Parental linguistic content and distancing predict beliefs about emotion and child emotion regulation.

ABSTRACTEmploying a constructionist framework of emotion, this study examines whether parental language during emotion belief discussions predicts parents' self-reported beliefs about emotion and child emotion regulation (ER). 102 parents of children ages 8 through 12 participated in focus groups about emotion beliefs, and nine months later, completed questionnaires on their emotion beliefs and child ER. Focus group content was analyzed for positive and negative emotion talk, cognitive process talk, and an established linguistic marker of psychological distancing. Parents' positive emotion talk and parental linguistic distancing when discussing their child's (but not their own) emotion experiences positively predicted beliefs about children's emotional capabilities. Finally, negative emotion talk negatively predicted parental beliefs about children's capacity to control their own emotions and the value of anger expression as well as child ER. Current findings contribute to our understanding of how parental communication patterns about emotions may influence emotion beliefs and child emotion development.

Is respiratory sinus arrhythmia a modifiable index of symptom change in cognitive behavioral therapy for youth? A pooled-data analysis of a randomized trial.

OBJECTIVE: We evaluated whether respiratory sinus arrhythmia (RSA) reactivity and resting RSA-physiological markers reflecting the increase in heart rate with inspiration and decrease during expiration related to parasympathetic influence on the heart-are modifiable and predict symptom change during youth psychotherapy. Methods: Diverse youth (N = 158; ages 7-15; 48.1% female) received the Modular Approach to Therapy for Children and completed pre-treatment (pre), post-treatment (post), and 18-months postbaseline (18Mo) assessments. We measured resting RSA, RSA reactivity during stress induction, and psychopathology symptoms. Results: Pre-to-post and pre-to-18Mo, reactivity decreased, and resting RSA increased. Changes in reactivity and resting RSA, separately, did not predict reduced psychopathology. Yet, decreased reactivity combined with increased resting RSA predicted reduced psychopathology over time, suggesting that observed RSA changes were beneficial for some. Higher dosage of a module utilizing slow-breathing, muscle-relaxation, and imagery predicted greater pre-to-18Mo changes in reactivity and resting RSA, whereas a similar module with less emphasis on slow-breathing did not. Conclusions: Findings raise the possibility that youth reactivity and resting RSA could be modifiable during cognitive behavioral therapy and contribute to the amelioration of psychopathology. More studies are needed to determine whether resting RSA and RSA reactivity are modifiable indices of symptom change in slow-breathing practices and psychotherapy. CLINICALTRIALS.GOV IDENTIFIER: NCT03153904, registered May 15, 2017.

Feasibility, Acceptability, and Usability of Physiology and Emotion Monitoring in Adults and Children Using the Novel Time2Feel Smartphone Application.

The present study tests the feasibility, acceptability, and utility of the novel smartphone application-Time2Feel-to monitor family members' emotional experiences, at the experiential and physiological level, and their context. To our knowledge, Time2Feel is the first of its kind, having the capability to monitor multiple members' emotional experiences simultaneously and survey users' emotional experiences when experiencing an increase in physiological arousal. In this study, a total of 44 parents and children used Time2Feel along with the Empatica E4 wrist-wearable device for 10 days. Engagement rates were within the acceptable range and consistent with previous work using experience sampling methods. Perceived ease of use and satisfaction fell mostly in the moderate range, with users reporting challenges with connectivity. We further discuss how addressing connectivity would increase acceptability. Finally, Time2Feel was successful at identifying physiological deviations in electrodermal activity for parents and children alike, and even though responses to those deviation-generated surveys were largely consistent with random survey responses, some differences were noted for mothers and fathers. We discuss the implications of using Time2Feel for understanding families' emotional and stressful experiences day-to-day.

Typologies of Non-Suicidal Self-Injury Functions and Clinical Correlates Among Inpatient Youth.

