Abstract
Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials and found to be an efficacious treatment. Studies have investigated the effects of increased parental/family involvement in treatment. In the majority of these studies, however, parental involvement is synonymous with maternal involvement leaving the role of fathers unknown. Studies including parents in treatment have yet to examine the independent contribution of mothers and fathers to child outcome. We examined the relationship between both mother (n = 45) and father (n = 45) attendance and engagement in therapy sessions, maternal and paternal psychopathology, and child (n = 45) treatment outcome when parents were included in a Family CBT program for anxiety-disordered youth. Some indications were found for the notion that greater rates of mother and father attendance in session, as well as higher ratings of mother and father engagement in session, are associated with improved child outcome. Parental psychopathology was not associated with attendance, engagement, or child outcome. Recommendations for future research are offered.
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References
Achenbach, T. M. (1991). Integrative guide to the 1991 CBCL/4–18, YSR, and TRF profiles. Burlington, VT: University of Vermont.
Achenbach, T., & Edelbrock, C. (1991). Manual for the CBCL and 1991Profile. Burlington, VT: University of Vermont.
Amato, P. R., & Rivera, F. (1999). Paternal involvement and children’s behavior problems. Journal of Marriage and the Family, 61, 375–384.
Bagner, D. M., & Eyeberg, S. M. (2003). Father involvement in parent training: When does it matter? Journal of Clinical Child and Adolescent Psychology, 32, 599–605.
Barmish, A. J., & Kendall, P. C. (2005). Should parents be co-clients in cognitive-behavioral therapy for anxious youth? Journal of Clinical Child and Adolescent Psychology, 34, 569–581.
Barrett, P. M. (2000). Treatment of childhood anxiety: Developmental aspects. Clinical Psychology Review, 20, 479–494.
Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996a). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333–342.
Barrett, P. M., Rapee, R. M., Dadds, M. M., & Ryan, S. M. (1996b). Family enhancement of cognitive style in anxious and aggressive children. Journal of Abnormal Child Psychology, 24, 187–203.
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.
Bodden, D. H. M., Bögels, S. M., Nauta, M. H., de Haan, E., Ringrose, J., Appelboom, C., Brinkman, A. G., & Appelboom-Geerts, K. C. M. M. J. (2010). Efficacy of individual versus family cognitive behavioural therapy in clinically anxious youth (submitted).
Bögels, S., & Phares, V. (2007). Fathers’ role in the etiology, prevention and treatment of child anxiety: A review and new model. Clinical Psychology Review, 28, 539–558.
Bogels, S. M., & Siqueland, L. (2006). Family cognitive behavioral therapy for children and adolescents with clinical anxiety disorders. Journal of the American Academy of child and adolescent psychiatry, 45, 134–141.
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, 893–905.
Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children’s internalizing and externalizing behavior problems: A meta-analysis. Psychological Bulletin, 128, 746–773.
Coplin, J. W., & Houts, A. C. (1991). Father involvement in parent training for oppositional child behavior: Progress or stagnation? Child and Family Behavior Therapy, 13, 29–51.
Crawford, A. M., & Manassis, K. (2001). Familial predictors of treatment outcome in childhood anxiety disorders. Journal of the American Academy of Child & Adolescent Anxiety, 40, 1182–1189.
DiNardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime Version (ADIS-IV-L). Albany, NY: Graywind.
DiNardo, P., Moras, K., Barlow, D. R., Rapee, R., & Brown, T. (1993). Reliability of DSM-II/-R anxiety categories: Using the ADIS-R. Archives of General Psychiatry, 50, 251–256.
Duhig, A. M., Phares, V., & Birkeland, R. W. (2002). Involvement of fathers in therapy: A survey of clinicians. Professional Psychology: Research and Practice, 33, 389–395.
Duhig, A. M., Renk, K., Epstein, M. K., & Phares, V. (2000). Interparental agreement on internalizing, externalizing, and total behavior problems: A meta-analysis. Clinical Psychology: Science and Practice, 7, 435–453.
Edmunds, J. M., O’Neil, K. A., & Kendall, P. C. (2010). A review of cognitive-behavioral therapy for anxiety disorders in children and adolescents: Current status and future directions. Journal of the Norwegian Psychological Association (in press).
