Child Psychologist John Piacentini on How Parents and Teachers Can Help Anxious Kids Stop Avoiding Discomfort, Before the Cycle Bakes Itself In

Childhood anxiety and depression are on the rise. What could bring them back down?

Let Grow’s Lenore Skenazy Zoomed with Dr. John Piacentini, a leading child and adolescent psychologist and Professor of Psychiatry and Behavioral Science at UCLA. He is also Director of the UCLA Center for Child Anxiety, Resilience, Education and Support (UCLA CARES Center). The interview has been edited for length and clarity.

LS: We’re hearing from so many parents and teachers that the biggest issue facing today’s kids seems to be anxiety. Has the psychological world always been aware of this?

JP: When I started working in anxiety in the late ‘80s there wasn’t much attention paid to it.

LS: Why not?

JP: One of the reasons is because anxiety is part of the human condition. It’s part of “fight or flight.” It’s what kept us alive. Babies have separation anxiety. No kid wants to go into the dark and fix the fuse box. So if a mom would go to the pediatrician and say, “My child is afraid of the dark,” we’d say, ”That’s normal They’ll grow out of it.“

LS: But sometimes kids don’t?

JP: There might be 15-20% of kids who have problematic anxiety. And anxiety disorders can be as crippling as some of the most severe disorders we have. It’s chronic and it can lead to really significant problems.

LS: What do parents have to know to keep that from happening?

JP: It goes back to evolution: If I’m a cave person and I’m walking thru the woods and see a tiger print, I’m running away.

LS: Me too.

JP: Even if the threat isn’t there. And what happens over time is, as I start thinking there’s something dangerous and I start avoiding it, I don’t have the chance to determine if the thing really is dangerous.

LS: The danger could be “all in your head”?

JP: People with anxiety disorders have been shown to demonstrate something we call heightened threat bias. Their anxiety alarm is turned up a little higher, so it tends to go off a little more easily at something that may not actually be dangerous. That’s when you see kids avoiding birthday parties, or speaking in class, or answering the phone. And then, the next time that opportunity arises – in their mind they’re creating these associations: “The last time the phone rang, I could have made a fool out of myself, so I didn’t answer it.”

LS: So if you’re that kid, the next time you don’t answer again?

JP: And you experience relief! Your body revved up, then you avoided the experience – and it calmed down. The bad feeling went away. That is called negative reinforcement.

LS: As opposed to –

JP: Positive reinforcement. That’s the idea that if you get a reward for something, you’re more likely to do it again. Negative reinforcement is getting rewarded for avoiding bad things. So if you’re in the elevator and it shudders and you say, “That’s it. I’m never riding the elevator again” – the problem is that you never get the chance to prove or disprove that the thing you avoid is bad. That’s why anxious kids avoid and consider dangerous all these things that most people think are just fine.

LS: Yes. We’re seeing kids avoiding things like homework, because it could be hard or they could look dumb. But they’re also avoiding fun things, like even walking the dog or climbing a tree, because they could “get hurt” or they’re afraid they’ll “mess up.”

JP: There’s a physical side to this. When my anxiety is triggered, I experience worried thoughts: “Oh my God, something bad is going to happen!” My heart beats faster, I’m short of breath, adrenalin pumping, I’m ready for fight or flight.  So [anxiety] is not just in the kid’s head. They’re feeling it in their body.

And also: anxiety is genetic. If you are an anxious child you are more likely to be living with another anxious person in your family. It’s nobody’s fault – it’s just that way it is.

LS: What do you tell parents of anxious kids?

JP: The primary thing we want to address is something called “accommodation of anxiety.” When a child is anxious and wants to avoid going to school, or to the birthday party, we often see the parents cajole or bribe the child. But if the child fights hard enough, the parent says, “Okay. Stay home.” And that is reinforcing the avoidance. If I say, “Okay, you don’t need to go to school today,” or, “You don’t need to go to your soccer game,” or, “You don’t need to thank Aunt Sally for the gift,” what I am telling the child is, “Yes. You were right. There may be something dangerous, because otherwise I would make you go.”

LS: You’re re-enforcing their fear as legit.

JP: The other thing that happens is usually the kids says no, the parents say yes, and it’s back and forth, yes-no-yes-no – creating emotional arousal. At the point where the parent finally gives in, the child is typically at their highest level of anxiety. And as soon as they learn they don’t have to do what they don’t want to do, their arousal level plummets.

LS: They’re flooded with relief.

JP: And what the child learns is: To avoid doing something scary, I just need to outlast my parents. And what the parent learns is: If I just give in, it makes life easier.

The cycles repeat and just get burned in. Kids who go through their whole lives with this – a lot of these kids have a hard time functioning. They can’t handle any difficulty because they have so successfully avoided any kind of situation that might help them learn how to manage emotion.

LS: So how can parents – and teachers – break that cycle? How can they help kids get used to facing some fears? Or even realizing that screwing up is not the end of the world?

JP: We want parents to really encourage their kids to stretch themselves, to face new situations, to do things that they don’t want to do. Kids should experience the full range of emotions. That doesn’t mean we want to make our kids anxious or depressed every day. But even in the best of times we all face fears or worries and feelings of sadness. And we NEED to experience these. Better for kids to experience them now when they’re young, so they can learn that these fears don’t last forever.

LS: I have to say: That is exactly what our Let Grow Project does. It’s a homework assignment students get that says, “Go home and do something new, on your own, without your parents.” We give a list of about 100 ideas — ride your bike, go to the store, make dinner, whatever. Basically we want kids to do something slightly out of their comfort zone, so they (and their parents) get used to exactly what you just said — facing some fears and seeing how truly great it feels afterward. It’s positive reinforcement instead of negative reinforcement – fighting the culture of avoidance.

JP: Avoidance spirals you down, because the less you do, the worse you feel, the less stuff you face, the fewer skills you have. In treatment, we want to show you that the MORE you do the STRONGER or better you feel.

LS: Exactly! That’s what The Project helps families do – break through the ice of anxiety and let the confidence flood in. We see it as helpful on an individual basis, but also as something important for our whole society.

JP: Doing nothing and letting the kids avoid [anxiety-inducing activities] is in the long term much more deleterious than pushing them to do things. We’re seeing a generation of individuals that really don’t have the resilience to manage. To create a resilient society –

LS:  Or child!

JP: We need to learn how to manage distress.

LS: Yep. Theirs and ours. Thank you, doctor.