Heeding the Oxygen Mask Warning: Why Treating a Child's Anxiety Starts with the Whole Family
By Jesse Chung
Most treatments for anxiety disorders in young people focus on individual therapy. Adults strive to ensure their children are given focused attention, but could this approach be deceivingly generalized? Many modern sources suggest that anxiety treatment for children is most effective when it includes the family.
Whether you’re a caregiver navigating your child’s anxiety or a therapist supporting families, understanding the relational roots of anxiety is essential. Involving parents, siblings, and other authority figures can enhance a child’s coping for anxiety. Caregivers can improve parenting skills around their child's symptoms by receiving individual therapy and/or parent management training in conjunction with their child's individual therapy. Anxiety disorders inevitably involve self-perception. Approaching treatment from anxiety's relational nature may just be the integrated approach needed to build holistic resilience for the family unit.
Clinicians should be mindful of how even well-meaning parental support can unintentionally reinforce anxiety.
In the Name of Freedom
It's not rocket science. It’s not a drama series. It's reality: adults seek support for their child when they feel the child’s symptoms are out of their hands. And rightfully so. It takes courage to acknowledge the limit of one’s capabilities. Many parents or caretakers may feel a sense of relief that their children are getting the treatment they need. This is also understandable. However, "children with mental illness commonly live with caregivers who also suffer from mental illness, which conveys both a genetic and environmental risk for the child" (Yoder, 2024). Many adults may be feeling a false sense of relief by neglecting their own mental health after attaining help for their child.
One could argue the point of prioritizing time away from children is to recuperate. If there is an implication of rejuvenation, what it is we are attempting to revitalize? Perhaps some parents are simply looking for grounding respite. Other times, there can be a sense of dread upon the child’s return from said temporary relief.
No Such Thing as an Individual Spiral
If there is recurrent dread, perhaps there are deeper issues to be addressed. Not with the child, but with the parent. In a comprehensive literature review of family-based treatment for anxiety disorders from 2010-2019, Goger and Weersing grant us imagery to this whirlpool: "anxious behaviors, cognitions, interactions, and symptoms may spiral within family environments - parents may actively reinforce anxiety in youth - parents may allow youth to avoid situations they find anxiety-provoking or actively reinforce anxious cognitions." (Goger, Weersing 2022).
Self reports from the youth further clarify this "spiral". "Anxious youth report that this reinforcement and parental accommodation of their symptoms makes them feel less stressed and anxious (Lebowitz et al., 2015) - despite data indicating that accommodation increases anxiety severity and functional impairment over time" (Storch, Salloum, Johnco, et al., 2015).
Help Yourself First — Or at the Same Time
The familiar phrase still applies: put your oxygen mask on first before before helping small children or others that may need assistance. Well, in this case, there's a little less emphasis on the order. If we were to rephrase this for a widely recommended anxiety treatment: make sure you are getting the treatment you provide your youth. Check-in with yourself. Schedule an intake session to gauge where you are as an individual, then assess what needs to be done as a parent.
If you’d like to meet with any of the therapists at our practice about parenting anxious children or if you’d like your child to meet with a counselor with your supportive involvement, you can make an appointment or contact us with questions. We look forward to working with you!
References
Goger, P., & Weersing, V. R. (2021). Family based treatment of Anxiety Disorders: A review of the literature (2010–2019). Journal of Marital and Family Therapy, 48(1), 107–128. https://doi.org/10.1111/jmft.12548
Lebowitz, E. R., Scharfstein, L., & Jones, J. (2015). Child- report of family accommodation in pediatric anxietydisorders: Comparison and integration with mother-report. Child Psychiatry and Human Development, 46(4),501–511. https://doi.org/10.1007/s10578-014-0491-1
Storch, E. A., Salloum, A., Johnco, C., Dane, B. F., Crawford, E. A., King, M. A., McBride, N. M., & Lewin, A.B. (2015). Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders.Journal of Anxiety Disorders, 35, 75– 81. https://doi.org/10.1016/j.janxdis.2015.09.001
Yoder, R., Michaud, A., Feagans, A., Hinton-Froese, K. E., Meyer, A., Powers, V. A., Stalnaker, L., & Hord, M. K. (2024). Family-based treatment for anxiety, depression, and ADHD for a parent and child. International Journal of Environmental Research and Public Health, 21(4), 504. https://doi.org/10.3390/ijerph21040504
