Fresh Take: Meredith Elkins, PARENTING ANXIETY

0:00We're leaving today and entering a world of Mickey Mouse waving, princess meeting and greeting, lightsaber clashing, the Twilight Zone Tower of Terror dropping, Banshee flying, Space Mountain launching, galaxy rewinding, what's the whole deck with galaxy rewinding, fireworks igniting, World of Other Worlds. For whatever you love, infinite worlds await at the most magical place on Earth. Walt Disney World Resort. Hello, and welcome to Fresh Take from What Fresh Hell? Laughing in the Face of Motherhood. This is Margaret, and today I am so excited to talk to Dr. Meredith Elkins. She is a clinical psychologist specializing in the research and treatment of anxiety and related disorders in children and families.

0:50She is a faculty member at Harvard Medical School, you may have heard of it, and the co-program director at the McLean Anxiety Mastery Program at McLean Hospital. Her debut book, and I wish it wasn't January because I will tell you, this is one of my favorite books that I have read in the last calendar year, you know, not just in the first two weeks of January. It is called Parenting Anxiety, Breaking the Cycle of Worry and Raising Resilient Kids. And I cannot wait for this conversation. Welcome, Dr. Meredith Elkins. Thank you so much, Margaret. I'm just delighted to be here. We were, I have to say, just talking a little bit before we got on, but I have to start with my favorite quote from the book.

1:34It doesn't matter if I ever get her to sleep, you say, talking about your daughter, infant. As soon as I'll wake up, some other fresh parenting hell will be waiting for me. You guys have been... It's like she's one of our people, the fresh parenting hell. Absolutely. You all have been a touchstone in my parenting journey for years. And I'm so, you know, it was just destiny that we would be having this conversation. Thank you also for your really kind words about the book. It makes me feel so good that you've enjoyed it. Well, our audience knows from listening for many years that I have been a lifetime sufferer or participant, depending on how you look at it, in anxiety.

2:14I had extreme postpartum anxiety, which was undiagnosed. And I only realized basically 10 years later, oh, that was not normal what I was dealing with. And I've had OCD for my entire life. So I'm very well versed in all things anxiety. And one of the points that I love that you make in this book, my mother was a therapist and she used to say in talking to me about my own anxiety, Listen, the anxious bunny survives. Anxiety serves a purpose in our lives, right? It's not just something to be cured or gotten rid of. Absolutely. Your mom, God bless, was spot on because anxiety does serve a purpose in our lives.

2:58And this is one of the first things that I always start off with when I'm working with a child or family. Actually, recently, I met with like an 11-year-old girl and her mom, and we were doing an intake. And at the end of the intake, I said, so what are your goals for your work here with us? And she said, I want my anxiety to go away. And mom similarly said, we don't want this to be ruling her life. We don't want her to feel like this anymore. And that makes so much sense. Anxiety is painful. It feels painful. And it leads us to do things that we don't want to do. We duck out of life in so many different ways.

3:38But one of the first things that I talked about with this child and her mom was that we are not going to be getting rid of your anxiety because we don't want to get rid of your anxiety. If you didn't have anxiety, you wouldn't look both ways before you cross the street. You wouldn't study for your math quiz. Grownups wouldn't brush their teeth before a date. We need some anxiety to help us because it helps to make sure that we do the things that we need to do for our life and our well-being. Sometimes anxiety becomes more present and interfering than we want it to be. And in those situations, that's where people like me are here to help.

4:18We don't want to get rid of your anxiety, but we want to help you better manage your anxiety. And so that's always the goal here. I am a huge metaphor person, and I loved the metaphor from the book about the beach ball. So tell us that metaphor, because I was like, yep, that seems just about right. Sure. So imagine that your painful thoughts and feelings are like a beach ball floating on the surface of the water of the pool. And the pool is kind of like your subconscious. If you are bothered by your anxious thoughts and feelings, we all have the drive to get rid of that beach ball. And we want to push it under the water and get it away from us so that it doesn't keep bumping into us as we're swimming and going about our life.

4:59But think about how much energy it takes to push that beach ball under the water. You would have to literally push it and kind of lean on it, sit on it, and keep it down. It's a lot of effort to keep it submerged. And what happens as soon as you let it go and try to keep swimming? It's going to pop up, it's going to whack you in the face. And so this is what we find happens when we try so, so hard to get rid of our anxiety, to suppress anxious thoughts, is that it takes a lot of effort and it's not really effective. If anything, it kind of can create this ricochet. So what we're actually trying to achieve when we're managing anxiety in the way that we want, that we ideally should be managing it, is that the beach ball is just kind of hanging out on the surface of the pool.

