Abstract
The Resilience Builder Program® (RBP) is a cognitive-behavioral based group therapy for children with psychosocial deficits. Previous studies in children with varied diagnoses (attention deficit/hyperactivity disorder, anxiety disorders, and autism spectrum disorders) have provided evidence for its effectiveness in emotion regulation, positive emotions, social skills, and resilience. However, little is known about the mechanisms through which specific therapeutic components of the RBP may reduce internalizing problems in children. The current study examined pre- to post-therapy change in self-regulation, resilience, and internalizing problems, and investigated the therapeutic pathways of the RBP for reducing children’s internalizing problems by accounting for resilience improvement. Children (N = 244) between 7 to 15 years old with diverse diagnoses and heterogeneous symptoms who completed the RBP were assessed with parent-report measures of executive functioning, emotion regulation, resilience, and internalizing problems prior to and following the RBP. Results found that improvement in self-regulation and resilience predicted significant reductions in internalizing problems in children following the RBP. In addition, the change in resilience was found to be a significant predictor of the relationship between the change in self-regulation and internalizing problems. These findings clarify the therapeutic mechanisms of RBP, and more broadly speak to the value of targeting self-regulation and resilience as a means of reducing internalizing problems in youth receiving psychotherapeutic interventions.
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References
Aduen, P. A., Rich, B. A., Sanchez, L., O’Brien, K., & Alvord, M. K. (2014). Resilience builder program therapy addresses core social deficits and emotion dysregulation in youth with high-functioning autism spectrum disorder. Journal of Psychological Abnormalities, 3(2), 1–10. https://doi.org/10.4172/2329-9525.1000118
Alvord, M., & Grados, J. J. (2005). Enhancing resilience in children: A proactive approach. Professional Psychology: Research and Practice, 36, 238–245. https://doi.org/10.1037/0735-7028.36.3.238
Alvord, M. K., Zucker, B., & Grados, J. J. (2011). Resilience builder program for children and adolescents: Enhancing social competence and self-regulation—a cognitive-behavioral approach. Research Press.
Alvord, M. K., Rich, B. A., & Berghorst, L. H. (2014). Developing social competence through a resilience model. In S. Prince-Embury & D. H. Saklofske (Eds.), Resilience Interventions for Youth in Diverse Populations (pp. 329–351). New York: Springer.
Anderson, E. R., & Mayes, L. C. (2010). Race/ethnicity and internalizing disorders in youth: A review. Clinical Psychology Review, 30(3), 338–348.
Bengtsson, H., Bravo, H. C., Gentleman, R., Hossjer, O., Jaffee, H., Jiang, D., … Hickey, P. (2018). matrixStats: Functions that apply to rows and columns of matrices (and to Vectors) (Version 0.54.0). Retrieved from https://CRAN.R-project.org/package=matrixStats. Accessed 22 Feb 2024
Bone, C., Simmonds-Buckley, M., Thwaites, R., Sandford, D., Merzhvynska, M., Rubel, J., Deisenhofer, A. K., Lutz, W., & Delgadillo, J. (2021). Dynamic prediction of psychological treatment outcomes: Development and validation of a prediction model using routinely collected symptom data. The Lancet. Digital Health, 3(4), e231–e240. https://doi.org/10.1016/S2589-7500(21)00018-2
Booster, G. D., Dupaul, G. J., Eiraldi, R., & Power, T. J. (2012). Functional impairments in children with ADHD: Unique effects of age and comorbid status. Journal of Attention Disorders, 16(3), 179–189. https://doi.org/10.1177/1087054710383239
Buuren, S. van, Groothuis-Oudshoorn, K., Robitzsch, A., Vink, G., Doove, L., Jolani, S., … Gray, B. (2019). mice: Multivariate imputation by chained equations (Version 3.6.0). Retrieved from https://CRAN.R-project.org/package=mice. Accessed 22 Feb 2024
Cain, M. K., Zhang, Z., & Bergeman, C. S. (2018). Time and other considerations in mediation design. Educational and Psychological Measurement, 78(6), 952–972.
