Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Mar;59(3):362-372.
doi: 10.1016/j.jaac.2019.02.014. Epub 2019 Mar 7.

Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions

Eli R Lebowitz  1 , Carla Marin  2 , Alyssa Martino  2 , Yaara Shimshoni  2 , Wendy K Silverman  2
Affiliations
Randomized Controlled Trial

Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions

Eli R Lebowitz et al. J Am Acad Child Adolesc Psychiatry. 2020 Mar.

Abstract

Objective: Treatment for childhood anxiety disorders is insufficient in many cases. Parent involvement has been examined to augment child-based cognitive-behavioral therapy (CBT), but no studies have compared the efficacy 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 of age; 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. A total of 97 participants (78%) completed all treatment sessions and assessments. Attrition did not differ significantly between groups. Primary anxiety outcomes included diagnostic interview 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, is noninferior to CBT, and provides an alternative strategy for treating anxiety in children.

Clinical trial registration information: Explanatory Clinical Trial of a Novel Parent Intervention for Childhood Anxiety (SPACE); https://clinicaltrials.gov; NCT02310152.

Keywords: anxiety disorders; cognitive-behavioral therapy clinical trials; family accommodation; parent-based treatment.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Dr. Lebowitz has received royalties from John Wiley and Sons and funding from the National Institute of Mental Health. Dr. Silverman has received royalties from Oxford University Press and funding from the National Institute of Mental Health. Drs. Marin and Shimshoni and Ms. Martino report no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1:
Figure 1:. CONSORT Diagram of Study Enrollment and Retention
Note: Response indicates Clinical Global Impression Scale (CGI) improvement rating of ‘Very Much Improved’ or ‘Much Improved’. Remission indicates a CGI Severity rating of ‘Not At All Ill’ or ‘Borderline Ill’. CBT = individual cognitive behavioral therapy; SPACE = Supportive Parenting for Anxious Childhood Emotions.
Figure 2:
Figure 2:. Mean Differences and Confidence Intervals for Child Anxiety Outcomes
Note: Panels A, B, and C, show mean differences in PARS (Pediatric Anxiety Rating Scale), parent-rated SCARED (Screen for Childhood Anxiety Related Disorders), and child-rated SCARED scores, respectively. The Diamond indicates the actual differences and bars indicate the 97.5% CI around the mean. The dotted lines indicate the noninferiority margin for each measure. Mean differences below 0 indicate lower anxiety following SPACE while mean differences above 0 indicate lower anxiety following CBT.
Figure 3.
Figure 3.. Parent-Rated Family Accommodation by Treatment Condition From Baseline to PostTreatment
Note: Data presented for estimated marginal means from mixed models analysis covarying for baseline child anxiety. CBT = Cognitive Behavioral Therapy; SPACE = Supportive Parenting for Anxious Childhood Emotions.
See this image and copyright information in PMC

Comment in

References

    1. Costello EJ, Egger HL, Copeland W, Erkanli A, Angold A. The developmental epidemiology of anxiety disorders: Phenomenology, prevalence, and comorbidity. Anxiety disorders in children and adolescents: Research, assessment and intervention. 2011:56–75.
    1. Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1990s. J. Clin. Psychiatry 1999;60(7):427–435. - PubMed
    1. Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J. Clin. Child Adolesc. Psychol 2008;37(1):105–130. - PubMed
    1. Barrett PM, Dadds MR, Rapee RM. Family treatment of childhood anxiety: A controlled trial. J. Consult. Clin. Psychol 1996;64(2):333–342. - PubMed
    1. Barmish AJ, Kendall PC. Should parents be co-clients in cognitive-behavioral therapy for anxious youth? J. Clin. Child Adolesc. Psychol 2005;34(3):569–581. - PubMed

Publication types

Associated data