If your child is struggling with anxiety, finding them a therapist is often a great option, but it’s certainly not the only one. Sometimes, effective help comes from therapy for parents.
In this episode of Parenting the Mental Health Generation, Amy and Lisa talk with Niki Aquino, LCSW, Mind Chicago, about SPACE: Supportive Parenting for Anxious Childhood Emotions.
So put in your earbuds, take this 30 minutes for you and join our conversation because mental health matters.
Eli Lebowitz TedX Talk (founder of SPACE Therapy)
SPACE Therapy website
Have a show topic or guest suggestion? Email email@example.com
Music credit: Tune 2 go / POND 5
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Amy O. CATCH (00:05):
Knowing how to best support our kids can be challenging, especially when they're anxious. On today's episode of Parenting the Mental Health Generation, we'll hear about a program called SPACE, Supportive Parenting for Anxious Childhood Emotions that works directly with parents to help alleviate their children's anxieties. Welcome, I'm Amy.
Dr. Lisa CATCH (00:29):
And I'm Lisa. And we're the hosts of Parenting the Mental Health Generation. It's difficult to know the right things to say and do to support our kids, and we sometimes make mistakes despite our best intentions here. We lay it all out together and discuss the topics that concern us on our parenting journey.
Amy O. (00:49):
And today we're speaking with Niki Aquino, a licensed clinical social worker at Mind Chicago. There Niki conducts therapy with children and adolescents and she also facilitates SPACE trainings to help parents support their anxious kiddos.
Dr. Lisa (01:07):
Niki is here to share with us some of the wisdom she's accrued through many years of working with kids, teens, and parents. She'll help us better understand some of the newer research around treatment for childhood anxiety disorders and some of the steps that parents can take if they're seeing worry thoughts impact their kids.
Amy O. (01:26):
So put in your earbuds. Take these 30 minutes for you and join our conversation with Niki Aquino.
Dr. Lisa (01:35):
Hello Niki. Thanks for joining us today.
Niki Aquino, LCSW, MIND Chicago SPACE Therapist (01:38):
Dr. Lisa (01:40):
Well, we thought that we'd actually start today with you sharing a little bit about what this SPACE program is. We're guessing a lot of our listeners are not familiar with it. I know it's newer research, so why don't you dive right in and we'll have lots to talk about from there.
Niki Aquino (01:56):
Yeah. Again, Supportive Parenting for Anxious Childhood Emotions. It is a parent-based therapy that has been shown to be effective in the treatment of child and adolescent OCD and other anxiety related disorders. So, what is a parent-based therapy? Well, the intervention is done through the parent's behavior. So, although the target is the child or adolescent's anxiety, the mechanism of change is the parent behavior. We see this to be especially effective because children are biologically designed to go first to their parent for alleviation of their symptoms, and parents are biologically designed to alleviate said symptoms. It focuses on two main concepts, which are accommodations and what we call support. Accommodations in the world of SPACE is anything a person, a parent, does or does not do in pursuit of either avoiding or lessening the intensity of the child's symptoms. Support is morphing those behaviors into ones that support the child's ability and development in coping. So not alleviating the symptoms. In fact, oftentimes SPACE can make the symptoms harder or worse, which is part of the protocol where we talk about how to handle that. But when we talk about support or supportive statements, it's like a math problem. So, it's validation plus confidence equals support.
Amy O. (03:03):
Can you give us an example of that?
Niki Aquino (03:04):
Yeah, yeah. So, things like if a child has a lot of either a lot of anxiety or even OCD type behavior around time management, the child might constantly persistently ask, “What time is it? What time is it? What time is it?” And the parent is drawn to say, “Well, this is the time,” and give the time. And it may seem like a natural give and take behavior. It's actually further cementing that child's belief that in order to alleviate the anxiety, that comes from not knowing the time, I need someone else to do that for me. I like to say it's kind of like the parent and the child are on different sides of a canyon and in the canyon is anxiety. And so, if there's anxiety symptom canyon and the parents want to alleviate this anxiety, they fill the canyon. So, if parents fill the canyon, there's no space for the child to try and fill it themselves or to tolerate that anxiety canyon. And SPACE is built upon the idea that everyone has an inner desire for autonomy. And so, what SPACE relies on is giving children room to develop or further express that inner autonomy.
