Stephen P. H. Whiteside, Ph.D. is a Board-Certified Clinical Psychologist, Professor of Psychology in the Mayo Clinic College of Medicine and Science, and Director of the Pediatric Anxiety Disorders Program at Mayo Clinic in Rochester, MN. His new book, Anxiety Coach, is available April 2024.
495: Separation Anxiety & Generalized Anxiety: How to Deal
Stephen P. Whiteside, Ph.D.
What do you do when your child ruminates on anxious thoughts, can’t sleep in their room alone, or doesn’t have friends due to social anxiety? In this episode, Hunter talks to Dr. Stephen Whiteside of the Mayo clinic about how parents can address each of these challenges, as well as the most common types of child anxiety and what causes it.
Separation Anxiety & Generalized Anxiety: How to Deal - Stephen P. Whiteside, Ph.D. [495]
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[00:00:00] Stephen Whiteside, PHD: Just fell in love with working with anxiety disorders and, OCD, because, partly because the treatment's very active, and then also, kids, they get better. and so it's really satisfying for us as therapists and, for them as families, to go through that journey together.
[00:00:22] Hunter: You are listening to The Mindful Parenting Podcast, episode number 495. Today, we're talking about separation anxiety and generalized anxiety and how to deal with them with Dr. Stephen P. Whiteside.
Welcome to the Mindful Parenting podcast. Here, it's about becoming a less irritable, more joyful parent. At Mindful Parenting, we know that you cannot give what you do not have, and when you have calm and peace within, then you can give it to your children. I'm your host, Hunter Clark Fields. I help smart, thoughtful parents stay calm so they can have strong, connected relationships with their children.
I've been practicing mindfulness for over 25 years, I'm the creator of the Mindful Parenting course, and I'm the author of the international bestseller, Raising Good Humans, and now, Raising Good Humans Every Day, 50 Simple Ways to Rest Pause, Stay Present, and Connect with Your Kids. Welcome back to the Mindful Parenting Podcast.
Do, I'm glad you're here. I'm your host. I'm in a little bit of a wy mood apparently. but hey, I do wanna say before we dive in, if you have gotten some value from the Mindful Parenting Podcast ever in the past, then please just tell one friend about it today. It makes all the difference in the world and.
It helps us to get this in your podcast player every week, so thank you. Thank you so much for everyone who is telling One Friend. I really, appreciate it, and I'm so excited to talk to you today because today I'm talking to Dr. Steven P. H. Whiteside, a board certified psychologist, professor of psychology in the Mayo Clinic College of Medicine and Science.
And director of the Pediatric Anxiety Disorders Program at the Mayo Clinic, his new book Anxiety Coach is out now, and you can get it everywhere books are sold, and we're going to talk about kids and anxiety. what do you do when your child ruminates on anxious thoughts or can't sleep in their room alone or doesn't have friends due to social anxiety?
I'm going to talk to Dr. Whiteside about this, about how parents can address each of these challenges, as well as the most common types of kids anxiety and what causes it. if you have a kid who has struggled, this is an episode for you. If you have a friend, the kid is struggling with anxiety, send that friend this episode.
Dr. Whiteside has so much good information here. Join me at the table as I talk to Dr. Steven Whiteside.
Thank you so much for coming on the Mindful Parenting podcast. I'm really glad you can be here.
[00:03:16] Stephen Whiteside, PHD: My pleasure. Thank you for having me.
[00:03:19] Hunter: I think this is such an important topic. We're going to talk about kids. We're going to talk about anxiety and, how we can help adjust things and, change things for these kids suffering with anxiety.
But the way I like to start my, conversations is just thinking about, the piece about ourselves and how much we model and how things are shifting. So I'm just thinking about for you how were you raised and what was your childhood like, maybe how it led into this work?
[00:03:47] Stephen Whiteside, PHD: Yeah, yeah, that's actually a great question because I'm a, child psychologist, I'm a clinical psychologist, and it just so happens that both, not one, but both of my parents are clinical psychologists, so I did not, I was not very creative, with my career selection.
[00:04:04] Hunter: The apple didn't fall far from the tree.
[00:04:06] Stephen Whiteside, PHD: Yeah, I stumbled into it, and, but they both, Work with adults. My father works with, oh, when, he was working, work with college students, my mom, worked with families and, and couples. and then, so probably my interest in working with kids came from being a camp counselor at a YMCA camp for many years,
[00:04:27] Hunter: probably
[00:04:27] Stephen Whiteside, PHD: how I ended up with this career choice.
[00:04:30] Hunter: That's great. I guess you'd like that. I was inadvertently, someone tricked me into doing a chem counseling job a summer, year after, on a freshman year in college, and I, it wasn't my thing. It was a little I was, I was like the bunk counselor for the 11 year old girls, and that was a, challenging, challenging job.
Yeah. And I also, I didn't like waking up to Copacabana over the loudspeaker every morning.
[00:04:57] Stephen Whiteside, PHD: We did not have that. I agree that would not be a good way to, we woke up to a bell and then going and jumping in the lake.
[00:05:04] Hunter: Oh, you had to jump in the lake. Did you have to jump in the lake every
[00:05:06] Stephen Whiteside, PHD: morning?
no, it was volunteer.
