Evidence for decreased maladaptive guilt following PCIT-ED for depression as measured by story stem narratives: a promising method for preschool self-disclosure of emotions and experiences of parenting

Preschool-Onset Major Depressive Disorder (PO-MDD) has been validated in children as young as 3 years old. Guilt is a highly specific symptom of the disorder, and maladaptive parenting behaviors are a key risk factor. The purpose of this study is to investigate the utility of the MacArthur Story Stem Battery (MSSB), a narrative technique, as a valid tool through which depressed preschoolers may express their own internal representations of their maladaptive guilt and their caregiver’s parenting. MSSB narratives were coded for children’s representations of their own guilt and their caregivers’ parenting styles before and after an evidence-based dyadic therapy for PO-MDD—Parent-Child Interaction therapy-Emotional Development (PCIT-ED)—and compared to Waitlist controls. Results indicate that narrative guilt themes significantly decreased in children assigned to PCIT-ED compared to a Waitlist control group, and that parenting style themes correlated significantly with observed parenting behavior. These findings validate the use of MSSB narrative techniques to track changes in preschoolers’ maladaptive guilt following treatment for depression. Findings also provide validation of this method to capture preschool children’s experiences of parenting.