5:45Sometimes it bumps into us and bothers us. But if we can just kind of notice it and exist with it, even when it bumps into us, then we can keep swimming and we can have a grand old time, even though it's still there. Sometimes you need a metaphor to help you understand it. And that one really spoke to me. Now, that being said, we're not trying to rid anxiety. Anxious Bunny is going to make it. Anxiety is our friend to a certain degree. But as we look at ourselves and our kids, and I should say the book really speaks to both parents and children. because as we know, it's a system, right? Absolutely.

6:20So as we start to say, okay, we're okay with anxiety, we're going to coexist with the beach ball somehow. But for those of us, including myself, who have dealt with anxiety that is not normal or really interfering with our lives, you give three signposts to look for in terms of when anxiety is not normal. The first is interference. Absolutely. When clinicians are trying to help determine whether somebody meets criteria for a clinical anxiety disorder, we are really looking for three things. And I try to guide families in this as well. So like you said, the first is interference. How much is anxiety and the symptoms of anxiety messing things up for you in your life?

7:07How much is it getting in the way of you doing the things that you love to do, doing the things that you need to do? And often within families, the interference isn't just with me as the individual struggling with anxiety. It can be an interference in family life. Is this impacting parents' work schedules? Is this impacting siblings? Can we not have friends over to the house because of my anxiety, right? Can my siblings not have friends over? Right. We can't go places. We can't take family trips. Exactly, exactly. We need to drive everywhere rather than flying because of my flying fear, right?

7:42So the ways that things mess things up for us, that's a real marker that this is more than just normative anxiety, that this is something where there is sustained interference that's messing up life for me and my family. And then the other two markers are distress and duration. So distress is, of course, subjective, right? It's hard to measure how much distress qualifies you for an anxiety disorder. But if we subjectively know that the child or the parent who's coping with anxiety is just like, this is just causing me so much distress in my life. Like, I am unhappy. I am deeply bothered by this experience.

8:23You know, that's something that we look for and we attend to. Again, there's no way to measure it, but it's important. Yeah, I've said at times, if I'm waking up and my body feels like I'm being chased by a bear, I'm off the norm. You know, I mean, I'm not just feeling like, oh, I hope today goes OK. I'm having like an overwhelming sense of anxiety that is very much out of proportion to what's going on around me. Absolutely. And distress and interference are so tightly linked. right? Because if you're feeling such distress that it is disrupting your sleep, right? That's counting as interference.

8:55Or if it's you are so distressed that this is taking on like most of your conversations with your loved ones are focused on this topic, right? That's another marker of distress plus interference. And then the other thing to be mindful of is duration. So we know that it is just a part of life to be experiencing anxiety, particularly around acute stressors, you know, the beginning of the school year, right, or coming back after the holidays. Transition times are a time where we expect to see anxiety increase. If somebody has been sick, we're just off of our game physically, and we're more vulnerable to kind of our emotional life.

9:32Or if there's been a big transition, like a move or a divorce or a death in the family, we expect to see anxiety increase. This is likely normal and transitory. When anxiety lasts, when it is persisting kind of beyond when the acute stressor is in place. That's when we want to take note and say, you know, maybe this has reached a clinical level of anxiety. We have our work cut out for us when we're talking about anxiety because the word anxiety is used colloquially both to refer to the normative, natural, needed human emotion that we all experience, as well as a shorthand for an anxiety disorder.

10:11So if somebody's talking to me about I have anxiety, It's like, me too. We all do. Otherwise, we would be dead. Because it's protective. So I would love us as a culture to get better at differentiating between anxiety, the emotion, and anxiety when it's an anxiety disorder. Because I think that a lot of the confusion that we're getting on over pathologizing normative stressors is due in part to that language issue. Yeah. And this dovetails with the idea of intensive parenting and where we are currently as parenting. you talk about the Surgeon General's advisory, which we talked, we did a full episode on the podcast about it.

10:49Thank you. About maternal anxiety. And I don't want to say that, you know, that we're doing it to ourselves because we really avoid ever on the podcast being like, and moms, this is also your fault. Also recycling not well enough. Also, they also solving, you know, government problems. It's not our fault, but it is worth examining this idea of intensive parenting. So let's talk a little bit about intensive parenting. Absolutely. And I think this is a feature that I found somewhat under-recognized and under-explored. And I'm so glad that we're going there because it's so important. This was really punctuated for me as the book was starting to take shape.

11:30So early on in the process of the book, we signed my daughter up for Irish step dance class because I live in a part of Massachusetts It's called the Irish Riviera. And this is how my people dance. And so she wanted to get involved. No need to explain it to me, but possibly some people in our audience do not understand. Yeah, it's wonderful, but sometimes requires some explanation. So we signed her up. She was so excited. And on the first day, she panicked. And I treat anxiety for a living. So you would think that this would have been my finest hour. Walk in the park. Walk in the park. But I found myself really pulled in two directions here because as a psychologist, I know, especially a psychologist who does this work, I know that what anxious kids need in the moment is for adults to validate, normalize, and encourage them to face the hard but safe thing.