[00:05:09] Hunter: It was optional, but obviously you did. It must have felt pretty good.
[00:05:14] Stephen Whiteside, PHD: It was a terrible walk to the lake, but after you jumped in, it was a great feeling. after you got out, it was a great feeling to have started the day that way.
[00:05:23] Hunter: Great. that's wonderful. And you're a parent yourself.
You're a father yourself now. How did you get into studying kids and anxiety?
[00:05:33] Stephen Whiteside, PHD: it, happened when I was on fellowship. so I currently, am at Mayo Clinic in Rochester, Minnesota, and, that's where I did my fellowship and I never left. and one of the, actually, one of the adults, like a psychologist who works with adults, John Abramowitz, specializes in OCD and anxiety.
And so I started, Working with him, we had some research project interests and, just fell in love with, working with anxiety disorders and OCD, because partly because the treatment's very active, exposures, facing your fears. there's a lot of going out and doing things, which, fits me better than sitting and talking.
and then also, kids, they get better. and so it's really satisfying for us as therapists and, for them as families, to go through that journey together.
[00:06:27] Hunter: That's so cool. This is going to pair this talking about this is probably going to pair really nicely. We're talking about with we have another conversation that I will be talking about on the podcast about moms and fear.
So this is going to go really well with that. Dear listener, just so you know. Did you ever struggle with anxiety yourself? Is that something that brought you to it?
[00:06:50] Stephen Whiteside, PHD: Yeah. So, when, we're educating, or one of the first steps in our treatment process is to learn about anxiety and how it works, why it doesn't go away on its own.
We always use a example of a fear of dogs. and I tell them that I love dogs now. I have a dog. but when I was a kid, I was pretty afraid of dogs. So that's, one little example, but also I'm just generally a shy, quiet person. and I probably worry about things as well. and so it's just very easy for me to relate to the kids and teenagers who are struggling with anxiety because I know what it's like.
[00:07:28] Hunter: Yeah, sure. With your parents being clinical psychologists, do you think they were they I mean now that you have perspective on it as an adult, do you think they were more more clued into the language of, acknowledging feelings and things like that, than other parents of
[00:07:47] Stephen Whiteside, PHD: Yes, definitely.
that, that may be part of the reason that I am, I found a niche of psychology where it's very action oriented rather than sitting and talking about your feelings. It's probably a rebellion against my childhood, because yes. Yeah, it was worse, doing something wrong and getting in trouble, worse than being, punished was, talking about it and talking about kind of their feelings and my feelings that led to it.
That was like the worst punishment ever.
[00:08:15] Hunter: Oh, wow. Was it effective? I
[00:08:20] Stephen Whiteside, PHD: don't know. I was a pretty good kid, so I probably didn't break too many rules, so they were pretty successful.
[00:08:28] Hunter: that's great. And when did you realize that was different from the way other kids were raised?
[00:08:33] Stephen Whiteside, PHD: Oh my gosh, probably, I don't know, that's a really hard question.
I don't know. I think I've always had some sort of sense that, cause some, when I was a teenager and, some of, we would joke with, with my friends about how, like we, we had, more the, white side family, we had more family time and things that we had to do.
So it was clear that things were a little bit different, at that point, but I don't know if I've ever really fully appreciated how different it is to have two psychology parents.
[00:09:09] Hunter: Interesting. Yeah. I would just wonder, it's like, Oh, because a lot of us, you and I are of a similar age, I'm guessing.
but, if you, grew up in like the 80s or the early, it was a different world. It was, there was a lot of there was, there's a lot of people smacking around kids now, but there was a lot more of that then. And it was a lot more normalized and, Yeah.
[00:09:37] Stephen Whiteside, PHD: Yeah. I had, a bit, I had a bit of a temper when I was younger.
I would just, get upset when I got frustrated and I clearly remember my parents putting me on a, point system. So if I went through the day without having an emotional outburst, I would get a point. And after I filled up the, behavior chart, I got a basketball hoop.
[00:09:57] Hunter: Oh.
[00:09:59] Stephen Whiteside, PHD: So yeah. Wow.
That, that was probably different than most parents. I, nowadays everyone has some sort of behavioral plan that they put into place here or there, but back in the 80s, probably wasn't as, common.
[00:10:11] Hunter: All right. let's talk about kids and anxiety. So there are a lot of children, a lot of adolescents, and of course, a lot of adults these days, who are dealing with anxiety now.
what are some of the common behavioral and emotional problems that, are misidentified as anxiety disorders.
[00:10:33] Stephen Whiteside, PHD: Yeah. Oh yeah. that's a great question. Then we, that's, it's often the first step is, it's always the first step is figuring out whether or not. What a child is experiencing is an anxiety disorder, and trying to, suss that out from other common presenting concerns.
So it's probably a good place to start, with the description of what an anxiety disorder is. And this is actually where, where I start in the Anxiety Coach book is the first section is what is an anxiety disorder? Let's make sure we're on the right track before we start having our kids face their fears.
so an anxiety disorder quite simply is when kids are more afraid, nervous, or worried than we would expect them to be in a situation. And so there, there are, the first thing we want to make sure is that the emotion that we're dealing with is anxiety. so fear or worry as opposed to anger or frustration or sadness or difficulties managing emotions in general.
