CBT for the treatment of child anxiety disorders: A review of why parental involvement has not enhanced outcomes

Anxiety affects 10% of all children and disrupts educational, socio-emotional development and overall functioning of the child and family. Research has shown that parenting factors (i.e. intrusiveness, negativity, distorted cognitions) contribute to the development and maintenance of childhood anxiety. Recent studies have therefore investigated if the treatment effect of traditional cognitive behavioural therapy may be enhanced by adding a parental component. However, randomised controlled trials have not shown unequivocal support for this assumption. The results are inconsistent and ambiguous. This article investigates possible reasons for this inconsistency and in particular differences in methodology and the theoretical relevance of the applied parental components are highlighted as possible contributory factors. Another factor is that treatment effect is mainly measured by change in the child's diagnostic status rather than changes in parental or family functioning.

► Theoretically, parenting factors such as intrusiveness, negativity and distorted cognitions contribute to the development and maintenance of childhood anxiety.
► It is hypothesized that the treatment effect of child cognitive behavioural therapy may be enhanced by adding a parental component.
► Randomised controlled trials have not shown unequivocal support for this assumption and the results are inconsistent and ambiguous.
► Differences in methodology and theoretical relevance of the applied parental components are suggested to be part of the explanation.
► Also the main-effect is often the child's diagnostic status rather than factors expected to change due to parental involvement.