Overview of the Program
The SPACE Program (Leibowitz and Omer) was created to address an essential area in the treatment of anxiety disorders and obsessive-compulsive disorders among children and adolescents. At the OCD & Anxiety Center we incorporate SPACE into most of our work with children, teens and young adults, and especially when kids, teens, and young adults are resistant to treatment. The idea is that by working soley with parents, a lot of progress and change can be made in reducing their child’s anxiety or OCD. The primary aim of SPACE is to decrease parental accommodations of anxiety that are, although well-intended, likely maintaining or even exacerbating the child’s anxiety. In order to achieve this intended purpose, we guide parents to change their way of interacting with their child’s anxiety by reducing their accommodations of anxiety while concurrently increasing their support of their child. SPACE also involves coaching parents on how to respond to disruptive behavioral responses (which can be associated with a reduction in parental accommodation) and how to minimize escalation of the child’s behavior, while maintaining a supportive stance.
Why Does the SPACE Program Focus on Making Parental Changes?
SPACE conceptualizes child/teen anxiety under the framework of social signaling. In other words, parents are “programmed” to be responsive to their children’s distress, and children are “programmed” to seek out their parents when they feel distressed. Generally, this social signaling system is positive and adaptive. However, in the context of anxiety disorders and obsessive-compulsive disorders, children’s fear responses are overactive or excessive and parental intervention may not be helping the child learn to manage and overcome anxiety in the long-run. Research has repeatedly demonstrated that parental accommodation of anxiety typically has a negative impact on the trajectory of anxiety and obsessive-compulsive disorders in children and teens. Additionally, while the child is usually the identified patient in treatment, research has revealed that parental accommodations dilute the effectiveness of the child-focused treatment process. We find it essential to include parents in the treatment process.
Parental Accommodation Cycle:
The cycle begins with an anxiety reaction being triggered in the child, who then responds by seeking out his/her parents. Parents aim to reduce their child’s distress but may do so in ways that inadvertently accommodate and maintain the anxiety. Examples of parental accommodations include (but are not limited to):
- Doing things for the child that would be developmentally appropriate for him/her to do independently
- Staying within the child’s line of vision so that he/she does not become distressed by parental absence
- Repeatedly answering the same questions (providing reassurance)
- Responding to all phone calls and text messages from the child
- Engaging in safety behaviors, compulsive behaviors, and/or rituals (excessive handwashing, rigid nighttime routines, checking locks, avoiding certain topics of conversation, etc.)
- Taking the child to unnecessary doctor appointments because of health-related anxieties and/or engaging in unnecessary health behaviors, such as repeated temperature taking, reassuring the child that he/she is fine and won’t get sick, allowing the child to stay home from school “in case” they become ill
- Speaking for the child when in public places
- “Helping” the child to avoid his/her anxiety triggers
Over time, the child will become increasingly reliant on his/her parents in order to feel less anxious. This is problematic for many reasons, chief of which is an exacerbation (increase in intensity and frequency) of anxiety. A worsening of anxiety corresponds to greater functional impairments in important life areas, such as home life, academic work and success, positive health behaviors, and making and keeping friends. Such impairment puts a significant strain on the family unit and negatively influences life at home, leading to consequences that may include: an increase in overall familial stress, disruption to family routines, acting out or withdrawing behaviors in siblings, parental disagreements regarding how the anxiety should be handled, etc. To make matters worse, the efforts that parents are exerting to help their child cope with anxiety often maintain and can exacerbate the anxiety, while also hindering the effectiveness of child-focused anxiety treatment.
Although parents are generally aware that anxiety has created notable challenges for their child and has made it difficult for him/her to manage anxiety and function in developmentally appropriate ways, they may feel trapped in the accommodation cycle. Although parents often recognize that the problem is not being resolved by their current ways of responding, they may also feel anxious and/or hopeless about rerouting the accommodation cycle because they “don’t want to make the anxiety worse!” The SPACE Program conceptualizes the reduction of parental accommodations as a means to empower the child to learn to manage anxiety in healthy and adaptive ways. The Program also is intended to remove ineffective parental strategies while establishing supportive parental response styles that facilitate child autonomy.
