Examining the Effectiveness of Circle of Security Parenting (COS-P): A Multi-Site Non-Randomized Study with Waitlist Control

Efficacy of a randomized controlled trial of a perinatal adaptation of COS-P in promoting maternal sensitivity and mental wellbeing among women with psychosocial vulnerabilities

“…A third potential explanation for the lack of a main effect on maternal sensitivity is that mothers benefit differently from the Circle of Security program. Cassidy et al [ 56 ] indicated that COS-P may be particularly beneficial for mothers who are high on attachment avoidance or low on depressive symptoms, and Maxwell et al [ 30 ] found within-treatment group effects showing greater reduction in caregiving helplessness for mothers with older children and a greater reduction in hostility for mothers with pre-intervention clinical levels of depression. Ramsauer et al [ 55 ] found that maternal unresolved state of mind regarding attachment moderated changes in maternal sensitivity in the intervention group, as compared to treatment as usual.…”

“…Several studies have found that COS-P positively affects parental self-efficacy, defined as the parent´s sense of their own parenting abilities, which is comparable to a lower experience of parenting stress [ 30 , 53 ]. It has been argued that the COS-P intervention aims to enhance parents´ understanding of their child´s behavior and to develop their abilities to observe and reflect as well as help to understand their own thoughts and feelings in relation to parenting–that is, the representational level of parenting [ 30 ]. This might explain why we detected intervention effects on mothers’ experiences of their parenting but not on observed behaviors.…”

“…As a group, mothers participating in the study reported subthreshold levels of depression. Maxwell et al [ 30 ] found that, in the intervention group, mothers with probable clinical depression at baseline (defined in their study as an EPDS score ≥ 13) had a significantly greater reduction in depression scores than did mothers with baseline depression scores in the lower range.…”

“…parenting stress [30,53]. It has been argued that the COS-P intervention aims to enhance parents´understanding of their child´s behavior and to develop their abilities to observe and reflect as well as help to understand their own thoughts and feelings in relation to parentingthat is, the representational level of parenting [30].…”

“…A recent meta-analysis of the effect of the COS and COS-P intervention [ 29 ] found medium effect sizes for improving child attachment security (Hedge´s g = 0.65, p = .003), quality of caregiving (Hedge´s g = 0.60, p = .012), and reduction of caregiver depression (Hedge´s g = 0.53, p < .001), and a large effect size for improving caregiver self-efficacy (Hedge´s g = 0.98, p < .001). Despite its wide dissemination, there remains a need for studies on the effect of the COS-P [ 30 , 31 ]. While the COS and the COS-P are usual carried out with pre-school children (mean age 34 months; 18), a perinatal version of COS has been examined among pregnant women with a history of substance use in jail for nonviolent offences [ 32 ].…”