Taming The Wild Things

Despite huge gains in knowledge about the neurophysiological and psychological roots of anxiety, as well as the billions spent each year on psychotropic medications meant to assuage anxiety, Americans are more anxious than ever. Anxiety disorders—OCD, phobias, PTSD, generalized anxiety disorder, social phobia, panic disorder, separation anxiety—are by far the most commonly diagnosed disorders in America, especially among the young. More than 30 percent of children up to age 18 receive one of these diagnoses at some point, and anxiety symptoms are the primary reason parents seek out a mental health professional for their child.

Why are our children so anxious and getting more so? At first, the epidemic of childhood anxiety disorders seems puzzling. After all, we live in the age of “helicopter parents” and ubiquitous child professionals—teachers, counselors, therapists—all trying their best to shield children from feelings of fear, insecurity, uncertainty, or discomfort. Professionals and parents alike seem to share the sentiment that allowing children to feel afraid is tantamount to neglect, like not getting kids vaccinated or withholding antibiotics when they’re ill. We seem to regard a child’s anxiety as a kind of infection, caused by an “anxiety bug” of some sort. As soon as this “pathology” surfaces, we feel we must immediately remove all sources of the pathogen. If the child is afraid of school, keep her home. If he’s afraid to sleep alone, don’t make him. If the child still “gets” a case of anxiety, carpet-bomb it to extinction with psychotropic medications!

But too often in our anxiety to stop the anxiety, we surround the child with an anxiety-reinforcing system, comprised of family, school personnel, physicians, and even therapists, all fixated on protecting the child from any twinge of the dreaded disease. Imposing this array of deeply caring adults not only rewards the anxiety, but encourages it to consume ever more of the child’s life. In short, by building a systemic protective shield around the anxious child, we make sure that the anxiety remains in charge.

In their zeal to create an anxiety-free environment for the child, adults focus on changing the external surroundings—the meds, the furniture, the classroom, the nanny—that trigger or relieve anxiety, never understanding the nature of the beast they’re trying to tame or kill. In many families, anxiety resembles an endlessly shape-shifting alien, taking different forms, settling around different subjects, jumping (anxiously, so to speak) from focus to focus. So do the adults trying to corral it, but the more attention they pay to its ever-changing manifestations, the bigger and more protean it grows. The results would be comic if they weren’t so potentially tragic for children who get locked in a state of continual hypervigilance against their ever-expanding, ever-mutating fears and anxieties, setting the stage for full-fledged anxiety disorders later in life.

Theresa and her 15-year-old daughter, Grace, came to see me several months ago. Grace had been in therapy off and on since the age of 7, and given various diagnoses and medications over the years. Now she was starting in a new school, which had ramped up her anxiety symptoms again. She was having trouble finishing her homework because of obsessive worrying about getting good grades—her parents were, of course, anxious that she should get into a good college—and she said she felt “paralyzed by the pressure.” I asked Theresa what she’d learned from therapists about managing Grace’s anxiety.

“I’ve learned so much,” Theresa said. “Most importantly, Grace needs to know exactly what’s going to happen during her day. She hates surprises. We got her a cell phone early on, and we text each other throughout the day. The school’s been good about making sure she has all her assignments, and she meets every morning with a tutor who checks all her work. She’s an excellent student, but she needs reassurance.”

Grace had been worrying throughout the school day about Rufus, the family dog. She’d frequently text her mother asking how Rufus was. Theresa would take a picture of Rufus and send it to Grace. When Theresa would leave the house, she’d take a picture of the dog in the kitchen, let Grace know where she was going, and then send her another picture of the dog when she returned home. “Our pediatrician said that we needed to make Grace feel safe, so the school allows her to check her phone whenever she needs to.” Such stories are now legion.

Another client of mine, a 12-year-old boy terrified of fire alarms at school, must be warned by his teachers five minutes before a drill and escorted out onto the playing field to wait for his classmates to join him. “As long as I’m outside, I’m okay,” he tells me. Or take Alison, a third-grader who lives in a bucolic little community with a low-to- vanishing crime rate, who was, nonetheless, afraid of robbers. To soothe their daughter’s fears, her parents bought a 150-pound dog to keep her company at night. This wasn’t enough, so her parents installed an expensive, state-of-the-art alarm system in the house and, at her insistence, changed the locks repeatedly. Commonly, kids I see are so afraid of thunderstorms they won’t even go outside if it’s cloudy. Obliging grown-ups teach them how to tune in to the Weather Channel and track pressure systems, not so they’re less afraid to go out in the rain, but to make them more technically informed about how to predict—and thus stay out of—thunder and lightning. In effect, these kids think, “I can’t handle thunderstorms, but now I know much better how to dodge them and stay safe.”

