Last week,
I had loads of questions come in about putting distress tolerance into practice.
And so definitely check those out if you missed it.
It gives you lots of different ideas that we can do.
But one that we definitely need to work on is tolerating not knowing.
There's a lot of distress of not knowing.
And this is really such a crucial aspect of treating anxiety,
Because anxiety is all about not knowing what's going to happen and the belief that I can't handle it,
Right?
Like I feel all stressed out.
Idea how it's going to turn out,
And I can't handle it.
And so,
You know,
It's the situation itself,
It could be the discomfort of the anxiety.
So they really need skills of being able to manage uncertainty.
This is a big part of distress tolerance,
Because uncertainty can be very distressing for a lot of kids.
So sitting with not knowing helps boost emotional flexibility,
It helps reduce avoidance,
It's really strengthening a lot of those long term skills.
And one thing I often like,
You know,
Tongue in cheek,
He sort of joke about is,
You know,
Validating,
Wow,
Yeah,
That would be scary if you think a monster's under your bed.
I don't know if there is,
Let me know how it goes in the morning,
Right?
That's an example of uncertainty.
I have no idea.
We cannot guarantee anything,
Right?
So of course,
We're starting with the foundation that starts with trust.
We have to have a good working alliance,
A good relationship.
They have to be able to trust us.
Right?
And we need to make sure we do have a good base of understanding as well,
Right,
Of anxiety,
But also of uncertainty.
So we're explicitly explaining to kids how avoiding any situation,
Especially when the outcome is uncertain,
Or even constantly reassuring,
You know,
Or seeking reassurance,
Or seeking predictability,
Or for sure that things are going to turn out,
Checking for sure things are going to be safe.
I mean,
That's just keeping their anxiety and it might even get stronger in the long run.
So we don't want to eliminate the anxiety.
That's not the goal.
We want to do that thing,
Whether it's sleeping on their own in their own bed or going to school or going to the party,
Even if you're feeling anxious,
Even if we have no idea about how it's going to turn out.
I have no idea if I'm actually going to throw up.
I have no idea if I'm actually going to fail the test.
I have no idea if people are going to actually laugh at me.
Nobody has control over those outcomes.
But we're not letting it get in the way with our life.
So we're talking about how uncertainty affects them and why it's important to be able to tolerate that because otherwise we'll never leave the house if,
Because nothing is ever certain.
We want to externalize it,
Name it.
Uncertain Ned shows up when we don't know what's going to happen.
Right when we don't know if there's going to be a surprise kid,
We want to kid a surprise quiz sorry I've got a concussion for the past little while and so my words are even more fuddles.
I normally utter my words,
But it's even more so.
So I don't know if there's going to be a surprise quiz,
A pop quiz,
Right?
And then we've got to normalize it.
We all experience uncertainty.
No one in the world knows all things all the time.
So we need to shift to this curious sort of mind frame.
We're shifting from,
I must know,
Everything must be predictable,
To I can be curious and brave even if I don't know.
And I always love using MacGyver as an example.
I have no idea how it's going to turn out,
But I'm going to use what I can and my resources to try to figure it out and to try to solve it.
So we want kids to be able to identify and articulate their discomfort around that ambiguity,
And of course,
And tolerating that uncertainty through lots of structured,
Repeated practice,
Lots of different situations where outcomes are not guaranteed,
Which is pretty much everything in life.
So maybe we're collaborating with them to identify some of those anxiety provoking situations where they don't know,
Right,
And scale it on a level of uncertainty or how terrible the anxiety is,
Right,
How anxiety-provoking that uncertainty will be on a scale of 1 to 10.
So,
Maybe not knowing what's for dinner,
Maybe for them is not a big deal.
For some kids,
It might be a big deal.
For some of them,
You know,
Maybe it's a 1.
For some of them,
It might be an 8.
So,
From low to high,
Maybe the uncertainty,
Am I going to make the volleyball team?
