Regulating Our Emotions as Parents with Alissa Jerud, PhD

Parenting brings love, joy and plenty of emotional challenges. In this episode, clinical psychologist Dr. Alissa Jerud explores how parents can better understand and regulate their emotions instead of getting stuck in cycles of frustration, anxiety, or control. Drawing on exposure therapy, DBT skills, and her Emotion-Savvy Parenting approach, Dr. Jerud introduces practical tools: the ART framework (Accept, Regulate, Tolerate) to help parents stay grounded during emotional storms. Whether it's managing anxiety, tolerating distress, or responding more calmly to your kids, this conversation is full of evidence-based strategies for building resilience, deepening connection, and showing up as the parent you want to be. Connect with Alissa Jerud on her Instagram https://www.instagram.com/emotionsavvydoc/ or LinkedIn https://www.linkedin.com/in/alissa-jerud-210764174/ Check out her new book Emotion-Savvy Parenting https://www.amazon.com/Emotion-Savvy-Parenting-Alissa-Jerud/dp/1032544945/ref=sr_1_1?crid=4SNXXESTLTDY&dib=eyJ2IjoiMSJ9. RoeP29kaNMjR_-tC6dlgqJeE3eGlAjWAFtj3oZNsr60y6TrcbpAcD9nnxJdzbJsYbytpLR8mis8BUO0CQjLRvnbSgs6-8sushr1dikx6fcJFHwFK5YGILFqRDHmi04vDBD9i-d2jftHo8B4oPl_Taf0yIba1Zg2siR_hFYaAsACU6RPS_w-3Qewd5tcJzhaISYAIpGFSGpL4zoamQ3xgSGHMPNs7Luypx5ARM0pKhww.0iiJMFtEsSVc2o19AfrNHOieBTUjS4-aUyXOZWDIffY&dib_tag=se&keywords=emotion-savvy+parenting&qid=1755394534&sprefix=emotion-savv%2Caps%2C229&sr=8-1. Announcement: for interest in psychotherapy cohort, go to www.psychiatrypodcast.com/cohort https://www.psychiatrypodcast.com/cohort By listening to this episode, you can earn 1.25 Psychiatry CME Credits. https://www.psychiatrypodcast.com/cme-program Link to blog. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-245-regulating-our-emotions-as-parents-with-alissa-jerud-phd Link to YouTube https://www.youtube.com/watch?v=9CalH5Qzc-Y&t=4s

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:13David Puder?

  All right, welcome back to the Psychiatry and Psychotherapy Podcast. Before we start this podcast, I just wanted to give a brief announcement. This is the second year we will be running psychotherapy cohorts. I had a wonderful group of therapists, psychiatrists, nurse practitioners from around the world. In our last one, we will be going into a deep dive on psychodynamic psychotherapy, reflective function, transference, counter-transference. We will be in the process of utilizing these things in a highly applicable, like, how do we actually do this in therapy? That's the goal of this type of cohort. And also, this type of cohort is just a great time to get to know each other, different

• 0:58David Puder?

  professionals. It is weekly, two hours. It's a commitment of reading some material every time. If you're interested in this, we have a link in the show notes. It will be on the podcast website, psychiatrypodcast.com, on the top bar. If you're getting this later than the application process allows, we already have some spots filled, you can apply and ask to be put on the waiting list for next year. My wonderful assistant Jonathan is calling each person to make sure that they get these emails once you submit the application. And we will be building a waitlist for future groups. I also have some different colleagues who will be co-leading, or not co-leading, but

• 1:43David Puder?

  we're all leading the same material, but they will be leading their own groups. These are people that I trust that have been through the process before. So if you're interested, please apply.

• 1:55David Puder?

  All right. Welcome back to the podcast. I am joined with Alyssa Jared. She has written a book called Emotion-Savvy Parenting: Shame-Free Guide to Navigating Emotional Storms and Deepening Connection. She has a background in dialectal behavioral therapy and specifically behavioral approaches to anxiety. Why don't, can you give us a little bit about your background and how you got into this?

• 2:25Speaker 01

  Yeah, sure. Thank you so much for having me, first of all. So I'm a licensed clinical psychologist, and I really, as you said, primarily specialize in exposure-based treatments for anxiety-related disorders. But I also really enjoy working with others to help them better navigate their own emotions. And then I especially, as a mom of two kids, I especially enjoy working with parents to help them do the same. And so that's kind of a little bit about what I do, and then also led to me writing this book that I wrote.

• 2:57David Puder?

  Okay. So yeah, let's, let's talk a little bit about your, your background here. So you've been seeing patients for how many years?

• 3:04Speaker 01

  Oh, my. I graduated in 2016, started my postdoc then, and then I was kind of on my own beginning in 2018.

• 3:12David Puder?

  Okay. And what was your postdoc in?

• 3:15Speaker 01

  I was working at the Center for the Treatment of Anxiety, sorry, Center for the Treatment and Study of Anxiety at the University of Pennsylvania. So really, they are doing a lot of exposure therapy for the, you know, for OCD, social anxiety, specific phobias, PTSD, all anxiety-related disorders.

• 3:35David Puder?

  Great, great. And then when did you get the DBT background? When did that come?

• 3:40Speaker 01

  I was really lucky. I went to the University of Washington to get my doctorate, and that's where Marsha Linehan is. And so I actually was a part of her two-year DBT practicum. So first, you know, we took like a good number of courses with her, and then I was part of her treatment team. And so really, you know, every single week, getting to have meetings with her. As part of that, we would watch videos of her and other therapists, other DBT therapists kind of doing DBT, and then also provide both DBT on an individual basis as well as kind of to groups. So I led and co-led a DBT group there as well.

• 4:17David Puder?

  Great, great, yeah. I haven't done too much on DBT during this podcast, so it's good to kind of get some exposure in that. And then it seems like we're applying this, a lot of your expertise, to the parenting role and to the emotions that come up with a parent.

• 4:35Speaker 01

  Yeah, exactly.

• 4:37David Puder?

  And so, yeah, tell me about the, just the accept, regulate, tolerate framework art.

• 4:45Speaker 01

  Yeah, so this is something that I include in the book and then I talk about all the time, even in my private practice. My website has this framework on there too, because I think this is just kind of so key to being able to live skillfully with whatever emotions show up. So maybe first I'll just say that, right, as humans, we're kind of wired to want to avoid emotional pain, right, whether, and I should say, pain of any kind, right? So if our hand's in the fire, we want to pull that hand out. And if we're feeling anxious, we're angry, we're sad, we want to not have to feel that so strongly. And that's so understandable, so normal, so natural. The thing, though, is with emotional pain, oftentimes our attempts to avoid it can kind of prolong and exacerbate our suffering. And so I could go through many examples of that.

• 5:30Speaker 01

  But really, art is designed, this framework that I came up with, is rooted in both the exposure-based treatments I provide, as well as DBT skills. And it's about helping people accept, regulate, and tolerate their emotions. And not just their emotions, but other things in the environment as well. So for instance, with accept, right, we can accept not only our own emotions, but also others' emotions, our thoughts, our physical sensations, our surroundings, including, again, what other people are feeling, or thinking, saying, maybe even what they're doing. Not always, maybe we can't accept it, but to be clear here, acceptance really doesn't mean liking or approving of something.

• 6:13Speaker 01

  It just means kind of noticing what's actually happening and just noticing the facts, nothing more. So we really can accept just about, you know, most things, I would say, we can work toward accepting. That's accept. And then regulating is all about, how can we kind of like understand? What we're feeling, understand our emotions so that we can, in understanding them, in accepting them and understanding them, use that information to help us be less vulnerable to experiencing painful emotions in the first place, and to help us begin to maybe change those emotions when they arise and aren't serving us all that well. And then the final set of skills, or the final kind of like letter in that that framework is T,

• 6:56Speaker 01

  tolerate, which is for when when we are experiencing strong unwanted emotions and there's maybe a situation we can't change. This is just how things are and it kind of, you know, it stinks. It's not enjoyable. It's it's hard. How can we tolerate that situation, that moment, those emotions we may be feeling without doing something that we might later regret that might make the situation worse?

• 7:20David Puder?

  Okay.

• 7:20Speaker 01

  So that's the framework.

• 7:22David Puder?

  That's the framework. And then maybe I could go through some difficult situations and

• 7:28Speaker 01

  Yeah, sounds great.

• 7:29David Puder?

  And see kind of what we're doing. So, okay, so like, let's say you have a parent, a new parent who's at home with the toddler all day, feeling deeply alone despite, you know, not being alone. And this this deep loneliness is there. So maybe there's some frustration with this feeling of aloneness. Like, gosh, I thought I would enjoy this more than I am. So what so what do you do with that?

