Editorial perspective: Bayesian statistical methods are useful for researchers in child and adolescent mental health.

Bayesian statistical approaches offer nuanced, detailed, and intuitive analyses, even with small sample sizes. Although these qualities are highly relevant for researchers in child and adolescent mental health, Bayesian methods are still quite rarely employed. This editorial perspective will briefly describe what is different about Bayesian statistical methods, discuss some of the ways they may benefit research in our field, and provide an introduction to how Bayesian statistics are employed in practical research.

Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care.

BACKGROUND: Emotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children's mental health symptoms.  METHOD : 120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents' emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents' sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change. DISCUSSION: This study will provide insights into the effectiveness of EFST in improving children's mental health and the mechanisms of change responsible for the program's effectiveness. Impotently, this study may provide information regarding whether children's mental health issues can be alleviated through therapeutic work provided to the parents alone. TRIAL REGISTRATION: Clinical trials.gov Identifier: NCT04885036 . First Posted on May 13, 2021. TRIAL STATUS: In recruitment.

Efficacy of Emotion-Focused Parenting Programs for Children's Internalizing and Externalizing Symptoms: A Randomized Clinical Study.

OBJECTIVE: Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents' mental health problems. METHODS: In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6-13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. RESULTS: EFST showed efficacy in reducing parent-reported externalizing (b = -1.72, p < .001, d = 1.0) and internalizing (b = -1.71, p < .001, d = 0.9) symptoms, and teacher-reported externalizing (b = -.96, p < .001, d = 0.4), but not internalizing (b = -.13, p > .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p's > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. CONCLUSION: EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention.

Predicting change through individual symptoms and relationship distress: A study of within- and between-person processes in couple therapy.

OBJECTIVE: In couple therapy clients often suffer from a blend of individual psychiatric symptoms as well as severe relational distress. However, research is inconclusive on whether relational change predicts symptom change or vice versa. Because answers to this question could have important clinical implications on what to focus on in couple therapy at which time in treatment, more research is recommended. METHOD: In this study, data collected before every therapy session were used to test whether changes in relational functioning predicted symptom functioning or vice versa. The study used a multilevel modelling approach, and the variables of interest were disaggregated into within- and between-person effects. RESULTS: The results indicated that if an individual improved more than expected on relational functioning, this predicted more improvement than expected on individual symptoms. No significant reciprocal relationship was found between these variables. CONCLUSIONS: The clinical implication is discussed, suggesting that an emphasis on relational improvement seems to be an important mechanism during couple therapy that may facilitate the change on individual symptoms in the long run.

Feedback in Couple and Family Therapy: A Randomized Clinical Trial.

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC ("treatment as usual" or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire-45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.

Updating prospective marriage and divorce data on Norwegian cohorts of two-sex marriages from 1886 until 2018 with same-sex marriages from 1993 until 2018.

This paper presents an update to the previously published dataset known as prospective marriage and divorce data on Norwegian cohorts of two-sex marriages from 1886 until 2018. This update adds prospective data from all same-sex marriages formed in Norway between 1993 and 2018, with annual follow-up for 25 years, totaling 26 cohorts and 5,187 marriages. The data list the number of marriages that ended in divorce throughout each year of follow-up. The data contain information about the age of both spouses, the number of divorces from each cohort in the total population of marriages, as well as divorces among marriages formed in urban and rural areas of the country. Marriages formed within a calendar year are pooled into cohorts, and each pair is examined annually to ensure that the same two people remain married. As a result, the method is equivalent to the initial dataset on two-sex marriages presented in the first dataset.

The effectiveness of the in-person and online Gottman Seven Principles Couple Enhancement Program: A propensity score matching design.

