Parental Psychological Flexibility Research Articles

Piloting the Circle of Security Parenting group with parents of children with a learning disability: An exploratory case study

AbstractBackgroundThe Circle of Security Parenting programme is a manualised parenting intervention that aims to enhance secure attachment and improve relationships between children and their caregivers. It is gaining global popularity and acquiring emerging support. Researchers are increasingly interested in its effectiveness in enhancing parent–child attachment, improving parent psychological flexibility and reducing parental stress. However, research to date has predominantly focused on parents of typically developing children, despite the Circle of Security Parenting intervention being used as a parenting programme in specialist services for children with learning disabilities. There is, however, no clear evidence that this programme meets the diverse needs of parents who encounter additional challenges that may impact on the development of secure parent–child attachment relationships. This case study aims to pilot a seven‐session Circle of Security Parenting programme for parents of children with learning disabilities.MethodsFour participants completed pre‐ and post‐intervention outcome measures specified by Circle of Security Parenting, including: the Parental Stress Scale, Parental Acceptance Questionnaire, Acceptance and Action Questionnaire II and the Caregiver Helplessness Questionnaire.FindingsQuantitative results are mixed, and did not demonstrate the improvements in parental stress or psychological flexibility that might be expected. Qualitative accounts of participants' experiences offer potential explanations for the findings that may be unique to parents of children with learning disabilities.ConclusionThis paper recognises that further research is needed to identify evidence‐based programmes that meet the needs of this population.

Relationship between paternal adult attachment and adolescent anxiety: The chain-mediating effect of paternal psychological flexibility and father-adolescent attachment.

Grounded in family systems theory and the internal working model of attachment, the present study tested the effects of paternal adult attachment, paternal psychological flexibility and father-adolescent attachment on adolescent anxiety. In total, 906 pairs of fathers and their adolescents completed a set of questionnaires, including the Experiences in Close Relationships Scale, Parental Psychological Flexibility Questionnaire, Inventory of Parent and Peer Attachment, and Trait Anxiety Inventory. The results revealed that paternal adult attachment avoidance had a positive impact on adolescent anxiety. The relationship between paternal adult attachment and adolescent anxiety was chain mediated by paternal psychological flexibility and father-adolescent attachment. The mediation effects contained two paths: the separate mediation effect of paternal psychological flexibility, and the chain mediation effect of paternal psychological flexibility and father-adolescent attachment. The results of the study show that the father's adult attachment can not only directly affect adolescent anxiety, but also indirectly affect adolescent anxiety through the paternal psychological flexibility and the quality of father-adolescent attachment. Fathers have an important effect on adolescent anxiety.

Effects of an Online Acceptance and Commitment Therapy Intervention on Children\u2019s Quality of Life

The present study examined if an Acceptance and Commitment Therapy (ACT)–based online intervention for parents had indirect effects on their children’s quality of life mediated by changes in parental well-being, psychological flexibility and mindfulness skills. Participants were 74 adults, who either received an ACT-based guided online intervention or were allocated to the wait list control group, and their children (n = 66) who had type 1 diabetes or functional disabilities. Structural equation modeling (SEM) and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment on children’s quality of life through changes in parents’ well-being and psychological processes involving psychological flexibility, cognitive defusion, and mindfulness skills. Children’s quality of life was assessed both by self-reports and parents’ evaluations. Significant indirect effects on children’s quality of life were found through improvements in parental well-being and mindfulness skills. The intervention had significant indirect effects on parents’ evaluations of their children’s quality of life concerning family and other social relationships, as well as on physical well-being. In regard to children’s self-reported quality of life, the intervention had significant indirect effects on self-esteem, family relations, emotional well-being, and functioning at school/kindergarten. The results indicate that it is beneficial for children’s quality of life to improve parents’ ability to describe their experiences, being non-reactive to one’s inner experiences and acting with awareness as well as cognitive defusion.

A Review of the Effects of Parents’ Psychological Flexibility and Parental Psychological Flexibility on Children and Adolescents

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Factors Influencing Adolescent Anxiety: The Roles of Mothers, Teachers and Peers.

