Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis.

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p = .006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed.

Psychometric properties of self-report measures of eating disorder cognitions: a systematic review.

BACKGROUND: Although eating disorder (ED) models display some differences in theory and treatment approach, cognitive-behavioural, schema-focused, and disorder-specific models all highlight the fundamental nature of cognitions as key factors in ED development and maintenance processes. As such, it is vital that ED cognitions continue to be assessed and monitored as therapeutic targets and treatment outcomes as well as being examined as constructs in empirical research. This review aimed to systematically identify and evaluate the psychometric properties of existing self-report measures of ED cognitions. METHODS: A systematic review protocol was registered using the international prospective register of systematic reviews (PROSPERO; CRD42023440840). Included studies described the development, validation and/or the psychometric evaluation of a measure (or subscale) that was specifically developed to solely assess ED cognitions (that is thoughts, expectations, assumptions, or beliefs), in English-speaking, adult populations. The search was conducted using three electronic databases: PsycINFO, MedLine, and Embase. Two independent reviewers conducted screening, selection and evaluation of the psychometric properties of relevant measures using a standardised, well-established quality appraisal tool. RESULTS: Of the initial search of 7581 potential studies, 59 met inclusion criteria and described the psychometric evaluation of 31 measures (or subscales) of ED cognitions. The findings from the current review indicate that of the included measures, none currently meet all nine criteria of adequate psychometric properties. The Eating Beliefs Questionnaire (EBQ; and EBQ-18), and the Eating Disorder Inventory Body Dissatisfaction subscale (EDI [BD]) currently possess the most evidence supporting their validity, reliability, and clinical utility. CONCLUSIONS: The findings of the current systematic review provide guidance for future researchers to focus efforts on improving evidence for the validity, reliability and utility of self-report measures of ED cognitions. Overall, the present study has provided a detailed and systematic evaluation to support researchers and clinicians in future selection of measures of ED cognitions dependent on the specific aims of their research and treatment.

Theoretical and empirical research suggests that eating disorder (ED) cognitions (that is, thoughts, expectations, assumptions, and beliefs) are important factors contributing to the development and maintenance of EDs. As such, it is important to continue to assess and monitor these in research and in clinical practice. Valid, reliable and useful assessment tools are critical in this process. This systematic review aimed to identify and evaluate the psychometric properties of existing self-report measures of ED cognitions. Included studies described the development, validation and/or the psychometric evaluation of a measure specifically developed to solely assess ED cognitions. Three electronic databases were searched, and studies screened and selected by two independent reviewers. The included studies and self-report measured were evaluated using a standardised tool to evaluate their psychometric properties. Fifty-nine studies were included, that identified a total of 31 measures (or subscales) assessing ED cognitions. The findings from the current review indicate that none of the included measures currently meet all nine criteria of adequate psychometric properties. The EBQ, EBQ-18, and EDI-III (BD) currently have the most evidence in support of their psychometric properties. This study provides direction for future researchers to focus efforts on improving evidence for the validity, reliability and utility of these self-report measures. Overall, we provided information to support researchers and clinicians in future selection of measures of ED cognitions.

Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes.

There is increasing research interest as to whether Dialectical Behaviour Therapy (DBT), specifically the group skills training component, is an effective early intervention approach when delivered universally in schools. The current study aimed to provide the first large-scale examination of a universal DBT-based intervention and to also determine the extent to which home practice of DBT skills predicted changes in social and emotional outcomes over time. A non-randomised controlled trial design was employed whereby 1071 participants (51.30% Male; M age = 13.48 years) completed either an adapted eight-session DBT skills-training intervention ('WISE Teens) (n = 563) or class-as-per-usual (n = 508). On average, the 'WISE Teens' intervention did not improve outcomes with significant deteriorations or null effects observed across outcomes relative to class-as-per-usual immediately post-intervention. The largest deteriorations were observed for depressive (d = -0.22; 95% CI = -0.35, -0.08) and anxiety symptoms (d = -0.28; 95%CI - = -0.41, -0.14). Applying Bonferroni corrections, most group differences in outcomes had dissipated at follow-up, however, 'WISE Teens' participants continued to report significantly poorer quality of parent-child relationships relative to control (d = .16 for mother (95% CI = 0.01, 0.31); d = 0.17 for father (95% CI = 0.02, 0.33). While home practice was modest on average, further exploratory analyses nevertheless revealed that greater home practice was generally associated with more positive outcomes both immediately post-intervention and at follow-up. Based on these findings, the DBT-based 'WISE Teens' intervention is not recommended in its current format for universal dissemination amongst early adolescents in schools. Further research is needed to determine how to improve engagement and feasibility of delivery of DBT-based interventions universally in this context.

