Parenting Under Pressure: The Transformative Impact of PCIT on Caregiver Depression and Anxiety and Child Outcomes

Background Objectives: Parental anxiety and depression demonstrate bidirectional connections with child developmental outcomes (e.g., disruptive behavior). Directly targeting child development through behavioral parent training (BPT) has potential for reversing this cycle. Parent-Child Interaction Therapy (PCIT), a BPT with robust research evidence for decreasing child disruptive behaviors, has demonstrated promise in also decreasing caregiver anxiety and depression. However, the mechanisms that explain this relationship are less understood. Methods: The current study examined whether caregivers (N = 840) completing time-limited PCIT experienced significant reductions in depression and anxiety symptoms and improvements in child disruptive behaviors at each time point. Generalized estimate equation analyses assessed whether caregiver anxiety and depression moderated changes in child disruptive behavior. Mediation analyses explored the extent that changes in caregiver-child interactions over time explained changes in family outcomes. Results: Child disruptive behavior and caregiver depression and anxiety symptoms improved significantly at each time point of PCIT. Change in child behavioral outcomes was significantly moderated by caregiver race. Caregivers with higher anxiety reported fewer improvements in child disruptive behavior compared to other caregivers. Changes in caregiver anxiety and depression over the course of treatment were partially mediated by improvement in caregiver-child interaction skills. Changes in child disruptive behavior were not mediated by improvement in caregiver-child interaction skills. Conclusions: Results demonstrate that time-limited PCIT could significantly improve caregiver anxiety and depression, and some PCIT-taught parenting skills are direct drivers of this process. Further research is needed to understand other mechanisms underlying the relationship between PCIT and improved family outcomes.