• 8:03Speaker 01

  Well, first, I think you gotta accept that you're feeling alone because we can't change a given emotion or circumstance unless we're aware of it. Right? So first, it's an acceptance. And one tool, one skill we can use to help us be more accepting is mindfulness, which is simply the act of paying attention to the present moment on purpose, without judgment, as experienced through any one of the five senses. And we can be mindful of just that emotion. Right? Like, oh, yeah, right? That that feeling of being alone, just noticing that it's there. Not that it's a bad thing, not that it shouldn't be there, just that it's there. Right? And that can cue us in to say, okay, this is an emotion, it's an unwanted emotion. It doesn't feel good to feel lonely or alone.

• 8:49Speaker 01

  And it might not be serving her all that well. Maybe it's the feeling of being isolated and alone is making it hard to show up as she wants to with, or he wants to, that person wants to with their kid, right? And so then it could be thinking about, well, okay, that might be a situation where we can regulate, right? We can go in and possibly change that emotion. It's possible to do that. It may not be easy, but maybe this person could problem solve, right? So that's an emotion regulation skill. There are a number of different emotion regulation skills. One of them is problem solving. Okay, what might help them to feel a little less alone, right? Might it be possible to join some play groups where, you know, the toddler can play, they can connect with other parents, that sort of thing.

• 9:33Speaker 01

  Maybe it's just inviting friends over. It's maybe it's hard to get out of the house with a toddler sometimes. Could they invite somebody over to their house to just hang out, spend time? If none of that is even an option, would it be possible to connect with people over, you know, over the phone, over FaceTime, Zoom, that sort of thing? So that's, you know, that's just one option, problem solving at that level. What I will just say too, that might be helpful to know is that our emotions, it turns out, are much more complex than many of us realize. And so part of the reason it's so helpful to understand that piece, that complexity, is because then that offers so many different avenues for intervention. Right? So on the regulate side, there are those, all those skills we can use to regulate emotions.

• 10:18Speaker 01

  And other regulating skills that we can use would be to maybe like change the vulnerability factors. Maybe there are things that are making this person feel especially vulnerable to being lonely. Right? Maybe they're also, maybe because they're so busy as a parent of a toddler, not having time to do things that help to kind of help them feel good. So maybe they could get back if they're not getting enough sleep, if they're not having a chance to exercise or to nourish their body, right? Like they could do those things, which I realize might not sound like rocket science, but it can go a long way toward kind of enabling us to be less vulnerable, maybe to that loneliness, for instance.

• 10:56David Puder?

  Okay, so what if they feel like so much guilt and shame that they're feeling lonely at all, like, I shouldn't feel lonely, I should, you know, like, so what do you, I mean, I imagine they could feel guilt and shame for anger, if they feel frustrated, if they feel like, so what do we do, what's your approach for the guilt and the shame and just the self-loathing, maybe even that I should be this, I didn't imagine it this way, I didn't imagine I would ever feel anger towards my child.

• 11:27Speaker 01

  Right, right. Oh, my gosh, well, this could be actually like a whole podcast just in and of itself. I think I will say that those feelings, all the unwanted emotions that exist under the sun are all really normal and natural for parents to feel at times. And I hear it so often, parents saying, you know, like, no good mom or dad should feel this way. And what I would say is, we all do, right? We're human, we're wired to have those emotions. And so of course, you're gonna find yourself feeling angry sometimes, resentful sometimes, lonely sometimes, as a parent. And what's tricky is when we kind of judge ourselves for that, we, you know, say we shouldn't be feeling that way, that's

• 12:09Speaker 01

  when we can turn that, like, the pain that comes with feeling anger, you know, isolation, like lonely, sad, that turns that pain into suffering. Because then it's not just, then we don't just have the pain of like, or the discomfort of feeling angry, now I've got like, the shame and the, you know, the judgment that I'm layering on top of that. And that can just make our experience so much more overwhelming and hard to navigate. And what I will say is, we rarely do our best when we're feeling badly about ourselves. So when we get caught up, when we start beating ourselves up, right, like, we think we're doing that to maybe make ourselves like, do better, but it actually can make it harder to do better because we're kind of feeling so down on ourselves, it's hard to then show up as our

• 12:52Speaker 01

  best selves. And so the more parents can use the mindfulness skills there, really practice noticing, not that that's a bad thing that you're feeling that way, or that you're having thoughts about your kid, like, oh, my gosh, I can't believe, you know, like, who is this kid, or, you know, they're such a jerk. We all have those kinds of thoughts from time to time about our kids. And so not giving yourself such a hard time for that, but instead just noticing, oh, I'm having that thought, or, this is what I'm feeling, that can actually go a long way. But it's certainly easier said than done.

• 13:26Speaker 01

  And I guess maybe I'll add into, right? When we're feeling a really strong emotion, trying to bring in mindfulness, if we haven't established a mindfulness practice, can be really challenging because mindfulness is this like skill that we really do have to build, build up to. It's like, you know, strengthening that muscle for being able to tune into the present. And so it's like trying to ride a bike for the first time on a downhill, right? It's almost going to be impossible. If that's your first time to ever ride a bike, you need to first practice on the flat surfaces. Same with mindfulness. So ideally, people would be first practicing, you know, when drinking their first sip of coffee in the morning, when doing the dishes, when going for a walk, like at times where stakes are low,

• 14:10Speaker 01

  emotions are not super high and heated, before trying to use it in these more challenging moments when a strong emotion is on board.

• 14:20David Puder?

  What do you think is the easiest beginning approaches to mindfulness? Like you said, coffee, like I imagine just sipping the coffee slowly and just enjoying that first sip.

• 14:33Speaker 01

  That's a great one. I love it, right? I try to do that every morning and it doesn't mean I drink my whole cup mindfully, but maybe it's just that very first sip, right? So we can practice, Marshall Lennyhan talks about it as like Pac-Man sized bites, I believe she says, right? You know, in the game Pac-Man where each time you like get a little kind of dot, the Pac-Man gets a little stronger. And same thing, like each time we tune in, just even if it's for half a second to the present moment, our muscles for being able to do so get a little stronger. And so, yeah, whether it's that, I think it really depends. Some people are, find it easier to tune into the external world first because for many of us, we are kind of taught to want to avoid.

• 15:15Speaker 01

  Our own emotions, especially those uncomfortable ones. And so we're kind of used to more looking outward and that can be an easier place to start, but it could be, you know, the leaves rustling in the trees. It could be tuning into the beats in a piece of music or just noticing, this is more kind of turning inward, but it might be just noticing, like, what does it feel like to have your hand on a table, like on the flat table? And I realize all this might seem kind of boring and mundane, but it actually like we, it kind of really can open our eyes to things that we never even noticed before when we tune into these brief little moments. And again, can be a thing, a tool that we can use in general to sharpen

• 15:56Speaker 01

  our focus, help us better appreciate moments when, you know, those kind of positive moments, and help us better tolerate those tougher moments as well.

• 16:06David Puder?

  So my understanding is that in DBT groups, they don't do walking mindfulness. And I've heard Marshall Anahan tried to do it, but then everyone hated the idea of walking around in a circle. But I actually found that really enjoyable to like, just walk and feel the bottom of my feet.

• 16:25Speaker 01

  Yeah.

• 16:25David Puder?

  And I do that just as kind of a grounding thing between clients sometimes to kind of re-center myself.

• 16:33Speaker 01

  Yeah.

• 16:34David Puder?

  Yeah. Any thoughts on walking mindfulness and just feeling the very bottom of your feet?

• 16:38Speaker 01

  Yeah, I think it's a fabulous way to practice mindfulness or to go walk and maybe you choose to instead focus on the external as you're walking, what other people around you in the park are doing, or just, you know, again, like the leaves, like I said, rustling in the trees. I will just know in DBT groups, that walking mindfulness exercise is actually one sometimes we'll use to help with non-judgmentalness. Right? So in DBT mindfulness is broken down into a number of different kinds of skills that you use, the what skills and the how skills. And one of the how skills is non-judgmentally. And it can be really hard to, if you're walking around in a circle. With like, you know, following other people who are walking slower than you want to be walking, you can start to have a lot of judgments about that.

• 17:24Speaker 01

  And so it can be a way to practice just that walk, noticing those judgments when they show up, because we're going to have judgments come up from time to time. We're going to have distracting thoughts come up from time to time when we're practicing mindfulness. It's all about noticing those and then gently bringing ourselves back to whatever it is we're choosing to be mindful of. And so that's an exercise, or it's like a great practice of being able to like, notice the judgments and then come back. And so same thing, we'll have people look at their hands, because most of us have like imperfections on our hands that we don't love. So you can just be mindful of that, notice the judgments when they come up, but then shift your attention back to like, kind of just noticing or describing what you see on your hand non-judgmentally.

• 18:06Speaker 01

  Same thing with like, you could write the alphabet with just your left hand, or sorry, I'm assuming people here are all right-handed, that's clearly not the case, but write with your non-dominant hand, right? And it's going to look really messy and you're probably going to have judgments about how it looks, but getting back to doing it and like, really throwing yourself into it without judging those letters that you're writing.

