behaviorally inhibited temperament exposure ladder

My struggle with balancing anxiety treatment and life

Sometimes dealing with anxiety (or a behaviorally inhibited temperament) can feel like a losing battle. You finally address one fear and five more pop up. There are many days when I wonder, “how much fear-facing is too much?” How should I weigh “encouraging bravery and working on fears” with “accepting my child as-is and building a positive, loving relationship”? Experts would say those two goals are the same and do not need to be balanced, especially when you look at the big picture of a person’s life. But every parent of an inhibited child knows that those two goals come into conflict daily. Crying, tantrums, resistance, and abject terror on your child’s face are just some of the possible outcomes of facing fears, even in controlled environments. These behaviours are physically and emotionally exhausting for both the caretaker and the child.

Facing fears is extremely hard. I often wonder how many psychologists and therapists have used cognitive behavioural therapy and exposure therapy to face their own worst fears? I first learned about this treatment when I used both therapies for a medical condition and associated phobia in my twenties. I spent 2 hours per day on meditation, mindfulness and thought records, and then worked on the exposure ladder. I chose each step and set the timeline and rewards. It was incredibly difficult and time-consuming. For the specific phobia, working through the exposure ladder was one of the hardest things I have ever done. I know the physical and emotional toll it takes to face a fear using these methods. This is one of the reasons why I balk at the idea of continuous and constant exposure for inhibited children.

I mentioned my daughter’s tendency to avoid busy play-gyms to the psychologist and she told me, “oh no, you can’t avoid play gyms. You need to go to them.” And I thought, why? I hate them too! They are loud and over-stimulating. Many of the children are poorly behaved with caregivers sitting on the sidelines with their faces in phones ignoring their child who is grabbing toys from anyone within reach. As the gym filled up with more and more children, my daughter stopped moving, looked at the door and walked towards it. I would have had to physically restrain her and have her cry to keep her in the gym (or reward her a lot!). Then, would I have to decide how long before we were “exposed” enough? I could set up an exposure ladder with rewards to achieve a cry-free extended play-gym experience. But is this worth it? I don’t know. I know that I do not like big groups of my peers at busy bars and pubs (the adult equivalent to play-gym?). I do not want to go to a party and make small talk for hours. I am happy and content with my life. I love being a mom and I am a good scientist. I like getting together with close friends. I like being with bigger groups of friends and family on special occasions. I got to “work” my friend’s wedding and I had a blast. I felt useful while still being in the hustle and bustle celebrating my friend’s big day without having to make small talk continuously. I help others and get a lot of joy out of my interests like baking and sewing. So why does my 22-month-old need to survive play gym?

The psychologist would probably agree that there needs to be balance, but when I read information about anxiety, there never seems to be a balance: the recommendation is exposure, exposure, exposure. And the research seems to support this. Researchers have shown that anxious rat pups (baby rats) exposed to novelty early in life became less anxious adult rats compared with control (unexposed) pups. A human child might be less inhibited as an adult with forced, continuous exposure therapy in early life, but at what cost? I do not think science and research has an answer for me. Those mother rats never had to endure tantrums from their exposed pups, and those rat pups did not cry when the researchers picked them up and removed them from their mom (or maybe they did!). And when they were adult rats, we have no idea if they still “loved” their mom and had a positive attachment to their mom. Unlike mother rats, human parents weigh the benefits and consequences to find a solution that works for their family. This might mean exposure, exposure, exposure. But it also might mean some exposure and some avoidance to make space for other non-fear related positive child-parent interactions because there are only so many hours in the day.

The bias underlying anxiety treatment (and the associated research) is that uninhibited, social traits are preferred over all other personality traits [more info]. As an introverted, inhibited, shy person, that slant feels wrong to me. Our strange existence in the pandemic has given me pause to reflect on anxiety treatment and exposure and I am still working towards finding a balance for my daughter and me. I found great success with the elevator exposure ladder, but would I want to do this every day for every fear? No. I am taking a page from Ross Greene’s book Raising Human Beings, and prioritizing my daughter’s fears. I do not need to tackle them all. She does not need to tackle them all.

In my next post I discuss behaviour modification and my mostly hate relationship with this ubiquitous parenting strategy.

The Good in Inhibited Children

After I wrote this post, I started reading an evidence-based book, The Orchid and the Dandelion by W. Thomas Boyce. The author weaves his personal family history with research findings related to inhibited (orchid) and uninhibited (dandelion) children. He creates a story that describes the challenges of having an inhibited temperament and the unique opportunities to nurture great beauty in the child. It is the first writing that I have come across that explicitly states research-backed positive traits of an “orchid” child. I will provide an update when I finish the book.