Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service.

Parent-Child Interaction Therapy (PCIT) is an intensive parent support program for caregivers and their children who exhibit difficult-to-manage disruptive behaviors. After more than four decades of research supporting its efficacy for reducing children's disruptive behaviors and improving parent-child relationships, PCIT has become one of the most popular and widely disseminated parenting support programs in the world. The evidence for the efficacy of PCIT can be found in many reviews of randomized clinical trials and other rigorous studies. To add to those reviews, our aim was to provide practical guidance on how PCIT can be part of an evidence-based program for families that depends on practitioner expertise, as well as attention to families' diverse needs. To do this, we describe the evolution of PCIT as practiced in a university-community partnership that has continued for over 20 years, alongside a narrative description of selected and recent findings on PCIT and its use in specific client presentations across four themes. These themes include studies of 1) whether the standard manualized form of PCIT is efficacious across a selection of diverse family situations and child diagnoses, 2) the mechanisms of change that explain why some parents and some children might benefit more or less from PCIT, 3) whether treatment content modifications make PCIT more feasible to implement or acceptable to some families, at the same time as achieving the same or better outcomes, and 4) whether PCIT with structural modifications to the delivery, such as online or intensive delivery, yields similar outcomes as standard PCIT. Finally, we discuss how these directions in research have influenced research and practice, and end with a summary of how the growing attention on parent and child emotion regulation and parents' responses to (and coaching of) their children's emotions has become important to PCIT theory and our practice.

The Circle of Security Parenting Program (COS-P): A Randomized Controlled Trial of a Low Intensity, Individualized Attachment-Based Program With at-Risk Caregivers.

The Circle of Security-Parenting Intervention (COS-P; Cooper et al., 2009) is a psychoeducational program for caregivers of young children that has been widely disseminated. The program is founded in attachment theory and relies on computer-delivered content and parent reflection and discussion to teach concepts of safety and security to promote better caregiver-child relationships and child wellbeing. The present study is a randomized controlled trial of COS-P, individually delivered to 85 Australian caregivers (51 COS-P, 34 waitlist control) who reported parenting distress and child disruptive behaviors. Caregivers completed a baseline assessment and repeated the assessment after completion of COS-P or 8 weeks on the waitlist. Caregivers completed surveys to report child symptoms, and parenting stress, anxious and avoidant attachment, reflective functioning, parenting practices, and depressive symptoms. No differences in COS-P vs. waitlist participants were found at baseline. Analyses of complete data (35 COS-P, 25-26 waitlist) revealed a greater decline in caregivers' attachment anxiety and negative parenting relative to waitlist, but only attachment anxiety in intent-to-treat analyses. Other improvements were found, but these extended to both the COS-P and waitlist conditions and did not differ between conditions. Overall, effects of COS-P were small and rarely significant, suggesting the need to consider alternative programs that have evidence of effectiveness when providing services to at-risk families.

Peer relationships and stress: Indirect associations of dispositional mindfulness with depression, anxiety and loneliness via ways of coping.

INTRODUCTION: Adolescents higher in the trait of dispositional mindfulness report fewer socioemotional problems. Focusing on the domain of peer stressors, we tested a model of adolescents' mindfulness as a resource that undergirds more constructive stress coping responses, in turn resulting in fewer socioemotional problems. METHOD: The participants were 361 Australian secondary school students (40% boys; ages 11 to 18; M = 14.9 years; SD = 1.4). Each completed a questionnaire to report four facets of dispositional mindfulness; engagement and disengagement coping and involuntary stress responses to recent peer interpersonal stressful events; and socioemotional problems of loneliness, social anxiety, and depression. RESULTS: Adolescents who reported more dispositional mindfulness, including facets of awareness, describing, non-judgement and non-reactivity, were lower in involuntary peer stress responses, disengagement coping, loneliness, social anxiety, and depression; associations of mindfulness facets with engagement coping were mixed. Mediational path models showed that almost all the significant negative associations of dispositional mindfulness with loneliness, social anxiety and depression were fully indirect via peer stress coping responses. Further, an alternative model, which tested whether loneliness, social anxiety and depression were the instigators of stress coping responses via mindfulness, had an adequate but poorer fit. CONCLUSION: As hypothesized, the benefit of adolescents' dispositional mindfulness for reducing loneliness, social anxiety and depression seems to be indirect, with positive peer stress coping responses key mediators in these indirect pathways. It is less likely that the alternative occurs, whereby adolescents' socioemotional problems are the foundation for mindfulness and peer stress coping responses.

Unique associations of social media use and online appearance preoccupation with depression, anxiety, and appearance rejection sensitivity.

Social media (SM) can create a climate of social comparison and preoccupation with appearance, which can pose risks for emotional problems, such as depression and social anxiety. In this study, 763 adolescents and young adults reported time spent and intensity of social media use and preoccupation with both general and appearance-related (AR) social media activities and content. Associations were investigated with markers of depression and social anxiety symptoms and appearance sensitivities - appearance anxiety and appearance rejection sensitivity (appearance-RS). Social media use was positively associated with symptoms of depression, social anxiety, appearance anxiety, and appearance-RS. General and AR preoccupation had unique and positive associations with depression and social anxiety symptoms and with appearance sensitivities. AR preoccupation was also found to strengthen the relationship between time spent on social media and appearance-RS. Although there were gender differences on all measures, with young women scoring higher on all measures, there was no evidence that gender moderated the effects of AR social media preoccupation. Findings support emerging evidence that social media engagement and behavior, particularly activities involving appearance comparisons and judgements, may be more of a risk to depression and social anxiety symptoms and appearance sensitivities than simply the frequency of social media use.

Attachment and emotion regulation: A person-centred examination and relations with coping with rejection, friendship closeness, and emotional adjustment.

Guided by attachment theory of emotion regulation (ER), the current study utilized a person-centred approach to identify clusters of individuals that differed in their attachment representations and ER, and further examined individual differences in socio-emotional functioning based on these profiles. Participants included 658 emerging adults (M = 19.9, SD = 2.7, 65.5% female) who completed surveys measuring responses to rejection, friendship closeness, and emotional maladjustment. Five clusters were identified: secure regulated (19%), disorganized unregulated (21%), anxious unregulated (16%), emotive (21%), and avoidant suppressor (22%). Each group displayed unique patterns, with the secure regulated group reporting significantly less withdrawal, retribution, rumination, and emotional maladjustment, and the disorganized unregulated group reporting the poorest functioning across all indicators. Significant cluster × sex effects were also found for friendship closeness. These findings suggest the importance of considering attachment and ER, and implications for attachment theory and development are discussed. Statement of contribution What is already known on this subject? Insecure attachment representations are a significant risk factor for poorer outcomes across development. Hyperactivating and deactivating strategies are maladaptive responses to coping with emotional threat. These strategies are an extension of the internal working model and positive correlates of poorer functioning. What does this study add? Previous studies have over-relied on variable-centred approaches to replicate findings of attachment theory. A person-centred approach allowing for the joint consideration of patterns of both attachment and ER strategies. The identification of five novel profiles revealing unique differences in three important domains of functioning.