Calkins, S. D. (2007). The emergence of self-regulation: Biological and behavioral control mechanisms supporting toddler competencies. Socioemotional development in the toddler years: Transitions and transformations, 261–284.
Casey, E. C., Finsaas, M., Carlson, S. M., Zelazo, P. D., Murphy, B., Durkin, F., … Masten, A. S. (2014). Promoting resilience through executive function training for homeless and highly mobile preschoolers. In S. Prince-Embury & D. H. Saklofske (Eds.), Resilience Interventions for Youth in Diverse Populations (pp. 133–158). https://doi.org/10.1007/978-1-4939-0542-3_7
Castaneda, A. E., Suvisaari, J., Marttunen, M., Perälä, J., Saarni, S. I., Aalto-Setälä, T., … Tuulio-Henriksson, A. (2008). Cognitive functioning in a population-based sample of young adults with a history of non-psychotic unipolar depressive disorders without psychiatric comorbidity. Journal of Affective Disorders, 110(1–2), 36–45. https://doi.org/10.1016/j.jad.2007.12.239
Cath, D. C., Ran, N., Smit, J. H., van Balkom, A. J. L. M., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: A preliminary case-controlled study. Psychopathology, 41(2), 101–110. https://doi.org/10.1159/000111555
Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., Miranda, J., … Borntrager, C. F. (2013). Long-term outcomes for the Child STEPs randomized effectiveness trial: A comparison of modular and standard treatment designs with usual care. Journal of Consulting and Clinical Psychology, 81(6), 999.
Chorpita, B. F., Korathu-Larson, P., Knowles, L. M., & Guan, K. (2014). Emergent life events and their impact on service delivery: Should we expect the unexpected? Professional Psychology: Research and Practice, 45(5), 387–393. https://doi.org/10.1037/a0037746
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75(2), 317–333. https://doi.org/10.1111/j.1467-8624.2004.00673.x
Conners, C. K. (1997). Conners’ parent rating scale-revised. Multi-Health Systems.
Cuijpers, P., Reijnders, M., & Huibers, M. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207–231. https://doi.org/10.1146/annurev-clinpsy-050718-095424
Disabato, D. (2016). The double standard against cross-sectional mediation. Squarespace. https://www.daviddisabato.com/blog/2016/5/22/the-double-standard-against-cross-sectional-mediation. Accessed 22 Feb 2024
Doll, B., Spies, R. A., LeClair, C. M., Kurien, S. A., & Foley, B. P. (2010). Student perceptions of classroom learning environments: Development of the ClassMaps Survey. School Psychology Review, 39(2), 203–218.
Ehrenreich-May, J., Rosenfield, D., Queen, A. H., Kennedy, S. M., Remmes, C. S., & Barlow, D. H. (2017). An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. Journal of Anxiety Disorders, 46, 46–55.
Eisen, S. V., Ranganathan, G., Seal, P., & Spiro, A. (2007). Measuring clinically meaningful change following mental health treatment. The Journal of Behavioral Health Services & Research, 34(3), 272–289.
Gaviţa, O. A., Joyce, M. R., & David, D. (2011). Cognitive behavioral parent programs for the treatment of child disruptive behavior. Journal of Cognitive Psychotherapy, 25(4), 240–256. https://doi.org/10.1891/0889-8391.25.4.240
Gelfand, L. A., Mensinger, J. L., & Tenhave, T. (2009). Mediation analysis: A retrospective snapshot of practice and more recent directions. Journal of General Psychology, 136, 153–176.
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior rating inventory of executive function. Psychological Assessment Resources.
