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Melanie Cole (Host): Hello, I’m Melanie Cole. Welcome to Anxiety in Schools a special podcast series from Rogers Behavioral Health. This is episode number four of our six-part series where we look at anxiety and how it can impact learning. In this episode, we will discuss reassurance seeking and I’d like to welcome Dr. David Jacobi, he’s the lead psychologist in Child and Adolescent CBT Services at Rogers Behavioral Health. Dr. Jacobi, what is reassurance seeking and is that something that is done pretty commonly by an anxious child?
David Jacobi, PhD (Guest): Reassurance especially for children is an easy way to get their needs met and specifically to help reduce their anxiety. So, we consider it to be a form of accommodation certainly on the part of parents or school personnel. Reassurance seeking really fundamentally is about anxiety reduction. So, the child will generally repeat a question over and over again. They may challenge or argue with the individual providing that response because they are looking for a specific response to ease their distress and anxiety. They may ask anyone who is able to provide them with that reassurance. Again, they want that specific response and definitive answers to those kinds of reassurance requests.
Melanie: Does it send a message when we reassure that these thoughts, that they are having are very important? Are we validating that these child’s concerns are real?
Dr. Jacobi: I think when parents do provide that reassurance, they do it for a couple of reasons. One is that it does ease the child’s anxiety pretty quickly. That said, it also typically eases the parent’s anxiety as well because they don’t like to see their child distressed. They don’t want to see them deal with this anxiety any longer really than they need to. But I think the unintended consequence is as you’re saying, that it sends a message that I have to do this otherwise the child can’t cope or that something terrible will happen if that reassurance isn’t provided. So, it’s really one of the reasons that we really encourage parents and teachers and anybody else who has an interaction with the child to learn how to fairly quickly reduce that reassurance so the child can learn that a lot of things that they are concerned about and that they need reassurance for, really aren’t likely to occur, that and even if some of these bad things do happen, that the child really has the ability, the wherewithal to be able to manage and cope with those situations.
Melanie: Is there a difference then between information versus reassurance seeking? I mean if our child is saying is daddy going to be okay when he goes away, we are giving information, oh yes, well flying is very safe or yes, he’s taking the train whatever it is – that’s information, but what about versus reassurance?
Dr. Jacobi: That’s a good question. I think it can be really difficult for families who aren’t familiar with anxiety or even as the anxiety disorder develops, a lot of the questions that kids are asking seem like kind of questions a kid would normally ask. But when we look at the differences between information and reassurance seeking, we do see some differences.
Generally, with information seeking, the child will just ask the question once, they are looking for specific information typically. Even if they are not given an answer necessarily that they are wanting or complete answer, they are usually okay with that. They may also ask questions that are really unanswerable; meaning, I’m not sure if you are going to know the answer to this but I’d like to ask it anyway and they are also okay generally with accepting what we call a relative or qualified response; meaning, I’m not exactly sure, I’ll check on it and get back to you.
Melanie: Are there some levels of validation that parents and the school systems might be giving that anxious child that is seeking reassurance and then Dr. Jacobi, give us some strategies to reduce reassurance seeking by that anxious child.
Dr. Jacobi: Yeah, there’s a couple of ways I think that family members and school personnel can intervene and sort of generally we talk about validation. So, validation is a great skill for family members to develop, again, because it does show that you are interested, that you are empathizing, but you are not providing that reassurance. Other kind of general strategies that we use pretty routinely in working with kids with anxiety are things like providing uncertain responses. So, putting it back on the child by saying things like “What do you think?”, “Maybe yes, maybe no”, “I don’t know” and what we are really trying to do is not given that child the ability to reduce their anxiety. We actually want them to work through that feeling of anxiety to realize that they can manage it.
We can also limit the number of worry question in a given time frame, working, of course, to kind of reduce that over time. We can ask a child also to delay that reassurance. In other words, a child may ask for reassurance about something, we may say “Let’s wait five or ten minutes and come back to this and if you still feel like you need to get that reassurance, perhaps we can provide that, but I’m hoping that with some time, you may find that your anxiety about this reduces.” And then lastly, I think sometimes with our older teens, they may have very specific goals in terms of being participating socially or in sports, moving on to college, for example and so we may be able to look at sort of the cost-benefit or the long-term versus short-term benefits of going without reassurance requests and so forth.
Melanie: Really great information Dr. Jacobi. So, wrap it up for us with some of your best advice, as you just stated, some of the role model responses and what the parents or school professionals are to do when a child consistently seeks this reassurance, what you want them to know about the difference between validation and reassurance. So, wrap it up for us.
Dr. Jacobi: Sure, so it can be very difficult and very challenging I think, especially for school personnel, to recognize that a child is asking for reassurance. These are kids that maybe asking the same sorts of questions again, over and over, there just seems to be a change in terms of their observable anxiety, their avoidance of school or tasks related to school, problems for example with being able to focus and these are changes again from sort of previous levels of functioning. So, when teachers and school counselors begin to notice these sorts of things, it is certainly good to be able to identify the types of behaviors that are problematic. So, is it asking for a lot of reassurance about homework tasks? Is it leaving the classroom repeatedly because of feelings of anxiety? and then to have a strategy to intervene. So, it might be simple things like providing a very uncertain response like “I have already answered that, what do you think?” or “I’m not exactly sure.” It could be, again, limiting the number of times the child is able to leave that classroom or ,if they are able to leave, make it very time limited so that the child can kind of regroup but then return to the classroom. Again, you are trying to learn and teach the child essentially that they can cope with these feelings of uncertainty, of anxiety and still continue.
We also encourage our school personnel in particular to recognize when the anxiety disorder might be just too much for them, too much for them to handle in a classroom setting. So, working with an outpatient provider, working with an intensive outpatient program, for example, can be a great way to get that child the help that they need and then return to the classroom with some support that would lead them to be able to maintain those treatment gains and be able to function effectively in the classroom.
So, as we talk to school personnel, part of this is going to be identifying when you believe that your child has an anxiety disorder, knowing the limitations to what you believe that you can offer in a classroom setting in terms of setting some limits, providing some exposure work, talking to the parents about what’s happening in the school setting, as well as giving them some education about the appropriate treatments for anxiety disorders. And then of course, as I mentioned, knowing when to refer out to get that specialized help for the student so that they can again be successful in a classroom setting.
Melanie: Thank you so much, Dr. Jacobi, for sharing your expertise with us today. Rogers Behavioral Health is working each day to ensure that those with mental health challenges have access to the highest quality of care and most effective treatment available today. To learn more about the many ways Rogers can help children, teens, families and schools please visit rogersbh.org today. That’s rogersbh.org. I’m Melanie Cole. Thanks so much for listening.