Grounded in social–ecological system theory, the present study tested the mediating effects of maternal psychological flexibility and mother–adolescent attachment on the relationship between maternal adult attachment and adolescent anxiety as well as the moderating effects of teacher support and peer support on the relationship between mother–adolescent attachment and adolescent anxiety. In total, 1139 Chinese mothers and adolescents completed a set of questionnaires, including the Experiences in Close Relationships Scale, Parental Psychological Flexibility Questionnaire, Inventory of Parent and Peer Attachment, Trait Anxiety Inventory, and Multidimensional Scale of Perceived Social Support. The results revealed that maternal adult attachment had a positive impact on adolescent anxiety. The relationship between maternal adult attachment and adolescent anxiety was chain mediated by maternal psychological flexibility and mother–adolescent attachment. In addition, teacher support and peer support had moderating effects on the relationship between mother–adolescent attachment and adolescent anxiety. These findings support the systematic social ecosystem perspective and highlight the differences in the effects of different maternal adult attachment styles, teacher support, and peer support on adolescent anxiety.

Influence of Parental Psychological Flexibility on Pediatric COVID-19 Vaccine Hesitancy: Mediating Role of Self-Efficacy and Coping Style.

Background: Pediatric COVID-19 vaccine hesitancy hinders the establishment of immune barrier in children. Psychological flexibility may be a key contributing factor to pediatric COVID-19 vaccine hesitancy, and self-efficacy and coping style play an important role in the relationship, but the underlying mechanisms remain unknown.Methods: A cross-sectional study was conducted on parents from June 2021 to July 2021. A total of 382 parents were recruited for an online-investigation. Serial mediation models were used to examine whether self-efficacy and coping style mediated in the psychological flexibility-pediatric COVID-19 vaccine hesitancy linkage.Result: Psychological flexibility was negatively related to pediatric COVID-19 vaccine hesitancy (r = −0.198, P < 0.001). Coping styles rather than self-efficacy played a mediating role independently (95% CI: −0.263 to −0.058). Serial mediation analyses indicated that self-efficacy and coping style co-play a serial mediating role in the association of psychological flexibility and pediatric COVID-19 vaccine hesitancy (95% CI: −0.037 to −0.001).Conclusion: The present study showed that high psychological flexibility, high self-efficacy, and positive coping style were conducive to the lower pediatric COVID-19 vaccine hesitancy.

Parental Psychological Flexibility as a Mediating Factor of Post-Traumatic Stress Disorder in Children after Hospitalization or Surgery.

Background: Illness, surgery, and surgical hospitalization are significant stressors for children. Children exposed to such medical events may develop post-traumatic medical syndrome (PMTS, pediatric medical traumatic stress) that could slow their physical and emotional recovery. Objective: This study examined the relationship between the level of parental psychological resilience and the development of PMTS in young children. Method: We surveyed 152 parents of children aged 1–6 who were admitted to the pediatric surgery department. Parents completed questionnaires in two phases. In the first phase, one of the parents completed the Acceptance and Action Questionnaire (AAQ-ll) and the Parental Psychological Flexibility (PPF) Questionnaire. In the second phase, about three months after discharge, the same parent completed the Young Child PTSD (Post Traumatic Stress Disorder) Checklist (YCPC) and the UCLA (Los Angeles, CA, USA) PTSD Reaction Index for DSM-5 Parent/Caregiver Version for Children Age 6 Years and Younger Evaluating Post-traumatic Disorder. In addition, the parent completed a Posttraumatic Stress Diagnostic Scale (PDS) questionnaire to assess the existence of post-traumatic symptoms in the parents. Results: The findings indicate that (1) a parent’s psychological flexibility is significantly associated with the level of personal distress (r = −0.45, p < 0.001), (2) a parents’ level of distress is significantly correlated with the child’s level of PTMS, and (3) a parent’s level of psychological flexibility is a significant mediating factor between the level of parental post-traumatic distress and the child’s level of PTMS. Conclusions: A parent’s psychological flexibility may act as a protective factor against the development of the child’s mental distress after hospitalization or surgery.

Coparenting Alleviated the Effect of Psychological Distress on Parental Psychological Flexibility.

Parenting is full of challenges and responsibilities. It is particularly important for parents to be open to parental difficult experiences and adopt behaviors consistent with self-chosen values, which termed as parental psychological flexibility (PPF). However, few studies have focused on the effect of psychological distress (anxiety and depression) on different components of PPF. This study examined the effect of psychological distress on the three components of PPF (cognitive defusion, committed action, and acceptance) as well as the role of coparenting quality in Chinese parents. A total of 462 parents of children aged 1–18 years completed self-report measures of anxiety, depression, coparenting, and PPF. Our results revealed that higher level of PPF went along with less anxiety and depression, while it was also associated with better coparenting quality. Coparenting partially mediated the effect of anxiety on cognitive defusion and acceptance and fully mediated the effect of depression on cognitive defusion and acceptance. Moderation analyses showed that the link between anxiety and cognitive defusion, as well as the link between anxiety and acceptance were moderated by coparenting. We discussed the implications of coparenting as a protective factor in alleviating the negative effect of psychological distress on PPF.