In short, kids and parents are often so anxious about anxiety itself that they must prevent even the least anxious twinge—any feelings of uncertainty and discomfort. As anxious parents try to reassure, comfort, explain, argue, punish, and bribe their child out of the anxiety, they grow more and more emotionally reactive, angry, and distraught, even bursting into tears before ultimately capitulating.

Too often, mental health professionals focus on diagnoses and prescribe medications as the first (and sometimes only) line of anxiety treatment, thereby reinforcing parents’ worst fears about their anxious child. After multiple conversations with school guidance counselors, teachers, family physicians, and mental health providers, worn-out parents arrive in my office scared to death that there’s something horribly and irrevocably wrong with their child. True, the fierce power and often nutty symptoms of anxiety can be overwhelming and mystifying. It’s also true that there’s a genetic predisposition to anxiety, but this is routinely overemphasized to the child’s detriment.

Biology Counts—But Not Much

Child professionals, I’m sorry to say, are often unconsciously complicit in maintaining and reinforcing a child’s anxiety. Like parents, many therapists are so anxious to calm kids that they neglect to help kids handle their anxiety. Anxious kids don’t want to do anything that makes them uncomfortable. Knowing they ultimately have to do those things—get on the bus, go to school, see the dentist, sleep alone in their own beds—is what brings them to the therapist. The hitch is that while parents and kids want the child to do the necessary things he or she fears, they want the child to feel relaxed while doing it.

Many therapists seem to agree with the parents that helping the child feel better, calmer, and safer at all times is somehow the main point of therapy. Other therapists teach relaxation techniques or deep breathing and stop there, so that the child never learns to tolerate anxiety. Defining success as being able to go into difficult situations and feel relaxed virtually sets the child up for a lifetime of anxiety. If continual relaxation were the standard for successful living, how many of us could stand going through a job interview? A first date? A colonoscopy? Moving away from home? Being able to calm your body and slow down is a great skill, but it’s a skill, not a cognitive shift that enables the child—or anybody—to live with and handle feelings of discomfort, vulnerability, and uncertainty. The first time it doesn’t work (and it won’t work if that’s all there is, I guarantee), the child returns and says, “I still can’t feel comfortable at school, so I can’t control my anxiety. Those skills don’t work. Your treatment doesn’t work.”

Do Something Fast

By the time I see them, worried parents and their anxious kids have frequently been through several stints of unsuccessful therapy, and have been told by professionals that their child may have a serious, possibly permanent mental illness. Or parents have been told that the doctors don’t know what’s wrong with their child because medical evaluations for physical symptoms like stomach pain, headaches, and sleep issues have come back normal. Parents swing between hoping I can help and being skeptical that I’ll have anything new to offer.

Momentum is critical—I have to move fast to win them over, give them some hope, and get them to come back. My goal is that by the end of the first 90-minute session, they’ll not only feel more optimistic, but will get a taste of victory over the anxiety bugaboo—and have fun doing it. My expectation is to see significant and noticeable improvement between the first and second session. This means I won’t spend much time getting history in that first session, because once the child is in the room with me, my job is to engage that family in an energetic experience that shows them immediately how to change their patterns and create a new relationship with this thing called anxiety. (I’ll tell parents to e-mail me what they think I should know, or even meet with them separately first if they have a lot to share.)

Such is the case with Perry and his mother, Beth, who first come to see me a week after Perry has turned 9. Because of Perry’s rather dramatic symptoms, they’ve been to many healthcare providers. At this initial appointment, they’re both a bit shy and polite as a worried Beth gives me the history. Since preschool, Perry’s been vomiting. “I don’t like looking at disgusting foods like mashed potatoes and tuna. I feel like I need to throw up,” he tells me. He had a full gastrointestinal workup—completely normal—and was referred to occupational therapy for 10 weeks. Though he has been cooperative at his occupational therapy appointments, the vomiting remains constant.