Friedlander, M. L., Wildman, J., Heatherington, L., & Skowron, E. (1994). What we do and don’t know about the process of family therapy. Journal of Family Psychology, 8, 390–416.
Ginsburg, G., & Schlossberg, M. C. (2002). Family-based treatment of childhood anxiety disorders. International Journal of Psychiatry, 14, 142–153.
Ginsburg, G. S., Silverman, W. K., & Kurtines, W. K. (1995). Family involvement in treating children with phobic and anxiety disorders: A look ahead. Clinical Psychology Review, 15, 457–473.
Ginsburg, G. S., Siqueland, L., Masia-Warner, C., & Hedtke, K. A. (2004). Anxiety disorders in children: Family matters. Cognitive and Behavioral Practice, 11, 28–43.
Guy, W. (Ed.). (1976). Clinical global impressions. In: ECDEU Assessment Manual for Psychopharmacology, revised. Rockville, MD: National Institute of Mental Health.
Howard, B., Chu, B.C., Krain, A.L., Marrs-Garcia, M.A., & Kendall, P.C. (2000). Cognitive-behavioral family therapy for anxious children: Therapist manual (2nd ed.). Ardmore, PA: Workbook Publishing. www.WorkbookPublishing.com.
Hudson, J., Comer, J., & Kendall, P. C. (2008). Parental responses to positive and negative emotions in anxious and nonanxious children. Journal of Clinical Child & Adolescent Psychology, 37, 303–313.
Hudson, J. L., & Rapee, R. (2004). From anxious temperament to disorder: An etiological model of generalized anxiety disorder. In R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press.
Hughes, A., Furr, J., Sood, E., Barmish, A., & Kendall, P. (2009). Anxiety, mood, and substance use disorders in parents of children with anxiety disorders. Child Psychiatry and Human Development, 40, 405–419.
Hughes, A., Hedtke, K., & Kendall, P. C. (2008). Family functioning in families of children with anxiety disorders. Journal of Family Psychology, 2, 325–328.
Kane, P., & Garber, J. (2004). The relations among depression in fathers, children’s psychopathology, and father–child conflict: A meta-analysis. Clinical Psychology Review, 24, 339–360.
Kazdin, A. E. (1997). Parent management training: Evidence, outcomes and issues. Journal of the American Academy of Child& Adolescent Psychiatry, 36, 1349–1356.
Kendall, P. C. (2006). Guiding theory for therapy with children and adolescents. In P. C. Kendall (Ed.), Child, adolescent therapy: Cognitive-behavioral procedures (3rd ed.). New York: Guilford Press.
Kendall, P. C. (2009). Principles of therapeutic change circa 2010. Applied and Preventive Psychology, 13, 19–21.
Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual and workbook (3rd ed.).Ardmore, PA: Workbook. www.WorkbookPublishing.com.
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., SouthamGerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366–380.
Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth” A randomized clinical trail evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76, 282–297.
Kendall, P. C., & Ollendick, T. (2004). Setting the research and practice agenda for anxiety in children and adolescents: A topic comes of age. Cognitive and Behavioral Practice, 11, 65–74.
Kendall, P.C., Podell, J., & Gosch, E. (2010). The Coping Cat: Parent Companion. Ardmore, PA: Workbook Publishing. www.WorkbookPublishing.com.
Kendall, P. C., & Treadwell, K. (2007). The role of self-statements as a mediator in treatment for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 75, 380–389.
Khanna, M. S., & Kendall, P. C. (2009). Exploring the role of parent training in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 77, 981–986.
Lamb, M. E. (2004). The role of fathers in child development (4th ed.). Hoboken, NJ: Wiley.
March, J. S., Parker, J., Sullivan, K., Stallings, P., & Conners, C. (1997). The multidimensional anxiety scale for children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 554–565.
McBride, B. A., & Lutz, M. M. (2004). Intervention: Changing the nature and extent of father involvement. In M. E. Lamb (Ed.), The role of the father in child development (4th ed., pp. 446–475). New York: Wiley.
Mendlowitz, S. L., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Shaw, B. F. (1999). Cognitive–behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1223–1229.
