Parent Perceptions of an Anxiety Prevention Manual for Young Children

1. Introduction

Anxiety is a normal response to stressful experiences, and it is common in children (Kodish et al., 2011; Vallance & Fernandez, 2016). Muris et al. (2000) found that over 70% of children between four and twelve years of age reported some experience of anxiety. Children worry about many things, including school performance, friendships, negative social experiences (like teasing), becoming ill or even dying (Muris et al., 1998). Anxiety may be defined as, “…emotional reactions arising from …(thinking about, anticipating)… a threat to the self” (p. 25, Fonseca & Perrin, 2011). Wehry et al. (2015) found that about 15-20% of children experience anxiety at some point in their lives. Rates vary across studies, and some show lower prevalence rates, about 8% for anxiety disorders in children, and anxiety is typically more common in girls than boys (e.g., Merikangas et al. (2009). If anxiety is not addressed, symptoms may persist into later years (i.e., adulthood, Allan et al., 2014; Ginsburg & Smith, 2023). Prevention strategies or learning coping strategies in the early years may help children cope with feelings of anxiety, which, in turn, sets a positive trajectory for moving through anxiety-provoking situations, improves coping skills, and sets a positive trajectory for being able to cope with worrisome situations. Moreover, anxiety can run “in the family,” so it is important to teach parents coping strategies so that they can teach their children and role model positive coping (McClure et al., 2001).

Children need to learn about how anxiety affects both the body and mind as well as learn coping strategies, and parents who know these things are teachers to improve their children’s abilities to cope with anxious feelings (Kendall, 2012; Rabner et al., 2017). Along with learning coping strategies, young children need to know that anxiety or “worry” about different situations is part of life, and they need to understand how anxiety impacts them physically and mentally (Kendall, 2012; Nabors et al., 2019). Children may experience changes in breathing, heart rate, nausea, and perspiration rate. They may shake or cry. Children also need to understand rumination – reflecting on something that makes them anxious, so that they avoid coping with their stressors (Vallance & Fernandez, 2016). Children also need coping skills, such as cognitive-behavioral strategies (breathing, positive imagery, thinking, distraction, and relaxation), to cope with their worries, de-stress, and continue with their daily routines (Comer et al., 2019; Nabors et al., 2019; Rabner et al., 2017; Scaini et al., 2022). Parents may not seek therapy services or interventions to help children with anxiety (Zhang, 2023), and, as such, having prevention-oriented materials for parents may assist them in helping their children learn to cope.

Evidence-based, prevention-oriented materials that adopt strategies such as cognitive-behavioral coping techniques have proven effective in managing anxiety (Cuijpers et al., 2016). These practical strategies, including deep breathing exercises, positive self-talk, distraction techniques, mindfulness activities, muscle relaxation, and guided imagery, foster anxiety management among children, helping them stay calm in moments of distress and building emotional resilience (Comer et al., 2019; Toussaint et al., 2021). For instance, deep breathing exercises help regulate the nervous system (Obradović et al., 2021). Additionally, positive self-talk and cognitive restructuring encourage children to challenge worrying thoughts and replace them with more balanced perspectives to reduce worry intensity (de Mooij et al., 2023). Further, distraction techniques, such as engaging in hobbies, playing with games or toys, movement-based activities, or sensory grounding, redirect children’s attention from distressing thoughts and promote emotional regulation (Zarra-Nezhad et al., 2023). Muscle relaxation and guided imagery techniques help children recognize body tension and actively practice relaxation (Toussaint et al., 2021).

