Cognitive-Behavioral Group Treatments in Childhood Anxiety Disorders: The Role of Parental Involvement
Abstract
Objectives This study examined (1) the effect of a cognitive-behavioral group intervention on anxiety, depression, and coping strategies in school-age children (aged 7-12 years) with Axis I anxiety disorders; and (2) the effect of parental involvement on treatment outcomes.Method Parents and children (N = 62) were randomly assigned to one of three 12-week treatment conditions: parent and child intervention, child-only intervention, and parent-only intervention. Child anxiety, depression, and coping strategies were assessed before and after treatment.Results All treatment groups reported fewer symptoms of anxiety and depression posttreatment and changes in their use of coping strategies. Children in the parent and child intervention used more active coping strategies posttreatment compared with children in the other 2 treatment conditions. Parents in this treatment condition reported a significantly greater improvement in their children's emotional well-being than parents in the other treatment conditions.Conclusions Cognitive-behavioral group interventions reduced symptoms of anxiety and depression in school-age children with anxiety disorders. Concurrent parental involvement enhanced the effect on coping strategies. Further investigation is needed to corroborate the effectiveness of such short-term interventions and the maintenance of treatment effects.
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Parent-focused interventions for child anxiety disorders and OCD neglect covert psychological processes that underlie overt parental actions and the reasons why parents engage in unhelpful responses.
“By trying to alter the topography of parent behavior, these interventions neglect to address covert psychological processes that underlie overt parental actions and the reasons why parents engage in unhelpful responses.”
From A Qualitative Study of Participant Feedback on an Acceptance and Commitment Therapy Group-Based Intervention for Parents of Youth with Anxiety Disorders. (2026) · cites this paper as [22]
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“However, in other studies, parental involvement failed to produce superior effects on treatment outcomes (Barrett et al., 1998; Mendlowitz et al., 1999; Nauta et al., 2001, 2003; Spence et al., 2000).”
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“For example, the protocol has proven to be both transportable and adaptable to other cultures such as in Australia (e.g. Barrett et al., 1996) and Canada (Mendlowitz et al., 1999).”
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“This type of intervention is based on anxietymanagement approaches (e.g., relaxation training, cognitive restructuring, exposure) that have been effective in treating social anxiety and related disorders (Mendlowitz et al., 1999).”
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ResultSchool-Based Interventions for Anxious Children
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Kang, Y., Rahrig, H., Eichel, K., Niles, H. F., Rocha, T., Lepp, N. E., Gold, J., & Britton, W. B. (2018) · Journal of School Psychology · doi:10.1016/j.jsp.2018.03.004 · Cited by 143 · see citing works
Choate-Summers, M. L., Pincus, D. B., Eyberg, S. M., & Barlow, D. H. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80047-1 · Cited by 141 · see citing works
“Treatment studies with anxious children between the ages of 7 and 14 have demonstrated enhanced effectiveness when a parent training componen t is inc luded in which parents are taught specific skills for helping their anxious children (Cobham, Dadds, & Spence, 1998; Mendlowitz et al., 1999).”
BackgroundPredictors of Treatment Response in Pediatric Obsessive-Compulsive Disorder
Ginsburg, G. S., Kingery, J. N., Drake, K. L., & Grados, M. A. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181799ebd · Cited by 139 · see citing works
What Is the Evidence for Evidence-Based Treatments? A Hard Look at Our Soft Underbelly
Jensen, P. S., Weersing, V. R., Hoagwood, K., & Goldman, E. E. (2005) · Mental Health Services Research · doi:10.1007/s11020-005-1965-3 · Cited by 136 · see citing works
“Four studies met both criteria (Dishion & Andrews, 1995; Mendlowitz et al., 1999; Murray et al., 2003; Wayland, 2003), thus yielding a total of 52 rather than 56 (29 + 27) studies.”
