Caregiver-led exposure therapy: evaluating a novel storybook intervention for young children with anxiety
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Citation
Abstract
Recent research has highlighted the importance of developing accessible, low-intensity interventions for child anxiety. Bibliotherapy, which utilizes books and written materials as a form of therapeutic intervention, can increase access to evidence-based treatment approaches at an extremely low cost. The present study employs a brief storybook intervention (The Bravery Book) to guide caregivers and children (ages 4-7) to complete personally-relevant anxiety exposures from home, without therapist support. Participants included forty children (15 males, Mage = 6.1, SD = .97) identified by caregivers as exhibiting elevated symptoms of fear and/or anxiety.Study 1 examined the feasibility and acceptability of the storybook intervention. Results showed that all caregiver-child dyads in the experimental group (n = 20) read the storybook at least once, and a majority continued to utilize it during the 6-week study timeframe. On average, caregivers provided moderate to high ratings on indices of satisfaction with the storybook intervention. Results suggest that caregivers of children with less severe anxiety were more satisfied with the storybook than those with more severe anxiety. Overall, findings support the feasibility and acceptability of the storybook intervention for caregivers and young children with anxiety concerns.
Study 2 evaluated whether the storybook improved children’s and caregivers’ knowledge about anxiety and exposure practices, and increased their preference for exposure-based approaches. Caregivers in the experimental group reported significantly more knowledge about anxiety and exposures by the end of the study relative to the waitlist control group. Overall, caregivers in both groups held favorable views of exposure at the start of the study. Contrary to our hypotheses, caregivers’ attitudes toward exposure and children’s approach- and avoidance-based responses to anxiety case vignettes did not significantly differ by condition.
Study 3 examined whether the storybook intervention resulted in exposure engagement and decreased anxiety-accommodating caregiver behaviors. The storybook intervention resulted in the development of personalized exposure hierarchies and exposure engagement among a majority of dyads in the experimental group. Caregivers’ anxiety-accommodating behaviors significantly decreased as a function of time across both the experimental and waitlist control groups, but contrary to our hypotheses, the effect of condition was not significant.
Though this study was limited by a small sample size, findings suggest that the storybook is an acceptable intervention that holds promise for improving caregivers’ and children’s knowledge about exposures and facilitating exposure engagement.
Description
2024