Get to know psychologist and author on anxiety disorders Dr. Deborah Ledley.
Can you tell us a little about GAD (Generalized Anxiety Disorder) and how it usually arises and manifests itself?
GAD is a disorder of chronic worry. People with GAD worry about all sorts of things from their performance at work or school, to their own physical health, to their finances. This worry is out of proportion to the reality of their situation and the worry is hard to “turn off” once it starts. Worry is accompanied by physical problems like muscle tension, gastrointestinal complaints, and sleep difficulties. People with GAD tend to engage in a lot of checking behaviors and reassurance seeking, much like we see in people with obsessive-compulsive disorder. For example, a woman who worries about her husband getting home from work safely might obsessively listen to the traffic report and call him repeatedly to check in.
Why role does genetics play on anxiety and depression?
Anxiety disorders and depression are definitely heritable, to a moderate degree. There are most certainly kids who are “hard wired” to see the world in an anxious and/or negative way. I see it as my job to teach kids about their brains and bodies, but to also understand that “biology isn’t destiny.” As an example, many of the anxious kids I work with have what we call the “automatic no.” If their parents ask them to try a new food, sign up for a new activity, or invite a friend over to play who they have not had over before, they will quickly say “NO!”. I teach kids that this is where their brains go first. But, it does not need to be the stopping point. They can learn to try things even if their brains say no and see that the things they were initially scared of were actually kind of fun once they got used to them.
At what point in the treatment of children for depression do you think it’s a good idea to refer to a doctor for medication? Do you usually see the therapy working together with the medication from that point on?
Cognitive behavioral therapy is the first line of treatment for mild to moderate depression. I recommend that parents take their child for a medication consult if (a) they are suicidal; (b) their daily functioning is greatly impaired; or (c) if they are unable to engage in cognitive behavior therapy after 4-6 sessions because their anxiety is too intense or they are so depressed that they can’t find the motivation to do the work required.
Can you give us some tricks for stopping or lessening a panic attack when you feel one coming on?
Interestingly, there is not much you can do to stop a panic attack once it is coming on. I teach patients how to carry on with life even if they are having a panic attack. With panic, people fear physical symptoms. They worry that they are having a heart attack, or will go crazy, or will lose control of themselves in some way. Although panic attacks are very uncomfortable, there is nothing dangerous about them. I teach patients to remind themselves of that (“No emergency here”) and to carry on despite feeling anxious. I use the metaphor of turning down a radio. You can’t turn off a panic attack, but you can turn your attention “down” and focus instead on something else like what is happening outside your classroom window, or what the lyrics are to a song that you really like, or what books and newspapers people are reading on your morning subway ride.
What is the most challenging part of your job as a psychologist?
I think it is really challenging to “correct” parenting styles, especially when parents have the best of intentions. For example, when kids are anxious, parents tend to shield them from the very things that cause anxiety. This can range from protecting their kids from dogs to not sending their children to school! I find it hard (but do it all the time!) to tell parents that although they might have had the best intentions, this style of parenting was actually feeding, rather than extinguishing, their child’s anxiety.
We hear a lot about separation anxiety in children. Can you tell us what is the best treatment for this?
The best treatment for separation anxiety is cognitive behavior therapy. Basically, we want to expose children to age appropriate activities that they fear and/or avoid in order to help them learn that their fears are highly unlikely to occur. Kids with separation anxiety typically worry that something bad will either happen to them (e.g., being kidnapped, being in the house when a robbery occurs) or their parents (e.g., a car crash) when they are apart. Many kids with separation anxiety also doubt their coping skills when they are away from their parents. For example, they might fear that if they were to get sick when they were apart from mom or dad, they wouldn’t be able to handle it, they wouldn’t know what to do, and no one else would be able to take care of them like their parents. In treatment, we help kids go to birthday parties, sleepovers, extra-curricular activities, or stay home alone (if age appropriate) to help them see that they could cope with any challenges that arise and that nothing bad will happen to them or their parents when apart.
Which person (alive or not) do you most admire and why?
I greatly admire my grandfather, Henry, who passed away at the age of 90 in November 2014. He was an immigrant from Eastern Europe and came to Canada with nothing. He quickly learned English and astounded his teachers with his intelligence. Just a few years after his arrival in Barrie, Ontario, his teachers ensured that he attend the University of Toronto to become an engineer. Grandpa Henry built a very successful land development business and at the time of his death, he was still very much the patriarch of our family!
There are a few things I particularly admire about Henry. One is that he never forgot his roots. He was so grateful to Barrie, Ontario and focused most of his philanthropy on the people of this city, including donating land for a synagogue and endowing a entrepreneurship program at Georgian College. Second, he valued education above all else. He paid for all my education and supported me every step of the way. I will never forget that. Finally, he never stopped learning. My last conversation with him was about the philosophy project he had chosen to focus on over the winter in Florida. He was always reading and studying about business, philosophy, and history. When he passed away, I made a commitment to myself that I am going to study the texts that had the most impact on his life.
What is your greatest extravagance?
Travel. I love to travel! I have a list a million miles long of the places I would like to visit. The nice thing is that my husband and kids like to travel too. We had a wonderful trip last summer to Jackson Hole and Yellowstone National Park. It was magical. My kids, who are 9 and 7, have opinions on where we should go next. My 9 year old wants to see more of Canada (since she is half-Canadian) and my 7 year hopes to go on a cruise to Alaska.
If you could meet anyone in the world dead or alive who would it be and what would say to them?
I would love to meet one of the great classical music composers. Maybe Mozart, since he sounds like he would have been more fun than Beethoven! I would ask him how he composed whole symphonies in his head without writing them down. I would also ask what it was like to hear your own compositions finally played in the beautiful concert halls of Europe.
If you could choose your last meal on earth, what would it be?
I would probably have a big plate of Florida Stone Crab claws, a delicious bread with salted butter, a simple salad, and a good glass of cold white wine. And, something creamy and chocolaty for dessert like a pot au crème.
What is your favorite past time?
Besides traveling, I also love to go to the orchestra. I grew up going to the Toronto Symphony and now I am a frequent attendee of the Philadelphia Orchestra. They are just outstanding. There is nothing better than closing your eyes when the orchestra is all playing together and letting the music wash over you. I particularly love it when there is a chorus involved too, like Beethoven’s 9th Symphony or Mozart’s Requiem.