behaviorally inhibited temperament play-it-out re-enactment


In my previous post, I discussed some of the strategies that my partner and I used to help our daughter with specific aspects of her anxiety that were exhibited before 2 years of age. Most of those strategies were developed in response to her actions and were not based on any treatment or specific anxiety knowledge – just our best guess of how to cope in the moment! In this post, I will discuss one of our earliest “informed” strategies that is broadly applicable to general anxieties from the past, present and future and continues to have great impact in our daily life. I titled this strategy “play-it-out” and it is the manifestation of my husband’s and my interpretation of a few sections from the book The Whole Brain Child by Daniel Siegel and Tina Bryson.

The Whole Brain Child has wonderful information. The brain science is fascinating, and the “comic” descriptions of the various strategies were very useful. Of interest to my husband were the sections on storytelling to integrate the left and right sides of the brain (Chapter 2, Strategy 2) and on memory integration with events (Chapter 4, Strategies 6 and 7). Integrating the left and right sides of the brain works to link facts and details (left) with feelings and emotions (right). Through storytelling, the child names the event and is then better able to move towards taming the feelings for future related events. This strategy conveniently involves memory integration, in which we remember the event and associated feelings such that the feelings are explicitly connected to the event instead of floating around disconnected. Floating feelings can become attached to unrelated events, causing phobias and fears that, from an outsider’s perspective, appear to have no origin.

For example, a young child is bitten by a dog. The child cries and eventually recovers and the days and weeks (maybe months) pass. Eventually, the child fears cats, birds, dogs, and various animals. You might reassure her that the animals are friendly, safe, and more afraid of her than she is of them, but nothing you say seems to change her fear. What happened? The dog-biting event created a feeling of fear in the child. By effectively ignoring the event (i.e. allowing “time to heal all wounds” and “memory to fade”), the disconnected, floating fearful feelings attached themselves more broadly to many animals. No reassurances will fix the problem because the reassurance does not address the original dog-biting event. At this stage, a brave story and exposure ladder could be used to help the child face the fear. What could the parent have done differently to possibly prevent this phobia from developing in the first place? After the dog-biting event, the parent can talk to the child by describing the event and naming her feelings and experience. In the days and weeks that follow, the parent can help the child tell the story (if the child is verbal) and even re-enact it with stuffed animals. This creates a connection between the fear and hurt with that specific dog-biting event. If the dog was unfamiliar, then your child will probably never see the dog again and that will be that. If the dog was familiar, the child will still probably have some lingering fear about that dog in future situations because that dog really did bite her! She will need many positive interactions before she can “trust” the dog again. And of course, she may need more explicit instruction on how to safely interact with that dog (and all dogs). That is normal. But, hopefully, she will not develop a phobia of all dogs from the single dog-biting incident.

As you probably guessed, my daughter was that child that was bitten by a strange dog (without teeth!) when she was 12 months old. After the bite, she did not cry, there was no blood or cut and I did not think it hurt. I ignored the situation since she appeared to be fine and thought, “oh well, her memory will fade”. But I was wrong! She was terrified of dogs for the next 8 months and at 3 years old rarely pets a dog and has a look of terror on her face if a dog comes towards her. As soon as I read The Whole Brain Child, I knew I hadn’t handled the dog-biting event well! The problem is that I did wait long enough for the memory to fade so now I am not sure if there is any point in describing the original event as it would be completely unknown to my daughter. Just as predicted in the book, the feelings attached themselves to all dogs (luckily, they did not attach themselves to cats or birds – look out Goose, my daughter is coming for you!). Now I am faced with a phobia treatment with a story and exposure ladder. However, her dog fear is low on my fear-conquering priorities, so it is on the back burner for now.

After discussing the left-right brain integration and memory integration, my husband implemented our new “play-it-out” strategy to link our daughter’s emotion with an event. For example, our very active daughter liked to spin in our small living room with hardwood flooring and various pieces of furniture. Inevitably, she would fall and impact something and burst into hysterical crying. I held her and witnessed the tears and provided words for the experience, “ouch, you had a tumble. That hurt. You are sad. It’s ok to be sad and cry.” Eventually, she stopped crying and my husband used her large stuffed penguin (which was about her size!) to re-enact the event. He showed her with the penguin how she fell (trip, face-plant, etc.), what she hit (foot stool) and where on her body she hit (head). He repeated the process as many times as she asked. She was enthralled after the first time! Often, my husband re-enacted the event himself and then our daughter re-enacted the re-enactment at slow speed, complete with a fake fall! We did this repeatedly. Sometimes, we did not see the event and could not re-enact it accurately. Instead, we first asked her what part on her body hurt. She might point to her knee and then we guessed what she impacted “might this have happened? Or maybe you hit this?” She might grunt (which was her sound for yes). And then we re-enacted what we thought happened. Now that she is 3, she often points or describes which part on her body is hurt and then she will sob into my chest and mumble “show [me] what happened”. The re-enactment is now part of her healing process! She stops crying almost immediately when Daddy re-enacts the event. Not only are we integrating events, feelings, facts and memories, we are also changing the unknown into the known, the exact root fear of people with anxiety! So much of what is scary about falling is not knowing how or why it happened and then not knowing how to prevent it in the future!

