Avital Falk, PhD
Avital Falk, PhD is a licensed clinical psychologist at Weill Cornell Medicine. She is the Program Director of the Intensive Treatment Program (ITP) for OCD and Anxiety. Dr. Falk specializes in cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) for OCD and anxiety disorders.
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Avital Falk, PhD (Guest): A lot of kids are struggling with anxiety. Some of that is typical levels on anxiety. Everybody feels anxious sometimes. They worry about school. They worry about friends. As adults, we worry about work and that’s okay and normal. But where it becomes a problem is when it starts getting in the way of somebody’s life, meaning that it’s preventing them from going out with their friends, from doing schoolwork, from being able to face school. So, when we start seeing that, we start thinking about how we can help our kids learn to face the challenges that they’re having a little bit better.
Host: Do you feel that our kids are under stress, that maybe we were not a bunch of years ago and what does it look like? What are some of the symptoms that we would notice that our child is under a little bit more anxiety than just normal everyday worry?
Dr. Falk: I do think that types of triggers that are happening for kids nowadays are different from what we might have faced. The anxiety categories are often the same. So, for example, social anxiety disorder is characterized by a fear of judgement and evaluation from others. And that’s existed for a very long time. However, now with social media with people being in touch with people 24 hours a day; that can be a lot of pressure on a teen or a kid who has social anxiety disorder and who was already afraid and concerned about judgement and evaluation from others. So, we want to think about how to help them face those social situations in a way that is healthy and good for them. And how to make sure that they are not avoiding things that they should be able to be facing.
Host: So, then what do we do? If we start to recognize changes in our child and we start to notice that they are having social anxiety or school avoidance or any of these other things. Should we try and work with them ourselves or should we take them to a pro and what should we look for in someone to help our child?
Dr. Falk: It’s a great question. Because I think parents do want to figure out how they can support their kids and if the can and if it’s able to be solved within the home; then your kids may not need to go see somebody. But if it feels like it’s unmanageable, that might be the time to call a clinician and get some support. So, what we want to tell our kids is that if there’s something that is not actually dangerous, meaning their anxiety alarm system is going off, it feels dangerous to them but it’s not actually dangerous meaning facing fears or something like that and it’s something that they’d like to be able to do because they need to be able to go to school or they’d like to be able to hang out with their friends; then we have to learn how to be brave and how to face those situations.
And the more that we practice step by step facing those situations; the better and better the kid will get and the easier and easier these things will be. And so, if that feels doable within the home and some encouragement and support helps the kid be able to face those things; that’s wonderful. When it feels like there’s school avoidance there, when a kid just feels like they can’t handle it even with some parental support and encouragement; that might be the time to seek some professional help. And cognitive behavioral therapy is the type of treatment that we do which teaches a kid to think realistically about their own thoughts and learn how to engage in productive behaviors that will help them do the things that they need to be doing in a way that they can feel more confident about.
Host: So, then speak about that just a little bit more. Expand on cognitive behavioral therapy and what a parent can expect that their child will go through, and as someone who just did this with my teen; tell us what is it like for the child in a session with you when you are doing that type of therapy.
Dr. Falk: So, the very first step would be education and where we really want to teach the child and the family about anxiety, why it’s happening, what’s going on in their body, why they have the urge to avoid things that are difficult for them. Then once they truly have an understanding of what’s going on; we want to start teaching them the tools that they need to be able to live their day to day life with lower levels of anxiety.
So, for example, we might teach them to identify when they are having negative thoughts that might be colored by their anxiety such as nobody likes me, I’m going to fail all these tests, I’m never going to get into high school, and we want to teach them how to shift those thoughts to the more realistic versions and how to evaluate what’s actually going on. Because we can deal with the reality, but these negative thoughts might be overwhelming and distorted by the anxiety.
We also want to teach them to do the behavioral piece which is learning how to face situations that are challenging for them. And by facing these situations, which is an element of cognitive behavioral therapy that we call exposure; they learn slowly but surely that they can handle things that they didn’t think they could handle before and that the feared outcome often doesn’t happen. So, they think they’re going to fail, they think nobody’s going to like them and then they actually face these situations and have that amazing corrective experience where they realize heh, actually that didn’t go so badly. All those things that I feared, didn’t come true.
