Supportive Parenting for Anxious Childhood Emotions (SPACE) Therapy Method

Abstract

Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-focused therapeutic approach designed to address anxiety symptoms in school-aged children and adolescents. Developed by Dr. Eli Lebowitz at the Yale Child Study Center, SPACE targets the dynamics of the parent-child relationship influenced by anxiety, aiming to enhance parental support and reduce children's reliance on maladaptive behaviors. The therapy emphasizes modifying parental responses to anxious behaviors and gradually diminishing habitual avoidance patterns in children, fostering their ability to self-regulate emotions. Conducted over 10-12 weeks, SPACE involves only parents in sessions, making it particularly suitable for children reluctant to participate in therapy. The process is semi-structured, comprising eight core stages—ranging from introducing the therapy and identifying adaptive parental behaviors to implementing behavior change plans and concluding with a summary of progress—alongside five optional session modules tailored to specific needs, such as teaching anxiety regulation strategies or addressing severe behaviors like self-harm. Grounded in nonviolent resistance principles, SPACE empowers parents to alter their own behaviors rather than directly controlling the child’s actions, promoting sustainable change. International research, including randomized controlled trials and case studies, supports SPACE’s efficacy in reducing anxiety symptoms, with comparable outcomes to Cognitive Behavioral Therapy (CBT) and notable effectiveness for conditions likeanxiety disorders, obsessive-compulsive disorder, autism spectrum disorder, and eating disorders.

Keywords

• childhood
• anxiety disorder
• obsessive compulsive disorder
• parent-based intervention

Kaygılı Çocukluk Duyguları İçin Destekleyici Ebeveynlik (KÇDDE) Terapi Yöntemi

Abstract

Kaygılı Çocukluk Duyguları için Destekleyici Ebeveynlik (KÇDDE), okul çağındaki çocuklar ve ergenlerde anksiyete semptomlarını ele almak için tasarlanmış ebeveyn odaklı bir terapi yaklaşımıdır. Yale Çocuk Çalışma Merkezi’nde Dr. Eli Lebowitz tarafından geliştirilen KÇDDE, anksiyeteden etkilenen ebeveyn-çocuk ilişkisinin dinamiklerini hedefleyerek ebeveynlerin çocuklarına daha iyi destek sağlamasını amaçlar. Terapi, ebeveynlerin kaygılı davranışlara tepkilerini değiştirmeye ve çocukların alışılagelmiş kaçınma kalıplarını kademeli olarak azaltmaya odaklanarak çocukların duygularını kendi kendilerine düzenleme yeteneklerini geliştirmeyi teşvik eder. 10-12 hafta süren KÇDDE, yalnızca ebeveynlerin katıldığı oturumlarla yürütülür ve bu da özellikle terapiye katılmakta isteksiz çocuklar için uygun bir seçenek sunar. Süreç yarı yapılandırılmıştır ve sekiz temel aşamadan oluşur: terapinin tanıtılmasından, ebeveynlerin uyarlayıcı davranışlarının belirlenmesine, davranış değiştirme planlarının uygulanmasına ve ilerlemenin özetlenmesiyle sonuçlanmaya kadar. Ayrıca, anksiyete düzenleme stratejileri öğretme veya kendine zarar verme gibi ciddi davranışları ele alma gibi özel ihtiyaçlara göre uyarlanmış beş isteğe bağlı oturum modülü içerir. Şiddetsiz direnç ilkelerine dayanan KÇDDE, ebeveynlerin çocuğun eylemlerini doğrudan kontrol etmek yerine kendi davranışlarını değiştirmelerini güçlendirerek sürdürülebilir değişimi teşvik eder. Uluslararası araştırmalar, randomize kontrollü çalışmalar ve vaka çalışmaları dahil, KÇDDE’nin anksiyete semptomlarını azaltmada etkili olduğunu desteklemekte olup Bilişsel Davranışçı Terapi (BDT) ile karşılaştırılabilir sonuçlar sunmakta ve anksiyete bozukluğu, obsesif-kompulsif bozukluk, otizm spektrum bozukluğu ve yeme bozuklukları gibi durumlarda dikkat çekici etkinlik göstermektedir.

