For parents
SPACE: parent-based treatment for child anxiety and OCD
SPACE treats childhood anxiety and OCD by working only with parents. It changes how the family responds to the anxiety at home, and your child or teenager does not attend or have to agree to treatment.
What SPACE is
SPACE stands for Supportive Parenting for Anxious Childhood Emotions. It was developed by Eli Lebowitz and colleagues at the Yale Child Study Center and first described in print in 2013. You attend the sessions, and your child does not attend or need to agree to treatment, so it can go ahead when a child will not go to therapy, has stopped going, or is too young for individual therapy to go well. It works on family accommodation, which is the name for anything the family does to reduce a child’s anxiety in the moment, such as answering the same worried question again, sleeping in their room, speaking for them, or writing the note that gets them out of the school trip. In a Yale study of children with anxiety disorders (Lebowitz and colleagues, 2013), almost all parents reported some accommodation. It is what caring parents do, and it works in the short term, but over months it can teach a child that the fear was justified and that somebody else has to remove it.
The two things parents change
Supportive statements. Parents often move between protecting (“you don’t have to go”), which can suggest the fear is justified, and pushing (“everyone else manages it”), which can suggest the child is not up to it. A supportive statement has two parts, acceptance that this is hard for them and confidence that they can handle it, for example “I know it feels frightening to sleep in your own room, and I know you can handle feeling frightened.” It deliberately leaves out any answer to the worry itself, because that answer is the reassurance that keeps the anxiety going.
Reducing accommodation. We list the accommodations across the day and start with one that happens often and that you can keep to when your child is upset. The change is always in what you do, for example answering a question once, leaving the bedroom after ten minutes, or no longer washing your hands when asked. You are not asking your child to stop a ritual or face a fear, which is why SPACE can go ahead when they will not take part. From there we work down the list, one or two items at a time.
A made-up example: worry questions in a nine-year-old
A nine-year-old girl asks her parents many times each evening whether her grandmother is going to be all right. Her parents tell her on a Sunday that from now on they will answer each question once. When it comes again they say, “I can see the worry is really loud tonight. I’ve answered that already, and I know you can cope with not being completely sure,” and carry on with what they were doing. In the first week she asks more and tries each parent separately, which they had planned for. The repeated questions become less frequent once she has learned that the answer is not coming.
Try it: plan a first step at home
The free planning tool takes you through choosing the hardest part of the day, ticking what happens in your family, and picking one thing to start with. It gives you a supportive statement you can edit, a first small step and what to expect, and nothing you choose is saved or sent anywhere.
How a course runs
Sessions are weekly at first and then spaced out as you take over the work, and both parents attend wherever possible, including separated parents. In the first session we go through a typical day and everything the family does around the anxiety, and I ask about safety, brothers and sisters, and school. By the end of it I tell you whether I think SPACE is the right route or whether direct work with your child would suit better, though sometimes further assessment is needed first. Next we work out supportive statements that sound like you, then choose the first accommodation to reduce and agree exactly what you will do instead. Each later session starts with what happened that week, and once a change has become ordinary family life we add the next target. Towards the end we plan for setbacks, so that you know what to do without me.
Your child is told that you are getting help with how the family handles the worry and that some things at home are going to change. Each change is announced in advance, in a short note we write together that says what will change, from when and why, and that you read to your child at a calm time. Protest afterwards is expected: more questions, anger, tears and going to the other parent or a grandparent are all common, and we plan for them. You give one supportive statement, you do not argue, explain again or threaten consequences, and you stay nearby and calm. If a step turns out to be too large to keep to, we make it smaller rather than abandon it, because giving in after a long protest teaches that protesting for longer works.
Aggression or threats of self-harm
Where anxiety comes with hitting, breaking things, running off or threats of self-harm, safety comes before any accommodation is reduced. We write a specific plan first, covering how to keep your child and the rest of the family safe, who you call and when. Threats of self-harm are always taken seriously, and you are never asked to ignore one or to test whether it was meant. Where there is a significant risk to your child’s safety I contact your GP, and I may suggest a referral to your local CAMHS (child and adolescent mental health service). In an emergency call 999.
OCD, school avoidance, teenagers, and children already in treatment
In OCD, families are often drawn into the compulsions themselves: parents wash when asked, answer the same checking question, or wait while a ritual finishes. SPACE treats these as accommodation in the same way, and the parents’ own part in the ritual is usually the first target. The evidence in OCD is smaller than in anxiety, and I have not found a published randomised trial comparing SPACE with exposure and response prevention (ERP), the form of CBT that NICE recommends for OCD in young people. ERP remains my first suggestion where a young person is willing to take part, and SPACE is where I start when they are not, or alongside ERP when accommodation at home is undoing the work.
School avoidance usually plays out at home, in the hour before school, and the accommodation tends to include ringing school to report the child ill, driving them in late, and a day at home that is more comfortable than a day at school. SPACE can go ahead when a young person who is avoiding school will not come to sessions either, though I am not aware of a trial of SPACE for school avoidance in particular. With teenagers, accommodation tends to look different, for example lifts everywhere, contacting school or friends on their behalf, and covering for them when they cancel plans; the statements are written in more adult language, and the announcement is more often talked through than read out. The 2020 trial included children up to 14 and the 2024 video trial young people up to 17, so there is evidence for parents of older teenagers, but less of it.
When a child or teenager is having CBT with me, parents are part of the treatment as well. The two SPACE changes still apply, so you use supportive statements instead of reassurance and we reduce accommodation one piece at a time, and the difference is that your child is also practising agreed steps towards what they fear between sessions. This is not a service for defiant or disruptive behaviour without anxiety or OCD behind it; for that NICE recommends group parent training programmes for parents of children aged 3 to 11, usually reached through your GP, your child’s school or the local authority.