The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis.

Research has demonstrated a strong link between intolerance of uncertainty and generalized anxiety disorder (GAD). The current systematic review and meta-analysis aimed to evaluate how effective evidence-based psychological treatments are at reducing intolerance of uncertainty for adults with GAD. An extensive literature search identified 26 eligible studies, with a total of 1199 participants with GAD. Psychological treatments (k = 32 treatment groups) yielded large significant within-group effect size from pre- to post-treatment and pre-treatment to follow-up for intolerance of uncertainty (g = 0.88; g = 1.05), as well as related symptoms including worry (g = 1.32; g = 1.45), anxiety (g = 0.94; g = 1.04) and depression (g = 0.96; g = 1.00). Psychological treatment also yielded a large significant between-group effect on intolerance of uncertainty (g = 1.35). Subgroups analysis found that CBT that directly targeted intolerance of uncertainty (CBT-IU) throughout treatment was significantly more effective than general CBT at reducing intolerance of uncertainty (p < 0.01) and worry (p < 0.01) from pre- to post treatment, however, this result was not maintained at follow-up. Meta-regression analyses supported this finding as increases in the amount of time spent directly targeting intolerance of uncertainty, significantly increased the effect size for both intolerance of uncertainty (z = 2.01, p < 0.01) and worry (z = 2.23, p < 0.01). Overall, these findings indicate that psychological treatments are effective at reducing IU, and related symptom measures of GAD.

Change Patterns During Family-Based Treatment for Pediatric Obsessive Compulsive Disorder.

Cognitive behavior therapy (CBT) for young people with obsessive compulsive disorder (OCD) has recently been enhanced to target family environment factors. However, the process of change for OCD symptoms and family factors during treatment is not well understood. Uniquely, we explored patterns of change for OCD symptoms and a range of family variables throughout Baseline, Early, Mid, and Late treatment phases of family-based CBT (FCBT) for 15 young people with OCD using multiple informants. We predicted a linear reduction in OCD symptom severity and family accommodation (FA) across treatment phases, however the investigation into other family factor change patterns was exploratory. OCD symptom severity, FA, parental distress tolerance (DT), and conflict all showed significant linear change patterns across treatment phases according to multiple informants. In addition, the largest proportion of change for these variables typically occurred during the first third of treatment, highlighting the importance of identifying participants with and without early gains in future research. Blame also showed a significant linear change pattern, although with small reductions between treatment phases. Preliminary bivariate analyses sought to better understand whether family factor change predicted subsequent OCD severity change or vice versa. Similar patterns emerged across informants, including identification of OCD severity as a significant predictor of change for Blame at subsequent treatment phases. Analyses also showed bi-directional effects for DT and OCD symptoms across informants, where DT predicted OCD severity at subsequent treatment phases and vice versa. These outcomes support further research aimed at understanding the role of family factors in pediatric OCD symptom change.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization.

BACKGROUND: Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals. METHOD: Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style. RESULTS: Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother. CONCLUSION: Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Psychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder.

Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD.

The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short-form (DTS-SF).

OBJECTIVE: Distress tolerance (DT) has been found to be implicated in the development and maintenance of depressive symptomatology and various other significant psychological conditions. As such, it is critical to have measures of DT that are effective and easy to administer. This study aimed to examine the factor structure, psychometric properties, and clinical utility of the Distress Tolerance Scale (DTS) and the short-form version, the Distress Tolerance Scale Short-form (DTS-SF), in a large population of individuals with varying levels of self-reported depressive symptoms. METHOD: A total of 959 participants completed an online battery of questionnaires which included an assessment of depressive symptoms as well as the DTS and related measures. Results: Confirmatory factor analyses validated the four-factor structure of the DTS and the one-factor structure of the DTS-SF. Good construct validity and good internal consistency were observed across both the DTS and DTS-SF. CONCLUSION: Overall, this paper provides new evidence for the validity, reliability and discriminative ability of the DTS and the brief version of the questionnaire, the DTS-SF.

