Parents learn to treat children for anxiety

Can parents treat their anxious child using CBT? A brief report of a self-help program.

Between 5 and 10 per cent of all children suffer from anxiety, and there is a widespread belief among parents, teachers, doctors, day-care workers and even school psychologists that anxiety is a normal part of childhood and something that gradually disappears as we get older. But for many children, anxiety is a part of everyday life that can prevent them from enjoying a normal and active childhood with school, friends and hobbies.

And for many people, anxiety is a life-long companion, leading to significant social problems and impacting negatively on their schooling and education. An estimated 140,000 adults in Denmark suffer from anxiety to such an extent that they are not able to hold down a job, complete an education or generally live a normal, active life, and anxiety is regarded as a condition that affects a large part of the population.

But anxiety can be treated. Barbara Hoff Esbjørn was head of the University of Copenhagen’s Centre for Anxiety, which carries out research into the treatment of anxiety among children and young people, thereby advancing scientific knowledge about how we can treat children with anxiety and thus prevent them from suffering from the condition throughout their lives. The main thrust of Barbara Hoff Esbjørn’s work is to disseminate the knowledge gained to everyone who has contact with - and can help - children with anxiety disorders.

Method

Barbara Hoff Esbjørn established the Centre for Anxiety in the summer of 2007, since when she and her research team have carried out several major research projects (Barbara is no longer working at the University of Copenhagen).

In a pilot project carried out in 2014-2015, researchers demonstrated that a child's anxiety can be treated effectively by the parents themselves if they have both the necessary know-how about the mechanisms that cause anxiety and the right tools to help the child in their day-to-day life. Such know-how could, for example, take the form of supporting the child in challenging their anxiety - even though it is difficult - by gradually confronting the cause of their anxiety.

The problem in Denmark today is that there is too little treatment provision for children with anxiety, and what is available is not good enough; incorrect treatment can actually make the child's anxiety worse, no matter how well-intentioned it is. We will only get effective treatment for children with anxiety if the people working with children in the different local authorities are given access to our knowledge and learn the specific treatment methods that are needed. At the Centre for Anxiety, we are therefore working consciously to create solutions that are tailored to a local authority’s everyday challenges in relation to anxiety in children. For example, we train teachers, day-care workers and school psychologists so they can ensure the quality of the treatment offered by the local authorities, and all children who need it can get quick and effective help with their anxiety.

In all, 26 families participated in the 'Help with self-help' project, all of whom had a child aged 7-13 years diagnosed with some form of anxiety. This could be separation anxiety, generalized anxiety, specific phobias or social phobia. More than half of the children, in fact, suffered from a combination of several types of anxiety.

Over the course of 12 weeks, the child's parents met twice for a two-hour workshop, where they received information on how anxiety can develop, and how they can act in specific situations in everyday life, so they help tackle the child's anxiety and not unintentionally reinforce it. In this way, the researchers at the Centre for Anxiety equipped parents so that they could treat their own children, which turned out to be both cheap and effective: after 12 weeks, two out of three children were completely free of anxiety.

Results

In the period 2016-2017, the very promising results from the pilot project were tested on a larger scale in Lyngby-Taarbæk. The Centre for Anxiety trained five psychologists working for the council’s educational psychology counselling service so that they could run the parent workshops.

The parents of all families with children in school years 0 to 3 (6 to 9 years old) from the local schools were invited to participate in a meeting about anxiety and given information about the 'Help with self-help' project. Parents who were able to recognize the descriptions of childhood anxiety in their own children, and who wanted help to deal with the anxiety attacks, were given the opportunity to participate in the project. These parents also completed questionnaires before, during and after the treatment of their child’s anxiety symptoms.

Following the very positive results from Lyngby-Taarbæk, a decision was made to expand the project to include families with children in school years 4 to 6 (10 to 12 years old), and so in the autumn of 2017, these families were also offered 'Help with self-help'. Preliminary results indicate that the treatment had beneficial effects in Lyngby-Taarbæk as well. Final results assessing the effect of the treatment are expected to be ready in the autumn of 2018.

A further benefit has been that teachers, day-care workers, school psychologists and others working with children in Lyngby-Taarbæk have had access to the researchers' latest knowledge about anxiety and its treatment. This can help to ensure that children with anxiety disorders are identified early on, which again means that more children will be able get help at an early stage.

Further research

Barbara Hoff Esbjørn and her colleagues at the Centre for Anxiety are now working on a method to enable them to identify more precisely which children and families are likely to derive the most benefit from this type of early intervention. The Centre is seeking funding to carry out a randomised, controlled study, which will examine how different versions of the 'Help with self-help' programme will work with different groups of children.

Media reviews and publications

Book review on www.videnskab.dk from 31 October 2017: 'How best to suport your anxious child'

Article in the local newspaper Lokalavisen Lyngby-Taarbæk from 25 October 2017: Anxiety project nearing conclusion: 'I regard Lynbgy-Taarbæk as a really pioneering local council'

The publication 'Can parents treat their anxious child using CBT? A brief report of a self-help program': Esbjørn. BH; Munkebo, BC; Walczak, M; Østergaard, SW; Breinholst, S (2016). Acta Psychopathologica, 2 (1)

The most recent books by Barbara Hoff Esbjørn

2016 'Metakognitiv terapi til børn'
('Metacognitive therapy for children')
A manual drawing on experiences from treating anxiety in adults and adapting it to children and written in a manual so that both parents and professionals can use it in the treatment of children with anxiety disorders. The methods described in the book have proved to be very successful - even with children who have not managed to benefit from any traditional anxiety treatment: Two out of three children with generalized anxiety disorders will overcome their anxiety. Read more on saxo.com.

2017 'Fri af angst'
('Free of anxiety')
A handbook aimed at parents of mildly or moderately anxious children. The book contains, among other things, good advice on how to deal with your child’s anxiety, and how you can help your child develop positively. There is also a description of the techniques used in cognitive behavioural therapy to treat anxiety in children. Read more on akademisk.dk.

'Help with self-help'

Pilot study of treatment parents can offer if their children suffer from anxiety.

• 2014-2015: Researchers developed a self-help programme called 'Help with self-help' for parents of moderately anxious children to enable parents to provide the support necessary to help their children overcome their anxiety.
• The parents of 26 families participated in two two-hour workshops with researchers from UCPH. They were also given a self-help manual and offered the option of holding online consultations with researchers.
• 17 families completed the 12-week programme
• After completing the treatment, 65% of all the children who took part had overcome their anxiety
• 2016-2017: Lyngby-Taarbæk local authority screen all children between school years 0 and 6 (6 to 12 years old) to identify any signs of anxiety that might require treatment
• 80 families participate in the 'Help with self-help' workshops for parents

'Anxiety costs society DKK 10 billion a year'

In Denmark, 140,000 adults are estimated to suffer from anxiety to such an extent that they are not able to hold down a job, complete an education or generally live a normal, active life. It is the most common psychological disorder to trigger early retirement and is estimated to cost the Danish state up to DKK 10 billion a year in treatment, pensions and lost production.

What is anxiety?

Anxiety in children can manifest itself in many ways:

• The child may get a headache or a stomach ache every time they have to go to a birthday party. As a result, they choose to stay at home
• The child is perhaps reluctant to let mum and dad leave when they have taken them to school
• The child worries about things which are not appropriate for their age like, for example, family finances or concerns about younger siblings
• The child's anxiety requires treatment if it affects their everyday life and prevents the child from doing the same things as their peers