You can't treat kids in a vacuum. The effect of parental anxiety on treatment for childhood anxiety

Cobham, et al (1998) took 67 children (ages 7-14) who met diagnostic criteria for an anxiety disorder, assessed their parents' anxiety level and randomly assigned them either to child-focused CBT (CBT) or child-focused CBT plus parental anxiety management (CBT+PAM). The CBT treatment consisted of 10 group sessions which included relaxation training, cognitive restructuring and coping self-talk, parent-assisted in-vivo exposure, and contingency management. The CBT+PAM treatment consisted of this plus 4 sessions for parents (usually only mother attended) which included education about the role of the family in the development of childhood anxiety, cognitive restructuring, relaxation training, and contingency management.

For anxious children whose parents were not anxious, both treatments were equally effective (82.4% and 80% diagnosis-free). However, for anxious children whose parents were also anxious, CBT alone was less effective (38.9% diagnosis-free) while CBT+PAM was equally effective (76.5% diagnosis-free). At a 12-month follow-up the same pattern persisted but was no longer statistically significant because the anxious children with anxious parents who had received CBT alone were 59% diagnosis-free at that point.

It appears that parental anxiety impedes CBT for children with anxiety disorders and that providing treatment for anxious parents overcomes this impediment.

• Cobham, V. E., Dadds, M. R. & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 66, 893-905.

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