Parents can support children with effective coping mechanisms that enhance their ability to navigate stress and anxiety by incorporating these cognitive-behavioral strategies into daily routines (Rienks et al., 2025). These foundational skills can be reinforced at home, helping children develop long-term emotional resilience before professional intervention is needed (Carpenter et al., 2014). Studies have shown that involving parents in anxiety interventions for children effectively reduces their children’s anxiety and fosters long-term emotional resilience (Jewell et al., 2022; Rienks et al., 2025). Specifically, training parents equips them with skills to reinforce using strategies at home, creating a consistent support system that improves the child’s ability to internalize coping mechanisms and reduce anxiety over time (Rienks et al., 2025). Parents’ involvement strengthens parent-child relationships, helps them understand the child’s experiences, and promotes a supportive environment where they model effective coping mechanisms themselves, further promoting a positive and adaptive approach to stress management within the family (Carpenter et al., 2014).

This pilot study examined parent perceptions of a children’s book, “Coping Positively with My Worries Book,” featuring cognitive-behavioral strategies for anxiety management for elementary school-age children. Data were collected through virtual and in-person interviews. The virtual interviews were conducted first, and then a second phase of the study, with in-person meetings, using the same interview questions, was used as a validity check on information provided by parents during virtual interviews. Parents provided information about whether the book would be useful for their children as well as providing their opinions about the strategies in the book, such as which strategies they might use with their child. Information about the strategies parents used before the review of the book, as well as their perceptions of worry in today’s children, was also assessed. Results provide information on parent perspectives related to how they perceive and plan to cope with worries for their young children, which is an important of study as prevention of anxiety in children will improve their emotional coping and has the potential to prevent more significant experiences of anxiety for children.

2. Materials and Methods

2.1. Instrumentation

Worry Coping Manual. The Worry Coping Strategies Project is evidence-based, focusing on cognitive behavioral strategies that will work to help prevent anxiety and help as an intervention for those children experiencing anxiety (Nabors et al., 2019; Nabors et al., 2024). The workbook begins with a developmentally appropriate explanation of how worry works in the body and what it can feel like. Then, there are six worry management strategies covered in the workbook include: relaxation (breathing and muscle relaxation), positive imagery, distraction, talking to someone else, using positive self-talk, and challenging worry using your own superhero. The workbook has a developmentally appropriate explanation of how to use each worry management strategy and there are instructions for practicing the strategy with the child (Nabors 2019, 2024). At the end of the workbook there is a coping menu where children can list their favorite strategies.

Interview. Parents provided demographic information on their sex, age range, occupation, and they provided demographic information about their child (e.g., sex, age, grade). Then, parents completed questions to assess their perceptions of the worry manual. These questions addressed their perceptions of the manual, what they thought of the strategies, what strategies they were using before reviewing the manual, what new strategies they learned, and their ideas of strategies they would use (or not use) as well as when/how they would implement anxiety management strategies (Nabors et al., 2024). They also responded to a question about if they thought today’s children were worrying and what they were worrying about (Nabors et al., 2024).

2.2. Participants

Twenty-one parents participated in interviews. Fifteen parents completed virtual interviews and six completed in-person interviews. Participants were from Ohio, Kentucky, Georgia, Alabama, and Colorado. A university-based institutional review board approved this study.

2.3. Procedures

Procedures for Virtual Interviews. Parents received an email explaining the study with a consent form. If they elected to participate, they emailed written consent for study participation to L. N. Participants reviewed the children’s manual. Then, they completed interviews to assess their opinions of the manual via Zoom meeting. Interviewers were L. N. and T. N. A. Parents completed the interview questions, and probes were to tell me more about it, provide an example, and please explain what you mean. Interviews lasted between 15 and 45 minutes, with an average interview lasting about 30 minutes.

Procedures for In-Person Interviews. Parents completed a consent form. They were interviewed by L.N. at two schools, three parents at each school. The same interview questions and probes were used from Study 1. Interviews lasted between 15 to 30 minutes, with an average of about 20 minutes.

Coding Qualitative Data. Three coders (L. N., O. S., and A. R.) used an open coding process, reviewing transcripts and use memos and notes to determine themes in the data (Corbin & Strauss, 2014; Miles & Huberman, 1994). A third coder (A. R.) served as a verification coder (Creswell, 1994). First, coders reviewed data independently to determine categories or themes in the data. Then, coders met over three meetings to develop and verify themes in the data as well as select representative quotes to support these themes. Disagreements were resolved by consensus.