Pain and QOL in Pediatric Sickle Cell Disease: Buffering by Resilience Processes.

Sickle cell disease (SCD) is a group of inherited blood disorders. The central feature of this chronic condition is pain. Several identified risk factors exacerbate the impact of pain on quality of life (QOL) in SCD; however, there are relatively fewer investigations of strengths-based resilience variables that might buffer the influence of pain on living with SCD. The purpose of this study was to examine strength-based resilience processes in youth with SCD and their parents. Grounded in an ecological resilience-risk model, we evaluated whether adolescent and parent protective factors (pain acceptance, mindfulness, and psychological flexibility) moderated the relation between adolescent-reported pain burden and QOL. Ninety-three 12- to 18-year-old adolescents with SCD and their parents participated. Adolescents completed assessments of pain characteristics, pain acceptance, mindfulness, and QOL. Parents completed instruments measuring demographic and disease variables and parent psychological flexibility. Pain variables were associated with protective factors in predicted directions. Adolescent acceptance and mindfulness were positively correlated with QOL. Parent psychological flexibility and adolescent QOL were not related. After controlling for demographic, pain, and disease variables, moderation analyses indicated that adolescent pain acceptance buffered the relation between SCD pain burden and QOL. Moderation analyses were not significant for adolescent mindfulness or parent psychological flexibility. Results suggest that strengths-based factors may play an important role for adolescents' QOL within the context of SCD pain. Interventions that enhance teenagers' ability to accept pain might be particularly useful to improve QOL in adolescents living with SCD pain.

Effectiveness of a Web-Based Intervention on Parental Psychological Flexibility and Emotion Regulation: A Pilot Open Trial.

“Parenting Forest” is an informed contextual therapy parenting program for improving parental emotion regulation strategies and psychological flexibility. The aim of this study was to evaluate the preliminary effectiveness of a self-guided web-based intervention of the Parenting Forest program. The intervention program consists of six self-applied sequential modules that use strategies from contextual therapies for providing a parenting style open to experience, mindful and committed to its actions. A pilot controlled open trial was conducted. Eligible parents (n = 12) enrolled in the web-based intervention completed baseline (T1) and post-intervention (T2) assessment instruments. Parental psychological flexibility, avoidance, emotional regulation, parental stress, satisfaction with life, children’s psychological adjustment and client satisfaction were measured to assess the effects of the intervention. Mood, coping, and value-related actions were assessed as measures of progress. The results showed positive effects on the parents’ psychological flexibility and emotion regulation. Parents’ mood and coping skills improved throughout the intervention program. These results provide preliminary evidence of the web-based Parenting Forest’s efficacy, although further research is needed to assess its effectiveness for prevention and in clinical populations.

A Pilot Study Examining the Effect of Acceptance and Commitment Therapy as Parent Counseling

There is some scientific evidence to support the applicability and preliminary effects of ACT as a parent intervention but more research is needed. In this pilot research, Acceptance and Commitment Therapy (ACT) is provided as a parent counseling therapy in order to increase psychological flexibility which in turn helps parents to choose attuned parenting behavior, invest in a helpful parent-child relationship, deal with feelings of incompetence, and cope with their own psychopathology. ACT parent counseling is developed for parents of children (3–18 years old) with psychiatric problems. The mean age of the parents (n = 101) was 47.1 years (range = 30–66). A repeated measures design was used including pretreatment, posttreatment, and 6-month follow-up measurements. The main outcomes were ACT measures (psychological flexibility, parental psychological inflexibility, and cognitive fusion). Secondary outcomes included parenting behavior, the quality of the parent-child interaction, parental competence, parental psychopathology, and the satisfaction with the treatment program. This is the first study we know of that showed statistically significant improvements on parental psychological flexibility, parenting behavior (except behavioral control), parent-child relations, parental competence, and parental internalizing psychopathology directly after treatment. At 6-month follow-up, significantly less conflicts, more parental competence, and less parental psychopathology was found. However, the improvements were not clinically significant, as calculated with the RCI. No control group was used in this uncontrolled pilot study but preliminary findings indicate that ACT parent counseling can help parents to increase psychological flexibility in order to choose more flexible and effective parenting behavior.

Acceptance and Commitment Therapy for psychological and behavioural changes among parents of children with chronic health conditions: A systematic review.