Host: Wow. What great advice. This is so interesting. Dr. Falk tests, social life can be so stressful. Let’s talk about the school environment for a minute. Give us some tips to help address it in the classroom, in the school. What are some things the school can do to help and as a parent, should we be telling the school that this is what my child is suffering from anxiety? Do we not? I mean what’s a parent to do in this situation?
Dr. Falk: Sure. It can be complicated, and we want to make sure that the school is supportive but in an ideal world, the school should be helpful, understanding and supportive when a kid is struggling with an anxiety disorder. And if that’s the case, then it can be very helpful to tell the school. The school can then understand what the kid is working on so for example, if the kid is working on raising their hand more in class which had previously been something that was difficult for the; the teacher can give them a lot of praise and support in doing that and understand when they are struggling with it. so, things like that can be very helpful from the school and we also want to make sure that the school and the families for that matter, are not engaging in too much accommodation because even though that might be helping the kid short term, so say you excuse a child from a thing that causes them anxiety, say okay you don’t have to go to gym class. That might make them feel less anxious in the short term; but it’s not actually helping them face their fears.
So, we want to make sure that the school and the parents are onboard with that the kid is learning how to face these things of course, at a level that he or she can handle but that they are trying to face these things rather than just be excused from anxiety triggers.
Host: That’s really great advice. So, at home, if we feel like there are somethings, we can do to help our kiddos get through some of this anxiety and sleep issues, certainly and you mentioned social media and they are on their phones all the time which can also increase anxiety and social anxiety as well. Give us some tips to address it at home. Can we get our kids doing exercise, yoga, relaxation, stress management. How can we help them? Take their phones away? What do we do?
Dr. Falk: So, I think teaching your kids about healthy lifestyles can be very helpful. And taking their phones away doesn’t necessarily have to be a punitive thing. It can be that they are having their phones during certain hours of the day, but that you’re teaching them how to have healthy sleep habits, that you are supposed to put your phone away a certain number of minutes before you get into the bedroom. That the bedroom should be a relaxing sleep time, that there should be a set bedtime and wake times so that they can get the same number of hours of sleep each night. Things like that where you are really just encouraging healthy living, health sleeping habits, healthy eating habits and all of that can create a really stable environment that doesn’t necessarily have to feel like oh we are taking something away from you.
Host: It really is much more about the positive reinforcement. As we wrap up, this is such a big topic, Dr. Falk, give us your best advice for anxiety in our children and it can be frustrating and cause anxiety and worry in parents too because we are so worried about our children and their happiness and their wellbeing. What would you like us to know about the program at Weill Cornell Medicine and how you can help kids that are suffering from some of these anxiety disorders?
Dr. Falk: Sure. So, our program does provide cognitive behavioral therapy. We do it on a week by week basis meaning that you come in for one session a week or we also have an intensive treatment program which allows kids to come in for groups and individual sessions and come in for anywhere up to ten sessions per week. And the goal of both of these programs going from just weekly sessions all the way to our intensive treatment program is to give kids and families all the skills that they need to handle the stressors that life is throwing at them.
And so, cognitive behavioral therapy is typically a short term treatment that can really give a family the tools that they need to handle whatever is happening and can leave your kid just stronger and more equipped to handle school, to handle family life and to handle stress.
Host: And do you have any final thoughts you’d like the listeners to take away from the message that you’d like them to know about this rising level that we feel of anxiety in our children and the stress at school and all of these things?
Dr. Falk: I think that the final piece that I’d love to share with all of you is that there actually is hope. If you have an anxious child, they are not fragile, they just may need some extra skills and these skills can really change their life and help them feel equipped to handle things. And cognitive behavioral therapy is a wonderful way to do that.
Host: Thank you to our guest Dr. Avital Falk and to our listeners.
This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts.
For more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter.Until next time, I’m Melanie Cole.