Enhanced Cognitive-Behavioral Treatment for Anxiety Disorders in Children of Clinically Anxious Parents: Two Case Studies

Abstract

Children with anxiety disorders are significantly less likely to recover following cognitive-behavioral therapy (CBT) if they have a parent with clinical anxiety. Despite this, prior research which has adapted CBT treatments to cater for this vulnerable clinical cohort of children is limited. In response to the identified need to optimize treatment outcomes for this particular group of children with anxiety disorders, an enhanced CBT intervention was recently developed, specifically to target anxiety maintenance factors in clinically anxious child–parent dyads. This dual case study presents the implementation of the enhanced intervention with two children with complex clinical presentations. Prior to treatment, both children met criteria for multiple anxiety disorders, as did their mothers. The presented case studies describe session-by-session treatment accounts, with a particular focus on the children’s experiences of individual and joint-observational exposure treatment components. Outcome data is provided for both children and their mothers, based on assessment measures collected at pre- and post-treatment, and during the intervention. At post-treatment, both children demonstrated symptom reduction and improved functioning across all diagnoses, including remission on a secondary diagnosis, although both still met criteria for their primary diagnoses. Additionally, self-reported outcomes on intervention acceptability measures were favorable. Results implied that the enhanced intervention provided a viable alternative treatment approach for children and their parents with co-occurring anxiety disorders. Recommendations are provided for clinicians delivering CBT to clinically anxious child–parent dyads.