Estilos, estratégias e crenças de pais e mães e ansiedade infantil : o pai é importante?

Tese de doutoramento, Psicologia (Psicologia Clínica), Universidade de Lisboa, Faculdade de Psicologia, 2016Anxiety disorders are one of the most prevalent mental health disorders in childhood and adolescence. If left unattended, they tend to persist and cause a great impact in child’s functioning. Parental variables and their contribution to the outcomes of these disorders are among the most studied etiological factors found in specialized literature. According to theoretical models, parents may contribute to the development, maintenance, aggravation or amelioration of child’s anxiety in several ways. This process may occur through “direct” learning mechanisms, such as modelling, information transfer and reinforcement of avoidance. It can also occur through parenting styles and practices, following more “indirect” risk (e.g., overcontrol, negativity, withdrawal) or protective (e.g., autonomy granting, positive affect, confronting) pathways. Nonetheless, several meta-analyses have demonstrated that parenting styles, namely control and rejection, only account for a modest part of child anxiety. This highlights the existence of certain limitations and incongruences in theory and research needing to be addressed. Consequently, recent studies are becoming more focused on specific and observable parental behaviors, on parental anxiety and on the bidirectional interactions between parents and anxious children. Furthermore, studies have scarcely focused the role of father in childhood anxiety and the relevant parental cognitive styles that might be promoting and reinforcing the child’s anxiety. Based on developmental psychopathology, the current investigation has the following main objectives: (I) identify parenting patterns in mothers and fathers, applying well-known parenting styles and behaviors associated with children’s anxiety, and analyze their relation with parents’ and children’s anxiety levels; (II) describe and compare parental behaviors that occur more frequently during interactions between parents and their anxious/nonanxious children, and identify transactions between parents and children more probable to occur; (III) examine and compare the strategies parents say they use more frequently in their daily lives with the ones they used during the interactions with the child; and (IV) explore parents’ beliefs and perceptions regarding the causes, the impact and the evolution of their child’s anxiety problems, and compare them using parents who sought professional help and those who did not. Our research included both mothers and fathers in order to clarify if these behavioral and cognitive variables differ according to parental. Our subsamples were selected by a multilevel screening procedure, with a total of 390 children, between 8-13 years old, and their parents as participants. Different perspectives (qualitative, quantitative, mixed), distinct types of samples (community, children with and without anxiety disorders), multi-informants (father, mother, child, independent observers) and multi-methods (questionnaires, observations, interviews) were included. We got the following results: (I) Three parenting patterns (i.e. overprotective, supportive and disengaged) were obtained. Disengaged and overprotective (only for fathers) types had higher parental anxiety, whereas disengaged mothers had children with higher levels of anxiety. (II) Fathers and mothers of children with anxiety behaved in a more overinvolved way, withdrawn and anxious in parent-child interactions than parents of non-anxious children. Also, distinct parental behaviors tended to precede and to follow children’s manifestations of anxiety when these groups of parents were compared. (III) More parents referred using reassurance and avoidance reinforcement strategies in their daily lives than those who actually applied them during observed interactions, whereas more parents showed overinvolvement and anxious behaviors during observations than those who reported them previously in interviews. (IV) Most parents attributed their child’s anxiety to external and parental factors (perceiving this as a feature with a negative impact on their children functioning), foreseeing anxiety as a permanent condition in their child’s lives, with the possibility to get worse. Globally, our finding revealed many similarities regarding parenting practices, cognitive and behavioral factors of mothers and fathers. However, there are gender differences concerning the relation between specific parental behaviors and the child’s anxiety. Considering all this data, based in an innovative use of multiple levels of analyses and multimethod in the research, we can conclude that both caregivers are key-elements on the development and maintenance of the children’s anxious response through different associations and pathways. Identifying dysfunctional cycles of interactions is a key contribution in the understanding of the bidirectional nature of child’s anxiety and parent’s behaviors/reactions. Our findings also reveal that sundry evaluation methods are a more sensitive data gathering approach, bypassing the disadvantages of the complemental method. Exploring parental beliefs, emotional reactions and strategies used when dealing with child’s anxiety and distress is one of the clinical implications of this study. This exploration will entail adjusted treatments to each family, through cognitive restructuring and emotional self-regulation techniques, and promote more effective strategies to manage child´s anxiety in his/her everyday life. We see both the knowledge of such strategies and its suited application in specific situations as factors that might improve the success of the intervention with these families. Last but not least, we suggest the inclusion of fathers in the research and in interventions, since they have an important role in the child’s emotional adjustment.Fundação para a Ciência e a Tecnologia (FCT, SFRH/BD/7737/2011) Quadro de Referência Estratégico Nacional (QREN, 2007-2013), Programa Operacional Potencial Humano (POPH