Skip to main content
SpringerLink
Log in

Family Treatment of Child Anxiety: Outcomes, Limitations and Future Directions

  • Published:
Clinical Child and Family Psychology Review Aims and scope Submit manuscript

Abstract

Anxiety of childhood is a common and serious condition. The past decade has seen an increase in treatment-focussed research, with recent trials tending to give greater attention to parents in the treatment process. This review examines the efficacy of family-based cognitive behaviour therapy and attempts to delineate some of the factors that might have an impact on its efficacy. The choice and timing of outcome measure, age and gender of the child, level of parental anxiety, severity and type of child anxiety and treatment format and content are scrutinised. The main conclusions are necessarily tentative, but it seems likely that Family Cognitive Behaviour Therapy (FCBT) is superior to no treatment, and, for some outcome measures, also superior to Child Cognitive Behaviour Therapy (CCBT). Where FCBT is successful, the results are consistently maintained at follow-up. It appears that where a parent is anxious, and this is not addressed, outcomes are less good. However, for children of anxious parents, FCBT is probably more effective than CCBT. What is most clear is that large, well-designed studies, examining these factors alone and in combination, are now needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alfano C. A., Beidel D. C., Turner S. M. (2002). Cognition in childhood anxiety: Conceptual, methodological and developmental issues. Clinical Psychology Review, 22, 1209–1238

    PubMed  Google Scholar 

  • Baker, D. P., Entwisle, D. (1987). The influence of mothers on the academic expectations of young children. Social Forces, 65, 670–694.

    Article  Google Scholar 

  • Bandura A. (1969). Social learning of moral judgements. Journal of Personality and Social Psychology, 11, 275–279

    Article  PubMed  Google Scholar 

  • Barrett P. M. (1998). Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. Journal of Clinical Child Psychology, 27(4), 459–468

    Article  PubMed  Google Scholar 

  • Barrett P. M., Dadds M. R., Rapee R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64(2), 333–342

    Article  PubMed  Google Scholar 

  • Barrett, P. M., Duffy, A. L., Dadds, M. R., & Rapee, R. M. (2001). Cognitive-behavioral treatment of anxiety disorders in children: Long term (6 year) follow-up. Journal of Consulting and Clinical Psychology, 69(1), 135–141.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Ward C. H., Mendelson M., Mock J. E., Erbaugh J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571

    PubMed  Google Scholar 

  • Berg-Nielsen T. S., Vikan A., Dahl A. A. (2002). Parenting related to child and parental psychopathology: A descriptive review of the literature. Clinical Child Psychology and Psychiatry, 7(4), 1359–1045

    Article  Google Scholar 

  • Berman S. L., Weems C. F., Silverman W. K., Kurtines W. M. (2000). Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children. Behavior Therapy, 31, 713–731

    Article  Google Scholar 

  • Bodden, D. H. M., Bogels, S. M., Nauta, M. H., de Haan, E., Ringrose, J., Appelboom, C., et al. (submitted). Efficacy of individual versus family cognitive behavioural therapy in clinically anxious youth

  • Bodden, D. H. M., Dirksen, C. D., Bogels, S. M., Appelboom, C., Appelboom-Geerts, K. C. M. M. J., Brinkman, A. G., et al. (submitted). Cost and cost-effectiveness of family CBT versus individual CBT in clinically anxious children

  • Bögels, S. M., & Phares, V. (submitted). The role of the father in the etiology, prevention and treatment of child anxiety: A review and new model

  • Bögels S. M., Siqueland L. (2006). Family cognitive behavior therapy for children and adolescents with clinical anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(2), 134–141

    Article  PubMed  Google Scholar 

  • Briggs-Gowan M., Horwitz S., Schwab-Stone M. E., Leventhal J., Leaf P. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child & Adolescent Psychiatry, 39(7), 841–849

    Article  Google Scholar 

  • Brown, T. A., DiNardo P. A., Barlow D. H. (1994). Anxiety disorders interview schedule for DSM-IV. New York: Graywind

    Google Scholar 

  • Bugental, D. B., Johnston C. (2000). Parental and child cognitions in the context of the family. Annual Review of Psychology, 51, 315–344

    Article  PubMed  Google Scholar 

  • Buhrmester, D., Furman, W. (1990). Perceptions of sibling relationships during middle childhood and adolescence. Child Development, 61, 1387–1398

    Article  PubMed  Google Scholar 

  • Butler A. C., Chapman J. E., Forman E. M., Beck A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31

    Article  PubMed  Google Scholar 

  • Cartwright-Hatton S., McNally D., White C. (2005). A new cognitive behavioural parenting intervention for families of young anxious children: A pilot study. Behavioural & Cognitive Psychotherapy, 33(2), 243–248

