Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation

Abstract

Background A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions—particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children—for instance, by mitigating known anxiety risk factors—remains unexplored. Objective This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9

Adolescent dropout from brief digital mental health interventions within and beyond randomized trials

“…Participants were characterized as either Full Completers, Post-Activity Non-Completers, or Pre-Activity Non-Completers. These groups were modeled after categories used to classify completion in a previous study investigating an SSI ( Sung et al, 2021 ). Full Completers were participants who reached the end of the full SSI content, defined by submitting a response to the final activity.…”

“…Single-Session Interventions (SSIs), structured interventions that intentionally last only one session, may be ideal interventions to investigate predictors of digital intervention retention ( Schleider et al, 2020b ). The brevity of SSIs allows researchers to determine what factors may impact dropout outside of intervention length (which tends to be consistent across digital SSIs: between 20 and 30 min total; Dobias et al, 2021 ; Schleider et al, 2020a ; Sung et al, 2021 ). Digital, self-guided SSIs have been demonstrated to reduce symptoms of depression and anxiety in adolescents with effects lasting up to 9 months, but completion rates vary widely, from 40%–100% ( Dobias et al, 2021 ; Schleider et al, 2020a ; Schleider and Weisz, 2018 ; Sung et al, 2021 ).…”

“…The brevity of SSIs allows researchers to determine what factors may impact dropout outside of intervention length (which tends to be consistent across digital SSIs: between 20 and 30 min total; Dobias et al, 2021 ; Schleider et al, 2020a ; Sung et al, 2021 ). Digital, self-guided SSIs have been demonstrated to reduce symptoms of depression and anxiety in adolescents with effects lasting up to 9 months, but completion rates vary widely, from 40%–100% ( Dobias et al, 2021 ; Schleider et al, 2020a ; Schleider and Weisz, 2018 ; Sung et al, 2021 ). It is not clear whether incentives, demographics, or psychological variables affect dropout in digital, self-guided SSIs for adolescents.…”

Intergenerational trauma: Parental PTSD and parent‐reported child abuse subtypes differentially relate to admission characteristics in the autism inpatient collection

“…For example, trauma‐focused cognitive behavioral therapy incorporates parents to a significant degree in order to help caregivers understand child trauma, reinforce the development of therapeutic skills, and promote supportive parent–child communication, and caregiver behavior predicts symptom change for youth (Yasinski et al, 2016). In addition, separate interventions have been developed that focus solely on assisting parents in supporting child anxiety without the child present, in multisession and single‐session formats (Lebowitz et al, 2020; Sung et al, 2021). Lastly, considering when to provide individual support for a parent's own traumatic symptoms, or broader interventions for addressing social determinants of health such as income insufficiency, will also be important for developing comprehensive treatment options that consider the youth and their caregiver/family in context.…”

Adolescent Dropout from Brief Digital Mental Health Interventions Within and Beyond Randomized Trials

“…Indeed, this work suggests that briefer interventions (e.g., those requiring a single program encounter/use) may facilitate greater engagement and completion compared to higher-burden programs-but little research has specifically examined whether other factors, such as incentive type or user characteristics, predict dropout in brief digital interventions, as they appear to in lengthier minutes ). Yet even within online SSI studies, completion rates vary widely, from 40% -100% (Dobias et al, 2021;Schleider and Weisz, 2018;Sung et al, 2021). SSIs are ideal interventions to investigate predictors of digital intervention retention, because their brevity allows researchers to determine what factors may impact dropout outside of intervention length (which tends to be consistent across digital SSIs: between 20-30 minutes total).…”