Even with use of the best treatments currently available, treatment for childhood anxiety disorders is insufficient in approximately one-half of cases. Previous studies have examined parent involvement in augmenting child-based cognitive-behavioral therapy (CBT), with the idea that parent-based treatment can help parents respond to their children’s anxiety in more productive ways and empower parents to help children who are unable or unwilling to directly participate in therapy. However, comparisons of the efficacy of stand-alone parent-based treatment with that of CBT in treating childhood anxiety are lacking.
For a study published in the Journal of the American Academy of Child & Adolescent Psychiatry, Eli Lebowitz, PhD, and colleagues randomly assigned children with primary anxiety disorders to 12 weekly sessions of CBT with no parent treatment or SPACE (Supportive Parenting for Anxious Childhood Emotions)—a parent-based treatment designed to reduce accommodation of childhood anxiety—with no direct child-therapist contact. Anxiety and other variables were assessed before, during, and after treatment, with evaluations that included gathering information from the child and parent, as well as evaluation by a clinician blinded to the child’s treatment.
“The most important finding from this study is that SPACE—a parent-based treatment that does not require the child’s direct participation in therapy—can be as efficacious in treating childhood anxiety as the strongest and best-established treatment we have, CBT,” says Dr. Lebowitz. “Children assigned to SPACE were as likely to be cured of their disorder, and their symptoms were as improved, as children assigned to CBT. These findings were consistent across informants, meaning they held up whether we examined the parent report, the clinical evaluation, and when we asked the children. This indicates that children whose parents participated in SPACE felt themselves to be as helped as children who received 12 sessions of excellent CBT.” While family accommodation and parenting stress were significantly reduced in both groups, reductions in family accommodation were significantly greater with SPACE. Treatment credibility and satisfaction were high.
“With SPACE, parents learn to increase support and decrease accommodation,” adds Dr. Lebowitz. “Advice from clinicians such as ‘It’s important to let your child be anxious sometimes’ or ‘It’s more important to teach your child to cope with anxiety than to make sure they are not anxious’ can take seconds but can have a meaningful impact on the life of a child and family.”
Parent-Based Treatment as Efficacious as Cognitive Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions