Date post: | 31-Dec-2015 |
Category: |
Documents |
Upload: | naida-koch |
View: | 19 times |
Download: | 1 times |
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
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)
Hypothesis & Purpose
•An ACT for parents intervention will favorably impact…
▫ACT processes (acceptance, mindfulness, valuing)
▫Parenting behavior and distress
▫Child behavior
ParticipantsGeneral 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
DesignSingle-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
Procedure- Referral received
- Screening and informed consent at least 25 days prior to intervention
- Parents keep ACT Daily Diary
- 1 week pretest/Reading Assigned
- Intervention
- Posttest (immediately post intervention), including Treatment
- Utility and Satisfaction Interview
- Parents keep ACT Daily Diary for 25 days post 3-4 month follow-up
Treatment ProtocolDidactic 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
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
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
Parent A
Baseline
Baseline Trend
Baseline Mean
Post-Interven-tion
Post-Interven-tion Trend
Post-Interven-tion Mean
Time in Days
Wo
rka
bil
ity
Ra
tin
gs
Parent B
Baseline Baseline Trend Post-Intervention
Post-Intervention Trend Baseline Mean Post-Intervention Mean
Time in Days
Su
ffe
rin
g R
ati
ng
s
Parent B
Baseline Baseline Trend Baseline Mean Post-Intervention
Post-Intervention Trend Post-Intervention Mean
Time in Days
Str
ug
gle
Ra
tin
gs
Parent B
Baseline Baseline Trend Baseline Mean
Post-Intervention Post-Intervention Trend Post-Intervention Mean
Time in Days
Valu
es R
ati
ngs
Parent F
Baseline Baseline Trend Baseline Mean
Post-Intervention Post-Intervention Trend Post-Intervention Mean
Time in Days
Str
ug
gle
Rati
ng
s
Hypotheses 2,3,4, and 5:
Clinically & Statistically Significant Change
•RCI for clinically
significant change
•RM ANOVA for
statistically significant
change
Hypothesis Measures
Hypothesis 2: ACT-related variables
AFQ, KIMS, MVM, VLQ & DERS
Hypothesis 3: Parenting variables
APQ-9, PLOC, PSI-SF
Hypothesis 4: Depression, anxiety, and stress
DASS-21
Hypothesis 5: Child behavior
BASC-2
Acceptance (AFQ)
1 2 30
5
10
15
20
25
30
35
40
45
Parent M
AF
Q S
co
res
• 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
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
1 2 30
20
40
60
80
100
120
140
160
Parent M
DE
RS
Sco
res
1 2 30
20
40
60
80
100
120
140
160
Parent I
DE
RS
Sco
res
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
Valuing (MVM & VLQ)
1 2 360
70
80
90
100
110
120Parent M
MV
M S
core
s
1 2 30
10
20
30
40
50
60
70Parent I
VLQ
Score
s
1 2 30
10
20
30
40
50
60
70Parent J
VLQ
Score
s
1 2 360
70
80
90
100
110
Parent J
MV
M S
core
s
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
1 2 30
10
20
30
40
50
60Parent I
1 2 30
10
20
30
40
50
60Parent L
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
1 2 30
5
10
15
20
25
30Parent A
1 2 30
5
10
15
20
25
30Parent B
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 scores1 2 3
0
20
40
60
80
100
120
Parent M
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)
1 2 30
5
10
15
20
25
30
35
40
45
50
Parent N
Externalizing Behavior (BASC-2 Ex)
• 76.9% pre- to post-test
• 80% pre- to follow-up
• Consistent with pilot data
(Murrell & colleagues,
2009)
1 2 30
20
40
60
80
100
120
Parent I
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
Adaptive Skills (BASC-2 Adap)
•Age of children? Just
changing over time?
•Not really targeted with
our intervention
•Probably not related to
intervention?
1 2 30
10
20
30
40
50
60
Parent EB
ASC
-2 A
dapti
ve S
kills
1 2 30
10
20
30
40
50
60
Parent K
BA
SC
-2 A
dapti
ve S
kills
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.”
Limitations• Recruitment
• Data collection (logistics)
• Design (stable baseline vs. control group)
• Measurement
▫ Social desirability
▫Reading level
• NOT ENOUGH TREATMENT