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Cognitive Behavioural Family Therapy with Anxiety Disordered Children Research Paper

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Updated: Jul 2nd, 2019

Introduction

Anxiety refers to the natural emotion that individuals develop when they are under intimidation, risk, or when frustrated among others. In addition, anxiety may develop because of certain life challenges such as terminal ailments, demise of a loved one, or marital problems.

Experiencing anxiety in such situations is natural and thus it should not cause any apprehension. However, since feelings of anxiety occur frequently, it is crucial to distinguish between signs of anxiety disorder and normal anxiety.

An anxiety disorder is a complicated mental ailment because it is made up of faction ailments that are characterised with a series of immense anxiety, as well as acute discomposure (Craske et al., 2009).

If not treated within the right time, the disorder may have a detrimental effect to not only the victim, but also the family and society as a whole.

This paper discusses the effect of anxiety disorder to the affected child, the family, and family functioning coupled with how it can be addressed using cognitive behavioural family therapy.

It also addresses the challenges associated with this psychotherapy together with how to overcome them. Moreover, the paper will examine the outcomes of the psychotherapy intervention, which affirms its effectiveness.

Dynamics of anxiety disorder and its impact on the family and family functioning

Various psychopathologies are affected by the family variable as indicated by several theories. Similarly, there is minimal uncertainty that anxiety problem is transmitted through the family. Several researches have shown similar anxiety problems among close relatives.

This analogy has been recorded among anxiety disordered adults and youngsters struggling with anxiety disorders. A recent study indicated there is a significant family similarity for various types of anxiety disorders such as obsessive compulsive disorder, as well as generalised anxiety disorder (GAN) (Craske et al., 2009).

The study noted that the odds of developing anxiety in a given family bracket were 4-6. Several other scholars have also made similar conclusion.

For instance, a study done in Holland with a total of 20,000 subjects revealed that a person was 6.8 times likely to suffer from an anxiety that one of the close family members was suffering from (Chapman & Woodruff-Borden, 2009).

The vulnerability was high irrespective of nature of the relationship, viz. parent, or sibling.

Another research conducted in Sweden showed a youngster was at a huge risk of developing an anxiety problem if either of the parents was a victim of anxiety disorder. However, the risk exacerbated if both parents were struggling with a particular anxiety ailment.

Most of these researches relied of data from medical diagnoses, which are often erratic and a minute number of participants who were tormented with anxiety and thus they came to seek medical attention.

However, that does not dispute the credibility of these studies for their observations were similar to past researches, viz. there can be family transmission of anxiety disorders (Bittner et al., 2007).

The main question that scholars attempt to answer as they do their research concerning the relationship of anxiety disorder and family revolves around specificity.

For instance, they investigate if a family member suffers from a particular anxiety disorder, does that mean his or her relatives will be affected with an analogous disorder or a distinct psychopathology? Studies done in response of this question have revealed that first-degree relatives have similar anxiety disorders.

A deeper examination of the family transmission of anxiety disorders indicates an intriguing genetic penetrance. The examination shows that the vulnerability of developing an anxiety disorder among twins is between 30 to 40 per cent, if one of them is affected.

Moreover, a major impact of hereditary or environmental factors is largely dubious for most disorders; hence, it is comparably common for anxiety disorders to be a result of intricate gene-environment associations (Suveg et al., 2006).

Several other family variables can be associated with anxiety disorders. Marital disputes have been linked with childhood psychopathology. Most studies have shown a more solemn association with externalising signs than internalising impacts.

In a majority of studies done to check the internalising effect, researchers have often merged anxiety and distress. However, from the few researches that have used anxiety as a single score, it is clear that interparental conflicts promote anxiety disorder among children.

For instance, a study of teenagers between the age of eleven and sixteen indicated that youngsters who had divorced parents recorded an acute degree of anxiety than those whose parents had no marital problems (Bittner et al., 2007).

Another comprehensive research, which involved over 1,200 adolescents, showed a clear relationship of domestic violence and anxiety disorder. The participants narrated their experience with interparental disputes before they were examined for various psychological outcomes.

The study disclosed that most paternal disputes resulted to anxiety disorders among the youngsters (Chapman & Woodruff-Borden, 2009).

