Directional effects of parent and child anxiety 1 year following treatment of child anxiety, and the mediational role of parent psychological control

Abstract

Background: We leveraged a recent efficacy trial to investigate directionality between parent anxiety and child anxiety at posttreatment and 12-month follow-up, and the potential role of parent psychological control as a mediator. We also explored child age and sex as moderators.Method: Two-hundred and fifty-four children were randomized to individual cognitive behavioral therapy (CBT) or to one of two CBT arms with parent involvement.Parent anxiety was not a treatment target in any of the three arms.Results: Child anxiety at posttreatment was associated with parent anxiety and psychological control at 12-month follow-up, providing evidence of child-to-parent directionality. Parent anxiety at posttreatment was associated indirectly with child anxiety at 12-month follow-up through associations with parent psychological control, providing evidence of parent-to-child directionality. At posttreatment, parent psychological control contemporaneously mediated the relation between parent and child anxiety. Neither child age nor sex moderated any association.Conclusions: Findings highlight the directional effects between child anxiety, parent anxiety, and psychological control from posttreatment to 12-month follow-up, even when parent anxiety is not a treatment target. Research and clinical implications are discussed, with an emphasis on enhancing durability following treatment effects.

Transactional associations of child irritability and anxiety with parent psychological control in Taiwanese school‐aged children

“…Limitations aside, our findings support psychological control as a promising target for reducing child anxiety as demonstrated in previous randomized controlled trials (Silverman et al, 2019(Silverman et al, , 2021 and disruptive and irritable behaviors as demonstrated in PMT-inspired interventions on collaborative parenting (less parental control and more positive reinforcements) (Hawks et al, 2020;Linke et al, 2020).…”

“…or that these children in fact have a different understanding of psychological control from their parents (Choe et al, 2023, also see a discussion on multi-informant assessments by De Los Reyes et al, 2015). When comparing to past between-person findings leveraged from parent-rated parenting data, our lagged paths highlight a parent to child effect from parent psychological control to child anxiety (Settipani et al, 2013) but not a child to parent effect from child anxiety to parent psychological control (Silverman et al, 2019(Silverman et al, , 2021. Besides these past studies' different focus on between-person effects and clinical samples (which may hence speak to a greater child impact on their parents), the inconsistency may be due to confounding variances from a potential effect between psychological control and irritability, which was not measured in the studies.…”

“…Based on non-Western findings (Nelson et al, 2006;Olsen et al, 2002) and the recent trials on child anxiety (Silverman et al, 2019(Silverman et al, , 2021, we hypothesized that there would be positive transactional associations between child irritability and anxiety and parent psychological control in this Taiwanese school-aged sample.…”

Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety

“…While ABFT for adolescent depression focuses on repairing attachment ruptures (44), ABFT for adolescent anxiety focuses more on promoting independence and competency in order to increase the teen's courage to face their fears, take risks, make mistakes, and experience discomfort (47). Thus, although the theoretical framework and structure are the same, ABFT for adolescent anxiety focuses on specific aspects of family interactions that contribute to childhood anxiety disorders, including parental beliefs about anxiety, overprotection and accommodation, and psychological control (56)(57)(58)(59).…”

Testing reciprocal associations between child anxiety and parenting across early interventions for inhibited preschoolers

“…The current study was conducted in accordance with recent recommendations for conducting and reporting on RCTs for childhood anxiety (Creswell et al, 2021) and offers important methodological advances informed by the seminal CBT studies for school-age youth and adolescents (Settipani et al, 2013;Silverman et al, 2009Silverman et al, , 2019Silverman, Marin, Rey, Jaccard, & Pettit, 2021). Indeed, many previous studies examining mediators of treatment response solely examined outcomes across two or three timepoints, due to study design.…”