Anxiety can be concerning when families notice it in childhood. Anxiety can cause a variety of maladaptive behaviors. Parent-child interaction therapy (PCIT) can offer parents effective tools for responding to anxiety in ways that strengthen connection, increase parental confidence, and empower the child to take small, brave steps. This post discusses how anxiety affects children and parents, how PCIT helps children and parents handle anxiety, and provides PCIT-based tips for helping your child manage anxiety.

What Does Anxiety Look Like in Children?

Kids express anxiety in different ways. People usually think of anxious kids expressing their worries or having trouble separating from their parents. That does happen, but anxiety can also look like other things. I often hear kids say they do not know why they engage in verbal or physical aggression, or they avoid their uncomfortable emotions when they are brought up. Some kids show their anxiety by avoiding unfamiliar situations, refusing to attend school, or becoming upset when routines change. Anxiety can also look like trouble sleeping, emotional outbursts, and difficulty focusing on a task. Children may cling to parents and repeatedly seek reassurance. Some even complain about physical symptoms.

These behaviors can affect the entire family. While some of these anxious behaviors may be overlooked, avoidance patterns can strengthen over time. Children facing anxiety with any of these behavioral symptoms need to build coping skills to foster their emotional growth.

How Parents Accidentally Maintain Anxiety

When a child becomes upset, parents understandably want to protect them from whatever is causing distress. Parents might provide repeated reassurance, allow avoidance of feared situations, or step in quickly to solve problems. This can unintentionally send the message that the child cannot handle difficult feelings on their own.

For example, a child may feel anxious about going to school and complain about a stomachache. The child might even beg to stay home from school. The parent, wanting to reduce their child’s distress, allows the child to stay home, and the child feels relief. Yet this sends the message that school is indeed overwhelming. Next time, the child will want to stay home again, since avoiding it last time worked. Avoidance reduces anxiety in the short-term but makes anxiety stronger over time.

How Can PCIT Help with Anxiety?

As discussed in the previous blog post on PCIT, the skills and process of PCIT can help children feel understood and emotionally connected to their caregivers. Implementing principles of PCIT builds a strong foundation for helping anxious children feel more secure, confident, and capable of handling life’s challenges.

PCIT can give parents effective coaching tools to respond with warmth, consistency, and confidence when the child feels nervous or stuck. PCIT can help parents establish routines, set limits, and communicate expectations in ways that feel predictable and supportive. This consistency can be helpful for children who become anxious when situations feel uncertain.

Furthermore, a special version of PCIT, PCIT-CALM, was developed in 2018 specifically to add anxiety-focused strategies. In PCIT-CALM, parents learn how to support their child in approaching feared situations, encourage brave behavior, and reduce patterns that may accidentally keep anxiety going.

Increasing Confidence Through Praise

What is the opposite of avoiding something because you are anxious? Being brave. This can also mean that you feel anxious but still take the next step! This is one helpful way to think about managing anxiety. Parents naturally want to focus on solving the problem or making the anxiety go away. However, when parents focus primarily on providing solutions, they may miss opportunities to notice and reinforce the child’s own efforts to cope. Praising or acknowledging brave behaviors can help children recognize their own strengths and abilities. Parents can use what they learn in PCIT about noticing and praising desired behaviors and apply it to brave behaviors, effort, persistence, and problem-solving.

 Simply saying specific praises or describing their behaviors can go a long way. Try saying something like, “You looked nervous when I drove you to school, but you still walked through the front doors.” or “You kept trying even when it felt hard.” Over time, this can help children learn they can try new things, handle uncomfortable feelings, and ask for help when needed.

Avoiding Questions and Commands to Teach Independence

Parents can also use PCIT principles to help with anxiety by encouraging children to face difficult, uncomfortable situations instead of immediately avoiding them. As parents, our first instinct is to make the uncomfortable feelings go away. This makes sense! We want to protect our children when they are feeling uncomfortable. But, stepping in can unintentionally tell children, “This is too hard for you to handle. You can’t do this.” Instead of playing a problem-solving role, parents can use PCIT principles to take a coaching role with their anxious child.

During child-directed play, parents learn to avoid using questions or commands. This makes room for the child to learn to lead rather than only doing parent-led activities. It also allows the parent to switch from problem-solver to coach. As children explore and gain independence in a supportive environment, they gain skills for facing things that elicit anxiety. For example, as the parent steps back and shows their child they can do things themselves, the child can gain the confidence and independence to go to school alone. 

How Can PCIT Principles Be Adapted for Adolescents?

While PCIT was originally developed for young children (2-9 years old), its core principles can be applied to anxious adolescents. PCIT teaches parents to gradually step back while remaining emotionally supportive, which can help anxious children and teens alike. Say a teen has a question about one of their classes but feels anxious about approaching the teacher. Instead of the parent sending an email to the teacher, the parent can sit with the teen and provide guidance while the teen writes and sends the email. In this setting, the parent can utilize skills taught in PCIT to encourage independence, praise bravery, avoid rescuing, and celebrate effort.

PCIT and Anxiety: Conclusion

It can feel heartbreaking and overwhelming to help your child manage anxiety. I hope this post offers insight into ways you can help. PCIT teaches parents skills to respond to anxiety with encouragement and confidence. Parents who implement PCIT skills can help their child practice coping with uncomfortable feelings and taking brave steps forward. As you help your child manage their anxiety, you will provide great support to their emotional growth. If you need assistance helping your anxious child or are interested in PCIT, please contact our office.

If you found this post helpful, please share it with a friend! Thank you!

Post written by Dr. Krystal Mendez, Licensed Psychologist with Provisional Status

Please note posts are educational in nature and are not intended to replace psychological services when needed.