SPACE: A Parent-Based Treatment for Childhood Anxiety
When children are struggling to manage feelings of anxiety, our instinct is typically to provide them with their own support through child-based treatments, such as cognitive-behavioral therapy (CBT). These treatments focus on ways that children can change their behavior, such as challenging anxious thoughts and practicing relaxation strategies, and require their active participation in the treatment. While there is a lot of evidence supporting the effectiveness of child-based treatment models, parents can actually do a lot to help reduce their child’s anxiety without the pressure of having their child do anything. This is the underlying principle of the parent-based treatment program, Supportive Parenting for Anxious Childhood Emotions (SPACE). SPACE is an evidence-based treatment for childhood anxiety disorders and obsessive-compulsive disorder (OCD). While this treatment program aims to treat children and adolescents, the child or adolescent does not actually have to participate in the treatment. This might be a huge relief to parents who have highly anxious children that are resistant to engaging in their own therapy.
The reason working with parents alone is effective at reducing anxiety in children is because fear is inherently a social response. In other words, children are hardwired to signal to their parents when they are afraid and seek them out for comfort and safety. Parents are usually very good at picking up on these fear signals and naturally want to protect their children from harm. Therefore, when a child is highly anxious and their fear response is overly active, they are more likely to perceive situations as dangerous and frequently seek out comfort from their parents. Even when parents are aware that the situation their child is afraid of is not actually dangerous, parents are still tempted to provide this comfort and help their child feel safe. After all, no parent enjoys seeing their child in distress.
While providing this comfort and reassurance can help your child feel less anxious in the moment, it may actually be less helpful in the long term. In fact, when caregivers change how they are responding to their child when they are anxious, a child can learn to regulate more independently. This is where SPACE comes in. SPACE focuses on the ways that parents can change their behavior in response to their child’s anxiety. The treatment helps to teach parents alternative ways of responding in order to help children feel less anxious overall, rather than just reducing anxiety in the moment.
One of the main components of the SPACE treatment model is identifying the accommodations parents are using that help their child avoid or lessen feelings of anxiety. Accommodations come in all shapes and sizes. For example, if a child is afraid to stay with a babysitter in the evening, parents might accommodate by not going out at night. Or if a child is worried about getting sick, parents might accommodate by providing reassurance, such as repeatedly telling the child that they are healthy. Accommodations are very normal and common for parents of highly anxious children and almost all parents will find themselves engaging in these behaviors. In fact, providing accommodations means that you are attuned to how your child is feeling and want to help them feel better. While these accommodations do help the child feel better in the moment, they ultimately do not allow the child to experience the anxiety and learn that they are able to tolerate it. Furthermore, accommodations can unintentionally communicate to a child that you do not believe they can cope with their anxiety. By reducing accommodations, instead you are communicating that you believe they can experience anxiety and still be okay.
A main goal of the SPACE treatment is for parents to systematically work on targeting certain accommodations and finding alternative ways of responding when their child is anxious. Breaking this accommodation cycle can be very challenging, especially when parents have a hard time seeing their child anxious and struggle resisting the urge to rescue them. However, it is helpful to remember that allowing a child to feel uncomfortable is extremely valuable and will help them build the skills they need to be successful later in life.
In combination with reducing accommodations, SPACE also emphasizes the importance of increasing support. Support helps children cope with the increased anxiety they will likely experience in response to parents reducing accommodations. Additionally, providing support is also an alternative way for parents to respond to their children when they stop providing the accommodations. The two important components of support are acceptance and confidence. The acceptance part focuses on parents providing validation and communicating that they understand their child is anxious and that the situation is hard for them. The confidence part focuses on parents communicating that they believe their child can cope with the anxiety and still be okay. Some examples of this include:
“I understand that this is hard for you, and I know that you can cope.”
“It’s uncomfortable to be anxious, and I know you can handle it.”
Implementing all of these changes can be challenging, especially when parents have been stuck in this accommodation cycle for a long time. However, working through this treatment model with the support of a clinician trained in SPACE, such as myself, can help make these changes feel less overwhelming and more achievable.
References:
Lebowitz, E.R. (2021). Breaking free of child anxiety and OCD: A scientifically proven program for parents. Oxford University Press.
