An Attachment-Based Family Therapy for Anxiety and Depression in Children: A Mixed-Methods Evaluation of BEST-Foundations.

Background/objectives: Parent-child attachment and family relationships have been identified as risk factors for childhood internalising symptoms such as anxiety and depressive symptoms. This mixed-methods evaluation examined the feasibility of a recently developed attachment-based family intervention, Behaviour Exchange Systems Therapy-Foundations (BEST-F), delivering 16 h of therapy over 8 weeks to treat internalising symptoms in children aged between 3 and 11 years.

Methods: The quantitative outcomes of this uncontrolled study of 17 families were based on the parent-reported Child Behaviour Checklist (CBCL) measure, completed at four-timepoints (baseline, pre-, post-intervention, and follow-up), while qualitative data were collected from interviews with participants at follow-up.

Results: Pre- and post-BEST-F intervention results demonstrated a significant change in internalising symptoms from the borderline and clinical range to the normal range, with a large effect size ( = 0.85). Notably, additional reductions in internalising symptoms were reported two months after cessation of treatment, with a very large effect size ( = 1.85). Furthermore, there were substantial reductions in child externalising symptoms and parental mental health symptoms, with large effect sizes ranging from = 0.80 to 1.12. Qualitative reports were consistent with these quantitative findings.

Conclusions: These pilot results suggest that children presenting with clinical-range internalising symptoms may benefit from family-based approaches where the parent-child relationship is a focus.