Family-Based Intervention May Help Prevent Anxiety Disorders in Children

A cognitive-behavioral intervention aimed at families in which at least one parent had an anxiety disorder reduced the likelihood that children developed anxiety disorders, according to a study published September 24 in AJP in Advance.

Previous studies showed that the children of anxious parents are at a greater risk of developing an anxiety disorder, and parenting practices, such as overcontrol and overprotection, contributed to elevated anxiety. While anxiety prevention programs carried out in schools have been only modestly successful at reducing childhood and adolescent anxiety, less is known of the effects family-based interventions might have on the high-risk offspring of anxious parents.

“Prevention is always better than providing intervention after a disorder has been identified,” child psychiatrist Paramjit Joshi, M.D., division chief of psychiatry and behavioral medicine at Children’s National Medical Center in Washington, D.C., told Psychiatric News. “In that sense I think this is an important study and has clinical applicability.”

For the AJP in Advance study, Golda Ginsburg, Ph.D., a professor of psychiatry at the University of Connecticut Health Center, and colleagues randomly assigned 136 families to either the eight-week Coping and Promoting Strength program or a control condition using an informational pamphlet. All participating families had at least one parent who met DSM-IV-TR criteria for an anxiety disorder and at least one child aged 6 to 13 without an anxiety disorder.

As part of the intervention program, each family met individually with a trained therapist for 60 minutes a week for eight weeks. The first two sessions were for parents only, after which the children were included. As part of the program, parents learned about how to reduce modeling of anxiety, overprotection, and overall distress. The children were counseled to reduce risk factors like anxiety symptoms, social avoidance or withdrawal, or maladaptive thoughts. Families were shown how to identify signs of anxiety and strategies to cope with and reduce anxiety.

Participants in the information-monitoring group received a 36-page pamphlet containing information about anxiety disorders and associated treatments. Anxiety was assessed before the trial began, at the end of the intervention (or eight weeks after randomization), and at follow-ups six and 12 months later.

After finishing the program, children in the intervention group had lower symptom scores on average. Just three children (5 percent) in the intervention group met criteria for an anxiety disorder by the end of the 12-month follow-up compared with 19 children (31 percent) in the information-monitoring group. At the one-year follow-up, youth in the control group also had higher anxiety symptom ratings than those in the intervention group.

“[A]mong youth who received the intervention, those with high baseline anxiety symptom severity levels showed greater reductions in severity than those with low baseline levels, which suggests that the intervention is particularly helpful for youth with elevated anxiety symptoms,” the study authors wrote.

“One interpretation could be that targeting only those with elevated symptoms would be more efficient,” said Ginsburg in an interview. “However, we did not look at all moderators, and my next step is to look at what other factors predicted who went on to developing an anxiety disorder in order to also ‘personalize’ who might be at most risk and benefit most from prevention.”

About 13 percent of the intervention cohort and 22 percent of the control families reported that their children received mental health services for anxiety during the study period, but the difference was not statistically significant. That narrow gap may have been either because the intervention’s effect had no effect on treatment-seeking or because anxious young people typically seek care at low rates, the authors noted.

Reductions in the parents’ modeling of anxiety and their global distress at the trial’s end and at the six-month follow-up point mediated the intervention’s effect on the severity of children’s anxiety symptoms after one year, the authors said. “This finding clarifies potential mechanisms of the intervention’s impact and suggests that targeting specific parenting behaviors (such as reducing anxious modeling) and lowering parents’ overall distress levels (not anxiety specifically) were critical in reducing child anxiety symptoms.”

While the study authors noted that the work needs to be replicated in a larger and more demographically diverse cohort, it may represent a step forward in efforts to reduce the number of children and adolescents with anxiety disorders.

“I think the important aspect of this study is that if we can provide an intervention for kids at risk for developing anxiety disorders given a family history of anxiety in a parent, then this speaks to the whole notion of early identification of at-risk children and preventative intervention,” said Joshi.

The researchers recently received funding from the National Institute of Mental Health to follow this cohort of children for another seven years, said Ginsburg. “So we will also look at what holds up over time.” ■

“Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention” can be accessed here.