• 18:28David Puder?

  That's good. So it's kind of, it's like a behavioral experiment of reducing self-judgment, right? So that when you get to harder things, like your anger, or like our anger, we all have anger, we can have less judgment about it.

• 18:45Speaker 01

  Yeah.

• 18:46David Puder?

  Realizing that the judgment and maybe makes it worse, right? Because then we maybe don't see it for what it is, or we make less of it, or create defenses around it. Is that, is that, is that correct? So you're, you're essentially like progressively desensitizing someone to the experience of internal judgment?

• 19:11Speaker 01

  Yeah, and I don't even know I'd say desensitizing because like we're gonna have those internal negative judgments and sometimes they're gonna be hard to sit with, right? Sometimes that we're gonna have thoughts about ourselves that aren't gonna be pleasant, but ideally we're helping people notice that when that shows up and know that like, oh, I don't have to stew on those thoughts on that negative judgment. I can notice that, notice that I'm having those thoughts and then choose to shift my attention back on to the present moment, right? Choose to do something that's gonna be more effective in the present moment. And know that like, I just, you know, this is a little separate from mindfulness, but just, you know, just for all of your listeners to know, right? Like, again, we are all human. We're all gonna feel, like you said, emotions like anger.

• 19:54Speaker 01

  And so the more we can just give ourselves some self-compassion, I think whether we're parents or not, like, life is hard. And interacting with other people or like, just, you know, the challenges of our day to day can bring up really difficult emotions like anger. And so the more we can just know that, that like, just about anyone would probably, or many people would be struggling in this situation, right? Or in other situations, even if somebody might not find this very situation hard, there are other people out there struggling in other situations too, and feeling this kind of emotion. And just giving yourself that compassion to, like, allow yourself to feel that way, again, without that judgment, can be really freeing and can, again, kind of like lessen the intensity of of those emotions.

• 20:38David Puder?

  Okay. Okay, so some of the other skills that I've found helpful that I've learned from DBT is like holding ice. And this morning I went into my sauna, went into the cold plunge. And I find the cold plunge to be a whole lot better than holding ice. But I'm curious like what your thoughts are in terms of where where you integrate that into this sort of approach. Obviously, it's like a more gripping.

• 21:10David Puder?

  Or like, you know, like walking mindfulness or breathing mindfulness, which I think learning those things is good as well. But there's something about temperature which really kind of just pulls you back into your body in a powerful way.

• 21:24Speaker 01

  Yeah, yeah. So I think ice in general, I think of it as a skill that we can use to help increase distress tolerance. So if you think about those, the different skills I talked about, the regulating skills are all about how can we kind of prevent unwanted emotions from firing in the first place and start to change them when they do arise and aren't serving us all that well. Distress tolerance skills are really like when an emotion is there, how can we sit with that emotion again without making the situation worse, without doing something we're going to regret? And that's where the ice comes in, at least in DBT, and where I talk about it in my book. So the first kind of way it may come in, the example you're giving is more, and maybe you're not using it as this, maybe you're actually using that cold plunge in a more

• 22:08Speaker 01

  mindful way where you're just noticing the physical sensations in your body when you choose to do the cold plunge, which is great, fabulous. And yes, it's certainly, you're gonna really notice those physical sensations, it's gonna be easier to tune into them when you're feeling probably such, if I had to guess, there are probably some, you know, like pretty drastic shifts that occur in your body that can help you really tune into those. Other times though, ice, like holding, you know, ice cubes in your hand can be an example of distracting yourself, right? Just to get, not as like a long-term solution to a given situation, but sometimes when we're so heated, we're so aroused, our brains are kind of offline, the prefrontal cortex, like we can't engage that because it's been hijacked in that moment by the more primitive

• 22:53Speaker 01

  parts of our brain. And so in those moments, we can use something to maybe help just take the edge off of that emotion a little bit so that we might be able to use more effortful strategies after the fact. And so the ice is a way we can kind of like distract a little bit from the, you know, from what we may be feeling in the moments. You could hold ice in your hand, for instance, even like just drinking a cold glass of water could be an example that you might do there. My favorite one of all, though, is actually a skill that is designed to elicit what's called the dive reflex. And it's the, you know, what tends to happen to us when we are submerged in very cold water. You may be familiar with this, right?

• 23:38Speaker 01

  Yeah. So our heart rates kind of slow down, stop pumping blood to our extremities in order to conserve energy and heat our core, right? And so we can elicit that dive reflex, especially when like we're really, really aroused. But I say, taking like a cold ice pack or a bowl, filling it with cold water, maybe adding a few ice cubes. And then we can either put that ice pack kind of above on our cheekbones and our temples, kind of leave it there for about 30 seconds. Or we can dunk our head into that bowl of water, which can get a little messy, but doing it for 30 seconds. And I should say, for those listening, that this is a skill that if you have a heart condition or some other medical condition that might affect your heart, you want to talk with your doctor before doing this.

• 24:19Speaker 01

  But for those who don't, these can drastically reduce heart rates by about 50% or more. I've seen it within 30 seconds, right?

• 24:26David Puder?

  I do it every day.

• 24:27Speaker 01

  Yeah, right in the cold blood. Yeah, exactly.

• 24:29David Puder?

  Put my head under and I can feel, I can feel my heartbeat. And it goes, you know, when I start out, because I usually come from the sauna, it's like 150.

• 24:40Speaker 01

  Yep.

• 24:41David Puder?

  It'll drop down to 50 within 30 seconds.

• 24:45Speaker 01

  Yeah, right. Because you're going all the way in, right?

• 24:47David Puder?

  I'm going all the way in. I put my head completely under. And I also have the, where the water circulates blasting into my face. So that, that, you know, water, when the water's moving, it's even colder.

• 25:01Speaker 01

  Yeah.

• 25:02David Puder?

  I would, yeah, for caveat, though, for, for anyone with like an arrhythmia.

• 25:06Speaker 01

  Yeah.

• 25:07David Puder?

  Like, the reason why I'm measuring my heart rate on my jugular is because if it drops too low, it'll keep dropping. And I've seen this on TikTok and different shorts, you know, it's like people, people show themselves going into asystole even.

• 25:21Speaker 01

  Yeah.

• 25:22David Puder?

  And so I usually don't push the amount of time that I'm under unless I have a friend that can pull me out. And so it's good to kind of know your limits, but I love, I mean, that's, it's incredibly powerful to drop, to drop your heart rate.

• 25:36Speaker 01

  Yep, and you're using it, it sounds like just kind of every day, maybe not, not necessarily because you're feeling a strong emotion, but this is something like imagine you're really, really upset with your partner or with your kid in a moment, you can just walk over to the kitchen. And I actually had a friend who told me, because she had listened to me give a talk, she was about to lose it with her kids the other day, and she walked to her, to her kitchen, she actually filled up a bowl of cold water, dunked her head for 30 seconds, and she was like, oh, my gosh, it worked wonders. Like, I came in and I wasn't, you know, I no longer felt like I was going to explode. And so, yeah, it's something we can use to really drastically change what we're feeling inside as quickly as maybe using some sort of illicit substance, but without the harmful side effects. Again, assuming you don't have a heart condition that would, you know, make that risky to

• 26:21Speaker 01

  do.

• 26:23David Puder?

  Yeah, and I would say, I mean, I do do it every day, like, as a practice, but doing it when I'm emotionally dysregulated, I should start to do probably more. If I'm coming home emotionally dysregulated, like, if I've had, like, nine hours of patience and I'm exhausted, sometimes my wife will be like, I think you need to go to the cold plunge. And I'll be like, oh, no.

• 26:47Speaker 01

  That sounds terrible.

• 26:48David Puder?

  That sounds terrible. But I get it, I get it.

• 26:52Speaker 01

  Yeah.

• 26:53David Puder?

  Okay, what about opposite action? Where does that fit in? How do you use that?

• 26:57Speaker 01

  Yeah, so Marshall Linehan considers opposite action an emotional regulation skill. I actually group it under the distress tolerance skills, because for me, I like to think about, yeah.

• 27:11David Puder?

  That's rebellious of you.

• 27:12Speaker 01

  Yes, I know, challenging something that I admire so much, decided to do.

• 27:17David Puder?

  It's good, some good differentiation, I appreciate that.

• 27:19Speaker 01

  Yeah, so in large, where that came from, because as a work, as my work as an exposure therapist, really, with that treatment, I'm really aiming to help people break the habit of reducing anxiety through avoidance. And so, this is going to be a very long-winded answer, and I apologize in advance.

• 27:37David Puder?

  I love it, I love it. Go for it.