At home, he has to leave the dinner table often, usually after about three bites of food. When the family tries to go out to dinner, he leaves the restaurant to throw up, either in the parking lot or the car. At school, he eats lunch alone, on a bench in the hallway near the bathroom. His grandmother is the school secretary, so he goes to see her when he knows it’s going to be a tuna or mashed-potato day. When Beth took Perry to see his pediatrician, the doctor told her, “He’s a complete mystery to me; I’ve never seen anything like it.” The GI doc put him on a prescription medication to increase his appetite in the hopes that he’d gain some weight, but the doctor had no other advice about the vomiting.

We talk for a few more minutes. I want to learn as quickly as I can how Perry and his mom view the problem. As Beth talks, I’m listening for certain things. Do they see it as a family legacy? “My mother and grandmother and Aunt Trudy all have anxiety, so it’s in our genes.” Do they notice that the anxiety “comes and goes,” or do they describe the child as “always anxious”? Do they use lots of global words that reveal how huge and pervasive they see the problem? “It’s ruling our lives; it’s never-ending.” Do the parents repeatedly say things in front of the child that reinforce his identity as an anxious child? “He’s been this way forever. Even when he was a baby, I knew he was going to be a worrier. It’s who he is.” The words and phrases help me identify the patterns that I’ll need to address, and they’re rather predictable: anxiety is usually experienced as a big, permanent, genetic, overwhelming constant in people’s lives.

Beth briefly tells me about her own struggles with anxiety. As a child, she was a perfectionist in school, had some counting rituals, but nothing that intrusive, and when things didn’t follow the plans she made, she’d “freak out.” She began having panic attacks in her early twenties, but she’s been managing them well for the past few years. This is good: she knows that this problem can improve. When the occupational therapist, who knows me well, suggested to Beth that this might be an anxiety issue, Beth scheduled this appointment: also good. She listens to suggestions, and follows up. She’s looking for solutions, and, though confused, she’s far from hopeless.

Externalize: “I’m Not My Anxiety—My Anxiety Isn’t Me”

I ask Perry what he thinks. What makes him throw up? “Sometimes my brain tells me to throw up. I have a good imagination. I won the Best Imagination Award at school.” Pay dirt. Perry has already started to externalize and compartmentalize the problem. He sees his brain, his imagination, and himself as separate. He “hears” his brain, or what I call the worry part, “telling” him to throw up, and he values his good imagination.

I ask if anything else makes him feel worried, even if he doesn’t actually throw up. Mom reports that he’s not great with changes, like starting a new school year. He gets “a bit freaked out” when he arrives at birthday parties that are chaotic, and he knows better than to watch scary movies. With that imagination of his, scary movies stick around in his head for way too long. This is important information, because all the other professionals have been focused on food, on content. Teaching Perry how to tolerate tuna would be nice, but teaching Perry how to deal with unexpected unpleasantries and his souped-up imagination is far more useful. This isn’t really about food, and that’s what I must help this family understand right away. So, after these first 10 minutes or so (remember, the clock is ticking!), I get to work. Perry needs to learn how anxiety operates. I want him to understand how it works in his brain and body and, like a magician explaining just how he gets his special effects, I want him to see that anxiety isn’t that mysterious, once you know its secrets.

Normalize, Normalize, Normalize

First, I want to normalize anxiety. It’s normal to worry. We should expect it. Before getting to me, families have usually told many people their long, miserable story of continual, expanding anxieties, the escalation of attempts to protect the child from any and all anxiety triggers, and their growing fear that something is terribly, unusually wrong with their child. Many professionals have responded with grave and serious nods, confirming their fear. So when they tell me their story, I usually nod a bit nonchalantly and say in a matter-of-fact voice, “Yes, I’ve heard that before; lots of families I’ve seen tell me the same things.” When Beth tells me of her pediatrician’s confused and disconcerting shrug, I say, “Really? Because you’ve been talking to me for seven minutes and I have a really clear picture of what we need to do.” My ho-hum response tends to both reassure the child and his parents that their situation isn’t uniquely terrible and model for the parents a way they can lower their own emotional temperature—which is critical for calming their child.

During this first session, I want to hammer the “anxiety is normal” message home to the whole family. I’ll say to the child, “You’re a human being. That means you’re going to have nervous feelings every single day. It’s normal to feel nervous. First day of school? Little League tryouts? Math test? Recital? Normal, normal, normal.” I’ll ask parents in a session to talk about something they did well, but were nervous about. Or an unexpected situation that was frustrating or scary that they managed to handle without disaster—lost luggage, flat tire, getting cut from their high school basketball team. I coach parents on how to move away from a “catastrophic response” and be more matter of fact. “Yep, I’d be nervous, too, if I was going away to camp,” I say. Or, “I’d be totally frustrated if I struck out, too.”

