Date of Award

2023

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Camilo Ortiz, Ph.D.

Second Advisor

Jill Rathus, Ph.D.

Third Advisor

Hilary Vidair, Ph.D.

Abstract

Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge 2021; Parodi et al., 2021). Exposure-based cognitive-behavioral therapy is considered the gold standard in the treatment of anxious children (Hofmann et al., 2012). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child and adolescent anxiety that draws on research in child development (e.g. Daddis, 2011) and is considerably simpler to administer than traditional exposure-based approaches. This new approach is composed of independence activities (IAs), which are defined as child-directed, fun, unstructured, developmentally challenging tasks that are performed without any help from parents. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy, which is topographically similar to anxiety-causing stimuli. Despite this dissimilarity, IAs target the hypothesized mechanisms involved in the development and maintenance of child anxiety (e.g. parental accommodation and overinvolvement, child avoidance, and unhelpful thinking styles). IAs also target decreasing rates of child independence from parents, which may in and of itself be an important mechanism in the development of child anxiety (Skenazy, 2021). It was hypothesized that treating child anxiety in this way, without requiring exposure exercises, would result in high treatment acceptability from children and parents. This study employed a nonconcurrent multiple baseline design to examine independence activities as an intervention for child anxiety and independence as a mechanism of child anxiety. Small to large improvements in child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, measures of child anxiety and avoidance, parent (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness were observed. Results have valuable theoretical implications for our understanding of the role that parental overinvolvement plays in child anxiety.

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