Mindfulness-based therapeutic parenting group (MTPG) for parents with adverse childhood experiences (ACEs) : a randomized controlled trial

Abstract

Adverse childhood experiences (ACEs) include various kinds of maltreatment and household dysfunction occurring before 18 years of age. Growing up with ACEs interrupts a person’s healthy development by exposing them to unstable early relationships and environments. Parents with ACEs may face multiple challenges and are likely to experience high parenting stress. Exposure to toxic stress impairs parental mental health and increases the risk of dysfunctional parenting. ACEs are associated with developing maladaptive schemas as a result of unmet psychological needs. These maladaptive schemas can be triggered in parenting, shaping one’s parenting style and heightening parenting stress, leading to dysfunctional parent–child interactions. Parent ACEs as a risk factor are currently not given enough attention in parenting interventions. It is hypothesized that cultivating mindfulness in parents with ACEs could reduce parenting stress through reducing the maladaptive parental schemas and improving mindful parenting. This thesis designs and follows an 8-week online mindfulness-based therapeutic parenting group (MTPG) targeting parents with ACEs. Three studies are included: Study one is a systematic review and meta-analysis of 12 studies, which synthesized the effects of group parenting interventions (GPIs) on parents with ACEs. The results show that GPIs present small positive effects on parenting (Hedge’s g = 0.36, 95% CI [0.22–0.49]) and parent mental health (g = 0.34, 95% CI [0.16–0.53]), with moderate heterogeneity across the studies. Study two is a randomized controlled trial (RCT). Seventy-eight parents with reported ACEs who were facing parenting problems were randomized into an online MTPG and a wait-list control group (WLCG). Parent outcomes were assessed at baseline before intervention and post-intervention for both treatment and control conditions and two months after the intervention for the treatment group. The results showed that, compared with the WLCG, parents in the MTPG had a significant decrease in total parental stress (Cohen’s d = 0.742, p = 0.005) and a significant improvement in their emotional awareness of interpersonal mindful parenting (d = 0.544, p = 0.035). The parents in the MTPG also demonstrated significant within-group decreases in total maladaptive schemas and its two subscales (i.e., failure, enmeshment), with small effect sizes. A mediation effect was identified that the pathway of the MTPG reducing parenting stress could be partly explained by an improvement of emotional awareness. Study three is a qualitative interview conducted to understand how parents with ACEs made a change in parent–child interactions after the MTPG. Using interpretative phenomenological analysis (IPA) and theme analysis, data analysis of 27 parents revealed three change patterns: a) overall improvement in mental and emotional state when with the child, b) creation of a mindful pause or space and a new response in dysfunctional parent–child interactions and c) differentiation of personal issues from the child’s problem. These results show the feasibility and efficacy of the MTPG for reducing parenting stress in the ACEs population and can inform future interventions targeting ACEs of the importance of differentiating the maladaptive schemas in parenting practice as well as improving emotional awareness as a domain of mindful parenting.