Assessing negative core beliefs in eating disorders: revision of the Eating Disorder Core Beliefs Questionnaire.

BACKGROUND: Increased theoretical and empirical attention has been given to examining the role of core beliefs in both the development and maintenance of eating disorders (EDs). The Eating Disorder Core Beliefs Questionnaire (ED-CBQ) is self-report measure designed to assess five dimensions of core beliefs relating to eating disorders; self-loathing, unassertive/inhibited, demanding/needing help and support, abandoned/deprived, and high standards for the self. The present study aimed to evaluate the psychometric properties of the ED-CBQ and to develop a revised and improved version of the original measure after evaluating its factor structure and related properties. METHODS: A sample of undergraduate university students (N = 763) completed an online test battery of questionnaires. Putative ED-symptomatic (n = 384) and non-ED (n = 379) subgroups were created from self-reported responses from the Eating Disorder Examination Questionnaire (EDEQ). Confirmatory factor analyses (CFAs) were performed, and internal consistency, construct validity, group differences and clinical utility was examined. RESULTS: An initial CFA did not support the original five-factor 40-item ED-CBQ. A revised version was developed that possessed equal or superior psychometric properties to the original 40-item measure. The ED-CBQ-R demonstrated superior model fit, similar levels of reliability and construct validity, and the ability to discriminate between putative ED diagnostic groups. CONCLUSIONS: Our results suggest that the ED-CBQ-R is a valid, reliable, but more importantly an efficient and accessible measure with the potential to be utilised both clinically and in research settings.

In this study, we evaluated and revised the Eating Disorder Core Beliefs Questionnaire (ED-CBQ); a measure designed to assess five areas of core beliefs hypothesised to be relevant to the development and maintenance of a variety of eating disorder presentations. The present study aimed to evaluate the ED-CBQ and to develop a revised and improved version of the original measure after evaluating its factor structure and related properties. We did not find support for the original ED-CBQ, and as such, a revised version was developed that possessed equal or superior properties to the original 40-item measure. The ED-CBQ-R was able to differentiate between eating disorder symptomatic and non-eating disorder groups, and importantly, was a valid, reliable and efficient tool for future clinicians and researchers. This new tool may prove useful in future research when considering the core cognitive features underlying a variety of disordered eating and feeding presentations.

A Mindful Parenting Program for Parents Concerned About Child Internalizing Problems: a Randomized Controlled Feasibility Study.

Objectives: This study sought to establish four aspects of feasibility for a mindful parenting program: demand for the program from parents with concerns regarding their child's internalizing problems, acceptability of the program to those parents, preliminary efficacy, and the likelihood of successful expansion of the program to the intended population. Methods: The study was a pilot, randomized controlled trial comparing a mindful parenting program to waitlist. Participants were parents (N = 25) of children aged 3-18 years, with self-reported concerns regarding their child's internalizing problems, recruited from the community. Demand was assessed using recruitment and adherence rates. Acceptability was assessed using parent-reported usefulness. Preliminary efficacy was assessed using parent reports of child internalizing problems, mindful parenting, parenting stress, cognitive emotion regulation, parental experiential avoidance, and parent beliefs about child anxiety. Intervention group parents also provided weekly in-session data on coping in stressful parenting situations. The likelihood of successful expansion was assessed using qualitative feedback on whether and how the program had helped parents manage child internalizing problems, particularly anxiety. Results: Feasibility was established for the four aspects assessed. The program was well-attended and acceptable to parents. Moderate to large effects were found in favor of the intervention group for most parent and child outcomes. Weekly data showed improved coping in difficult parenting situations. Qualitative feedback suggested that parents believed that increased acceptance and empathy had helped them cope with child internalizing problems. Conclusions: Mindful parenting programs may assist parents of children with internalizing problems to manage parenting stress and emotionally regulate themselves, even in difficult parenting moments. They may also reduce child internalizing problems, through improved parental emotion regulation, and greater acceptance of and empathy for their child. Trial Registration: Australian Clinical Trials Registry, registration number ACTRN12620000690954.

