Treating Childhood Anxiety with a Mega-Dose of Independence

Whether you read scientific journals or The Washington Post, you have no doubt seen many pieces about how anxious kids are these days. Unfortunately, it’s true. The numbers are grim and they’re everywhere, so I won’t bore you with them here. As a clinical psychologist, I’ve trained practically all my life for this. Many of my colleagues and I use a highly effective, state-of-the-art treatment for child anxiety disorders called exposure therapy. The idea is simple, but the science is complicated.

Exposure therapy is currently the best treatment we have, but it’s not doing a damn thing to slow down the runaway train of anxiety in children and adolescents. We need something new, and some of us may be on to a solution—intense and frequent child independence. The beauty of this approach is that practically anybody can do it, and you don’t need to pay for some highfalutin Ph.D.

Before I describe how this promising treatment works, let’s spend a moment examining why anxiety is so difficult to manage. When kids (and adults, for that matter) are afraid of something, from spiders to plane crashes, they avoid those things. And man, is this strategy effective. We are brilliant at distracting ourselves from uncomfortable thoughts and situations. It’s often as easy as opening the Twitter app on your phone. You are instantly transported to a world of voyeurism and outrage. Problem solved. What was I worried about again? Here’s the rub. This only works temporarily, and sometimes that means just a few seconds of relief. In no time, those thoughts are back. Like Randy Quaid’s character in the Vacation movies, no matter what you do, they keep showing up.

But why doesn’t anxiety stay away once we’ve temporarily banished it? Because it is evolutionarily advantageous for anxious thoughts to return. As I tell my patients, anxious thoughts are “sticky” for a reason. But how could being miserable and anxious be advantageous? Because, sadly, your genes are indifferent to your happiness. They are all about replicating themselves and thus only “care” about your survival, not whether the ride is pleasant. Homo sapiens who could successfully rid themselves of anxious thoughts and get back to daydreaming about the attractive potential mate in their tribe were less likely to survive. That is because the rattling noise behind the bush was sometimes worth ruminating about. Prehistoric ancestors prone to anxious worry were less carefree, but more likely to survive. We are all the descendants of these neurotic hunter-gatherers.

Avoidance also doesn’t work as a long-term strategy because it makes what psychologists call “corrective learning” impossible. Once we get it in our heads that something is dangerous, we don’t change our minds easily. If you think something is dangerous, you will hold onto your initial assumption until you receive a lot of disconfirming evidence. Our brains operate on the principle of inertia; they are as skeptical as Vizzinni from The Princess Bride (“Inconceivable!”).

The problem is that you cannot disconfirm a fear when you avoid it. “Thank God I crossed the street when that tiny white dog was walking toward me. They are killers!” will stay in place unless you pet that dog (and many other dogs) without getting bitten. This cognitive stubbornness is, again, for evolutionary reasons. Holding on to a fear is annoying, but it increases survivability. When you take the long way home to avoid something, all you lose is a little time. Easily letting go of fears can mean missing a real threat and thus the end of you (and your genes).

So, clinicians who are skilled at delivering exposure therapy will work with kids (and their parents) to devise “approach” tasks where kids repeatedly face their fears. The trick, particularly with kids, is to find exposure activities that they are willing to do, but that also elicit high levels of anxiety. This is no easy feat. For most kids, spending an hour after a long day of school in a therapist’s office facing your greatest fear is probably the last thing you want to do. Lots of kids refuse. And lots of therapists are too reluctant to even suggest exposure therapy because they feel bad for the patients, or are so anxious themselves that they aren’t willing to witness it. The result is very few kids with life-impairing anxiety receive a full course of exposure therapy at the intensity required for sustained improvement. This has led to a spiraling pandemic of anxiety where the best treatment we have is viewed pretty dimly by those who need it and those who are supposed to administer it.

Well, what if we could get all the benefits of exposure therapy through a treatment that kids not only don’t hate, but are actually excited about? Sounds impossible, right? Maybe, but it’s possible my graduate students and I (and some other smart people) have hit upon an idea that is bold enough to work.

Before I get to that idea, I need to briefly describe three other trends that have been occurring while (and before) children’s anxiety rates began soaring. First, parents have been spending more time with their kids. Second, kids have been taking (or more accurately, being allowed to take) fewer risks. Third, kids are playing less with other kids in person. All three trends are intertwined and add up to plummeting child independence. I think less independence is at the center of why so many kids are anxious. But how does less childhood independence lead to more anxiety? In so many ways!

When parents hover and prevent children from independently exploring the world around them, they foster many of the processes that scientists have identified as causes of anxiety. Kids who don’t practice independence (yes, it is a skill that withers without practice) are less self-confident, have worse social skills, are less tolerant of uncertainty, have worse problem-solving skills, and are less resilient. They overestimate danger, underestimate their own ability to handle problems, and catastrophize when things don’t go as expected. Kids need lots of practice with what I call the four Ds: discomfort, distress, disappointment, and (mild) danger. When parents step in to “save” children from the four Ds, they inadvertently weaken children’s ability to successfully navigate these integral parts of life. In contrast, independence is a fantastic way for kids to get this practice and without even realizing it, inoculate themselves against anxiety.