And then the second piece is we want to make sure that the kids are more anxious than we would expect. So we want to differentiate that from stress. So kids can be very nervous and worried because life is just not going well. Their parents are arguing or they're failing classes or they're being bullied at school.
And that's, that anxiety is a normal expected reaction. And we handle that differently than when kids are more anxious about a situation than we would expect. We also, since the pandemic, we've been seeing a lot more kids who have, eating, and weight issues and not even, like a full fledged eating disorder, but for just whatever reason, their eating habits have been disrupted and they're eating less and their weight has decreased and, It ends up looking a lot like anxiety or, OCD, but really before we can treat that, we really need to help them get back to their normal eating habits, and increase their weight to a, healthy weight for them.
And I would say that probably the fourth area is kids who are, on the autism spectrum, who have, rigid behavior or get anxious in situations that are hard for them because they don't have the, comfort level or the social skills. and, differentiating those kids and that presentation from kids who have anxiety disorders.
[00:12:50] Hunter: Stay tuned for more Mindful Mama podcasts right after this break.
Okay, so an example of an anxiety disorder according to that might be like, just feeling, let me think, why don't you give me an example?
[00:13:11] Stephen Whiteside, PHD: Yeah. So, there's about six or seven anxiety disorders. The, most common, are social, social phobia, social anxiety disorder, and they're all very aptly named, pretty self evident of what they deal with.
So social anxiety disorders, when kids are very shy and nervous, they're always worried that they're going to say the wrong thing or do something embarrassing and people are going to judge them and not like them and it will be awkward. And so they're just very nervous, talking. to peers or talking at school to the point that it prevents them from engaging in activities that they need to.
the second of the three that we most commonly see is generalized anxiety disorder. So these are kids who just worry all the time about lots of different things. So they're doing well in school, but they're constantly worried that they're not going to do well in the next test or get their homework done.
Their parents are healthy. Family stable, but they're worried that if, mom's late, she must have gotten into a car accident or if mom and dad have a disagreement, maybe they're going to get divorced when something new comes up, like a trip, they're excited, but also worried, what, is the plane ride going to be safe?
is it going to be safe where we go? Just worrying about lots of different topics to the point that it gets in the way of life, makes it harder to do things and affects the way they feel physically. Stomach aches, headaches, being more irritable. and then
[00:14:32] Hunter: the other rival brain gone crazy.
[00:14:36] Stephen Whiteside, PHD: Yeah, and then, separation anxiety disorder, particularly in, in younger kids where they feel very nervous about being away from their parents, so separation for school, staying home alone, sometimes in more extreme cases, if parents go to the bathroom, kids are pounding on the bathroom door, having inability to feel comfortable going to, to sleep at night in their own room and need their parents to stay with them until they fall asleep.
[00:15:01] Hunter: Where do these come from? what, I imagine it's a whole host of, complex reasons and things that play into it. But is, there, can we look at a certain, things of these, where these come from?
[00:15:15] Stephen Whiteside, PHD: Yeah. Yeah. So there's, two main components. and so for like pretty much everything, there's a genetic, heritable portion to it.
Anxious parents are more likely to have anxious kids. that's not one to one. There are certainly anxious parents whose kids are not, and there are kids who are anxious whose parents are not, but if, there's, a genetic proportion to it. secondly, there's an experiential, and that is that if you have, if you're anxious about something, And you tend to avoid it, successfully in your day to day life.
You are more likely to, continue to be anxious. and if that anxiety, if that avoidance spreads, you become more anxious about more things, becomes more problematic. And, that's, one of the first things that we, after we've decided that family or that a child is experiencing an anxiety disorder, one of the next steps is to help them understand how this, the model of avoidance works for them and how they've been avoiding things that's made anxiety worse, over time.
and then actually, sometimes people have a scary event or. A not so scary event that sort of triggers things, with, post traumatic stress disorder that can actually, be a traumatic event, sometimes with, OCD, somebody getting sick at school and they're still starting to be worried about germs at school, sets things off, a frightening experience with a dog can set up a, set off a fear of phobias, but interestingly, That's rare.
Most of the time, I think a dog phobia is a great example. Rather than most people saying, yeah, they had this bad experience. They've been scared ever since. It's more common. We don't know. He's just always been afraid of dogs. He's never had a dog. He's never really been around them. We don't know why.
It's more of an experience that we'll hear from families.
[00:17:08] Hunter: I was afraid of a chicken when I was a kid. My friend had a very scary chicken named Twinkle, and mine would have my, it would just peck at you, and it was very scary.
[00:17:19] Mindful Parenting Member: And
[00:17:19] Hunter: my mom, I'd have my mom carry me to the, through the driveway to her house.
But I was, I also still have a phobia of, Spiders. Very classic phobia, but I'm, getting, I'm better. They're small and not too thick. It's not so bad. But these are, this is, this is a whole different story. yeah, that genetic piece, can certainly see that in my own family.
The generation past to the current generation to, I can see that and then, we can, that's interesting that sort of traumas and experiences are like one of the smaller events, but I imagine that can lead a child to wanting to, to worrying about those things and wanting to control life.
But then this idea of experience and avoidance, this is something that, you talk about with this idea of exposure therapy. And. You've said that, like, when kids are experiencing anxiety, when they avoid, when they're avoiding situations or the thoughts or the feelings that cause them distress, this prevents them from learning about how to deal with it.
