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When Anxiety's All in the Family

News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences

Dr. Ginsberg
"The whole family plays a crucial part in blocking anxiety," says Ginsburg.

Mornings were hard,” says Lynn Hendrix, “and those last September were the worst.”  Lynn’s daughter, Annie, lively and articulate at 12, had often been uneasy at the beginning of a school year. She had friends and was an A student but “had always been a little nervous,” her mother says. Last fall, however, anxiety hovered around the young woman like a cloud of gnats. She worried about her father’s plane trips; she feared her parents wouldn’t return from an evening out. Thoughts of a scout trip to Six Flags made her stomach ache. Sleep wouldn’t come without one parent at the bedside. And then, says Lynn, “going to school became very difficult. Just opening the front door brought tears.” “Anxiety disorders are the most common psychiatric illness in children,” says child psychologist Golda Ginsburg. More than 10 percent of children experience them. But despite their prominence, gaps exist in understanding. “We know, for example, that risk runs in families,” she says, “but the mechanisms aren’t clear.”

And though studies exist on single treatments, combined approaches need scrutiny, as does prevention, the route of choice. “It isn’t unusual for early anxiety to extend into adulthood, coloring every aspect of life,” Ginsberg explains. So she and colleagues in Child and Adolescent Psychiatry have welcomed federally supported projects to shed light on both prevention and therapy. The first, the Child Anxiety Prevention Study (CAPS), combines known tactics to relieve anxiety—cognitive behavioral therapy or relaxation techniques, for example—and exposes children to them before frank illness appears. What’s also novel is that CAPS involves parents.

Children of anxious parents can be seven times more likely to have generalized anxiety disorder, social phobia or separation anxiety disorder, say researchers. Conversely, some 60 percent of kids with diagnosed anxiety have at least one parent with the problem. So parents come alone to the first CAPS teaching session. They’re taught how high criticism or overprotection spark anxiety. And the cognitive behavioral therapy they learn aims to help them and their children.

In subsequent sessions over the year, the whole family meets. “We teach children how to recognize anxious or skewed thoughts, feelings and behaviors—to identify the red flags,” says Ginsburg. They also learn they’re not to blame for their parents’ depression or anxiety. And ways to tame anxiety are passed from therapist to parent to child.

At the one-year follow-up after a 32-family CAPS pilot study, none of the treated children developed anxiety disorders. Parents were highly pleased with results.

And for children like Annie, who have an existing disorder? They can join the nationwide Child Anxiety Multi-modal Study. CAMS variously compares a placebo, psychotherapy, Zoloft or a combination of the latter two. Though on placebo, Annie later received the high-quality combined treatment at the study’s end. Says her mother: “I’m very emotional about this program. It’s changed our lives. And Annie has a path, a vision that’ll carry her through life.” 

For more information about this research, call 410-955-1544

Details were changed for patient privacy.

Find other Hopkins Newsletter articles from past issues.