Am I going to pass the test,
Right?
Those might be a little bit higher up.
And I'll tell you,
If you can handle the hardest thing,
If you can handle that 10,
Everything else is going to be way easier.
So where do you want to start?
So I'm always saying,
If you can do this 10,
Everything else is easier.
We don't even have to do and practice everything because you're going to realize,
But where do you want to start?
So on that scale,
We want to include the hypothetical what if questions,
Right?
Like listening to the news without knowing the outcome or asking a parent a what if question and receiving no response.
For separation anxiety,
Maybe it's waiting for a parent without knowing the exact pickup time,
For example.
So we got to remember the goal is for them to experience that distress of the situation.
And still be in it despite feeling anxious.
So we got to make sure we're not interfering with anything that's going on.
We want to make sure we don't reduce that anxiety because otherwise they're never going to learn that they can actually manage it.
So they don't necessarily need to reduce that anxiety or seek out reassurance or support to reduce that anxiety immediately.
So we're never focusing on them not feeling anxious.
That's an outcome that we have no control over.
We need to have some really specific behavioral guidelines.
So maybe it's you're going to stay in your room for five minutes without asking where mom is.
Rather than saying,
Don't worry about it.
She'll be back in five or don't feel anxious.
It's not a big deal.
No,
Your job is to stay in the room.
We're going to set the timer for five minutes.
And then after five minutes,
We'll go find mom,
Right?
We don't have to talk about all that messy stuff.
I am going to be doing an episode on exposure,
But that's essentially what this is.
So we're setting up these behavioral experiments and we'll have kids treat those anxious thoughts as guesses or predictions.
So now we're going to go test them.
We're going to be little detectives and we're going to test those hypotheses and see what actually happened versus what those henchmen emotional catastrophizing henchmen predicted and discuss how did you manage it?
How did you manage that five minutes?
What did you do?
Important,
Getting to the house.
So specific ideas,
Because those are where a lot of questions have been coming up.
I mean,
Again,
Being playful,
Making it fun,
So you get that buy-in is really important.
So maybe we're going to start with a mystery box game where you guess inside with what's inside that box using touch clues,
Or it's a dice decision game where you're letting the die decide the next activity or the next snack,
Maybe you're packing a mystery lunch with some unknown item.
You could read a story,
But before,
You know,
Before you get to the ending,
Maybe you got to stop and imagine outcomes and then maybe sit.
We're going to read the ending tomorrow,
Whenever there's a big cliffhanger or a show,
Whenever there's a big,
Big cliffhanger,
Stopping it,
Being able to sit with that discomfort of not knowing.
Plan a day with one or two events marked only as question marks or have a surprise of the day.
I love,
For my older teens and young adults,
Just random driving routes,
Right?
So you're gonna go out for dinner and you're gonna follow the first red car that you see for three red turns and then the next red car and for the next three turns and see where you end up.
One that I know that's really hard for adults to not help kids and jump in is to do riddles.
You know,
Like a riddle of the day or some sort of puzzle.
And the kids have to work through it without any help,
Without any hints or tips or encouragement.
They have to do it.
Adults quiet until they get it.
And for some of the riddles,
It could take months,
But they got to keep working at it until they get it and collecting more and more data.
And when they do,
They have that,
Yes,
That huge dopamine hit.
If they keep getting help and hints all the time,
They don't get that huge dopamine hit and they'll have a lot of,
Yeah,
But yeah,
But didn't really count because you helped me.
So we need to think about that,
But we got to remember,
We always need to activate to generate meaning we have to trigger that emotional brain that anxiety or frustration or discomfort of not knowing if we want to build those new braver brain pathways.
Right,
We need to make sure that we're targeting things that kids are actually reacting to.
So if it's not a big deal for them,
You know,
One out of 10,
Then that might not be the thing that we need to work on.
So maybe it's something like they have to wait 10 minutes before asking a question,
You know,
To the teacher or some adult that you know has the answer.
