Treatments that Work: Mastery of Anxiety and Panic
for Adolescents: Parental Involvement

Anxiety and panic often first appears in adolescence, making effective treatment while still young imperative. The Treatments That Work series explains the most effective interventions for a particular problem in user-friendly language.  In Mastery of Anxiety and Panic for Adolescents, Riding The Wave: Therapist Guide, by Donna B. Pincus, Jill T. Ehrenreich and Sara G. Mattis, the aim is to help adolescents with panic disorder and agoraphobia.  In the excerpt below the authors focus on the importance of parental involvement in effective treatment.

Research on the importance of including parents in child and adolescent anxiety treatment has grown substantially during the past decade.  Numerous studies indicate that children and adolescents have the most significant and lasting gains in anxiety treatment when parents are involved.  Recent systemic research has suggested that incorporating parents more centrally into the treatment of children and adolescents with anxiety disorders may enhance treatment effectiveness and maintenance (Ginsburg, Silverman, & Kurtines, 19915; adds, Heard, & Rapee, 1992).  Ollendick and King (1998) highlight the need for intensive parental involvement when treating children with fears and anxiety.  They suggest that parents might be regarded as co-therapists, responsible for the implementation of procedures developed by the therapist and for giving children or adolescents ample praise and positive reinforcement for brave behavior.  Although this may seem common-sense, a review of the literature reveals that involving parents directly in the treatment process has been the exception rather than the rule (Braswell, 1991)…Since the parent is one of the most significant persons in an adolescent’s life, and an adolescent’s avoidance of activities often causes considerable disruption in most families, the inclusion of parents in the active treatment process should yield greater clinical benefit…

General Tips for Parental Involvement

As an adolescent is learning new concepts and tools for dealing with his panic attacks, it is very helpful to have parents on the “same page” as their child.  This can be accomplished by teaching both the adolescent and his parents a “common language” regarding the most appropriate tools to use during a panic attack.  For example, during a panic attack, a parent might suggest that the adolescent “restructure his maladaptive panic thoughts” or “notice the triggers of panic attacks” and “not avoid the feelings.”  While it is important for an adolescent to know how to cope most effectively with a panic attack, it is also crucial that parents also understand how to help most effectively.  Thus, including parents in a portion of treatment sessions ensures that they will be able to help reinforce concepts that the adolescent learned in therapy.

Many parents of adolescents with panic disorder (PD) are worried that their child might be in significant distress during a panic attack, and may inadvertently reinforce the child’s avoidance of places or situations that might trigger panic.  It is important that parents are educated about the nature of anxiety and panic, the fact that anxiety won’t hurt or harm their child, and the importance of nonavoidance of physical sensations and of situations that might trigger panic attacks.  Although parents are typically given handouts and reading materials regarding the nature of anxiety and panic, it is also helpful to have parents join part of the session, to teach these importance concepts in person.

A common fear of parents of adolescents with panic is whether getting rid of their adolescent’s PD will make them feel “less close” to their child.  Parents state that, unlike many adolescents who are trying to separate from their parents, their teenager tries to “stay close” to them out of fear of getting a panic attack and having to deal with it alone.  This often makes parents feel a sense of importance and emotional closeness to their teenager.  When attempting to treat PD, it is important to discuss with the adolescent and his parents other way that they might maintain a close relationship if panic attacks were no longer occurring.

Although parents can be involved in treatment in many ways, it is important to first discuss the plan with the adolescent and parent(s), so that both parties are comfortable and aware of the plan.  In addition, the inclusion of parents at the end of sessions does not mean that they must be informed about everything the adolescent talked about in therapy; only the important treatment concepts need to be conveyed.