Circle of Security Parenting Program Shows No Clinical Advantage in NHS Study

You’re supposed to be swimming in love, but sometimes the water feels murky.

Exhaustion, anxiety, guilt, and self-doubt swirl together, especially in the first year after birth. For some, these feelings grow into serious perinatal mental health difficulties—affecting up to one in four new parents.

For years, therapists have turned to the Circle of Security–Parenting (COS-P) program to help.

It’s a widely used, attachment-based course that helps parents tune into their baby’s emotional needs and strengthen their sense of connection.

Early studies suggested it could improve both mental health and bonding.

But a landmark UK trial has now tested COS-P in the real world—and found that it doesn’t deliver the hoped-for results.

A closer look at the “Circle of Security” idea

The COS-P program rests on a simple yet powerful metaphor: the circle of a child’s needs.
On one side of the circle, children explore; on the other, they seek comfort.

Parents act as the secure base from which exploration begins and the safe haven to which children return.

In theory, helping parents understand this emotional dance could reduce anxiety, depression, and feelings of failure.

It’s a gentle, reflective approach, drawing on decades of attachment research inspired by John Bowlby and Mary Ainsworth.

The question, however, is whether that circle holds strong under the pressures of real clinical care—particularly for parents already struggling with serious mental health difficulties.

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Putting COS-P to the test

To find out, researchers from Anna Freud and University College London ran one of the largest trials of its kind.

Across ten NHS Trusts in England, 371 birthing parents experiencing moderate-to-severe perinatal mental health difficulties took part.

All were already receiving support from specialist perinatal teams.

Half received standard NHS care—therapy, medication, parent-infant support, and peer help.

The other group received the same care plus ten COS-P sessions, mostly delivered online in small groups.

This wasn’t a lab study—it was deliberately pragmatic, mirroring the realities of busy NHS clinics and online service delivery.

After 3, 7, and 12 months, researchers measured depression, anxiety, emotion regulation, bonding, and child development using validated scales.

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What they found surprised many

Both groups improved over the year.

Symptoms of distress dropped from moderate to mild, and bonding scores improved.

But when researchers compared the two groups, there was no meaningful difference.

Adding COS-P didn’t make parents less depressed, less anxious, or more securely bonded with their babies than standard NHS care alone.

Even when researchers looked only at parents who completed all ten sessions, the program still didn’t outperform regular care.

There was one small bright spot: parents with personality difficulties or bipolar disorder showed stronger improvements with COS-P.

That suggests it might help certain groups who struggle with emotion regulation and relationship instability—though more research is needed to confirm this.

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Why didn’t it work?

The findings don’t mean COS-P is useless—it may simply not fit this particular population or delivery format.

Many participants were coping with complex, overlapping mental health problems: depression, trauma, anxiety, and parenting stress, often compounded by sleep deprivation and isolation.

For parents in survival mode, reflective exercises about attachment might feel abstract or emotionally taxing.

Another challenge was timing. COS-P was designed for parents of children up to six years old, not specifically for those with newborns.

It can be hard to “read” a baby’s emotional cues when you’re barely sleeping and your baby can’t yet communicate beyond crying.

And while online sessions increase access, they can dilute the warmth and safety of face-to-face groups—crucial elements for building trust and reflection.

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What this means for new parents and clinicians

The takeaway isn’t discouragement—it’s refinement.

The study shows that current NHS perinatal mental health services already help parents recover, even without COS-P. That’s a huge success story in itself.

But it also points to what’s missing: interventions that directly target emotion regulation, a shared thread across depression, anxiety, and trauma.

Programs drawing on approaches like Dialectical Behaviour Therapy (DBT) or Mentalisation-Based Treatment (MBT) might better equip parents to manage overwhelming emotions and respond sensitively to their babies.

For clinicians, the lesson is to look beyond one-size-fits-all models. Attachment-based work remains valuable—but it may need adapting for the intensity and timing of the perinatal period.

For parents, the message is reassuring: healing doesn’t always come from new or trendy programs. Sometimes, the support already in place—compassionate care, regular therapy, and small daily acts of connection—makes the biggest difference.

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Why it matters

The transition to parenthood rewires the brain. It’s a period of extraordinary plasticity, sensitivity, and vulnerability. Interventions during this time can have lifelong ripple effects for both parent and child.

This trial’s null findings remind us that even well-intentioned, theoretically sound interventions must be rigorously tested. Science isn’t about confirming what we hope—it’s about learning what actually works.

In that sense, the Circle of Security has come full circle: reminding us that security isn’t built from programs alone, but from ongoing curiosity, empathy, and evidence.