Benefits of Child-Focused Anxiety Treatments for Parents and Family Functioning

Abstract

Background To examine (1) changes in parent (global psychological distress, trait anxiety) and family (dysfunction, burden) functioning following 12 weeks of child-focused anxiety treatment, and (2) whether changes in these parent and family factors were associated with child's treatment condition and response. Methods Participants were 488 youth ages 7–17 years (50% female; mean age 10.7 years) who met DSM-IV-TR criteria for social phobia, separation anxiety, and/or generalized anxiety disorder, and their parents. Youth were randomly assigned to 12 weeks of “Coping Cat” individual cognitive-behavioral therapy (CBT), medication management with sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) within the multisite Child/Adolescent Anxiety Multimodal Study (CAMS). At pre- and posttreatment, parents completed measures of trait anxiety, psychological distress, family functioning, and burden of child illness; children completed a measure of family functioning. Blinded independent evaluators rated child's response to treatment using the Clinical Global Impression-Improvement Scale at posttreatment. Results Analyses of covariance revealed that parental psychological distress and trait anxiety, and parent-reported family dysfunction improved only for parents of children who were rated as treatment responders, and these changes were unrelated to treatment condition. Family burden and child-reported family dysfunction improved significantly from pre- to posttreatment regardless of treatment condition or response. Conclusions Findings suggest that child-focused anxiety treatments, regardless of intervention condition, can result in improvements in nontargeted parent symptoms and family functioning particularly when children respond successfully to the treatment.

Parenting, Family Functioning and Anxiety-Disordered Children: Comparisons to Controls, Changes After Family Versus Child CBT

“…With regard to our second research question, we found, in line with previous research (e.g., Crawford and Manassis 2001;Keeton et al 2013), anxiety-enhancing parenting/ family functioning decreased and anxiety-reducing parenting/family functioning increased after treatment that focused on childhood anxiety disorders. But contrary to our expectations, the FCBT that, besides child anxiety, targeted anxiety-enhancing parenting and family functioning was not more successful in reducing anxiety-enhancing parenting and family functioning than the CCBT, in which no explicit instructions were given to parents about parenting or family interactions.…”

“…To conclude, although the above studies had methodological limitations (no active treatment condition for comparison; limited power), parenting and family functioning seem to improve as a result of FCBT. Keeton et al (2013) studied effects of CCBT, pharmacotherapy and the two therapies combined for childhood anxiety disorders on family functioning and several parental variables (e.g., caregiver perceived burden). Child-reported family functioning and caregiver perceived burden improved significantly after treatment in all conditions (respectively small and large effect).…”

Parental Anxiety as a Predictor of Medication and CBT Response for Anxious Youth

“…Thus, present findings must be interpreted in light of the study-specific sample characteristics pending replication with broader clinical samples. In addition, Keeton and colleagues [54] found in the CAMS sample that a reduction in youth symptoms was associated with reduced Week 12 parental anxiety and psychological distress. Because we do not have data on parental anxiety in the intermediate weeks (weeks 4 and 8), we cannot rule out parental anxiety out as a mediator in the medication condition, though we do not view this as likely.…”

Parental psychopathology and treatment outcome for anxious youth: Roles of family functioning and caregiver strain.

“…Studies using CAMS data corroborated this finding (Compton et al, 2004). CAMS data also demonstrated that, like family dysfunction, overall caregiver strain measured using the BAS improved over the course of cognitive-behavioral and medication-based youth anxiety treatments (Keeton et al, 2013). …”