I ask Beth and Perry to review times they were anxious but successful, and they come up with plenty of examples. Beth had some minor surgery a few years ago, and she’d been nervous as she’d gone in for the procedure. Perry tells me how all the kids at school are nervous when they have to do the standardized testing required by the state. “The teachers tell us we have to do our best. They make a big deal out of it, so we get scared!” We talk about what it must be like to pilot an airplane for the first time, and Beth and I remember out loud our shakiness while taking our driver’s license tests when we were 16.

“That reminds me of the time I got my car stuck in the mud when I was a teenager,” I tell Perry. I want to suggest to him early on that it’s not the content of the anxiety that gives children problems, but how they react to it. Tuna, I want him to understand, isn’t the villain in his story. “My friend and I kind of panicked and she kept yelling at me to step on the gas pedal more, which just made the wheels spin and sank us deeper and deeper into the hole we were making. When the tow-truck driver finally came, he told us what to do next time: “‘Just hit the gas lightly and take it slow; stay calm and feather the pedal,’ he said. (I show Perry with my hand what that looks like.) Now I know how to handle mud. Your worries are just like mud. Not super-tricky, sticky-weird worries—pretty normal, actually. You just need a better plan.”

In short, kids don’t need to avoid forever the “mud” they fear in their own lives—parties, school, cafeterias, their own beds at night—but just work out better ways of dealing with it. “It’s not the mud, it’s the reaction,” I say again. I imitate pressing the pedal to the metal and make a revving engine sound. “It’s not the food, it’s the reaction,” echoes Beth.

I also want to address the physical symptoms that are getting everyone’s attention. This is one of anxiety’s trickiest strategies, and I need to blow its cover from the start. Anxious children are often somatic and focus on how bad their body feels. Even after they’ve been cleared medically, it can be hard to convince kids and adults that anxiety can create such dramatic symptoms. Kids who are anxious about being in school find an ally in the school nurse, who tends to daily tummy aches and headaches. Vomiting, as Perry discovered, makes grown-ups jump to attention.

Earlier, I said that teaching kids to manage anxiety is not about simply teaching them to relax and feel comfortable. It’s the cognitive shift and new perspective that changes things. That said, I want kids to know how to interrupt their physical symptoms, because it gives them a chance to reboot for a moment and immediately shows them how malleable this whole anxiety experience really is. When they learn to slow down and shift their bodies’ reactions, they feel capable of shifting their emotional reactions as well. They feel powerful and autonomous—a huge accomplishment for kids who’ve been bossed around by anxiety for so long. So before Perry leaves that first day, we make a recording together, a self-hypnosis CD that teaches him how to calm his body, loosen his throat, and disconnect from his too-automatic gag reflex. He’s learning to send different instructions to his body and to override the demanding voice of anxiety. I tell him how I used my imagination to make my hand very heavy—which calmed me down enough to stop me from fainting at the doctor’s when I was a kid. He decides to imagine petting a cat. He practices on my cat, who’s excited to be invited into the office. It’s a win-win. “You’re like a superhero,” I tell him. “Your superpower is your imagination. In comic books, when people discover their superpowers, they must decide whether to use them for good or for evil. Your imagination, your superpower, was making you vomit because that evil worry part was in control. Now you’re going to use that power for good, and you’ll be unstoppable!” It’s a lot to cover in a first session, but the momentum is moving in a different direction, and we all feel it.

When Perry returns a few weeks later, things have improved significantly. He reports that he’s staying at the dinner table longer and was able to stay in the cafeteria for an entire lunch. He’s strung together several vomit-free days and is eating more. We exchange smiles as Mom and Perry tell me we’re on the right track. Maybe this anxiety thing isn’t so catastrophic after all.

Laugh It Out of Power

The leitmotif of anxious families is unalloyed grimness about their situation. Any levity or humor about their truly awful, serious, exhausting, probably unsolvable problem is unthinkable to them. But the little-known secret about anxiety—which it works hard not to reveal—is that it can’t stand being laughed at, and tends to shrivel up at the first giggle or joke at its expense. So I spend much of my time being a comedian, getting kids and parents to see how silly and puny this monster is. Humor and creativity allow us, as Jay Haley said, “to change the framework of the situation in the spirit of play.”