Studies have shown that parental psychopathology such as dejection has grave impact on children as well as family functioning. Researchers have consistently confirmed that maternal dejection affects a child’s development.

Several hypothetical models have hinted that family variables as well as psychopathology are essential in the growth and management of children suffering from anxiety disorders (Hughes, Hedtke, & Kendall, 2008).

Moreover, studies have shown that family dysfunction promotes minimal positivity in youngsters who are victims of anxiety disorders.

Scholars have observed that the majority of anxiety-disordered children have mothers that are authoritative or more pessimistic when interacting with the family. However, few scholars have invested their time in scrutinising the magnitude of family functioning from both parents.

A recent research, which sought to scrutinise if the presence of anxiety disorder or dejection can cause negative family functioning, made remarkable conclusion.

The study found a steady trend with both maternal as well as paternal records of meagre family functioning substantially related with exacerbated child results founded on measures of the children, parent, or medical practitioners (Hughes, Hedtke, & Kendall, 2008).

Child anxiety had an essential relationship with family functioning, but had a meagre effect on family functioning when parental anxiety was included. The scholars stated that parent psychopathology might have envisaged family functioning, but not child anxiety because of common source discrepancy.

Nonetheless, the result of this study was akin to other previous studies that have revealed that parental psychopathology leads to a poor child adjustment as well as family functioning.

In relation to definite scope family functioning, the study suggested that parents of anxiety-disordered children have meagre family functioning accompanied with reluctance in monitoring the disparate behaviours in the family.

The ability of parents to monitor behaviour among the family members has been considered as a good way of managing children with anxiety problem by circumventing the growth of self-efficient ideas for handling tentative scenarios (Bittner et al., 2007).

The scholars also asserted that communication might fail to detect precise communication impediments that are signs of children with anxiety problems.

Recent studies have also strongly linked meagre family functioning with inferior treatment outcome, which implies that parental anxiety envisaged exacerbated family functioning.

Therefore, anxiety-disordered children whose parents also have anxiety problems can largely gain from family rather personal therapy (Suveg et al., 2006). The benefit may even be better if the therapy focussed on monitoring parental behaviour.

Cognitive Behavioural Family Therapy (CBFT)

Considering the effect of child outcome and the association between child anxiety problems and adult functioning, the application of effectual intervention in managing anxiety disorders is crucial. Several researchers have indicated that cognitive-behavioural family therapy is effective.

Most studies indicated that 75% of treated victims had been relieved of disorders when post diagnosis and follow-ups were conducted after CBFT treatment.

CBFT, which is a form of Cognitive Behavioural Treatment (CBT), is popularly used in the field of psychological health because of its effectiveness in tackling mental problems. CBT refers to a mental treatment that is concerned with how people reason, feel, and behave.

It normally has a time limit of between ten to 20 sessions. During these sessions, the therapy centres on the present problems facing the victim and adheres to a well-organised method of intervention.

The growth of CBT has largely been boosted by the impressive results from several researches that have confirmed its effectiveness (Hughes, Hedtke, & Kendall, 2008). CBFT encourages more of family treatment than individual intervention.

Goals of CBFT

The objectives of this form of psychological treatment are unequivocal and narrow. It aims at correcting the precise behaviour sequence to remove the presenting signs. It rarely focuses on systems alterations or development.

Sign alteration is not normally perceived to cause symptom replacement, but to introduce good spiral behaviour and it is handled using techniques that can initiate impressive substitute behaviour.

Behavioural family clinicians design treatment that is suitable for each specific family in an effort to instil desired family behaviours as described by a given family.

Occasionally, therapists are compelled to alter a family’s objective of reducing a negative behaviour by raising the positive or attuned character instead of a trait that is individual oriented (Chapman & Woodruff-Borden, 2009).

However, these are just techniques that clinician use to solve presenting challenges, not extensive goals.

Most spouses often desire goals that minimise aversive traits, but this strategy only lessens discontentment without raising positive emotions. Hence, family therapists also assist such couples to raise their contentment by increasing their positive behaviour.

Generally, the aims of CBFT are to accelerate the speed of rewarding interaction through promoting positive behaviour and minimising the rate of intimidation as well as aversive control.

