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Perspectives on Early Childhood Psychology and Education

Submission Type

Article

Abstract

Pediatric anxiety rates have doubled during the COVID-19 pandemic (Racine et al., 2021), but access to care has not increased commensurately (Panchel et al., 2021). Intensive group- and family-based outpatient treatment that implements cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) for pediatric anxiety disorders and OCD is a treatment design that treats more children at one time and may facilitate treatment momentum with its intensive nature so that new patients can be treated sooner. This paper describes CBT-based interventions from an intensive treatment program for pediatric anxiety disorders and/or OCD that involves parents and that can be applied in relevant community-based settings with the hopes of increasing access to evidence-based care.

Impact Statement

Pediatric anxiety rates doubled during the COVID-19 pandemic (Racine et al., 2021), but access to care has not been able to meet the increase in demand (Panchal et al., 2021). Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is a “well-established” treatment for pediatric anxiety disorders(Higa-McMillan et al., 2015) and a “probably efficacious” treatment for pediatric obsessive-compulsive disorder (OCD; Freeman et al., 2014); however, weekly outpatient treatment still only yields remission for about half of treatment participants (Bloch & Storch, 2015; Ginsburg et al., 2011). Even when a child has access to CBT and the opportunity to experience improvement, research has demonstrated that there are additional factors that may contribute to poor treatment outcomes, such as parent psychopathology, which has been associated with poor treatment outcomes for children with anxiety and OCD (Garcia et al., 2010; Southam-Gerow et al., 2001).

Intensive group- and family-based outpatient treatment that implements CBT with ERP for pediatric anxiety disorders and OCD is a treatment design that treats more children at one time, and may facilitate treatment momentum with its intensive nature so that new patients can be treated sooner. This treatment set-up has resulted in significant reductions in both child- and parent-reported children’s anxiety symptoms and functional impairment (Sperling et al., 2020. Moreover, the treatment yielded significant decreases in parent-reported distress and demonstrated that greater reductions in parental distress by the end of treatment predicted more improvement for children (Sperling et al. 2021). Given that compared to before the pandemic, parents have endorsed increases in depression, anxiety, stress, and irritability (Westrupp et al.,

2023)and that parental distress may impact children’s mental health as described above, it is imperative to recognize how we can ensure that treatment supports the family system. Despite the potential for intensive group- and family-based CBT to help families, programs of this kind are rare. CBT can, however, offer generalizable advice for treatments that involve family systems. The aim of this paper is to provide an overview of interventions that can be implemented for parents of children experiencing anxiety disorders and/or OCD, and whose children are enrolled in a treatment program that implements primarily CBT with ERP and involves parents. It is recognized that not just parents care for children. For the sake of brevity, “parents” will refer to all caregivers involved in raising children.

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