Early on, I give families a lesson in how the worry part hijacks the brain, firing off the not-so-bright but obedient alarm system called the amygdala. I describe how that alarm system gets them ready for danger—making kids’ bodies feel weird, and convincing them to get out whenever possible—even when the “danger” is just in their imaginations that are being controlled by worry parts. With a big dry erase board and colorful markers, I draw cartoon caricatures of the anxious child in front of me, along with the bossy worry part, amygdala, and frontal cortex. It’s a simple rendition of the brain, but that’s the point—keep it simple. Using thought bubbles and arrows, I show kids the trap of “uh-oh” or “oh-no” thoughts, and how the amygdala just does what it’s told. The final drawing is of a child with big eyes and an open mouth, shaking and scared. Then I erase and draw the new and improved pattern I’m teaching them, this time depicting a determined kid with hands on hips telling the worry part to back off while the “thinking part” gets called into action. They become the star of their own comic strip as it unfolds in real time before their eyes.

In a trancelike state, Perry watches as I take him through his own story. He falls back onto the couch when I’m done, amused and laughing. Together, Perry and I draw pictures of more worry parts on my dry erase board. I ask Perry what his worry says to him on mashed potato day in the cafeteria, or tuna day, or at a restaurant.

“It says, ‘You’re going to throw up. Don’t think about food. You have to puke.’ And then I go throw up.”

“And you listen every time, don’t you? Your worry part is really predictable. And all this time you thought it was so powerful! You thought you had to listen! That’s your oh-no thought. Let’s show worry who’s boss.”

I explain to Perry that we’re going to play a game. I’m going to be Perry and he’s going to be his worry. His job is to say what his worry says, over and over. “I’m going to make you throw up!” he says. “You’re going to puke.”

I roll my eyes and shake my head dismissively. I pretend to nod off or yawn dramatically as Perry repeats what his worry has been telling him for years.

I act like a texting teenager being called to dinner: “Oh, I’m sorry, were you talking to me?”

Then we switch roles. As Perry’s worry part, I’m unrelenting, but predictable and repetitive. I coax, beg, and demand. I remind Perry that we’ve been together for years, that I understand what’s good for him and that this Lynn lady doesn’t know what she’s talking about. Perry gets the hang of it and loosens up, talking back with some sass and swagger. He’s learning how to keep anxiety off balance.

I move in and out of character, laughing and encouraging, cueing Perry when he’s looking for words. Beth is laughing and watching, too, the mom and the student of anxiety. She’s going to use this with her own worry.

I explain to Perry that when his worry shows up—when it starts pestering him with its predictable, boring, and annoying demands—he can talk to it and let it know he has other plans. At school, at home, at restaurants, he should expect his worry to show up and try to boss him around. It’ll tell him he can’t handle looking at food and to get out as quickly as he can—same old stuff. But instead of leaving, he’s going to stay longer. Anxiety will protest, but I want him to practice a different dialogue and a different response. He’s going to change his relationship with his worry and see what happens. Before coming to see me today, I tell him, he didn’t know this was possible. Now he knows. It’s time for him to use his imagination, that award-winning imagination, to put anxiety in its place.

The Only Certainty Is Uncertainty

Perry’s progress continues. He’s eating more in general, gaining weight, going to restaurants, and sitting at the dinner table without leaving. There are a few “close calls,” but Perry has embraced this new stance and uses his techniques to handle each situation. Sure he might see gross food, and he might throw up, but the more he practices, the less it happens. The less it happens, the more powerful he feels. The momentum continues to shift.

I’m seeing him about once a month now. The final piece for Perry involves moving consistently into uncertainty, without needing to know all the details of what’s to come. I keep reminding both Perry and Beth of anxiety’s dogged agenda: it wants certainty and comfort. It has to know exactly how things are going to go. It hates surprises and doesn’t know how to solve problems or handle uncomfortable moments. When I met Perry, his anxiety required him to check the school lunch menu weeks in advance, so that it knew when to keep him out of the cafeteria. Though the vomiting has almost disappeared, he still often asks his mom when the next assembly at school will happen, and needs lots of reassurance and details about holidays and family gatherings that combine food, noise, people, and potential surprises. When going to someone else’s house, Perry can’t control the menu, the guest list, or the behavior of others.

