Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example.

Concerns regarding parent mental health and well-being during the COVID-19 pandemic are justifiably on the rise. Although anxiety, depression, and traumatic stress levels have risen precipitously across all demographics during the pandemic, parents residing with their children are under particular and unique strain. Caregivers with children in the home are responsible not only for their own health, financial security, and safety during this time, but often full-time caregiving, household management and, in many cases, their children's schooling. In this case paper, we describe the development of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Caregivers (UP-Caregiver) and provide a case example of its implementation. This 4-session indicated prevention for caregivers is a modification of existing versions of the Unified Protocols for adults and children, modified to maximize its responsiveness to issues faced by parents and caregivers living with youth (ages 6-13) during the current pandemic. UP-Caregiver was offered as part of a randomized, controlled trial via telehealth in a small group format to any parent with a child in the specified age range with mild or greater anxiety, depression or traumatic stress symptoms during an initial screening. The case example provided is of a White, Hispanic mother with a range of self-reported emotional disorder concerns at an initial assessment. Declines in anxiety, depression and traumatic stress symptoms were all noted, as well as improvements in parenting self-efficacy and distress tolerance 6-weeks after initiating UP-Caregiver. An ongoing randomized, controlled trial of UP-Caregiver will further evaluate the utility and feasibility of this approach to alleviate parental distress during COVID-19.

Transdiagnostic cognitive behavioral therapy for misophonia in youth: Methods for a clinical trial and four pilot cases.

BACKGROUND: Misophonia is a condition marked by dysregulated emotions and behaviors in response to trigger sounds, often chewing, breathing, or coughing. Evidence suggests that misophonia develops in adolescence and the emotions and behaviors are a conditioned response to distress, resulting in social avoidance, stress, and family conflict. In addition, co-occurrence with other psychiatric illnesses such as anxiety, OCD, and Tourette syndrome is common. A transdiagnostic cognitive behavioral therapeutic (CBT) approach appears appropriate. There are currently no controlled studies of youth with misophonia. The current paper describes the approach to a pilot randomized, blinded family-based treatment study for youth ages 8-16 years. Preliminary results from a pilot open trial also are described. METHODS: A 2-phase dual site telehealth treatment study using a transdiagnostic CBT approach, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May et al., 2018), is proposed. Phase 1 consisted of a 4-case pilot of UP-C/A. Phase 2 includes a randomized trial comparing the UP-C/A to a standard relaxation and education protocol. RESULTS: Preliminary results from the pilot show modest improvements in evaluator-rated misophonia symptoms on the Clinical Global Impression Severity and Improvement scales. LIMITATIONS: There is little research to inform evidence-based practice for youth with misophonia. Study limitations include lack of standardized misophonia assessment instruments and an absence of formal diagnostic criteria. CONCLUSIONS: The current paper describes proposed methods for the first randomized controlled trial for youth with misophonia and their families along with results from a 4-case pilot.

Altruistic self-regulation in young children.

We investigated whether children would be willing to sustain delaying their own gratification in order to benefit someone else. We used a modified version of the classic "marshmallow task," in which children must sustain delaying gratification in the presence of the immediate reward for an unspecified amount of time in order to receive a larger reward later. Children were assigned to one of three conditions. In the Self condition, children were given a food item and were told that if they waited to eat it, they would receive a second food item. In the Prosocial condition, children also were given a food item but were told that if they waited to eat their food item, another child would get a food item. In the Nonsocial Control condition, children were given a food item but were told that waiting to eat it would not benefit anyone. We found that children waited significantly longer in both the Self and Prosocial conditions than in the Nonsocial Control condition, and children's wait durations in the Self and Prosocial conditions were not significantly different. Our results suggest that children are willing to engage in effortful self-regulation in order to benefit another child.