What the research shows, and what is not known
The main trial (Lebowitz and colleagues, 2020) was a randomised non-inferiority trial, which means it was designed to find out whether SPACE was not meaningfully worse than an established treatment. It randomly allocated 124 children aged 7 to 14 with a primary anxiety disorder to 12 sessions of SPACE, with no therapist contact for the child, or 12 sessions of CBT for the child. SPACE was comparable to CBT on anxiety ratings by independent assessors, parents and children, and family accommodation fell more after SPACE. In the press release about the trial, Yale reported that about six in ten children in each group no longer met the criteria for an anxiety disorder after treatment, which also means that some children in both groups still did. A 2024 trial of 68 young people aged 7 to 17 (Storch and colleagues) compared 12 weekly video sessions of SPACE with a lighter version and found about 70 per cent responded to standard SPACE and 68 per cent to the lighter version, but with no group that did not receive SPACE it cannot say how much of that change was due to treatment. A systematic review published in 2026 (Egan and colleagues) found 12 studies. Most reported reductions in children’s symptoms and in family accommodation, but the reviewers rated most of the studies as low in quality, found that gains were not consistently maintained at follow-up, and noted how few studies had a proper comparison group.
So: there is one randomised trial against child CBT, in children up to 14 with anxiety disorders, and no published randomised trial against ERP in OCD. Evidence in older teenagers is limited, there is no trial in school avoidance specifically, and I have not found a trial of SPACE run in the UK. Follow-up in most studies is measured in months rather than years. Research on which children do better with which treatment is still early (Lebowitz and colleagues, 2021), so in practice the decision between SPACE and direct work rests on your child’s willingness and on what is happening at home.
Reading
Eli Lebowitz’s book for parents, Breaking Free of Child Anxiety and OCD (Oxford University Press, 2021), sets out the SPACE programme in plain language with worksheets. The free family accommodation tracker is for noting what happens across a week, and the planning tool helps you choose a first step. If you want a validated measure of accommodation, the Family Accommodation Scale, Anxiety (FASA) is available free from its developers at spacetreatment.net (opens in a new tab).
Sources
- Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child and Adolescent Psychiatry, 59(3), 362-372. doi.org/10.1016/j.jaac.2019.02.014 (opens in a new tab)
- Yale University (2020). New treatment for childhood anxiety works by changing parent behavior. News release. eurekalert.org/news-releases/616040 (opens in a new tab)
- Lebowitz, E. R. (2013). Parent-based treatment for childhood and adolescent OCD. Journal of Obsessive-Compulsive and Related Disorders, 2(4), 425-431. doi.org/10.1016/j.jocrd.2013.08.004 (opens in a new tab)
- Lebowitz, E. R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., et al. (2013). Family accommodation in pediatric anxiety disorders. Depression and Anxiety, 30(1), 47-54. doi.org/10.1002/da.21998 (opens in a new tab)
- Storch, E. A., et al. (2024). Randomized trial comparing standard versus light intensity parent training for anxious youth. Behaviour Research and Therapy, 173, 104451. doi.org/10.1016/j.brat.2023.104451 (opens in a new tab)
- Egan, R., Byrne, G., Hadfield, K., & Swords, L. (2026). Supportive Parenting for Anxious Childhood Emotions (SPACE) in addressing paediatric psychological difficulties and family accommodations: a systematic review. Child Psychiatry and Human Development. doi.org/10.1007/s10578-026-01992-x (opens in a new tab)
- Lebowitz, E. R., Zilcha-Mano, S., Orbach, M., Shimshoni, Y., & Silverman, W. K. (2021). Moderators of response to child-based and parent-based child anxiety treatment: a machine learning-based analysis. Journal of Child Psychology and Psychiatry, 62(10), 1175-1182. doi.org/10.1111/jcpp.13386 (opens in a new tab)
- Lebowitz, E. R. (2021). Breaking Free of Child Anxiety and OCD. Oxford University Press.
- SPACE Treatment. Family Accommodation Scale, Anxiety (FASA), parent and child report forms. spacetreatment.net/fasa (opens in a new tab)
Common questions
Does my child need to attend?
No. SPACE is delivered entirely to parents. Your child does not attend, does not need to agree to treatment and does not need to know the details of what we discuss, although you tell them in advance about each change before it happens. It works because you are usually there when the anxiety shows itself, and your own responses are something you can change without your child’s agreement.
Is this not just telling parents they caused the problem?
No. The things families do to ease a child’s anxiety do not cause childhood anxiety or OCD. They are the reasonable things loving parents do when their child is distressed, and in the short term they work, which is why they become a habit. SPACE starts from the fact that parents are present for most of the moments when the anxiety takes charge, which puts them in a strong position to help.
We are separated. Can we still do SPACE?
Yes. It works best when both parents respond in the same way, because a child will take the worried question to whichever parent still answers it. Separated parents can attend together. Where only one parent can take part, the work goes ahead with that parent, and we plan for the differences between the two homes.
How many sessions does SPACE take?
There is no fixed number. The main trial used 12 weekly parent sessions (Lebowitz and colleagues, 2020). I give you an estimate by the end of the first session, and sometimes further assessment is needed before I can.
Free 20-minute call
Not sure whether this is the right fit?
Start with a free 20-minute call. We talk through what is going on, I answer any questions you have, and I tell you whether I think I can help. If I cannot, I will try to point you to someone who can. The call is free and there is no obligation to book.
Weekdays, 9am to 5pm. No GP referral needed.