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Parenting Intervention Combined with Acceptance and Commitment Therapy: Processes of Change

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Abstract

Objectives

We report an investigation into processes of change in a randomized controlled trial of Stepping Stones Triple P (SSTP) and acceptance and commitment therapy (ACT) for families of children with cerebral palsy (CP). In comparison with the control group, the SSTP-only group showed improvements in child behavior problems and emotional symptoms and the SSTP-plus-ACT group showed benefits in child behavior problems, child hyperactivity, dysfunctional parenting styles, child functional performance in the mobility domain, child quality of life, and parental adjustment.

Methods

Sixty-seven parents of children with CP were randomly allocated to one of three groups: waitlist control, SSTP-only and SSTP-plus-ACT groups. We investigated three potential processes of change: parenting style, parental attitude to child emotion, and parental psychological flexibility. We used bootstrapping to perform the mediation analysis.

Results

Contrary to the existing literature, we find that neither dysfunctional parenting styles nor parental attitude to child emotion were significant mediators of the intervention effect on child behavior and adjustment. Consistent with existing literature, we find that psychological flexibility mediates the intervention effect on dysfunctional parenting styles (overreactivity confidence interval [CI] = −0.4750 to −0.115) and parental adjustment (depressive symptoms CI = −6.5641 to −0.5922; stress CI = −6.0546 to −0.4195).

Conclusions

Overall, our findings support the conclusion that ACT makes a unique contribution to parenting intervention.

Clinical Trial Registration

Australian New Zealand Clinical Trials Registry (00336291).

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References

  • Arnold, D. S., O’Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144.

    Article  Google Scholar 

  • Boggs, S., Eyberg, S., & Reynolds, L. (1990). Concurrent validity of the Eyberg child behavior inventory. Journal of Clinical Child & Adolescent Psychology, 19(1), 75–78.

    Article  Google Scholar 

  • Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behavior Research and Therapy, 35(1), 79–89.

    Article  Google Scholar 

  • Brown, F. L., Whittingham, K., Boyd, R. N., & McKinlay, L. (2015). Does stepping stones triple p plus acceptance and commitment therapy improve parent, couple and family adjustment following paediatric acquired brain injury? A randomised controlled trial. Behavior Research and Therapy, 73, 58–66.

    Article  Google Scholar 

  • Brown, F. L., Whittingham, K., & Sofronoff, K. (2014). Parental experiential avoidance as a potential mechanism of change in a parenting intervention for parents of children with pediatric acquired brain injury. Journal of Pediatric Psychology, 40(4), 464–474.

    Article  PubMed  Google Scholar 

  • Coyne, L. W., & Wilson, K. G. (2004). The role of cognitive fusion in impaired parenting: an RFT analysis. International Journal of Psychology and Psychological Therapy, 4(3), 469–486.

    Google Scholar 

  • Dumas, J. E. (2005). Mindfulness-based parent training: strategies to lessen the grip of automaticity in families with disruptive children. Journal of Clinical Child & Adolescent Psychology, 34(4), 779–791.

    Article  Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory and Sutter-Eyberg student behavior inventory–revised: professional manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Eyberg, S., & Ross, A. (1978). Assessment of child behavior problems: the validation of a new inventory. Journal of Clinical Child & Adolescent Psychology, 7(2), 113–116.

    Article  Google Scholar 

  • Gardner, F., Burton, J., & Klimes, I. (2006). Randomised controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: outcomes and mechanisms of change. Journal of Child Psychology and Psychiatry, 47(11), 1123–1132.

    Article  PubMed  Google Scholar 

  • Gardner, G., Hutchings, J., Bywater, T., & Whitaker, C. (2010). Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trail of a parenting intervention. Journal of Clinical Child & Adolescent Psychology, 39(4), 568–580.

    Article  Google Scholar 

  • Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.

    Article  PubMed  Google Scholar 

  • Gottman, J. M., Katz, L. F., & Hoover, C. (1996). Parental meta-emotion philosophy and the emotional life of families: Theoretical models and preliminary data. Journal of Family Psychology, 16(3), 243–268.

    Article  Google Scholar 

  • Gottman, J. M., Katz, L. F., & Hoover, C. (1997). Meta-emotion: how families communicate emotionally. Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Halberstadt, A. G., Dunsmore, J. D., McElwain, N. M., Eaton, K. L., & McCool, A. (2001). Parents’ beliefs about negative emotions. Raleigh: North Carolina State University. [Unpublished questionnaire].

    Google Scholar 

  • Halberstadt, A. G., Thompson, J. A., Parker, A. E., & Dunsmore, J. D. (2008). Parents’ emotion-related beliefs and behaviors in relation to children’s coping with the 11 September 2001 terrorist attacks. Infant and Child Development, 17, 557–580.

    Article  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York, NY: Guilford Press.

    Google Scholar 

  • Hayes, A. F., & Preacher, K. J. (2014). Statistical mediation analysis with a multicategorical independent variable. British Journal of Mathematical and Statistical Psychology, 67, 451–470.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). ACT: model, processes and outcomes. Behavior Research and Therapy, 44, 1–25.

    Article  Google Scholar 

  • Hayes, S. C., Strosal, K. D., & Wilson, K. G. (2003). Acceptance and commitment therapy: an experiential approach to behavior change. New York, NY: Guilford Press.