• 27:39Speaker 01

  So, we used to think long ago that exposure worked, we would have people approach anxiety-provoking situations repeatedly and for prolonged periods of time. And initially, we believed that the reason why exposure was so effective is because people would go into these situations, and over time, anxiety would have a chance to naturally decline on its own. They wouldn't avoid in any way to try to make anxiety go down, and so it would kind of like run its natural course, and they'd experience what we call habituation.

• 28:06Speaker 01

  But we've actually since had, you know, done a lot of research. We now have a lot of data to suggest that that habituation or reduction in anxiety is neither a strong nor consistent predictor of treatment outcomes. And what I will say, so I'm gonna, I realize one thing that might be helpful to know is that exposure therapy really is a form of opposite action. Opposite action is essentially doing the exact opposite of what your emotions are pulling for. So what anxiety usually pulls for is avoidance. And so exposure therapy is doing the opposite. We approach instead of avoid. So you were gonna jump in, it looked like, a minute ago?

• 28:44David Puder?

  Oh, no, I, I'm, I'm, I'm really interested in, yeah, what is, what is the most important aspect of exposure therapy to make it work the best? Because so many of our patients have anxiety and I think this is, this is gonna be really helpful for the audience to hear from an expert. So, yeah, go for it.

• 29:03Speaker 01

  Yeah. So we now think that the more critical ingredient, the secret sauce to exposure therapy, is increasing distress tolerance. Because if you think about it, anxiety is this normal, natural emotion we all feel at times. And my, what I aim to do in treatment with people is to help them learn to develop a new relationship with anxiety, where they can feel anxiety, no matter how intensely it happens to show up, no matter how long it happens to stick around for, and not need to do anything to try to fight it or make it go away. They can allow that anxiety to tag along for the ride, still do what's effective for them and important to them. And so, and that's in general, we now think of as being the most critical ingredient within kind of that reduction in anxiety that sometimes occurs.

• 29:48Speaker 01

  Sometimes it just does occur, right? You, you approach a situation many, many times, don't make it go away, you build those muscles for tolerating distress, and what do you know? Over time, anxiety does go down. When that happens, though, I like to think of that as a bonus side effect of exposure. Or like icing on the cake. It's not essential, it's kind of nice when it happens. But that's not what we're aiming for. And one of the other reasons I say it's not what we're aiming for is you can probably imagine a situation where somebody starts to see exposures as a way to avoid anxiety. Oh, I feel anxious now, so I'm gonna do an exposure so that I don't have to feel this way anymore. Right? And so that anxiety, the exposure in and of itself, can start to almost function as what we would call a ritual or avoidance behavior.

• 30:32Speaker 01

  I want to help people learn to say like, ah, I feel anxiety. How fabulous. This is another opportunity for me to like, learn that I can tolerate that anxiety and distress. And so that's kind of what brings me then to talking about opposite action. Why view it more as a distress tolerant skill? We know that people get better in exposure therapy, even if anxiety never decreases. Even if anxiety gets high, they can still, again, get better, do great in exposure therapy. Right? And so we could talk more about that if you want. But because of that, again, opposite action, whether that's exposure therapy or some other form of opposite action, opposite action for anger, that emotion may not necessarily budge.

• 31:16Speaker 01

  For me, that's not the, the kind of, the barometer for success. It's more, can I do what's effective? Can I act opposite to that emotion? Not given to the urges that come with that emotion and tolerate the emotion in the process. So that's why I think of it more as a distress tolerant skill. Plus, we can't really act opposite to a given emotion unless it's already there. Right? Like, I can't act opposite to anxiety if I'm not feeling anxious already. And so, and I think of the distress tolerance skills as kind of being the skills that we bring in when an emotion is already in full swing. Whereas those emotion regulation skills, we can use when an emotion is already there. But oftentimes, we're using it to, those skills to,

• 31:58Speaker 01

  even to like, prevent an unwanted emotion from arising in the first place.

• 32:03David Puder?

  Okay, so key to doing like the behavioral experiment type of thing is to allow ourselves to feel the anxiety and to tolerate the distress of the anxiety and to not avoid the anxiety. What about the idea of when we run behavioral experiments with patients? Like the thoughts that they have going into the experiment and then the thoughts after? And then the discrepancy between when they go in and what they actually experienced?

• 32:35Speaker 01

  Yeah.

• 32:35David Puder?

  And then like looking at that discrepancy, is that important? Or like?

• 32:40Speaker 01

  Yes. I'm so glad you asked that. Yeah, yeah. So from an exposure therapy perspective, I don't want to try to touch those thoughts before an exposure. Right? So there are some therapists who won't want to try to reframe those thoughts before a given exposure.

• 32:55David Puder?

  Okay.

• 32:55Speaker 01

  You know, for instance, for somebody who has a fear of flying, maybe the therapist will first try to like, you know, challenge those, the thoughts they may be having about the riskiness, the, you know, the safety of flying. So maybe somebody is really worried their plane's going to crash and the therapist comes in and talks about how, well, it's really unlikely that the plane's going to crash, right? Statistically speaking, how many flights have you been on in the past where you had that thought and then the plane didn't crash? You may try to go after all of those thoughts in that way. But we actually know that learning is strongest when there is a mismatch between what somebody thinks is going to happen and what actually happens. So if I go in and I try to challenge and change those beliefs ahead of time and then the flight ends up being fine, that kind of is going to map on with what they were maybe

• 33:39Speaker 01

  kind of thinking was going to happen anyway. But if we sit with the idea, you know what? It's possible, maybe this plane is going to crash. And then they get on that plane and the plane doesn't crash. And they do that plane ride after plane ride after plane ride. That's going to provide more powerful corrective learning. Right? That that initial thought I had that planes are dangerous isn't necessarily true. Right? I've got a lot of data now to suggest that that doesn't always end up being what happens. Plus, in the case of anxiety, what can happen is those kind of attempts to restructure those thoughts, the anxiety provoking thoughts, you know, to convince yourself it's unlikely to happen or things are probably going to be fine, might work in the moment. So maybe somebody feels better briefly. But anxiety is kind of sneaky.

• 34:22Speaker 01

  And what's going to happen is if there's even the tiniest bit of doubt or uncertainty, even if like the chance of something happening is like point oh, oh, oh, oh, oh, oh, oh, one percent, super small, that's going to be enough for anxiety to latch on to. And it's going to come back and say, but what if this time is different? What if this time the plane really does crash? And so, and then so what happens for people is they end up yo-yoing. You know, they, they have the thought the plane's going to crash and feel anxious. You know, no, it's probably going to be fine. Statistically, it's unlikely to happen. And then they go back up again and then it just keeps going up and down. I'd rather help people learn they can sit with that thought, right? Tolerate that and not have to do anything to make that thought go away to, you know,

• 35:06Speaker 01

  to reassure themselves in any way, shape or form. And so then we can explore that in the processing conversation after an exposure. Right? So that's where we can maybe start to restructure some of those beliefs. Like how, so you know, beforehand, you were telling me you thought it was really likely that this plane could crash. And now you've, or that when you would fly one day, a plane would crash. And now you've flown, you know, 15 times and none of those planes have crashed, even though you weren't doing any of the behaviors that previously you thought you needed to do in order to stay safe on a plane. Right? What are you thinking now about planes? And, you know, like, how do you feel about them? How, how safe do you think they are now? So we can explore that. And then, and then how did that shift occur?

• 35:49Speaker 01

  Right? How is that that you've come to this place where planes no longer seem as dangerous to you?

• 35:55David Puder?

  Hmm. Okay. Okay. So now let's, um, let's think about how to apply that to parents.

• 36:01Speaker 01

  Okay.

• 36:02David Puder?

  And maybe some of the, what, what would be common? Like anxiety provoking things for parents to imagine. I mean, the first thing I, I think about is like, I've, I have some, some clients who are just afraid of having kids at all, right? Like, oh gosh, I'm going to have kids. And I have a couple of clients who their child, their own childhoods were so awful that they would, it's almost like imagining bringing a child into a world where their child would be. In a situation that might be as awful as their situation. It's like they don't even wanna consider it almost, but they do want it. It's like they have this drive to have a child, but also this incredible fear to have a child.

• 36:44Speaker 01

  Yeah.

• 36:45David Puder?

  Yeah. Any thoughts?

• 36:47Speaker 01

  I mean, really, at the end of the day, what's neat about exposure therapy is that we don't have to reinvent the wheel, regardless of the fear, right? So, because anxiety can show up in so many different ways. Sometimes I, there was a ice cream store that used to exist near me called Little Babies, and they would have all sorts of different flavors of ice cream. They would have your vanilla, your chocolate, your strawberry, but then they would have like pizza flavored ice cream and ranch flavored ice cream, sriracha flavored ice cream, right? These bizarre flavors. No matter the flavor, though, you would eat it the same way, right? Either in a bowl or on a cone. And the same idea with anxiety, right? That it can, we can have the more common flavors of anxiety as well as these like, you know, maybe less common flavors of how anxiety might show up. But we're gonna take the same approach.

