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For frightened children, parents may need to learn to face their fears: shots



Joseph Calise, 9, plays in his bedroom on his iPad. Joseph always became anxious when he was alone, even when he was showering or at bedtime. That's why his parents, Jessica and Chris Calise, learned new parenting skills at the Yale Child Study Center.

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Joseph Calise, 9, plays in his bedroom on his iPad. Joseph always became anxious when he was alone, even when he showered or at bedtime, so his parents Jessica and Chris Calise learned new skills as parents in the Yale Child Study Center.

Christopher Capozziello for NPR

Jessica Calise first recalls the nine-year-old son of Joseph's anxiety when he first appeared at a school concert about a year ago. He said his stomach hurt and he could vomit. "We spent the whole performance in the bathroom," she recalls.

Afterward, Joseph struggled whenever he needed to do something alone, like showering or sleeping in his bedroom. He asked his parents to sit in front of the bathroom door or let him sleep in their bed. "It's heartbreaking to see your child look so mad and feel like it's vomiting because of something nervous, which in my eyes is not a big deal," says Jessica. Jessica decided to enroll in an experimental program that was very different from other therapies for childhood anxiety she knew about. It was not Joseph who saw a therapist every week – it would be her.

The program was part of a Yale University study that addressed children's anxiety by providing new ways for their parents to respond.

"Parental reactions are a central and integral part of childhood anxiety," says Eli Lebowitz, a psychologist at the Yale School of Medicine who developed the training.

For example, when Joseph was afraid to sleep alone, Jessica and her husband Chris Calise did what he asked and consoled him. "I've done the right thing in my head," she says. "I would say" I'm right there "or" Come sleep in my bed. "I would do anything to keep him from feeling anxious or worried."

But this soothing – something psychologists call shelter – can actually be counterproductive for children with anxiety disorders, says Lebowitz.

"These precautions lead to worse fears among their children than to less anxiety," he says. That's because the child always relies on parents, he explains, so that children never learn to deal with stress alone, and never learn that they can handle those moments.

"If you offer a lot of accommodation The unspoken message is," You can not do that, so I'll help you, "he says, wondering if helping parents to change that message and theirs would help Encouraging facial expressions rather than encouraging them to flee children.

Currently, the established treatment for childhood anxiety is cognitive-behavioral therapy delivered directly to the child.

When researchers have tried to involve parents in their child's therapy According to findings from studies suggested that parenting in cognitive-behavioral therapy did not make much of a difference to the child's recovery, Lebowitz says this may be because cognitive-behavioral therapy encourages the child to change his behavior. "If you ask parents to change their child's behavior, set it up for a very difficult interaction one, "he says.

Instead, Lebowitz & # 39; s research examines whether training can only help parents without direct childhood therapy. He conducts experiments to compare cognitive behavioral therapy for the child with exclusively parental parents. A study of this approach appeared in the Journal of the American Academy of Child & Adolescent Psychiatry last month.

Jessica Calise received training from Lebowitz parent for 12 weeks as part of a follow-up study whose findings have yet to be published

Jessica and Chris Calise sit in the living room with their son Joseph Calise.

Christopher Capozziello for NPR


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Jessica and Chris Calise are sitting in their living room with their son Joseph Calise.

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Once a week, she drove to Yale University for a one-hour session with a therapist from Norwalk, Connecticut. Like all parents who had taken part in Lebowitz's training program, Jessica began working with the therapist on a plan for how she and her husband would stop when Joseph became anxious.

Lebowitz says the key is to make children feel heard and loved while using supportive statements to build their trust. Parents need to "show their child that it understands how horrible it is to feel anxious," he says. They must accept that their child is "truly anxious and not just looking for attention," he adds.

The next step is to tell the children "that they can endure this fear and do not need to be saved from it." Lebowitz says that this gives them the power to face their fears.

This approach was tough at first, says Joseph's father, Chris Calise. He is a six-meter-tall contractor with a solid frame like brick. "The hardest hunchback was the way I was raised," he says, tapping his fingers against the kitchen table. "I've always thought of the way you do things [is to say]:" Overcome that. You're alright. Take it up. "But it was obvious that our work did not work."

