SPACE – Supportive Parenting for Anxious Childhood Emotions by Eli Lebowitz, PhD
Brief Description
Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment for childhood and adolescent OCD, anxiety, and related conditions. Parents play an active role in reducing accommodation behaviors without requiring the child to participate in therapy sessions. It is particularly helpful for children who are unable to engage in traditional treatments like exposure and response prevention (ERP). SPACE may also be a good option for families who have tried other therapies but are still dealing with significant symptoms.
Although children are the “patients” in SPACE, only parents attend the treatment sessions — no demands at all are placed on the child. Treatment focuses on helping parents make two main changes in the way they respond to their child’s symptoms: (a) how to be more supportive and (b) how to be less accommodating (accommodation refers to the ways parents change their behavior to help their child avoid or alleviate the distress caused by their symptoms).
Treatment generally begins with 1–2 sessions focused on introducing the principles and main ideas of SPACE. Then, parents learn about supportive responses to a child’s distress: responses that communicate both acceptance of the child’s distress and confidence in the child’s ability to tolerate distress. Parents learn to use supportive statements when their child is anxious, and they start practicing using these statements between sessions.
Next, the therapist helps parents identify patterns of accommodation that maintain OCD and anxiety over time. Parents are taught to choose specific accommodation behaviors to practice reducing, and to develop detailed plans for how they will change their behavior and tell their child about these plans. SPACE also includes tools for helping parents cope with potentially difficult child reactions to the steps parents are taking.
A typical course of SPACE lasts approximately 12 sessions, but can be adjusted based on individual needs. The treatment protocol follows a manual, but is tailored to the particular child and their parents. SPACE is delivered both in individual and group formats and can be done both in person and over teletherapy (e.g., Zoom). Self-help resources can complement the treatment process.
SPACE is generally administered by licensed mental health professionals such as psychologists, social workers, and counselors who have trained in the treatment method. To find a provider with training in SPACE visit https://www.spacetreatment.net/space-providers. It is always important to verify the provider’s credentials and experience.
WHY/HOW IT WORKS
SPACE works by reducing accommodation of the child’s or adolescent’s symptoms and communicating messages of support that convey acceptance of their distress as well as confidence in their ability to cope. Accommodation is natural, and almost all parents of anxious children accommodate their child, but research shows that accommodation actually leads to more anxiety, more impairment, and poorer functioning. By reducing their accommodation, parents allow their child to improve their ability to regulate their anxiety, and to become less avoidant and more confident. Children also become less dependent on their parent(s) for managing OCD symptoms.
SUMMARY OF RESEARCH SUPPORT
Clinical trials support the efficacy of SPACE and indicate that it can be as effective as working directly with a child in therapy. Because SPACE is a relatively new treatment, the number of trials testing SPACE is smaller than the number of trials testing some other treatments, such as cognitive behavioral therapy (exposure and response prevention) or medications. But multiple randomized controlled trials, as well as several open trials, indicate that SPACE is highly effective. Research has included patients with OCD as well as other anxiety problems.
AGE CONSIDERATIONS
SPACE can be effective from the pre-school age and through the school-age years.
OTHER IMPORTANT CONSIDERATIONS
As with all treatments, SPACE may not be optimal or effective for everyone. Research to identify characteristics of patients who respond best to SPACE is ongoing. One important consideration is the work that parents put into the treatment. Because the child is not attending the therapy sessions, it is critical that parents implement the tools and strategies they learn in between sessions.
WHEN TO TRY THIS TREATMENT
SPACE can be useful to any child or adolescent who is coping with anxiety or OCD. Deciding whether to try SPACE or another treatment can be a joint and collaborative decision between the child, the parents, and the therapist. Because the child is not required to attend treatment sessions or to do the “work” of therapy, SPACE can be particularly useful when a child is not motivated to participate in therapy or cannot participate for another reason. If a child has tried other treatments, such as ERP, and still has significant symptoms, it may also make sense to try SPACE. Parents who are struggling with high levels of accommodation may also want to try SPACE. Learn more about SPACE.