• 37:31Speaker 01

  And so for me, what tends to fuel anxiety is uncertainty, right? We don't know how the future is gonna look. If you have kids, for sure, we don't.

• 37:42Speaker 01

  Rather than try to convince you that it's gonna be better, that you're gonna do just fine as a parent, when in reality, you're probably gonna make mistakes. Maybe not the same mistakes your parent made, but we all make mistakes as parents. So rather than try to convince you otherwise, we could sit with the possibility, you know what? Like, maybe it's not a good idea to have kids, right? Maybe, but just because it might not be a good idea, does that mean that you then can't have kids? Could you still have kids anyway? Choose to do what's effective and skillful and, you know, and see, kind of to your point on these behavioral experiments, we'll never know unless we give it a try. So that would be an example. But I think other common scenarios. So for instance, my son has a pretty severe egg allergy.

• 38:24Speaker 01

  And we decided this summer to send him to summer camp for the first time because he really wanted to go. And the initial camp we were gonna send him to, we decided we couldn't do. It's where my daughter goes, but they are like an hour and a half away from the nearest hospital. If he had an anaphylactic reaction, it would be really dangerous for him. We decide, and they also like couldn't, the kitchen wasn't able to accommodate him really fully. We decided to send him to another camp that serves eggs on most mornings, but that, you know, could really accommodate well, could make sure he had vegan food that was prepped separately from other food. And that was only 15 minutes from a hospital.

• 39:01David Puder?

  Hmm.

• 39:02Speaker 01

  But we also knew it was possible. He could still have an anaphylactic reaction while at camp, right? And so a lot of the work that I had to do for myself was to accept might happen. I knew we had taken reasonable steps to reduce the likelihood of that happening. But beyond that, it wasn't fully within my control. And I had to be able to accept that because I really believe, like as somebody who loved summer camp as a kid, and you know, I just, I believed it would be really good for him and he loved it. And so I'm so glad he went and he ended up being fine. He didn't have any anaphylactic reactions, but he could have. And I needed to accept that possibility and acknowledge that whenever that, that kind of fear would come up.

• 39:42David Puder?

  Yeah, that's, that's great. I could see how you're actively using your own, your own things you're learning here.

• 39:50Speaker 01

  Yeah.

• 39:50David Puder?

  I, I think like, um, in one of your other podcasts, you talked about like sleepovers and the risks of sleepovers. And, um, I have to admit, I was listening to it and I was like, I'm, I'm like paranoid to let my kids do sleepovers, you know, like,

• 40:07Speaker 01

  Yeah.

• 40:08David Puder?

  I have like, you know, I mean, there, there's like a couple of couples where I'm like, maybe, you know, but I'm like paranoid, you know?

• 40:18Speaker 01

  Yeah. And I don't blame you, right? I feel anxious about it too.

• 40:21David Puder?

  Yeah.

• 40:22Speaker 01

  Let my kids have sleepovers because I really do think it's this really important thing for them to be able to do developmentally. Like it's, it's a fun, you know, a way to connect with their kids, with other kids and to like have some independence. And so, and I, and I will say part of my anxiety comes from the piece that like I treat post-traumatic stress disorder oftentimes stemming from child sexual abuse. And so I, you know, I've had, long had a fear of that happening at a sleepover. And so for me, right, from a very early age, I was talking to my kids about, you know, okay touches, not okay touches, and what to do if a not okay touch occurred. There was a book I would read to my kids called my underpants rule. And, you know, like we talked about it all the time. That's fun. So that like,

• 41:04Speaker 01

  I feel pretty confident if they ever were touched in appropriately, they would, you know, know to tell me immediately. And that doesn't fully protect them. Something bad still could happen. Obviously, there are other things that could happen at a, you know, at a playdate or sleepover too. And I've decided, same idea, to, you know, accept all those things could happen. And I think it's a reasonable risk to take to let them have those sleepovers. So that's where I've fallen.

• 41:30David Puder?

  Hmm.

• 41:32Speaker 01

  Or where I've landed there.

• 41:34David Puder?

  That's good. I think a lot of emotion comes up for parents in the bedtime routine. And just like kids protesting going to bed, kids protesting brushing their teeth, kids protesting, you know, each individual step that moves them closer to bed. So, so like, how do you redeem the bedtime routine?

• 41:56Speaker 01

  Yeah. It's such a good question. And it's one, I think, we all struggle with myself, right? So I want to be clear that like, that is normal to be expected. And I may not have, my answer may not work for, for you or for your listeners. I think the more, though, we can focus on regulating our own emotions in those difficult moments, the more likely we're going to be met with success. Because what can happen is when our kids start protesting, naturally, they don't want to go to bed. And so they're like, oh, no, I just want to play for another 10 minutes. I don't want to brush my teeth. Or like, I don't want to go to bed ever. Right? Like, they're saying that. We have this natural reaction. It brings up that discomfort in us. And the way we want to try to get rid of that discomfort is by exerting

• 42:38Speaker 01

  control over them. So we're like, nope, you have to brush now. Or, okay, you can have five more minutes, but then we're brushing and you're kind of like, you know, maybe you're getting a little firm in your tone in a way that can be kind of disregulating for kids. And so I'm not saying you can't be firm. I actually think a firm, firm, you know, like, just, nope, sorry, sweetie, I know you want to do this. And this is, you know, or I know you don't want to brush your teeth, and it's time to brush your teeth. That's some being firm, but doing it in a kind, loving, compassionate way, as opposed to, you know, kind of really coming down hard on my kids. As I say, now is the time to brush your teeth. And so really, the more we can keep our own cool in the moment, even if we're like, act from a place of calm, even if we're not quite feeling calm inside, and this is where opposite action comes in, right? Like, I can let my value of, I want

• 43:22Speaker 01

  to show up ideally on an ongoing basis with my kids in a kind, loving, compassionate, supportive way. And so I can do that in a respectful way, I should add in. I can do that even when I'm feeling. Frustrated, annoyed, angry inside. That's opposite action. That's acting opposite to those emotions that I may be feeling in a given moment. And I can do that then. So again, you know, you may, I mean, what you decide on one night might be different from another night. Maybe some nights you're able to give, you know, you have a little more bandwidth. You're not as fried that night. Maybe other nights you're just absolutely exhausted and like you can't stay up another second longer for them to dilly-daddle. And so you decide, you know what? Hey, sweetie, I'm sorry. We, you really do have to get ready for bed now. And if maybe get in there and lovingly help them, right?

• 44:06Speaker 01

  If they're having a hard time parting from a toy and like, oh, you know what? I'm gonna give you a helping hand. I'm gonna walk you over to your room so we can get started with bedtime. And so you can do those sorts of things that might help expedite the process. But the more you can like also when the, when they're stalling, not get worked up about that or not like start acting kind of heated in the moment. Cause if you start coming down hard on your kids or really trying to exert control, oftentimes kids pick up on that. It dysregulates them even more. And then what do you know, you're gonna have an even harder night in your, in, in store for you.

• 44:40David Puder?

  Hmm. Okay, that's good. Yeah, I like, uh, multiple warnings, like, okay, three minutes. And then I like starting to shut the lights off. And then a routine, like this happens and then this happens and this happens and then this happens and this happens.

• 45:00Speaker 01

  Yeah, oh yeah, for sure. Those routines are so helpful for kids to have in general. Yeah.

• 45:04David Puder?

  Yeah. But I think that kind of keeping our own cool. But you know, I, I, I appreciate that you say like, it's okay to be firm. It's as a parent. Is there ever a role for a parent to shame their kid?

• 45:23Speaker 01

  So again, I want to be clear, like, I don't think there is a writer, like, I don't think there's only one right way to parent. And so I, there may be some folks listening who are like, you know what? I think shame is really important sometimes. And I don't want to tell you that you're doing it wrong by any means. If that's working for you, you think that's important, then by all means, you don't have to change a thing there. For me, though, what I would say is, again, if you come back to that idea that we do best when we feel better about ourselves, right, I think coming when we shame our kids, oftentimes we leave them feeling badly about themselves. They feel like, oh, now I'm a bad kid in some way. And so oftentimes, we're gonna then see more of that behavior we don't wanna see because they're not feeling good about themselves.

• 46:03David Puder?

  Hmm.

• 46:04Speaker 01

  I also like, you know, what the way we talk to our kids is gonna be kind of how they learn to talk to themselves, too. And ideally, just like, we don't wanna beat ourselves up for it, you know, when we're having a hard moment, when we make a mistake. I don't want my kids to do that. And I want them to see me as a safe person to come to, even when they do mess up and make mistakes.

• 46:23David Puder?

  Right, right.

