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.

Face-to-Face and Cyber-Victimization: A Longitudinal Study of Offline Appearance Anxiety and Online Appearance Preoccupation.

Most adolescents and young adults navigate seamlessly between offline and online social environments, and interactions in each environment brings with it opportunities for appearance concerns and preoccupation, as well as victimization and teasing about appearance. Yet, research has concentrated primarily on face-to-face victimization and its role in offline appearance anxiety symptoms in adolescents and young adults. To extend this to include cyber-victimization and online behaviors indicative of appearance anxiety, the present longitudinal study investigated the risk of face-to-face and cyber-victimization for offline appearance anxiety and online appearance preoccupation. Participants were 650 adolescents age 15 to 19 years (Mage = 17.3 years, 59% female) who completed two surveys over one-year. Correlations identified both forms of victimization as associated with offline appearance anxiety and online appearance preoccupation. Yet, in a structural equation model, face-to-face peer victimization, but not cyber-victimization, was uniquely associated with increased offline appearance anxiety and online appearance preoccupation from T1 to T2. Offline appearance anxiety and online appearance preoccupation strongly covaried and were bidirectionally associated over time. Female gender and age were associated with more anxiety and preoccupation. When gender moderation was tested, only the stability in appearance anxiety was moderated, with greater stability in females than males. Overall, offline and online appearance anxieties are highly interrelated and share a common risk factor in face-to-face appearance-related victimization by peers.

Risk factors and temporal patterns of disordered eating differ in adolescent boys and girls: Testing gender-specific appearance anxiety models.

Adolescent dieting and disordered eating (DE) are risks for clinical eating disorders. In this five-wave longitudinal study, we tested gender-specific models linking early risk factors to temporal patterns of DE, considering appearance anxiety as a mediator. Participants were 384 Australian students (age 10 to 13; 45% boys) who reported their purging and skipping meals, experience with appearance-related teasing, media pressure, and appearance anxiety. Parents reported pubertal maturation and height/weight was measured. Gender differences in temporal patterns of DE were found and predictive models were tested using latent-variable growth curve and path models. Boys' DE was generally stable over time; girls showed stability in purging but an average increase in skipping meals. Peer teasing, media pressure, and pubertal maturation were associated with more elevated initial DE in girls, and pubertal maturation was associated with a steeper increase in DE. For boys, body mass index had a direct positive association with DE. Appearance anxiety was associated with more DE, but there was only one significant indirect effect via anxiety, which was for boys' pubertal maturation. Findings support the dominant role of social interactions and messages, as well as pubertal maturation, for girls' DE and the prominence of physical risk factors for explaining boys' DE.

Emotion regulation and support from others: Buffering of body dysmorphic symptoms in adolescent and young adult men but not women.

INTRODUCTION: Adolescents and young adults who overemphasize the social values placed on an attractive appearance may develop body dysmorphic symptoms (BDS), defined as over-preoccupation with perceived appearance flaws and repetitive behaviors to conceal the flaws. Further, research has found that a heightened expectation of judgement and rejection by others because of appearance (i.e., appearance-based rejection sensitivity [appearance-RS]) is both a maintaining and an aggravating factor in BDS. This study focused on emotion regulation (ER), appearance-related support from others and self-acceptance, expecting they would buffer the negative impact of appearance-RS on BDS. METHODS: Participants included 782 Australian high school and young university students, aged 14-28 years (M = 17.94 years, 40% male) who completed a survey to report their BDS, appearance-RS, ER, appearance-related support from others and self-acceptance. RESULTS: Multiple regression analyses revealed that youth reported more BDS when they were higher in appearance-RS but reported less self-acceptance, ER, and support from others. Further, the association between appearance-RS and BDS was weaker when young people reported higher (relative to lower) ER and support from others. However, when three-way interactions with gender were tested, these buffering effects were only significant for young men. CONCLUSION: Findings suggest that ER and appearance-related support from important others are promising targets for intervention, given they could mitigate the risk of appearance-RS in young men. However, further research is needed to consider additional factors that buffer against the negative effects of appearance-RS on BDS for young women.

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy.

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.

Parental body dissatisfaction and controlling child feeding practices: A prospective study of Australian parent-child dyads.

