Childhood anxiety treatment may best be targeted at parents, study finds

At a time when childhood and adolescent anxiety has reached epidemic proportions, Yale researchers have come up with a novel way to help nervous youngsters:

Treat their parents.

In a new program developed at the Yale Child Study Center called SPACE, or Supportive Parenting for Anxious Childhood Emotions, grown-ups are being taught to help their kids manage anxiety by reducing – lovingly and supportively – the accommodations the adults make for their children’s symptoms.

What are accommodations? They run the gamut: allowing an anxious child to stay home from school, sleeping nightly with a frightened child, responding to numerous calls or texts every day from a nervous tween, not having houseguests because of a youngster’s social anxiety. An estimated 98 percent of parents with anxious kids engage in these kinds of behaviors.

In a recently published study in the Journal of the American Academy of Childhood and Adolescent Psychiatry, Yale researchers found this admittedly old-school approach of limiting accommodations was not only effective but appeared to work as well as what has been the gold standard for treating anxiety, cognitive behavioral therapy (CBT). (Medication is also used for many people with anxiety disorders.)

The four-year, federally funded Yale trial involved 124 youngsters ages 7 to 14. Sixty kids were given 12 weeks of high-quality training in CBT, learning to identify anxious thoughts, challenge them, and practice facing their fears.

For each of the other children, one parent received 12 weeks of training in SPACE program techniques to use with their kids.

“One of the most remarkable outcomes of this study,” said Eli Lebowitz, lead study author and director of the Yale center’s Program for Anxiety Disorders, “is these children whose parents got SPACE told us they were as much better as the kids who got cognitive behavioral therapy.”

The SPACE approach, it should be noted, is not just about saying no to an anxious child.

“Even before we start to work on changing the accommodation, we work on helping the parents to respond to their child in a supportive manner,” Lebowitz said. “We don’t want the message to be ‘I’m sick of this’ or ‘I’m mad at you’ or ‘You need to suck it up.’ We help parents to respond in a supportive way.”

In the training, a specific accommodation was selected for each parent to work on. Then a strategy for coping was developed.

“Sending parents home with the message of ‘don’t accommodate’ without giving them a detailed plan is like sending a soldier into battle without telling them what to do,” Lebowitz said. “It’s not going to go well.”

Key to the success of SPACE, he said, is the parent’s systematically communicating to the child that he or she is loved and supported and that the parent believes in him or her.

Parents, in turn, don’t mandate a certain behavior from the child. Rather, adults change their own behavior – declining to continue to sleep with a worried child, for example.

Over time, “the child is learning they in fact can cope,” Lebowitz said. “It’s actually living and experiencing that they can be OK, that their anxiety will pass.”

Anxiety is a huge and growing problem for America’s youth.

Nearly a third of adolescents have had an anxiety disorder, and more than 8 percent of them experience severe impairment, according to the National Institute of Mental Health. Anxious kids often grow into anxiety-stricken adults, with better than 19 percent of U.S. adults suffering from anxiety disorder in a given year.

Up to now, there have been just two evidence-based treatments for anxiety – medication and CBT – yet only half of children respond to them, Lebowitz said. Some of the youngsters won’t comply with the rigors of CBT or lack the verbal ability to do it.

Lebowitz said his center has begun training other organizations in SPACE. He and his colleagues also have used a combination of SPACE and CBT with families they work with, and hope to formally study that dual approach.