Anxiety hates this, and begins a pestering quest to get as many details firmed up as possible. Anxiety wants to know—has to know—so it can then decide whether or not Perry will attend or figure out what he must avoid if he’s forced to go. Parents are often peppered with never-ending questions about an upcoming event, because their child is looking for reassurance and certainty. Before parents understand the dynamics of anxiety, they attempt to answer all these questions thinking this is the solution. They don’t know what else to do! The goal is to get families used to the idea that none of us will ever know exactly what’s going to happen next. The future, even five minutes from now, is nothing but uncertain, so I often give homework assignments that help them play with and get used to this reality.

I give Perry one of my favorites. I take a piece of paper and draw a vertical line down the center. The heading atop one side says “What I Know,” and the other, “What I Don’t Know.” There’s an upcoming family event, so for this particular occasion, I want Perry to list what he knows about the party on one side and what he doesn’t know on the other side. For example, he knows the party starts at 6 o’clock on Saturday evening, he knows it’s at Aunt Liza’s house, he knows he’ll wear clothes to the party (I encourage them to throw in some funny ones), and he knows there’ll be food there. He doesn’t know exactly what he’ll eat, how many people will be there, whether or not Aunt Liza’s dog will poop on the carpet, or exactly what he’ll do with his cousins. We identify a few of these unknowns together to get the hang of it, and he’s to take the paper home and add to it. Then, he’s to bring the paper (secretly) with him to the party. Every time he answers one of his many “What I Don’t Know” questions, every time something uncertain becomes certain, he draws an arrow showing that it’s moved from one column to the other, unknown to known. The exercise visually demonstrates a powerful lesson: we don’t know everything, but experience allows us to learn a lot of things we didn’t know before.

Exercises like this help kids better understand anxiety’s trap: the demand to know everything. “How can I know everything?” they ask. “I’m just a kid!” Again, making with the dramatics, I throw up my hands and wail, “I know! Anxiety doesn’t like surprises and has convinced you not to like them either. It’s been telling you over and over that you need to know everything in advance and that you can’t handle things if you don’t. But that’s impossible, isn’t it? It’s about time we show anxiety that you’ll be okay, even if you don’t know exactly what’s going to happen next.”

Beth calls me a few days after the party. Perry brought his paper and had fun drawing his arrows. The “What I Don’t Know” column was highlighted with irreverent boy poop talk, she says, so he laughed as he made his arrows. Aunt Liza’s dog, he wants me to know, didn’t poop on the carpet. More importantly, he had vomit-free fun.

I’ve been meeting with Perry for about nine months, and Beth wonders if we can see how they do on their own for awhile using the tools and settling into their new groove. We decide to meet again in a few months after Perry’s tenth birthday: that’ll be our last session if all continues to go well.

When Perry bounces happily into my office a few months later, I pretend not to recognize him, now that’s he’s 10. The truth is he really does look different from the boy I met a year ago. He’s gained weight and grown a bit. He’s no longer on any GI medication, and his cheeks are ruddy and full. He immediately begins to tell me about his birthday presents, his cake, and the piñata filled with candy. “I’m curious about your worry,” I finally ask him. “Anything new?”

He shakes his head slowly at me, like a disappointed parent. “New? Anxiety? Miss Lynn, I’m surprised at you. You know that anxiety always says the same old things.”

As a society, we’re obsessed with security, safety, and predictability. As good parents, we tend to think that we should keep our children from ever feeling afraid, upset, or vulnerable. After all, we have technology for keeping in constant touch with our kids, reassuring them and ourselves that we always have their backs. It makes us and them feel better, too, so why not use it?

Here’s why not: kids need to be problem solvers. They need to learn how to improvise when things go awry, to take the next step when plans fall apart, in order to grow up. Anxiety will come. So will disappointments, grief, and, occasionally, even disaster. Sometimes our imaginations will be enough to make us panic, but sometimes our imaginations are just practice for the real thing. Children need to learn how to function with anxiety in the passenger seat. When we overprotect them, we deprive them of the practice needed to manage in the world.

As counterintuitive as it sounds at the start of therapy, parents ultimately learn that allowing their children to be uncomfortable—and move forward anyway—is the way out of anxiety’s maze. They understand that a “cure” doesn’t mean the end of anxiety: it means a willingness to try new things, take some risks, and accept anxiety as an inherent part of growing and living. They allow themselves to be uncomfortable, too, but keep their own worries in check so their children can thrive, experiment, and sometimes fail. As I end my treatment with families, parents often tell me that they can look at events in their family life in a wholly different way. What was once a potential crisis to be avoided at all costs is now seen as a golden opportunity to learn.

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Illustration © Sis / Rob Colvin