This study investigates the effectiveness of the 12-h Gottman Seven Principles couple enhancement program delivered in person and online. In Norway, we recruited 490 participants and 242 people for a control group. All were in close relationships. The revised dyadic adjustment scale (RDAS) was used to assess the quality of their relationships before and after program participation, and at 6-month follow-up. Repeated measures ANOVA, t tests, reliable change, and multilevel multiple regression using propensity score matching to control for confounders were used to investigate the effectiveness of the course. The results demonstrate that the Gottman Seven Principles course improves couple relationships and is equally effective whether delivered in person or online. Furthermore, it does not matter whether there are therapists with a clinical background delivering the course, suggesting that the material itself is sufficient.

Emotion-focused skills training for parents with anxious children. A pilot study.

Anxiety disorders are common among children and adolescents. Effective treatments exist, but meta-analyses indicate that 40% of children continue to have significant symptoms posttreatment. Alternative therapeutic interventions are needed. Emotion-focused parental interventions have been found to be effective in targeting children's internalizing difficulties, but no research has examined remission. In this pilot trial, we examined whether Emotion Focused Skills Training (EFST) was associated with remission of diagnosis in children with anxiety. Nine 8-14-year-olds diagnosed with anxiety were recruited at a mental health clinic in Norway. Both parents of each child attended a 2-day EFST program followed by five 1-hour weekly sessions. Pre- and posttreatment diagnosis and severity were evaluated using a multiinformant approach using the Spence Children's Anxiety Scale and the Anxiety Disorders Interview Schedule. After treatment, 33% no longer met criteria for any anxiety diagnosis, 66% obtained remission from their primary anxiety diagnosis, and 89% from at least one.

Effects of emotionally oriented parental interventions: a systematic review and meta-analysis.

Objective: This systematic review and meta-analysis investigates the effects of emotionally oriented parental interventions. Background: Several emotionally oriented parental interventions have been developed during the last decade. Some of these have gained popularity and spread across several continents. The literature is growing and consists of qualitative studies; intervention only, quasi-experimental, case-control studies; and randomized controlled trials. They indicate effects for parents and children. However, no systematic review or meta-analysis has, to our knowledge, summarized the results. Method: Using several search engines, we located 8,272 studies. After abstract and full-text screening, 33 studies were assessed for bias and included in the study. Outcomes for parents and children were extracted and combined into three constructs for parents and two for children. Meta-analyses were conducted for each construct to estimate the effect of the interventions using a robust Bayes meta-analysis. Results: The results indicate the presence of a small to medium effect on parents' mental health, behavior, and use of emotionally oriented parenting, as well as on children's internalizing and externalizing difficulties. Most participants were recruited from the general population, and clinical settings were rare. The results show little evidence of publication bias. Conclusion: There is evidence of a small to medium effect of emotionally oriented interventions on parents and children. Systematic review registration: https://osf.io/un3q4/.

Prospective marriage and divorce data on Norwegian cohorts of two-sex marriages from 1886 until 2018.

The article contains prospective data on all two-sex marriages formed in Norway between 1886 and 2018, with annual follow-up for 60 years, totaling 133 cohorts and 2 698 632 marriages. The data list the number of marriages that ended in divorce throughout each year of follow-up. The data were obtained through a special order from Statistics Norway. The data from 1981 to 2018 contain additional information about male and female ages, the number of divorces from each cohort in the total population of marriages, as well as divorces among marriages formed in urban and rural areas of the country under four marriage and remarriage constellations: first time for both spouses, first time for one and second time for the other, second time for both, and third time or more for at least one in the couple. Marriages formed within a calendar year are pooled into cohorts, and each pair was examined annually to ensure that the same two persons remained married.

Bayes factor benefits for clinical psychology: review of child and adolescent evidence base.

Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.

Cohort data on divorce among first, second and higher order marriages in Norway 1981 until 2013.

This article present prospective data on all Norwegian two sex-marriages that was formed from 1981 to 2013, all together more than 770 000 marriages, with yearly follow up for until 32 years. Four different categories of marriages and remarriages were investigated: First time for both spouses, first time for one and second time for the other, second time for both, and third time or more for at least one in the couple. The data stems from a special order from Statistics Norway and marriages formed within one calendar year are combined to cohorts where each couple were checked for each successive year if the same two individuals were still married to each other. The data holds the original population for each of the 33 cohorts and number of divorced couples for each year of follow up.