This study identified typologies of specific non-suicidal self-injury (NSSI) functions among youth admitted for psychiatric hospitalization and investigated clinically relevant correlates. Inpatient youth (n = 68) aged 10-17 years reported on their reasons to engage in NSSI, frequency and severity of NSSI, and symptoms of borderline personality disorder (BPD). A latent class analysis using youth's specific NSSI functions as indicators found two NSSI function typologies, which were differentially associated with clinical correlates. The Multiple Functions class (n = 28) endorsed to "feel something," "punish self," "escape feelings," "relieve anxiety," "stop feeling self-hatred," "stop feeling angry," "show much they are hurting," and "create a hurt that can be soothed." Conversely, the Single/Avoidant Function class (n = 40) endorsed one primary function-i.e., to "escape feelings." Youth in the Multiple Functions class reported significantly more frequent self-injury and greater BPD symptomology. The present study illustrates the importance of examining constellations of specific NSSI functions in inpatient care settings, given their unique associations with NSSI frequency and features of BPD. These findings could inform targeted psychological screening and, in turn, guide the implementation of interventions for elevated NSSI frequency and BPD symptomology among inpatient youth, based on NSSI functions endorsed.

Evaluating a Modular Approach to Therapy for Children With Anxiety, Depression, Trauma, or Conduct Problems (MATCH) in School-Based Mental Health Care: Study Protocol for a Randomized Controlled Trial.

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH) on students' mental health and academic outcomes. Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five school districts. School clinicians are randomized to either MATCH or usual care (UC) treatment conditions. The target sample includes 168 youths (ages 7-14) referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health. Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board (IRB14-3365). We plan to publish the findings in peer-reviewed journals and present them at academic conferences. Clinical Trial Registration: ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016.

A systematic review of the effectiveness of behavioural treatments for pica in youths.

Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.

Clinician training, then what? Randomized clinical trial of child STEPs psychotherapy using lower-cost implementation supports with versus without expert consultation.

OBJECTIVE: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes? METHOD: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7-15 years, M = 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n = 101) or CLC (n = 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on multiple clinical outcomes using standardized measures (e.g., Child Behavior Checklist, Youth Self-Report) and idiographic problem ratings (Top Problems Assessment). RESULTS: Coding of therapy sessions revealed substantial therapist adherence to MATCH in both conditions, with significantly stronger adherence in CLC; however, LC and CLC did not differ significantly in MATCH competence. Trajectories of change on all outcome measures were steep, positive, and highly similar for LC and CLC youths, with no significant differences; a supplemental analysis of posttreatment outcomes also showed similar LC and CLC posttreatment scores, with most LC-CLC differences nonsignificant. CONCLUSIONS: The findings suggest that effective implementation of a complex intervention in clinical practice may be supported by procedures that are less costly and logistically challenging than expert consultation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Cascade Effect of Parent Dysfunction: An Emotion Socialization Transmission Framework.

The current study tested a preliminary cascade model of parent dysfunction-i.e., internalizing psychopathology and emotion dysregulation-whereby parent dysfunction is transmitted to children through the impact of parental emotion socialization on child emotion regulation. Participants were 705 mothers (M age = 36.17, SD = 7.55) and fathers (M age = 35.43, SD = 6.49) of children aged 8 to 12 years who self-reported on their internalizing psychopathology, emotion regulation difficulties, and emotion socialization practices, and on their child's internalizing psychopathology and emotion regulation. Using a split sample method, we employed a data-driven approach to develop a conceptual model from our initially proposed theoretical model with the first subsample (n = 352, 51% mothers), and then validated this model in a second subsample (n = 353, 49% mothers). Results supported a model in which the transmission of dysfunction from parent to child was sequentially mediated by unsupportive parental emotion socialization-but not supportive parental emotion socialization-and child emotion dysregulation. The indirect effects from the final model did not differ by parent gender. Findings provide preliminary support for a mechanism by which maternal and paternal internalizing psychopathology and emotion dysregulation disrupt parental emotion socialization by increasing unsupportive emotion socialization practices, which impacts children's development of emotion regulation skills and risk for internalizing psychopathology.

Meta-analysis of the effectiveness of the Trier Social Stress Test in eliciting physiological stress responses in children and adolescents.

