Parent vs. Child Therapy: Comparing SPACE and CBT for Childhood Anxiety

When it comes to treating childhood anxiety, parents and mental health professionals now have access to two powerful, evidence-based approaches: SPACE (Supportive Parenting for Anxious Childhood Emotions) and CBT (Cognitive Behavioural Therapy). Understanding these distinct yet complementary methods can help families make informed decisions about their child’s treatment journey.

Understanding the Core Differences

At their foundation, SPACE and CBT tackle childhood anxiety through different pathways. While both aim to reduce anxiety symptoms, their approaches and primary participants differ significantly. SPACE treatment focuses on empowering parents to modify their responses to their child’s anxiety, while CBT works directly with the child to develop coping strategies.

The SPACE Approach

Developed at the Yale Child Study Center, SPACE is a parent-focused intervention that doesn’t require direct child participation. This approach recognizes that parents, with the very best of intentions and often unknowingly, accommodate their child’s anxiety through behaviors like providing excessive reassurance or allowing avoidance of anxiety-triggering situations. While it might seem counterintuitive to increase the anxiety and stress experienced by your child, it is a critical step in building their resilience and accessing their coping to manage anxiety. By working with parents to gradually reduce these accommodations while maintaining supportive responses, SPACE helps children develop greater resilience and independence.  Parents are in a position to effect the most change in the family system, thereby efficiently and expediently targeting child anxiety.

The CBT Approach

CBT takes a more direct route by working with the child to identify and challenge anxious thoughts, develop coping skills, and gradually face feared situations. Through structured sessions, children learn to recognize their thought patterns, manage physical symptoms of anxiety, and build confidence through controlled exposure exercises.

Comparing Effectiveness and Outcomes

Research has shown that both SPACE and CBT demonstrate impressive success rates in treating childhood anxiety. Recent studies indicate that approximately 60% of children no longer meet anxiety disorder criteria after completing either treatment. Here’s what the evidence tells us about their effectiveness:

• SPACE shows particular strength in reducing family accommodation patterns and producing sustainable gains reducing child anxiety
• CBT excels in helping children develop independent coping strategies
• Both approaches significantly reduce parenting stress
• Treatment outcomes are comparable across various anxiety disorders

Choosing the Right Approach for Your Family

When deciding between SPACE and CBT, several factors should be considered. How parents respond to anxiety can significantly impact treatment success. Here are key considerations for each approach:

SPACE May Be Best When:

• You have a school aged child- treating the environment leads to sustainable gains
• The child is resistant to direct therapy
• Parents are highly motivated to modify their behaviour and support their child
• The child is younger or less able to engage in cognitive work
• Family accommodation patterns are strongly present

CBT May Be Preferred When:

• The child is willing to actively participate in therapy- sometime this is a challenge given that the natural urge associate with anxiety is to avoid!
• The child has the cognitive maturity to understand and apply concepts
• Specific skill-building is needed (such as social skills)
• Is willing to engage in direct exposure work- i.e a supported and graded approach to facing fears.

The Role of Parents in Both Approaches

While SPACE and CBT differ in their primary focus, both recognize the crucial role parents play in supporting their child’s recovery. Understanding this role is essential for managing anxiety in various contexts, including school-related concerns.  At FFEW a core value of ours is to work with parent before, or while working with the child to maximize the chances for success.  Children have developing brains and are learning to build their regulation- and without a parent to guide, support, and gently push- your child may have difficulty drawing on CBT strategies in the moment.

Parental Involvement in SPACE

In SPACE therapy, parents are the primary agents of change. They learn to:

• Recognize and reduce accommodation behaviors
• Respond supportively to anxiety without enabling avoidance
• Build confidence in managing anxiety-related situations
• Maintain consistency in their approach

Parental Support in CBT

While CBT works directly with the child, parents play a supporting role by:

• Reinforcing skills learned in therapy
• Supporting homework assignments
• Providing opportunities for exposure practice
• Maintaining consistent responses to anxiety

Implementation and Timeline

Both SPACE and CBT typically follow a structured format over several weeks or months. Understanding the commitment required can help families prepare for the treatment journey:

SPACE Treatment Structure

• Usually consists of 12 weekly parent coaching sessions sessions (or an 8 week Parenting your Anxious Child Group)
• Focuses on parent training and support
• Includes ongoing monitoring of accommodation patterns
• May involve both parents when possible

CBT Treatment Structure

• Typically ranges from 12-16 weekly sessions
• Includes both individual work and parent updates
• Progressive exposure exercises
• Regular skill practice between sessions

Combining Approaches for Maximum Benefit

Recent trends in anxiety treatment suggest that many families may benefit from a combined approach. This integrated method can leverage the strengths of both SPACE and CBT to create a comprehensive treatment plan. Consider how:

• Parents can learn SPACE techniques while their child engages in CBT
• Treatment can begin with one approach and incorporate elements of the other as needed
• Different family members might benefit from different aspects of each approach
• The combination may provide more robust support for complex cases

Making Your Decision

When choosing between SPACE and CBT, consider your family’s unique circumstances:

• Your child’s age and willingness to participate in treatment
• Your family’s schedule and ability to commit to regular sessions
• The specific nature of your child’s anxiety
• Your family’s dynamics and patterns around anxiety

Remember that there’s no one-size-fits-all solution to childhood anxiety. Both SPACE and CBT offer evidence-based paths to recovery, and the best choice is one that aligns with your family’s needs and circumstances. Consider consulting with mental health professionals who can assess your situation and guide you toward the most appropriate treatment approach for your child.