Is that, tell me more about this.
[00:18:33] Stephen Whiteside, PHD: Yeah, so in, the first step of our treatment program is we give families a lot of information. and one of the first things is we all need to have the, we need to have a shared understanding about how anxiety works. and so we help them pinpoint what are the situations that are, what are the things that set off your child's anxiety?
And it could be, external events like being around a chicken, or a dog, or it could be an action like having to talk to people or. Being around, items that you think are contaminated, but it could also be an internal event, like thoughts. Sometimes we're not in a situation that sets off our anxiety, but it's the thought about what's happening to mom, what's going to happen during the trip, what's going to happen in my test next week, or bad memories of the past, or weird OCD thoughts that pop into our head, and it's that thought itself that sets off the anxiety.
And then finally, sometimes it's feelings in our body that we're going to have a panic attack, or that we're going to be nauseous and, throw up, and it's those feelings that set off. So we help the families understand that. And then the essence of an anxiety disorder is that we feel anxious at a time where we don't need to.
[00:19:40] Mindful Parenting Member: And
[00:19:40] Stephen Whiteside, PHD: so what makes those things scary for us, when they're not scary for other kids? So that comes down to what we expect to happen. And either we expect that something bad is going to happen, people will laugh at me, the dog will bite me, my worries will come true, I'll get sick from these germs, or sometimes we know nothing bad is probably going to happen, it just feels overwhelming, like I just can't handle this gross, dirty feeling from the contamination, or I know no one's going to yell at me or be mean to me, I just feel nervous talking to people, so I have to get away to feel better.
And then the next piece is we talk about, all right, so we know that it's your, that you're, it's your expectations that makes you frightened. Why haven't you just learned through daily living that, it's unlikely to happen and that's where we come down to avoidance. We do lots of things to avoid situations that make us nervous.
So sometimes we just physically don't go there. I see a dog, I cross the street, my friend has a dog, I don't go to his house, I don't join extracurricular activities, so I don't have to talk to people. But other times, we do rituals like an OCD to wash our hands over and over again or over prepare and recheck things more times than we need to.
And sometimes we rely on our parents to do things for us or we cling to them or to stay close to them. And all that avoidance prevents us from learning that 1. What we're afraid of probably won't happen and even if it does, we could probably handle it. And 2. That bad feeling of feeling anxious will go away, even if we don't avoid.
And if we always avoid, we never learn those two things. So that keeps us stuck in the cycle and the fact that nobody likes to feel scared, anything that we do to avoid that makes us feel better is automatically rewarded or reinforced. So that means we do it more because this was a good way to feel better.
I'm gonna do that again and that can really make an anxiety disorder or OCD get much worse over time.
[00:21:27] Hunter: Yeah, in fact, we have another episode with the creator of the movie Anxiety Nation, which you probably know about. And she, yeah, I was thinking about this, the idea of it, this idea of the comfort zone and, I see it in my, own daughter.
My own daughter has a chronic pain condition that leads to a lot of anxiety, feeds the chronic pain condition and all of this, right? and there's a lot of anxiety. My husband's family goes down. But this, I, the avoidance of, difficulties and, at least for in our family, in her case, like her pain, it leads to the comfort zone getting smaller and smaller and smaller.
So that it's is this what happens when we let the sort of anxiety voice run the show is that, oh child's world can just get so, small that they're not really living, basically?
[00:22:27] Stephen Whiteside, PHD: Mmhmm yeah and you know so that can happen naturally with kids themselves because, I feel anxious, so I avoid and in this other situation I don't feel as anxious but a little bit anxious but I might as well avoid that because that's a good way to feel better quickly.
So that can happen. And then we as parents, we very much want to help our kids feel better in the moment. we want to solve things right now for our kids. And so we can get sucked into that cycle as well, where we help start doing things for our child, helping them through situations, all very well intentioned and meaningful.
And most of us do it and get away with it because our kids aren't. as prone to be anxious, but when kids are already prone to be anxious, that can feed this cycle, of just more avoidance in us doing things for them and prevents them from having the opportunities to learn that, that they can handle these situations and handle their feelings of anxiety.
and it's that understanding of how things, of how anxiety disorders and OCD work that sets us up for our treatment through exposures.
[00:23:26] Hunter: yeah. I'm looking forward to talking about that, but you also, I'm trying to imagine like parents who are, you may think, oh, maybe my kid's anxious.
I don't really know. they're not telling me they're anxious. You may just have a quiet kid who is just internalizing all this anxiety and doesn't actively, does not want to talk about it because that makes them feel uncomfortable, right? Yeah. so you. Talked about how you can use children's, jobs, right?
their school, their friends, and their family as a benchmark of anxiety. Is this something we can, look to figure out if that's what's going on? Yeah.
[00:24:03] Stephen Whiteside, PHD: Yes. Yeah. Yes. So, there's two concepts, that are related. and so one, anxiety, just a little bit of circular reasoning.
Anxiety is a problem when anxiety is a problem. So it is perfectly normal to be anxious at times. Being afraid of something that is dangerous or we think is dangerous, worrying about things is normal. And if you didn't feel anxious or fearful or worried ever, that would be a different set of problems.