12:25But I'm also a parent with a social media feed. And my social media feed was telling me that if I didn't pull her from Ira Steff immediately, I was on track to create a foundational attachment injury. This is the origin of her childhood trauma and that I was going to be dysregulating her nervous system. And I still don't even fully understand what that means when I see it, but it sounds bad. And so you have this bad parent story that's really percolating that is such a part of this intensive parenting culture that we're in where parents get the message that we need to be utterly deferential to our child's distress as a marker of good parenting.

13:08And if we are not kind of prioritizing the emotional experience of our child and following their lead, that we are bad parents. And even if you do this for a living and you know that that message is wrong because you've seen how actually the friction needed to do exposure work is really where the growth happens. When it's your own kid, you really question everything. And so in that moment, I became even more aware of how our culture is just amplifying the experience of anxiety for parents. And it's pulling for us to help our kids avoid distress in a way that is well-meaning in the short term, but is really crippling kids and families in the long term.

13:58And I think this is a really important area that we need to be exploring. Super important. So important. We're going to talk about it more when we get back right after this break. I am talking to Dr. Meredith Elkins and her book is called Parenting Anxiety. We'll be right back. You know, every parent can relate to being out of some crucial item and facing the horrible prospect of getting all the kids into the car to the grocery store to pick up more. And it's like, how badly, Amy, do I actually really need or want that milk? That's when it's time to think DoorDash, which I've always thought of as just for takeout, which takeout is also the savior of many a night for parents.

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17:25And I cannot tell you how helpful Monarch has been in showing us our full financial picture, helping us to track our spending and reach important savings milestones. Our weekly meeting, Amy, it's now run by Monarch. Love it. Achieve your financial goals for good with Monarch, the all-in-one tool that makes money management simple. Use code FRESH at Monarch.com for half off your first year. That's 50 % off at monarch.com, code FRESH. So I think this idea of being a bad parent, correct, anxiety producing, making us sometimes feel like we have to make the world easier for our kids. I also think we live in an age where there's just a generalized expectation that we are responsible for our child's outcomes, that we are in charge of cruise directing and caring for, especially as moms.

18:31And this is not coming from nowhere. This is coming from, listen, on the one hand, very positively. there's a ton of parenting information, right? My mom didn't have the option. I mean, she read Dr. Spock and she did what he said. Now there's 4 ,000 books, including some really great ones. But I think this idea that there are answers out there that we just have to keep finding and that every interaction is either gentle or wrong, or it's either 80s style parenting or terrible. And I think it's not only the idea that we just don't want our kids to feel hard things, but that we've been kind of overall convinced that there is a good way to parent if we could figure it out.

19:21Right. It's parenting as brain surgery. Yes. It's kind of more amorphous than just this is the way to do it. It's like not only is my kid having a temper tantrum at the dinner table, but I read a book that said that kids in France eat frog legs at 2 a.m. and never complain. So like, so I must be doing it wrong. Yeah. But now I feel worse. I think that book is attending to be helpful. It helps lots of people who have feeding issues. But I think that idea that there is a right way to do it is foundational to why we're so anxious. Right. And I think it's certainly a tension that I've been aware of kind of throughout the process of writing the book and talking about the book is how do I not just add to the noise, right, with another book?

20:07And, you know, one of the things that I feel very strongly about is that I am not a parenting expert. I have one kid, and she's okay. Like, she's great. But you know what I mean? Like, I have one kid. I am not a parenting expert. You know, I am an anxiety expert. And we have a pretty shameful history in my discipline of blaming parents for their child's outcomes. And so we really want to be thoughtful about that. And I think one of the challenges is that because we want to be so mindful of not blaming parents, I think sometimes as clinicians, we fall into the trap of not examining the ways that parents are responding to anxiety that is well-meaning, but can be crippling down the road.

20:54And that's a really tough tension. It's an excellent point. And I think the book actually does it really well. It's very hands on. It ends every chapter ends with like, here's what you can take away. It's accessible, but it's really not about parenting. It's more about the science of or the medicine of anxiety, the medical version. And one of the things that you talk about, which I have found very useful for myself is the role of psychological flexibility. So let's talk about that. Yes. So psychological flexibility is really at the core of today's most impactful evidence-based treatments for a range of things, not just anxiety.

21:39Psychological flexibility is the ability to notice what's going on for me in this present moment, the painful, the joyful, anything that's going on for me in the present moment, and to be able to make a choice of how to act in line with my values. So if I have been asked to give a presentation and I notice anxiety increase, because I don't want to embarrass myself in front of my classmates, I'm afraid that the teacher is going to criticize me. And I notice the urge to stay home. I'm just going to call out sick that day. But I choose to go and give the presentation, even though I feel uncomfortable about it, that is being psychologically flexible.