Muris, P., Steerneman, P., Merckelbach, H., & Meesters, C. (1996). The role of parental fearfulness and modeling in children’s fear. Behaviour Research and Therapy, 34, 265–268.
Nauta, M., Scholing, A., Emmelkamp, P., & Minderaa, R. (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 and Adolescent Psychiatry, 42, 1270–1278.
Ollendick, T. & King, N. (2010) Empirically supporter treatments for children and adolescents. In Kendall, P. C. (Ed). Child and adolescent therapy: Cognitive-behavioral procedures (4th ed.) New York: Guilford Press (in press).
Patterson, G. R., Chamberlain, P., & Reid, J. B. (1982). A comparative evaluation of a parent-training program. Behavior Therapy, 13, 638–650.
Phares, V., & Compas, B. E. (1992). The role of fathers in child and adolescent psychopathology: Make room for daddy. Psychological Bulletin, 111, 387–412.
Phares, V., Fields, S., Kamboukos, E., & Lopez, E. (2005a). Still looking for Poppa. American Psychologist, 60, 735–736.
Phares, V., Lopez, E., Fields, S., Kamboukos, D., & Duhig, A. M. (2005b). Are fathers involved in pediatric psychology research and treatment? Journal of Pediatric Psychology, 30, 631–643.
Postner, R. S., Guttman, H. A., Sigal, J. J., Epstein, N. B., & Rakoff, V. M. (1971). Process and outcome in conjoint family therapy. Family Process, 10, 451–474.
Rapee, R. M. (1997). Potential role of childrearing practices in the development of anxiety and depression. Clinical Psychology Review, 17, 47–67.
Rapee, R. M. (2000). Group treatment of children with anxiety disorders: Outcome and predictors of treatment response. Australian Journal of Psychology, 52, 125–129.
Shirk, S. Jungbluth, N., & Karver, M. (2010). Change processes in cognitive-behavioral therapy for children and adolescents. In Kendall, P. C. (Ed). Child and adolescent therapy: Cognitive-behavioral procedures (4th ed.) New York: Guilford Press (in press).
Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 452–464.
Silverman, W. K., & Albano, A. M. (1997). Anxiety disorders interview schedule for DSM-IV: Child and parent versions. Boulder, CO: Graywind Publications Incorporated.
Silverman, W. K., Cerny, J. A., Nelles, W. B., & Burke, A. E. (1988). Behavior problems in children of parents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 779–784.
Silverman, W. K., Kurtines, W. M., & William, M. (2005). Progress in developing an exposure- based transfer-of-control approach to treating internalizing disorders in youth. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 97–119). Washington, DC: American Psychological Association.
Silverman, W. K., Pina, A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for children and adolescents: A ten year update. Journal of Clinical Child Adolescent Psychology, 37, 105–130.
Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937–943.
Southam-Gerow, M., 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, 422–436.
Tiano, J. D., & McNeil, C. B. (2005). The inclusion of fathers in behavioral parent training: A critical evaluation. Child and Family Behvaior, 27, 1–28.
Treadwell, K. R. H., & Kendall, P. C. (1996). Self-talk in anxiety-disordered youth: States-of-mind, content specificity, and treatment outcome. Journal of Consulting and Clinical Psychology, 64, 941–950.
Videon, T. M. (2005). Parent-child relations and children’s psychological well-being: Do dads matter? Journal of Family Issues, 26, 55–78.
Walkup, J., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S., Sherrill, J., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766.
Webster-Stratton, C. (1985). The effects of father involvement in parent training for conduct problem children. Journal of Child Psychology and Psychiatry, 26, 801–810.
Wood, J. 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 and Psychiatry, 44, 134–151.
Wood, J. J., Piacentini, J. C., Southam-Gerow, M. A., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of American Academy of Child & Adolescent Psychiatry, 45, 314–321.
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This work was supported by NIMH research grants (MH 59087 and MH 64484) awarded to the second author. Address correspondence to the first author at 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia PA 19122. PKendall@Temple.edu.
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Podell, J.L., Kendall, P.C. Mothers and Fathers in Family Cognitive-Behavioral Therapy for Anxious Youth. J Child Fam Stud 20, 182–195 (2011). https://doi.org/10.1007/s10826-010-9420-5
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DOI: https://doi.org/10.1007/s10826-010-9420-5