Cognitive-Behavioral Treatment of Childhood Anxiety: Examining a Parent Consultation Model

Abstract

Strong evidence supports the use of cognitive-behavioral therapy (CBT) for the treatment of clinical anxiety in children. As parents may play an etiological role in the development, progression, and maintenance of childhood anxiety, researchers have noted that including parents in child treatment confers some benefit upon child outcomes. Conducting CBT solely with the parents of anxious children may be equally beneficial and potentially more cost-effective than treatment modalities with only the child. The present study examined the efficacy of a ten-session parent-only CBT intervention delivered individually to parents of anxious children (ICBT) in comparison to a ten week wait-list control condition (WL). Conditions were compared at three time-points, with regard to the child’s anxiety symptoms (by child, parent, and teacher reports) and diagnostic status (by structured interview with parents), as well as parents' self-reported anxiety, protective parenting behaviors, parenting satisfaction, and parenting self-efficacy. The ICBT intervention was more effective than the WL condition in reducing total number of anxiety disorder diagnoses, the total parent-rated interference of those diagnoses, and the total clinician-rated severity of those diagnoses (via structured diagnostic interview), as well as reducing maternal protective parenting behaviors. These changes were maintained at 3-month follow-up in the ICBT group. There were no significant differences between conditions in father-report of any variables, in child self-report or teacher-report of child anxiety, or mother-report on maternal anxiety, satisfaction, or self-efficacy. These findings suggest that treatment with the parents of anxious children can be an effective treatment modality. They also suggest that the influence of parenting factors such as protective behaviors should be a fundamental consideration for practitioners when planning childhood anxiety treatment in any modality. Future research is warranted with larger, more diverse samples and long-term follow-up in order to elucidate the mechanisms through which individual CBT with the parents of anxious children results in symptom reduction for the child and whether these gains are maintained over time.