Changes in dyadic emotional flexibility and expressivity during parent–child interactions following successful treatment of child anxiety

Abstract Child anxiety is linked to emotions during parent–child interactions, and observing emotional flexibility and expressivity may reveal treatment-related changes. This observational study investigated whether changes in dyadic emotional flexibility and expressivity were associated with treatment non-response (responders vs. non-responders), and whether treatment modality (child vs. family cognitive behavior theory (CBT)) and parent gender (mother– vs. father–child dyads) affected these changes. Participants were 116 referred children with anxiety disorders (59.4% girls, M age = 12.4 years, SD = 2.7) and both parents, enrolled in a randomized controlled trial comparing child CBT ( n = 58) with family CBT ( n = 58). Anxiety was assessed using the Anxiety Disorders Interview Schedule. Father–child and mother–child dyads were videotaped separately pre- and post-treatment discussing a conflict. Affect (positive, negative, neutral) was continuously coded. Dyadic measures of emotional flexibility (transitions, dispersion, and average duration) and expressivity (positive, negative) were derived from state space grids. Hierarchical linear models showed improvements in dyadic emotional flexibility among treatment responders, and in dyadic positive affect regardless of whether CBT was successful changes did not differ by parent gender or treatment modality. Dyadic negative affect increased only in responders within father–child dyads and in individual CBT. Findings highlight changes in flexible emotional exchanges of parent–child dyads after successful CBT for child anxiety.