Goolsby, J., Rich, B. A., Hinnant, B., Habayeb, S., Berghorst, L., De Los Reyes, A., & Alvord, M. K. (2018). Parent–child informant discrepancy is associated with poorer treatment outcome. Journal of Child and Family Studies, 27(4), 1228–1241. https://doi.org/10.1007/s10826-017-0946-7
Goolsby, J., Alvord, M. K., & Rich, B. A. (2019). Impact of child and parent motivation on social skills training outcome. Child and Family Behavior Therapy, 41(1), 32–46. https://doi.org/10.1080/07317107.2019.1571774
Gresham, F. M., & Elliott, S. N. (2008). Social skills improvement system rating scales manual. Pearson Assessments.
Habayeb, S., Rich, B., & Alvord, M. K. (2017). Targeting heterogeneity and comorbidity in children with autism spectrum disorder through the Resilience Builder group therapy program. Child & Youth Care Forum, 46(4), 539–557. https://doi.org/10.1007/s10566-017-9394-1
Hochsztein, N. G. (2014). Executive functioning and social competence as predictors of resilience in emotional functioning in youth diagnosed with epilepsy (Ph.D., Long Island University, The Brooklyn Center). Retrieved from https://search.proquest.com/docview/1673167054/abstract/92ADE68B40DE481EPQ/3. Accessed 22 Feb 2024
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … Wang, P. (2010). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748–751. https://doi.org/10.1176/appi.ajp.2010.09091379
Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., … Vitiello, B. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 147–158. https://doi.org/10.1097/00004583-200102000-00009
Jorgensen, T. D., Schoemann, A., Rosseel, Y., Miller, P., Quick, C., Garnier-Villarreal, M., … Mansolf, M. (2018). semTools: Useful tools for structural equation modeling (Version 0.5–1). Retrieved from https://CRAN.R-project.org/package=semTools. Accessed 22 Feb 2024
Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., … van Dyck, P. C. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395–1403. https://doi.org/10.1542/peds.2009-1522
Lagasse, L. L., Conradt, E., Karalunas, S. L., Dansereau, L. M., Butner, J. E., Shankaran, S., … Lester, B. M. (2016). Transactional relations between caregiving stress, executive functioning, and problem behavior from early childhood to early adolescence. Development and Psychopathology, 28(3), 743–756. http://dx.doi.org.proxycu.wrlc.org/10.1017/S0954579416000286. Accessed 22 Feb 2024
Leadbeater, B. J., Kuperminc, G. P., Blatt, S. J., & Hertzog, C. (1999). A multivariate model of gender differences in adolescents’ internalizing and externalizing problems. Developmental Psychology, 35(5), 1268.
Lee, H. H., & Cranford, J. A. (2008). Does resilience moderate the associations between parental problem drinking and adolescents’ internalizing and externalizing behaviors? A study of Korean adolescents. Drug and Alcohol Dependence, 96(3), 213–221. http://dx.doi.org.proxycu.wrlc.org/10.1016/j.drugalcdep.2008.03.007. Accessed 22 Feb 2024
Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202.
Liu, J., Chen, X., & Lewis, G. (2011). Childhood internalizing behaviour: Analysis and implications. Journal of Psychiatric and Mental Health Nursing, 18(10), 884–894. https://doi.org/10.1111/j.1365-2850.2011.01743
Lucassen, M. F. G., Stasiak, K., Crengle, S., Weisz, J. R., Frampton, C. M. A., Bearman, S. K., … Merry, S. N. (2015). Modular approach to therapy for anxiety, depression, trauma, or conduct problems in outpatient child and adolescent mental health services in New Zealand: Study protocol for a randomized controlled trial. Trials, 16, 457. https://doi.org/10.1186/s13063-015-0982-9
McClelland, M. M., Cameron, C. E., Connor, C. M., Farris, C. L., Jewkes, A. M., & Morrison, F. J. (2007). Links between behavioral regulation and preschoolers’ literacy, vocabulary, and math skills. Developmental Psychology, 43(4), 947–959. https://doi.org/10.1037/0012-1649.43.4.947
McClelland, M. M., Ponitz, C. C., Messersmith, E. E., & Tominey, S. (2010). Self-regulation: Integration of cognition and emotion. In W. F. Overton & R. M. Lerner (Eds.), The handbook of life-span development, Vol. 1. Cognition, biology, and methods (pp. 509–553). John Wiley & Sons, Inc.. https://doi.org/10.1002/9780470880166.hlsd001015
Merrell, K. W., McClun, L. A., Kempf, K. K., & Lund, J. (2002). Using self-report assessment to identify children with internalizing problems: Validity of the internalizing symptoms scale for children. Journal of Psychoeducational Assessment, 20(3), 223–239.
