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

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.

Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment

“…Clinician: 'I was nervous, and slightly intimidated, to work with parents before : : : I thought that because I didn't have children myself, they would question how I could understand : : : ' It can feel daunting to work with parents, especially for clinicians with limited experience, but as noted above, similar outcomes have been found when parent-led CBT was delivered by novices or by more experienced practitioners (Thirlwall et al, 2013). Qualitative interviews from the same study indicated that although some parents may have been initially surprised at being so involved in the treatment, they found the approach acceptable, reported empowerment and skill development, and identified wide-ranging benefits both for the child and the wider family (Allard et al, 2021). Clinicians have also described parent-led CBT as an 'empowering' and 'practical' approach (Evans et al, 2019) with high satisfaction reported by clinicians from a range of professional backgrounds when delivered to families individually (Creswell et al, 2010) and in groups (Evans et al, 2019).…”

“…As shown in Table 1, parent-led CBT has commonly been delivered in groups. While this may bring advantages from peer support for some parents, this format may also introduce barriers for others (Allard et al, 2021). From our interactions with clinical teams we are aware that groups are often used as a way to deliver the intervention efficiently, but notably costeffectiveness evaluations comparing groups with the individual approach have not yet been conducted.…”

“…The second treatment session provided Lehka with an opportunity to role-play key skills with the clinician, including asking open curious questions, being empathetic, and checking understanding, to help Lehka and the clinician to identify what Saira needed to learn to overcome her difficulties with anxiety (Halldorsson et al, 2019). Learning these skills (and having success with implementing them at home) enabled Lehka to gain better insight into Saira's difficulties with anxiety and to become more empathetic (Allard et al, 2021).…”

Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders

“…Parents’ knowledge of CBT and their role in this type of treatment for their child has been investigated via qualitative measures primarily in the context of parent-delivered CBT or CBT enhanced with a parent training module. Parents commonly endorse initial feelings of surprise when learning about the negative consequences of accommodating their child’s anxiety and endorsed feelings of guilt when practising behaviours such as selective ignoring and carrying out exposures to help their child confront pathological fear (Allard et al ., 2022; Jones, 2017; Pishva, 2017). This ‘paradoxical parenting’ became easier for most parents to implement as they changed roles during their child’s treatment progression from comforters and protectors to supporters and advocates (Allard et al ., 2022; Jones, 2017; Pishva, 2017).…”

“…Parents commonly endorse initial feelings of surprise when learning about the negative consequences of accommodating their child’s anxiety and endorsed feelings of guilt when practising behaviours such as selective ignoring and carrying out exposures to help their child confront pathological fear (Allard et al ., 2022; Jones, 2017; Pishva, 2017). This ‘paradoxical parenting’ became easier for most parents to implement as they changed roles during their child’s treatment progression from comforters and protectors to supporters and advocates (Allard et al ., 2022; Jones, 2017; Pishva, 2017). After completion of these programmes, parents were also able to identify the nature of anxiety, its relationship with thoughts and physiological symptoms, and have conversations with their child about their anxiety (Jones, 2017; Pishva, 2017).…”