Children of parents who experience significant anxiety are themselves at increased risk of developing anxiety problems, reflecting a complex combination of inherited vulnerability and environmental influences, including the ways children learn about threat, avoidance, uncertainty, and coping within everyday family life. This raises an important question: rather than waiting for children to develop an anxiety disorder and then treating them, could we intervene earlier by supporting anxious parents to create experiences that foster confidence and reduce avoidant patterns? Dunn et al. (2024) tested this idea in a large randomised controlled trial involving 1,811 highly anxious parents of children aged 2–11 years. Parents were allocated either to a completely self-guided online parenting intervention or to a no-intervention control condition. The programme translated an earlier face-to-face preventive intervention into brief online modules that could be completed without therapist support. Six months later, children whose parents had access to the intervention showed modestly lower parent-reported anxiety than those in the control condition. Parents themselves also reported reduced anxiety, and effects on child anxiety remained similar at later follow-up. The effect was small, but the trial suggests that a very low-intensity parenting intervention can influence child anxiety through parent interventions.
Why focus on anxious parents?
Anxiety tends to cluster within families. This does not mean that anxious parents inevitably raise anxious children, nor that parenting “causes” childhood anxiety. Murray, Creswell, and Cooper (2009) describe the development of child anxiety as resulting from interactions between biological vulnerability, temperament, environmental experiences, information about threat, and parental influences. Parents are therefore one part of a wider developmental system. Nevertheless, some parenting behaviours may be particularly relevant. When adults themselves experience significant anxiety, they may understandably perceive more situations as potentially threatening, intervene quickly when a child becomes distressed, encourage avoidance, or model cautious responses. Longitudinal findings provide some support for these processes. For example, Edwards, Rapee, and Kennedy (2010) found that parental overprotection predicted later anxiety symptoms in preschool children even after earlier anxiety was taken into account. The important clinical point is not that anxious parenting is “bad parenting”. Many of these responses are motivated by protection. If a child is frightened about attending a birthday party, avoiding the party immediately reduces distress. If a parent is also anxious, allowing avoidance may reduce the parent’s distress too. The short-term outcome can therefore feel successful for everyone. The potential problem is what the child does not learn: I was frightened, I tried it anyway, and I coped.
From treating anxiety to preventing it
There is strong evidence that CBT can help children who already have anxiety disorders (James et al., 2020), but can we intervene before difficulties become sufficiently severe to require treatment? Previous family-based studies suggested that this might be possible. Ginsburg et al. (2015) randomised 136 families in which a parent had an anxiety disorder but the child did not. At one year, 31% of children in the control condition had developed an anxiety disorder compared with 5% of children whose families received the preventive intervention. Cartwright-Hatton et al. (2018) subsequently tested a brief one-day parenting workshop specifically for parents with anxiety disorders. Their feasibility trial also produced encouraging findings: children whose parents were assigned to the control group were 16.5% more likely to have an anxiety disorder at follow-up. These studies provided an important proof of principle. But face-to-face interventions create another problem: reach.If prevention requires specialist clinicians, clinic attendance and multiple appointments, only a relatively small proportion of the population at risk may ever receive it. The challenge therefore becomes not only whether prevention works, but whether it can be delivered cheaply and widely enough to make a meaningful difference. Kazdin (2019) has argued that meeting population mental-health needs requires models of intervention delivery that extend beyond traditional one-to-one psychotherapy. The Parenting with Anxiety project tested exactly that possibility.
What was the intervention?
Dunn et al. (2024) adapted Cartwright-Hatton’s earlier face-to-face programme into an online course requiring no clinician involvement. Parents completed short modules of approximately 20 minutes at their own pace. The content translated well-established ideas about childhood anxiety into practical parenting strategies. A core theme involved helping parents understand the relationship between anxiety, avoidance, and confidence. Other content addressed reducing avoidance through manageable steps, using play to build confidence, emotion coaching, positive behaviour management, sleep and lifestyle, reducing overprotective responses, modelling confident behaviour, and setting effective limits. This is an important feature of the programme. It does not aim to eliminate parental anxiety before parents can help their children. Nor does it require parents to present as permanently calm. Instead, parents are encouraged to consider how they respond when anxiety appears. A parent can feel frightened and still model approach rather than avoidance. They can acknowledge a child’s fear without automatically removing the challenge. They can help a child take a manageable step while communicating confidence in the child’s capacity to cope. That distinction is particularly relevant for anxious parents because expecting parents never to show anxiety would be both unrealistic and potentially shaming.