The aim of the present study was to examine whether parents' reported use of controlling feeding practices (restrictive feeding and pressure to eat) change over 6 months, and whether parents' concerns about their own weight and shape are prospectively associated with increasing use of controlling feeding practices. Participants were 48 Australian parents (92% female; Mage = 37.8 years) who completed questionnaires twice, with a 6-month time lag, regarding a target child aged 7.6 years on average (52% female). Results revealed that, in general, parental feeding practices and body dissatisfaction showed little change over 6 months. As expected, parental body dissatisfaction predicted increased use over time of restrictive feeding practices for the purpose of managing child weight, but (unexpectedly) not restrictive feeding for child health or pressure to eat. The findings provide key evidence that parents who use higher levels of controlling feeding practices are likely to continue to do so over time, and that parental body dissatisfaction poses a small but significant risk for parents' increasing use of restrictive feeding for management of child weight. The present findings support suggestions that the connection between parent body dissatisfaction and maladaptive feeding practices play a role in the intergenerational transmission of body image and eating pathology.

Intuitive, mindful, emotional, external and regulatory eating behaviours and beliefs: An investigation of the core components.

The aim of this study was to identify the interrelations between, and the core components of, adaptive and maladaptive measures of eating behaviours. Participants were 2018 females (Mage = 23.14 years) who completed measures of intuitive eating, mindful eating, overeating regulation, dietary restraint, emotional eating, external eating, and overeating dysregulation in contexts of leisure and discomfort. Most associations between eating measures were significant, with the largest association between eating for physical rather than emotional reasons (intuitive eating) and emotional eating, and the smallest and nonsignificant associations usually involving the mindful eating subscales. Principle component analysis of the composite scores for all measured eating subscales revealed a 4-component structure. Component 1, labelled attuned eating, reflected positive loadings for eating for physical rather than emotional reasons (intuitive eating); act with awareness, present eating, and non-reactivity (mindful eating); and overeating regulation. Attuned eating also had negative loadings for emotional eating, external eating, and leisure and discomfort overeating dysregulation. Component 2, labelled unrestrained eating, reflected positive loadings for unconditional permission to eat (intuitive eating) and acceptance (mindful eating), but also a negative loading for dietary restraint. Component 3, labelled eating and hunger awareness, had positive loadings for reliance on hunger/satiety cues (intuitive eating) and awareness (mindful eating). Component 4, labelled casual eating attitudes, was represented by positive loadings for non-reactivity and flexibility (mindful eating). These findings highlight the complexity of eating behaviour by revealing that although many adaptive and maladaptive eating concepts appear to tap opposite ends of a continuum of attuned versus disinhibited eating, several other adaptive and maladaptive eating concepts are better described as tapping somewhat unique attitudes, beliefs, motivations, and behaviours regarding food and eating.

Maternal self-rated health and psychological distress predict early feeding difficulties: Results from the longitudinal study of Australian children.

BACKGROUND: Drawing from the extended UNICEF model of children's eating and weight problems and growing empirical evidence, exposure to adversity may place mothers at increased risk for child feeding difficulties. AIM: The aim of the present study of a community sample of mothers was to examine whether maternal psychological distress, exposure to stressful events, and poor self-rated health in their child's first year of life were associated with breastfeeding duration, as well as concurrent and prospective feeding problems. MATERIALS & METHODS: Participants were 5107 Australian mother-child dyads from the infant cohort of the Longitudinal Study of Australian Children (LSAC). Data for the present study was drawn from questionnaires completed by the mother at Wave 1 and Wave 2 (conducted 2 years apart). On average, at Wave 1, mothers and children (51% male) were aged 31 years and 9 months, respectively; while at Wave 2 their ages were 33 years and 34 months, respectively. RESULTS: Maternal psychological distress and poorer self-rated health were uniquely predictive of concurrent and prospective child feeding difficulties, while poorer self-rated health was also concurrently associated with a shorter duration of breastfeeding. DISCUSSION: These findings suggest that poorer maternal functioning poses a significant risk for early child feeding difficulties, and highlights the potential benefit of screening and early intervention for mothers experiencing emotional and physical health problems. CONCLUSION: Further research is needed that takes a broad view of maternal functioning, and examines reciprocal interactions between maternal and child characteristics in understanding the development of child feeding problems.