There are lots of good reasons well-meaning parents don’t encourage independence. To help, we developed a short and easy to administer “treatment” that consists of mega-doses of child independence. A lot of this work is inspired by the work of Lenore Skenazy and her organization,, which has spent over a decade warning America about the perils of plummeting child independence. They encourage parents to “let go and let grow” so that kids can do what evolution has prepared them beautifully for—doing stuff without their parents around to gum it up. Lenore is not a psychologist or an academic. Her lack of formal training (plus being from Queens, NY) has allowed her to think outside the box and hit upon what practically everyone in my field was missing. If you break down barriers to independence, kids will flock to it, and they will be the better for it.

So, here’s where my students and I come in. We have developed a 5-session treatment that can be administered in person or over Zoom that consists largely of educating parents and kids on the benefits of independence. We brainstorm daily “IAs,” or independence activities, and follow up to see how things went and reinforce the lessons kids learned from their experiences. But here’s the really exciting part. These independence activities (unlike exposure therapy assignments) are purposely meant to be unrelated, on the surface, to the things kids are anxious about. We think you don’t need to make kids face their exact fears to make those fears better. As we have joked, “So you’re scared of the dark, go to the corner and buy me a half a pound of salami!” In other words, IAs are “topographically” different (a term psychologists borrowed from map-makers) from a child’s anxieties. They are helpful because they exercise many of the psychological muscles needed to better tackle anxiety. IAs increase resilience, tolerance of discomfort and uncertainty, social skills, and smart risk-taking. For example, one of the first kids to go through our treatment was afraid to sleep in her own bed at night. This 9-year-old picked taking the bus to school by herself as one of her big IAs. She did a beautiful job and came home beaming about how grown up she felt. That night, she proceeded to sleep in her own bed for the first time in her life.

Obviously, this is an anecdote, but it is informative because it demonstrates that our theory may be right. What we have learned is that you don’t need to make kids miserable with the treatment in order to help them become less miserable from anxiety. You can have the best of both worlds.

The definition of an IA is an unstructured, developmentally challenging task that is performed without any help from adults. IAs often involve adventure and mild risk of discomfort or danger. These activities are typically chosen by the child and fall into four categories (outdoor, indoor, with other children, involving mild risk of injury). Examples of outdoor IAs include riding a bike to the park or taking the subway by oneself. Indoor IAs can be cooking a meal from beginning to end or painting a wall in your bedroom. IAs with other children can be going to a movie with friends or camping out in the backyard, and IAs that involve risk are whitling with a sharp knife or building a fire. These categories can be combined for extra powerful doses of independence. A great example are so-called “junk playgrounds” like The Yard in New York City. They are filled with construction materials, don’t allow parents inside, and are full of amazing opportunities for children to learn how to navigate risk. Children can interact in groups of various ages; mixed-age groups provide younger children with more opportunities to learn and older children with opportunities to cultivate leadership skills.

So far, we have found that kids are enthusiastic about practicing independence. The biggest barriers have come in the form of adults. And I don’t mean the children’s parents, who often know that independence is good for their kids and, after some coaxing, are able to let go. We’ve had to plan for strangers messing things up, and not in the way you might think. So-called “stranger danger” has been flipped on its head in our work. We’ve never had a stranger try to harm a child practicing independence; on the other hand, we’ve seen plenty of anxious strangers stepping in to “protect” our kids by trying to stop the independence activity. Here’s where we have leaned on Let Grow’s expertise. They have handy “Kid Licenses” informing strangers that a child out and about in the world is nothing to be alarmed about. Kids sign them, and then they can flash them like a literal badge of honor if anyone questions what they are doing.

Our research is ongoing, and it’s still early. But so far, we have found that these short bursts of independence have led to reduced anxiety in kids and their parents, increased self-esteem and willingness to try difficult things, and more free time for parents, who don’t have to spend every waking moment chasing their kid. Some parents have even made time to go on dates! Our plans are to conduct larger studies and continue to improve the manual so even more clinicians can use it. We are fighting against a tidal wave of overprotectiveness, but we may have found a way to push back against the damaging idea that kids are fragile and in need of constant protection—all while allowing kids to have a heck of a good time.

Camilo Ortiz
Camilo Ortiz
Camilo Ortiz, PhD, is an associate professor and director of clinical training in the clinical psychology doctoral program at Long Island University-Post. He is also a fellow with the Flourishing in Action project at the Archbridge Institute’s Human Flourishing Lab. His scholarship focuses on parenting, disruptive behavior problems in children, child anxiety, elimination disorders, and cognitive behavior therapy for child and adult psychiatric disorders. He completed a pre-doctoral internship at Montefiore Medical Center and a postdoctoral research fellowship at Stony Brook before joining the faculty at LIU-Post in2001. He teaches statistics and clinical classes that focus on cognitive-behavior therapy (CBT) and evidence-based treatment of children and adolescents. Dr. Ortiz is a licensed psychologist in New York State and maintains a private psychology practice where he sees adults and children. He received a Ph.D. in clinical psychology from the University of Massachusetts, Amherst.
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