Parental involvement in the development and treatment of childhood anxiety

Anxiety is one of the most prevalent psychological disorders affecting children, with up to 15% of children experiencing some sort of anxiety disorder (Breinholst, Esbjørn, Reinholdt-Dunne & Stallard, 2012; Ginsburg & Schlossberg, 2002). Childhood anxiety affects functioning across a range of areas, including school achievement and social relationships, and often persists into adulthood, contributing to further psychopathology (Wei & Kendall, 2014).

Early diagnosis and treatment of childhood anxiety is vital. Parents play an important role in the development, course, and treatment of anxiety in their children; and psychological researchers and clinicians have developed a number of ways that parents can help their children to deal with this anxiety.

How parents can contribute to childhood anxiety

Psychological literature has established that a number of parenting practices can contribute to the development and maintenance of anxiety in children. Some of these practices include parental control, lack of acceptance and warmth, modelling and reinforcement of anxious behaviours, and the influence of parental anxiety on parenting practices (Brenholst et al., 2012; Ginsburg & Schlossberg, 2002; Luis, Varela & Moore, 2008, Wei & Kendall, 2014).

Parental control

Too much control can reinforce anxious behaviours in children and contribute to the maintenance of childhood anxiety. This includes parent’s over-involvement in their child’s activities, over-protection, and restriction of their behaviour (Wei & Kendall, 2014). Parental over-control lessens their child’s autonomy and control over situations where they may feel fear or distress and reduces their ability to deal with these situations in the future (Wei & Kendall, 2014). Children are not provided the opportunity to naturally explore their environment and learn from difficult and stressful situations, which may lead them to believe they are unable to navigate these situations (Luis, Varela & Moore, 2008).

Warmth and rejection

A lack of warmth and acceptance is also associated with increased anxiety in children. Warmth and acceptance contribute to children’s ability to regulate their emotions, a positive sense of self-worth, and validation of their feelings and emotions (Wei & Kendall, 2014). Children faced with rejection and criticism are less able to regulate their emotions and may believe they will not receive any parental support when navigating their environment, contributing to increased anxiety (Ginsburg & Schlossberg, 2002; Luis, Varela & Moore, 2008).

Parental anxiety

There is a strong and consistent link between parental anxiety and anxiety disorders in children. Studies have shown that 60% of children with anxious parents also suffer from an anxiety disorder, and that 80% of parents with anxious children also show symptoms of anxiety (Breinholst et al., 2012). Parental anxiety may lead parents to be overly cautious with their children in anxiety-inducing situations, encouraging the avoidance of those situations (Breinholst et al., 2012). Parental anxiety plays a role in the other factors as well, as anxious parents tend to be more controlling, more negative, critical, and less affectionate, and encourage their children to avoid anxiety-inducing situations (Wei & Kendall, 2014).

Modelling and reinforcement

Modelling and reinforcement refer to how children learn from their parent’s responses to anxiety-provoking situations, anxious behaviours, and anxious thought patterns (Breinholst et al., 2012; Wei & Kendall, 2014). Parents may actively reinforce anxiety by encouraging avoidance of anxiety-inducing situations or may inadvertently reinforce anxiety in their children through their own ways of acting and communicating (Breinholst et al., 2012; Wei & Kendall, 2014).

Treating childhood anxiety

Cognitive behavioural therapy (CBT) has been shown to be highly effective for treating anxiety disorders in both children and adults (Breinholst et al., 2012). CBT teaches patients to identify and change maladaptive thought patterns and behaviours. While CBT is frequently used in clinical settings with only a therapist, research suggests that parental involvement in CBT, or family-based CBT, can be effective in providing parents with the tools to treat both their child’s and their own anxious behaviours.

Family-based CBT varies in its implementation and focus, but areas commonly targeted are: psychoeducation for parents, contingency management, parental coping, parental anxiety, cognitive restructuring, and improving parent-child communication (Ginsburg & Schlossberg, 2002; Wei & Kendall, 2014).

1. Psychoeducation: Often the first step, psychoeducation focuses on teaching parents about anxiety and the different ways that it can manifest so they are able to recognise and respond to it. Parents are also taught about CBT and why it’s used.

2. Contingency management: Teaches parents to stop the reinforcement of avoidant and learned behaviours and encourages the rewarding of coping in anxious situations, or ‘brave’ behaviour.

3. Parental coping: Parents are taught to also demonstrate the coping skills necessary in anxious situations so their children learn from them.

4. Parental anxiety: Parents learn strategies and CBT strategies for dealing with their own anxiety.

5. Cognitive restructuring: Teaches parents to identify and change thoughts about the inability of their children to handle anxiety-inducing situations, and replace them with more positive, constructive thoughts about their child’s anxiety.

6. Parent-child communication: Focuses on changing negative communication styles, such as blaming and criticizing, into more positive communication between parents and their children.

Practical tips for dealing with anxiety in your child

Here are seven practical ways for parents to treat and deal with anxiety in their children:

1. Open communication

- Create a safe and non-judgmental environment for your child to express their feelings and concerns.

- Encourage them to talk about what makes them anxious, and listen attentively without interrupting or dismissing their worries.

2. Educate yourself

- Learn about childhood anxiety and its common triggers and symptoms to better understand your child's experiences.

- Knowledge will help you identify when your child might need extra support.

3. Be a positive role model

- Children often learn by example. Demonstrate healthy coping mechanisms for dealing with stress and anxiety in your own life.

- Show them that it's okay to feel anxious at times and how to manage those feelings constructively.

4. Establish routines

- Consistent routines can provide a sense of stability and predictability for anxious children.

- Create daily schedules that include regular meal times, bedtime routines, and homework/study time.

5. Teach relaxation techniques

- Teach your child relaxation exercises like deep breathing, mindfulness, or progressive muscle relaxation.

- Practice these techniques together, so your child can use them when they feel overwhelmed.

6. Encourage problem-solving

- Help your child break down their anxieties into smaller, manageable parts.

- Guide them in brainstorming solutions and setting achievable goals to address their concerns.

7. Seek professional help

- If your child's anxiety is severe, persistent, or significantly interferes with their daily life, consider consulting a mental health professional.

- A therapist or counselor can provide specialized strategies and interventions tailored to your child's needs.

Remember that treating childhood anxiety often requires patience and persistence. Be supportive and adaptable in your approach, as what works for one child may not work for another. It's essential to be there for your child, offer reassurance, and show them that their anxiety doesn't define them or limit their potential for a happy and fulfilling life.

References

Breinholst, S., Esbjørn, B. H., Reinholdt-Dunne, M. L., & Stallard, P. (2012). CBT for the treatment of child anxiety disorders: A review of why parental involvement has not enhanced outcomes. Journal of anxiety disorders, 26(3), 416-424.

Ginsburg, G. S., & Schlossberg, M. C. (2002). Family-based treatment of childhood anxiety disorders. International Review of Psychiatry, 14(2), 143-154.

Luis, T. M., Varela, R. E., & Moore, K. W. (2008). Parenting practices and childhood anxiety reporting in Mexican, Mexican American, and European American families. Journal of Anxiety Disorders, 22(6), 1011-1020.

Wei, C., & Kendall, P. C. (2014). Parental involvement: Contribution to childhood anxiety and its treatment. Clinical Child and Family Psychology Review, 17, 319-339.