The trial
The study was unusually large for a psychological prevention trial. A total of 1,811 parents were randomised: 900 received access to the intervention and 911 were allocated to the control condition. Participants were recruited directly from the UK community rather than through mental-health services. All participating parents reported substantial anxiety, but they did not need a formal psychiatric diagnosis or current involvement with clinical services. Their children were aged between 2 and 11 years. The primary outcome was child anxiety measured six months after consent using the parent-report version of the Spence Children’s Anxiety Scale or its preschool equivalent. Secondary outcomes included child internalising, externalising and attention problems, as well as parental anxiety. Crucially, this was not a treatment trial involving children diagnosed with anxiety disorders. It was designed as a preventive population-level intervention directed at parents.
Did it work?
At six months, children in the intervention group had significantly lower parent-reported anxiety than children in the control condition. The effect size was small: Cohen’s d = −0.16, with a 95% confidence interval from −0.23 to −0.08. An effect size of −0.16 is not large. For an individual family, this should not be presented as a dramatic therapeutic transformation. It is considerably smaller than effects often reported when CBT is used to treat children who already have an anxiety disorder (James et al., 2020). But prevention operates according to a somewhat different logic. The intervention required no therapist, could be delivered remotely, consisted of brief modules, and was made available to more than 900 parents within this single trial. A modest reduction experienced across a very large population can potentially have meaningful public-health consequences, particularly if an intervention is inexpensive and easy to distribute. This creates an important distinction between clinical effect size and population impact. A highly effective intervention that reaches very few people may have limited population impact. A smaller intervention effect delivered at enormous scale may potentially prevent considerably more distress overall. Dunn et al. (2024) therefore provide an interesting example of how digital interventions might complement rather than replace conventional psychological treatment.
The engagement problem
The scalability argument comes with an important qualification. Access is not the same thing as engagement. Of the 900 parents allocated to the intervention, 73.7% started at least one module, only 32% completed two or more modules, and approximately 19% completed the entire programme. Dropout was also noticeably higher in the intervention group than the control condition. This is not unusual for unsupported digital mental-health interventions. Linardon and Fuller-Tyszkiewicz (2020) found substantial problems with adherence and attrition across smartphone-delivered mental-health interventions more broadly. Interestingly, Dunn et al. reported a strong dose-response pattern: parents who completed all available modules showed considerably larger reductions in child anxiety. However, this cannot be interpreted straightforwardly as proof that completing more modules caused the larger improvement. Parents who completed the programme may differ systematically from those who stopped—for example, in motivation, available time, family stress, socioeconomic resources, symptom severity, or their belief that the intervention was useful. The trial therefore demonstrates efficacy of offering the programme, but the next clinical challenge may be finding ways of helping more parents use it.
Confidence rather than avoidance
One of the most clinically appealing aspects of this work is its emphasis on confidence-building rather than anxiety elimination. Children will encounter uncertainty, novelty, failure, frustration and fear. The goal cannot realistically be to remove these experiences. Some parenting behaviours may instead help children learn that anxiety is tolerable. Research by Majdandžić et al. (2018), also cited by Dunn et al., examined “challenging parenting behaviour”: playful, encouraging behaviours that support children to take age-appropriate risks, push their limits and explore uncertainty. Higher levels of such behaviour predicted fewer child anxiety difficulties. This fits closely with the logic of Parenting with Anxiety. A confident child is not necessarily a child who rarely feels fear. Confidence may instead mean developing the expectation: “I can feel anxious and still have a go.” For anxious parents, modelling that lesson may be particularly powerful because parents themselves can demonstrate that courage and anxiety can coexist.
Implications for clinical practice
The study offers a useful shift in how clinicians might think about parental anxiety. An anxious parent does not necessarily need individual therapy before they can help their child. Supporting specific parenting behaviours may itself be worthwhile. Clinicians can explore how anxiety operates within everyday family situations: whether the child is frequently helped to avoid distress, whether reassurance becomes repetitive, whether adults unintentionally communicate that situations are dangerous, and whether opportunities exist for children to practise manageable independence. Importantly, these conversations should avoid blame. Overprotection often reflects love combined with threat perception. Accommodation often works extremely well in the immediate moment because everybody becomes less distressed. The therapeutic task is to help parents notice the longer-term learning that may follow. Digital programmes may also have a role within stepped care. A self-guided intervention could potentially be offered early and widely, with additional support reserved for families who struggle to engage or whose children already have clinically significant anxiety. The study does not show that online parenting programmes should replace treatment for childhood anxiety. Instead, it suggests that intervention may begin earlier, upstream, and with parents themselves.
