When Families Won’t Play Ball: A Case Example of the Effect of Family Accommodation on Anxiety Symptoms and Treatment

Family accommodation is a pervasive problem among families of youth with anxiety disorders that frequently perpetuates anxiety symptoms and oppositional behaviors occurring in response to anxiety. Unfortunately, this problem is addressed all too infrequently in the literature regarding empirically supported treatments for anxiety disorders. The purpose of this report is to present a case of severe family accommodation for a young child with anxiety and oppositional behaviors. This case highlights the detriment of family factors such as accommodation, maternal distress, and anxious modeling as well as provides strategies for adapting an empirically supported treatment protocol (i.e. cognitive-behavioral therapy) to address such family factors. Behavioral and cognitive behavioral techniques, described within, were modified and utilized for treatment of a 6-year-old with significant anxiety symptoms. With adaptations, despite complicating family factors, behavioral treatment was successful in alleviating clinical symptoms of anxiety in a young child. This case exemplar suggests that treatment adaptation can produce successful outcomes in terms of symptom reduction; however, for circumstances in which families are particularly challenging, full remission may not be achieved should family accommodation fail to be eradicated.