The next aspect of the play-it-out method is performing oral stories and plays to address previous anxiety-inducing incidents (like a dog-biting event!). After nap time, I used her stuffed animals to ask her about her morning. Usually, she did not describe anything, so the animals asked me, and I provided a few details. The animals continued to probe but, unfortunately, my daughter’s language is a little delayed and she just did not have the words, so I typically recounted the incident in as factual language as possible. The animals asked questions and expressed feelings and concerns. For the first storytelling, the animals acted as an interested audience to the story and then transitioned into play. For retellings of the story, the animals acted out an analogous story and showed the expected/desired behaviour with possible ideas and solutions that my daughter could use the next time she found herself in that situation.

For example, during one of our first days at a parent and tot forest school when my daughter was 2 years old, another child walked up to my daughter and pushed her over. It happened fast. My daughter and I were both shocked. I was so busy trying to assess the group of kids and help my daughter stand near the group without freezing that I was not anticipating a direct knock-out! My daughter burst into tears and I provided comfort and eventually we carried on with the class. That day after nap, I began my storytelling. My daughter was visibly upset about the situation. We talked about how the other child was having a hard time that day and she was feeling mad. It was wrong of her to push. It was surprising and unexpected. We moved on to play as I did not want her to dwell on the event and I hadn’t actually thought of what the best strategy was moving forward! Even Mommies need time to think. In subsequent retellings, the animals suggested that my daughter say, “no” or “ouch! That hurt! Don’t push!” (I would have been lucky to have her make any sound directed towards another child, so it was a bit of stretch to suggest speaking. I was hoping for the “no”). For my part, I decided that I needed to be more upfront with the other child. A week later, we attended the next class and as the other child made another beeline to my daughter, I stepped forward and said (in the most enthusiastic, cheerful voice I could muster), “Hello, Jill, I like your whistle.” This preemptive invitation to a friendly interaction paid off. The child stopped moving towards us and looked at her whistle. Then I pointed out my daughter’s whistle. Then, the teacher started talking and we avoided a negative interaction. After a few more classes with forced Mommy-induced positive interactions, the other child had settled into forest school and I no longer needed to head her off at the pass! We retold the pushing story almost daily for weeks (usually from my daughter’s prompt). But by the end of forest school, my daughter talked about this other child in a positive way and included her in our “forest school play” at home. The other child was now referred to as a friend who rolled down hills and was a highlight of our forest school experience. The play-it-out method not only integrated her memory and feelings with the single pushing event but eventually, allowed my daughter to think more fondly of this child as we talked about her many positive attributes in our stories.

Another example is when my daughter was afraid of her little cousin who had learned to crawl! From an adult’s perspective, it was a funny scene: my 18 month old 80th percentile-size toddler slowly backing away and saying “no” with a sheer look of terror on her face from an army-crawling 10 month old 10th percentile-size baby. The little Crawler was desperate to get closer and touch my daughter and my daughter would repeatedly say “no” and fall into my lap and scramble up my body to get away from the little Crawler. My daughter could not focus on any activity if the Crawler was in the room. The only time she appeared to feel safe was in the highchair where the Crawler could not reach her. I used the animals to re-create the situation, and the animals came up with different ideas to cope with the little Crawler, like climbing onto the couch, giving the Crawler a toy, or having a snuggle with Mommy. After performing this play many times, my daughter started giving the Crawler toys, unprompted! It was amazing. My daughter still had great fears and concern about her little cousin. But, as we talked about more ideas (like Mommy will make sure everyone has food, since my daughter would be in a panic that the Crawler would eat all her food) and helped each of them have positive interactions, their relationship has grown to have more and more positive interactions. Now that they are 3 and 2.25 years old, they both speak in their own limited language (which does not overlap that much!) and “argue” about everything like whether it is raining. Whatever choice one makes the other makes the opposite, regardless of the weather or the truth. The little cousin always offers help when my daughter is upset and although my daughter still refuses that help, she occasionally offers hugs to her cousin when she is hurt!

In my next post I will discuss my struggle with balancing anxiety treatment and fears with life enjoyment.