ResultComponents of Cognitive Behavioral Therapy Related to Outcome in Childhood Anxiety Disorders
Ale, C. M., McCarthy, D. M., Rothschild, L. M., & Whiteside, S. P. H. (2015) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-015-0184-8 · Cited by 136 · see citing works
“…WL G Community SoP 50 13–17 Masia Warner et al. (2007) CBT versus AP G Community SoP 32 14–16 Melfsen et al. (2011) CBT versus WL I Mixed SoP 44 8–14 Mendlowitz et al. (1999) CBT-child versus CBT-parent versus CBT- both versus WL G Clinic CADs 102 7–12 Mifsud and Rapee (2005) CBT versus WL G…”
BackgroundSigurvinsdóttir, A. L., Jensínudóttir, K. B., Baldvinsdóttir, K. D., Smárason, O., & Skarphedinsson, G. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1686653 · Cited by 130 · see citing works
Christophersen, E. R., & Mortweet, S. L. (2001) · American Psychological Association eBooks · doi:10.1037/10405-000 · Cited by 131 · see citing works
Chu, B. C., & Harrison, T. (2007) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-007-0028-2 · Cited by 127 · see citing works
The Effect of Parent Involvement in the Treatment of Anxiety Disorders in Children: A Meta-Analysis
Thulin, U., Svirsky, L., Serlachius, E., Andersson, G., & Öst, L.-G. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.923928 · Cited by 124 · see citing works
“…2006), 2. individually without the child (Deblinger et al., 1996; King et al., 2000; Nauta et al., 2001, 2003), 3. in groups with their children (Barrett, 1998; Mendlowitz et al., 1999; Spence et al., 2000), and 4. in groups without their children (Mendlowitz et al., 1999; Öst et al., in press).”
BackgroundInfluentialFamily Treatment of Child Anxiety: Outcomes, Limitations and Future Directions
Creswell, C., & Cartwright‐Hatton, S. (2007) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-007-0019-3 · Cited by 124 · see citing works
“The results to date present a very mixed picture, with some studies reporting statistically significant improvements from the addition of a family component (e.g. Barrett, Dadds, & Rapee, 1996; Heyne et al., 2002; Mendlowitz et al., 1999) and others reporting no added value of FCBT over and above CCBT (e.”
BackgroundMethodResultInfluentialWaters, A. M., Ford, L. A., Wharton, T. A., & Cobham, V. E. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.04.008 · Cited by 119 · see citing works
“Mendlowitz et al. (1999) showedreductions inanxietyanddepressive symptoms in anxious children receiving parentþ child, child-only, and parent-only focused interventions compared to a Wait-list Control condition.”
MethodResultSpielmans, G. I., Pasek, L. F., & McFall, J. P. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.06.001 · Cited by 117 · see citing works
Separation Anxiety Disorder in Children and Adolescents
Masi, G., Mucci, M., & Millepiedi, S. (2001) · CNS Drugs · doi:10.2165/00023210-200115020-00002 · Cited by 119 · see citing works
Muris, P., Meesters, C. M. G., & van Melick, M. (2002) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(02)00025-3 · Cited by 115 · see citing works
CBT for adolescents with anxiety: mature yet still developing
Kendall, P. C., & Peterman, J. S. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14081061 · Cited by 115 · see citing works
Piña, A., Silverman, W. K., Fuentes, R., Kurtines, W. M., & Weems, C. F. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200310000-00008 · Cited by 120 · see citing works
Forehand, R., Jones, D. J., & Parent, J. M. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.10.010 · Cited by 115 · see citing works
“2Two studies (Mendlowitz et al., 1999; Rapee, 2000) were excluded based on this criterion.”
BackgroundSchool-Based Intervention: Examining a Universal Approach to Anxiety Management
Barrett, P. M., & Pahl, K. M. (2006) · Australian Journal of Guidance and Counselling · doi:10.1375/ajgc.16.1.55 · Cited by 115 · see citing works
“, 1997) and group formats (Shortt, Barrett, & Fox, 2001; Flannery-Schroeder & Kendall, 2000; Mendlowitz et al., 1999; Silverman et al., 1999), with treatment response rates across studies ranging from 60% and 95% diagnosis-free following treatment.”
