6 - (IOP 15) Randomized Controlled Trial of a Brief, Web-based, Parenting Intervention to Reduce Child Anxiety Risk

Anxiety disorders often originate in childhood and are associated with substantial lifelong distress and impairment, as well as increased risk for depression, substance use problems, suicidality, and physical health problems. Interventions that target early risk markers of anxiety can reduce lifelong suffering associated with clinical anxiety. Based on a body of literature showing that an abnormal neural response to errors is associated with greater risk for anxiety, and given experimental research demonstrating that parental behaviors can modulate a child’s neural response to errors, we developed a brief, online, cognitive-behavioral intervention for parents of 5-7-year-old children to reduce their child’s distress and over-reactivity to errors: “Making Mistakes—Parents” (MMP). In a randomized controlled trial, we tested the efficacy of MMP against an active control with a mixed sample of parents recruited for elevated error sensitivity (N = 100, 50 per condition; 46% Black; 64% women; 84% married). There was no attrition from baseline to 1-month follow-up. A MANCOVA revealed medium-large effect sizes on the multivariate pattern of parent-reported sensitivity to errors, child anxiety, and negative parenting styles, Wilks’ Λ = .87, F(6, 87) = 2.23, p = .048, η²p = .133. Univariate ANCOVAs revealed that the intervention group had significantly better outcomes with respect to parent error sensitivity, F (1,92) = 6.08, p = .015, η²p = .062; authoritarian parenting style, F(1,92) = 8.09, p = .005 η²p =.081; and child anxiety, F(1,92) = 5.90, p = .017, η²p = .060. A marginal effect was observed for child error sensitivity, F(1,92) = 3.55, p = .063, η²p = .037. All models remained significant after group-wise Bonferroni correction. Follow-up mediation analyses were conducted, wherein parental error sensitivity and parental sensitivity to child errors—measured immediately post-intervention—were modeled as mediators of the respective improvements in authoritarian parenting and child anxiety. No mediation models reached significance. Regarding perceptions of MMP, the program was rated as highly acceptable and appropriate by parent participants, assessed via the Acceptability of Intervention Measure (AIM): M = 4.74 out of a possible 5, SD = 0.39; and the Intervention Appropriateness Measure (IAM), M = 4.67, SD = 0.41. Likewise, qualitative feedback collected from parents yielded strongly positive reactions to the program. Our findings show that a fully online cognitive-behavioral intervention that focuses on parental reactivity to child mistakes achieves substantial, timely reductions to negative parenting style, child anxiety, and parental error sensitivity within a diverse group of parents. Findings support the utility of digital mental health interventions as a scalable tool to effect positive change, even in very young children. Findings also have relevance for parent-mediated interventions targeting anxiety, as well as interventions targeting perfectionism and related constructs. MMP is a promising, well-liked, highly disseminable intervention to prevent child anxiety and improve family functioning. Future work should evaluate MMP at longer follow-up and incorporate observational assessment measures.