Amy O. (04:26):
So, I could guess that parents are probably not coming to you and saying, hello, I need some SPACE treatment. I would like to understand how I can better stop accommodating my kid. How does a parent get identified or a family get identified as being an appropriate candidate for SPACE?
Niki Aquino (04:48):
Yeah, so sometimes it comes from a referral from another provider. So, we will often get referrals from like neuropsychologist or other therapist or even sometimes teachers who point out like, hey, this child is really struggling. And more and more it's being accepted in the mental health community that there is always a parent component, not a parent blame, but a parent component to any sort of child mental health difficulty. So primarily the child comes to us, right? The child's experiencing a lot of distress, the child's exhibiting all these symptoms. And so, when we do, or adolescent, when we do the evaluation, a huge part is assessing what's going on at home. And usually, we can pick up fairly early on if there are either exact accommodation behaviors which we target or just an overall sense of, let me remove this anxiety. And so sometimes parents are recommended to do the full SPACE program, which is a structured treatment model.
Niki Aquino (05:54):
So some parents benefit from doing the whole program to a T and some parents benefit from learning the essential concepts and theoretical approach that SPACE emphasizes. This idea of removing behaviors that accommodate the child's symptoms.
Amy O. (06:48):
Having parented a child with severe anxiety disorder, I'm remembering the mornings when anxiety got in the way of her wanting and sometimes being able to go to school. So would it be possible for you to, I mean, I assume there's a component of this that involves like homework for the parents or something. Can you take us through maybe just a couple of the first steps that would happen if a parent was learning how to accommodate and support a kid who really didn't want to go to school?
Niki Aquino (07:25):
Yeah. The first steps are all about education really breaking down what is anxiety, what behaviors does anxiety manifest in and what is shown to be effective in the treatment of anxiety. So, it's a lot of education and a shared understanding of what anxiety is, what anxiety symptoms are, and how we target them. And we go a lot into, you know, the science behind SPACE that it is an evidence-based treatment. We talk about how accommodations can intensify or just further prolong and solidify this belief that the child or adolescent is unable to self-manage. So, step one is education, and then building kind of a basis of skills. So, support is one of the biggest skills and working on what we call supportive statements, the validation plus confidence. So, once we get that foundation, then we game plan, we talk about what is the actual change we're going to do at home.
Niki Aquino (08:26):
And so first we do an accommodation map. Parents, there is a lot of homework. I always say that this is a time commitment and an emotional commitment. So, I always want parents to be aware that this is tough. And you know, if we get through the education part and they're like, you know what? I can't do this right now. It's in the middle of the school year. I have three other kids to manage. Like this is not going to go well. Like, yeah, you're right. It, it might not. So come back to me in the summer because I would imagine there's still accommodation happening outside of school. But we might have more time to address it versus in these moments where like, you have to get to school, you have to get to work, you have to do all these other responsibilities. So, we're doing the accommodation map, so going through the day what are all the things that you parents do in service of the child's anxiety? So, I'm thinking of a kid who has a fear of contamination. And so, she was very particular about what roads could be driven on because she had this anxious belief that certain roads carry a lot of contamination and so we have to avoid those. So, parents were driving like way out of the way to get to school to avoid those roads.
Dr. Lisa (09:48):
Niki, I'm going to just chime in here and confess that even as a psychologist. I have been having to do my own digging about ways that I am accommodating my anxious child that I really wasn't even aware of. And I imagine it is sometimes conscious and sometimes significantly less. So, I'll throw in a personal example where my older son had a pretty significant fear of thunderstorms and other inclement weather and it made nighttime really hard, especially during the summer when there were a lot of thunderstorms. And so, I was so proud of myself, like I'm doing such a great job of not accommodating here because he always wanted to come into my room and I would never let him sleep in my bed. And I'd walk him back to his room and I'd walk him back to his room and it wasn't really going away.
Dr. Lisa (10:38):
And I was having dinner with a friend who happens to be a clinical psychologist who specializes in working with children who have anxiety. And I was just sort of sharing with her and she's like, wait, pause on that part of the story where I had said something about how every night before he falls asleep, he asks to check my weather app to see if it's going to storm. And I was like, sure buddy, why not? Let's just look right? And then she's like, okay, so maybe we're going to not do that anymore though. And I was like, okay. And I think, you know, the validation part that you're talking about and, and the creating that mechanism for change, that language that it got flipped with was, I know you really want to know what the weather's going to be like tonight. We don't need to know and you're going to be okay no matter what the weather ends up being like tonight. But I was so stuck on that very conscious accommodation of not letting him sleep in my bed and how successful I was feeling that I missed these other things that I was absolutely doing to accommodate that anxiety.
