“You can do it!”: The role of parental encouragement of bravery in child anxiety treatment

Individual cognitive-behavioral therapy (CBT) provides anxious youth with skills and experiences to increase “brave” behavior in the face of feared situations. This study addresses whether parental encouragement of bravery during an anxiety provoking and potentially avoidable naturalistic speech task (a) differs between parents of youth (ages 9-13) with anxiety disorders (N = 47) and parents of healthy non-anxious controls (N = 20); (b) influences response to treatment; and (c) changes during treatment for anxious youth randomized to receive CBT (N = 30) or Child-Centered Therapy (CCT; a non-directive active comparison treatment; N = 17). Parent-child dyads were videotaped during a discussion of whether or not the child should complete an optional speech task. Parents of anxious youth showed less encouragement of bravery than parents of controls. Encouragement of bravery increased from pre- to post-treatment for youth who received CBT but not CCT, and pre-treatment encouragement of bravery predicted a better response to treatment, particularly for youth receiving CBT.