Direct and indirect associations among mothers' invalidating childhood environment, emotion regulation difficulties, and parental apology.

BACKGROUND: Effective emotion regulation abilities are essential for engaging in positive, validating parenting practices. Yet, many parents report difficulties with both emotion regulation and positive parenting, and these difficulties may in part be the result of parents' own childhood experiences of invalidation. Building upon prior literature documenting the intergenerational transmission of invalidation and emotion dysregulation, the present study examined the associations between these constructs and a specific parenting practice - parental apology - that can be conceptualized as a type of validating parenting practice. METHODS: Using a sample of 186 community mothers, we tested direct and indirect relationships via correlational and path analysis between participants' retrospective reports of parental invalidation during childhood, difficulties with emotion regulation, and two aspects of parental apology - proclivity (i.e., participants' self-reported propensity to apologize to their child) and effectiveness (i.e., participants' inclusion of specific apology content when prompted to write a child-directed apology). Parental invalidation, difficulties with emotion regulation, and parental apology proclivity were measured via self-report questionnaires. Apology effectiveness was measured by coding written responses to a hypothetical vignette. RESULTS: There was a significant negative bivariate relationship between difficulties with emotion regulation and parental apology proclivity and effectiveness. Parents' own childhood experiences of invalidation were linked to parental apology indirectly via emotion regulation difficulties. CONCLUSIONS: Results suggest that mothers with greater difficulties regulating emotions may be less able to or have a lower proclivity to apologize to their child when appropriate. Thus, parent apology may be an important addition to current calls for parent validation training.

A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior.

Given the high rates of co-occurrence of psychopathology within families, it is important to identify and characterize interventions that simultaneously reduce both parent and child symptoms, and improve parenting quality. This is needed as intervention development is increasingly moving toward integrated interventions that target some combination of parent and child mental health, and parenting behavior. Even so, much remains unknown regarding which treatment components provide maximum benefit for parent symptoms, child symptoms, and parenting behavior. This systematic review identified and characterized psychotherapeutic interventions that report improvements in each of three outcomes: parent symptoms, child symptoms and parenting behavior. Fifty-six unique interventions were eligible for review, of which 25 reported improvements in all three outcomes. All 25 of these interventions directly intervened on parenting behavior, often as the sole target of the intervention. Few interventions improved all three outcomes in samples in which parents, children or both met clinical-level thresholds of psychopathology. Additional research is needed to better understand the bi-directional and transactional influences of treatment on family members, and to better inform the development of interventions for dually disordered parent-child dyads across a range of diagnostic profiles.

The Role of Caregiver Psychopathology in the Treatment of Childhood Trauma with Trauma-Focused Cognitive Behavioral Therapy: A Systematic Review.

Trauma-focused cognitive behavioral therapy (TF-CBT) is regarded as one of the most effective treatments for children who have experienced trauma and is rapidly being disseminated. To best ensure efficacy, even among treatment refractory symptoms, a better understanding of the factors that lead TF-CBT to be more or less effective for some children is warranted. One major factor that has not been systematically considered is the role of caregiver psychopathology. Therefore, this systematic review of 18 empirical studies examined how TF-CBT has incorporated caregiver psychopathology into the treatment of childhood trauma and how it is related to treatment outcomes. The results of this review provide preliminary support for TF-CBT decreasing caregiver psychopathology, in terms of symptoms of depression, PTSD, and emotional distress related to the child's experience of trauma, as well as partial support for caregiver depression, rather than caregiver PTSD or distress, influencing child treatment outcomes. It also illuminates the strong need for future TF-CBT studies to routinely measure caregiver psychopathology. Several recommendations are provided to ensure that the emerging research base can inform clinical practice guidelines on how to incorporate caregivers who exhibit psychopathology and potentially develop modifications to the existing treatment to address trauma and symptoms in both members of the caregiver-child dyad, when needed.

Identifying novel applications of dialectical behavior therapy: considering emotion regulation and parenting.