One, that's normal. Two, there's a normal is a wide range, a big group. And so it is perfectly normal to have a little bit of anxiety and it's perfectly normal to have more anxiety. And people with more anxiety, can be particularly responsible, caring, helpful people. So there's nothing wrong with being more on the anxious side.
When we decide it's a problem that we need to do something about it is when it's upsetting and stopping kids, teenagers, or adults from doing things that you need to do or that you want to do. Okay. So if you really want to go out for the soccer team, but you're just so nervous that you're going to make a mistake and it would be really embarrassing and people would laugh at you, then anxiety is becoming a problem because it's stopping you from doing something you want to do.
Or if you're super nervous about your schoolwork and so you put it off, or you spend way too much time doing it and you don't have time to get enough sleep or hang out with your family or friends, then anxiety has become a problem that's making life difficult. With kids and teenagers, sometimes kids don't have so much of a insight into that it's being problematic.
So we often rely on parents to say, yeah, he says he just doesn't really like kids at school and doesn't want to hang out with them. But whenever he's with kids, he has a great time. and he just gets really upset when I suggest that he reach out to people and he seems pretty nervous. So parents have great insight into whether or not it's become problematic.
And then, so what do kids need? So that kind of leads to the question, what should kids be doing? What do they need to be doing? And, so that, that kind of goes to the three jobs that, that kids have, school, friends, and family. first job is that kids need to be going to school and putting forth a good effort to do their homework and, doing well at school.
secondly, be involved with the family, do chores at home, do family activities, interact with the family. And third, do fun things with friends. have one or two close friends that they, See, not only in school and during activities, but also out of school and be involved in some group activity or have some hobby.
And if kids are doing that, even if they're more on the anxious side, then that's fine. They, but if they're not, then that's a time that there might be a problem that we want to help them with.
[00:26:49] Hunter: Yeah, we, I think, it's interesting to see, The transition into adolescence and how adolescence is different also today with the, where, I don't know.
When I was a teenager, we would go out and find people. Staying at home was really boring. You had, I would be watching my parents watch Masterpiece Theater. It would be incredibly boring. So you had to go find people, you had to get over that, the inertia and the difficulty of oh, I'm gonna call so and they may not be home or they may be dizzy, etc.
And now, yeah, that, that piece about the kids and get, The kids getting together with their friends. It's, a really much more difficult thing these days. I guess that's a little bit of a tangent into this conversation, but it's, I imagine it's leading to more anxiety because they're already anxious.
Like they don't want to even call each other. Do they just want to text? They, and spending time in person seems like above and beyond in a weird way sometimes for them. I don't know.
[00:27:57] Stephen Whiteside, PHD: Yeah, I think, so social media is such a double edged sword, because on one hand, you can be so much more connected.
you can be texting with friends, you can be connected with friends, you can, talk to them. I don't know if the kids do talk on the phone anymore, but you can so much more. On the other hand, it helps you avoid, sometimes we'll see these kids with pretty clear, pretty severe social anxiety.
And they'll say, Oh, I've got plenty of friends. And they list off some online friends that they have and being a 50 year old man, I don't really understand whether or not an online friend, how much of a true friendship that can be. I'm just so out of it. but it seems pretty clear that they are avoiding interaction and they're compensating by having these, less direct interactions.
And also just the constant access to peer interactions or seeing people being, apparently happy on their Facebook posts and, everyone getting liked and you have to be responding. And if someone's, you don't want to interact with somebody rather than you're at home. So they really can't get to you now they're all over the place on social media.
So it's much harder to have a break from the rest of life.
[00:29:19] Hunter: Stay tuned for more Mindful Mama podcasts right after this break.
So setting those big, major problems aside, you teach and work with something called Parent Coach Exposure Therapy, and you've mentioned exposure a couple of times. Talk to us about this like path towards recovering from some, an anxiety disorder. Take
[00:29:44] Stephen Whiteside, PHD: Yeah, based on the idea that an anxiety disorder is being more afraid of something than we, would expect to be, and that it can be, Sticks around and gets worse and we don't get through it because we're avoiding, the situation on daily activities that sets us up for the treatment is we need to face our fears and we need to do the things that we're afraid of repeatedly until we learn two things primarily.
One, what I, nothing bad that I can't happen is likely to happen. Nothing bad that I can't handle is likely to happen. And two, I can handle this rotten feeling. I can handle feeling anxious until this feeling goes down or goes away. You, no one can tell kids that. we all learn based on our experience or our job is.
To give kids those experiences to learn it for themselves. And all of that is obviously easier said than done. And that's what exposure therapy is. You're exposing yourself to things that you're afraid of. So that's our job is to help kids take their fears and break them into small steps to practice.
And we do each step and we do it over and over again until they feel like they've mastered it and they're confident to go on to a more challenging. step in there and call it a fear ladder. That's the plan of the treatment plan. We start with easier things and work, climb our way up to harder exposures.
[00:31:03] Hunter: I was going to say, so what would you do with, social anxiety in that scenario? what would the ladder be in that case?