A systematic review of the psychometric properties of death anxiety self-report measures.

Recent research suggests that the transdiagnostic construct of death anxiety may be a basic fear underlying a range of anxiety disorders. Although the investigation of death anxiety in clinical populations is relatively recent, the death anxiety literature as a whole has a longer history evidenced by the number of instruments developed to measure this construct. This systematic review aimed to evaluate the evidence supporting the psychometric properties of self-report death anxiety measures. Relevant studies were identified via a systematic search of four electronic databases in addition to reference list searches. Two independent reviewers evaluated relevant studies using the established Terwee et al. quality appraisal tool. Of the 1831 studies identified, 89 met inclusion criteria. These studies investigated the psychometric properties of 21 self-report scales of death anxiety as well as six subscales. No measure was found to possess evidence of adequacy on all evaluated quality criteria. The Templer Death Anxiety Scale, Concerns about Dying Instrument and Death Concern Scale were found to possess the most evidence supporting their validity and reliability. Overall findings suggest that additional research is needed to establish the psychometric adequacy of death anxiety instruments, especially given increased utilization of these measures in both clinical and research settings.

Measuring state pre-event and post-event rumination in Social Anxiety Disorder: Psychometric properties of the Socially Anxious Rumination Questionnaire (SARQ).

Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.

The impact of alcohol use disorders and alcohol consumption on treatment-seeking individuals with social anxiety disorder.

Comorbid social anxiety and alcohol use disorders (SAD-AUD) in the community and the complex interactions that occur between these disorders have emerged as a significant clinical, public health, and research issue. The authors examined (a) the rates of comorbid SAD-AUD, (b) the impact of comorbid SAD-AUD on outcomes targeting social anxiety disorder, and (c) the effect of pretreatment alcohol consumption and alcohol use before, during, and after social situations on a composite measure of social anxiety in 172 adults presenting with social anxiety disorder. There was low incidence of AUD in this sample of individuals with SAD. Results indicated that alcohol consumption did not lead to worse social anxiety symptoms; however, alcohol use before and during social situations was associated with more severe social anxiety symptoms. These findings suggest that the function of alcohol use may be more important than the overall level of alcohol use and has implications for treatment.

Psychometric properties of the Self-Beliefs related to Social Anxiety (SBSA) scale in a sample of individuals with social anxiety disorder.

The Self-Beliefs related to Social Anxiety (SBSA) scale assesses maladaptive social-evaluative beliefs, a key aspect in models of social anxiety disorder (SAD) that is frequently measured in research and clinical contexts. The SBSA has been evaluated psychometrically in student samples, but not in a large sample of individuals diagnosed with SAD. The current study tested the psychometric properties of the SBSA in a sample of individuals with SAD pooled from several studies (total N = 284). Results showed that the optimal factor structure for the SBSA was a correlated three-factor model (high standard beliefs factor, conditional beliefs factor, unconditional beliefs factor). The SBSA total and its subscales (formed based on the factors) exhibited good internal consistency. In terms of construct validity, the SBSA total, the high standard beliefs subscale, and conditional beliefs subscale had stronger associations with a measure of social anxiety than with a measure of depression, although the unconditional beliefs subscale was similarly related to both measures of social anxiety and depression. In terms of discriminative validity, the sample of individuals with SAD had higher SBSA total and subscale scores compared with a sample of individuals without SAD (N = 32). These findings provide a psychometric evidence base justifying the use of the SBSA for the assessment of maladaptive social-evaluative beliefs.

Factors influencing inpatients perception of psychiatric hospitals: A meta-review of the literature.