Keywords

• çocukluk çağı
• anksiyete bozukluğu
• obsesif kompulsif bozukluk
• ebeveyn temelli müdahale

References

1. Albano AM, Kendall PC (2002) Cognitive behavioural therapy for children and adolescents with anxiety disorders: Clinical research advances. Int Rev Psychiatry, 14:129-134.
2. APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Washington, DC, American Psychiatric Association.
3. Berger U, Silverman WK, Lebowitz ER (2024) Preliminary randomized controlled trial of the supportive parenting for anxious childhood emotions intervention for highly dependent adult children. Emerg Adulthood, 12:807-819.
4. Binbay T, Direk N, Aker T, Akvardar Y, Alptekin K, Cimilli C et al. (2014) Türkiye’de psikiyatrik epidemiyoloji: yakın zamanlı araştırmalarda temel bulgular ve gelecek için öneriler. Turk Psikiyatri Derg, 25:264-81.
5. Bittner A, Egger HL, Erkanli A, Jane Costello E, Foley DL, Angold A (2007) What do childhood anxiety disorders predict?. J Child Psychol Psychiatry, 48:1174-1183.
6. Chase RM, Eyberg SM (2008) Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms. J Anxiety Disord, 22:273-282.
7. Chronis AM, Lahey BB, Pelham Jr WE, Williams SH, Baumann BL, Kipp H et al. (2007) Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder. Dev Psychol, 43:70-82.
8. Cobham VE, Dadds MR, Spence SH, McDermott B (2010) Parental anxiety in the treatment of childhood anxiety: A different story three years later. J Clin Child Adolesc Psychol, 39:410-420.