Niki Aquino (11:38):
Yeah. Accommodations are super sneaky. When we do the exercise of the accommodations map, I often have parents track it for two weeks because there are ones that are daily, there are ones that are weekly…
Amy O. (11:49):
Well and they feel good, right? I mean, accommodations
Amy O. (11:53):
Make you feel better.
Dr. Lisa (11:55):
Oh, absolutely. Most nights when there was no storm in the forecast, I was like, look buddy, we're good. No storm all good. We're all going to get some sleep tonight. It absolutely temporarily is that relief that everyone's looking for. Temporarily being the operative term.
Amy O. (12:12):
For sure. Yeah. I remember the mornings when my daughter would stay home from school and we'd be like, so what shall we watch and no struggle to get to school. The couch was pretty comfortable. We made some hot chocolate, felt really, really good.
Niki Aquino (12:27):
Yeah. In the initial introduction education part, I talk about, why do we do accommodations? Number one, they work, right? They alleviate the symptom. They work in the moment. They're often like kind of not easy because it's still something that's often frustrating or takes up time, but it's a higher likelihood that the distress will either lessen or be fully eliminated.
Dr. Lisa (12:55):
Niki Aquino (12:58):
In the moment. Yeah. In the moment. And so, I'm like to my parents, I'm like, of course you do it. Of course, you do it. I would do it. Parenting is hard. My goodness.
Amy O. (13:06):
Then you get to do it all over again tomorrow.
Niki Aquino (13:11):
What we already kind of touched on is when we're choosing what accommodation to change. So, we always identify the accommodation and the next step is to kind of talk about what we do differently. You know, the model says for it to be significant and pervasive and impactful. I throw in their highest likelihood of success because especially for the first ones, we want to throw in some wins and taking into consideration the constraints of living. So again, maybe it's not targeted before school. Maybe it's not targeted before work. A lot of times it's not targeted before bed because everyone needs to sleep in order to function. And so,
Dr. Lisa (13:49):
So just to be super explicit, here, you are saying that after you do this accommodations map, you pick one. So, we're just choosing one thing to target at a time. We're not trying to go whole hog here and eliminate all of the accommodations, all of the anxieties at once.
Niki Aquino (14:04):
Amy O. (14:05):
And one more question for you. Is the kid now aware of what is being targeted or are the parents responding to this sort of map in a more subtle way?
Niki Aquino (14:20):
Both. I think depending on the severity of the anxiety in the child, if they hear that behavior might change sometimes, like there's more of a panic, which I am then causing additional issues before giving skills to manage that. So, I'll say don't lie, but saying things like we're just looking at different options in our ways to support you. Whereas adolescents are very much aware that it's happening. But caveat, I try to discuss with the parents, oftentimes when we highlight a problem, we kind of pause on doing that problem. And I don't want you to do that. I don't want you to feel embarrassed or ashamed for the accommodations you do. We just need data and its non-judgmental objective, just the facts data. I mean throughout, I always throw in a lot of self-compassion for parents because this is hard.
Niki Aquino (15:15):
And there's a lot of stigmas that comes around with parenting in general and especially parenting kids with anxiety. But especially as we start identifying behaviors and showing like how they're not helpful, shame can pop up and shame is very sneaky. So as best as I try to kind of keep an eye out for it, I also just continuously remind the parents like, this is a non-judgmental zone. Let's find what helps. Let's find what doesn't help. Because yeah, when we start pointing out the behavior, sometimes parents will either leave things out intentionally or unintentionally and start to feel some potential judgment. I think that what's important for clinicians to remember, too is we get really deep into like the science of the intervention and we, I will speak for myself, I get very deep into the science and will sometimes forget that I'm working with humans and that humans don't go along the way I want them to. And that's okay.
Amy O. (16:15):
I have a couple questions to follow that, but one is, does this kind of intervention in your mind work for all age ranges of children?
