An attachment‐based program for parents of youth with clinically significant mental health problems: Scaling up and drilling down to mechanisms of change

JCPP advances Pub Date : 2024-05-17 DOI:10.1002/jcv2.12248
Marlene M. Moretti, S. P. Dys, Stephanie G. Craig, Carlos A. Sierra Hernandez, N. Goulter, Katherine O’Donnell, Dave S. Pasalich
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Abstract

Given the prevalence and recent increases in youth mental health problems, there is a pressing need for interventions that target transdiagnostic protective factors that could be targeted as mechanisms of change in treatment. Such interventions are most likely to succeed in meeting population needs if they are scalable, sustainable, and effective. Connect is a manualized, 10‐session trauma‐informed and attachment‐based parent program that is structured, emotion‐focused and skills‐oriented. Developed for broad implementation by community mental health workers, Connect is designed to promote parent–child attachment security, a well‐established transdiagnostic protective factor for youth mental health.We examined whether parent–youth attachment anxiety and avoidance predicted reductions in internalizing and externalizing problems in a large one‐group clinical sample of youth (N = 527; ages 8–18 years) of parents (N = 690) who completed the Connect program in a longitudinal study with 6 time points (pre‐, mid‐, and post‐treatment; 6‐, 12‐ and 18‐month follow‐up).Findings confirmed that parent and youth reports of attachment anxiety and avoidance, as well as internalizing and externalizing problems, significantly declined over the course of the intervention. Parent reported reductions in youth attachment anxiety, but not avoidance, predicted declining levels of youth internalizing problems. As well, parent reported reductions in youth attachment avoidance and anxiety predicted declining youth externalizing behavior. In contrast, youth reports of reductions in youth attachment anxiety, but not attachment avoidance, were associated with declines in youth externalizing problems.Our findings support the role of attachment as an important transdiagnostic mechanism of change in attachment‐based programs for parents of teens with clinically significant mental health problems.
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为有严重临床心理健康问题的青少年的父母提供以依恋为基础的计划:扩大规模并深入研究变革机制
鉴于青少年心理健康问题的普遍性和近期的增长,迫切需要针对跨诊断保护因素的干预措施,这些因素可以作为治疗中的改变机制。如果这些干预措施具有可扩展性、可持续性和有效性,就最有可能成功满足人们的需求。连接"(Connect)是一个以创伤为导向、以依恋为基础的家长项目,它是一个结构化的、以情感为重点、以技能为导向的手册化项目,共 10 个疗程。连接 "是为社区心理健康工作者广泛实施而开发的,旨在促进亲子依恋安全,这是一个已被证实的青少年心理健康跨诊断保护因素。在一项纵向研究中,我们对完成 "连接 "项目的父母(690 人)的青少年(527 人;8-18 岁)进行了大规模的单组临床抽样调查,共设 6 个时间点(治疗前、治疗中和治疗后;6、12 和 18 个月的随访),研究结果证实,在干预过程中,父母和青少年报告的依恋焦虑和回避以及内化和外化问题均显著减少。家长报告的青少年依恋焦虑的减少(而不是回避)预示着青少年内化问题水平的下降。同样,家长报告的青少年依恋回避和焦虑的减少也预示着青少年外部化行为的减少。我们的研究结果表明,在针对有严重心理健康问题的青少年家长开展的依恋为基础的项目中,依恋是一个重要的跨诊断变化机制。
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