Inpatient psychiatric hospitals have remained a standard aspect of mental health treatment for many centuries. While numerous treatments have been empirically validated to assist inpatients, less is known about how inpatients perceive psychiatric hospitals. A meta-review, which is a systematic review of systematic reviews, was conducted to examine the factors reported by inpatients which affect their perception of psychiatric hospitals. MEDLINE, PsycINFO and EMBASE were systematically searched. Reviews that considered the perception of adults with mental illness admitted to an inpatient psychiatric hospital were eligible for inclusion. The AMSTAR-2 was used to assess for methodological quality and bias of eligible reviews, with reviews judged to have critical issues excluded. Thematic synthesis was used to detect key overarching factors that generalised across multiple reviews. Twelve systematic reviews were included of which seven key factors were extracted. These were; relationships on the ward, the ward environment, coercive measures, legal status, autonomy, feeling deserving of care, and expectations of care at admission and discharge. Inpatients report several factors that need to be considered when creating a therapeutic environment in a psychiatric hospital. While the importance of therapeutic rapport was the most consistently referenced factor in the included reviews, all factors are likely interwoven and modifiable. Limitations of this meta-review and directions for future research are discussed.

Psychometric properties of the Intolerance of Uncertainty Scale-12 in generalized anxiety disorder: Assessment of factor structure, measurement properties and clinical utility.

Intolerance of uncertainty is a psychological vulnerability implicated in the development and maintenance of generalized anxiety disorder (GAD). The Intolerance of Uncertainty Scale-12 (IUS-12) is a widely used measure, however no studies have thoroughly tested the psychometric properties in a clinically diagnosed GAD sample. This study aimed to evaluate the factor structure, measurement properties and clinical utility of the IUS-12 in clinical and non-clinical samples. Participants were screened using the Anxiety Disorders Interview Schedule for DSM-IV to ascertain clinical (n = 136: principal diagnosis of GAD) or non-clinical status (n = 76). Confirmatory factor analysis determined that the bifactor type (two-factor testlet) model demonstrated significantly better fit in comparison to the unidimensional model for the clinical sample. The IUS-12 exhibited limited multidimensionality indicating that only the total score provides meaningful interpretation. The IUS-12 demonstrated good construct validity (with DASS-21, MCQ-30, and PSWQ), good internal consistency, as well as good test-retest reliability over 12-weeks. The IUS-12 demonstrated responsivity to treatment following cognitive behavioral therapy and mindfulness based psychological interventions. Receiver operating characteristic curve analysis indicated an optimal cut-off score of 28 for distinguishing individuals with GAD from non-clinical cases. Overall, the IUS-12 is a valid, reliable and clinically useful instrument for individuals with GAD.

A meta-analysis of the relationship between anxiety and attentional control.

Attentional Control Theory (ACT) (Eysenck & Derakshan, 2011) proposes that attention control (AC) deficits are central to the development of anxiety. This meta-analysis investigated the size and nature of AC deficits in anxious compared to non-anxious participants. We made the following hypotheses based on ACT: i) anxiety-related AC deficits occur in the AC components of inhibition and switching, but not updating; ii) deficits will be more pronounced for AC efficiency (reaction times) than effectiveness (accuracy); iii) studies with high cognitive load conditions will observe greater deficits than studies with normal cognitive load; iv) age and anxiety level will moderate the effect of anxiety on AC. Fifty-eight studies (N = 8292) met inclusion criteria. The meta-analysis revealed a significant AC deficit for high compared to low anxiety participants (Hedges' g = -0.58). Overall, results supported assumptions of ACT: anxiety produced significant deficits in AC efficiency but not effectiveness; these deficits occurred in inhibition and switching but not updating and studies with high cognitive load conditions found larger anxiety related AC deficits. Age moderated the relationship between anxiety and AC in behavioural studies and anxiety severity moderated this relationship in self-report studies. Theoretical implications of the results are discussed, and future directions for research are proposed. This meta-analysis has been registered with PROSPERO in 2016, Registration number: CRD42016036927.

The Effect of Mindfulness Interventions for Parents on Parenting Stress and Youth Psychological Outcomes: A Systematic Review and Meta-Analysis.

