Coaching Caregivers to Design Bravery Challenges

Exposure therapy, or ‘bravery challenges',’ are the gold-standard treatment approach for children with anxiety (Whiteside et al., 2022). Bravery challenges are most helpful when there is a behavior that a parent has a low degree of control over (e.g., getting a child to try a new food, getting a flu shot), because we need to motivate a child to change their behavior. In contrast there are other situations in which parents have a high degree of control (e.g., repeatedly answering a child’s reassurance questions), where it may be most effective to change the parent’s behavior (see Coaching Caregivers to Reduce Anxiety-Driven Accommodations).

The goal of a bravery challenge is to help children approach anxiety-provoking situations that they often avoid in order to have a corrective learning experience (e.g., “The ‘bad’ thing didn’t happen,” ”It wasn’t as bad as I thought it would be,” and/or “I can tolerate feeling anxious”).

The formula for designing bravery challenges involves:

1. Identifying a specific target behavior (e.g., ordering at a restaurant)

2. Create a fear ladder comprised of small challenges to build a bridge to the final goal. Have the child rank each step.

   1. Order ice cream at a familiar place (Small)

   2. Order food at a fast food restaurant (Medium)

   3. Order an entree at a familiar sit-down restaurant (Large)

   4. Order an entree with a modification (e.g., no cheese) at a familiar sit-down restaurant (XL)

   5. Order an entree at an unfamiliar sit-down restaurant (XXL)

3. Break challenges down into even smaller bite-sized pieces if needed

   1. Point to ice cream order on menu

   2. Have a parent say “Can they have a small chocolate ice cream?” and have the child respond to the question “Cup or cone?”

   3. Saying the whole sentence “Can I have a small chocolate ice cream in a cone?”

4. Plan bravery challenges well in advance vs. in the moment, when a child may already be dysregulated

5. Practice, practice, practice

6. Reward, reward, reward (Being brave is hard, and deserved of a reward. Remember there is already a reinforcement system in place that we need to override - the sweet relief that they experience when they avoid.)