A prospective study of adolescents' body dysmorphic symptoms: Peer victimization and the direct and protective roles of emotion regulation and mindfulness.

In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (Mage=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.

Girls' and boys' trajectories of appearance anxiety from age 10 to 15 years are associated with earlier maturation and appearance-related teasing.

Adolescents' appearance-related concerns can provoke increasing emotional, social, and eating-related problems. The aims of this five-wave (2.5-year), multiple-informant longitudinal study were to (a) examine growth trajectories of appearance anxiety symptoms and appearance esteem, (b) identify whether trajectories differed by gender, and (c) examine several launching factors including parent-reported physical maturation, peer-rated physical appearance, body mass index, and appearance teasing by parents and peers. Participants were 387 adolescents (44% boys) aged 10 to 13 years at the first assessment. Steep growth in appearance anxiety symptoms was found for both girls and boys, but there was no average change in appearance esteem. Girls had more elevated appearance anxiety symptoms and lower appearance esteem than boys, girls' body mass index was associated with symptoms, and earlier physical maturation and teasing about appearance, alone and in combination, were associated with growth in appearance anxiety symptoms for girls and boys. Earlier maturing boys who were highly teased by parents, but even more so when teased by peers, were at utmost risk for elevated appearance anxiety symptoms and increasing symptoms over time. In contrast, all girls exhibited elevated or increasing appearance anxiety symptoms across time, with the exception of girls with the latest maturation who also reported little teasing about their appearance.

"Pretty Pressure" From Peers, Parents, and the Media: A Longitudinal Study of Appearance-Based Rejection Sensitivity.

Drawing from the tripartite sociocultural model of body image, the researchers examined whether direct messages and modeling from peers, parents, and media were concurrently and prospectively associated with appearance-based rejection sensitivity (appearance-RS) in young adolescents (Mage  = 12.0 years). Appearance-RS was higher among those who concurrently reported more appearance-related teasing and pressure by peers, more parent teasing, and greater acceptance of media appearance ideals. In prospective analyses, greater increases in appearance-RS over 1 year were found for adolescents who perceived higher levels of parental appearance-related teasing and negative attitudes about their own appearance. Moderation analyses indicated the positive prospective association between parental negative appearance attitudes and appearance-RS was found in younger but not older participants. Gender did not moderate associations.

Body image and peer relationships: Unique associations of adolescents' social status and competence with peer- and self-reported appearance victimization.

Adolescents were asked to nominate peers who experience appearance-related victimization or engage in appearance-related aggression, in order to examine the peer social status and competency correlates of receiving more nominations. Moreover, the correlates of peer-report vs. self-report appearance-related victimization were considered. Participants were 371 young Australian adolescents (55% girls, Mage = 12.0 years) who completed surveys. Results showed that victimized adolescents were rated as less liked, prosocial, popular and good-looking, and perceived themselves to be less attractive, less competent at sport and more teased by peers about appearance. Aggressive adolescents were rated as more popular and better looking, but also less prosocial. Aggressive adolescents also perceived themselves to be less academically but more romantically competent, and reported more appearance anxiety symptoms. Findings from peer-report measures generally support previous research findings using self-report measures, but the significant correlates did appear to differ between peer- and self-report of appearance victimization.

Early adolescents' body dysmorphic symptoms as compensatory responses to parental appearance messages and appearance-based rejection sensitivity.

Body dysmorphic disorder (BDD) is marked by high distress and behavioral and functional impairments due to preoccupation with perceived appearance anomalies. Our aim was to examine parental correlates of offspring's symptoms characteristic of BDD, testing both direct associations and indirect associations via appearance-based rejection sensitivity (appearance-RS). Surveys were completed by 302 Australian adolescents (9-14 years) and their parents. Findings indicated parents' weight and appearance teasing and child-report (but not parent-report) of parental negative attitudes about weight and appearance were uniquely associated with offspring's heightened BDD-like symptoms, and associations were partially indirect via adolescents' appearance-RS. Findings support theory that identifies parents as socializers of children's appearance concerns, and show that BDD-like symptoms may be partly elevated because of the mediating role of appearance-RS. We propose that BDD symptoms could partly emerge as compensatory responses to parents' appearance messages, and the associated bias to expect and perceive rejection based on one's appearance.

