We all had our fair share of struggle this past year-plus. But it’s hard to argue that parents of young children had it particularly rough. Workloads doubled, tripled, or quadrupled overnight for parents who suddenly found themselves not “just” parenting and working their regular jobs, but now also acting as stand-in teachers and childcare providers. All without the usual help of family, friends, or neighbors. Talk about stress. The pandemic also saw the rates and severity of childhood anxiety skyrocket. It was heartbreaking to observe the number of families flooding our mental health care system with not enough providers to go around. At our center, call after call from parents describing an uptick in their child’s anxiety symptoms made it clear that for children with anxiety disorders or OCD, COVID was taking an especially brutal toll.

As a specialist in pediatric anxiety and OCD, this crisis called for a response to both the increase in child anxiety and a way to help parents get some relief. Enter SPACE: Supportive Parenting for Anxious Childhood Emotions, or SPACE, is an empirically supported yet still relatively unknown treatment for child and adolescent anxiety disorders and OCD…with a twist. Instead of the child or adolescent coming to sessions, treatment is delivered to and through the parents. With outcomes equally efficacious as CBT and ERP where the child is in the patient’s seat. Pretty cool, right? This standalone treatment, developed by Dr. Eli Lebowitz at the Yale Child Study Center, teaches parents to disrupt unhelpful responses to child symptoms of anxiety and OCD. The data show that 97-99% of parents of children diagnosed with an anxiety disorder or OCD either participate in their child’s symptoms and/or modify family routines in order to accommodate their child’s anxiety. While perfectly natural (and biologically-based), this kind of parent response actually is associated with more negative outcomes for the anxious child—and with a higher burden experienced by the family. Through SPACE treatment, child symptoms of anxiety are reduced, child confidence inability to cope with anxiety is increased, and parents learn how to truly and effectively support their child with anxiety or OCD while ultimately doing less work.

I find the SPACE protocol to be particularly rewarding in my work with families because it combines my experience in treating child anxiety and OCD with my love for working with parents who are doing the best they can but feeling exasperated by parenting an anxious child. I love seeing parents watch their child become better able to cope with anxiety while at the same time becoming more confident in their own anxiety around parenting an anxious child. It is a parallel process with so many payoffs. I also have a particular passion for coaching parents on how to deal with the really messy stuff—like when their child’s anxiety disorder leads to rage, aggression, or violence; when parents get stuck in the good cop / bad cop dynamic, or when parents find their lives totally revolve around their child’s symptoms. SPACE is also a fantastic way to bring relief to anxious kids who, for whatever reason, are not ready for treatment themselves.

During the pandemic, however, with not enough child therapists to go around, I wanted to reach more families, and I also wanted to connect families together. Over the past decade of working with anxious children and their parents, a refrain I’ve heard over and over is how parents of anxious children wish they knew other parents who were going through the same thing. Well-meaning friends and neighbors just don’t get it. Parents need support, and not just from “experts” on parenting, but from other parents who are also in the trenches. What better way to combine the need for child treatment, parent coaching, peer support, and more efficient treatment than getting a group of parents to do SPACE together?

So, with excitement and a healthy dose of uncertainty of my own, I decided to adapt the SPACE protocol to a group format. Since SPACE was not designed to be delivered in a group, I had an opportunity to get creative. I joined an online forum run by Dr. Lebowitz to share my ideas and hear the ideas of other providers who were interested in delivering SPACE this way (there were 3-4 of us nationally who were piloting group-based SPACE treatment). It was also important to me that group members be able to have the option to access more individualized support, so I created a hybrid model of weekly group treatment sessions and additional individual coaching sessions for parents who wanted them (they all did). I carefully curated the group to include parents of children with a primary OCD diagnosis, whose symptoms included aggressive, destructive, or violent behavior. Parents of children with this constellation of symptoms need specialized, compassionate, and non-judgmental coaching on how to manage the most challenging behaviors.

