Family based treatment of anxiety disorders: A review of the literature (2010–2019)

Abstract

Anxiety disorders are the most common and impairing mental health problems across the lifespan. Familial factors are strongly implicated in the onset and maintenance of anxiety, but available evidence-based treatments are usually individual-focused. The aim of this review was to evaluate the current evidence base (2010-2019) of family based interventions addressing youth and adult anxiety and highlight findings comparing family based and individual-focused treatments. A systematic literature search was conducted. Articles were considered if they targeted primarily anxiety-related issues and utilized a randomized controlled trial design, resulting in 22 included youth studies. No adult studies met criteria for inclusion. Overall, family based treatments performed better than no-treatment controls and as well as individual-based interventions, with some evidence that family based interventions might outperform individual-based ones in certain populations (i.e., autism). Family based interventions may represent a good alternative for anxiety treatment in youth.

Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010–2019)

“…We reviewed outcome research studies published from 2010 to 2019 in English-language journals, focusing specifically on the collection of studies included within 11 articles in this special issue. Studies were reviewed across the following mental health topics: infant and early childhood mental health (IECMH; Kaminski et al, 2022), disruptive behavior problems (Sheidow et al, 2022), attention-deficit/hyperactivity disorder (ADHD; Babinski & Sibley, 2022), anxiety disorders (Goger & Weersing, 2022), depressive and bipolar disorders , suicidal ideation and behavior (Frey et al, 2022), substance use disorders (Hogue et al, 2022), traumatic event exposure (McWey, 2022), intimate partner violence and child maltreatment (Stith et al, 2022), couple relationship education (Markman et al, 2022), and couple relationship distress (Doss et al, 2022). Although physical health was also featured in the special issue (Lamson et al, 2022), we did not review physical health interventions as we considered these interventions to have important methodological differences meriting their own review.…”

Conceptualizing Emotion Regulation and Coregulation as Family-Level Phenomena

“…CBT is well established for the treatment of anxiety disorders in children and adolescents, with both individual child CBT and individual family-based CBT shown to be efficacious (Goger & Weersing, 2021 ; Higa-McMillan et al, 2016 ). Individual family-based CBT (FCBT) was developed with the recognition that a high proportion of children with anxiety disorders also have parents with anxiety, that children’s anxiety can be distressing for parents, and that caregiver behaviors (e.g., modeling of anxious behaviors and maladaptive coping strategies, parental accommodation of children’s avoidance, etc.)…”

“…Individual family-based CBT (FCBT) was developed with the recognition that a high proportion of children with anxiety disorders also have parents with anxiety, that children’s anxiety can be distressing for parents, and that caregiver behaviors (e.g., modeling of anxious behaviors and maladaptive coping strategies, parental accommodation of children’s avoidance, etc.) contribute to and maintain child anxiety (Goger & Weersing, 2021 ). Although the degree of caregiver involvement and specific family emotion regulation topics covered vary by specific model, FCBT for anxiety generally includes caregivers in at least some sessions in which they receive psychoeducation on the impact of their own emotional responses to their children’s anxiety and their behaviors (e.g., accommodation, overprotection, modeling) that may be maintaining it, and skills training to enhance their own emotion regulation, parenting, and emotion socialization behaviors (Wood et al, 2009 ).…”

“…Although the degree of caregiver involvement and specific family emotion regulation topics covered vary by specific model, FCBT for anxiety generally includes caregivers in at least some sessions in which they receive psychoeducation on the impact of their own emotional responses to their children’s anxiety and their behaviors (e.g., accommodation, overprotection, modeling) that may be maintaining it, and skills training to enhance their own emotion regulation, parenting, and emotion socialization behaviors (Wood et al, 2009 ). A substantial number of studies have been conducted on FCBT, and interestingly, evidence for the incremental benefit of FCBT over individual child CBT has been mixed, with several meta-analytic studies showing no benefit (Goger & Weersing, 2021 ; Peris et al, 2021 ). It may be that FCBT is incrementally beneficial for specific populations (e.g., families in which parents have an anxiety disorder; Kendall et al, 2008 ), or that for FCBT to be uniquely helpful, it must include certain parenting components (Manassis et al, 2014 ).…”

Restoring Connectedness in and to Nature: Three Nordic Examples of Recontextualizing Family Therapy to the Outdoors

“…Family-based interventions targeting mood disorders, such as childhood anxiety and depression, are more effective than individual treatment when considering long-term outcomes ( Carr, 2019a ). This may especially be the case when it comes to children with ASD and childhood anxiety ( Goger and Weersing, 2022 ). Family therapy offered in a multi-family format includes the added group elements of mutual self-help and peer support built into the therapeutic approach ( Jewell and Lemmens, 2018 ).…”