Miklós, M., Futó, J., Komáromy, D., & Balázs, J. (2019). Executive function and attention performance in children with ADHD: Effects of medication and comparison with typically developing children. International Journal of Environmental Research and Public Health, 16(20), 3822.
Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., … Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences, 108(7), 2693–2698. https://doi.org/10.1073/pnas.1010076108
Morgan, J. K. (2010). Emotion regulation as a determinant of children’s internalizing behaviors: Implications for emotion utilization. University of Delaware.
Nigg, J. T. (2017). Annual Research Review: On the relations among self‐regulation, self‐control, executive functioning, effortful control, cognitive control, impulsivity, risk‐taking, and inhibition for developmental psychopathology. Journal of Child Psychology and Psychiatry, 58(4), 361–383.
Obradović, J. (2010). Effortful control and adaptive functioning of homeless children: Variable-focused and person-focused analyses. Journal of Applied Developmental Psychology, 31(2), 109–117.
Prince-Embury, M. K. (2014). Review of resilience conceptual and assessment issues. In S. Prince-Embury & D. H. Saklofske (Eds.), Resilience Interventions for Youth in Diverse Populations (pp. 13–24). Retrieved from https://link.springer.com/chapter/10.1007/978-1-4939-0542-3_15. Accessed 22 Feb 2024
Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics, 175(11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482
Reid, M., Fesalbon. M., Mendoza, E., Alvord, M. K., & Rich, B. A. (2019). Examining the relationship between parental symptomatology and treatment outcomes in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(11), 4681–4685. https://doi.org/10.1007/s10803-019-04151-5
Reivich, K., Gillham, J. E., Chaplin, T. M., & Seligman, M. E. P. (2013). From helplessness to optimism: The role of resilience in treating and preventing depression in youth. In S. Goldstein & R. B. Brooks (Eds.), Handbook of Resilience in Children (pp. 201–214). https://doi.org/10.1007/978-1-4614-3661-4_12
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children, second edition (BASC-2). In The Encyclopedia of Clinical Psychology. https://doi.org/10.1002/9781118625392.wbecp447
Rich, B. A., Hensler, M. A., Rosen, H. R., Watson, C., Schmidt, J., Sanchez, L., O’Brien, K., & Alvord, M. K. (2014). Attrition from therapy effectiveness research among youth in a clinical service setting. Administration and Policy in Mental Health and Mental Health Services Research, 41, 343–352.
Rich, B. A., Shiffrin, N. D., Cummings, C. M., Zarger, M. M., Berghorst, L., & Alvord, M. K. (2019). Resilience-based intervention with underserved children: Impact on self-regulation in a randomized clinical trial in schools. International Journal of Group Psychotherapy, 69(1), 30–53. https://doi.org/10.1080/00207284.2018.1479187
Rich, B. A., Shiffrin, N.S., *Senior, C., *Zarger, M. A., Cummings, C. M., Collado. A., & Alvord, M. K. (2023). Improved resilience and academics following a school-based resilience intervention: A randomized controlled trial. Evidence-Based Practice in Child & Adolescent Mental Health,8(2), 252-268. https://doi.org/10.1080/23794925.2022.2025630
Riggs, A. A., Cusimano, A. M., & Benson, K. M. (2011). Childhood emotional abuse and attachment processes in the dyadic adjustment of dating couples. Journal of Counseling Psychology, 58, 126–138.