BackgroundDeRosier, M. E., Swick, D. C., Davis, N. O., McMillen, J. S., & Matthews, R. (2011) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-010-1128-2 · Cited by 113 · see citing works
“By supporting and reinforcing positive changes, enhancing communication, and modeling positive attitudes towards treatment, parent involvement can significantly enhance treatment efficacy (Kolivas et al. 2008; Mendlowitz et al. 1999).”
BackgroundFamily Cognitive Behavioral Therapy for Children and Adolescents With Clinical Anxiety Disorders
Bögels, S. M., & Siqueland, L. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000190467.01072.ee · Cited by 110 · see citing works
Chase, R. M., & Eyberg, S. M. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.03.006 · Cited by 107 · see citing works
“Recent CBT studies have suggested that parent involvement in the treatment of child anxiety may enhance outcome (Eisen, Engler, & Geyer, 1998; Mendlowitz et al., 1999; Silverman & Berman, 2001).”
BackgroundDichotic Listening and Response Inhibition in Children With Comorbid Anxiety Disorders and ADHD
Manassis, K., Tannock, R., & Barbosa, J. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200009000-00015 · Cited by 106 · see citing works
Self-citationComputer-Assisted CBT for Child Anxiety: The Coping Cat CD-ROM
Khanna, M. S., & Kendall, P. C. (2008) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.02.002 · Cited by 102 · see citing works
Parental Involvement: Contribution to Childhood Anxiety and Its Treatment
Wei, C., & Kendall, P. C. (2014) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-014-0170-6 · Cited by 99 · see citing works
“Still other studies did not find significant differences between parent-involved CBT and child-focused CBT (Barrett 1998; Bodden et al. 2008; Mendlowitz et al. 1999; Nauta et al. 2001, 2003; Siqueland et al. 2005; Spence et al. 2000; Waters et al. 2009).”
BackgroundEffectiveness of Modular CBT for Child Anxiety in Elementary Schools
Chiu, A. W., Langer, D. A., McLeod, B., Har, K., Drahota, A., Galla, B. M., Jacobs, J., Ifekwunigwe, M., & Wood, J. (2013) · School psychology quarterly · doi:10.1037/spq0000017 · Cited by 96 · see citing works
“…diagnosis of SAD, SP, or GAD; (b) no psychiatric medication use or stable use of psychiatric medication for at least 1 month at the time of the pretreatment assessment; and (c) if medication was being used, families agreed to maintain that dose throughout the study (cf. Mendlowitz et al., 1999).”
MethodThienemann, M., Martin, J. L., CREGGER, B., THOMPSON, H. B., & Dyer-Friedman, J. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200111000-00004 · Cited by 94 · see citing works
Parental Anxiety in the Treatment of Childhood Anxiety: A Different Story Three Years Later
Cobham, V. E., Dadds, M. R., Spence, S. H., & McDERMOTT, B. M. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374411003691719 · Cited by 92 · see citing works
“Mendlowitz and colleagues ( 1999 ) reported that parents in their family-focused condition reported significantly greater improvements in children's emotional well-being.”
BackgroundComorbid mental disorders and substance use disorders: epidemiology, prevention and treatment
Proudfoot, M. T. H. (2004) · Cited by 88 · see citing works
Considerations in the use of exposure with children
Bouchard, S., Mendlowitz, S. L., Coles, M. E., & Franklin, M. (2004) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(04)80007-5 · Cited by 87 · see citing works
Self-citationFlannery-Schroeder, E. C., Choudhury, M. S., & Kendall, P. C. (2005) · Cognitive Therapy and Research · doi:10.1007/s10608-005-3168-z · Cited by 85 · see citing works
“Research on the efficacy of GCBT is emerging (e.g., Barrett, 1998; Manassis et al., 2002; Mendlowitz et al., 1999; Silverman et al., 1999).”
Prins, P. J. M., & Ollendick, T. H. (2003) · Clinical Child and Family Psychology Review · doi:10.1023/a:1023730526716 · Cited by 83 · see citing works
No need to worry: the promising future of child anxiety research
Kendall, P. C., Settipani, C. A., & Cummings, C. M. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.632352 · Cited by 82 · see citing works
“, 1997), group CBT (e.g., Barrett, 1998; Flannery-Schroeder & Kendall, 2000; Mendlowitz et al., 1999), and social effectiveness training (e.”