Dialectical behavior therapy (DBT) is an effective treatment for an increasing number of mental disorders. Its increased application to a range of disorders has been prompted by the recognition that DBT targets emotion dysregulation, which is a transdiagnostic feature underlying several forms of psychopathology. More recently, DBT has been used to target additional clinically relevant domains that are outside diagnostically bound categories, such as improving parenting quality as a means of preventing psychopathology in children of parents with psychopathology. As the ability to regulate emotions is critical to parenting, this paper uses the connection between DBT, emotion regulation, and parenting as an illustration of how focusing on mechanistic features by which DBT is effective aids in strategically identifying areas by which DBT may be a highly useful treatment option.

In the spirit of full disclosure: Maternal distress, emotion validation, and adolescent disclosure of distressing experiences.

The purpose of the current study was to investigate the dynamic process of disclosure within the adolescent-mother relationship by examining how maternal personal distress and validation of adolescent negative affect would be related to adolescent disclosure of a distressing experience for the first time. A community sample of 66 mothers and their adolescent children (M = 14.31 years, 58% female) participated. The adolescents disclosed an emotionally distressing experience to their mothers for the first time. Mothers' validating behaviors and personal distress in response to their adolescents' expressions of negative emotion were predictive of adolescent disclosure. Adolescents made less detailed or substantive disclosures to their mothers when adolescents perceived their mothers as less validating of their negative emotions and when mothers were more likely to become distressed themselves. Neither adolescent-perceived maternal invalidation nor observed maternal validating or invalidating behaviors were related to adolescent disclosure. Maternal personal distress was further indirectly associated with less substantive disclosures through less maternal validation of negative emotion. These findings provide the foundation for future research evaluating clinical interventions targeted at increasing mothers' emotion regulation skills and validation of children's negative emotions. Such interventions may provide an effective way to promote better mother-adolescent communication, especially in regard to distressing experiences. (PsycINFO Database Record

Overwhelmed by Emotion: Pathways from Revictimization to Mothers' Negative Emotional Responsivity.

Maternal history of childhood abuse has consistently been linked to increased risk for poor emotional adjustment and parenting as an adult. The aim of this study was to examine a model that may explain the link between maternal history of childhood abuse and mothers' tendencies to respond negatively to their adolescent children's negative emotions. A community sample of 66 mothers with adolescent children participated. Path analysis supported associations between mothers with a history of high betrayal trauma revictimization (i.e., trauma perpetrated by someone close to the mother during childhood and again as a young adult) and increased difficulty regulating their emotions. In turn, mothers who struggled to regulate their own emotions were also more likely to respond negatively to their adolescent's negative emotions. Findings highlight effects of childhood trauma may be particularly problematic for mothers who are revictimized as young adults. These results provide the foundation for future research evaluating clinical interventions targeted at increasing maternal emotion regulation skills.

Linking typologies of childhood adversity to adult incarceration: Findings from a nationally representative sample.

Ecologically valid typologies of adverse child experiences (ACEs) were identified to investigate the link between ACEs and adult incarceration. In a nationally representative sample (N = 34,653, age 20+), latent class analysis (LCA) was conducted with childhood maltreatment (physical, sexual, and emotional abuse, interpersonal violence [IPV] exposure, physical neglect) and caregiver maladjustment (substance use, incarceration, mental illness, and suicidal behavior) indicators. LCA identified a 5-typology model (1. Low Adversity Risk; 2. Caregiver Substance Use, and Maltreatment Acts of Omission; 3. Physical and Emotional Maltreatment; 4. Severe Cross-Subtype Maltreatment and Caregiver Substance Use; and 5. Caregiver Maladjustment). Controlling for sociodemographics and substance use problems, logistic regression analyses determined that, compared with the Low Adversity Risk typology, all typologies (except Caregiver Maladjustment) had elevated incarceration risk (adjusted odds ratios: 1.76­4.18). Maltreatment experiences were more predictive of incarceration for women versus men. Childhood maltreatment confers risk for incarceration beyond established risk factors, but caregiver maladjustment, alone, does not. Preventative efforts should focus on understanding and targeting pathways to delinquency for individuals with childhood maltreatment.