• 46:25Speaker 01

  Um, as opposed to like, oh, no, I can't let my mom know that I did this because if I do, she's gonna shame me for it. So that's my, my way I come in. I'd rather not use shame as a way to bring about the behavior I wanna see, but instead, I'd rather use that connection, connect with my kids. And maybe, maybe that means there's not gonna be a change in behavior right here, right now.

• 46:44David Puder?

  Hmm.

• 46:45Speaker 01

  But maybe later on, I'm gonna be more likely to have that. So just as an example, the other day, my son was, um, he had like a thing of black beans. We put like our beans into these big containers. And this one doesn't have the greatest lid. And he was like flipping it upside down. I was like, oh, you know what, sweetie, I think that might actually come off if you keep doing it. Well, you know, he did it one more time and flew off. We have black beans all over the kitchen. And I was kind of annoyed. I was like in the middle of cooking dinner and, you know, like, it was kind of the last thing I needed to have to deal with. And I recognized that in that moment, shaming him, like, oh, I told you not to do that. And like, now we have this big mess on our hands. He already felt bad about it. There was no need to add that extra layer of shame. And so I was just

• 47:27Speaker 01

  like, you know what, it happens. Now you know. Now these probably shouldn't be flipped upside down. Let me get in there and lovingly help you. And that's what I did. Yes, it made my day a little more stressful. But from my perspective, there was no need to shame him in the moment. He learned the lesson. And he probably, like, first of all, I made sure to not convey any annoyance, even though I was annoyed. Maybe he could have picked up on some of it, but I don't think he did. And yet, he probably apologized to me like fifteen times in that interaction, which even, and I let him know, I was like, there's, you really don't need to apologize. Like, I know you didn't mean to do that. But he did feel, he felt so badly already. So why come down hard on him?

• 48:03David Puder?

  No. Yeah, absolutely. No, I, I, I think of the scenario where like,

• 48:10David Puder?

  We're in a parking lot and my son's running between two cars. And he's about to hit the section that I can see a big car going really fast.

• 48:19Speaker 01

  Yep.

• 48:19David Puder?

  And I yell like, stop.

• 48:22Speaker 01

  Yeah, yeah.

• 48:23David Puder?

  And he stops and crumbles and cries, but then he realizes there's a car there, but he's still like that. That crumbling is the experience of shame, right?

• 48:33Speaker 01

  Yep.

• 48:33David Puder?

  Where it's like, yeah, but you're about to die.

• 48:36Speaker 01

  But you didn't. Yeah, I mean, to be clear, in a situation like that, please yell, right? Yell like a kid because again, that's life or death right there. And so you don't have to worry about making them feel bad in that moment. You, your job then is to keep them safe. And so I think, yes, right? To keep them alive, exactly. And they may not, it might not feel good being yelled at in that way. But it's really important. And so, and again, so I like there, yes, I think there's a time and place when safety is like truly an issue, you can raise that voice and know that, but you weren't trying to shame him in raising the voice. Right? You weren't raising your voice to shame him, to make him feel bad for running ahead. It was more to make sure you could keep him safe.

• 49:16David Puder?

  Right? Yeah. And I think the other thought that I have though is like, okay, if we're hiding our frustration, are we hiding from them the ability to, to know how they're, how they're leading for us to be experiencing them?

• 49:34Speaker 01

  Yeah.

• 49:34David Puder?

  Okay, so let me, so let me give like a question, the question here, okay? So imagine they're doing something that's annoying. And you as the parent are being annoyed and they do, they're doing it over and over again.

• 49:48Speaker 01

  Yep.

• 49:49David Puder?

  And so would you tell them that they're being annoying? Or would you take a more positive parenting pseudoscience, pop culture sort of take of like, not telling them, right? And now they're going to be annoying around their teachers. They're going to be annoying around their friends. They don't know how annoying they are, maybe, you know? And I even see some parents like, like only always defend their kid. Their kid, nothing is ever wrong with their kid. Their kid does no wrong. Their kid starts annoying the teachers now, annoying their classmates, but it's always the parent's problem, or it's always the teacher's problem.

• 50:31Speaker 01

  Right, never the kid.

• 50:32David Puder?

  It's always the other kids. And so what role do we have in that sort of?

• 50:38Speaker 01

  Hmm, such a great question. So I think you certainly could let them know, hey, sweetie, you know what? I'm finding myself feeling a little annoyed when you do that. Right, you could let your kid know that. But I think a few things to keep in mind is that sometimes just our kid knowing that they're like kind of pushing our buttons for some kids might like lead them to wanna see like, oh, well, like, how far can I take this? And like, how long is it gonna take before mom or dad kind of snaps because I'm annoying them? So for some kids, that might lead them to do even more of the thing that was annoying you. But if you can, especially in a moment of calm, talk about it, sure, you could tell them. And I would say recognizing that that may not lead to a change in the behavior.

• 51:20Speaker 01

  Maybe it's become a habit for your kid in some way to do something that you find annoying. And that might not change right away. And so every time, if every time they do that behavior, you're like, you know what? That's annoying, right? Remember, I told you that was annoying? It's probably not gonna feel that good for you. It's gonna reinforce the belief that you can't tolerate that annoyance without having to try to correct it and change it in that moment. And then again, it might not, you know, it might not actually lead to change. So you might get more and more frustrated and exacerbated and more annoyed. So just as an example, my daughter, she is the sweetest person. And she will oftentimes, when I'm like, especially in the kitchen, and I am trying to move around quickly and do lots of stuff, she just wants to stand like right next to me, which is the sweetest thing, right?

• 52:05Speaker 01

  Like, but when I am busy and I'm working, like, you know, trying to go fast, like, I actually find it really annoying. And I've told her that before. I was like, oh, sweetie, like, when I am really busy in the kitchen, it's hard for sometimes, I like, I love that you wanna stand near me and... Sometimes it's hard for me in those moments because I know that like I need to move and I can't because I'm kind of like boxed in a little bit. And so I've let her, I let her know that one time.

• 52:29David Puder?

  Okay.

• 52:29Speaker 01

  She still stands next to me all the time.

• 52:31David Puder?

  Okay.

• 52:31Speaker 01

  And so I try in those moments to just accept it, right? And to like see that it is this beautiful thing that she wants to stand so close to me. I feel a little annoyed inside and don't try to change it, correct it all the time. She knows. And every now and then I think she moves a little bit away if I like, if she can tell I'm like having a hard time moving around. But I, I don't feel the need to like let her know. And you know what? Maybe friends, maybe teachers, maybe sometimes she's standing close to them in a way that they may find annoying. And maybe one day they're gonna let her know. For me, I'd rather it happen that way. Like, you know, then maybe she learns, okay. And I also don't know that she does that with her friends or teachers necessarily. I think it might just be a thing she does with me.

• 53:12Speaker 01

  But that's just one example where like I, yes, I have let her know while also accepting that behavior is probably not going to change anytime soon. And in some ways I hope it doesn't, even though it does kind of, you know, just regulate me a bit.

• 53:25David Puder?

  Okay, I like that. I like that. Okay, so here's my, I want, I want your feedback on my approach here, okay?

• 53:31Speaker 01

  Okay.

• 53:32David Puder?

  So my daughter started saying sigma this and sigma that because you know, it's like kind of the vernacular, right? So every time she would say it, I would start to sing Baby Shark, okay? And she like, within a day, stopped saying sigma this, sigma that. So what do you think? Good approach?

• 53:53Speaker 01

  I mean, it sounds like you did it in a playful way. My guess is you weren't like, you know, right? So you didn't shame her for being annoying.

• 53:59David Puder?

  Baby Shark.

• 54:00Speaker 01

  You just decided to do something that was a little annoying too. And yeah, I think that's totally fine. You could do that for sure. And if she kept saying sigma, I would say, accept it. That's what she's gonna do now. And I think the big thing, like both with the treatment for anxiety with exposure therapy and what I try to help parents do is instead of seeing those moments where you feel annoyed, anxious, angry, as like these terrible moments that should be avoided at all costs. What if instead we shifted that lens and started to view those moments as golden opportunities to practice relating differently to those uncomfortable emotions? So learning, it's not about, you said like, if we're hiding that we're annoyed. But I wouldn't think of it as hiding or suppressing that annoyance, just learning, yeah, right, I can feel that.

• 54:43Speaker 01

  I can acknowledge it, accept it. Maybe I even sometimes let my kids know I am annoyed. And I can choose to act opposite. And when I do let them know that I'm annoyed, like you can say, yeah, I do find that behavior annoying, but making it clear like whether or not I find that behavior annoying, to be honest, is still on me, right? Like, not everybody may find the behavior annoying. So it's not like it may always an objectively annoying behavior. But even if it is, I don't have to be annoyed by it. And if I am, it's still my responsibility to choose how to navigate that, because the only person we really fully control is ourselves. And so if we're fixated on controlling our kids, getting them to stop doing behaviors,

• 55:25Speaker 01

  maybe we get one behavior to stop, but another one's going to crop up. So rather than see those moments where these annoying, frustrating, infuriating behaviors show up as like terrible moments, what if each time we saw those moments as those fabulous opportunities or gifts from the universe, a chance to practice building those muscles for relating differently to unwanted emotions?