[00:31:09] Stephen Whiteside, PHD: Yeah. with all fears, fear, the, fear ladder of the plan needs to be tailored to that child's specific, fears and worries. But generally, we start off with, we do all of our treatment in groups.
because it's helpful to, to have access to get people in. it's also really nice to be with a bunch of other kids and parents who are dealing with something similar, makes it really obvious this is a normal thing that many people go through. And also if you are socially anxious, it's pretty handy to have a bunch of other kids around that you can practice talking to.
So early exposures can just be introducing yourself to the group individually, or some kids, an early exposure, just walking around the hallway, making eye contact with people. Yeah, we have kids go up to the front desk and ask if they can borrow a pencil and then go back up and ask if they can borrow a pen.
Asking questions in public places. We often, we leave the office all the time. We go down to, stores and have kids go up to the information desks and ask for directions. Go to stores, ask where sweatshirts are. give presentations to the group. and then, yeah, it's obviously really important that they, so there's two, two categories of exposures.
One are things that we do during the day. The group session, because those are things that we can organize and do. and families will go do similar kind of structured practice, go to a mall and ask questions. but then also we need to generalize it to the real world setting. so kids need to reach out to friends to make plans, talk in class, say hi to someone at school they would normally talk to.
Things like that.
[00:32:57] Hunter: That makes a lot of sense. you just have to get, realize, I've done this terribly scary thing, and I didn't die, and actually it's okay, and then suddenly you're, you can get more comfortable. It's making me feel grateful for my daughters, and they were little, they went to very, little, Two years old, we're at a Montessori school and the teacher would be crouched down at the door every morning when they go, went in and would look them in the eye and shake their hand and say, hello, how do you know?
Nice to see you today. And they would have to shake their hand and look at their teacher's eye and say, hello. And so nice to, nice to see you too, whatever, and walk in as a 2-year-old. And I thought, gosh, that's so great. You know that there's a lot of. It's hard for a lot of people to, look at somebody and say, hello, and how are you?
[00:33:51] Stephen Whiteside, PHD: Yeah, that's a great routine. Yeah, my, my daughter is in both, ballet and piano. and the really cool thing about this piano program, is that they have group lessons. Every couple months and then, they have recitals and things. So she's always playing the piano in front of the other, kids who take lessons, and in front of the other families and then through ballet, she does performances and at least so far, she's very confident with performing, getting up in front of people and performing.
[00:34:22] Hunter: That's
[00:34:22] Stephen Whiteside, PHD: smart, that they do it. Much more confident than I was at that age.
[00:34:26] Hunter: What do you do, what would be a ladder for something like separation anxiety be like?
[00:34:31] Stephen Whiteside, PHD: Yeah, so the so we start, so with, social anxiety and separation anxiety, the main part of that is what are sometimes called in vivo, so in real life exposures, or sometimes we call them action oriented exposures, where you're going off and doing something.
Talking to people for separation anxiety, it might be sitting in a room by yourself. And those are always the most powerful. If there's something, if there's an action that you can do, that is the most powerful learning experience for an exposure. But sometimes, what makes you nervous are the thoughts themselves.
So especially with generalized anxiety disorder, I'm worried about the future. I can't do an exposure to the future. So when it's a thought that sets off your anxiety, the way we do exposures is we repeat that thought over and over again until it gets boring. Constantly worried that the car is going to break down.
They have to repeat, the car is going to break down. The car is going to break down. The car is going to break down. So that thought gets boring.
[00:35:30] Hunter: Wow. That sounds like counterintuitive to me.
[00:35:33] Stephen Whiteside, PHD: Exactly. It is. Yeah. And it's counterintuitive to many parents. because one, they're used to, when their child comes to them with a worry, they respond with reassurance,
[00:35:44] Mindful Parenting Member: like we
[00:35:44] Stephen Whiteside, PHD: all do.
[00:35:45] Mindful Parenting Member: Yeah.
[00:35:46] Stephen Whiteside, PHD: it's a normal thing to do. when their child comes to them with a fear that clearly, is not going to happen and is not rational. They respond with kind of rational response for that. this won't happen because of this and that. Again, a very reasonable approach. and then also there's this general idea of like sort of positive affirmations and positive power of positive thinking.
I need to focus on these. If I think about this positively, then it'll inspire me to do it. and so for the, probably those three reasons, Repeating scary thoughts is counterintuitive for people. but what we explain.
[00:36:23] Hunter: Swimming my fingernails, thinking about it.
[00:36:26] Stephen Whiteside, PHD: so what, we explained is if we don't repeat all thoughts, we don't just repeat bad thoughts.
We are focused on thoughts that make you nervous, because thoughts are just thoughts. Thoughts cannot hurt you. They can't make you do things you don't want to do. they don't make things come true. and any thought that you repeat over and over again, especially out loud, Becomes pretty boring pretty quickly.
and so the goal is for kids to learn when they're out and about and. They sit down to take a test and they have this thought, I'm going to fail. Rather than that thought being overwhelming, that's uncomfortable, but it's not that big a deal because they've had that thought so often and they've repeated it, that it's just lost its power.
So rather than making them overwhelmed with anxiety, it's just mildly irritating and they can push through. So for separation anxiety, we, it depends, again, what makes kids nervous. we would, we might start with a child sitting in the group room while their parent leaves. if that tends to be the lowest level, the easiest exposure they can do.