9. Cobham VE, Filus A, Sanders MR (2017) Working with parents to treat anxiety-disordered children: A proof of concept RCT evaluating Fear-less Triple P. Behav Res Ther, 95:128-138.
10. Comer JS, Furr JM, Del Busto C, Silva K, Hong N, Poznanski B, et al. (2021) Therapist-led, internet-delivered treatment for early child social anxiety: A waitlist-controlled evaluation of the iCALM telehealth program. Behav Ther, 52:171-1187.
11. Costello EJ, Egger HL, Angold A (2004) Developmental epidemiology of anxiety disorders. In Phobic and anxiety disorders in children and adolescents: A clinician's guide to effective psychosocial and pharmacological interventions (Eds TH Ollendick, JS March): 61–91. New York, Oxford University Press.
12. Erözkan A (2012) Ergenlerde kaygı duyarlığı ve ebeveyn tutumları arasındaki ilişkinin incelenmesi. Educational Sciences Theory and Practice, 12:43-57.
13. Genç M, Tolan Ö (2021) Okul öncesi dönemde sık görülen psikolojik ve gelişimsel bozukluklarda oyun terapisi uygulamaları. Psikiyatride Güncel Yaklaşımlar, 13:207-231.
14. Ghodrat MS, Aghebati A, Asgharnejad Farid AA, Shirazi E (2022) Comparison of the effectiveness of online supportive parenting intervention (SPACE) and timid to tiger program (FTTT) on childhood anxiety disorders and family accommodation with samples of Iranian parents. Front Psychol, 13:1001705.
15. Grills-Taquechel A, Ollendick TH (2007) Introduction to special issue: Developments in the etiology and psychosocial treatments of anxiety disorders in children and adolescents. Clin Child Fam Psychol Rev, 10:197-198.
16. Havighurst SS, Duncombe M, Frankling E, Holland K, Kehoe C, Stargatt R (2015) An emotion-focused early intervention for children with emerging conduct problems. J Abnorm Child Psychol, 43:749-760.
17. Hovens JG, Giltay EJ, Wiersma JE, Spinhoven P, Penninx BW, Zitman FG (2012) Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatr Scand, 126:198-207.
18. Jalali M, Pourahmadi Esfastani E (2024) Effectiveness of from timid to tiger program on clinical symptoms of children with separation anxiety disorder and family accomadation of their parents. Clinical Psychology and Personality, 22(2):1-16.
19. Jokela M, Ferrie J, Kivimäki M (2009) Childhood problem behaviors and death by midlife: the British National Child Development Study. J Am Acad Child Adolesc Psychiatry, 48: 19-24.
20. Kessler RC, Ruscio AM, Shear K, Wittchen HU (2010) Epidemiology of anxiety disorders. In Behavioral Neurobiology of Anxiety and Its Treatment, 2nd. (Eds MB Stein, T Steckler):21-35. Berlin, Springer.
21. Kowalchuk, A, Gonzalez SJ, Zoorob RJ (2022) Anxiety disorders in children and adolescents. Am Fam Physician, 106:657-664.
22. Köse, B. (2021) Üniversite öğrencilerinde anksiyete düzeyleri ile bağlanma stilleri arasındaki ilişkinin incelenmesi (Uzmanlık tezi). İstanbul, Gelişim Üniversitesi.
23. Küçük F, Eryılmaz SE, Özdemir S (2024) Relationship between post-traumatic stress reactions SSRN, doi: 10.2139/ssrn.4981656.
24. Lebowitz ER (2013) Parent-based treatment for childhood and adolescent OCD. J Obsessive Compuls Relat Disord, 2:425-431.
25. Lebowitz ER, Ome, H (2013) Treating Childhood and Adolescent Anxiety: A Guide For Caregivers. Hoboken, NJ, Wiley.
26. Lebowitz ER, Omer H, Hermes H, Scahill L (2014) Parent training for childhood anxiety disorders: The SPACE program. Cogn Behav Pract, 21:456-469.
27. Lebowitz ER, Shimshoni Y (2018) The SPACE program, a parent-based treatment for childhood and adolescent OCD: The case of Jasmine. Bull Menninger Clin, 82:266-287.
28. Lebowitz ER, Majdick JM (2020) SPACE, parent-based treatment for childhood and adolescent anxiety: Clinical case illustration. J Cogn Psychother, 34:107-118.
29. Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK (2020) Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of supportive parenting for anxious childhood emotions. J Am Acad Child Adolesc Psychiatry, 59:362-372.
30. Lebowitz ER, Zilcha‐Mano S, Orbach M, Shimshoni Y, Silverman WK (2021) Moderators of response to child‐based and parent‐based child anxiety treatment: A machine learning‐based analysis. J Child Psychol Psychiatry, 62:1175-1182.
31. Lee EB, Goodman WK, Schneider SC, Storch EA (2020) Parent-led behavioral intervention for a treatment-refusing adult with obsessive-compulsive disorder with poor insight and extreme family accommodation. J Psychiatr Pract, 26:149-152.
32. Lin Y, Chen Z, He M, Zhou W, Wang L, Guo H, et al. (2024) The relationship between anxiety and depression in adolescent depression patients: the mediating effect of hope level and coping modes. Heliyon, 10:3546.
33. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al. (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry, 49:980-989.
34. Musella KE, DiFonte MC, Michel R, Stamates A, Flannery-Schroeder E (2025) Emotion regulation as a mediator in the relationship between childhood maltreatment and symptoms of social anxiety among college students. J Am Coll Health, 73:2643-2650..
35. Naseh M, Zeng Y, Ahn E, Cohen F, Rfat M (2024) Mental health implications of family separation as the result of migration policies in the United States: A systematic review. Soc Sci Med, 352:116995.
36. Özkaya BT (2015) Ebeveyn-çocuk ilişkisi üzerine odaklanan bir oyun terapisi yaklaşımı: Filial terapi. Psikiyatride Güncel Yaklaşımlar, 7:208-220.
37. Pegg S, Hill K, Argiros A, Olatunji BO, Kujawa A (2022) Cognitive Behavioral therapy for anxiety disorders in youth: efficacy, moderators, and new advances in predicting outcomes. Curr Psychiatry Rep, 24:853-859.
38. Puliafico AC, Comer JS, Pincus DB (2012) Adapting parent-child interaction therapy to treat anxiety disorders in young children. Child Adolesc Psychiatr Clin N Am, 21:607-619.
39. Raila HE, Julian MM, Lebowitz ER, Silverman WK (2021) Separating from the mothership: A coordinated individual and parent-based approach to severe agoraphobia in a young adult. Cogn Behav Pract, 28:422-434.
40. Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J (2025) A pilot trial of SPACE (Supportive parenting for anxious childhood emotions) in autism. Child Psychiatry Hum Dev, 56:249-263..
41. Seçer İ (2014) Ergenlerde obsesif kompulsif bozukluk ile anksiyete duyarlılığı arasındaki ilişkinin yapısal eşitlik modeli ile incelenmesi. Eğitim ve Bilim, 39:369-382.
42. Shimshoni Y, Silverman WK, Lebowitz ER (2020) SPACE‐ARFID: A pilot trial of a novel parent‐based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord, 53:1623-1635.
43. Storch EA, Guzick AG, Ayton DM, Palo AD, Kook M, Candelari AE et al. (2024) Randomized trial comparing standard versus light intensity parent training for anxious youth. Behav Res Ther, 173:104451.
44. Swan AJ, Kendall PC (2016) Fear and missing out: Youth anxiety and functional outcomes. Clin Psychol (New York), 23:417-435.
45. Sylvester CM, Pine DS (2021) Pediatric anxiety disorders: ınsights from basic neuroscience, development, and clinical research. Biol Psychiatry, 89:638-640.
46. Şanli ME, Çiçek İ, Yıldırım M, Çeri V (2024) Positive childhood experiences as predictors of anxiety and depression in a large sample from Turkey. Acta Psychol, 243:104170.
47. Taj T, Mulukuri NS, Raj B (2024) Impact on physical and mental health of sexually abused children. In Child Sexual Abuse: A Public Health Problem in India (Eds. A Shaik, SL Thota, LR Atmakuri):135-143. Singapore, Springer Nature.
48. Wong AH, Aslanidou A, Malbec M, Pittig A, Wieser MJ, Andreatta M (2023) A systematic review of the inter-individual differences in avoidance learning. Collabra Psychol, 9:77856.
49. Wood JJ, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M (2006) Family cognitive behavioral therapy for child anxiety disorders. J Am Acad Child Adolesc Psychiatry, 45:314-321.
50. Wu YL, Zhao X, Li YF, Ding XX, Yang HY, Bi P et al. (2016) The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children. Psychiatry Res, 240:103-109.