This week The Child Therapy List explores a parent-focused method, for parents and caregivers to learn to help their children cope and even overcome anxiety. Thanks to Daisy Vergara, for her practitioner perspective. Daisy is Owner and Director of Ohana Behavioral Health, a Licensed Mental Health Counselor Supervisor and Registered Play Therapist- Supervisor.
In this time of COVID-19, the story doesn’t have to stop at our children being in distress! Parents and Caregivers, we can help our children become resilient, stay well, and be connected to us like never before. This particular method might not be for everyone, but it opens a valuable conversation about the power we have to change the impact of COVID-19 on our kids. Share this with a parent whose child is struggling at home ~ plant a seed with them.
SPACE Treatment Offers Hope to Families Dealing with Anxiety
A study reviewed in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) recently reported that a new, completely parent-focused treatment known as SPACE (Supportive Parenting for Anxious Childhood Emotions), is as effective as other current methods of treatment.
Anxiety disorders, such as social phobias, separation anxiety, and generalized anxiety, are some of the mental health challenges experienced in childhood and adolescence. Children who suffer a significantly impairing anxiety disorder, often have compounding developmental impairment, in the areas of personal identity development, socialization, and academic ability. When treatment is not successful in childhood, this can lead to further clinical implications later in life.
The Yale study included more than 120 kids with previously diagnosed clinical anxiety disorders. The participants were assigned to randomly receive either CBT treatment – currently considered the industry standard – or SPACE treatment. SPACE treatment is a treatment approach devised by Dr. Eli Lebowitz and his team at the Yale Child Study Center at the Yale School of Medicine in Connecticut. Dr. Lebowitz is the associate director of the Anxiety and Mood Disorders Program at the Yale Child Study Center.
Lebowitz began working on the new treatment after seeing that only half of the children treated with current therapy options respond to them. He believed there was a need for other options for families dealing with these struggles. Thus, SPACE treatment was developed.
Treatment Focuses on Reduction of Symptom Accommodations by Parents
The SPACE treatment protocol focuses on teaching parents to reduce the amount of symptom accommodation they are providing, and instead to respond to the child’s anxiety symptoms with supportive feedback and validation. They are trained to communicate acceptance of the child’s distress, without enabling their symptoms. Instead of focusing on taking away the uncomfortable feelings for the child, they are being trained to focus on helping the child use coping skills to tolerate distress.
Daisy Vergara, Child Practitioner, “I believe that parent involvement is THE key success to treatments with children and adolescents. parental involvement needs to be a protocol of success in any treatment for children and adolescents. Not only involvement, parents need to be motivated to work together with their children and teens. I usually hear parents are busy, or have their own issues. Especially with teens, it is difficult to engage parents. They tend to want us to “fix” the teens while we have been telling them over and over again that they need to repair that relationship rapture with their teens. This is why I am an advocate for early intervention/prevention. I focus more on early childhood up to age of 6 for this reason. When you catch the behaviors or any attachment raptures early on, it is easier to rebuild the relationship and repair the attachment issues. Many believe children will outgrow behaviors, seen as “normal” phases, but if parents see persistent and consistent behaviors across the developmental stages, it is time to check in with mental health professionals. Pediatricians can help, they know about mental health symptoms and issues, but they are not trained in mental health prevention or intervention.”
In the first study published about SPACE, the parents were asked to follow a script of supportive and validating expressions to use when they attempt to reduce accommodations for their child. Doing so helped reframe a response for the parents, in order to train them not to accommodate, while still providing comfort.
To explore this concept further, it is typical for children to go to their parents for help coping with their anxiety, and for comfort. Children and Adolescents with an anxiety disorder are constantly seeking reassurance. They create avoidance patterns by looking to their parent every time they experience distress. The child learns that if they seek the assistance of the caregiver, the parent will make their anxiety and uncomfortable feelings disappear. It’s common for parents to end up creating a life that accommodates their child’s needs and mold their behavior around their child’s comfort. This is called “family accommodation” or “symptom accommodation.” It means decisions and behaviors are based on keeping the problem feelings at bay.
According to Lebowitz, “Parents of anxious children almost always try to accommodate their child.” If he or she has social anxiety, they don’t invite friends over. Kids with generalized anxiety get constant reassurance.” These parental responses are natural, but they do nothing to manage the issue. In many cases, they exacerbate the child’s challenges. Research shows that family accommodation correlates to the long-term maintenance of the child’s anxiety symptoms.
SPACE at Least as Effective as Other Treatment Protocols
Following both CBT and SPACE treatment, about 60% of the kids were no longer clinically diagnosable as having the disorder that was present before treatment began. Even more – nearly 90% for SPACE and just over 75% for CBT – demonstrated remarkable progress in the reduction of their symptoms. Parents and kids both completed self-evaluations, all of which showed everyone was happy with the treatment they received and saw improvement in symptoms.
The study conclusions were surprising: Not only did SPACE reduce anxiety symptoms just as well as the CBT did, but the parents who participated in the SPACE therapy also reported an improved relationship with their children, whereas this was not reported by the parents in the CBT group.
Daisy Vergara, “Play Therapy is also an evidence-based treatment according to The National Registry of Evidence-Based Programs and Practices (NREPP) provided on the SAMHSA website. Play Therapy is not just play or using toys as a medium of communication, it also serves all ages throughout the lifespan. In Play Therapy, we work with parents with psychoeducational and tools, so they can help with their children’s anxiety. We want the parents to be the agents of change for their children for a greater, long-lasting change.”