The Trier Social Stress Test (TSST) is known to reliably induce physiological stress responses in adult samples. Less is known about its effectiveness to elicit these responses in youth samples. We performed a meta-analysis of stress responses to the TSST in youth participants. Fifty-seven studies were included representing 5026 youth participants. Results indicated that the TSST was effective at eliciting stress responses for salivary cortisol (sCort; effect size [ES] = 0.47, p = 0.006), heart rate (HR; ES = 0.89, p < 0.001), pre-ejection period (PEP; ES = -0.37, p < 0.001), heart rate variability (HRV; ES = -0.33, p = 0.028), and systolic blood pressure (ES = 1.17, p < 0.001), as well as negative affect (ES = 0.57, p = 0.004) and subjective anxiety (ES = 0.80, p = 0.004) in youth samples. Cardiac output (ES = 0.15, p = 0.164), respiratory sinus arrhythmia (ES = -0.10, p = 0.064), and diastolic blood pressure (ES = 2.36, p = 0.072) did not reach statistical significance. Overall, effect sizes for the TSST varied based on the physiological marker used. In addition, several physiological markers demonstrated variance in reactivity by youth age (sCort, HR, HRV, and PEP), gender (sCort), type of sample (i.e., clinical versus community sample; sCort and HR), duration of TSST (sCort, HR, HRV, negative affect, and subjective anxiety), number of judges present in TSST (HR and subjective anxiety), gender of judges (sCort), and time of day the marker was assessed (morning versus afternoon/evening; sCort). Overall, the findings provide support for the validity of the TSST as a psychosocial stressor for inducing physiological and psychological stress responses in children and adolescents, but also highlight that some markers may capture the stress response more effectively than others.

Development and Validation of the Parents' Gendered Emotion Beliefs Scale.

OBJECTIVES: The aim of the current research was to develop and validate a parent, self-report questionnaire to measure parents' gendered beliefs about emotion. METHODS: Scale items were first developed based on a previous qualitative study examining emotions, parenting, and gender in a sample of parents. The Parents' Gendered Emotion Beliefs scale (PGEB) was validated in a sample of 704 parents of middle childhood youth. RESULTS: Item-response theory analyses indicated a three-factor solution with factors measuring beliefs consistent with: gendered emotion expression, gender-neutral emotion expression, and gendered emotion socialization. All factors showed good internal consistency with alphas ranging from 0.79 to 0.90. Analyses then examined convergent validity by correlating PGEB factors to established measures of broad emotion beliefs, emotion socialization, family expressiveness, and child emotion regulation and psychopathology. CONCLUSIONS: Overall, findings support the PGEB, its factor structure and psychometric properties, and its potential to contribute to our understanding of the role of gender in emotion socialization and children's emotional development.

Efficient Monitoring of Treatment Response during Youth Psychotherapy: The Behavior and Feelings Survey.

An emerging trend in youth psychotherapy is measurement-based care (MBC): treatment guided by frequent measurement of client response, with ongoing feedback to the treating clinician. MBC is especially needed for treatment that addresses internalizing and externalizing problems, which are common among treatment-seeking youths. A very brief measure is needed, for frequent administration, generating both youth- and caregiver-reports, meeting psychometric standards, and available at no cost. We developed such a measure to monitor youth response during psychotherapy for internalizing and externalizing problems. Across 4 studies, we used ethnically diverse, clinically relevant samples of caregivers and youths ages 7-15 to develop and test the Behavior and Feelings Survey (BFS). In Study 1, candidate items identified by outpatient youths and their caregivers were examined via an MTurk survey, with item response theory methods used to eliminate misfitting items. Studies 2-4 used separate clinical samples of youths and their caregivers to finalize the 12-item BFS (6 internalizing and 6 externalizing items), examine its psychometric properties, and assess its performance in monitoring progress during psychotherapy. The BFS showed robust factor structure, internal consistency, test-retest reliability, convergent and discriminant validity in relation to three well-established symptom measures, and slopes of change indicating efficacy in monitoring treatment progress during therapy. The BFS is a brief, free youth- and caregiver-report measure of internalizing and externalizing problems, with psychometric evidence supporting its use for MBC in clinical and research contexts.

Development and Validation of the Praise, Indulgence, and Status Parenting Scale.