If, they feel uncomfortable around other people, then maybe we would have them sit in a room by themselves and their parents step out. One way that we help kids take small steps is to have parents check in on them frequently. so let's say a child is, for the first step, is going to sit in a room by themselves because that makes them nervous, but that's less stressful.
Even
[00:37:51] Hunter: sleeping in a, sleeping in their own room. That's a very common thing that's in this audience. Yeah.
[00:37:57] Stephen Whiteside, PHD: Yeah. Yeah. So that, if the main problem is sleeping alone, let's say that they're, if they're, worried about separation, so they can't play in a room by themselves. We should probably build their confidence to be playing in a room by themselves during the day before we expect them to fall asleep on their own at night, because everything is harder at night, but the nighttime one is a great example, so let's say, they're generally fine with separation during the day, but at night, They're either nervous or don't want to go to bed or just want that extra attention.
so it's hard for them to be in the room by themselves. What happens is parents put them down, then they cling or they call out and parents come and quiet them down, or they come out and say they're anxious or upset and parents calm them down, quiet them down, get them back in bed. And so what happens is kids are getting a lot of attention for when they call out and are upset.
and when they're lying in bed quietly, they're ignored, which is pretty Traditional, normal way that it goes, but when kids are struggling, that parent's attention is unfortunately making the problem worse rather than making it better. So we try to shift that by having parents check on their kids while they're quiet.
So you explain, I'm going to check on you frequently, you need to stay in bed quietly, and if you are, I know it's hard, so I'm going to check on you a lot. And you close the door, you count to five, you open it right back up, so you're doing a great job being quiet. So you reinforce them with your attention and support before they even have a chance to call out.
Then you, as perhaps very gradually, extend it so that you wait 20 seconds before you go in again. 30 seconds, you can extend it and extend it throughout that night. And probably you have to do it multiple nights. It's not a problem you can probably fix in just one sitting, but the general idea is if you're quiet and being brave and calmly facing your fears, I'll give you attention and check on you.
But if you're calling out, I'm going to ignore you till you're quiet. And then I'll come in after you're quiet. all that's easier said than done. So we practice that in the session. So kids with separation anxiety, their parent, they're, sitting in the room by themselves and their parent is checking in on them every couple, minutes eventually, but before that, maybe every five, 30 seconds.
[00:40:12] Hunter: So do it when it's familiar during the daytime.
[00:40:15] Stephen Whiteside, PHD: Yeah. Yeah.
[00:40:16] Hunter: Yeah. You make it comfortable.
[00:40:18] Stephen Whiteside, PHD: Because if a child is too anxious to play Legos in a room by themselves during the daytime, they are certainly going to be too anxious to go to sleep at night when it's dark and they're having scary thoughts about monsters in the closet.
[00:40:31] Mindful Parenting Member: And
[00:40:34] Stephen Whiteside, PHD: so depending on the child's age, we will add in thought exposures. if they're, If the worry is there's a monster in the corner, we will have them sit in the room by themselves and working their way up, to eventually the extra challenging exposure. They're sitting in the office, lights off, it's dark, and they're repeating themselves.
There's a monster in the corner. There's a monster in the corner. There's a monster in the corner. And their parents check in on them every once in a while, or yeah, this is the ultimate exposure. So every once in a while and they just get, have the child tell them how anxious they are until they are bored, sitting in that room, repeating the silly thought over and over again, with the goal being now when the child's in bed at night.
under normal circumstances, and they have this thought, there's a monster in the closet. They're like, I can handle that thought. I sat in a room by myself for 10 minutes repeating that thought. Nothing happened. I can handle this now.
[00:41:32] Hunter: There's some parallels there, I think, to meditation. So interesting. And so the, this, the results of this, parent, coach, this exposure therapy have been pretty positive, it sounds
[00:41:44] Stephen Whiteside, PHD: Yeah. So I. exposure therapy has been around for a long time, decades. and so there's good empirical evidence for that, cognitive behavioral therapy, which involves exposures and other, other exercises is been the most studied treatment of any treatment, therapy or medications, the most studied treatment for childhood anxiety disorders, and there's a good amount of research supporting that.
And then one of the reasons that we decided to write the book Obviously from our model, we think parents are super important. and we want parents to learn to be exposure coaches, to be experts on exposure. And so I've always wanted to write a book to help them. Help more parents know about this treatment approach.
But I really wanted to make sure that we had something important and legitimate to say before I presume that I could write a book that other people should read. So I wanted to wait until we had done a research, study, and we did that, finished a couple of years ago now, and we're still working on finishing the manuscripts and getting things published.
But basically, So that our approach when compared to standard CBT, Cognitive Behavioral Therapy, so working with parents and kids together, starting exposures early, led to more improvement over fewer sessions. So the more effective and efficient treatment, at least based on our clinical experience in that first study.
So we feel pretty confident that this is a good path for families to take.
[00:43:11] Hunter: That's great. Bye. Bye. that Dr. Whiteside is mentioning is called Anxiety Coach and it's out now. You can go get it. There's, wow, this is a big topic. I have so many more questions. Huma and I, we, unfortunately don't have all the time in the world.
this has been really fascinating, I think, and it would be a really valuable and instructive, episode for everyone to listen to and share around. I. I really appreciate you sharing your time with us today. Is there anything that we missed that, that you want to get in there? Or also where can people, find out more about you if they want to?