Background: The psychological well-being of parents and children is compromised in families characterized by greater parenting stress. As parental mindfulness is associated with lower parenting stress, a growing number of studies have investigated whether mindfulness interventions can improve outcomes for families. This systematic review and meta-analysis evaluates the effectiveness of mindfulness interventions for parents, in reducing parenting stress and improving youth psychological outcomes. Methods: A literature search for peer-reviewed articles and dissertations was conducted in accordance with PRISMA guidelines in the PsycInfo, Medline, PubMed, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Studies were included if they reported on a mindfulness-based intervention delivered in person to parents with the primary aim of reducing parenting stress or improving youth psychological outcomes. Results: Twenty-five independent studies were included in the review. Eighteen studies used a single group design and six were randomized controlled trials. Within-groups, meta-analysis indicated a small, post-intervention reduction in parenting stress (g = 0.34), growing to a moderate reduction at 2 month follow-up (g = 0.53). Overall, there was a small improvement in youth outcomes (g = 0.27). Neither youth age or clinical status, nor time in mindfulness training, moderated parenting stress or overall youth outcome effects. Youth outcomes were not moderated by intervention group attendees. Change in parenting stress predicted change in youth externalizing and cognitive effects, but not internalizing effects. In controlled studies, parenting stress reduced more in mindfulness groups than control groups (g = 0.44). Overall, risk of bias was assessed as serious. Conclusions: Mindfulness interventions for parents may reduce parenting stress and improve youth psychological functioning. While improvements in youth externalizing and cognitive outcomes may be explained by reductions in parenting stress, it appears that other parenting factors may contribute to improvements in youth internalizing outcomes. Methodological weaknesses in the reviewed literature prevent firm conclusions from being drawn regarding effectiveness. Future research should address these methodological issues before mindfulness interventions for parents are recommended as an effective treatment option for parents or their children.

Family-Based Psychological Treatment for Obsessive Compulsive Disorder in Children and Adolescents: A Meta-analysis and Systematic Review.

A significant number of children and adolescents with obsessive compulsive disorder (OCD) demonstrate poor response to the current gold standard treatment, cognitive behaviour therapy (CBT) with exposure and response prevention (ERP). Recent findings suggest that family variables affect treatment response highlighting the need for a meta-analytic review of the precise impact of family variables on OCD-related symptoms and processes. The current review and meta-analysis examined the effect of family-based interventions on OCD symptom and family factor outcomes for children and adolescents with OCD. The moderating effects of the degree of parental involvement and number of family factors targeted in treatment were investigated. An extensive literature search identified 37 eligible studies (1727 OCD participants). Large significant pooled mean effect sizes for OCD symptoms and Family Accommodation (FA), respectively, were obtained at posttest (g = 1.56; g = 1.00) and follow-up (g = 1.69; g = 1.98). Moderator analyses indicated that the number of family factors targeted in treatment significantly moderated outcomes on measures of FA (z = 2.21, p = 0.03), but not on Children's/Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS) outcomes. FA has been significantly correlated with OCD symptom severity and poorer treatment outcomes, and there is data to suggest that FA may mediate OCD symptom outcomes (e.g., Piacentini et al. in J Am Acad Child Adolesc Psychiatry 50:1149-1161, 2011). Findings show that the greater the number of family factors targeted, the greater the reduction in FA at post, highlighting the importance of addressing a range of family factors in child OCD treatment to optimise outcomes.

Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating.

BACKGROUND: There are a number of factors commonly believed to be important to the development and maintenance of binge eating that have been identified across multiple models and theories in the psychological literature. In the present study, we sought to develop and test a psychological model for binge eating that incorporated the main variables identified in the literature to drive binge eating behaviour; specifically, core low self-esteem, negative affect, difficulty with emotional regulation, restricted eating and beliefs about eating. METHODS: Questionnaire data was collected from 760 unselected participants. The proposed model of binge eating was developed, bivariate relationships between the included variables were assessed, and the goodness-of-fit of this new model was evaluated using structural equations modelling. RESULT: The results identified significant bivariate relationships between all the included variables. While the originally proposed model did not provide a good fit to the data, the revised version of the model provided a good fit to the data. CONCLUSIONS: Supporting, integrating and building upon the current existing psychological models of binge eating, this study presents a new integrated cognitive and behavioural model of binge eating. The dual-pathway to binge eating identified in the new model provides a different way to understand transdiagnostic binge eating.