Robitzsch, A., Grund, S., & Henke, T. (2019). miceadds: Some additional multiple imputation functions, especially for “mice” (Version 3.4–17). Retrieved from https://CRAN.R-project.org/package=miceadds. Accessed 22 Feb 2024
Rubin, K. H., Coplan, R. J., Fox, N. A., & Calkins, S. D. (1995). Emotionality, emotion regulation, and preschoolers’ social adaptation. Development and Psychopathology, 7(1), 49–62. https://doi.org/10.1017/S0954579400006337
Rudy, T. E., Kerns, R. D., & Turk, D. C. (1988). Chronic pain and depression: Toward a cognitive-behavioral mediation model. Pain, 35(2), 129–140.
Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57(1), 1–10. https://doi.org/10.1037/a0018082
Senior, C., Godovich, S., Habayeb, S., Alvord, M. K., & Rich, B. A. (2020). The effects of a resilience-based group intervention for youth with ADHD. Journal of Child and Adolescent Counseling, 6(3), 200–214. https://doi.org/10.1080/23727810.2020.1719353
Smith, S. W., Daunic, A. P., Barber, B. R., Aydin, B., Van Loan, C. L., & Taylor, G. G. (2014). Preventing risk for significant behavior problems through a cognitive-behavioral intervention: Effects of the Tools for Getting Along curriculum at one-year follow-up. The Journal of Primary Prevention, 35(5), 371–387. https://doi.org/10.1007/s10935-014-0357-0
Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), 25338.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales:(VABS). NCS Pearson.
Stein, S., & Watson, J. (2007). Behavior assessment system for children, second edition. In K. F. Geisinger, R. A. Spies, J. F. Carlson, & B. S. Plake (Eds.), The seventeenth mental measurements yearbook, (pp. 96–102). Lincoln: Buros Institute of Mental Measurements.
Sterba, S., Egger, H. L., & Angold, A. (2007a). Diagnostic specificity and nonspecificity in the dimensions of preschool psychopathology. Journal of Child Psychology and Psychiatry, 48(10), 1005–1013. https://doi.org/10.1111/j.1469-7610.2007.01770.x
Sterba, S. K., Prinstein, M. J., & Cox, M. J. (2007b). Trajectories of internalizing problems across childhood: Heterogeneity, external validity, and gender differences. Development and Psychopathology, 19(2), 345–366.
Testa, R. J., Michaels, M. S., Bliss, W., Rogers, M. L., Balsam, K. F., & Joiner, T. E. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology, 126, 125–136.
Tugade, M. M., & Fredrickson, B. L. (2007). Regulation of positive emotions: Emotion regulation strategies that promote resilience. Journal of Happiness Studies, 8(3), 311–333. https://doi.org/10.1007/s10902-006-9015-4
Watson, C. C., Rich, B. A., Sanchez, L., O’Brien, K., & Alvord, M. K. (2014). Preliminary study of resilience-based group therapy for improving the functioning of anxious children. Child & Youth Care Forum, 43(3), 269–286. https://doi.org/10.1007/s10566-013-9238-6
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This research was supported by funding from the Group Foundation for Advancing Mental Health.
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Dr. Alvord is co-author of the book “Resilience Builder Program for Children and Adolescents: Enhancing Social Competence and Self-Regulation” and receives royalties on its sales. The other authors report no conflicts.
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Rich, B.A., Jessani, Z., Cummings, C.M. et al. Targeting Self-Regulation to Reduce Internalizing Problems in Children: The Predictive Effect of Resilience. ADV RES SCI (2024). https://doi.org/10.1007/s42844-024-00132-5
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DOI: https://doi.org/10.1007/s42844-024-00132-5