[00:43:52] Stephen Whiteside, PHD: Yeah. people can, find me. I hope, I am, I hate to admit it, but I am not the most savvy when it comes to, I know, social media. So, I have just standard old websites, at Mayo, Stephen Whiteside, at Mayo Clinic. We've got a clinician, a clinic, page for our clinic. We've got a page for, our research program as well.
and then, so in terms of kind of the final thoughts, I think what's most important, is for kids and parents to know that anxiety disorders are very common, most common mental health problem in kids, and that they're treatable, and that the general idea, if your child's afraid of something, that You need to calmly and warmly, but firmly, help them face their fears.
And that's often easier said than done, so that there are people who can help you do that.
[00:44:48] Hunter: Yeah, this is, I think, so powerful. Thank you so much, Stephen. I really appreciate it. I appreciate meeting you and talking to you. And the work that you've done and put out in the world, I think this is incredibly valuable.
So thank you so much for coming on the Mindful Parenting Podcast.
[00:45:04] Stephen Whiteside, PHD: Thank you very much for having me. It was a pleasure.
[00:45:11] Hunter: I hope this episode was helpful for you. I think that, oh, it's so heartbreaking. Kids who can't have social anxiety are ruminating and all those things. And we're so helpless in some ways to just change it, right? It can, feel very helpless. So I hope this episode gives you some help, some, ways to address this.
so yeah. And if it's helpful, please do, of course, share it with a friend. Maybe you have a friend who would find it helpful. If you're finding this helpful, share it with a friend. That helps us to just get this podcast out to you each week. So please do share it. It really has a big real world impact when you do.
and yeah, I hope this has helped and I hope you have a good week. I thank you for listening. Thank you for being here. Thank you for. Wanting to just do better for these kiddos and I think that's I am so heartened that, so many people are here listening to this. I, think that you're, that beautiful intention that's in your heart and your soul is just really lifts me up to know that you are there listening to this, so thank you for being here.
Thank you for doing what you do. I wish you ease and peace. I wish you chocolate and giggles and snuggles and all the good things in life this week. And I will be back as always talking to you again here on the Mindful Parenting Podcast. We are here for you, and I'll be here because I love it. I love doing this.
it's funny, so I talked, another week ago about how, I'm a painter and how I'm an artist and I had been an artist for many years painting, actually painting images of moms and animals and, that was really helpful for me and really a lot of people got great things from the, work.
But to me. I get so much out of just directly connecting, so like through this podcast. So I thank you for being there and yeah, wishing you all the good things in life, my friend. And I'll talk to you soon. Thanks for listening. Namaste.
[00:47:50] Mindful Parenting Member: I'd say definitely do it. It's really helpful. It will change your relationship with your kids for the better. It will help you communicate better. And just, I'd say communicate better as a person, as a wife, as a spouse. It's been really a positive influence in our lives. So definitely do it. I'd say definitely do it.
It's so worth it. The money really is inconsequential when you get so much benefit from being a better parent to your children and feeling like you're connecting more with them. Not feeling like you're yelling all the time or you're like, why isn't this working? I would say definitely do it. It's so, worth it.
It'll change you. No matter what age someone's child is, it's a great opportunity for personal growth and it's a great investment in someone's family. I'm very thankful I have this. You can continue in your old habits that aren't working or you can learn some new tools and gain some perspective to shift everything in your parenting.
[00:48:54] Hunter: Are you frustrated by parenting? Do you listen to the experts and try all the tips and strategies, but you're just not seeing the results that you want? Or are you lost as to where to start? Does it all seem so overwhelming with too much to learn? Are you yearning for community people who get it, who also don't want to threaten and punish to create cooperation?
Hi, I'm Hunter Clark Fields, and if you answered yes to any of these questions, I want you to seriously consider the Mindful Parenting Membership. You will be joined by I'm joining hundreds of members who have discovered the path of mindful parenting and now have confidence and clarity in their parenting.
This isn't just another parenting class. This is an opportunity to really discover your unique, lasting relationship, not only with your children, but with yourself. It will translate into lasting, connected relationships, not only with your children, but your partner too. Let me change your life. Go to mindfulparenting.
org MindfulParentingCourse. com to add your name to the waitlist so you will be the first to be notified when I open the membership for enrollment. I look forward to seeing you on the inside. MindfulParentingCourse.com
[00:49:12] Hunter: Are you frustrated by parenting? Do you listen to the experts and try all the tips and strategies but you're just not seeing the results that you want? Or are you lost as to where to start? Does it all seem so overwhelming with too much to learn? Are you yearning for community people who get it, who also don't want to threaten and punish to create cooperation?
Hi, I'm Hunter Clark Fields. And if you answered yes to any of these questions, I want you to seriously consider the Mindful Parenting membership. You will be joining hundreds of members who have discovered the path of mindful parenting and now have confidence and clarity in their parenting. This isn't just another parenting class.
This is an opportunity to really discover your unique, lasting relationship, not only with your children, but with yourself. It will translate into lasting, connected relationships, not only with your children, but your partner too. Let me change your life. Go to mindfulparentingcourse. com to add your name to the waitlist so you will be the first to be notified when I open the membership for enrollment.
I look forward to seeing you on the inside. MindfulParentingCourse.com
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