3. Results

3.1. Virtual Interviews with Parents

Demographics. Fifteen parents participated in Zoom interviews, 2 males and 13 females. Parents provided data on age range, and 2 participants (13.3%) were in their 20’s, 9 (60%) were in their 30’s, 3 (20%) were in their 40’s, and 1 (6.7%) one was in her 50’s. Six (40%) were white, 3 (20%) were African American, and 1 was (6.7%) native American. Five parents (33%) did not wish to provide data on their race group. Their children were in the first through fifth grades (all grades in this range were represented). Children were between the ages of 5 and 9 years (Mean = 7 years). There were 8 (53%) boys and 4 (27%) girls. Three of the parents (20%) did not provide information about the sex of their child. Ten of the parents provided data on the race of the child – six (40%) were white, 3 (20%) were African American and 1 (7%) was Native American. Five (33%) of the 15 parents did not wish to specify race group.

Themes for Parent Report. Five themes were discovered in the review of the data: (1) discussion of strategies parents would use with their child, (2) feeling that today’s children were worrying more often than children did in the past, (3) that the manual was useful, (4) new strategies that parents learned from reviewing the manual, and (5) alternative strategies used by parents beyond the manual.

Strategies Parents Would Use. The first theme was parent discussion of strategies they would use. Subthemes for strategies parents would use are presented in Table 1. These strategies were children imagining their happy place, like vacations or parties, (6 parents) used this technique. Additionally, beach ball breathing was used by (9 parents), with the rock and sponge technique applied by (3 parents) which helped with relaxation. Moreover, another (3 parents) used the “Talking to Someone” strategy. As well as (4 parents) used positive thinking as a strategy. Lastly, using a distraction like toys or TV was used by (2 parents).

What Children Worry About. The second theme reflected parents’ comments that today’s children were worrying more than in the past. Fourteen of the parents (93.3%) reported they felt ‘today’s’ children are worrying more. Table 2 presents what parents reported their children were worrying about. According to the interviews (8 parents) thought their child worried about social media, (5 parents) reported they are worried if “Mom and Dad are mad at me”, and (3 parents) said their child worries about their safety. Another (3 parents) found that their children worry about "parental concerns”, like finances and where their next meal will come from. Lastly, (8 parents) reported that their child worries about their friends, or has social concerns, with another (8 parents) stating that their child has academic concerns about school.

Why the Worry Manual is Useful. The third theme focused on parents’ reasons why the manual would be useful for children (see Table 3). All the parents believed that the manual was useful for elementary school-aged children. According to the reports, (5 parents) found the manual to be relatable for children. Another (4 parents) said it was a “Toolbox for parents,” and (6 parents) reported it was a “Good Resource” that was simple and manageable. Lastly, (3 parents) said they like the variety of strategies, (3 parents) said that it encourages emotional regulation, and (3 parents) said that it can be used at school or home.

New Strategies Learned from the Manual. The fourth theme focused on the new strategies parents learned after reviewing the worry strategy manual. Five parents (about 33% of the sample) said they learned a new strategy. Each parent endorsed one new strategy. One parent said they would use the beach ball breathing, one learned about positive thinking, one found the distraction strategy helpful, one said they would use the sponge and rock breathing technique, and one mentioned using the imagination of a happy place with their children in the future. Notably, the parent who learned about distraction stated, “Alone time helps a child to process his or her emotions. So, I like setting (them) up with something like a puzzle to do.”

