Coaching Approach Behavior and Leading by Modeling: Rationale, Principles, and a Session-by-Session Description of the CALM Program for Early Childhood Anxiety

Whereas the cognitive-behavioral treatment of childhood anxiety has been well-researched and empirically supported over the last 20 years, interventions for anxiety in young children (ages 7 and below) have garnered little attention. Because young children generally lack the required developmental skills to effectively engage in cognitive-behavioral treatment, a simple downward extension of treatments used for older children is inappropriate. The CALM program (Coaching Approach behavior and Leading by Modeling) was developed as a developmentally compatible intervention to treat anxiety disorders in young children ages 3 to 7. The CALM program is an adaptation of Parent-Child Interaction Therapy (PCIT), and an extension of Pincus, Eyberg, and Choate's (2000) adaptation of PCIT for young children with separation anxiety disorder. It is a parent-focused treatment that teaches parents skills to effectively reinforce their children's brave behavior and coaches the use of these skills during in-session parent-child interactions. The treatment emphasizes live, bug-in-the-ear coaching of parents during in vivo exposure sessions. This article describes the CALM program in detail.

► We review the CALM program, an adaptation of Parent-Child Interaction Therapy, to treat anxiety in young children.
► The CALM program is intended for children ages 3–7 suffering from the range of childhood anxiety disorders.
► Treatment focuses on teaching parents skills to manage their child's anxiety.
► Parents are coached in these skills via live bug-in-the-ear device as they interact with their children.
► We provide a session-by-session description of the CALM program, along with hypothetical transcripts.