NPR's Hidden Brain Explains Anxiety

As a therapist, of course I geek out about episodes of NPR’s Hidden Brain with Shankar Vedantam. But rarely as intensely as I did with this one. In this episode, Shankar and his guests get the explanation of anxiety exactly right. Listen here.

Is it an anxiety disorder or normal anxiety? A Maryland therapist explains.

The guest in this episode is Psychologist Tracy Dennis-Tiwary. A few minutes in, she plays a recording of herself responding to her child’s anxiety. Her son is learning to ride a bike. He is doing great, but is saying he is afraid he will fall. What she says to him sounds incredibly familiar. (Thank you, Dr. Dennis-Tiwary for your courage in letting us all hear this!)

The tension in her voice is palpable as she says “You are not scared. You’re crushing it.” She moves on to “You’re doing amazing! Why are you so negative about it?” He answers tearfully “I don’t know.” His mother tries again. “You are NOT scared. There’s nothing to be scared about. You did it perfectly. You haven’t fallen once. I should knock you down. Get over it.” We can guess how this goes from here.

Parent anxiety and child anxiety feed each other, so it’s important to treat both.

Dr. Dennis-Tiwary acknowledges in the episode that her own anxiety was growing. She was doing two things parents often do (and that we discourage). First, she was fast forwarding through her son’s life and imagining that this emotion would affect him in the same way forever. Then, she was generalizing this circumstance to possible future situations. She became fearful that her son would struggle in the face of other challenges.

As the mom in this situation, she eventually says “You’re so good at it, and you’re just talking yourself into this crazy… You’ve got to get your head together, man.” So does she have an anxiety disorder? Does her son?

Probably not. Her son is trying something new, and inherently scary. He is riding a bike, for the first time, on a gravelly hill. Would it hurt to fall? Yes. Does he have enough experience riding to be confident? Not yet.

And Dr. Dennis-Tiwary is also having a normal level of parental worry. She sees vulnerability in her child, and wants to stop it. There’s nothing wrong with that. She could help herself in the moment by slowing down and remembering that her son’s development is unfinished. He will continue to grow.

So it’s not an anxiety disorder for either of them. Here’s how it could become one.

Anxiety disorders by definition include worry or fear that is

• out of proportion to the situation and

• restricting or limiting the person’s activities

Dr. Dennis-Tiwary could have ended this interaction by saying something like “that’s it. If you can’t do it without complaining, you can’t ever learn to ride a bike.” She came pretty close to that on the recording. And then she could have gone home and canceled all future activities on the calendar that might involve biking. (That she did not do, as far as we know.) If she did, she might be in anxiety disorder territory.

The more likely scenario is that her son ends the interaction by getting off the bike. And leaves with the conclusion that he can’t learn to ride a bike. He could decide to try again when his Mom isn’t around, or ask his mom to handle it differently before he tries again. If he does this, there’s clearly no anxiety disorder at play.

So, what actually did happen? Dr. Dennis-Tiwary told us! She reached out after reading our post, and shared this excerpt from her book Future Tense: Why Anxiety is Good For You (Even Though it Feels Bad):

As soon as we got home, he went up to his room, clearly distressed by the experience. After a few minutes I asked him to come downstairs and join me at the kitchen table.

I took a deep breath, and hit Play on the video recording. As we listened to it together, he saw my face go pale and my eyes become a little misty.

“What’s wrong, mommy?”

“I’m sorry bud,” I said. “I wanted you to listen to this so you could see how wrong I was. You had absolutely every reason to be scared and worried – you’re new to bike riding, and you might have fallen. It’s actually smart to feel anxious in situations like that. I made a big mistake when I told you it wasn’t ok to be scared. I’m sorry. You did nothing wrong! And I love you just the way you are.”

…Not long after, Kavi learned how to ride a bike. He still wobbled at times, but I was ok with that. So was he. He and I faced our anxieties together, and came out stronger in the end.”

This example shows us so clearly that parents and kids can recover from mistakes. We won’t always handle our children’s anxiety, or our own, the best way. But we can apologize. And ask for a do-over.

So what if that do-over doesn’t happen, and the boy never tries riding a bike again? He might be able to live this way for a long time without it affecting him much. But what about when someone he cares about invites him on a bike riding date? Or his child wants to ride bikes together?

If you notice your child becoming afraid and avoiding activities that would trigger the fear, it’s best to have it checked out.

Consult an anxiety therapist who treats adults and children

This is important because anxious children often engage a parent to calm them down. And parent anxiety often leads to attempts to control the child. You need a therapist who can untangle this knot.

Social connection is critical for managing anxiety

Dr. Dennis-Tiwary references research that used FMRI to measure signals of anxiety in the brain. In the study, anxiety signals were diminished when participants were allowed to hold a stranger’s hand. This tells us something.

Being with or near an anxious friend, child, family member, or partner does help them

This is especially true if you are physically connected. We can soothe the nervous system by holding hands, placing a hand on the back, or even sitting side by side with shoulders or legs touching. Our kids seek us out when they are feeling anxious because our presence does soothe the anxiety.

And sometimes that’s what the situation requires. A squeeze of the hand before walking into a new classroom makes sense. So does a hug, when our children or partners are thinking about something that worries them.

Managing anxiety only with other people is a problem

When your child starts to run to you at the first sign of anxiety, and experiences a spike in anxiety the moment you leave, there’s a problem. Your child is likely perfectly safe when you are in the next room, or he/she/they are at school. An anxious child who only uses the parent’s nervous system to calm them doesn’t feel safe in these situations.

You can imagine what that would do to your life. Could you ever use the bathroom alone? Shower? Go to work? How would you get your child to school? Or to bed? This is a problem for many, many families. Especially now that child anxiety is on the rise.

SPACE: Supportive Parenting for Anxious Childhood Emotions is the solution

SPACE is a way for parents to respond to their children’s anxiety, without rearranging their lives. Parents meet weekly with the therapist, and truly become masters of setting limits in a supportive way. You won’t believe us when we tell you this, but it’s true. We’ve seen terrified kids start to sleep alone with the lights off.

When parents do the work to implement this approach, it pays off. Parents become experts in handling child anxiety. When another situation triggers a new fear, or another child in the family becomes anxious, they know what to do.

We could devote many blog posts to SPACE. In fact, we have. We explain the basics of the SPACE approach here. And talk a little more about our work in this area here and here.

Our team of Maryland therapists is trained in SPACE treatment

There’s so much more to this NPR story. We’ll try to find time to cover that in another post. In the meantime, check out our SPACE treatment page to learn how to help your child overcome anxiety, one step at a time.