    Google Scholar 

  • Katz, L. F., Wilson, B., & Gottman, J. M. (1999). Meta-emotion philosophy and family adjustment: Making an emotional connection. In M. J. Cox & J. Brooks-Gunn (Eds.), The advances in family research series. Conflict and cohesion in families: Causes and consequences (pp. 131–165). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Lovibond, P. E., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behavior Research and Therapy, 33, 335–343.

    Article  Google Scholar 

  • Murrell, A. R., Wilson, K. G., LaBorde, C. T., Drake, C. E., & Rogers, L. J. (2008). Relational responding in parents. Behavior Analyst Today, 9(3−4), 196–214.

    Article  Google Scholar 

  • Ost, L.-G. (2008). Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behavior Research and Therapy, 46, 296–321. https://doi.org/10.1016/j.brat.2007.12.005.

    Article  Google Scholar 

  • Palisano, R. (1997). Development & reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine Child Neurology, 39, 214–223.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.

    Article  PubMed  Google Scholar 

  • Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125–162.

    Google Scholar 

  • Ruiz, F. J. (2012). ACT versus traditional cognitive behavioral therapy: a systematic review and meta-analysis of current empirical evidence. International Journal of Psychology and Psychological Therapy, 12(2), 333–357.

    Google Scholar 

  • Sanders, M. R., & Dadds, M. R. (1993). Behavioral family intervention. Boston, MA: Allyn and Bacon.

    Google Scholar 

  • Sanders, M. R., Mazzucchelli, T., & Studman, L. (2003). Practitioner’s manual for standard Stepping Stones Triple P. Brisbane, Australia: Triple P International.

    Google Scholar 

  • Sanders, M. R., Mazzucchelli, T. G., & Studman, L. J. (2009). Facilitator’s Manual for Group Stepping Stones Triple P for families with a child who has a disability. Brisbane, Australia: Triple P International.

    Google Scholar 

  • Tellegen, C. L., & Sanders, M. R. (2013). Stepping stones triple P–Positive Parenting Program for children with disability: a systematic review and meta-analysis. Research in Developmental Disabilities, 34, 1556–1571.

    Article  PubMed  Google Scholar 

  • Whittingham, K., Sanders, M. R., McKinlay, L., & Boyd, R. N. (2013). Stepping stones triple P and acceptance and commitment therapy for parents of children with cerebral palsy: trial protocol. Brain Impairment, 14(2), 270–280.

    Article  Google Scholar 

  • Whittingham, K., Sanders, M., McKinlay, L., & Boyd, R. N. (2014). Interventions to reduce behavioral problems in children with cerebral palsy: an RCT. Pediatrics, 133, e1249–e1257.

    Article  PubMed  Google Scholar 

  • Whittingham, K., Sanders, M., McKinlay, L., & Boyd, R. N. (2016). Parenting intervention combined with acceptance and commitment therapy: a trial with families of children with cerebral palsy. Journal of Pediatric Psychology, 41(5), 531–542.

    Article  PubMed  Google Scholar 

  • Whittingham, K., Sofronoff, K., Sheffield, J. K., & Sanders, M. (2009). Stepping stones triple P: an RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469–480. https://doi.org/10.1007/s10802-008-9285-x.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by a National Health and Medical Research Council postdoctoral fellowship (K.W., grant number 631712); a National Health and Medical Research Council Career Development Fellowship (R.B., grant number 1037220) and a Smart State Fellowship (R.B).

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Authors and Affiliations

  1. Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia

    Koa Whittingham & Roslyn N. Boyd

  2. Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, Australia

    Koa Whittingham & Matthew R. Sanders

  3. Queensland Paediatric Rehabilitation Service, Royal Children’s Hospital, Brisbane, QLD, Australia

    Lynne McKinlay

Authors
  1. Koa Whittingham
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  2. Matthew R. Sanders
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  3. Lynne McKinlay
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  4. Roslyn N. Boyd
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Contributions

K.W. designed and executed the study and led the data analysis and write up of the paper. M.R.S. and L.M. collaborated on the design and the write up of the study. R.B. collaborated on the design and the write up of the study, and provided mentorship throughout.

Corresponding author

Correspondence to Koa Whittingham.

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Conflict of Interest

Stepping Stones Triple P is owned by The University of Queensland and sublicensed to Uniquest, The University of Queensland’s Technology Transfer Company. Professor Sanders is a co-author of the Stepping Stones Triple P program and receives royalty payments from the publisher Triple P International in accordance with The University of Queensland’s Intellectual Property Policy. Dr Whittingham and Dr Boyd are both employed by The University of Queensland.

Ethical Approval

Ethical clearance was obtained from the Children’s Health Queensland Human Research Ethics Committee (HREC/09/QRCH/125), the University of Queensland Behavioral and Social Sciences Ethical Review Committee (2009001871), and the Cerebral Palsy League of Queensland Research Ethics Committee (CPLQ-2010/11/1033). All participating parents provided written consent.

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Whittingham, K., Sanders, M.R., McKinlay, L. et al. Parenting Intervention Combined with Acceptance and Commitment Therapy: Processes of Change. J Child Fam Stud 28, 1673–1680 (2019). https://doi.org/10.1007/s10826-019-01386-9

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  • DOI: https://doi.org/10.1007/s10826-019-01386-9

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