Abstract
Zusammenfassung. Angststörungen sind im Kindes- und Jugendalter weit verbreitet. Die kognitive Verhaltenstherapie (CBT) hat sich als Intervention der Wahl erwiesen. Neben Psychoedukation, kognitiven Techniken und Expositionsübungen ist auch die therapeutische Arbeit mit den Eltern eine häufig eingesetzte Methode. In der vorliegenden Übersichtsarbeit wird der Frage nachgegangen, ob der Einsatz von Elternarbeit in der Therapie mit ängstlichen Kindern die Effektivität der Intervention steigert. Im Rahmen eines systematischen Reviews wurden 25 Studien identifiziert, die von wenigen Elternsitzungen bis hin zu reinen Elterntrainings ein großes Spektrum der Elternarbeit bei Kindern mit einer Angststörung abdecken. Es zeigt sich, dass die CBT Wartekontrollgruppen hinsichtlich der Remissionsrate der Angststörungen generell überlegen ist. Behandlungsansätze, die neben der kindbezogenen Intervention ein Elterntraining enthalten, erweisen sich nicht wirksamer im Vergleich zu ausschließlich kindbezogenen Interventionen. Mögliche Erklärungen für das Ausbleiben der Wirksamkeitssteigerung und daraus resultierende Konsequenzen werden diskutiert.
Abstract. Anxiety disorders are widespread among children. Separation anxiety, social phobia, and generalized anxiety disorder show overlapping symptoms, which is why interventions often seek to treat all three disorders together. Cognitive behavioral therapy has been proven in various meta-analyses to be the most effective in treating anxiety disorders. Beside psychoeducation, relaxation, cognitive techniques, and exposure, working with parents of affected children is common. However, the methods of working with parents differ widely among interventions. Next to psychoeducation, parents are taught to support exposures themselves and parental anxiety is addressed in several interventions. The present review examines whether working with parents increases the effectiveness of therapeutic interventions for anxiety disorders among children. In a systematic research, 25 studies were found where parents were involved in the treatment of their children, ranging from just a few sessions with the parents to interventions where only the parents were coached. While 13 studies focused on working with children, 12 studies focused on the parents in the therapeutic interventions, aiming to treat children’s anxiety by increasing parental competence in dealing with anxiety. It has been shown that cognitive behavioral therapy is generally superior in regard to remission of anxiety disorders compared with a wait control group. Interventions that include working with the parents are not more effective than interventions focusing solely on the children. Increasing the number of sessions with the parents does not increase the effectiveness of the interventions. This result is surprising because it contradicts the experience gained in therapeutic practice. However, the lack of increase in effectiveness by working with the parents is in conformity with previous studies. The differential effectiveness of specific modules of interventions has not been sufficiently explored. The studies analyzed in this review mostly comprised patients of widely differing age as well as patients with various anxiety disorders. This methodology complicates making a statement on the effectiveness of various modules, since it has been shown that cognitive behavioral therapy has different effects for different anxiety disorders. It is currently under discussion whether additional sessions with parents at the expense of further exposure – proven to be highly effective in the treatment of anxiety disorders – are useful. Despite the results of this review, treatment of anxiety disorders in children without working with parents could not be imagined. Particularly in the case of younger children and specific anxiety disorders, working with parents is necessary. The limitations of this review as well as possible implications for working with parents are discussed.
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