Niki Aquino (16:24):
Yes. Up until adolescents, yes. The younger ones, I think it looks different in application. It's shown to be effective. I think as young as five, I'm not expecting a five-year-old to have a high level of self-control just because that's not developed yet. So, there's also a piece of keeping in mind the developmental age or chronological age of the child when we talk about evaluating what to pick, what to do differently. But the big thing to remember in SPACE and any parent-based treatment, I measure the parent change. So, parents will come in and say, it's not working, it's not working. They're still so anxious. And I'll say like, yes, they're still anxious. Are you consistently doing something different? Yes. Oh, it's working because again, interventions on changing parent behavior, making things more long-term successful for you. Even if we're not seeing the gains we want to see in the children.
Dr. Lisa (17:27):
Is there a reason that we would see consistent change happening in the parents but it wouldn't be translating into anxiety reduction in the child?
Niki Aquino (17:39):
Yes. Or at least slower. Sometimes we'll see, you know, kind of like whack-a-mole situation where we eliminate one accommodation, it shows up somewhere else. We do that so that can sometimes feel like it's not working.
Dr. Lisa (17:51):
Sort of like the behavior changes in general, as we know as a psychological principle, behaviors often change before the emotional state changes. And so that's what you're saying, like the parents are changing the behavior. That's kind of step one in this grand plan of eventually that leading to anxiety reduction, but it's not a direct one-to-one.
Niki Aquino (18:11):
The science is pretty firm in that it is effective. In like anecdotal application. Some it's quicker than others.
Amy O. (18:21):
I love that you strive to understand the science behind this. I guess I'm curious about your own personal journey, Niki. How did you come to embrace SPACE after having been, I assume a therapist without it first, right? Like what piqued your interest in in particular? Can you share that with us?
Niki Aquino (18:42):
I started my journey as individual and then kind of morphed into family. And when I joined the team here at Mind morphed even more into parent-based treatment or parent coaching. And I was talking to our co-owner Lee, who is an amazing clinician and kind of talking about like, well what more training can I do? Because I love working with parents and she was trained in SPACE and she was like, I think it's a really effective tool. And so, I learned it and I love it. When I mentioned that sometimes you do the SPACE protocol to a “T” and sometimes you do the essence of it. Supportive statements are helpful anywhere. And me and my colleagues joke all the time. We do supportive statements to each other when we come to each other and are like, I don't know what to do with this case. So, we do validation and confidence, right? “Hey, I can see that you're really anxious about this case and want to do the perfect thing and I know that you have it in you to at least to start to figure it out. And if you're feeling really, really lost, we'll consult.” I just did a training in-house on Friday and then later asked for reassurance and my colleague goes, “I'm "SPACE-Ing" you right now. I'm not accommodating.” I was like, oh, what have I done?
Amy O. (19:55):
Is there one client in particular or one case in particular that stands out to you as being one where this particularly worked that you could share?
Niki Aquino (20:05):
So, I had a family who, their child, he was 14, and he had very significant anxiety and he had been in treatment for a while and was making good gains. Especially with skill usage. And their individual therapist recommended the parents kind of look into parent therapy. So, they came to me and we kind of discovered that, and we see this a lot with parents, there are differing views on accommodations and what should be allowed and what shouldn't. We talk a lot about the kind of spectrum of feeling like you have to be protective and feeling like you have to be demanding. So, I have to protect my child. They can't handle this. This is going to be too hard. I can't even imagine it. Demanding. They're old enough. They should be able to get this. They're in therapy. They know how to do it.
Niki Aquino (20:57):
So, we always want to find like a synthesis and even just highlighting the differences in approaches and talking a little bit more about “why”. And then we honed in on one behavior, which was around actually time checking. He would say, “Am I running late? Am I going to be late?” And usually they would say, “You're not going to be late; you're going to be fine. We're going to get there in time.” So then once we identified that accommodation and a plan to do something different, the parents would respond with a supportive statement, like, “It seems like you're very worried about not making somewhere on time and we always have. And if we don't, we'll figure it out then.” And for him, he bought into the therapy.
