Using a Videogame Intervention to Reduce Anxiety and Externalizing Problems among Youths in Residential Care: an Initial Randomized Controlled Trial

Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite best efforts, effect sizes remain moderate, which may be due to the disregarding of internalizing symptoms – in particular anxiety - and to limitations regarding the delivery model of interventions. This initial randomized controlled trial (n?=?37) aimed to examine the effectiveness of a biofeedback videogame intervention (Dojo) as an addition to treatment as usual for youths with and without intellectual disability (ID) in residential care with clinical levels of anxiety and externalizing problems. Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations. Youths were randomly assigned to play Dojo (eight 30-min gameplay sessions) or to treatment as usual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline, posttreatment, and 4-months follow-up through youths’ self-report and mentor-report. Completers-only analyses revealed decreases in self-reported anxiety and externalizing problems, and mentor-reported anxiety at posttreatment for participants in the Dojo condition compared to the control condition. Only mentor-reported anxiety was maintained at follow-up. No effect was found for mentor-reported externalizing problems. These findings provided preliminary evidence that Dojo is a promising, innovative intervention that engages high-risk youths. Practical implications are discussed.     

Computer-Guided Problem-Solving Treatment for Depression,PTSD, and Insomnia Symptoms in Student Veterans: A Pilot Randomized Controlled Trial

Depression is a highly prevalent psychological disorder experienced disproportionately by college student military veterans with many deleterious effects including risk for suicide. Treatment can help, but the debilitating nature of depression often makes seeking in-person treatment difficult and many are deterred by stigma, inconvenience, concerns about privacy, or a preference to manage problems themselves. The current study examines the efficacy of a computer-guided Problem-Solving Treatment (ePST^®) for reducing symptoms of depression, posttraumatic stress disorder (PTSD), and insomnia in student military veterans. Twenty-four student veterans (Mean_age = 32.7) with symptoms of depression were randomly assigned either to a treatment group receiving six weekly sessions of ePST or to a minimal contact control group (MCC). Participants completed the Patient Health Questionnaire-9 (PHQ-9) depression scale at baseline and then weekly through post-ePST or post-MCC. PTSD and insomnia questionnaires were also completed at baseline and posttreatment. A linear mixed model regression showed a statistically significant Group (ePST vs. MCC) × Time (pretreatment through posttreatment) interaction for depression, with the ePST showing substantial improvements in depressive symptoms over the 6-week period. Significant improvements were also seen in PTSD and insomnia symptoms. Results suggest that ePST can effectively treat depression, PTSD, and insomnia symptoms in student military veterans and may be a viable alternative for those who are not able to access live therapy. Future work should examine the durability of treatment effects and utility for more severe depression and suicide prevention.     

Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD,Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial

This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires.One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128, p = .001; d = .519, 95% CI = .142–.895), depression (F[1,118.29] = 9.978, p = .002; d = .519, 95% CI = .141–.898) insomnia (F[1,117.60] = 4.574, p = .035; d = .512, 95% CI = .132–.892), and anxiety (F[1,119.64] = 5.465, p = .021; d = .421, 95% CI = .044–.797) symptom severity and disability (F[1,111.55] = 7.015, p = .009; d = .582, 95% CI = .200–.963). Larger effect sizes (d = 0.823–1.075) were observed in participants who completed at least half of the treatment. The RESILIENT online treatment platform was successful to provide access to specialized evidence-based mental health care after a disaster.     

Brief Interventions to Reduce Ecstasy Use: A Multi-Site Randomized Controlled Trial

Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants’ satisfaction with their assigned interventions. Participants (N = 174; M_age = 23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use (n = 85) or a 50-minute session of MET that included an educational component (n = 89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks postbaseline, while the secondary outcome measure was assessed 4-weeks postbaseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both intervention groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9%–17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes.Australia and New Zealand Clinical Trial Registry: ACTRN12611000136909     

Intervening on Thwarted Belongingness and Perceived Burdensomeness to Reduce Suicidality Among Veterans: Subanalyses From a Randomized Controlled Trial

Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month 1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.     

