Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions
Open accessAbstract
Objective: Treatment for childhood anxiety disorders is insufficient in many cases. Parent involvement has been examined as an augment to child-based cognitive behavioral therapy (CBT), but no studies have compared the efficaciousness of stand-alone parent-based treatment to CBT. Research implicates family accommodation in the maintenance and course of childhood anxiety. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment that reduces accommodation of childhood anxiety. This study compared SPACE to CBT in a noninferiority trial. Method: Participants were children with primary anxiety disorders (N=124; 7–14 years old; 53% female participants; 83% white), randomly assigned to either SPACE (N=64) with no direct child-therapist contact, or CBT (N=60) with no parent treatment. Ninety-seven (78%) of participants completed all treatment sessions and assessments. Attrition did not differ significantly between groups. Primary anxiety outcomes included diagnostic interviews and clinician-rated scales. Secondary outcomes included parent and child ratings of anxiety severity, family accommodation, and parenting stress. Noninferiority margins were determined based on statistical and clinical considerations. Change in family accommodation and parenting stress were examined using mixed models analyses. Results: SPACE was noninferior, relative to CBT, on primary and secondary anxiety outcomes, and based on ratings provided by independent evaluators, parents, and children. Family accommodation and parenting stress were significantly reduced in both treatments, with significantly greater reduction in family accommodation following SPACE, compared to CBT. Treatment credibility and satisfaction were high. Conclusion: SPACE is an acceptable and efficacious treatment for childhood anxiety disorders, noninferior to CBT, and provides an alternative strategy for treating anxiety in children.
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The Family Accommodation Scale has been previously used in child anxiety treatment studies.
“This 9-point parent report scale assesses parental accommodating behaviors and has been previously used in child anxiety treatment studies [24].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [24]
The Methods (Measures) say the parent-report Family Accommodation Scale – Anxiety was administered in this childhood anxiety treatment study, supporting its use in such studies. But the citing sentence calls it a “9-point” scale; the source describes nine items rated on a five-point scale. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThree treatments have been developed to target accommodation: SPACE, ARI, and a parent-led exposure therapy program.
“Three treatments have been developed to target accommodation: Supportive Parenting for Anxious Childhood Emotions (SPACE) [88, 89], the Accommodation Reduction Intervention (ARI) [86••], and a parent-led exposure therapy program [82].”
From Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety. (2020) · cites this paper as [88]
Focusing on gradually removing parental accommodation has proved successful in the treatment of childhood anxiety.
“Focusing on gradually removing such parental accommodation has proved successful in the treatment of childhood anxiety, for example (25).”
From An emotion regulation skills training for adolescents and parents: perceptions and acceptability of methodological aspects (2024) · cites this paper as [25]
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References 55 · Cited by 268
Research works printed but not linked: 1
- [40]Silverman WK, Albano AM. Anxiety Disorders Interview Schedule (ADIS-IV) Parent Interview Schedule. New York: Oxford University Press; 1996.
- Authors
- Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K.
- Affiliations
- Yale University (US)
- Corresponding author
- Lebowitz, Eli R.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 59
- Issue
- 3
- Pages
- 362-372
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6732048
- OpenAlex
- W2921567862
- Semantic Scholar
- 951841e3b97be422d04909fb7cd7c96434393b6a
- Cited by
- 268
- References
- 55
- Citations by year
- 2026: 39 · 2025: 37 · 2024: 36 · 2023: 31 · 2022: 44 · 2021: 41 · 2020: 34 · 2019: 6
- FWCI
- 36.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH103555)
- Oxford University Press
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- childhood anxiety, cognitive behavioral therapy, space, family accommodation, parental stress, non-inferiority, treatment efficacy, childhood anxiety disorders, parent intervention
- MeSH terms
- Anxiety, Anxiety Disorders, Child, Cognition, Female, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Parenting, Treatment Outcome
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