Parent Training as Effective for Childhood Anxiety as Therapy

Yale study finds that training parents how to react to child behaviors is as effective at reducing anxiety as providing therapy to the child.

Sadie Cathcart
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Past research has shown that parent behavior influences the development and trajectory of childhood anxiety. Recently, research has been done to examine the impact of providing training for parents in combination with therapy for the child to reduce childhood anxiety. Now, a new study conducted at Yale University suggests that parents training alone may be just as effective at reducing childhood anxiety as interventions that provide cognitive behavioral therapy (CBT) to children.

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The new study, conducted by Eli Lebowitz, Carla Marin, Alyssa Martino, Yaara Shimshoni, and Wendy Silverman, was published in the Journal of the American Academy of Child and Adolescent Psychiatry. The researchers compared the impact of the Supportive Parenting for Anxious Childhood Emotions (SPACE) parent training program with more a more traditional, historically supported child-based CBT approach.

They tested the effect of providing parent training in the absence of child-facing CBT on childhood anxiety symptoms. The parents training was developed with an emphasis on the reduction of family accommodation. Family accommodation refers to parental behaviors that reinforce children’s anxieties and unhelpful thinking patterns.

The parent training condition served to reduce child anxiety as effectively as the child-facing CBT condition according to the noninferiority method applied. The results suggest that altering a child’s environment and relational patterns may be useful as a treatment for clinically significant anxiety and that child-facing therapy may not be a critical ingredient of the treatment process.

Anxiety is often meaningful and useful. It can prepare our bodies for action in the context of potential danger, and can also increase motivation and optimize performance. However, clinically significant levels of anxiety can substantially compromise the day-to-day quality of life for sufferers.

At the same time, overarching trends in anxiety can reveal environmental patterns present in society that contribute to increased stress and fear. As a result, pathologizing anxiety may result in the treatment of larger-scale issues as if they are within-person or within-child problems.

Whatever the cause, systems of support are needed to reduce suffering as the prevalence of mood and anxiety disorders among children continue to increase. There is a well-established connection between anxiety, unexcused absence, and truancy, and between environmental features and anxiety levels (parenting qualities vs. genetic links). Although medication and CBT are popular evidence-based approaches to treatment, long-term treatment outcomes are questionable.

“In contrast to numerous randomized studies examining whether parent involvement enhances child-based treatment, it is unknown whether parent-based treatment alone, without child-based therapy, is efficacious,” the researchers write. “Whether parent-only treatment can be as efficacious as CBT for child anxiety remains unanswered.”

CBT is considered a well-established, gold standard treatment for childhood anxiety. Past research has established connections between parent behaviors and childhood anxiety levels, and that parent training can be a supportive component of broader treatment approaches to childhood anxiety. However, Lebowitz and colleagues’ work is the first to compare parent training alone to CBT with the rationale that, although CBT can be helpful, better treatment strategies are needed.

Most parent training programs focus on providing psychoeducation regarding CBT techniques for childhood anxiety. According to this approach, parents are provided with tools to coach their children through psychoeducation surrounding anxiety, facilitate strategies for coping with anxiety, and promote shifts in child behavior to promote inhibitory learning (in which perceptions of safety begin to outweigh fear through exposure to anxiety-provoking stimuli). Comparatively, the parent training program examined by Lebowitz and team, SPACE, emphasizes training to reduce family accommodation.

“Family accommodation refers to the myriad changes in parental behaviors and routines intended to help a child avoid or alleviate anxiety-related distress,” they explain. “Despite being well-intentioned, family accommodation is linked to more severe child anxiety and greater functional impairment, and may predict poorer response to CBT.”

A total of 124 children (and their parents) between seven and 14-years-of-age diagnosed with anxiety disorders were enrolled to participate and divided into both study conditions (a 12-session SPACE training for parents, or a 12-session CBT program for patients). Ninety-seven participants attended all required sessions and training, and attrition rates were generally even across conditions.

“The present investigation was a randomized controlled noninferiority trial to determine whether SPACE is as efficacious as CBT, the best-established, strongest evidence-based treatment for childhood anxiety disorders. Non-inferiority methodology was selected rather than the more commonly reported superiority testing because failure to show superiority of one treatment over another is insufficient evidence of treatment equivalence.”

Consistent with what had been predicted, the results established non-inferiority of the SPACE approach to parent training when compared with CBT for child participants across both primary (“clinician-rated measures of child anxiety”) and secondary outcomes (“child and parent ratings of child anxiety and of family accommodation, as well as a parent-rated measure of parenting stress”). The SPACE and CBT conditions, both reduced child anxieties, resulted in similar reductions in family accommodation and were acceptable and satisfactory by clients.

More research is needed to explore the generalizability of these results and to test the strength of various approaches to parent training. However, Lebowitz and colleagues’ work provides preliminary support and possible directions for parent training in the treatment of childhood anxiety.

Parent training may be a valuable option when child buy-in is absent, or when developmental or communication problems are such that child-based treatment isn’t viable. On a larger scale, attention to caregiver qualities also represents an acknowledgment that systems beyond a child’s internal processes and genetics inform the development and experience of anxiety. Importantly these systems may extend beyond the family unit, but caregivers represent one potential access point.

 

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Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2019). Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry. (Link)

6 COMMENTS

  1. Parent training, or reporting to Child Protective Services? And I don’t mean just the subject of the article, I mean the article itself. Anyone who sees wrong and does not act is complicit.

    How can the child be in the therapist’s office without suspicion of child abuse.

    And CBT is just a torture regime.

    Should not be seeing articles like this, it’s just therapists playing God.

  2. “The results suggest that altering a child’s environment and relational patterns may be useful as a treatment for clinically significant anxiety and that child-facing therapy may not be a critical ingredient of the treatment process.”

    What a concept, all distress is NOT caused by “chemical imbalances” in people’s brains, that require drugs. How shocking this concept must be for our “mental health” workers.

    Nonetheless, this means the environment, or systems within which we function, matter. So to take this concept to a broader in scope societal conversation, given the following statement synopsizes where the intelligent within both political parties see our country:

    “We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.”

    I’m quite certain all the above mentioned systems need to be looked at, and radically changed? Our medical system needs to be radically changed, too much “death by medicine,” doctors. We have a two tier legal system, not justice for all, this needs to be radically changed. Our universities are brainwashing, not educating, our children. This needs to be radically changed. Washington is a hot mess, if you take the time to research what’s been going on there, it’s appalling. This needs to be radically changed. We have “fake news,” mainstream media. This needs to be radically changed. Shame on the religions and their “dirty little secret of the two original educated professions.” Get out of the child abuse covering up business, religions and your “social services” minion. And those bankers who took bailouts, then went off and “stole $trillions worth of houses” should be ashamed of themselves. The banking system needs to be radically changed.

    Our society’s problems stem from bad systems, not “chemical imbalances” in individual’s brains. We need to change those bad systems. And those working within those bad systems need to start working to change the bad systems within which you work.

    “The only thing necessary for the triumph of evil is for good men to do nothing.” You’ve been profiteering off of your bad systems, at the expense of everyone else, which is worse than doing nothing. And now the majority are awakening to the evil you’ve created.