Sleep-Related Safety Behaviors and Dysfunctional Beliefs Mediate the Efficacy of Online CBT for Insomnia: A Randomized Controlled Trial

Several trials have demonstrated the efficacy of online cognitive behavioral therapy (CBT) for insomnia. However, few studies have examined putative mechanisms of change based on the cognitive model of insomnia. Identification of modifiable mechanisms by which the treatment works may guide efforts to further improve the efficacy of insomnia treatment. The current study therefore has two aims: (1) to replicate the finding that online CBT is effective for insomnia and (2) to test putative mechanism of change (i.e., safety behaviors and dysfunctional beliefs). Accordingly, we conducted a randomized controlled trial in which individuals with insomnia were randomized to either online CBT for insomnia (n = 36) or a waiting-list control group (n = 27). Baseline and posttest assessments included questionnaires assessing insomnia severity, safety behaviors, dysfunctional beliefs, anxiety and depression, and a sleep diary. Three- and six-month assessments were administered to the CBT group only. Results show moderate to large statistically significant effects of the online treatment compared to the waiting list on insomnia severity, sleep measures, sleep safety behaviors, and dysfunctional beliefs. Furthermore, dysfunctional beliefs and safety behaviors mediated the effects of treatment on insomnia severity and sleep efficiency. Together, these findings corroborate the efficacy of online CBT for insomnia, and suggest that these effects were produced by changing maladaptive beliefs, as well as safety behaviors. Treatment protocols for insomnia may specifically be enhanced by more focused attention on the comprehensive fading of sleep safety behaviors, for instance through behavioral experiments.     

Testing a Low-Intensity Single-Session Self-Compassion Intervention for State Body Shame in Adult Women: A Dismantling Randomized Controlled Trial

State body shame is a risk factor for eating disorders, and self-compassion is emerging as a potentially effective treatment option in such cases. This study tested the efficacy of a brief (15-minute) self-compassion intervention in reducing state body shame. Using dismantling trial methodology, participants were randomly allocated to an active compassion condition (n = 23), an inactive control compassion condition (n = 23), or an educational control condition (n = 23). Measures of state body image and state shame were collected pre-intervention, immediately after the intervention, and a day after the intervention. Subjective units of state body shame (SUBS) were intensively measured during each invention. Self-compassion interventions were equally efficacious at protecting against deterioration of state body shame and were effective at reducing state shame compared to the educational control condition, with medium effect sizes (respectively – n_p² = .07 and n_p² = .08). Reductions in state shame were retained at follow-up. None of the interventions had an effect on body image (n_p² = .04). Findings demonstrate the clinical promise of brief self-compassion interventions, particularly as evidenced-based “homework” exercises.     

Positive Psychology Intervention to Improve Recovery after Renal Transplantation: A Randomized Controlled Trial

Journal of Contemporary Psychotherapy - There is an increasing body of evidence proving that transplanted patients’ perceptions of their disease and their emotional state may have an...     

Compassion-Focused Therapy to Reduce Body Weight Shame for Individuals With Obesity: A Randomized Controlled Trial

Adults living in larger bodies (Body Mass Index > 30) often experience body weight shame, are highly self-critical, and are at increased risk for anxiety and depression. To date, there have been no RCTs examining the efficacy of Compassion-Focused Therapy (CFT) to help those experiencing body weight shame. The aim of the current study was to investigate the efficacy of CFT as a 12-session group intervention to reduce body weight shame for individuals living in larger bodies. The study used an RCT design with participants randomized to the CFT (n = 28) or waitlist control (n = 27) condition. Participants in both groups were assessed at pre- and postintervention, with the CFT group alone assessed at 3- and 6-month follow-up intervention. Both self-report and a physiological measure of parasympathetic nervous system activity were used (i.e., heart rate variability). Results indicated that CFT had a significant positive impact at postintervention compared to the control group for body weight shame (internal and external), increasing self-compassion, reducing fears of compassion (self, other, and receiving), reducing self-criticism, and reducing external shame. Although there were no significant group effects at postintervention on depression and anxiety, 66% of participants had clinical improvement on depression in the CFT group compared to 8% in the control group at postintervention. CFT did not shift baseline heart rate variability at postintervention. The evidence from this RCT supports CFT as an efficacious intervention to reduce body weight shame for individuals with obesity.     

Development and Evaluation of an Online Intervention for Reducing Hostile Interpretation Bias: A Randomized Controlled Trial

Hostility is a trait-level construct characterized by a generally suspicious and cynical view of other people that results in a tendency to interpret ambiguous social situations in hostile or threatening ways. Cognitive behavioral treatments for hostility have high dropout rates, which may be due to hostile beliefs interfering with treatment engagement. As such, there is a need for an alternative approach to prevent dropout and enhance engagement. The current study therefore developed and tested a 1-session, 40-minute online intervention targeting hostility. It was hypothesized that the hostility intervention would be rated as acceptable as indexed by self-report and completion rates. It was also hypothesized that the hostility intervention would be associated with greater reductions in hostility as compared to a control intervention. Finally, it was hypothesized there would be indirect effects of intervention condition on anger and aggression via changes in hostility.Undergraduates (N = 101) who reported elevated hostility and hazardous alcohol use were randomized to complete either the hostility intervention or a control condition targeting physical health habits. Results showed that individuals randomized to the hostility intervention found the intervention to be highly acceptable and all participants completed the intervention in its entirety. The hostility intervention was associated with significantly faster reductions in hostile interpretations than the control condition with medium to large effects. There were significant indirect effects of intervention condition on month one follow-up anger and aggression via changes in hostile cognitions. This proof-of-concept study provides initial evidence that a brief, single-session intervention may be a promising approach for reducing hostility and its correlates.     