BackgroundEfficacy of psychosocial group intervention for children with chronic illness and their parents
Scholten, L., Willemen, A. M., Last, B. F., Maurice-Stam, H., van Dijk, E. M., Ensink, E., Zandbelt, N., van der Hoop-Mooij, A., Schuengel, C., & Grootenhuis, M. A. (2013) · PEDIATRICS · doi:10.1542/peds.2012-2222 · Cited by 82 · see citing works
Safety-Seeking and Coping Behavior During Exposure Tasks with Anxious Youth
Hedtke, K. A., Kendall, P. C., & Tiwari, S. (2009) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410802581055 · Cited by 81 · see citing works
“…across the world supporting the efficacy of CBT for anxious youth (e.g., Barrett, 1998; Barrett, Dadds, & Rapee, 1996; Cobham, Dadds, & Spence, 1998; Flannery-Schroeder & Kendall, 2000; Kendall, 1994; Kendall et al., 1997; Manassis et al., 2002; Mendlowitz et al., 1999; Silverman et al., 1999).”
BackgroundAlliance, technology, and outcome in the treatment of anxious youth
Chu, B. C., Choudhury, M. S., Shortt, A. L., Pincus, D. B., Creed, T. A., & Kendall, P. C. (2004) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(04)80006-3 · Cited by 79 · see citing works
Kendall, P. C., & Ollendick, T. H. (2004) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(04)80008-7 · Cited by 80 · see citing works
Manassis, K., Wilansky-Traynor, P., Farzan, N., Kleiman, V., Parker, K., & Sanford, M. (2010) · Depression and Anxiety · doi:10.1002/da.20724 · Cited by 79 · see citing works
“It utilizes cognitive restructuring and is derived from the earlier evaluated ‘‘Coping Bear’’ manual for child anxiety disorders,([22,23]) with principles identical to other extensively evaluated anxiety programs, such as Coping Cat.”
MethodSelf-citationPractitioner Review: Psychological Management of Anxiety Disorders in Childhood
Dadds, M. R., & Barrett, P. M. (2001) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00798 · Cited by 78 · see citing works
Prevention of depression in childhood and adolescence
Mendelson, T., & Tandon, S. D. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2015.11.005 · Cited by 77 · see citing works
Parent Training Interventions for Children with Autism Spectrum Disorders
Brookman-Frazee, L. I., Vismara, L. A., Drahota, A., Stahmer, A. C., & Openden, D. (2009) · Springer eBooks · doi:10.1007/978-1-4419-0088-3_14 · Cited by 77 · see citing works
Wood, J. J., McLeod, B. D., Piacentini, J. C., & Sigman, M. (2009) · Child Psychiatry & Human Development · doi:10.1007/s10578-009-0127-z · Cited by 76 · see citing works
“For adolescents, the effect of intervention group on composite anxiety change scores was robust (F [1, 19] = 7.52, p \ 0.01), with FCBT outperforming CCBT, but for children, the effect was nonsignificant (F [1, 13 ] = 0.23, p = 0.64).”
Influential
- Authors
- MENDLOWITZ, S. L., MANASSIS, K., BRADLEY, S., SCAPILLATO, D., MIEZITIS, S., & SHAW, B. E.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- MENDLOWITZ, SANDRA L.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 1999-10
- Volume
- 38
- Issue
- 10
- Pages
- 1223-1229
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2082066759
- Cited by
- 365
- References
- 23
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 9 · 2020: 6 · 2019: 9 · 2018: 5 · 2017: 12 · 2016: 15 · 2015: 15 · 2014: 20 · 2013: 22 · 2012: 18
- FWCI
- 15.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- 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
- group cognitive behavioral therapy, childhood anxiety disorders, parental involvement, parent-child intervention, childhood depression, coping strategies, elementary school students, treatment outcomes, emotional well-being
- MeSH terms
- Adaptation, Psychological, Anxiety, Anxiety Disorders, Child, Depression, Family Therapy, Female, Humans, Male, Parent-Child Relations, Psychotherapy, Group, Cognitive Behavioral Therapy
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