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Aditi Sinha, M.S. Karen M. O’Brien, Ph.D. Amy R. Murrell, Ph.D. University of North Texas

Evaluating the effectiveness of a parent training protocol based on an Acceptance and Commitment Therapy philosophy of parenting. Aditi Sinha, M.S. Karen M. O’Brien, Ph.D. Amy R. Murrell, Ph.D. University of North Texas Contextual Psychology Group. Introduction & Rationale.

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Aditi Sinha, M.S. Karen M. O’Brien, Ph.D. Amy R. Murrell, Ph.D. University of North Texas

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  1. Evaluating the effectiveness of a parent training protocol based on an Acceptance and Commitment Therapy philosophy of parenting Aditi Sinha, M.S. Karen M. O’Brien, Ph.D. Amy R. Murrell, Ph.D. University of North Texas Contextual Psychology Group

  2. Introduction & Rationale • Parental Stress  Parent & Child psychopathology • Limitations of Behavioral Parent Trainings (BPT) • Early success of mindfulness based therapies with parents • Limited studies of ACT with parents (2)

  3. Hypotheses (Summarized) • 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 (FBSS) • 1 to 3 children • Reporting high levels of parenting stress • >2SD above mean • 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. Procedure • ACT daily diary (25 days pre / 25 days post) • Package of Self-Report Instruments (Pre/Post/Follow-up) • Pre-treatment Reading • The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years • Coyne and Murrell (2009) • Parent Adherence Check • Two,12-hour, 2-day weekend workshops in group format • Karen O’Brien & Amy Murrell • Treatment Utility & Satisfaction Interview • Therapist Adherence Check

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

  7. Compensation • $10 per day of treatment • $20 at 3-month follow-up • Lunch during first day of workshop • Childcare for duration of workshop • Copy of The Joy of Parenting

  8. 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 Deserted Island • How do you want to be remembered? • Notice the words • Whatever it takes

  9. Treatment Protocol Day One: • Reading check • Group rules and expectations • Overview of ACT perspective on human suffering and an ACT philosophy of parenting. • Chapter 3, “Parenting Values: What Matters Most.” • Lunch • Chapter 4 “Is the Goal Control? Managing Feelings vs. Managing Behavior.”

  10. Treatment Protocol Day Two • Chapter 5, “Being Mindful: Appreciating Your Child” • Chapter 6, “Doing What Works, Not What’s Easy: Standing for Your Child” • Conclusion and Commitment • Posttest and Interview

  11. Treatment Protocol Horizon Metaphor “…Valuing is like sailing toward the horizon…Because it’s always shifting, you can never reach it— you can only move toward it. When you’re heading toward the horizon…You feel … Your behavior doesn’t always have to match your values flawlessly; if you are generally heading in the direction of what you want your life to stand for, you will feel the importance in that.”

  12. Describe any particularly stressful interactions with your child today and how you handled them: Suffering Rate how upset and distressed you were today overall: None Extreme amount 0 1 2 3 4 5 6 7 8 9 10 Struggle Rate how much effort was put into making these upsetting feelings or thoughts go away (for example, thought suppression; distraction; reassurance): None Extreme amount 0 1 2 3 4 5 6 7 8 9 10 Workability If life in general were like this day, to what degree would today be part of a vital, workable way of living?  Not at all Extreme amount 0 1 2 3 4 5 6 7 8 9 10 Valued Action Rate how effective you were in taking actions that are consistent with your values today:  Not at all Extreme amount 0 1 2 3 4 5 6 7 8 9 10 ACT Daily Diary

  13. 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 not expected to change and struggle decrease • Workability and valued action increase c) Post-intervention trend lines in the expected directions

  14. Diary Results Summary • Some caseworkers referred <25 days prior • Lack of parent compliance • Only 1 parent provided all 50 data points (Parent B) • Only 6 parents had both baseline and post-intervention data • Complete visual inspection criteria not met for any parent on any domain

  15. Diary Results Summary • Struggle/Experiential Avoidance • Only 1 parent (F) had data that was interpretable • Clear intervention effect stable baseline data/mean and level changes in expected directions • Workability/Behavioral Effectiveness • Only 1 parent (A) met all 3 criteria to conclude that changes in magnitude were due to the intervention • Demonstrated mean and level changes in expected directions

  16. Parent F

  17. Parent A

  18. Hypotheses 2,3,4, and 5: RCI for clinically significant change RM ANOVA for statistically significant change

  19. RM ANOVA: ACT-related variables

  20. RM ANOVA: Child behavior

  21. Reliable change

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

  23. Valuing (MVM & VLQ)

  24. Emotion Regulation (DERS) 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

  25. 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) • DASS-21 scores predicted treatment outcome

  26. 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

  27. 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

  28. 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

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

  30. Internalizing Behavior (BASC-2 Int) • General decreasing trend • 61.5% pre- to post-test • 70% pre- to follow-up

  31. Summary of results • Clear intervention effect for valuing behavior (MVM) and childhood externalizing behavior (BASC-2 Ex) • 10 parents had clinically significant change on at least 1 measure • Parents M and I evidenced clinically significant change on 4 measures

  32. 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.”

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

  34. Future Directions • Consider domain specific measures or behavioral measures • Use of control group • MORE TREATMENT • Individual versus group • Role of emotion regulation in parenting behavior

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