Parents’ Perspectives on Guided Parent-Delivered Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Qualitative Study

Charlotte Allard,Kerstin Thirlwall,Peter Cooper,Doireann O’Brien,Alex Brown,Cathy Creswell

doi:10.1177/10634266211028199

Abstract

Cognitive behavioral therapy (CBT) is an effective treatment for child anxiety disorders. Low-intensity forms of CBT, such as guided parent-delivered CBT (GPD-CBT), have been developed to increase access; however, it is unclear why some children benefit from this treatment and others do not. This qualitative study aimed to increase understanding of parents’ experiences of GPD-CBT and what facilitates and creates barriers to good outcomes. The sample was derived from a sample of families who took part in long-term follow-up assessments (reported in). Data were analyzed using thematic analysis. Two themes containing five subthemes were developed from the data. Theme 1 described factors influencing the experience of GPD-CBT. Theme 2 described perceived outcomes in the child and wider changes within the family. The identification of facilitators and barriers to the success of GPD-CBT could inform and improve future treatment delivery.

Highlights

Childhood anxiety disorders affect 6.5% of children worldwide (Polanczyk et al, 2015) and have a significant impact on children’s education, physical health, and social and family life (Essau et al, 2000; Ezpeleta et al, 2001), as well as posing a risk for long-term difficulties in adulthood (Woodward & Fergusson, 2001)
GPD-cognitive behavioral therapy (CBT) could fit within a stepped care model where low-intensity treatments are routinely offered for mild–moderate presentations, while more intensive treatments are reserved for those presenting with severe anxiety disorders and those who do not respond to low-intensity interventions (Bower & Gilbody, 2005)
There have been few consistent predictors of treatment outcome for GPDCBT; the findings add to recent reports that suggest that while children with generalized anxiety disorder (GAD) do not differ in their overall clinical outcomes from guided parent-delivered CBT (GPD-CBT) compared to children with other anxiety disorders, if they have not recovered during the treatment phase they are less likely to recover in the subsequent 6 months than children with other anxiety disorders (Thirlwall et al, 2017)

Summary

Introduction

Childhood anxiety disorders affect 6.5% of children worldwide (Polanczyk et al, 2015) and have a significant impact on children’s education, physical health, and social and family life (Essau et al, 2000; Ezpeleta et al, 2001), as well as posing a risk for long-term difficulties in adulthood (Woodward & Fergusson, 2001). One brief low-intensity form of CBT is guided parent-delivered CBT (GPD-CBT) in which a therapist guides the parent to apply CBT principles in their child’s day-to-day life This approach has been found to be effective to traditional CBT treatments at treating childhood anxiety disorders (Chavira et al, 2014; Cobham, 2012; Leong et al, 2009; Lyneham & Rapee, 2006) but can be delivered with markedly reduced therapist input and fewer resources (Rapee et al, 2006; Smith et al, 2014; Thirlwall et al, 2013). GPD-CBT could fit within a stepped care model where low-intensity treatments are routinely offered for mild–moderate presentations, while more intensive treatments are reserved for those presenting with severe anxiety disorders and those who do not respond to low-intensity interventions (Bower & Gilbody, 2005) Despite these promising findings, not all children benefit from a GPD-CBT approach and predictors of child outcomes have not yet been established (Thirlwall et al, 2017). What, according to parents, facilitates the treatment? What, from a parent’s point of view, was the outcome of the treatment and were any positive outcomes sustained? Do parents perceive any barriers to engaging with the treatment, and, if so, how can these be minimized?

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