Randomized controlled trial of Regulation Focused Psychotherapy for children: A manualized psychodynamic treatment for externalizing behaviors

Abstract

Objective

This article examines outcomes of the first randomized controlled trial of Regulation Focused Psychotherapy for Children (RFP-C), a manualized, short-term, psychodynamic intervention for decreasing symptoms of the oppositional defiant disorder (ODD) in school-aged children.

Method

Participants (n = 43) were school-aged children who were randomly assigned to RFP-C or a waitlist control group. Symptoms of ODD and explicit emotion regulation capacities were assessed at baseline, end of waitlist, and end of treatment. Multilevel modeling was used to account for patient and therapist factors in outcomes.

Results

At the end of treatment, parents reported significant reductions in children’s ODD symptoms on the primary outcome measure. There were no observed changes in explicit emotion regulation. Reliable change index scores indicated that 79.4% of children were recovered or improved after 10 weeks of treatment. There were no identifiable patient or therapist effects. Treatment adherence and completion was high.

Conclusion

This study is the first randomized controlled trial of a manualized psychodynamic intervention for children with ODD. Participants demonstrated significant reductions in symptoms of ODD after 10 weeks of treatment. Further investigation is needed to compare RFP-C relative to active treatment, assess changes in implicit emotion, and to determine long-term maintenance of symptom improvement.

Clinical trial registration information: Evaluation of Regulation Focused Psychotherapy for Children (RFP-C); https://clinicaltrials.gov/ct2/show/NCT03594253

Keywords:

• Regulation Focused Psychotherapy for Children
• oppositional defiant disorder
• emotion regulation
• randomized controlled trial
• school-aged children

Acknowledgements

This project was supported by a grant from The FAR Fund. We are also grateful to all of the children and their families who participated in this clinical trial, the dedicated study therapists who provided treatment, and the community of research assistants in the Psychodynamic Psychotherapy Research Lab at the Ferkauf Graduate School of Psychology.

Notes

1 Given the rapid, en masse shift to online treatment during the COVID-19 pandemic, RFP-C was adapted for online delivery quite quickly. In consultation with the clinical supervisor, the principal investigator, colleagues, and therapists working in the trial, we developed specific methods for conducting play therapy online which included specific camera placement – often with therapists sitting on the floor, camera pointed downward, with a wider angle lens of the room – and frequent use of the drawing and chat features of the online platform. Children appeared to adapt to this format easily and continued to engage in the defensive/avoidance maneuvers in a way that reflected the new environment. This included shutting of the camera (akin to leaving the therapy room) and retreating to the chat feature (instead of engaging verbally/more directly) (Udwin et al., n.d.).

2 Given the importance of youth receiving services as soon as possible, we considered many options for this non-treatment arm of the study. Prior to initiating this study, and in consultation with the local IRB, we contacted local clinics to determine current wait times for services. These ranged from 90 days – one year. Therefore, the 10-week waitlist period in this RCT remained shorter than that of community-based mental health services in the study catchment area.

3 For participants initially assigned to the waitlist, the week 10 of waitlist ODDRS score was used as the pre-treatment ODDRS score.

4 The RCT was ongoing during the COVID-19 pandemic and many families moved away temporarily from the urban area where the trial was conducted. Due to increased psychosocial stressors and the demands of remote schooling and work, several parents were unable to complete and return measures. For more information about the delivery of RFP-C online, please see (Udwin et al., n.d.).

5 According to the United States Census Bureau’s 2019 population estimates, the population of this locality was 56.4% Hispanic/Latinx, 43.6% Black/African American, 9.0% White/non-Hispanic, and 3.8% multiethnic. Within the adjacent locality, residents were 52.6% White/non-Hispanic, 25.5% Hispanic/Latinx, 16.7%, Black/African American, and 2.6% multiethnic (https://bit.ly/3zHnIXZ).

6 Consolidated Standards of Reporting Trials.

Additional information

Funding

This study was supported by a grant from The FAR Fund.