Family Accommodation of Anxiety

We often think of accommodations as services that schools or workplaces provide to individuals with disabilities. But clinical psychologists also use the term to refer to behaviors that family members of a child with anxiety engage in to reduce the child’s distress, by (for instance) taking away demands, providing excessive reassurance, or modifying family activities. Imagine a child who has a phobia of dogs. The family may stop visiting a neighbor who has dogs, or avoid staying at a hotel that’s pet-friendly, just to prevent the child from becoming upset. If the child has a responsibility that puts them in an anxiety-prone situation, like needing to take out the trash and put trash cans near the yard of a neighbor with a barking dog, the parent may do the child’s chore for them. In the short run these accommodations “work” (they reduce the child’s distress), but they also restrict the family’s life, and in the long run they actually communicate to the child that their fears are rational and justified—not the message that we want to send. Even when a child with an anxiety disorder begins evidence-based psychotherapy, family accommodation can prevent the therapy from working. Effective treatment for child anxiety should therefore include making sure that the child’s family isn’t accommodating the anxiety and accidentally reinforcing it. One evidence-based therapy for anxiety, SPACE—developed by Dr. Eli Lebowitz of Yale University—is structured around stopping family accommodation. In fact, children don’t even need to participate directly in the therapy, and research has repeatedly found the therapy to be effective.