Boundaries on Parent Involvement in Their Child's Anxiety Cognitive-Behavioral-Treatment Outcome: Parent Reinforcement and Relationship Behaviors Moderate Outcome

Extending a recent parent-mediation efficacy trial, we identified parent reinforcement and relationship behaviors as setting boundary conditions, or moderators, of youths' anxiety outcome in 254 youths and their parents, who were randomized to (a) cognitive-behavioral treatment (CBT) with parent reinforcement-behavior training (CBT + Reinf), (b) CBT with parent relationship-behavior training (CBT + Relat), or (c) individual-youth CBT-a comparator control arm. Findings revealed that parents with high baseline negative-reinforcement levels and acceptance levels (i.e., above the mean) report their children as having lower anxiety at outcome when assigned to CBT + Reinf and CBT + Relat, respectively, versus CBT. No moderation effects were found for either parent positive reinforcement or parent psychological control. Implications for treating anxiety disorders and moving toward precision-treatment approaches in youths and the importance of research replication and extension are discussed.

Automated summary

In this study, parent reinforcement and relationship behaviors were found to moderate the anxiety outcome of youths receiving cognitive-behavioral treatment (CBT). Parents with high levels of negative reinforcement and acceptance reported lower anxiety levels in their children when assigned to CBT with parent reinforcement-behavior training or CBT with parent relationship-behavior training, compared to CBT alone. However, there were no moderation effects for parent positive reinforcement or parent psychological control.