Category: Child / Adolescent - Anxiety
Introduction: Emerging evidence suggests that parental stress may influence youth anxiety treatment response with stress levels linked to unfavorable therapeutic outcomes, including reduced likelihood of diagnostic recovery and less symptomatic improvement (Crawford & Manassis, 2001; Wergerland et al., 2016). Thus, parental stress levels may be important to consider when determining when to involve parents in youth anxiety treatment. Attempts to enhance youth response to CBT by including parents in treatment has produced equivocal findings (Hudson et al., 2013; Bodden et al., 2008), but variables such as parental stress may moderate outcomes with some evidence that involving parents with high levels of stress results in greater treatment gains (Kendall et al., 2008).
Methods: The current study aims to further explicate the influence of parental stress on anxiety treatment response in thirty-three adolescents (50.6% female; ages 11-17) randomized to an intensive, 8-day CBT panic treatment with or without parental involvement. Data for this study comes from pre-treatment and 3 month follow up assessments, including mother report on the Depression Anxiety and Stress Scale-stress subscale (DASS Stress), the Stress Index for Parents of Adolescents- total stress subscale (SIPA TS), and youth report on the Panic Disorder Severity Scale- total, panic frequency, distress, and avoidance subscales (PDSS).
Results: Partial correlations were used to explore the relationship of pre-treatment DASS Stress and SIPA TS scores with PDSS Change scores (3-month follow up minus pre-treatment), while controlling for pre-treatment PDSS scores. Analyses were run separately by condition. In the parental involvement condition, DASS Stress scores were significantly correlated with PDSS Change scores for panic frequency (r=0.64, p=0.01) and SIPA TS scores were significantly correlated with PDSS Change scores for total intensity of panic symptoms (r=0.56, p=0.04), panic frequency (r=0.55, p=0.04), and distress (r=0.60, p=0.02). In the no parental involvement condition, no significant relations emerged.
Conclusion: Preliminary findings suggest that higher maternal stress levels are related to smaller reductions in panic symptoms following a course of intensive CBT, only when parents were involved in treatment. This may suggest that parental involvement should include modules to address skills such as parent stress management to buffer against the possible negative effects of maternal stress. Alternatively, when parents are highly stressed, limiting their participation in adolescent treatment might be most efficient since parental stress was detrimental to treatment outcomes only in the parental involvement condition. Subsequent analyses will further explore the link between parental stress and youth treatment response.
Alicia Fenley– Graduate Student, Boston University, Brookline, Massachusetts
Lindsay Holly– Postdoctoral Associate, Boston University, Boston, Massachusetts
Rachel Merson– Boston University Center for Anxiety and Related Disorders
David Langer– Research Assistant Professor, Boston University, Boston, Massachusetts
Donna Pincus– Associate Professor, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts