Is the Gold Standard Being Challenged? SPACE vs CBT: A New Contender in Treating Childhood Anxiety
Examining the Gold Standard: CBT
Cognitive-behavioral therapy (CBT) has been considered the gold standard for treating childhood anxiety for many years. CBT aims to identify and change negative thought patterns and behaviors that contribute to anxiety. CBT is an evidence-based treatment, meaning that it has been extensively researched and found to be effective in reducing symptoms of anxiety in children and teens.
CBT for childhood anxiety typically involves a combination of techniques, including psychoeducation, cognitive restructuring, exposure therapy, and behavioral strategies. Psychoeducation involves teaching children and parents about anxiety, its symptoms, and how it can be managed. Cognitive restructuring helps children identify and challenge negative thoughts and beliefs that contribute to anxiety.
Exposure therapy is often part of the CBT treatment process and involves gradually exposing children to feared situations or objects, helping them build confidence and reduce anxiety. Behavioral strategies involve learning and practicing skills to manage anxiety, such as deep breathing, visualization or progressive muscle relaxation.
Research has consistently shown that CBT is effective in reducing symptoms of anxiety in children. Given its effectiveness and evidence-based nature, CBT has long been considered the first-line treatment for childhood anxiety.
When CBT Isn't An Option, and Even When It Is
While cognitive-behavioral therapy (CBT) has been recognized as the gold standard in treating childhood anxiety, it may not be the best option for every child. There are several situations where parents might want to or need to consider other options, such as Supportive Parenting for Anxious Childhood Emotions (SPACE).
Your child may be too young to fully understand the cognitive and behavioral strategies involved in CBT: CBT requires a certain level of cognitive and language skills. Young children, below the age of 6 or 7, may not be able to fully understand or express their emotions, thoughts, or behaviors. If your child is younger than 6 years-old, or you feel like your child is not ready for CBT, you might want to consider alternative approaches such as SPACE that depend less on the child and more on the actions and intervention of their grownups.
Your child may not be able to follow through with the application of skills learned in therapy: While CBT can teach children practical skills to manage their anxiety, not all children are able to apply these skills consistently or effectively. This could be due to a variety of factors, but most often, children just "forget" the skills they've learned in the moment. If you feel like your child might struggle to apply the skills they've learned in therapy, you might want to consider alternative approaches that focus on using parental responses that have been proven to reduce child anxiety.
Your child may not have the language skills needed to fully participate in CBT: CBT often involves verbal communication between the therapist and child. If your child does not have the language skills needed to fully participate in therapy, they may not be able to get the most out of the treatment. In these cases, you might want to consider alternative approaches that don't require your child carrying a heavy language load over the course of therapy.
Your child may be refusing therapy or may not be comfortable with the idea of talking about their anxiety: Not all children are comfortable with the idea of therapy. Some don't want to talk about their anxiety. and many children and teens flat our deny that there is a problem or refuse to talk to someone they don't know. This could be due to a variety of factors, such as fear or anxiety about therapy, stigma surrounding seeing a therapist, or a lack of trust in the therapist. If your child is refusing therapy or seems uncomfortable with the idea of talking about their anxiety, CBT may not be the best treatment option.
You tried CBT, but it hasn't solved the problem: While CBT is an effective treatment for childhood anxiety, it may not work for every child, every situation, or for every type of anxiety. If your child has tried CBT but is still struggling with their anxiety, you might want to consider alternative approaches that address underlying issues.
Remember, every child is unique and has different needs and preferences when it comes to their anxiety. While CBT is an evidence-based approach, it may not be the best fit for every child. By exploring alternative approaches, you can help your child find the right treatment that meets their unique needs and promotes their mental health and well-being.
Beyond CBT: How SPACE is Changing the Game for Childhood Anxiety Treatments
CBT and SPACE are both evidence-based approaches to treating childhood anxiety, but they differ in their focus and methodology. While CBT focuses on teaching the child or teen how to identify and change negative thought patterns and behaviors, the SPACE approach focuses on reducing parental accommodation, which refers to the ways in which parents unintentionally reinforce their child's anxiety by giving in to their child's demands, helping their child avoid anxiety-provoking situations, and overprotecting their child. By reducing parental accommodation, children are encouraged to confront their fears and develop resilience, grit, coping skills, and independence, which can help them overcome their anxiety.
Discovering SPACE: The Parent-Led Approach to Reducing Child Anxiety
Supportive Parenting for Anxious Childhood Emotions, (SPACE,) is an innovative and highly effective approach to treating childhood anxiety that focuses on parents as the primary agents of change. Unlike traditional therapies, where the therapist works directly with the child, in SPACE treatment, the therapist works only with the parents. The goal is to teach parents specific strategies for responding to their child's anxiety in a supportive and validating manner, while also encouraging the child to gradually face their fears and develop coping skills.
SPACE is based on the principle that parental support and validation are essential in helping children manage their anxiety. The approach aims to reduce parental accommodation, which refers to the ways in which parents inadvertently reinforce their child's anxiety by providing excessive reassurance or allowing them to avoid anxiety-provoking situations. Through SPACE, parents learn how to provide comfort and support during times of distress without reinforcing the child's anxiety.
One of the key elements of the SPACE approach is the emphasis on supportive parenting that validates a child's feelings while expressing confidence in their ability to cope with anxiety-provoking situations. This is achieved through a number of strategies that help parents better understand their child's anxiety and provide the necessary support to help them develop resilience and coping skills.
The first step in this process is for parents to learn to validate their child's feelings, acknowledging the anxiety they experience without judging or minimizing it. This helps children feel heard and understood, which can reduce their sense of isolation and distress. At the same time, parents are encouraged to express confidence in their child's ability to handle difficult situations, emphasizing that anxiety is a normal part of life that can be managed with the right support and tools.
By combining validation with confidence, parents can create a supportive environment that helps their child feel both safe and empowered. This can help children build resilience, grit, and coping skills, enabling them to face their fears and overcome their anxiety. Additionally, this approach can help foster independence in children as they learn to take charge of their own emotions and develop a sense of control over their anxiety.
SPACE: Does it Work?
The largest SPACE study, to date is the 2019 (Lebowitz, et al.) randomized control trial published in the Journal of American Academy of Child and Adolescent Psychiatry. This study compared the effectiveness of CBT and SPACE in reducing childhood anxiety. The study involved 124 children between the ages of 5 and 12, all of whom had been diagnosed with an anxiety disorder.
Results demonstrated that both CBT and SPACE were effective in reducing symptoms of anxiety, with no significant differences between the two approaches. However, the researchers noted that the SPACE approach was particularly effective in reducing parental accommodation, which is a key element of the treatment. Additionally, the study found that children whose parents received SPACE treatment had lower rates of relapse than those who received CBT.
Further research has been conducted on SPACE for the treatment of:
1. Obsessive-Compulsive Disorder in children (OCD): https://www.spacetreatment.net/_files/ugd/770d1c_de3d8bc4eebb4a76b81c362692224904.pdf
2. Avoidant/Restrictive Food Food Intake Disorder (ARFID): https://www.spacetreatment.net/_files/ugd/770d1c_ec73b0033f384cf8bdafef02e553d9d7.pdf
3. Social Anxiety: https://www.spacetreatment.net/_files/ugd/770d1c_2197b7c7a8be44ad9f94ba1aae6e8ee3.pdf
4. SPACE and CBT: https://www.spacetreatment.net/_files/ugd/770d1c_b35750d30ffc428eb2f9c803855470c9.pdf
Overall, research provides further evidence for the effectiveness of the SPACE approach in treating childhood anxiety. It highlights the importance of addressing parental accommodation as a key component of treatment and suggests that the SPACE approach may be particularly effective in preventing relapse. These findings have important implications for the treatment of childhood anxiety and may help inform the development of future treatment approaches. More importantly, it adds a research-baed treatment model that does not require child/teen participation, thus providing a treatment option for children who cannot or will not participate in traditional CBT, or have tried CBT but are still struggling with anxiety.
If you've enjoyed this article, and would like to learn more about CBT, check out my article "The Science of Anxiety Relief for Kids: What to Expect from CBT"
