her life was like, what her brother went through, and provides analogies and examples to help. It matches up with Anxious Kids, the parenting book, which shows parents how to use the kid’s book. It’s available for the Nook and the Kindle, and there’s a PDF of the book on our website, www.playingwithanxiety.com.
Dr. Ackerman: Any last thoughts before we conclude?
Dr. Ackerman: Thank you both so much for taking the time to sit down with me and provide this interview for the readers of Counselor magazine.