Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Abstract

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.

Keywords: Anxiety; CBT; Family accommodation; Mechanisms; Youth.

Fig. 1

Previous session (T-1) to current session (T-0) relationship between variables. Anxiety is measured by Spence Child Anxiety Scale. Accommodation is measured by Family Accommodation Scale-Anxiety. Coefficients are standardized to describe within-person change. The cross-lagged effect of accommodation on anxiety was substantially greater than the reverse cross-lagged effect. *Denotes coefficients where the posterior 95% credibility interval did not overlap 0