Moreover, the mental treatment technique aspires to inculcate more effectual communication and decision-making skills (Smolders et al., 2008). The objectives of CBFT may be shaped in accordance with patients or location in which it is performed.

For instance, behaviour marital therapy is largely conducted by graduates in university teaching schools and the treatment utilises experiments extensively.

Behavioural Parent Training Technique

Practitioners may apply disparate techniques that CBFT during treatment. In the case of anxiety-disordered children, therapists may prefer behavioural parent training technique.

This technique is effective considering the massive evidence from several studies that have affirmed the importance of including parents when treating anxiety-disordered children.

A study done in Australia compared the efficiency of child-focussed intervention and a treatment that incorporated a parent training modality. The scholars observed that the introduction of parent training caused a more augmented outcome than when the latter was excluded.

Records from randomised clinical trials have also shown that although child-focused CBT essentially alleviates anxiety problems by between 50 to 80 percent in youngsters, the effect was less favourable on some children (Suveg et al., 2006).

The poor responses of some children when therapists used child-focused CBT inspired health practitioners to seek for other favourable modalities. Since parents play a crucial role in the development of child anxiety, it is largely believed that they affect treatment outcome, hence encouraging the application parent training.

In parental training, family therapists presume that the problem affects the family not just the child. Conversely, behaviour therapists concur with parents that some problems affect only the child, hence demand for the presence of only one of the parents.

Nevertheless, in certain scenarios, behaviour therapists may be compelled to meet with all the first-degree relatives (Chapman & Woodruff-Borden, 2009).

Clientele anticipate therapy to be similar to education, and thus behaviour therapists often work as teachers. Generally, most therapists design strategies that are in line with the problems described by parents and how they feel they can be rectified.

Under this technique, some therapists use educationally oriented programs whereby parents are taught about behavioural skills (Hughes, Hedtke, & Kendall, 2008). This approach helps parents to learn how they can tolerate a huge number of challenges related to anxiety disorders.

However, the demerit of this approach is that when therapists focus on teaching, they fail to understand and correct the issues that originally perpetrated the crisis (Wood et al., 2003).

Having learnt that educationally oriented techniques are not enough to address anxiety disorders, therapists have learnt to employ experimental theories in resolving medical issues, but they are discreet to validate the outcomes of their procedures.

A recent study conducted to check the effectiveness of manual family-based intervention in the treatment of anxiety disorders had imposing results.

It was anticipated that the subjects (parents and their children) would record enhancement on measures evaluating internalising signs as well as anxious disorders soon after therapy, but show no adjustment during disparate durations of baseline.

The results of the study strongly affirmed the effectiveness of CBFT in treating anxiety disordered children. Multi-method evaluation showed that the subjects had improvements after the treatment (Hughes, Hedtke, & Kendall, 2008).

Before the treatment process, the participants had huge anxiety problems, but after the management, clinically substantial changes were reported in the participants’ functioning.

The majority of the target problems embodied solemn dysfunctional behaviour or a scenario whereby anxiety had fatally disrupted their usual peer functioning. Pre-treatment outcomes showed the solidity of the participant’s comorbid as well as depressive signs at the baseline stages.

Symptoms of comorbid are common in anxiety-disordered children and comorbidity often interferes with the effectiveness of CBFT (Smolders et al., 2008).

On the other hand, results from the post-treatment showed that half of the subjects had comorbid symptoms, hyperactivity disorder, as well as oppositional defiant disability whilst parents of the subjects recorded medically important child depressive signs.

Modifications shown by the participants’ capability to tolerate personal target anxiety-triggering scenarios are essential for determining clinical effectiveness. For instance, one of the children who had been struggling with school refusal transformed and started going to school daily two weeks after the treatment (Rapee, 2012).

The study also helped the scholars to comprehend the merits and demerits of multiple-baseline designs in CBFT that scholars should note not to repeat in future studies.

Multiple-baseline is important in ensuring that observed effects are linked with intervention, but it fails to help one comprehend and correct intricate disorders.

The study’s results also suggest that enhancement in internalising signs as well as anxious behaviour were observed in the relatives who contrary to the youngsters, were originally not the focus of the treatment.