Maybe they have to leave a homework question blank or try a new food without knowing all of the ingredients or going to school without asking if a certain class has a test I don't know.
You know,
You got to look at where it is.
If you've got kiddos with separation anxiety,
We're practicing having parents leaving for increasing unspecified amounts of time,
Being in a different room.
You know,
Sometimes it's just in the house.
I have so many kids who can't be in a different room in the house or on a different level in the house.
So being in a different room or a different level without knowing exactly,
You know,
Where the parent is or what they're doing,
Intentionally planning for parents to be,
You know,
A little bit late for pickups with no guarantee of the exact timing.
Sleeping alone,
That's a big one.
You can start to eliminate some of the safety signals like nightlights or parents staying until the kiddos fall asleep.
You know,
There's different things like that,
Going to new places,
Seeing new people,
Trying new activities,
You know,
They just don't know what to expect.
All of those things are really helpful.
It could be having sleepovers of relatives and then of friends or even just having a new babysitter,
Right?
All of those types of things.
For generalized worries,
You could use what ifs,
You know,
Maybe we're using imaginal exposures to explore some of those worst case scenarios about abstract worries.
Because some kids really do have things.
It's not about getting bit by a dog.
It's maybe they're going to get sick or they're worried about financial problems.
So maybe we're writing out or role-playing some of those feared catastrophes that they've got,
Right?
And the progression and learning that they can cope,
Even if the worst things happens or,
You know,
The likelihood is low or just making it silly.
I always like making those situations silly at the end.
A lot of my kids have a lot of perfectionism,
A lot of rigidity.
So we're practicing intentionally.
Making minor mistakes in schoolwork,
Right?
Or maybe they're breaking small I don't want to teach them to break rules,
But maybe it,
You know,
Non-consequential rules.
So maybe they're a little bit late.
I mean,
What is a reasonable thing that could happen?
It is reasonable that you could be late to go somewhere for an appointment,
Right?
That is a reasonable thing that could happen for whatever reason.
So they just need to be able to tolerate the uncertain outcomes.
OCD,
It's all about response prevention,
Where we oftentimes prevent rituals or checking behavior.
So kids need to learn,
They have to tolerate the uncertainty and the discomfort that their feared outcome might occur.
So for example,
Touching a contaminated object and then not washing their hands or not checking the door if a door is locked.
And maybe it's for an extended period,
Like expanding the amount of time before they can go do those things.
We do sometimes,
I mean,
Imaginal exposures aren't great.
If you can go do it in real life,
We're not gonna imagine petting a dog if we can go actually pet a real dog.
But if there's intrusive thoughts or intrusive images,
Maybe we're varying those details of some of those imaginal exposures.
So we're increasing that discomfort.
We're looking at that,
We're resisting rituals.
The phrase right now can be inserted into any feared thoughts to create a testable hypothesis.
If they're scared of the dark,
We can start increasing the time that they spend in dimly lit rooms or even dark rooms,
Right?
Again,
Maybe eliminating those nightlights or other safety signals.
Maybe being in social activities where they can't predict other people's reactions,
Right?
Maybe I'm going to start a conversation with a stranger,
You know,
With my parents there.
It's reasonable.
It's reasonable to talk to someone in line when you're waiting at the grocery store and to see what happens.
I don't know if they're going to be nice or grumpy,
Right?
Maybe intentionally behaving in a slightly unacceptable way just to see what the consequences are right so there were D catastrophizing fears of criticism I have kids who,
For example,
Might be terrified that they have to get every question done on their worksheet.
Otherwise,
They're going to get in so much trouble.
Right.
And then they go to school.
They missed one.
And the teacher doesn't even notice or it's not even that big a deal.
Like,
Oh,
Wow,
Like you're the only one who finished nine questions.
So even if you missed one.
We can look at those things.
I always talk about real life.
What is real life uncertainty?