Use of Strategies Not in the Manual. The fifth theme reflected other strategies that parents mentioned using, specifically strategies they used that were not mentioned in the manual. There were 10 (66.7%) parents who discussed other strategies. Two parents used prayer or reading the Bible with their children as a calming strategy. Two used drawing to help their child feel calm when he or she was worrying. One parent discussed each of the following strategies: reading, yoga (including slow breathing), and journaling (journaling could include drawing and writing about worries). One parent used counting as a calming strategy, stating, “Counting to calm down is a great technique, especially for younger kids. Using numbers as a way to calm down and focus helps children regulate emotions.” Another mother reported that she used to play with toys, often a favorite stuffed animal, to help their child calm down, “Using toys like their favorite stuffed animal or dolls to calm down works well.”

In-Person Interviews with Parents

Six parents were interviewed, including four mothers (67%) and two fathers (33%). All were white. Age ranges for parents were as follows: 3 (50%) were 30-40, 2 (40%) were 40-50, and 1 (10%) was 51 and older. Their children were in kindergarten, first, second, fourth, and fifth grades. There were four (67%) girls and two (33%) boys. Five (83%) were white, and one (17%) was Asian. Children were 5, 6, 7, 8, 9, and 11 years (Mean = 7.7 years).

Parents’ Perceptions of Children’s Worry. Parents reported that their children worried. However, some worried more frequently than others. Four worried "sometimes," and two worried "most of the time." They reported that their children worried mostly about school (n = 5, such as about academic work). Three mentioned that their children worried about getting along with their friends or making friends. All the parents reported that it was normal for children to worry. After reviewing the Worry Strategy Book, three said they would use it "sometimes," and three said they would use it "all the time." All parents viewed the book as helpful for working with their children.

Application of Strategies from the Manual. Parents found the strategies in the manual to be very useful and affirmed the preferred strategies they would practice with their children. Breathing exercises were the most frequently endorsed strategy. Five parents mentioned that they would use this strategy often. Four would help their children think happy thoughts, and four favored "teaching their child to talk to someone else. Other mentioned strategies include rock sponge (4 parents), superheroes (2 parents), and doing something fun (2 parents). The parents also expressed confidence that their children would enjoy and benefit from these strategies. In addition to the strategies from the manual, parents reported strategies they were already using, including fidget toys, art, drawing, snuggles, and body movements "to help get the worries out of their child’s body.”

Parental Preferences for Coping Strategies. All the parents reported their favorite strategies, although two parents found it difficult to choose just one strategy. The strategies mentioned include talking to someone else (2 parents), breathing (3 parents), doing something fun (1 parent), superhero (1 parent), and thinking happy thoughts (1 parent). When asked if the parents would use some strategies for themselves, they mostly favored breathing exercises and talking to someone, with five parents preferring each. Three parents each mentioned they would apply “doing something fun” and “happy thoughts,” and one parent would use the rock sponge technique.

4. Discussion

This pilot study provided information about strategies parents would use to help young children cope with anxiety in their everyday lives, providing critical information for prevention work. Parental perceptions of an anxiety management book for young children revealed their opinions of cognitive-behavioral anxiety management strategies and which ones they would implement with young children. A strength of the study is the verification of information provided in online interviews, with in-person interviews. All parents, irrespective of the method of data collection, thought the manual was useful, had good information, and they stated they were going to implement cognitive-behavioral strategies from the manual with their children. Additionally, parents described the manual as easy to read and thought strategies in the manual could be useful at home or as something that could be used at school if worries occurred in this setting. Studies have shown that active parents’ involvement in reinforcing cognitive-based strategies at home fosters early adoption and sustainability among children, creating a consistent environment for growth (Jewell et al., 2022; Rienks et al., 2025).

