Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions - 20/02/20
, Carla Marin, PhD, Alyssa Martino, MS, Yaara Shimshoni, PhD, Wendy K. Silverman, PhDAbstract |
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); clinicaltrials.gov; NCT02310152.
Le texte complet de cet article est disponible en PDF.Key words : anxiety disorders, parent-based treatment, cognitive-behavioral therapy clinical trials, family accommodation
Plan
| Dr. Lebowitz’s work on this manuscript was funded by the National Institute of Mental Health (K23MH103555) and the Center for the Advancement of Translational Science (KL2TR000140). |
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| The authors wish to thank James Jaccard, PhD, of the New York University School of Social Work, for statistical consultation for this study. The authors wish to thank James Leckman, MD, PhD, of the Yale School of Medicine Child Study Center, and Ruth Feldman, PhD, of Interdisciplinary Center of Herzilya, who provided mentorship and consultation for this project. |
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| 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 have reported no biomedical financial interests or potential conflicts of interest. |
Vol 59 - N° 3
P. 362-372 - mars 2020 Retour au numéro
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