Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial

Abigail Dunn, James Alvarez, Amy Arbon, Stephen Bremner, Chloe Elsby-Pearson, Richard Emsley, Christopher Jones, Peter Lawrence, Kathryn J Lester, Mirjana Majdandžić, Natalie Morson, Nicky Perry, Julia Simner, Abigail Thomson, Sam Cartwright-Hatton, Abigail Dunn, James Alvarez, Amy Arbon, Stephen Bremner, Chloe Elsby-Pearson, Richard Emsley, Christopher Jones, Peter Lawrence, Kathryn J Lester, Mirjana Majdandžić, Natalie Morson, Nicky Perry, Julia Simner, Abigail Thomson, Sam Cartwright-Hatton

Abstract

Background: Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks.

Objective: This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms.

Methods: This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors.

Results: Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022.

Conclusions: The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety.

Trial registration: ClinicalTrials.gov NCT04755933; https://ichgcp.net/clinical-trials-registry/NCT04755933.

International registered report identifier (irrid): DERR1-10.2196/40707.

Keywords: RCT; anxiety; child; digital intervention; mental health; mental well-being; online; online intervention; parent; parenting; pediatric; randomized controlled trial; youth.

Conflict of interest statement

Conflicts of Interest: SC-H designed the digital intervention and funded its development.

©Abigail Dunn, James Alvarez, Amy Arbon, Stephen Bremner, Chloe Elsby-Pearson, Richard Emsley, Christopher Jones, Peter Lawrence, Kathryn J Lester, Mirjana Majdandžić, Natalie Morson, Nicky Perry, Julia Simner, Abigail Thomson, Sam Cartwright-Hatton. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 10.11.2022.

Figures

Figure 1
Figure 1
Participant flow through the project. CPBQ: Comprehensive Parenting Behavior Questionnaire; PSC: Pediatric Symptom Checklist; SCARED-A: adult version of the Screen for Child Anxiety Related Disorders; SCAS: Spence Children’s Anxiety Scale; SCAS-P: parent-report version of the Spence Children’s Anxiety Scale; SWEMWBS: Short Warwick Edinburgh Mental Well-being Scale.

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