Category: Treatment - CBT
Parental anxiety has long been associated with poorer treatment success in some cases of cognitive-behavioral therapy (CBT) for anxious youth (Meadows, et al., 2007). Thus, efforts made to address factors related to parental anxiety may contribute to enhanced treatment outcomes (Woolfenden, Williams, & Peat, 2002). In addition, highly anxious parents tend to respond to negative child affect and behavior by means of disengagement or exerting control (Woodruff-Borden, et. al, 2002; Stark, et al., 1990), which some have attributed to the parents’ own “experiential avoidance” (EA) (Cheron, Ehrenreich, & Pincus, 2009). Parents model avoidant behavior to their children, which ultimately interferes with exposure-based interventions. EA is typically comprised of two sub-components, a parent’s unwillingness to witness their child’s distress, and inaction,or inability to manage their own distress in response to the child. In this study, we examine the effects of parent symptomatology, parent EA, and their interaction on treatment outcomes. Mother EA was hypothesized to negatively treatment outcomes and that this effect would be moderated by maternal psychopathology.
Objective and Methods
Participants were 50 youth (Mage = 11.0, SD = 2.0; 52% female) who had received CBT or anxiety and completed assessments pre- and post-treatment in an open clinical trial. Child anxiety symptoms were assessed via the Revised Child Anxiety and Depression Scale (RCADS; Chorpita et al., 2000)at pre- and post-treatment. Mother’s EA (inaction, unwillingness subscales) and psychopathology were measured via the Parental Acceptance and Action Questionnaire (PAAQ: Cheron, Ehrenreich, & Pincus, 2009) and Depression-Anxiety-Stress Scales (DASS-21; Lovibond & Lovibond, 1995) at pre-treatment.
Hierarchical regression analysis demonstrated main effects between child anxiety outcomes and mother psychopathology (β= -0.24; p=0.01), Inaction (β= 0.302; p=0.002), and Unwillingness (β= -0.176; p=0.043) subscales. The interaction between maternal distress and inaction was significant at the trend level (β= 1.13; p=0.08), such that greater maternal inaction was associated with worsened anxiety outcomes for mothers reporting high, but not low, psychopathology. This suggests that special attention in treatment may be useful for parents with high distress who demonstrate high inaction to better address modeling of avoidant behavior to the child. Further, the interaction between maternal distress and unwillingness was significant (β= -.874; p=0.04), such that greater unwillingness was associated with better anxiety outcomes for mothers reporting high, but not low, psychopathology. This counter-intuitive finding suggests that different aspects of parental experiential avoidance may further enhance or inhibit child development of coping skills during youth CBT, thus warranting further study.