Parents reported learning new techniques after reviewing the worry strategy manual, including beach ball breathing, positive thinking, guided imagery, and the sponge and rock technique that can be easily incorporated into daily life. This will allow parents to support their child's emotional regulation and build resilience (Rienks et al., 2025). Parents reported that cognitive-behavioral strategies, including breathing, relaxation, talking to someone else, positive imagery, and distraction, would help children reduce feelings of worry. Therefore, results were consistent with other studies showing that children benefit from using behavioral and cognitive strategies to reduce the experience of anxiety (Comer et al., 2019; Rabner et al., 2017; Scaini et al., 2022). Parents reported that breathing techniques were a strategy they would use to help calm their children. Research has shown that these strategies help children calm themselves and promote relaxation (Obradović et al., 2021). Other strategies mentioned include positive thinking and distraction strategies, such as imagining a happy place with their children; these are core components of cognitive behavioral strategies that have been found effective in managing anxiety (Cuijpers al., 2016). Adopting positive thinking and open conversations, as mentioned by the parents, would foster cognitive restructuring. This will help children reframe negative thoughts and feel better supported (de Mooij et al., 2023). Integrating cognitive-based strategies into daily family routines may equip the children with early coping skills that promote emotional resilience before needing formal intervention (Carpenter et al., 2014).

Parents were using some unique strategies not reviewed in the manual, such as music, prayer and reading the Bible, drawing, playing with stuffies and fidget toys, as well as yoga and body movements. These strategies could be used to expand the manual. Moreover, it will be important to build upon parents “natural” or “typical” strategies so that they feel comfortable in expanding the interventions they use to help their child. Building parental skills and comfort in intervening with their child has the potential to reduce anxiety, which can build and become more serious in later childhood (Ginsburg & Smith, 2023). If parents have greater knowledge of how anxiety works and how to help their child, they may be able to help their child prevent it, and recognize when professional help is needed, which may reduce parental tendencies to avoid treatment for child anxiety (Zhang, 2023). We did not ask when strategies were used, and details on the situations in which children experienced anxiety and which strategies were used in different situations might provide direction for future research to determine strategies parents find most effective in moments of distress.

Parents indicated that their children were worrying about weighty real-world problems, like school success and family stresses, consistent with other research (Muris et al., 1998, 2000). They believed that today’s children are worrying more than in the past and that social media could influence child anxiety (Twenge & Campbell, 2018). Children were worrying about their academic performance, and things like their ability to speak in the classroom at school, and this may be one reason that parents mentioned the manual could be helpful in the school setting. Previous research indicated that teachers also thought the manual could help young children reduce anxiety related to academic performance and other worries while at school (Nabors et al., 2024). Research examining strategies to reduce anxiety about school performance will advance knowledge in the field.

This pilot study had several limitations. For example, the sample size was small, and interviewing more participants may lead to more commonalities in themes, especially regarding favorite strategies. However, results from the in-person interviews served as a type of verification check. The results of these interviews were consistent with those of the online interviews, showing that parents believed the manual was useful and identified strategies they would use with their children, which supported the purpose of developing the manual. Questions in the interviews did not examine how children’s worries evolved over time, and the interview itself occurred at one point in time. Longitudinal data on how children experience and cope with worry over time will provide information to guide interventions. As mentioned, interview questions did not assess how parents apply worry strategies in different situations, and learning whether different strategies work for different concerns will also inform intervention development. Parents were volunteers, and a positive bias may have predominated their response to the manual. The preponderance of participants were white, and obtaining more information from parents of color and learning more about how their own worries impact their own and their child’s lives will be important to address in future studies.

5. Conclusions

Training and equipping parents with developmentally appropriate, evidence-based strategies from the manual has the potential to improve children's access to consistent support in managing anxiety at home. By providing early intervention, parents can foster emotional regulation, reduce anxiety symptoms, and build resilience over time among children. Additionally, recognizing that children respond differently to various techniques emphasizes the need for flexible, individualized approaches incorporated into the manual. As children engage in calming practices such as breathing exercises, guided imagery, or creative play, they internalize coping skills that may benefit them across developmental stages and in future anxiety-provoking situations. In the future, determining what strategies work for different stressors will be important. Moreover, learning how parents use strategies at home will provide information for developing programming that works for them. Also, learning about whether prevention efforts reduce the experience of anxiety in the long-term will indicate whether prevention can reduce symptoms and decrease anxiety disorders in children and adolescents.