Parent-Child Interaction Therapy: A Meta-analysis.

CONTEXT: Parent-child interaction therapy (PCIT) is effective at reducing children's externalizing behavior. However, modifications are often made to PCIT, and it is not known whether these impact effectiveness. OBJECTIVE: To systematically review and meta-analyze the effects of PCIT on child externalizing behaviors, considering modifications, study design, and bias. DATA SOURCES: We searched PubMed, PsycINFO, Education Resources Information Center, Sociological Abstracts, and A+ Education. STUDY SELECTION: We selected randomized controlled or quasi-experimental trials. DATA EXTRACTION: We analyzed child externalizing and internalizing behaviors, parent stress, parent-child interactions, PCIT format, and study design and/or characteristics. RESULTS: We included 23 studies (1144 participants). PCIT was superior to control for reducing child externalizing (standardized mean difference [SMD]: -0.87, 95% confidence interval [CI]:-1.17 to -0.58). PCIT studies that required skill mastery had significantly greater reductions in externalizing behavior than those that did not (Mastery: SMD: -1.09, 95% CI: -1.44 to -0.73; Nonmastery: SMD: -0.51,95% CI: -0.85 to -0.17, P = .02). Compared with controls, PCIT significantly reduced parent-related stress (mean difference [MD]: -6.98, 95% CI: -11.69 to -2.27) and child-related stress (MD: -9.87, 95% CI: -13.64 to -6.09). Children in PCIT were observed to be more compliant to parent requests (SMD: 0.89, 95% CI: 0.50 to 1.28) compared with controls. PCIT effectiveness did not differ depending on session length, location (academic versus community settings), or child problems (disruptive behaviors only compared with disruptive behavior and other problems). LIMITATIONS: Results for parent-child observations were inconsistently reported, reducing the ability to pool important data. CONCLUSIONS: PCIT has robust positive outcomes across multiple parent-reported and observed parent-child interaction measures, and modifications may not be required even when implemented in diverse populations.

An Evaluation of Parent-Child Interaction Therapy With and Without Motivational Enhancement to Reduce Attrition.

Although many interventions for child externalizing behavior report promising outcomes for families, high attrition prior to program completion remains a problem. Many programs report dropout rates of 50% or higher. In this trial we sought to reduce attrition and improve outcomes by augmenting a well-known evidence-based intervention, Parent-Child Interaction Therapy (PCIT), with a 3-session individual motivational enhancement component. Participants were 192 Australian caregivers (91.7% female; Mage = 34.4 years) and their children (33.3% female; Mage = 4.4 years). Families (51% referred from child welfare or health services for risk of maltreatment) were assigned to PCIT or a supported waitlist, with families assigned to PCIT receiving either standard PCIT (S/PCIT) or motivation-enhanced PCIT (M/PCIT), depending on their time of entry to the study. Waitlist families received phone calls every week for 12 weeks. Parents in M/PCIT reported more readiness to change their behavior from preassessment to after the motivation sessions. Also, parents who reported high, rather than low, motivation at preassessment did have a lower attrition rate, and there was some evidence that enhancing motivation was protective of premature attrition to the extent that caregivers achieved a high degree of change in motivation. Yet comparison of attrition rates and survival analyses revealed no difference between M/PCIT and S/PCIT in retention rate. Finally, there were greater reductions in externalizing and internalizing child behavior problems and parental stress among families in S/PCIT and M/PCIT compared with waitlist, and there was generally no significant difference between the two treatment conditions.

Stress exposure and generation: A conjoint longitudinal model of body dysmorphic symptoms, peer acceptance, popularity, and victimization.