Exposing Clinicians to Exposure: A Randomized Controlled Dissemination Trial of Exposure Therapy for Anxiety Disorders

ObjectiveThe present study evaluated three technology-based methods of training mental health providers in exposure therapy (ET) for anxiety disorders. Training methods were designed to address common barriers to the dissemination of ET, including limited access to training, negative clinician attitudes toward ET, and lack of support during and following training.MethodClinicians naïve to ET (N = 181, M_age = 37.4, 71.3% female, 72.1% Caucasian) were randomly assigned to (a) an interactive, multimedia online training (OLT), (b) OLT plus a brief, computerized motivational enhancement intervention (OLT + ME), or (c) OLT + ME plus a Web-based learning community (OLT + ME + LC). Assessments were completed at baseline, posttraining, and 6 and 12 weeks following training. Outcomes include satisfaction, knowledge, self-efficacy, attitudes, self-reported clinical use, and observer-rated clinical proficiency.ResultsAll three training methods led to large and comparable improvements in self-efficacy and clinical use of ET, indicating that OLT alone was sufficient for improving these outcomes. The addition of the ME intervention did not significantly improve outcomes in comparison to OLT alone. Supplementing the OLT with both the ME intervention and the LC significantly improved attitudes and clinical proficiency in comparison to OLT alone. The OLT + ME + LC condition was superior to both other conditions in increasing knowledge of ET.ConclusionsMulticomponent trainings that address multiple potential barriers to dissemination appear to be most effective in improving clinician outcomes. Technology-based training methods offer a satisfactory, effective, and scalable way to train mental health providers in evidence-based treatments such as ET.     

Be a Mom,a Web-Based Intervention to Prevent Postpartum Depression: Results From a Pilot Randomized Controlled Trial

Be a Mom is a self-guided web-based intervention, grounded in cognitive behavioral therapy, delivered to postpartum women to prevent persistent postpartum depression [PPD] symptoms. We aimed to evaluate Be a Mom in terms of its preliminary efficacy, feasibility, and acceptability. A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention (Be a Mom) or to the waiting-list control group. Participants in both groups completed baseline (T1) and postintervention (T2) assessments. The 194 women presenting risk factors/early-onset PPD symptoms were allocated to the intervention (n = 98) or to the control (n = 96) group. A significant Time × Group interaction effect was found for both depressive and anxiety symptoms, with women in the intervention group presenting a larger decrease in symptoms from T1 to T2 (p < .05). Less than half of the women (41.8%) completed Be a Mom. Most women (71.4%) would use Be a Mom again if needed. Results provide preliminary evidence of the Be a Mom’s efficacy, acceptability and feasibility, although further research is needed to establish Be a Mom as a selective/indicative preventive intervention for persistent PPD.     

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.     

A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility,Acceptability, and Potential Efficacy

Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28–55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = −0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = −1.1, p = .001), sleep onset latency (d = −0.6, p = .021), global sleep quality (d = −0.9, p = .002), and depression symptoms (d = −0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.     

The More the Better,Only in the Longer Term: A Cluster Randomized Controlled Trial to Evaluate a Compound Intervention Among Mainland Chinese Immigrants in Hong Kong

Barriers to adaptation faced by mainland Chinese immigrants to Hong Kong can be reduced by improving two targets of adaptation: information about negotiating their new environment and psychological well-being. We developed and evaluated a Compound intervention to address these two domains simultaneously and compared its effects to two separate interventions exclusively targeting either information about Hong Kong or psychological well-being. This cluster randomized controlled trial assigned 251 immigrants to an information provision arm (IP, n = 84) targeting knowledge and adaptation difficulties, a psychological well-being enhancement arm (WBE, n = 80) targeting resilience and mental health, or a Compound arm (i.e., IP + WBE, n = 87). The Compound arm showed stronger effects from baseline to postintervention on knowledge than the WBE arm. From postintervention to 6-month follow-up, the Compound arm showed better sustained effects on knowledge and adaptation difficulties than the IP arm and on resilience and mental health than the WBE arm. Additionally, participants in the Compound arm with more baseline depressive symptoms showed greater improvements in adaptation difficulties and general mental health than those with fewer symptoms. The study demonstrated the longer-term effectiveness of the Compound intervention and its greater benefits for immigrants with more depressive symptoms.     

Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial

To help create an evidence base in Europe for effective interventions that improve the well‐being of homeless people, we tested whether critical time intervention (CTI), a time‐limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel‐group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care‐as‐usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9‐month follow‐up. Outcomes were analyzed with three‐level mixed‐effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self‐esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long‐term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services.     

Improving Personal Happiness Through Couple Intervention: A Randomized Controlled Trial of a Self-directed Couple Enhancement Program

Although personal happiness is highly associated with social relationships, basic questions remain regarding the causal effect of improved social relationships on happiness. The main aim of this study was to test whether emotional and cognitive dimensions of personal happiness can be increased by means of a self-directed relationship enhancement program, which aims to increase relationship-relevant skills such as dyadic coping, communication, and conflict resolution. N = 220 couples were randomly assigned either to an intervention or to a waiting list control group (survey: pre-, post-, 3- and 6-month follow-ups). Multi-group latent change score models reveal that (1) personal happiness can be increased through a couple intervention; (2) change in personal happiness was predicted by an increase in skills and relationship satisfaction through the intervention; (3) the least happy participants benefited most from the intervention. Improving spousal interactions may help people become and stay happier. Participants in this study did not relapse to their set point of personal happiness as could be expected by adaptation theory. Thus, not treating individuals directly, but rather the dynamic system of spousal interactions as a whole, offers a potentially very powerful area for happiness research.     

Lessons Learned From a Randomized Controlled Pilot Trial Testing an Inhibitory Learning Approach to Exposure in Anxious Youth

Accumulating evidence from basic and translational research indicates that fear extinction may be best explained by principles of “inhibitory learning,” by which prefrontal cortical structures inhibit activity in the amygdala. New guidelines for the clinical practice of exposure therapy have arisen from research on inhibitory learning, but these guidelines have received little empirical testing in clinical samples of youth receiving treatment for anxiety disorders. We investigated the acceptability, feasibility, and initial efficacy of conducting exposure therapy for anxiety disorders in youth according to clinical guidelines developed from basic research on inhibitory learning principles, using a pilot randomized controlled trial design. Thirteen youths (ages 7 to 16) were recruited from a university hospital-based pediatric outpatient clinic to participate in a 9-week treatment study and were randomized to either an inhibitory learning-based exposure condition or a standard exposure condition. Results supported the feasibility and acceptability of an inhibitory learning-based approach to exposure therapy in youth and, despite the small sample size, effect sizes were in favor of the inhibitory learning approach on several measures. Differences between the standard exposure and inhibitory learning conditions are discussed using two case examples. Discussion of results and lessons learned may contribute to changes in clinical guidelines for optimally effective practice of exposure.     

Effects of A Parenting-Focused Mindfulness Intervention on Adolescent Substance Use and Psychopathology: A Randomized Controlled Trial

Substance use and psychopathology symptoms increase in adolescence. One key risk factor for these is high parent stress. Mindfulness interventions reduce stress in adults and may be useful to reduce parent stress and prevent substance use (SU) and psychopathology in adolescents. This study tested the feasibility and effects of a mindfulness intervention for parents on adolescent SU and psychopathology symptoms. Ninety-six mothers of 11–17 year olds were randomly assigned to a mindfulness intervention for parents (the Parenting Mindfully [PM] intervention) or a brief parent education [PE] control group. At pre-intervention, post-intervention, 6-month follow-up, and 1-year follow-up, adolescents reported on SU and mothers and adolescents reported on adolescent externalizing and internalizing symptoms. Primary intent to treat analyses found that the PM intervention prevented increases in adolescent SU over time, relative to the PE control group. The PM intervention also prevented increases in mother-reported externalizing symptoms over time relative to the PE control group. However, PM did not have a significant effect on internalizing symptoms. PM had an indirect effect on adolescent-reported externalizing symptoms through greater mother mindfulness levels at post-intervention, suggesting mother mindfulness as a potential intervention mechanism. Notably, while mothers reported high satisfaction with PM, intervention attendance was low (31% of mothers attended zero sessions). Secondary analyses with mothers who attended?>??=?50% of the interventions (n?=?48) found significant PM effects on externalizing symptoms, but not SU. Overall, findings support mindfulness training for parents as a promising intervention and future studies should work to promote accessibility for stressed parents.

Clinical Trials Identifier: NCT02038231; Date of Registration: January 13, 2014