Niki Aquino (21:49):
So they would even say things like, “I can see that you're really anxious if I tell you the time, I'm making things worse and I'm not doing a good effort to support you.” Another case I'm thinking of, she hated supportive statements. Hated it. She wouldn't go to lunch. She wanted to eat lunch inside, she would help the teacher. We eventually did see her. She started eating lunch outside. So even though she says it's not effective and she hated it, we did see a change in behavior. And what's nice about SPACE too is the goal is to equip parents to do this on their own. I maybe help with like one, maybe two accommodation targets, but then, then it's the parents should have all the skills in the world, the perspective, the insight, the plan of approach to do this independently. That is my goal.
Amy O. (22:41):
Do you also arm parents with means by which to tolerate the discomfort when their kids are struggling and they're supporting?
Niki Aquino (22:52):
Yes. So much self-compassion. Actual skills, like things like disengage from the conversation because oftentimes kids are going to then ask for reassurance in another way. You know, we talk about doing like broken record type thing of like, “I already answered this question. It's the same answer.” And sometimes the kid will be persistent or escalate and then we'll talk about, okay disengage, maybe disengage physically. So, walk out of the room. I like to say do something different. So, like, hey let's go play board game. More than anything, we work a lot on mindful self-compassion of taking a deep breath and saying something like, "I am doing the best I can." "This is really hard." "I know it's effective and it's so hard." "Wow, my kid just said something really, really hurtful. And that suck." When we talk about implementation of the plan, we talk about potential responses and one of the very common responses is emotional blackmail. "If you loved me, you would just do it."
Dr. Lisa (23:56):
Ooh, it hurts. It hurts my insides.
Niki Aquino (23:59):
Yeah. Oh, my or you what I hate. "You're a really bad parent." I'm thinking like direct quotes of kids.
Amy O. (24:11):
How about, "Seriously you had kids?" Ooh yeah. Yes. Tough.
Niki Aquino (24:20):
It's so tough. And even just saying, "Oh my gosh, what a hurtful thing to say." And I know this is anxiety speaking, geez, that stung and relying on supports. Calling a friend. Like can you believe what just got said to me?
Niki Aquino (24:38):
Just like what we're doing laughing about it because it's a symptom. It's the anxiety showing up and getting stronger and stronger and you know, when something that works before isn't working nine times out of ten, it's going to escalate. And so, escalation can look like really hurtful things.
Amy O. (24:56):
I like saying that. That's the anxiety talking because that separates the anxiety from the child. Which is so important, right? Because it's just part of who they are, not all of who they are and yeah, I like that.
Dr. Lisa (25:08):
And they feel bad about what they've said too. I mean they have their own shame around that. Yeah. And so, it, I think it helps them also when we're, when we're making that distinction.
Amy O. (25:16):
Sometimes not till later, but yeah, maybe they get to it eventually.
Dr. Lisa (25:20):
I didn't say in the moment. Amy
Niki Aquino (25:23):
Dr. Lisa (25:24):
Amy O. (25:25):
Dr. Lisa (25:25):
Yeah. Upon reflection. Right, right. Niki, can you tell me, so as a neuropsychic, you know, I do these evaluations and then I make recommendations for families of where to go from here, who to seek support from, what professionals they need in their lives. And I would love a little more guidance from you around when it makes sense to have, let's say, let's assume I've diagnosed an anxiety disorder in a child. Am I just recommending the SPACE program to the parents? Am I recommending that the child should be in their own therapy as well? Does it work equally effectively or better in one situation or the other? How does it typically play out?
Niki Aquino (26:05):
So, this is another reason why I love SPACE. It's shown to be effective, independent of individual therapy as well as in conjunction. You know, I think depending on the age for kids, even just skill building, if it's not like insight development, just skill building around like managing strong emotions is super helpful. I would say that it's always helpful for the parents to speak to someone and there be some sort of like check-in or evaluation. Even in parents I work with who I don't do SPACE with, we do SPACE sequel things. We talk about supportive statements, we talk about things like seeing anxiety symptoms as a function, as a behavioral function. That takes away a little bit of that like morality piece. I mean understandably so, I'll get a lot of, she's just trying to hurt me. He's just trying to hurt me.
Niki Aquino (26:55):
He's just getting out of this. He's saying what he needs to do to get out of this and I have to be like, yes, they're engaging in a behavior that gets them away from the discomfort. It's serving a purpose; it's serving a function. It is not an intentional harm, which it feels like. It feels like you're duping me. You're like pulling one over. And, it's like take away that intentionality and look at it as a function. This symptom, this behavior is serving a function. I would say for sure parents and then, if possible, the child to be at least seen and done some skill building, whether that's individual therapy or group-based.