This study examined the bidirectional (conjoint) longitudinal pathways linking adolescents' body dysmorphic disorder (BDD) symptoms with self- and peer-reported social functioning. Participants were 367 Australian students (45.5% boys, mean age=12.01 years) who participated in two waves of a longitudinal study with a 12-month lag between assessments. Participants self-reported their symptoms characteristic of BDD, and perception of peer acceptance. Classmates reported who was popular and victimized in their grade, and rated their liking (acceptance) of their classmates. In support of both stress exposure and stress generation models, T1 victimization was significantly associated with more symptoms characteristic of BDD at T2 relative to T1, and higher symptom level at T1 was associated with lower perceptions of peer acceptance at T2 relative to T1. These results support the hypothesized bidirectional model, whereby adverse social experiences negatively impact symptoms characteristic of BDD over time, and symptoms also exacerbate low perceptions of peer-acceptance.

A Longitudinal Rejection Sensitivity Model of Depression and Aggression: Unique Roles of Anxiety, Anger, Blame, Withdrawal and Retribution.

In this longitudinal study, attributional and social processes involved in symptoms of mental health problems (depressive symptoms and aggressive behavior) were identified by investigating anxious and angry rejection sensitivity (RS), causal attributions of self-blame and peer-blame, and responses to rejection threat of withdrawal and retribution. Young adolescents (N = 713, grades 5-7) completed questionnaires three times in their regular classrooms over 14 months. Participants who reported more self-blame for rejection were more likely to withdraw in response to rejection threat, and withdrawal and anxious RS were associated with increased depressive symptoms at T3 relative to T1. In contrast, adolescents higher in the angry form of RS and who reported more peer-blame for rejection were more likely to seek retribution, which in turn was associated with more overt/relational aggressive behavior at T3 relative to T1. Depressive symptom level measured at T1 also was associated with later RS and coping with withdrawal, and aggressive behavior at T1 was associated with later retribution. Sex of the participants did not moderate any longitudinal associations, and only one prospective path, from T1 depressive symptoms to T2 RS anxious, was moderated by age.

Young Adolescents' Body Dysmorphic Symptoms: Associations with Same- and Cross-Sex Peer Teasing via Appearance-based Rejection Sensitivity.

In this study of young adolescents' (N = 188, M age = 11.93, 54.8% females) body dysmorphic disorder (BDD) symptoms, we examined a theoretically-derived model to determine if symptoms could be explained by appearance-related teasing, general peer victimization, and social anxiety. BDD symptoms were assessed as distressing preoccupation with perceived appearance defects, social avoidance, and repeated grooming and appearance checking. Associations were expected to occur via the social-perceptual bias known as appearance-based rejection sensitivity (appearance-RS). The source of appearance teasing was also considered (same-sex vs. cross-sex peers), and age and gender moderation were assessed. As predicted, in a structural equation model, BDD symptoms were higher when adolescents self-reported more appearance teasing and higher social anxiety. Moreover, it was appearance teasing by cross-sex peers, rather than same-sex peers, that was uniquely associated with elevated BDD symptoms. These associations were partially mediated by appearance-RS. Notably, peer-reported general victimization was not associated with BDD symptoms. There was no evidence for gender moderation, but some age moderation was found, with stronger associations usually found among older compared to younger adolescents. The findings suggest that appearance-related social adversity, particularly cross-sex teasing, is linked with greater concerns about rejection due to appearance and, in turn, heightened BDD symptoms. This has important implications for understanding the development and treatment of BDD. Continued research to identify the social experiences and interpretative biases that contribute to BDD symptomology is needed.

The appearance culture between friends and adolescent appearance-based rejection sensitivity.

Appearance-based rejection sensitivity (appearance-RS) is the tendency to anxiously expect, readily perceive, and overreact to signs of rejection based on one's appearance, and is associated with a number of psychological and social problems (Park, 2007). This study of 380 adolescents (Mage = 13.84) examined a model linking the appearance culture between friends with appearance-RS in adolescent boys and girls, via internalisation of appearance ideals, social comparison, and body dissatisfaction. Gender differences were also tested. Consistent with expectations, appearance-focused characteristics of the friendship context were associated with heightened appearance-RS via internalization of appearance ideals, social comparison, and body dissatisfaction. The appearance-focused friend characteristics that were associated with appearance-RS included exposure to friends' appearance conversations, appearance teasing that caused distress, and perceived pressure to be attractive. Notably, associations rarely differed for boys and girls, with one exception: the association between BMI and body dissatisfaction was stronger in girls than in boys.