    Article  Google Scholar 

  • Cartwright-Hatton S., McNally D., White C., Verduyn C. (2005). Parenting skills training: An effective intervention for internalising symptoms in younger children? Journal of Child and Adolescent Psychiatric Nursing, 18(2), 45–52

    Article  PubMed  Google Scholar 

  • Cartwright-Hatton S., McNicol K., Doubleday E. (2006). Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children. Clinical Psychology Review, 26(7), 817–833

    Article  PubMed  Google Scholar 

  • Cartwright-Hatton S., Roberts C., Chitsabesan P., Fothergill C., Harrington R. (2004). Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. British Journal of Clinical Psychology, 43, 421–436

    Article  PubMed  Google Scholar 

  • Choate M. L., Pincus D. B., Eyberg S. M., Barlow D. H. (2005). Parent-child interaction therapy for treatment of separation anxiety disorder in young children: A pilot study. Cognitive and Behavioral Practice, 12, 126–135

    Article  Google Scholar 

  • Chorpita, B. F. (2006). Modular cogntive-behavioral therapy for childhood anxiety disorders. Guilford Press

  • Chorpita, B. F., Barlow, D. H. (1998). The development of anxiety: the role of control in the early environment. Psychological Bulletin, 124(1), 3–21

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Taylor A. A., Francis S. E., Moffitt C., Austin A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behaviour Therapy, 35, 263–287

    Article  Google Scholar 

  • Cobham, V. E., Dadds M. R., Spence S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 66(6), 893–905

    Article  PubMed  Google Scholar 

  • Cooper P. J., Fearn V., Willetts L., Seabrook H., Parkinson M. (2006). Affective disorders in the parents of anxious children. Journal of Affective Disorders, 93(1–3), 205–212

    Article  PubMed  Google Scholar 

  • Cooper, P. J., Gallop, C., Willetts, L., & Creswell, C. (submitted). Treatment response in child anxiety is differentially related to the form of maternal anxiety disorder

  • Crawford A. M., Manassis K. (2001). Familial predictors of treatment outcome in childhood anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 40(10), 1182–1189

    Article  PubMed  Google Scholar 

  • Creswell C., Brewin C., O’Connor T. (2006). A longitudinal investigation of maternal and child ‘anxious cognitions’. Cognitive Therapy and Research, 30(2), 135–147

    Article  Google Scholar 

  • Creswell, C., Schniering C. A., Rapee R. M. (2005). Threat interpretation in anxious children and their mothers: Comparison with nonclinical children and the effects of treatment. Behaviour Research and Therapy, 43, 1375–1381

    Article  PubMed  Google Scholar 

  • Dadds, M. R., Barrett P. M. (2001). Psychological management of anxiety disorders in childhood. Journal of Child Psychology and Psychiatry, 42(8), 999–1011

    Article  PubMed  Google Scholar 

  • Dadds M. R., Holland D. E., Spence S. H., Laurens K. R., Mullins M., Barrett P. M. (1999). Early intervention and prevention of anxiety disorders in children: Results at 2-year follow-up. Journal of Consulting and Clinical Psychology, 67(1), 145–150

    Article  PubMed  Google Scholar 

  • Dadds M. R., Spence S. H., Holland D. E., Barrett P. M., Laurens K. R. (1997). Prevention and early intervention for anxiety disorders: A controlled trial. Journal of Consulting and Clinical Psychology, 65(4), 627–635

    Article  PubMed  Google Scholar 

  • de Rosnay M., Cooper P. J., Tsigaras N., Murray L. (2006). Transmission of social anxiety from mother to infant: An experimental study using a social referencing paradigm. Behaviour Research and Therapy, 44(8), 1165–1175

    Article  PubMed  Google Scholar 

  • Federer M., Stuber S., Margraf J., Schneider S., Herle J. (2001). Self report of child anxiety and rating by parents and teachers. Zeitschrift fur Differentialle und Diagnostische Psychologie, 22(3), 194–205

    Article  Google Scholar 

  • Field, A. P. (2006 submitted). How to do a meta-analysis

  • Field A. P., Lawson J. (2003). Fear information and the development of fears during childhood: Effects on implicit fear responses and behavioural avoidance. Behaviour Research and Therapy, 41, 1277–1293

    Article  PubMed  Google Scholar 

  • Ford, T., Goodman R., Meltzer H. (2003). The British Child and Adolescent Mental Health Survey: The prevalence of DSM-IV disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 42(10), 1203–1211

    Article  Google Scholar 

  • Furman, W., Buhrmester, D. (1985). Children's perceptions of the qualities of sibling relationships. Child Development, 56, 448-461

    Article  PubMed  Google Scholar 

  • Gerull F. C., Rapee R. M. (2002). Mother knows best: Effects of maternal modelling on the acquisition of fear and avoidance behaviour in toddlers. Behaviour Research and Therapy, 40, 279–287