The overarching aim of this study was to develop and validate a new scale (i.e., the Praise, Indulgence, and Status Parenting Scale [PISPS]) to measure modern parenting practices and behaviors consistent with instilling ideals of specialness (i.e., the notion that one is special), self-esteem, and status in children. In 2 studies on emerging adults (Study 1: N = 582, M age = 19.46; Study 2: N = 464, M age = 19.58), the PISPS was developed and validated using classical test theory (Study 1) and further refined using item-response theory (Study 2). Results from both studies indicated a 3-factor structure with factors differentially linked with correlates of interest including parenting strategies, self-esteem, narcissism, entitlement, and internalizing symptoms. Study 3 further validated the PISPS in a sample of parents (N = 638, M age = 35.79) reporting on their parenting and their child's emotion regulation and symptoms of psychopathology. Overall, findings support the PISPS, its psychometric properties, and its unique contribution to child symptoms.

Practitioners' Use and Evaluation of Transdiagnostic Youth Psychotherapy Years After Training and Consultation Have Ended.

We examined practitioners' use of the transdiagnostic Modular Approach to Therapy for Children (MATCH) 7 years after learning MATCH for a clinical trial. The practitioners (N = 29; Mage = 52.10, SD = 12.29, 86% women, 97% white) reported using MATCH with 55% of their caseload; use of the various MATCH modules ranged from 39 to 70%. Use was positively associated with amount of MATCH experience in the trial, perceived effectiveness, and ease of implementation. Patterns of specific module use did not consistently match strength of prior evidence (e.g., exposure was least used of the anxiety modules), suggesting challenges for implementation science.

When the torch is passed, does the flame still burn? Testing a "train the supervisor" model for the Child STEPs treatment program.

OBJECTIVE: We assessed sustainability of an empirically supported, transdiagnostic youth psychotherapy program when therapist supervision was shifted from external experts to internal clinic staff. METHOD: One hundred sixty-eight youths, aged 6-15 years, 59.5% male, 85.1% Caucasian, were treated for anxiety, depression, traumatic stress, or conduct problems by clinicians employed in community mental health clinics. In Phase 1 (2.7 years), 1 group of clinicians, the Sustain group, received training in Child STEPs (a modular transdiagnostic treatment + weekly feedback on youth response) and treated clinic-referred youths, guided by weekly supervision from external STEPs experts. In Phase 2 (2.9 years), Sustain clinicians treated additional youths but with supervision by clinic staff who had been trained to supervise STEPs. Also in Phase 2, a new group, External Supervision clinicians, received training and supervision from external STEPs experts and treated referred youths. Phase 2 youths were randomized to Sustain or External Supervision clinicians. Groups were compared on 3 therapist fidelity measures and 14 clinical outcome measures. RESULTS: Sustain clinicians maintained their previous levels of fidelity and youth outcomes after switching from external to internal supervision; and in Phase 2, the Sustain and External Supervision groups also did not differ on fidelity or youth outcomes. Whereas all 34 group comparisons were nonsignificant, trends with the largest effect sizes showed better clinical outcomes for internal than external supervision. CONCLUSIONS: Implementation of empirically supported transdiagnostic treatment may be sustained when supervision is transferred from external experts to trained clinic staff, potentially enhancing cost-effectiveness and staying power in clinical practice. (PsycINFO Database Record

A Review of Behavioral Observation Coding Approaches for the Trier Social Stress Test for Children.

The Trier Social Stress Test (TSST) has become one of the most widely-used protocols for inducing moderate psychosocial stress in laboratory settings. Observational coding has been used to measure a range of behavioral responses to the TSST including performance, reactions to the task, and markers of stress induced by the task, with clear advantages given increased objectivity of observational measurement over self-report measures. The current review systematically examined all TSST and TSST-related studies with children and adolescents published since the original work of Kirschbaum et al. (1993) to identify behavioral observation coding approaches for the TSST. The search resulted in 29 published articles, dissertations, and master's theses with a wide range of coding approaches used. The take-home finding from the current review is that there is no standard way to code the Trier Social Stress Test for Children (TSST-C), which appears to stem from the uniqueness of investigators' research questions and sample demographics. This lack of standardization prohibits conclusive comparisons between studies and samples. We discuss relevant implications and offer suggestions for future research.

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

Profiles of Emotion Deficits and Adolescent Nonsuicidal Self-Injury in an Inpatient Sample.

