The effect of targeting tolerance of children’s negative emotions among anxious parents of children with anxiety disorders: A pilot randomised controlled trial

Hiller, Rachel; Apetroaia, Adela; Clarke, Kiri; Hughes, Zoe; Orchard, Faith; Parkinson, Monika; Creswell, Cathy

doi:10.1016/j.janxdis.2016.05.009

Cited by 15 publications

(14 citation statements)

References 44 publications

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“…Emerson et al (unpublished) demonstrated that improvements in parental experiential avoidance following a mindfulness-based parenting intervention uniquely predicted improvements in child internalizing problems. In contrast, a pilot randomized controlled trial of a tailored parent intervention targeting parental distress tolerance, Hiller et al (2016) reported no differences in child anxiety outcomes compared to standard behavioral parenting intervention. Hiller et al (2016) did report differential effects on positive parenting and the quality of the parent–child relationship, with increases for those in the targeted treatment condition, and decreases for those in the standard condition.…”

Section: Discussionmentioning

confidence: 88%

“…In contrast, a pilot randomized controlled trial of a tailored parent intervention targeting parental distress tolerance, Hiller et al (2016) reported no differences in child anxiety outcomes compared to standard behavioral parenting intervention. Hiller et al (2016) did report differential effects on positive parenting and the quality of the parent–child relationship, with increases for those in the targeted treatment condition, and decreases for those in the standard condition. The question remains whether targeting parental experiential avoidance within parenting interventions may or may not indicate improvements in child outcomes.…”

Section: Discussionmentioning

confidence: 88%

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The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

2019

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Parenting behavior and practices contribute to the intergenerational relationship between parent and child anxiety, with parental control being a consistent predictor of child anxiety. Parental experiential avoidance refers to how a parent copes with their internal world in the context of parenting. Little is known about how this relatively new parenting concept relates to child anxiety. The current study tested the indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance; the indirect effect of parent anxiety on parental control through parental experiential avoidance; and the moderating effect of parental experiential avoidance on the relationship between parental control and child anxiety. Using a cross-sectional design, parents ( N = 85) from a community sample of 8–12-year-old children self-reported on a survey measuring parent anxiety, child anxiety, parental control, and parental experiential avoidance. A hierarchical regression indicated that parental experiential avoidance significantly predicted child anxiety and accounted for further variance in child anxiety, over, and above parental control. There was an indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance. Parental experiential avoidance moderated the relationship between parental control and child anxiety, such that the relationship was only significant at high levels of parental experiential avoidance. The current study provides support for the role of parental experiential avoidance in an intergenerational understanding of anxiety. Future research should replicate the study with a clinical sample. Theoretical and practice implications are considered.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 88%

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

2019

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“…When it comes to parental anxiety, it remains unclear exactly how best to improve child outcomes (e.g. Hudson, Newall, Rapee, et al, 2014), although recent studies indicate that good outcomes can be achieved when parents are supported as part of, or alongside, their child's treatment (Creswell et al, 2020;Hiller et al, 2016).…”

Section: What Should We Deliver To Whom?mentioning

confidence: 99%

Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

Creswell

Waite

Hudson

2020

Child Psychology Psychiatry

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Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families. Key practitioner messages:Assessment of anxiety disorders should routinely involve valid and reliable interview and questionnaire measures of anxiety disorders and other common comorbid problems.Cognitive behaviour therapy is effective for treating anxiety disorders in children and young people. There is currently insufficient evidence for the effectiveness of any other psychological treatment. There is evidence that SSRIs are effective in the short-medium term, but there is a lack of longer-term evaluation.Few children who could benefit receive treatment for anxiety disorders. Brief guided interventions that can be delivered by nonspecialists are effective for some preadolescent children and provide a means to increase access to psychological interventions, potentially within a stepped care model, but less is known about their effectiveness for adolescents. Anxiety disorders in children and young people 637 Areas for future research:Experimental studies to elucidate (cognitive, behavioural, environmental) maintenance mechanisms of anxiety disorders and how they vary across childhood and adolescence and in particular contexts.Sufficiently large treatment studies to examine predictors, mediators and moderators of treatment to help optimise treatment outcomes and support improvements in personalised care.Use of technology to promote engagement, access, integrity, efficiency and effectiveness of treatments. Comparisons of different treatment approaches that are fully powered to detect meaningful clinical differences, with appropriate control conditions (e.g. including placebo where appropriate).Health economic evaluations to enable health services to increase access by offering the most efficient treatment approaches. Implementation research to maximise application and integrity of evidence-based treatments in routine clinical practice.

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“…PLTA models are characterized by parents implementing a structured, evidence-based treatment protocol independently at home while receiving limited assistance from a trained therapist. Studies on PLTA treatment for anxiety [27][28][29][30][31][32][33][34][35][36] have yielded promising results. Notably, one study 34 comparing treatment responses of varied CBT delivery formats targeting anxiety in a pooled sample of typically developing youth (n=1,253) found no significant differences between therapist-led individual or group treatment and PLTA interventions (except for primary specific phobia, where therapist-led individual treatment was superior).…”

Section: Parent-led and Stepped-care Interventionsmentioning

confidence: 99%

“…Matching treatment to families and individual patients' needs, and tailoring subsequent treatment, may be an efficient and effective approach consistent with parents' desire to help their child. Previous studies on PLTA treatment for anxiety [27][28][29][30][31][32][33][34] and recent stepped-care trials for childhood anxiety [38][39][40] provide strong preliminary evidence to support the advancement of testing stepped-care models for internalizing symptoms among youth. Together with the substantial impairment associated with clinical anxiety in individuals with ASD across the age span, [13][14][15] this provides a strong rationale for the use of a parent-led, flexible, individually-tailored cognitive-behavioral intervention for anxiety in youth with ASD.…”

Section: Innovations Of the Parent-led Stepped-care Cbt Modelmentioning

confidence: 99%

Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method

Ramírez

Grebe

McNeel

et al. 2020

Braz. J. Psychiatry

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Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a “full-package” treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety – a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.

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The effect of targeting tolerance of children’s negative emotions among anxious parents of children with anxiety disorders: A pilot randomised controlled trial

Cited by 15 publications

References 44 publications

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method

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