Our amazing group (four parent dyads, plus me) met twice a week for eight weeks, for an hour and a half each time. It was a big commitment—especially during a pandemic when parents had zero time to begin with. Yes, the group met on zoom and yes, there were interruptions to our flow from children, work emergencies, and Wi-Fi connections. Would I have preferred to do the whole thing in person with childcare and time off work for parents? Yep. But just like we all had to do last year, we did the best we could, and at the end of eight weeks, the best we could do ended up being pretty darn great.

Over the course of our eight weeks together, the SPACE group participants learned how childhood anxiety and OCD are different than these disorders in adults, because young mammals (kids) are hard-wired to signal their caregivers when they are in distress, and caregivers (parents) are hard-wired to respond to these signals. So, when a child’s fear response is chronically and inappropriately activated (as in an anxiety disorder or OCD), so is the social signaling and response system. Parents in the group identified and mapped all the changes they made to their own behavior in response to their child’s symptoms (known as family accommodation) and put together plans to target and reduce or eliminate those behaviors. One set of parents went from spending hours each day answering their 8-year-old son’s questions about whether he might get sick, cutting out “dots” on his food he thought were poisonous, and replacing foods, to no longer making any modifications at mealtime or answering any reassurance-seeking questions. Another parent stopped washing her son’s electronics and changing her own clothes every time he feared his things, or her clothing was contaminated by the upstairs bathroom.

I elaborated on the SPACE protocol by devoting two group sessions (3 hours total) to teaching and having parents practice coping skills for when the going got really tough, which helped them feel prepared and supported for any challenging reaction their child may have had to the changes parents were making. This was critical in building parents’ confidence to implement their treatment plans, and it ended up being a wonderful opportunity for parents to teach each other (and me) their own tips and tricks for getting through the hardest moments.

As I had hoped, the modeling that parents provided each other in the group was critical. For example, when it was time to implement the accommodation reduction plans, we had carefully crafted and stress-tested, one parent was anxious about introducing her plan to her child: would her 12-year old with OCD, who also had an autism diagnosis, completely lose it when he realized she would no longer be changing her clothes or washing his things when he was anxious? Would she be able to handle it if he had an epic meltdown or became aggressive? Her anxiety kept her from following through with the plan that week, but at the next group session, she heard the other parents describe their own successes in introducing their plans, and how each of them handled their child’s reactions with the coping skills they had learned. This was just the boost of encouragement this parent needed to take the plunge and roll out her plan. And it was a complete success!

At the end of treatment, I asked parents to fill out feedback forms on how the group went for them. 100% of parent participants reported they strongly agreed that because of their participation in the SPACE group, they gained concrete tools to cope with challenging behaviors from their child; they accommodated fewer of their child’s symptoms; and their child’s symptoms had improved. 70% of parents felt significantly more confident in their child’s ability to handle anxiety/discomfort, and 85% of the participants felt strongly that they were better aligned with their co-parent on how to respond to their child’s OCD. 85% of parents felt strongly that they were better able to identify their own role in their child’s symptoms and were significantly more confident in their own ability to handle anxiety related to their child’s symptoms.

100% of parents stated that having the support of other parents was one of the most helpful aspects of the SPACE group. As one parent remarked, “I just can’t fully articulate how much this group helped me. I didn’t have a lot of these skills, and if I did, it was happenchance I stumbled upon them. I am quite certain I would not have survived the last 8 weeks without SPACE. We went through some really, really dark days/weeks with [our son], and the information/skills/support obtained from this group helped immeasurably. Just knowing there is a group of parents out there going through the same thing was comforting.”

Putting together and running a parent treatment group was a ton of work. It was not always smooth sailing, and there were definitely areas for me to improve on. But seeing how SPACE treatment could not only help anxious kids and their parents but also connect parents together in their journey of recovery, had me sold. I can’t wait to do it all over again.

For more information visit The SPACE Website