3 - (SYM 11) A Randomized Controlled Trial of a Single-session Intervention to Reduce Parental Accommodation of Anxiety in Children Awaiting CBT

Many youth face long delays in accessing Cognitive-Behavioral Therapy (CBT), in part because the demand for CBT far exceeds the number of available providers. Delays in accessing care are harmful as they may lead to worsened symptoms, loss of motivation, and early drop-out once treatment starts. Therefore, there is a critical need for novel intervention approaches that 1) provide rapid access to interim care for youth waiting for treatment, and 2) can be easily implemented within already over-burdened mental healthcare systems. Digitial single-session interventions (SSIs) address these critical limitations by delivering an entire intervention in a single encounter and have shown promise for engaging mechanisms of action and improving child anxiety symptoms. SSIs can be delivered at the moment of referral, mitigating the adverse impacts of long waitlists by providing families with foundational skills before initiating treatment.

In the current study, we tested the effects of a self-guided, digital SSI delivered to parents of children ages 5-13 awaiting CBT for anxiety and/or OCD (N=46). The SSI, Project EMPOWER, targets parental accommodation, a family factor that can worsen child anxiety symptoms and impede efficacy of CBT. Parents of children on a CBT waitlist for anxiety were randomized to receive the SSI or to remain on the waitlist as usual (TAU). Parents completed the Spence Child Anxiety Scale, the Parent Accommodation Scale, and a single 7-point item of perceived ability to manage child’s distress (parent agency) at baseline, 2-weeks follow-up, and CBT intake.

We conducted mixed effects linear models and then tested piecewise slopes between adjacent occasions to examine possible nonlinear patterns of change. Parents who received the SSI, compared to TAU, reported significantly greater decreases in the frequency of their accommodation (d=.59) and child anxiety symptoms (d=.93), and greater increases in parent agency (d=.61) at a 2-week follow-up and these effects were maintained until youth initiated CBT. Parents also rated the SSI as helpful, indexed by average ratings of 4.09/5 (SD=.84) on a program feedback scale, and feasible (96% were full completers).

This pilot trial identified a brief, mechanism-targeted model with minimal operational complexities that streamlines access to care for children awaiting CBT. Given that digital SSIs are brief and engage targeted mechanisms of action, they are a promising approach to bridging gaps in access to mental healthcare by providing immediate, interim care for youth waiting for treatment.