• 55:46David Puder?

  Hmm. And then, so what about if if the child is like very emotionally dysregulated? And I think this is kind of like the same answer from what I've heard from some of your other interviews, but it's like this kind of idea of if they're very dysregulated and you're dysregulated to kind of see that as an opportunity to grow in these these strategies? That's that's

• 56:10Speaker 01

  Yeah.

• 56:11David Puder?

  Kind of a nice, a nice way of flipping the script of like, okay, how can we, how can we learn from this, you know, this moment? Right?

• 56:23Speaker 01

  Yeah, yeah. And it's easier said than done, right? To like view these really, really difficult moments with our kids as, again, gifts. And I think when we can, we can recognize like, oh, wow, instead of me losing it in this moment, even though, you know, I'm feeling dysregulated, my kid's dysregulated, rather than lose it, which is probably just going to fuel whatever's going on for our kid, right? Or maybe it maybe it even gets my kid to stop in their tracks and they like, you know, stop having their tantrum, maybe because they're really kind of afraid in that moment. But even if that happens, that emotion doesn't just go away altogether. And then they kind of learn, oh, it's not safe to express these feelings in front of mom. And so I have to like, kind of shove them down when they show up. If instead I can be welcoming and accepting of their emotion as well as mine.

• 57:08Speaker 01

  Practice on my end, you know, maybe it's opposite action, maybe it's mindfulness. Maybe I bring out some other distress tolerance skills to help me weather that storm without doing something that's going to make the situation worse. Then I can be somewhat of like a grounding force for my kid instead of fanning the flames of their dysregulation. Maybe they can see, they can borrow some of my calm and it may, you know, maybe that emotion still needs to run its course and so they're going to lash out, they're going to yell, they're going to scream for a while. But eventually afterward, oh my gosh, like how connecting is that for a kid to see, wow, you were willing to wade into that really difficult moment with me, not like shame me for that, not try to fix things, get in there, swoop, you know, swoop in and try to solve everything, but let me feel that way.

• 57:52David Puder?

  Hmm.

• 57:53Speaker 01

  Even though you were having a hard time too, maybe your kid doesn't even realize that, maybe they do. But that can be like, wow, they can feel so accepted, so seen and so safe in a moment like that. And as parents, for me, like when I'm able to do that, and to be clear, I'm not always able to, you know, to stay calm in those really heated moments, but when I'm able to, it feels so empowering, like wow, I just did that. Like I was so skillful in a moment when I could have so easily lost it.

• 58:21David Puder?

  That's good, yeah.

• 58:24David Puder?

  That's good. Okay, so it seems like there's this kind of, you know, a couple of new challenges that parents have to face. One I would say is youth sports and the all encompassing nature of youth sports and then how it kind of like can pull the family in many different directions. And how do you feel like this relates to that in general and kind of like this, the new challenge of what it's like to parent, you know, with, with the demands that our

• 59:05David Puder?

  kids are like sometimes being pulled in many directions, you know?

• 59:12Speaker 01

  Yeah, it doesn't make our lives any easier by any means. I think it can, you know, if we are taking our different kids to, you know, multiple sports, multiple nights a week and on the weekends, we're at, you know, baseball tournament, after tournament, soccer tournaments, right? We're like kind of all over the place. Well, I mean, we're all gonna be exhausted. And so I'm not saying that's if that if you really value sports, your kid loves to play soccer. Right? Like, I'm not saying your kid shouldn't play soccer, but I think recognizing that that might leave you more vulnerable. So coming back to like, understanding our emotions, that might make you more vulnerable and your kid more vulnerable to to sometimes experiencing those unwanted emotions. And so I think just recognizing that can be really important because then you can decide,

• 59:55Speaker 01

  is that a vulnerability factor that you want to change in some way? So for instance, my son loves baseball and he was on a travel team for a bit that, you know, was pretty demanding. And he actually, we purposely found probably like the least demanding travel team of all because we know ourselves. We knew that was going to be too much for us and probably for him, although he probably could play all the time. Um, but we ended up deciding to shift just to doing the like local little league. So, you know, we do that instead, he plays with his friends. We actually have a coach sometimes that like has, you know, occasionally he'll do like a one on one lesson, but it's that. And we don't do the higher level because for us, it's just, it's too much. And we're not going to be our best selves if we're constantly schlepping him from place to place to place for games and stuff like that.

• 1:00:39Speaker 01

  And I think for kids, if they don't have that downtime, they're coming home from school and then they're practicing for hours every day and they never have that unstructured playtime.

• 1:00:48David Puder?

  Yeah.

• 1:00:49Speaker 01

  How are they not going to serve them all that well unless that's like truly their passion? And that's really what they want to do. And then by all means, assuming you feel like you've got the bandwidth to support that, then you can do that.

• 1:01:01David Puder?

  Mm hmm. Okay. Issue number two is probably screens.

• 1:01:06Speaker 01

  Mm hmm.

• 1:01:07David Puder?

  And, you know, how much screens, how long?

• 1:01:13Speaker 01

  Yeah.

• 1:01:13David Puder?

  Uh, thoughts?

• 1:01:17Speaker 01

  Again, I don't know that there's a right or a wrong answer, but for many families, I think they find that their kids tend to be more dysregulated after being on the screen and that the screen, even if that's not the case, it can, for kids, almost like. It it doesn't give them the chance to learn that they can be bored, that they can find something to do.

• 1:01:38David Puder?

  Yeah.

• 1:01:38Speaker 01

  In a moment when there's nothing else to do, right? They can come up with their own thing. And so for me, my kids watch TV. They don't have, you know, they aren't, my daughter has like a phone that doesn't allow her to do anything other than text or call. But you know, she's got it, but she doesn't want to be on it because it's really boring. It's like one of those dumb phones. That's what we do and we do let them watch TV, but but otherwise we don't really have much in terms of screens. And, you know, other families will, but we made that choice just because it is dysregulating for them and I want them to be able to choose something else. There was a day one time where I was in sessions and they were both home and

• 1:02:17Speaker 01

  they watched a little bit of TV, but then I like let them know, you know, it's gonna be an hour or something like that of TV and then that was it. And they were kind of gonna be on their own to entertain themselves. And they ended up deciding, we didn't have the game Clue, they ended up deciding to make the board game Clue together. Like.

• 1:02:31David Puder?

  Wow.

• 1:02:32Speaker 01

  If they had just had unlimited access to screens all day, that wouldn't have happened. And now we have this game of Clue that we play all the time as a family. We wouldn't have had it. So I again, that is not, that's just, you know, my, in my family, I think in other families, they may choose to have screens or more. I think it's just noticing. How does that leave your kid afterward? Are they more vulnerable to those like, you know, meltdowns afterward? If so, it might be worth considering shifting and then you may need to problem solve with your kid. Talk about it. Let your kid know, you know, hey, I've noticed that like after you're on your computer, on your iPad for an extended period of time, like you seem to be having a harder time, right? It's hard to come back, be with the family. And so I wonder like, what do you think we could do? Have a conversation there?

• 1:03:16Speaker 01

  And then, you know, again, I I ideally go from there and sometimes you may decide, like even though your kid may not be open to it, that like you're gonna enforce some new limits. You know, you don't always have to wait for your kid's permission to say, take away the phone or the, and but you may choose to do something along those lines or to limit the times when those screens are allowed.

• 1:03:36David Puder?

  Yeah, that's good. I like how you approached it of as a parent, notice if it's making them more emotionally dysregulated. We have, they have iPads, they can play chess as much as they want. That doesn't seem to emotionally dysregulate them.

• 1:03:51Speaker 01

  Yeah, because they're using like their brain. It's not just this passive watching, right? And they're actually being active there.

• 1:03:58David Puder?

  Yeah, whereas like, and I think there's, you know, from a lot of the studies I've looked at, once you go beyond an hour and a half, two hours a day of screens, like you're having issues, you know, increase. And I think with the short form video, TikTok, and the access to all that stuff, my patients who use a lot of those things, they can't read anymore.

• 1:04:20Speaker 01

  Yeah.

• 1:04:21David Puder?

  And imagine growing up as a kid and not being able to read, or like, I'm hearing it from teachers as well, patients that are teachers, it's like, the kids cannot, their attention span is so short, right? And so, I love, I love your idea of like, okay, boredom is not a bad emotion, right?

• 1:04:41Speaker 01

  Yep.

• 1:04:41David Puder?

  It's, it's good to be bored. Out of, out of boredom comes creativity. Okay.

