New treatment for childhood anxiety works by changing parent behavior
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) reports that an entirely parent-based treatment, SPACE (Supportive Parenting for Anxious Childhood Emotions), is as efficacious as individual cognitive-behavioral therapy (CBT) for the treatment of childhood and adolescent anxiety disorders.
Anxiety disorders, including social phobia, separation anxiety, generalized anxiety, are the most common mental health problems in childhood, causing significant distress to the child and family. With up to one-third of youth experiencing a clinically impairing anxiety disorder by the time they reach adulthood, such disorders lead to impairment in personal, social and academic functioning. When not treated successfully, anxiety disorders in childhood can cause long term impairment and an increased risk of additional physical and mental health problems.
This new study enrolled 124 children with existing clinical anxiety disorders and randomly assigned them to receive either the current front-line CBT treatment, or SPACE—developed by Yale researcher, Dr. Eli Lebowitz and his team at the Yale Child Study Center, Yale School of Medicine, New Haven, CT, U.S..
SPACE teaches parents to reduce their accommodation and to respond to a child's anxiety symptoms in a supportive manner that conveys acceptance of the child's genuine distress along with confidence in the child's ability to cope with anxiety.
The authors found that children whose parents participated in 12 sessions of SPACE were as likely to overcome their anxiety disorder as children who participated in 12 sessions of CBT, the best-established evidence-based treatment for child anxiety.
Anxious children look to their parents for help in coping with their anxiety and avoiding the things that make them feel afraid. Parents of anxious children typically become entangled in their child's symptoms through a process known as family accommodation. For example, a child who is chronically worried may rely on a parent for constant reassurance, or a child with separation anxiety may require a parent to stay at home with them or sleep next to them at night.
For children with social phobia, parents often speak in place of the child or avoid having guests over to the home. Research indicates that family accommodation can contribute to maintaining the child's anxiety symptoms over time.
For both treatments, approximately 60 percent of children no longer met diagnostic criteria for any anxiety disorder following treatment, based on assessments conducted by independent evaluators who were unaware of which treatment children received. An even greater proportion (87.5 percent for SPACE and 75.5 percent for CBT) showed significant improvement in their symptoms. Anxiety symptom questionnaires completed by children and by their parents also showed equivalent improvement for SPACE and CBT. Parents and children rated both treatments as highly satisfactory.
More information: Eli R. Lebowitz et al, 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 (2019). DOI: 10.1016/j.jaac.2019.02.014