To systematically identify the application of Acceptance and Commitment Therapy among parents of children with chronic health conditions and determine its effectiveness in parental psychological flexibility, psychological distress and parenting behaviour. Systematic review. Nine databases (i.e. MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, PsychINFO, Web of Science, China National Knowledge Infrastructure and WanFang Data) were systematically searched from inception to October 2019. Quality of studies was appraised by using the Joanna Briggs Institute critical appraisal checklist. Findings were synthesized narratively. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Eight studies involving 485 parents were included. Results indicated that Acceptance and Commitment Therapy significantly improved parental psychological flexibility and reduced psychological distress compared with usual care and waitlist, but was not significantly different from active treatments. Limited studies have provided very preliminary evidence that Acceptance and Commitment Therapy can significantly improve dysfunctional parenting behaviour than usual care and waitlist. High attrition rate at follow-up made the overall confidence of maintained effect relatively low. This review provides preliminary evidence that Acceptance and Commitment Therapy is beneficial for improving psychological flexibility, psychological distress and parenting behaviour among parents of children with chronic health conditions. Future studies with rigorous designs and large sample sizes are warranted to verify the evidence and explore its long-term efficacy. Acceptance and Commitment Therapy has been increasingly applied to parents of children with chronic health conditions. This review provides positive evidence of its effects on psychological and behavioural outcomes among these parents. This work will help healthcare professionals and researchers with their practice and further research.

Is parental psychological flexibility a (uni) dimensional construct? A bifactor analysis of the Portuguese version of the parental acceptance questionnaire (6-PAQ)

This study aimed to examine the (uni) dimensionality of the Parental Acceptance Questionnaire (6-PAQ) in a sample of Portuguese parents of children within the community using a bifactor model that can test the separate contribution of the dimensions and of the general score. 390 parents of children (1–11 years) recruited online and in-person completed the assessment protocol, including the 6-PAQ and other measures. The bifactor model showed the best fit to data (χ2(118) = 382.95, p < .001, CFI = .95). The degree of unidimensionality (.59) and the OmegaH indexes (.81 for the general factor and < .47 for the dimensions) supported the strength of the general factor of parental psychological flexibility, which accounted for 87% of the reliable variance in the total score. Reliability indices showed high reliability for the general factor (.93). Although the 6-PAQ contains items assessing the Hexaflex six core-processes, the results were globally supportive of the unidimensionality of the Portuguese version of the 6-PAQ, and thus of computing its total score.

The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models

ObjectiveThis is a secondary analysis of a previously reported randomized controlled trial, aimed at examining the mediating role of parental psychological flexibility (PF) in an Acceptance and Commitment Therapy (ACT)-based childhood asthma management program for parents. MethodsThe participants were 168 parents (mean age (SD) = 38.40 (5.90) years; 88.1% mothers) and their children who had been diagnosed with asthma (mean age (SD) = 6.81 (2.50) years; 62% boys). They were randomly allocated to either the program composed of a four-session, group-based ACT plus asthma education (ACT Group) or to a group-based asthma education talk plus three telephone follow-ups (Control Group). The parents underwent assessments at baseline, and immediately, 3-months, and 6-months after the intervention for the following outcomes: PF (Acceptance and Action Questionnaire-II), psychological distress of the parents (Depression Anxiety Stress Scale-21); and the asthma symptoms and use of inhaled bronchodilators of their children. ResultsCross-lagged panel models showed that the improvement in parental PF at post-intervention mediated the effect of ACT on reducing parental psychological distress (all beta coefficients (βs) ranged from −2.20 to - 2.30, all Ps < 0.01) and childhood asthma symptoms in terms of daytime symptoms (β = −0.22, 95% CI [−0.52, −0.02], P = 0.04), nighttime symptoms (β = −0.17, 95% CI [−0.33, −0.02], P = 0.04), and the use of bronchodilators (β = −0.22, 95% CI [−0.48, −0.02], P = 0.03) at 6-months post-intervention. ConclusionACT makes a unique contribution to improving the health outcomes of parents and their children diagnosed with asthma through fostering parental PF.

First Things First: Parent Psychological Flexibility and Self-Compassion During COVID-19.

The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health. For parents, shaping these processes may help promote family nurturance, support children’s prosocial behavior, and provide effective and consistent use of evidence-based parenting “kernels.” The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.