Amy O. (27:41):
Thank you. We are going to have to wrap things up shortly, but I know that Lisa and I both wanted to touch on one more thing and that is, is it appropriate to have other adults, teachers or other, you know, trusted adults in a child's life as a part of this SPACE team so that the messaging is sort of consistent?
Niki Aquino (28:02):
I talk a lot if extended family is involved on an ongoing basis, pulling them into it. They don't necessarily have to do any sort of behavior change, but being aware of what's happening. The same thing with teachers. I'm encouraging parents more and more and more to talk to teachers to just let them know what's going on. Not necessarily expecting any sort of responsibility or intervention on the teacher's side, but just for teachers to have a heads up. And for teachers, I was thinking about how SPACE can manifest in the classroom and because SPACE is so individual and nuanced, it would be really difficult to apply across an entire class. At the same time, supportive statements, I mean similar to me giving the magic to my colleagues, supportive statements are helpful anywhere and everywhere. So even if it's something like, “You asked me about this math problem a few times now and I have a feeling your kind of worried about getting it wrong.
Niki Aquino (29:01):
I think you can do it. I really do. So, I'm going to take a lap, walk around the classroom and then if you're still feeling like you struggle, we can look at it again. But I bet you can at least do a little bit of it.” And my experience is teachers are already doing this, teachers are already so supportive of their kids that it's already kind of coming out that way. Giving a little bit more encouragement to not go just to validation without any sort of confidence. You want to throw in their validation of the emotion. You are very worried about this without endorsing that it is a stressful thing. So, you are very worried about this test. It is one test, part of one grade. I see this a lot with high school kids right now. I have to get straight A's. I have to get straight A's. And I think the more teachers can, you know, instill the confidence of like it's one test. We'll look at it, we'll talk about it, trying to alleviate that anxiety. But again, I think teachers are already doing such a wonderful job right now, especially right now because we're seeing a big spike with a lot of mental health in kids. And my experience with teachers is that they're doing a great job of trying to adapt to, you know, what we're seeing across the board in kids.
Dr. Lisa (30:27):
Niki, thank you. This has been incredibly helpful information for me both professionally and personally. I've got a lot on my mind here. Two things. One is can you remind our listeners what SPACE stands for?
Niki Aquino (30:40):
Yes. Supportive Parenting for Anxious Childhood Emotions.
Dr. Lisa (30:45):
Great. And that this is, is it Eli Lebowitz? That is the founder of this program? And research out of Yale. Is that right?
Niki Aquino (30:53):
Dr. Lisa (30:54):
Great. So, our listeners can look that up if they want more information. And then is Mind Chicago currently running, or are you personally running, any kinds of parent groups or anything for parents that might be interested in pursuing further?
Niki Aquino (31:08):
Yeah, there are a handful of us who are, who do it individually with families or with parents. And then also I do a three-session workshop. It's like SPACE for parents’ workshop where we do essentially phase one. So, a lot of the education around what anxiety is, what SPACE is, why it's effective, and an introduction to accommodations and supportive statements. And I do that throughout the year. We're also about to start up SPACE for picky eaters, which is kind of a newer protocol that came out. So, we're going to start running a parent group on that soon too. Yeah, ongoing workshops and individual work. Basically, we're doing it all.
Dr. Lisa (31:51):
I love it.
Niki Aquino (31:51):
When in doubt reach out.
Dr. Lisa (31:53):
That's great. And we will put some links in the Show Notes to some of the research on SPACE as well as to your practice and the different offerings that you guys have.
Amy O. (32:01):
I mean, you have really given us stuff that will help empower our families to reach out and be able to find ways to help their kids in manners that they may not have thought of before. At least it's true for me. Thank you very much for being here.
Niki Aquino (32:16):
Of course. Thanks for having me.
Dr. Lisa (32:18):
We really appreciate it. Thank you for your time. And thanks for listening to another episode of Parenting the Mental Health Generation.
Amy O. (32:27):
Stay current on all CATCH programming by liking us on Facebook @catchiscommunity, or by visiting our website catchiscommunity.org.
Dr. Lisa (32:37):
We're glad you joined us to continue the conversation. It's important to talk about our mental health and reach out for help if needed.