Play-and-humor-infused exposure therapy for children with Williams syndrome: Examining the impact on parents

Abstract

There is a high prevalence of anxiety disorders among individuals with Williams syndrome, with specific phobias being very common (37-56%; Pitts et al., 2016). Child anxiety has been shown to be affected by parents and also have an effect on parents. As parents play a vital role in their children’s development, a better understanding of the bi-directional nature of parent and child anxiety could lead to improvements in targeting child anxiety and both child and parent well-being. This study examined whether parents experience indirect effects of their family’s participation in a play- and humor- infused gradual exposure therapy targeting child specific phobias. Participants were parents of five children with Williams syndrome, aged 4- to 9-years old, who experienced strong emotional responses to specific stimuli and participated in a play-and humor-infused gradual exposure therapy intervention. Parents reported on their own behaviors of avoidance and feelings of distress before and after the therapy. Following the completion of all therapy sessions, they additionally participated in an interview exploring their experience and perspectives. Findings from the quantitative data that was able to be analyzed were mixed. Overall, pre-post data showed that all parents reported less distress following the intervention, with four out of five maintaining this reduction at the 3-month follow-up. Regarding avoidance, two parents indicated that they did not engage in avoidance of their child’s feared stimuli at pre-intervention leaving no room for calculable improvement, two parents experienced improvement in avoidance at both timepoints, and the remaining parent experienced an increase in avoidance post-intervention. The weekly data offered mixed but encouraging findings, sometimes, but not always, capturing improvement. Analysis of weekly data showed reductions in avoidance and/or distress related to the primary targeted fears for three of the five families. Analysis of qualitative data revealed themes of parents feeling hopeful and empowered, parents approaching their child’s fears and anxiety differently, and parents experiencing shifts in their parenting style. A discussion of the study's strengths and limitations is included, as well as the implications of the findings and possible future directions.