Conclusion
Dunn et al. (2024) provide unusually large-scale evidence for a simple idea: helping anxious parents change how anxiety is managed within everyday family life may modestly reduce anxiety in their children. The intervention was brief, online and entirely self-guided. More than 1,800 parents participated in the trial, and children in the intervention arm showed lower anxiety six months later, with similar differences observed at longer follow-up. The effects were small, engagement was limited, outcomes relied heavily on parent report, and the sample was not highly diverse. Those limitations matter. But so does the scale. The most interesting implication may therefore not be that an eight-module website is the solution to intergenerational anxiety. It is that prevention does not necessarily require waiting for an anxious child to arrive in a clinic. By helping parents reduce unnecessary avoidance, tolerate their children’s distress, model confident coping, and create opportunities for manageable challenge, clinicians may be able to influence anxiety before it becomes entrenched. For anxious parents, the message is not: hide your anxiety from your child. It is something more realistic and potentially more useful: Your child can see that you feel anxious and also see you approach, cope, recover, and carry on.
Where next?
Join us on 17 November 2026 for a fantastic event on ‘Helping Anxious Parents Raise Confident Children: Preventing the Intergenerational Transmission of Anxiety‘. Internationally renowned expert Professor Sam Cartwright-Hatton will lead the programme sharing extensive clinical and research expertise. Through in-depth presentation and interactive Q&A session, participants will learn how to support parents in reducing accommodating behaviours, fostering resilience, and promoting long-term emotional wellbeing in anxious children.
References
- Cartwright-Hatton, S., Ewing, D., Dash, S., Hughes, Z., Thompson, E. J., Hazell, C. M., Field, A. P., & Startup, H. (2018). Preventing family transmission of anxiety: Feasibility RCT of a brief intervention for parents. British Journal of Clinical Psychology, 57(3), 351–366. https://doi.org/10.1111/bjc.12177
- Dunn, A., Alvarez, J., Arbon, A., Bremner, S., Elsby-Pearson, C., Emsley, R., Jones, C., Lawrence, P., Lester, K. J., Morson, N., Simner, J., Thomson, A., & Cartwright-Hatton, S. (2024). Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: A parallel group randomised controlled trial. The Lancet Regional Health – Europe, 45, 101038. https://doi.org/10.1016/j.lanepe.2024.101038
- Edwards, S. L., Rapee, R. M., & Kennedy, S. (2010). Prediction of anxiety symptoms in preschool-aged children: Examination of maternal and paternal perspectives. Journal of Child Psychology and Psychiatry, 51(3), 313–321. https://doi.org/10.1111/j.1469-7610.2009.02160.x
- Ginsburg, G. S., Drake, K. L., Tein, J.-Y., Teetsel, R., & Riddle, M. A. (2015). Preventing onset of anxiety disorders in offspring of anxious parents: A randomized controlled trial of a family-based intervention. American Journal of Psychiatry, 172(12), 1207–1214. https://doi.org/10.1176/appi.ajp.2015.14091178
- James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 11, CD013162. https://doi.org/10.1002/14651858.CD013162.pub2
- Kazdin, A. E. (2019). Annual Research Review: Expanding mental health services through novel models of intervention delivery. Journal of Child Psychology and Psychiatry, 60(4), 455–472. https://doi.org/10.1111/jcpp.12937
- Linardon, J., & Fuller-Tyszkiewicz, M. (2020). Attrition and adherence in smartphone-delivered interventions for mental health problems: A systematic and meta-analytic review. Journal of Consulting and Clinical Psychology, 88(1), 1–13. https://doi.org/10.1037/ccp0000459
- Majdandžić, M., Lazarus, R. S., Oort, F. J., van der Sluis, C., Dodd, H. F., Morris, T. M., de Vente, W., Byrow, Y., Hudson, J. L., & Bögels, S. M. (2018). The structure of challenging parenting behavior and associations with anxiety in Dutch and Australian children. Journal of Clinical Child & Adolescent Psychology, 47(2), 282–295. https://doi.org/10.1080/15374416.2017.1381915
- Murray, L., Creswell, C., & Cooper, P. J. (2009). The development of anxiety disorders in childhood: An integrative review. Psychological Medicine, 39(9), 1413–1423. https://doi.org/10.1017/S0033291709005157