• 1:04:48Speaker 01

  Can I just jump in for one more thing?

• 1:04:50David Puder?

  Yeah.

• 1:04:50Speaker 01

  Because I think that point you noted about like, right, the social media, it's all these like quick videos that, and then you just keep scrolling and there's always one more and you just kind of want to keep doing it. It's so hard to resist the urge as adults, right? To like, want to not just look at everything. And our kids don't, their prefrontal cortexes are still developing until the age of 25. Now, we may not say they can't have social media until 25, so you may decide at some point to let them have a phone, let them be on social media.

• 1:05:18David Puder?

  Right.

• 1:05:18Speaker 01

  But I think it's worth having those conversations with them about that, right? That like, this really is designed to pull you in. It can be really hard to stop. And like, if you find that you're struggling with that, you know, I'm here. I want to know. I want to try to help you. So even just that, if you decide you want to let your kids have screens, I think having a really open conversation, normalizing that experience, so that ideally if they do, because, you know, kids are pretty unsightful and they'll realize like, you know, I can't pull myself off, but I also don't really love how I feel afterward, then they can open up even if you don't notice something going on there.

• 1:05:53David Puder?

  Yeah, and um, yeah, okay. The third, the newest issue, the newest iteration is kids' use of AI. And so what I heard, what I've heard is that a lot of them are not, it's not like they're using AI as the new Google, you know, Googling things. There's some, some people do that, but they're actually interacting with AI to get advice on every decision that they're making, some of these kids, to almost like decrease the anxiety.

• 1:06:26Speaker 01

  Yeah.

• 1:06:27David Puder?

  Thoughts on that?

• 1:06:28Speaker 01

  Oh, well, I mean, that's my jam, right? Like, that's what I want to talk with them about, how totally makes sense that you'd want to try to decrease that anxiety, that you'd want to like be as confident as possible that you're making the right decision. And I want to talk with them how, about how each time they do that, they turn to AI to get the right answer, the best answer, that strengthening that belief that they can't tolerate the anxiety they feel when they're unsure as to whether they're making the right decision or not. And there are going to be moments in their lives where they can't turn to AI, where AI might even lead them astray. And so, and, right?

• 1:07:05David Puder?

  Oh, I've seen it.

• 1:07:07Speaker 01

  Yep, and not only that, but, you know, anxiety is going to show up. So what, what tends to happen with avoidance is that it grows and spreads over time, right? Because each time, we avoid anxiety in some way. So we feel anxious about a decision, go on AI to get an answer, and then you reduce anxiety. Well, now that habit, I've strengthened that habit. So the next time I'm feeling anxious, whether it's about a decision, or maybe even something unrelated, a school presentation, a dance, you know, my basketball game, whether I might be contaminated, right? Like, whatever it may be, that I've now strengthened that habit of reducing that anxiety through avoidance. And so I'm probably going to be more likely to need to turn to some sort of avoidance behavior.

• 1:07:50Speaker 01

  And what can happen over the long run is that avoidance, again, it grows and spreads as kids or people's worlds contract more and more. There's less and less they can do either, like... You know, full stop, they just start avoiding more and more things. Or there's less and less they can do without some sort of avoidance behavior or ritual onboard. Where they're, you know, maybe they're approaching a given situation, they're making a decision, but they're only doing so with AI's help, right? Or with some other kind of thing there that's going to try to reduce their anxiety at the moment. As opposed to learning, no, I can let anxiety be there in full and not need to let that anxiety dictate what I do or don't do. I can sit with the anxiety and the uncertainty and still make those decisions. And then see what happens. That's how we learn too, right?

• 1:08:33Speaker 01

  We like learn by making mistakes sometimes. And then, and so that almost like robs them of that process too.

• 1:08:41David Puder?

  So good, so good. Yeah, I, I, I was listening to this one person who was like, he had a nutrition background. AI told him to use sodium bromide instead of normal salt. And he like created some toxicity. I don't know if you've seen that clip of this girl who fell in love with her psychiatrist or whatnot. They say she, she thought the psychiatrist fell in love with her and she's like, there's these, it's, it's really viral right now on like TikTok and X and stuff. And she's like holding up Chat, Chat GPT. And Chat GPT is telling her, you are the oracle. You are the one standing up against all that is evil in the world.

• 1:09:24David Puder?

  You are the one who sees truth for what it is. And like she's, she's smiling and this kind of like, yeah.

• 1:09:32Speaker 01

  Yeah, this is, this is truth. Yeah.

• 1:09:34David Puder?

  I'm, I'm the oracle.

• 1:09:38David Puder?

  And so, but I, I think this kind of speaks to exactly what you were talking about. Where it's like, it's reducing her anxiety. Probably I, the way that I see it with this particular case of like attachment anxiety. Like, like, okay, I'm, I'm, it's, it's reassuring me, you know, over and over again, right?

• 1:09:58Speaker 01

  Yeah.

• 1:09:59David Puder?

  Um, which can kind of like decrease the doubt.

• 1:10:02Speaker 01

  Yep, in the moment.

• 1:10:04David Puder?

  In the moment, in the moment. Yeah.

• 1:10:06Speaker 01

  Yeah, yeah. But it's a short term fix, right? As opposed to the long term power of a learning that can come. And we say like, oh, wow, I can feel that anxiety, that doubt and not have to do anything to try to make it go away.

• 1:10:19David Puder?

  Great, great. Well, I, in this, in this time spending this with you, I would probably refer a patient to you. I think like, there's, there's a, yeah, I can tell like, there's a lot of goodness that you're, that you're giving to people. And so if people are wanting to connect with you after this, are you on social media at all?

• 1:10:44Speaker 01

  I am. I'm on Instagram a little bit. I'm still really honestly learning how to use it. Sometimes I'm like, I don't even know when somebody mentions me in a reel. I'm like, how do I even accept that? But I think I've figured that part out. But I'm still getting familiar. So I'm on Instagram at @emotionssavvydoc. And then they can also go to my website, alyssajarred.com.

• 1:11:04David Puder?

  Okay. Thank you, Dr. Jared, for, for your expertise and for coming on here. Anything, just kind of as we wrap up our time, anything that you feel like you didn't quite hit? That it's like one last little pearl that you would like to share to a group of mental health professionals listening to this, or future mental health professionals?

• 1:11:26Speaker 01

  Oh, yes. Yeah. So I think for those mental health professionals, we are in this job, most of us, because we want to help people. And what I see oftentimes is the writing reflex kicks in. Right? It's hard to see a patient in distress, a patient who's struggling with anxiety, for instance, or any other emotion. And we want to jump in and fix things. And so a lot of times there are, you know, tools, coping tools that psychiatrists, psychologists, social workers are offering. And I will tell you, especially when anxiety is the kind of thing that somebody's really struggling with, those coping tools, you know, breathing, retraining of some sort, box breathing, or, you know, maybe saying a certain mantra to themselves, those sorts of kind of things

• 1:12:10Speaker 01

  that are intended to reduce anxiety in the moment, they may work wonders for a period of time. At some point, they're probably not going to work all that well for people. And so again, as therapists, as much as psychiatrists, you know, the listeners here, as much as you may want to try to jump in and fix the emotion in the moment for them, maybe even prescribe a benzo so that, you know, if they're having panic attacks, you can, they can stop. It might work for a period of time, but it's actually going to reinforce that habit of trying to reduce anxiety through avoidance. So in the long run, it's probably not going to serve them all that well. And most of the people, not most of them, a lot of the people I end up seeing are the people who were prescribed a benzo, who were taught coping skills by a former therapist.

• 1:12:55Speaker 01

  And maybe they got by for a period of time until those tools, the medication stopped working and now they're really struggling. And so I think the kind of more compassionate thing we can do, even though it's hard to see people in distress, is to, you know, to teach them a new way of relating to that distress. If that's something you know how to deal, maybe referring them to a therapist who can do so.

• 1:13:18David Puder?

  Yeah.

• 1:13:20David Puder?

  Yeah, good. I think there's like exposure response prevention and

• 1:13:26Speaker 01

  Yeah.

• 1:13:26David Puder?

  those types of things have taught me a lot about just not trying to get rid of the anxiety so quickly, right? It's like

• 1:13:34Speaker 01

  Or even at all.

• 1:13:36David Puder?

  We can be a part of the avoidance with our clients, right?

• 1:13:39Speaker 01

  Yeah.

• 1:13:40David Puder?

  Whereas the sitting in the doubt, whether for OCD or sitting in the anxiety can be so potent and trying to reduce the shame, trying to reduce the internal critic of the person in the midst of that.

• 1:13:56Speaker 01

  Yeah.

• 1:13:57David Puder?

  Yeah, good stuff. Okay, well, thank you so much for coming on. I really appreciate it and we will leave it there for today.

• 1:14:05Speaker 01

  And thank you so much for having me. It was so fun talking with you.