    Article  PubMed  Google Scholar 

  • Ginsburg G. S., Schlossberg M. C. (2002). Family based treatment of childhood anxiety disorders. International Review of Psychiatry, 42, 1203–1211

    Google Scholar 

  • Grave J., Blissett J. (2004). Is cognitive behavior therapy developmentally appropriate for young children? A critical review of the evidence. Clinical Psychology Review, 24(4), 399–420

    Article  PubMed  Google Scholar 

  • Heyne D., King N. J., Tonge B. J., Rollings S., Young D., Pritchard M., et al. (2002). Evaluation of child therapy and caregiver training in the treatment of school refusal. Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 687–695

    Article  Google Scholar 

  • Hudson J. L., Rapee R. M. (2004). From anxious temperament to disorder: An etiological model of Generalized Anxiety Disorder. In R. G. Heimberg, C. L. Turk, D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp 51–74). New York: Guilford Press

    Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006). Coping cat workbook. Workbook Publishing Inc

  • Kim-Cohen J., Caspi A., Moffitt T. E., Harrington H., Milne B. J., Poulton R. (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60(7), 709–717

    Article  PubMed  Google Scholar 

  • King N. J., Tonge B. J., Heyne D., Pritchard M., Rollings S., Young D., et al. (1998). Cognitive-behavioral treatment of school refusing children: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 37(4), 395–403

    Article  PubMed  Google Scholar 

  • Kovacs M., Gatsonis C., Paulauskas S., Richards C. (1989). Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Archives of General Psychiatry, 46, 776–782

    PubMed  Google Scholar 

  • Kushner M., Sher K., Beitman B. (1990). The relation between alcohol problems and anxiety disorders. American Journal of Psychiatry, 147(6), 685–695

    PubMed  Google Scholar 

  • Last C. G., Hersen M., Kazdin A. E., Francis G., Grubb H. J. (1987). Psychiatric illness in the mothers of anxious children. American Journal of Psychiatry, 144, 1580–1583

    PubMed  Google Scholar 

  • Last C. G., Hersen M., Kazdin A. E., Orvaschel H., Perrin S. (1991). Anxiety disorders in children and their families. Archives of General Psychiatry, 48, 928–936

    PubMed  Google Scholar 

  • Lyneham, H. J., Rapee, R. M. (2005). Evaulation of therapist supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Reserach and Therapy, 44(9), 287–300

    Google Scholar 

  • Manassis K., Mendlowitz S. L., Scapillato D. C., Avery D. C., Fiksenbaum L., Freire M., et al. (2002). Group and individual cognitive-behavioral therapy for childhood anxiety disorders: A randomized trial. [Article]. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1423–1430

    Article  Google Scholar 

  • Manassis K., Mendlowitz S. L., Scapillato D., Avery D., Fiksenbaum L., Freire M., et al. (2003). Group and individual cognitive-behavioral therapy for childhood anxiety disorders: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1423–1430

    Article  Google Scholar 

  • Mendlowitz S. L., Manassis K., Bradley S., Scapillato D., Miezitis S., Shaw B. F. (1999). Cognitive-behavioral group treatment in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1223–1229

    Article  PubMed  Google Scholar 

  • Murray L., Cooper P., Creswell C., Schofield E., Sack C. (2007). The effects of maternal social phobia on mother-infant interactions and infant social responsiveness. Journal of Child Psychology and Psychiatry, 48(1), 45–52

    Article  PubMed  Google Scholar 

  • Nauta M. H., Scholing A., Emmelkamp P. M. G., & Minderaa R. B. (2003). Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: No additional effect of a cognitive parent training. Journal of the American Academy of Child & Adolescent Psychiatry, 42(11), 1270–1278

    Article  Google Scholar 

  • Ost L. (1996). One-session group treatment of spider phobia. Behaviour Research and Therapy, 34, 707–715

    Article  PubMed  Google Scholar 

  • Pine D. S. (1997). Childhood anxiety disorders. Current Opinion in Pediatrics, 9, 329–339

    Article  PubMed  Google Scholar 

  • Rapee R. M. (1997). Potential role of childrearing practices in the development of anxiety and depression. Clinical Psychology Review, 17(1), 47–67

    Article  PubMed  Google Scholar 

  • Rapee R. M. (2000). Group treatment of children with anxiety disorders: Outcome and predictors of treatment response. Australian Journal of Psychology, 52(3), 125–129

    Article  Google Scholar 

  • Rapee R. M., Kennedy S., Ingram M., Edwards S., Sweeney L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting & Clinical Psychology, 73(3), 488–497