Data on the individual problems and strengths scale from the systemic therapy inventory of change. Clinical samples from Norway.

These data stem from 841 clients at different couple and family therapy sites in Norway that was collected between 2010 and 2016. They all answered the Individual Problems and Strengths scale (IPS) that is a part of the Systemic Therapy Inventory of Change (STIC) system in addition to some demographic variables. In addition to the 22 items constructing the IPS scale, the data contain 14 demographic variables describing age, educational level, civil status, prior therapeutic experience, use of medicine and year of data collection. Summary statistics are provided. Male and female clients between 12 and 72 years of age answered these questions prior to or at their first session of psychotherapy. The four sites collecting the data are located at different cities in the southern part of the country and represents low and high threshold agencies. The data can be used to test the construct validity of the measure for different populations. The data could, with a sample from the normal population, also be used for norming the scale and thus provide data to calculate cut off scores for clinical and non-clinical levels for each of the eight subscales. Further, the data could be used in combination with other measures of individual distress to test the construct validity of the scale within a Norwegian clinical sample and perhaps also within other countries.

Alliance predicting progress in couple therapy.

The therapeutic alliance has gained status as a common factor in psychotherapy due to its robust predictive relationship with outcome. The current challenge in our field is to gain a more nuanced understanding of alliance's impact on the progress of treatment over the course of therapy. In the current study, alliance was measured on 3 dimensions: (a) the individual's as well as the couple's joint perception of alliance with the therapist ("self/group-therapist"), (b) each partner's perception of the alliance between the spouse and the therapist ("other-therapist"), and (c) the couple's assessment of alliance with each other ("within-system"). Based on self-reported data from 165 adult clients, we analyzed whether scores on these alliance dimensions at the beginning of therapy predicted the frequently measured outcomes on individual symptoms and relationship distress during treatment. We found that 2 of the alliance dimensions, the "self/group-therapist" and the "other-therapist," at the start of treatment predicted the slopes of the outcome measures. These findings add to established research suggesting that early establishment of alliance is an important predictor for progress during treatment. Variations in the results among the 3 alliance dimensions suggest the usefulness of the clinician assessing different aspects of alliance in couple therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Physical Couple and Family Violence Among Clients Seeking Therapy: Identifiers and Predictors.

INTRODUCTION: Couple violence (CV) affects many, and the consequences of those actions are grave, not only for the individual suffering at the hand of the perpetrator but also for the other persons in the family. Violence often happens among more than just the adults within one family. Even if CV has been thoroughly investigated in the general population very few studies have investigated this objective on a clinical sample, and none of these have included family violence. AIM: This article identifies and describes the group of clients that have issues of physical couple and family violence. It analyses a model that can help to discover physical violence and help therapists to assess what actions to take in therapy to prevent further physical violence. METHODOLOGY: Descriptive analysis, t-tests, and structural equation modeling (SEM) are used on a sample of clients receiving couple and family therapy (CFT) in Norway (N = 830). Family violence is modeled by the partner's expectations toward each other, levels of anger, sexual satisfaction, and self-control. RESULTS: One-in-five clients experienced physical CV in their current relationship and one-in-four experienced physical family violence. The group of clients who experienced CV differed from those without such experiences in having lower income, more prior experience with psychotherapy, more experience with alcohol abuse in childhood, and far more physical family violence in their current family. Our model predicting physical couple and family violence explained as much as 53% of family violence and had three positive, significant predictors (expectation, anger, and sexual satisfaction) and one, significant negative predictor (self-control). Somewhat unexpected, sexual satisfaction was a positive, and not a negative, predictor of violence. CONCLUSION: Our study identified one-in-four clients in CFT experience physical CV. Unreasonable expectation from one partner toward the other, anger and sexual satisfaction were positive predictors of physical violence, while self-control was found to be a negative predictor of physical violence. Implications for therapeutic work and the prevention of physical violence are discussed.