The parents had committed to a plan to get Joseph to sleep alone and take a shower.

"It was baby steps first I say," I will not stay [outside the bathroom]but I'll come back in five minutes and see you, "says Jessica," then I'd say, "I know, it's scary for you but I know you can do it, you'll be great. "Just acknowledge the fear and underpin the statement.

It was slow at first, says Jessica, but every time she's been trained, Jessica praises Joseph if he manages to spend time alone. "[We’d] you say," Wow, you're one Rockstar, you were nervous and scared, but you did it, and you can do it, "she says.

And slowly, Joseph began to invest alone for a long time, finally sleeping alone all night. "It was about halfway when you noticed really big differences," Chris recalls. "He became more self-confident, he just did things on his own without us asking or saying."

Many parents in Lebowitz's recently published study had a similar experience. Almost 70 percent of the 64 children assigned to the parental exercise arm of the experiment were not afraid at the end of the study.

"It's amazing, it's really exciting.These kids had never met a therapist before they were probably cured of their anxiety disorder like the kids who had 12 sessions with the best available therapy," says Lebowitz about the results of his recently published Study.

Parent training seems to work because it allows children to confront them with fears, while parents provide distant love and support, says Anne Marie Albano, a psychologist at Columbia University who does not attend the Study has worked.

"They train the child a bit but do not take it in. It helps the child stumble in their own way to deal with any anxiety wave they have," she says. "That ultimately strengthens their confidence."

Joseph cleans his teeth before going to bed.

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Joseph brushes his teeth before going to bed.

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This suggests that this parenting training has great potential to advance the treatment of anxiety disorders in children, Albano says. "It's preliminary, but for me as a person who has worked in this field for 30 years, this work is very exciting," she says. "This treatment ultimately puts the parents at the center and focuses on the way parents [to stop] have to take over to break the fear cycle in children."

Lebowitz & Parent training is theoretically similar to traditional therapy, says Muniya Khanna. a psychologist at Children's Hospital of Philadelphia and director of the OCD & Anxiety Institute in Philadelphia, who was not involved in the work. "But that comes from a different angle," she says. "It aims to change the lifestyle and say, yes, changing lifestyle and family life can have almost the same effect as the child's theoretical understanding of [anxiety]."

Khanna believes that this parenting program combined with traditional therapy could lead to even better outcomes, especially for children who have not addressed behavioral therapy alone. "It's encouraging for families where children may not be willing to develop cognitive behavioral therapies," she says.

The study leaves many unanswered questions, adds Albano. "This is just a short-term result, and we have to follow the children after six months, twelve months or even several years," she says. Not only does it remain to be seen whether the benefits of parental education will persist as the child ages, but further research needs to be done to see if the same techniques continue to function when children reach the age of teenagers.

Jessica Calise looks for Joseph as he gets ready for bed. Joseph used to be afraid to sleep alone, but he has learned to be satisfied since his mother learned new approaches to parenting.

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Jessica Calise looks for Joseph as he gets ready for bed. Joseph used to be afraid to sleep alone, but he has learned to be satisfied since his mother learned new approaches to parenting.

Christopher Capozziello for NPR

Jessica and Chris Calise say they even use the techniques they learned as part of the parenting program with Joseph's twin sister and older brother Isabella and Nicholas. "It's important to confirm the feelings of your children and show them that we care," says Jessica. "I think that taught us to communicate better, and I think that made us better parents, honestly."

Joseph says he no longer feels afraid of being alone. He does not like it, "but I agree," he says. He has learned to dispel the terrifying thoughts that would come when he was alone, keeping him awake at night. "When I get a nightmare, I just change the subject to something lucky," he says. "Then I'm fine."

From time to time new fears emerge – like a recently discovered fear of heights. With the support of his parents, says Joseph, he also learns to face them. "I think I'll be fine," he says. "I'll just try it."

Angus Chen is a reporter living in New York. Follow him on Twitter: @angRchen .


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