The relationships between parent psychological distress, distress intolerance, and family accommodation in the context of child anxiety: a narrative review and empirical study

Anxiety disorders are the most common psychiatric mental problems of childhood. Research shows that psychopathology in parents is associated with the development, maintenance, and exacerbation of childhood anxiety disorders. Similarly, as a nascent focus of research in child anxiety, increasing studies identify family accommodation to be linked to increased anxiety symptoms in children. To date, literature has largely focused on the associations of parent psychopathology and family accommodation with child anxiety separately, with minimal empirical investigation into how these two important constructs are related. This thesis aimed to extend current knowledge about the relationships between parent psychopathology, such as psychological distress and distress intolerance, and family accommodation in the context of child anxiety. A narrative review of parent distress and distress intolerance research identified that parents who have difficulty tolerating distress, especially distress elicited by children’s distress, are more likely to be associated with dysfunctional parenting discipline and poorer emotional outcomes in children. To explore the relationships between parent distress, distress intolerance, and family accommodation, an online study was undertaken with parents of clinically anxious and non-anxious children according to the DSM-V diagnostic criteria for an anxiety disorder. Parents were split into high and low distress groups. Results found that parents with higher distress levels were more likely to have children who met criteria for an anxiety disorder, more severe child anxiety symptoms, and engaged in greater frequency of accommodation behaviour compared to parents with lower distress levels. Parent intolerance of child distress significantly predicted accommodation frequency assessed via a clinician-administered tool, while parent intolerance of general distress did not. Results are discussed with respect to previous research and limitations are noted. Additional research is required to examine the differential impacts general distress intolerance and child-specific distress intolerance have on family accommodation.