22:25The other side of that coin is psychological inflexibility. And this is when our painful thoughts and feelings really hook us. They drive us to make choices that provide often short-term relief, but that aren't in line with our goals and values. So that would be if I'm like, you know what, I'm going to bail on the presentation today. I'm going to call out sick. I'm going to tell my mom I've got a 100-degree fever, and I'm just going to stay under the covers. That is when I'm letting my painful thoughts and feelings drive my behaviors. And usually in the short term, that's super effective because we avoid the thing that's distressing.

23:01But in the long term, this creates patterns of disability and dependence and avoidance. So, you know, what we want to do is really try to cultivate psychological flexibility. And we can do that in the moments where it's really hard, right? When we're doing a hard thing, we can also do it in moments that are just everyday moments. So when you set your alarm to go to the gym at 530 in the morning, and you notice like, I don't really want to do this, but I always feel good afterwards, you know, you're making the psychologically flexible choice when you like get up and put your leggings on. Terrible example for me.

23:37You will catch me never at the gym at 530 a.m., but I get the overall point. And I do think talking to kids about this is so useful. I mean, Beyonce, my favorite, talks about like how she has trouble keeping her weight up before a tour because she gets so nervous. She can't eat. She won't eat. Joe Namath, oldie locks alert. Back in my day, who played for the Jets when he retired, they were like, oh, what are you thinking? He's like, I'm thinking I don't have to throw up every Sunday morning anymore. Like nerves are part of accomplishment, right? I mean, anxiety can be like a thermostat of what you're doing, right?

24:12Like, oh, you're going to try something really, really hard. That's why you're feeling this nervous. But on the other side of that is something pretty thrilling, accomplishing something that scared you. Right. When you're thinking back to your childhood and you're remembering the things, like the moments that really punctuated life for you, it's usually when there was something really challenging and like you rose to the occasion. When there was something hard or something unusual, like you got a curveball and like you managed it, it wasn't when like the well-meaning adults in your life swooped in and saved you.

24:48Right. So it's, we're looking for this frictionless existence and it's so easy to find right now because you can do anything from your phone immediately. And we have such an emphasis on wellness and feeling good. And it's so ironic because if there's all this focus on wellness, why aren't we all better? If being uncomfortable is the same thing as being unsafe and we're all paying attention to this, why is child mental health declining and parent well-being is tanking? Stranger Things just wrapped up and people keep asking on the internet, was it really like that? You know, do kids really just ride bikes around all day and get into adventures?

25:27And the fact is they did and they got hurt more than they do today. I mean, they did statistically. Right. And I think that you recognize that really well in the book. And that part of this is not just, oh, stop being so hovering and worrying. But really, look, what are you afraid of will happen? Like if I take my child to school, actually, I don't know if this is statistically true, But if I imagine I drive my kid to school, they're going to be much safer than if they bike to school where lots of different things could happen to them. Or if I let my kid go down to the city to watch a movie that he wants to.

26:06That's less safe than if I drive him to the mall and wait outside the movie for him. But I mean, my husband from Texas used to drive on the highway in the back of a pickup truck unrestrained. Like, I mean, some of the reasons we stopped doing that is because we actually realized they were dangerous. Right. But then it feels like we have ascribed danger to too many things at this point. The idea of like, I'm not advocating for kids riding in the back of a pickup truck on the highway without seatbelts. But how do we find a line where we're comfortable? Because let me tell you, when my husband thinks back to his childhood, that's his fondest memory for sure.

26:44Oh, I'm sure it is. Right. What a thrill. But how do we kind of find the balance between, okay, that was awesome, as was like drinking out of whatever rusty soda can we found in a field, you know, when we got thirsty. How do we find a balance between, okay, we really shouldn't have been doing that, and it's okay to let our kids explore and be free, understanding that they will actually face more dangers? Well, a couple things come to mind. One is that this is a chance for parents to be really psychologically flexible, because if you're considering letting your kid bike to school, and you're noticing what's coming up for you in that moment, so you're noticing the discomfort, you're noticing the anxious thoughts of like, this isn't safe, or something bad is going to happen, he's going to get hit by a car, he's going to get kidnapped, all the things that like, our parent brains just manifest for us, you know, seamlessly.

27:40all these terrors. Part of that psychologically flexible mindset is to be able to notice I'm having these thoughts, to be able to catch that and say, you know, how realistic is this? Is my instinct to say, you know what, nope, I'm going to drive you. Is that born out of an actual safety concern that is really likely to come true? Or is this something else? Is this part of the intensive parenting culture telling me that like good parents drive their kids to school, or good parents are protective of their kid's safety, regardless of anything else. Like that is the number one priority, even if we're being over attentive to it.