Karen M. O’Brien, M.S. Amy Murrell, PhD. University of North Texas

1. Evaluating the effectiveness of a parent training protocol based on an Acceptance and Commitment Therapy philosophy of parenting Karen M. O’Brien, M.S. Amy Murrell, PhD. University of North Texas

2. Introduction & Rationale • Limitations of Traditional BPT • Early success of acceptance and mindfulness based treatments, including ACT, with parents • Success of ACT with a variety of other populations • Limited studies of ACT with parents (2)

3. Hypothesis & Purpose • An ACT for parents intervention will favorably impact… • ACT processes (acceptance, mindfulness, valuing) • Parenting behavior and distress • Child behavior

4. Participants General Characteristics FLOW • Collin County Children’s Advocacy Center (CAC), Family Based Safety Services Program • Young • Mean age: 22.18 • Range: 18 to 46 • Female (84.2%) • 1-3 children • Reporting high levels of parenting stress • 34 parents referred and screened • 33 parents consented • 23 parents attended at least one day of either Workshop A or B • 19 parents completed an entire workshop • 14 parents completed follow-up measures

5. Design Single-case experimental Within-Ss, Repeated Measures • Interrupted time series data • ACT Daily Diary • 25 baseline observations • 25 post-intervention • 1 group, 3 time points • 10 measures: • AFQ • KIMS • MVM • VLQ • DERS • DASS-21 • APQ-9 • PLOC • PSI-SF • BASC-2

6. Procedure

7. Treatment Protocol Didactic Experiential • ACT Components and Concepts (e.g., valuing, whole, complete and perfect, FEAR) • Parenting practices that lead to child misbehavior • The ABC’s of behavior • Behavioral principles • Antecedent control • Giving directions effectively • Shaping • Consequences • Noticing your mind • Awareness of the smallest sound • The “just-so pizza” • How do you want to be remembered? • Notice the words • Whatever it takes

8. Hypothesis 1: ACT Daily Diary Data Visual inspection of diary ratings will indicate that the intervention had an impact a) Stable baseline data for all for domains (suffering, struggle, workability and valued action) • Stability around mean line • Stable trend line b) Mean and level changes in the expected directions • Suffering and struggle decrease • Workability and valued action increase c) Post-intervention trend lines in the expected directions

9. Diary Results Summary • Caseworkers referred <25 days prior • Lack of parent compliance • Only 1 parent provided 50 data points • 6 parents had both baseline and post-intervention data • 2 parents post only data • Unstable baselines (and post-intervention) • Complete visual inspection criteria not met for any parent on any domain

10. Parent A

11. Parent B

12. Parent B

13. Parent B

14. Parent F

15. Hypotheses 2,3,4, and 5: Clinically & Statistically Significant Change RCI for clinically significant change RM ANOVA for statistically significant change

16. Acceptance (AFQ) • 73.7% changed in the desired direction pre- to post. • 42.9% pre- to follow-up • Reliable change observed for Parent M at post-test & follow-up • Gains not maintained • MORE TREATMENT

17. Emotion Regulation (DERS) 31.6% pre- to post-test 50% pre- to follow-up Parents I and M had reliable change from pre- to post-test Same 2 parents with reliable change on 3 other measures (the most reliable change) Emotion regulation as a mediating variable Differentiate from experiential avoidance

18. Mindfulness (KIMS) • 36.8% pre- to post-test • 50% pre-test to follow-up • Possible incubation effects • No reliable change (or statistically significant change) • Sample size • Measurement issues • Coyne & Silva findings • NEED MORE TREATMENT

19. Valuing (MVM & VLQ)

20. Parental Efficacy (PE subscale, PLOC) 47.4% pre- to post-test 57.1% pre to follow-up Parents L and I had reliable change from pre to post-test Parent L maintained those changes at follow-up

21. Parenting Practices (APQ-9) APQ-9 demonstrated poor to average internal consistency reliability 47.4% pre- to post-test 50% pre- to follow-up Parents A & B showed reliable change from pre- to post-test Need for BOOSTER SESSION or MORE TREATMENT

22. Parenting Stress (PSI-SF) • High pre-treatment levels (>2SD above mean) • 57.9% pre- to post-test • 64.3% pre-test to follow-up • Parent M showed reliable change from pre-test to follow-up • General decreasing trend in mean scores

23. DASS-21 • 52.6% pre- to post-test • 28.6% pre- to follow-up • Parent N showed reliable change, no follow-up data • Consider pre-treatment levels • Blackledge & Hayes (2006) • Murrell & colleagues (2009)

24. Externalizing Behavior (BASC-2 Ex) • 76.9% pre- to post-test • 80% pre- to follow-up • Consistent with pilot data (Murrell & colleagues, 2009)

25. Internalizing Behavior (BASC-2 Int.) • General decreasing trend • 61.5% pre- to post-test • 70% pre- to follow-up • Internalizing behavior not given as much attention as externalizing behavior

26. Adaptive Skills (BASC-2 Adap) Age of children? Just changing over time? Not really targeted with our intervention Probably not related to intervention?

27. Parents said… “Not distressing, but it was emotional… understanding your emotions, realizing they’re there and what is there, and accepting it.” “Yes, to allow my thoughts to take place and me to make a good choice.” “I'm going to be mindful and slow down, talk about our mindsets and feelings.” “I like the atmosphere of sharing personal experience… I feel more empowered because I learned that my thoughts and feelings are normal. Thank you for introducing this topic to the general public! I believe there is a serious need for this to be more available.”

28. Limitations • Recruitment • Data collection (logistics) • Design (stable baseline vs. control group) • Measurement • Social desirability • Reading level • NOT ENOUGH TREATMENT

29. Future Directions • Consider domain specific measures or behavioral measures • Use of control group • MORE TREATMENT • Individual versus group • Explore relationship between constructs • MVM and VLQ • DERS and AFQ