Differential sensitization of parenting on early adolescent cortisol: Moderation by profiles of maternal stress.

The hypothalamic-pituitary-adrenal (HPA) axis is a critical component of the body's stress-response neurobiological system, and its development and functioning are shaped by the social environment. Much of our understanding of the effects of the caregiving environment on the HPA axis is based on (a) parenting in young children and (b) individual maternal stressors, such as depression. Yet, less is known about how parenting behaviors and maternal stressors interact to influence child cortisol regulation, particularly in older children. With an ethnically diverse sample of 199 mothers and their early adolescent children (M=11.00years; 54% female), a profile analytic approach was used to investigate how multiple phenotypes of maternal stress co-occur and moderate the relation between parenting behaviors and youths' diurnal cortisol rhythms. Latent profile analysis yielded 4 profiles: current parenting stress, concurrent parenting and childhood stress, childhood stress, and low stress. For mothers with the concurrent parenting and childhood stress profile, inconsistent discipline, poor parental supervision, and harsh caregiving behaviors each were related to flattened diurnal cortisol rhythms in their adolescents. For mothers with the current parenting stress and childhood stress profiles, their use of inconsistent discipline was associated with flattened diurnal cortisol rhythms in their adolescents. For mothers with the low stress profile, none of the parenting behaviors was related to their adolescents' cortisol regulation. Findings suggest that based on mothers' stress profile, parenting behaviors are differentially related to youths' diurnal cortisol rhythms. Implications for parenting interventions are discussed.

Systemic trauma.

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

Child diurnal cortisol rhythms, parenting quality, and externalizing behaviors in preadolescence.

This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9-12 year old children. Replicating extensive prior research, our analyses revealed that parents' inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring.

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.

Risk for maternal harsh parenting in high-risk families from birth to age three: does ethnicity matter?

Child maltreatment prevention programs typically identify at-risk families by screening for risk with limited consideration of how risk might vary by ethnicity. In this study, longitudinal data from mothers who participated in a randomized clinical trial of a home-visitation, child maltreatment prevention program (N = 262) were examined to determine whether risk for harsh parenting differed among mothers who identified themselves as Spanish-speaking Latinas (n = 64), English-speaking Latinas (n = 102), or non-Latina Caucasians (n = 96). The majority of the participants were first-time mothers (58.4%), and the average age of all participants was 23.55 years (SD = 6.04). At the time of their infants' births, the Spanish-speaking Latina mothers demonstrated higher SES risk, whereas the English-speaking Latina and non-Latina Caucasian mothers demonstrated higher psychosocial risk. Three years later, the English-speaking Latina and non-Latina Caucasian mothers reported harsher parenting behaviors than the Spanish-speaking Latina mothers. The need for prevention programs to consider how risk and protective factors differ by ethnic group membership when identifying at-risk mothers is discussed.

The development of a community-based family asthma management intervention for Puerto Rican children.

BACKGROUND: Puerto Rican children maintain disproportionately high asthma prevalence rates and effective asthma management interventions are needed. OBJECTIVES: This article describes how community-based participatory research (CBPR) was implemented in the development of a culturally tailored family asthma management intervention for Puerto Rican children: CALMA (a Spanish acronym for Take Control, Empower Yourself, and Achieve Asthma Management). METHOD: CALMA was developed according to CBPR principles and contemporary asthma guidelines through the collaboration of diverse members of the local, professional, and medical communities, academia, and local government. All group members contributed unique perspectives, making CALMA's development a collaborative effort. LESSONS LEARNED: The CALMA community dealt with challenges in both incorporating and managing a diverse group of stakeholders and maintaining equity in decision making power. However, the community maintained strengths, such as incorporating culturally accepted remedies and addressing culturally specific myths in the intervention, as well as having the medical community directly involved in overseeing the accuracy of the intervention. CONCLUSION: A CBPR approach enhanced the cultural sensitivity of the intervention as well as its potential for sustainability.