A huge percentage of the parents of participants in the study testified that they had undergone some anxiety problems during their childhood days and that they had immensely gained from the child-focused treatment in terms of anxiety problem reduction (Smolders et al., 2008).

Considering the results of present studies, relatives’ records of functioning indicate that ongoing family record measures are ineffective in tackling the kind of first-degree relative environments related with child anxiety ailments.

Possibly, irrespective of the bigger procedural impediments, it is necessary to incorporate medical ratings as well as behavioural outcomes of family relations in prospective studies focusing on families with children facing angst of anxiety problems (Suveg et al., 2006).

In the case of anxiety disorder, it would be prudent to underpin family association during the treatment process. However, one of the greatest observations in this study in relation to CBFT would be the significance of social procedures in the treatment results.

Another recent study also affirmed that CBFT leads to minimised parental and child anxiety, meagre dysfunctional parental and infant attitudes, and enhanced child nurturing as well as family functioning.

The scholars designed a family therapy layout where the treatment involved the entire family instead of the anxious child. The scholars hypothesised that adjustment within the family would result to improved outcome (Suveg et al., 2006).

After the end of the treatment period, the researchers conducted a follow up a year after the program was introduced. Both children and parents showed an impressive change in cognition.

The researchers accredited the achievement of treatment to family members who changed the dysfunctional feelings of the youngster. Moreover, it was noted that during the first few days after treatment, no substantial quantity on parental psychopathology as well as dysfunctional was recorded.

However, subsequent follow-ups indicated enhancement on internalising signs on both fathers and mothers whilst when it came to externalising signs, only mothers reported enhancement. In the case of family functioning, all family members experienced growth except mothers (Wood et al., 2003).

The results also showed that only fathers witnessed adjustment on self-reported fright.

Though both parents were genetically liable for child anxiety, this aspect raised a quandary, viz. did they cordially record their fears to avoid being faulted for poor development of the child? This element was among the few studies that have stressed the duty of fathers in the family.

Conclusion

Parental anxiety causes parents to be short-tempered and alters how they nurture their children, which prompts the growth of child anxiety. When parents witness their children struggle with anxiety problems, they too develop anxiety, and dejection.

When children are treated, it significantly enhances the family’s relationship as it terminates feelings of dejection. These studies confirm the effectiveness of CBFT as a technique of treating anxiety disorder.

Nonetheless, they also underpin the need to incorporate fathers in treatment considering the special roles they play in families. Notably, future research should concentrate on investigating the most therapeutic circumstances that demand the presence of parents by duress.

Reference List

Bittner, A., Egger, H., Erkanli, A., Costello, E., Folly, D., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology & Psychiatry, 48(12), 1174-1183.

Chapman, L., & Woodruff-Borden, J. (2009). The impact of family functioning on anxiety symptoms in African American and European American young adults. Personality and Individual Differences, 47(6), 583-589.

Craske, M., Rauch, S., Ursano, R., Prenoveau, J., Pine, D., & Zinbarg, R. (2009). What is an anxiety disorder? Depression & Anxiety, 26(12), 1066-1085.

Hughes, A., Hedtke, K., & Kendall, P. (2008). Family Functioning in Families of Children with Anxiety Disorders. Journal of Family Psychology, 22(2), 325-328.

Rapee, R. (2012). Family Factors in the Development and Management of Anxiety Disorders. Clinical Child and Family Psychology Review, 15(1), 69-80.

Smolders, M., Laurant, M., van Wamel, A., Grol, R., & Wensing, M. (2008). What determines the management of anxiety disorders and its improvement? Journal of Evaluation in Clinical Practice, 14(2), 259-265.

Suveg, C., Roblek, T., Robin, J., Krain, A., Aschenbrand, S., & Ginsburg, S. (2006). Parental Involvement When Conducting Cognitive-Behavioural Therapy for Children with Anxiety Disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 20(3), 287-299.

Wood, J., McLeod, B., Sigman, M., Hwang, W., Chu, B. (2003). Parenting and childhood anxiety: Theory, empirical findings, and future directions. Journal of Child Psychology and Psychiatry, 44(1), 134-151.

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