Spanish validation of the Parental Acceptance Questionnaire (6-PAQ)

Background/ObjectivePsychological flexibility is an ability with positive effects in health, also in the field parenting. The aim of this study is to validate the Parental Acceptance Questionnaire (6-PAQ) in Spanish sample. MethodA total of 426 parents (96.3% female), with an average age of 38.25 years (SD = 5.76) and with at least one child between 3 and 16 years old participated. Participants completed the 6PAQ and other instruments assessing experiential avoidance, thought suppression, satisfaction with life and symptoms of anxiety and depression. ResultsIn comparison with the original model, the three-factor structural solution with 16 items obtained a better adjustment (CFI = .996; GFI = .998; TLI = .995; RMSE = .016) that refer to response styles related to psychological flexibility (open, aware and active). The 6-PAQ adaptation has shown good internal consistency, with a Cronbach alpha of .81 and a McDonald's omega of .86 for the scale, and evidence of convergent validity with significant correlations with measure of avoidance, thought suppression, satisfaction with life and anxiety. ConclusionsThe Spanish version of the 6-PAQ with the three-factor structure presents psychometric property to be considered a reliable measure and a valid instrument for the evaluation of parental psychological flexibility.

Quality of Life in Youth With Chronic Pain: An Examination of Youth and Parent Resilience and Risk Factors.

Pediatric chronic pain has often been examined from a risk perspective, and relatively less is known about the individual and family-level resilience factors that help youth with chronic pain maintain their quality of life (QOL). This cross-sectional study: (1) examined the relations among purported youth and parent resilience (youth pain acceptance and pain self-efficacy, parent psychological flexibility) and risk (youth pain intensity and parent protectiveness) factors with youth QOL, and (2) tested exploratory statistical mechanisms that may explain relations between parent and youth variables. Participants included 122 youth (10 to 17 y; M=14.26, SD=2.19) seen in an interdisciplinary pediatric chronic pain program and a parent. Youth completed measures of their average pain, QOL, pain acceptance, and pain self-efficacy. Parents completed measures of their pain-related psychological flexibility and behavioral responses to pain (ie, protectiveness, distraction, monitoring, minimizing). Youth pain acceptance, pain self-efficacy, and parent psychological flexibility were highly positively correlated with each other, and with overall youth QOL. Evidence for a buffering effect of pain acceptance and pain self-efficacy on the association between pain intensity and QOL was not found. Protectiveness was found to be a significant mediator of the relation between parental psychological flexibility and youth QOL. The results are discussed in the context of the resilience-risk framework and current understandings of the role of parental factors for pediatric chronic pain.

Effectiveness of a Web-based Intervention on Parental Psychological Flexibility and Emotion Regulation

Effectiveness of a Web-based Intervention on Parental Psychological Flexibility and Emotion Regulation

Becoming flexible: Increase in parent psychological flexibility uniquely predicts better well-being following participation in a pediatric interdisciplinary pain rehabilitation program

Parents of youth with chronic pain are at risk for depression, anxiety, and poor health-related quality of life. Research indicates Acceptance and Commitment Therapy (ACT) is effective at reducing symptoms of depression and stress for parents of youth with chronic concerns such as asthma and cerebral palsy. However, it is unclear whether these interventions are effective in improving the mental health and adjustment of parents of youth with chronic pain. ObjectiveThe current study took place in a three-week interdisciplinary pediatric pain rehabilitation program. The primary aim of the study was to examine whether the change in parent psychological flexibility and pain catastrophizing from admission to follow-up uniquely predicted parent depressive symptoms and health-related quality of life at follow-up. MethodsParticipants in this single-arm pre-posttest clinical study included 268 adolescents and young adults and their parents, who completed measures assessing depressive symptoms, health-related quality of life, pain catastrophizing, and psychological flexibility. ResultsPaired t-tests with Bonferroni correction found significant improvements in parents' mental health, functioning, and psychological flexibility, as well as lower levels of parents’ pain catastrophizing from admission to follow-up, with most effect sizes in the small to medium range. Findings from multiple regression analyses suggest that when controlling for depressive symptoms, quality of life, physical symptoms, catastrophizing, and psychological flexibility at admission, change in parent psychological flexibility uniquely predicted improved parent mental health and quality of life at follow-up. Specifically, change in emotional acceptance was the strongest unique predictor of the psychological flexibility subscales when controlling for admission scores. ConclusionsInterventions that help parents of youth with chronic pain learn to accept uncomfortable emotions and engage in valued action may help support better parent mental health.

The Relationship between School Refusal Behavior and Parental Psychological Flexibility

The Relationship between School Refusal Behavior and Parental Psychological Flexibility