CBT Aids Parents and Children in Managing Food Allergy Anxiety

A recent study from the United Kingdom assessed the acceptability, feasibility and efficacy of online cognitive behavioral therapy (CBT) for parents with anxiety disorders.

The study focused specifically on the parents of children with food allergies, the risk factor of anxiety that can develop in their children, and how it can affect the quality of life (QoL) of them and their caregivers.

The team of investigators lead by Dr. Stefanie C. Vreeken-Ross, noted that the study existed in a field with limited evidence on the subject. Additionally, the short-term, small-scale nature of the study provided some limitations.

Nevertheless, the team observed a 2-session online intervention which focused on psychoeducation, managing early signs of anxiety, parenting skills. The sessions were 4 hours in total.

The study was comprised 39 parents, all of whom were female and had children with FA. The children’s ages ranged from 2-16 years old while the parents aged ranged from 28-50 years old. Over half of all parent participants had anxiety levels that were considered “normal.”

Additionally, 67% of patient participants had depression based on the subscales of the Depression, Anxiety and Stress Scale - 21 Items (DASS21)

Recruitment of parents and children was aided through opportunistic sampling via the Anaphylaxis Campaign.

Parental confidence and parent-reported child QoL (PedsQL) and anxiety were recorded for the study, as well as FA self-efficacy (FASE-P). Most of the children (32%) were reported as having allergies to 6 or more food groups.

Friedman’s Test was utilized for analysis of any data that did not meet parametric assumptions, and significant results were followed up using Wilcoxon tests.

Despite some limitations, the remote CBT-based parent group intervention proved to be effective in collecting usable data. Additionally, an overwhelming number of participants considered it to be helpful (97%), enjoyable (100%), and informative (100%).

While there were no significant changes regarding parental stress and depression measures, a reduction of parental anxiety scores was recorded, as well as parental self-efficacy regarding FA management.

The investigators attributed this change to the structure of the CBT-based intervention.

“These findings could be explained by the nature of the intervention, which was mostly focused on anxiety management in relation to fears, worries, and unnecessary restrictions around navigating their child’s FA,” the investigators wrote. “Only a few intervention elements attended to overall parental stress and wellbeing, and there was no content aimed at mitigating depression or low mood.”

Parent-rated child outcome measures did not change substantially in the context of the entire group. Rather, certain trends were noted by Vreeken-Ross and her colleagues when they studied specific age groups.

Short-lived improvements in QoL were recorded in children 8-12 years old. Additionally, children 6.5-16 years old saw a decrease in anxiety, which the team hoped was more sustainable.

The investigators noted that the parent-driven interventions could have an impact on observable effects on child outcomes.

While successful, the study was smaller and had additional limitations such as a lack of a control condition and the nature of self-reported FA diagnosis. Despite this, the team recommended CBT intervention be used in further studies regarding parents with children with FA.

They also believed further study on the subject was warranted.

“Future research should attempt to replicate using a similar intervention protocol with a larger sample size and a control group, creating an appropriately powered

randomized controlled trial design with stratification of duration of child’s FA diagnosis (clinician-verified) and mental health difficulties as both may affect coping strategies,” the team wrote. “Given the accessibility and potential cost-savings of this type of intervention, a definitive trial should also include a health economic analysis.”

The study, “Feasibility of an online CBT group intervention for parents of children with food allergy,” was published online in Clinical and Experimental Allergy.