Cognitive Behavioural Therapy for Separation Anxiety

This in the fifth in a series of blog posts about CBT formulations. This blog will focus on CBT formulation for separation anxiety.

1. What is separation anxiety?

Separation anxiety is a preoccupation with fears of being separated from a loved one whom the person has formed an attachment to, usually a caregiver or significant other. This includes fears of being away from the attachment figure incase they lose them or something bad happens to their caregiver. In order to meet formal diagnostic criteria for a separation anxiety diagnosis, this preoccupation must be present for a minimum of 4 weeks in children and a minimum of 6 months in adults. The distress must cause significant impairment in social, academic, occupational/education or other areas of functioning. The fear must exceed anxiety expected for the individual’s developmental level.

The adaptive side of separation anxiety is that it can motivate individuals to stay close to those who look after them and develop attachments. However, this can become problematic if the preoccupation is to such an extent as to prevent the individual separating whatsoever from their loved one. This can lead to high distress when the loved one leaves or refusal to go to school, work or other external places without the loved one.

Some people may be more vulnerable than others to developing these difficulties.

2. Predisposing factors

Predisposing factors may include: early exposure to stressful situations, particularly parental bereavement, parental separation or illness in the family. Parental overprotection and biological vulnerabilities may also predispose some individuals to developing separation anxiety.

3. Core beliefs

Core beliefs may include the belief that one is vulnerable and will be unable to cope without their loved one. They may lack belief in their ability to cope and function independently.

4. Precipitating factors

Precipitating factors include stress, routine changes (e.g. a parent working away for longer hours), entering into a romantic relationship as an adult, or becoming a parent

5. Perpetuating factors

Perpetuating factors include avoidance of situations in which the person will not be with the loved one (e.g. school, work etc). Individuals may also engage in behaviours in order to keep the loved one near, for example feigning illness so they will stay home to look after them.

6. Protective factors

Protective factors include: interests in engaging in activities, support from family and friends and an insight into their behaviour.

7. Case example

Luke hears his parents arguing on Sunday night. Luke tells his dad he has a pain in his tummy on Monday. Luke’s dad stays home with home until Wednesday when Luke seems to be feeling much better, playing again with his siblings and running around the house. Wednesday morning, Luke hides his dad’s car keys just before he needs to leave for work. When asked about why he did this Luke explains that he does not want dad to go to work. Luke’s friend, Damian has told Luke that his parents are separating and Damian is going to live with his mother. Luke is worried that his dad is going to move out too.

This can be understood within a CBT formulation as follows:

Predisposing factor: Luke’s parents and siblings are very protective of him as he is the youngest.

Precipitating factor: Damian’s parents separating has led Luke to worry that the same thing will happen with his parents. Hearing his parents arguing.

Perpetuating factors: Luke is avoiding being away from his father by pretending to be sick and then hiding his car keys. In this way he is trying to avoid the chance of them being separated. This is problematic, as Luke is not getting an opportunity to challenge his belief.

Protective factors: Luke has told his dad his worry about his parents separating. Luke’s and his dad have a strong bond and positive relationship.

The International Psychology Clinic

The International Psychology Clinic