Enacting Change (Indirectly)
The SPACE Program focuses on parental efforts and how to create positive changes in child anxiety by coaching and guiding parents on how to adjust their responses. Namely, parents are directed on how to reduce the accommodations that they have been providing. Instead of focusing on trying to directly change the child’s experience of anxiety, the targets of change are parents’ behavioral responses to their child’s anxiety. Parents are taught ways to reduce their child’s anxiety in an indirect manner by adjusting the way that they engage when the child is anxious. Keeping in mind the Cycle of Parental Accommodation, the SPACE Program focuses on the second step (“Child seeks out parents and parents accommodate anxiety”) in order to reroute the rest of the cycle. By targeting the second step of the Accommodation Cycle, parents participating in SPACE will no longer enact the same ineffective strategies and the result will be that the remaining steps of the cycle will also change. A helpful metaphor that illustrates this idea is thinking of the parent-child anxiety interaction as a dance. If one partner in a dance sequence (the parents) changes up the dance steps, the other partner (the child) may stumble as they regain their footing, but they will have to adjust their steps because the previous dance steps no longer apply. Thus, when parents take the initiative to change how they respond to their child’s anxiety (i.e. take the lead and change the dance steps), the child’s reactions will also change. Additionally, enacting change in this indirect way can prevent much of the escalation that may arise when parents try to direct their child to cope with anxiety. Furthermore, while it is not uncommon for anxious children to resist or outright refuse to participate in treatment, the SPACE Program does not require their “buy-in” in order to be effective. As long as parents are motivated and committed to participating in SPACE, positive outcomes can still be achieved. Often the anxiety may feel too intense or overwhelming for the child to be willing to challenge it. Parents who participate and invest themselves in the SPACE Program can take the initiative and begin enacting changes to decrease their child’s anxiety and to make headway in adaptive anxiety management.
SPACE Program Components
The SPACE Program focuses on helping parents to increase their methods of providing constructive support to their children, while simultaneously decreasing their accommodations. SPACE conceptualizes parental support as being comprised of acceptance, validation, and confidence, which is summarized in the following equation:
Acceptance and Validation + Confidence = Support
Parents support their children by expressing acceptance of their child’s anxiety, validating their concerns, and providing a vote of confidence that their children can tolerate the anxiety.
In the beginning phases of the SPACE Program, parents chart the accommodations that they are currently providing to their child when he/she is anxious and/or accommodations that they provide preemptively to prevent their child from becoming anxious. Once the current status of accommodations is reviewed, a target problem is chosen, and a plan is developed related to how parents will begin reducing the designated accommodation. The therapist helps the parents plan for and practice how they will inform the child of the changes that they (the parents) will be making. The therapist will also work with parents on how to cope with the variety of reactions that their child may have in response to changes that their parents will be making. Close monitoring of accommodation reduction will ensue. The therapist will provide consistent support and guidance to parents, while assisting them with navigating any setbacks and engaging in collaborative problem-solving related to the implementation of decreased accommodations. This process will then be repeated to address additional accommodations. If children are willing to participate in treatment, they will have opportunities to process their experiences as well as to learn and implement anxiety regulation strategies. The SPACE Program focuses on enacting indirect change, by helping parents take strategic steps back and reduce their accommodations so that their child can take steps forward in managing their anxiety and building their self-confidence to navigate challenging situations.
Need Help or Support?
If you are a parent or a caregiver and are interested in participating in parent training through the SPACE Program, please contact The OCD & Anxiety Center at (630) 522-3124 or email@example.com. We have offices located in Oak Brook and Orland Park, Illinois and Marietta, GA and our clinicians are trained to help parents and caregivers assist their child/teen with effectively managing anxiety disorders, Obsessive-Compulsive Disorders, and other co-occurring mental health conditions.
We provide telehealth services that are available in Illinois, Indiana, Iowa, and Georgia.
At The OCD & Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, work etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you and facilitating your therapeutic journey!
Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL. She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.