    Article  Google Scholar 

  • Rosenberg, M. (1979). Conceiving the self. New York: Basic

  • Rubin, K. H., Mills, R. S. L. (1991). Conceptualizing pathways to internalizing disorders in childhood. Canadian Journal of Behavioral Science, 23(3), 300–317

    Article  Google Scholar 

  • Shortt A. L., Barrett P. M., Fox, T. L. (2001). Evaluating the FRIENDS Program: A cognitive-behavioral group treatment for anxious children and their parents. Journal of Clinical Child Psychology, 30(4), 525–535

    Article  PubMed  Google Scholar 

  • Silverman W. K., Kurtines W. M., Ginsburg G. S., Weems C. F., White Lumpkin P., Hicks Carmichael D. H. (1999). Treating anxiety disorders in children with group cognitive-behavioral therapy: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 67(6), 995–1003

    Article  PubMed  Google Scholar 

  • Silverman W. K., Nelles W. B. (1988). The anxiety disorders interview schedule for children. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 772–778

    Article  PubMed  Google Scholar 

  • Southam-Gerow M. A., Kendall P. C., Weersing V. R. (2001). Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic. Journal of Clinical Child Psychology, 30(3), 422–436

    Article  PubMed  Google Scholar 

  • Spence S. H., Donovan C., Brechman-Toussaint M. (1999) Social skills, social outcomes, and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108(2), 211–221

    Article  PubMed  Google Scholar 

  • Spence S. H., Donovan C., Brechman-Toussaint M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training based, cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, 41(6), 713–726

    Article  PubMed  Google Scholar 

  • Spielberger C. D. (1983). State-trait anxiety inventory. Palo Alto, CA: Consulting Psychologist’s Press

    Google Scholar 

  • Toren P., Wolmer L., Rosental B., Elder S., Koren S., Lask M., et al. (2000). Case series: Brief parent-child group therapy for childhood anxiety disorders using a manual-based cognitive-behavioral technique. Journal of the American Academy of Child and Adolescent Psychiatry, 39(10), 1309–1312

    Article  PubMed  Google Scholar 

  • Treutler C. M., Epkins C. C. (2003). Are discrepancies among child, mother, and father reports on children’s behavior related to parents’ psychological symptoms and aspects of parent-child relationships? Journal of Abnormal Child Psychology, 31(1), 13–27

    Article  PubMed  Google Scholar 

  • Webster-Stratton C., Hollinsworth T., Kolpacoff M. (1989). The long term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. Journal of Clinical Child Psychology, 57(4), 550–553

    Google Scholar 

  • Wheatcroft, R., & Creswell, C. (in press). Parental cognitions and expectations of their preschool children: The contribution of parental anxiety and child anxiety. British Journal of Developmental Psychology

  • Windheuser H. J. (1977). Anxious mothers as models for coping with anxiety. Behavior Analysis and Modification, 2(1), 39–58

    Google Scholar 

  • Wood J. (2006). Effect of anxiety reduction on children’s school performance and social adjustment. Developmental Psychology, 42(2), 345–349

    Article  PubMed  Google Scholar 

  • Wood J., McLeod B. D., Sigman M., Hwang W.-C., Chu B. C. (2003). Parenting and childhood anxiety: Theory, empirical findings and future directions. Journal of Child Psychology & Psychiatry & Allied Disciplines, 44(1), 134–151

    Article  Google Scholar 

  • Wood J., Piacentini J., Bergman R. L., McCracken J., Barrios V. (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31(3), 335–342

    Article  PubMed  Google Scholar 

  • Wood J. J., Piacentini J. C., Southam-Gerow M., Chu B. C., Sigman M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 314–321

    Article  Google Scholar 

  • Youngstrom E., Loeber R., Stouthamer-Loeber M. (2000). Patterns and correlates of agreement between parent, teacher and male adolescent ratings of externalising and internalising problems. Journal of Consulting and Clinical Psychology, 68(6), 1038–1050

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Sam Cartwright-Hatton was supported by MRC clinician scientist fellowship G108/604 during the preparation of this manuscript. The authors are grateful to two anonymous reviewers for their helpful comments on an earlier draft of this manuscript.

Author information

Authors and Affiliations

  1. School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK

    Cathy Creswell

  2. School of Psychological Sciences, University of Manchester, Zochonis Building, Brunswick St, Manchester, UK, M13 9PL

    Sam Cartwright-Hatton

Authors
  1. Cathy Creswell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sam Cartwright-Hatton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sam Cartwright-Hatton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Creswell, C., Cartwright-Hatton, S. Family Treatment of Child Anxiety: Outcomes, Limitations and Future Directions. Clin Child Fam Psychol Rev 10, 232–252 (2007). https://doi.org/10.1007/s10567-007-0019-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10567-007-0019-3

Keywords

Search

Navigation