Challenges where they don't ask about the daily plan,
Or maybe they can.
We can't stop them from asking the daily plan,
But we don't have to tell them.
They have to discover as it happens.
Maybe they write out how they think the day will go or the things they know for sure will happen,
But then all of the other things that they don't know for sure what's going to happen on another side of the page,
And then they're going to learn.
Their arrows for any questions.
Is this going to happen?
Is this going to happen?
They're going to learn through their own experience.
And maybe they can practice phrases like,
I can handle not knowing yet,
Or I'm going to find out soon.
This is actually really important because,
You know,
How can they replace those what ifs with,
I don't know how it's going to turn out,
But I can handle it and I'm going to find out.
Or replace I need to know with I want to know,
But I can wait to find out.
Or this feels hard,
But I'm okay,
Right?
Having those sort of self-coaching phrases can be really important too.
And we want to model all of this.
I'm always saying we have to model things.
Like,
I don't know,
But I'm going to be okay waiting.
Right,
We're going to do a side-by-side tolerating waiting task,
Right,
So maybe it's a delayed surprise snack or we're co-creating a tolerating not knowing checklist that you're working and practicing together through.
Talking about the unexpected event of the day and how you handled it.
And like I said,
Kids don't even necessarily need to do anything.
You can just stop answering every what if question and making things so predictable so they never have to worry about,
You know,
What if.
We can acknowledge it,
You know,
Any what ifs that they have.
We can acknowledge,
Hey,
That's a really great question.
What do you think?
Another one is stop Googling.
Don't let them Google.
Start wondering more,
Right?
That can be really helpful.
Why is it that the sky?
I live in Calgary,
Which is one of the sunniest places in North America,
Maybe even the world.
Definitely in Canada.
So even when it's freezing,
Freezing cold,
Like minus 40,
It is a bright,
Beautiful sky,
Blue sky,
No clouds at all,
Bright and sunny.
Why is that?
Why wouldn't it be gloomy and cloudy like it is in other places,
Right?
We can think about that.
We don't need to Google,
Let's wonder.
Whenever kids do this,
We want to make sure that we're celebrating.
Their effort,
Right?
They're celebrating the process.
It's not about the outcome.
We have zero control over the outcome,
But it's celebrating the fact that you went to school,
Even though you weren't sure you're going to pass that test.
Even if they don't pass the test,
Dude,
You went to school and tried it anyway.
So having a solid debrief can be really important.
We're asking,
What did you notice?
How bad did you think it was gonna be?
How bad did it feel on a scale of one to 10?
What was hard?
What wasn't so hard?
Did that.
Hulk conspiracy story come true?
Even if it did,
Did you survive?
Right?
We want to have that debrief.
And definitely always ask about the hows.
How did you do that?
What did you say to yourself?
What did you do to get through that moment?
What helped?
Create some sort of journal or scrapbook of when they didn't know,
But they handled it.
And how was it that you handled it?
And again,
I've talked about this before,
When are we the most proud of ourselves or most proud of our kids?
It's when we had zero knowledge about what the outcome was going to be and they went and did something hard.
That's when we're proud,
Right?
So we want to have some sort of document to record this.
We want to keep a memory bridge to past successes as a reminder for future uncertainties,
Because our brain is always going to say,
Yeah,
But that was yesterday for sure today,
Something bad.
We're just going to forget completely.
So if we have enough of these past successes of handling uncertainty,
That's going to be easier.
So we're always rewarding their effort,
Their willingness to participate,
To cope with distress.
It's not about successful outcomes.
It's not about anxiety reduction.
So connecting those experiences to things that are important to them is really important.
So maybe they want to do a sleepover,
Maybe they want to write the SATs,
But they're avoiding because of not knowing how it's going to go.
So focus on those situations.
They really,
Really want to.
And then when they do,
What did you learn?
How can you apply this to over here?
Help kiddos be bold and courageous and I will see you next time.