This study examined profiles of specific emotion deficits, including poor emotion awareness, reluctance to express emotion, sadness inhibition and dysregulation, and anger inhibition and dysregulation. Self-report questionnaires assessed adolescents' emotion skills and nonsuicidal self-injury (NSSI) engagement, frequency, severity, methods, and age of onset. Latent profile analysis yielded a three-profile solution: Low Deficit (LD; n = 49), Unaware/Anger Dysregulated (UAD; n = 24), and Anger Inhibited (AI; n = 20) profiles. Adolescents in the UAD profile were more likely to engage in NSSI, displayed a higher NSSI frequency, and reported a higher number of NSSI methods when compared to adolescents in the LD profile. No links emerged for NSSI severity or age of onset.

Specific coping strategies moderate the link between emotion expression deficits and nonsuicidal self-injury in an inpatient sample of adolescents.

BACKGROUND: Non-suicidal self-injury (NSSI) is a behavior of increasing prevalence in adolescents with links to various negative mental health and adjustment outcomes. Poor emotion expression has been linked with NSSI use, whereas the use of adaptive coping strategies has been identified as a protective factor against NSSI. The current study examined whether specific coping strategies moderate the relation between poor emotion expression and NSSI, and whether moderation is conditional on adolescent gender. METHODS: Ninety-five adolescents hospitalized on an acute care inpatient psychiatric unit completed questionnaires measuring NSSI, emotion expression and use of specific coping strategies (i.e., problem-focused coping, positive reframing coping, support seeking, avoidance, and distraction). RESULTS: Results indicated that poor emotion expression was positively associated with NSSI. Positive reframing and support seeking emerged as significant moderators of the poor emotion expression-NSSI link. This result was not conditional upon adolescent gender. Problem-focused coping, avoidance, and distraction did not emerge as significant moderators. CONCLUSIONS: Encouraging youth to use particular coping strategies might protect against the negative impact of emotion expression deficits for both boys and girls.

Preschoolers' genetic, physiological, and behavioral sensitivity factors moderate links between parenting stress and child internalizing, externalizing, and sleep problems.

This study examined three potential moderators of the relations between maternal parenting stress and preschoolers' adjustment problems: a genetic polymorphism-the short allele of the serotonin transporter (5-HTTLPR, ss/sl allele) gene, a physiological indicator-children's baseline respiratory sinus arrhythmia (RSA), and a behavioral indicator-mothers' reports of children's negative emotionality. A total of 108 mothers (Mage = 30.68 years, SDage = 6.06) reported on their parenting stress as well as their preschoolers' (Mage = 3.50 years, SDage = 0.51, 61% boys) negative emotionality and internalizing, externalizing, and sleep problems. Results indicated that the genetic sensitivity variable functioned according to a differential susceptibility model; however, the results involving physiological and behavioral sensitivity factors were most consistent with a diathesis-stress framework. Implications for prevention and intervention efforts to counter the effects of parenting stress are discussed.

Coparental Affect, Children's Emotion Dysregulation, and Parent and Child Depressive Symptoms.

Children's emotion dysregulation and depressive symptoms are known to be affected by a range of individual (parent, child) and systemic (parent-child, marital, and family) characteristics. The current study builds on this literature by examining the unique role of coparental affect in children's emotion dysregulation, and whether this association mediates the link between parent and child depressive symptoms. Participants were 51 mother-father-child triads with children aged 7 to 12 (M age = 9.24 years). Triads discussed a time when the child felt sad and a time when the child felt happy. Maternal and paternal displays of positive affect were coded, and sequential analyses examined the extent to which parents were congruent in their displays of positive affect during the emotion discussions. Results indicated that interparental positive affect congruity (IPAC) during the sadness discussion, but not the happiness discussion, uniquely predicted parent-reported child emotion dysregulation, above and beyond the contributions of child negative affect and parental punitive reactions. The degree of IPAC during the sadness discussion and child emotion dysregulation mediated the association between maternal, but not paternal, depressive symptoms and child depressive symptoms. Findings highlight the unique role of coparental affect in the socialization of sadness in youth and offer initial support for low levels of IPAC as a risk factor for the transmission of depressive symptoms in youth.