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Cited by 17Child and Adolescent Psychosocial and Emotional DevelopmentMindfulness and Compassion InterventionsFamily and Disability Support Research

Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents

Open access
Featherston, Rebecca, Barlow, Jane, Song, Yunshan, Haysom, Zoe, Loy, Brenda, Tufford, Lea, Shlonsky, Aron·2024·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd012445.pub2PMC PMC10777456
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Abstract

Background: Emotional and behavioural difficulties (EBD) in children are common, characterised by externalising or internalising behaviours that can be highly stable over time. EBD are an important cause of functional disability in childhood, and predictive of poorer psychosocial, academic, and occupational functioning into adolescence and adulthood. The prevalence, stability, and long-term consequences of EBD highlight the importance of intervening in childhood when behavioural patterns are more easily modified. Multiple factors contribute to the aetiology of EBD in children, and parenting plays an important role. The relationship between parenting and EBD has been described as bidirectional, with parents and children shaping one another’s behaviour. One consequence of bidirectionality is that parents with insufficient parenting skills may become involved in increasingly negative behaviours when dealing with non-compliance in children. This can have a cyclical effect, exacerbating child behavioural difficulties and further increasing parental distress. Behavioural or skills-based parenting training can be highly effective in addressing EBD in children. However, emotional dysregulation may intercept some parents' ability to implement parenting skills, and there is recognition that skills-based interventions may benefit from adjunct components that better target parental emotional responses. Mindful parenting interventions have demonstrated some efficacy in improving child outcomes via improvements in parental emotion regulation, and there is potential for mindfulness training to enhance the effectiveness of standard parent training programmes. Objectives: To assess the effectiveness of mindfulness-enhanced parent training programmes on the psychosocial functioning of children (aged 0 to 18 years) and their parents. Search methods: We searched the following databases up to April 2023: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL Plus, PsycINFO, Sociological Abstracts, Social Sciences Citation Index, Conference Proceedings Citation Index – Social Science & Humanities, AMED, ERIC, ProQuest Dissertations & Theses, Cochrane Database of Systematic Reviews, Campbell Collaboration Library of Systematic Reviews, as well as the following trials registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also contacted organisations/experts in the field. Selection criteria: We included randomised and quasi-randomised trials. Participants were parents or caregivers of children under the age of 18. The intervention was mindfulness-enhanced parent training programmes compared with a no-intervention, waitlist, or attentional control, or a parent training programme with no mindfulness component. The intervention must have combined mindfulness parent training with behavioural or skills-based parent training. We defined parent training programmes in terms of the delivery of a standardised and manualised intervention over a specified and limited period, on a one-to-one or group-basis, with a well-defined mindfulness component. The mindfulness component must have included mindfulness training (breath, visualisation, listening, or other sensory focus) and an explicit focus on present-focused attention and non-judgemental acceptance. Data collection and analysis: We followed standard Cochrane procedures. Main results: Eleven studies met our inclusion criteria, including one ongoing study. The studies compared a mindfulness-enhanced parent training programme with a no-treatment, waitlist, or attentional control (2 studies); a parent training programme with no mindfulness component (5 studies); both a no-treatment, waitlist, or attentional control and a parent training programme with no mindfulness component (4 studies). We assessed all studies as being at an unclear or high risk of bias across multiple domains. We pooled child and parent outcome data from 2118 participants to produce effect estimates. No study explicitly reported on self-compassion, and no adverse effects were reported in any of the studies. Mindfulness-enhanced parent training programmes compared to a no-treatment, waitlist, or attentional control. Very low certainty evidence suggests there may be a small to moderate postintervention improvement in child emotional and behavioural adjustment (standardised mean difference (SMD) −0.46, 95% confidence interval (CI) −0.96 to 0.03; P = 0.06, I2 = 62%; 3 studies, 270 participants); a small improvement in parenting skills (SMD 0.22, 95% CI 0.06 to 0.39; P = 0.008, I2 = 0%; 3 studies, 587 participants); and a moderate decrease in parental depression or anxiety (SMD −0.50, 95% CI −0.96 to −0.04; P = 0.03; 1 study, 75 participants). There may also be a moderate to large decrease in parenting stress (SMD −0.79, 95% CI −1.80 to 0.23; P = 0.13, I2 = 82%; 2 studies, 112 participants) and a small improvement in parent mindfulness (SMD 0.21, 95% CI −0.14 to 0.56; P = 0.24, I2 = 69%; 3 studies, 515 participants), but we were not able to exclude little to no effect for these outcomes. Mindfulness-enhanced parent training programmes compared to parent training with no mindfulness component. Very low certainty evidence suggests there may be little to no difference postintervention in child emotional and behavioural adjustment (SMD −0.09, 95% CI −0.58 to 0.40; P = 0.71, I2 = 64%; 5 studies, 203 participants); parenting skills (SMD 0.13, 95% CI −0.16 to 0.42; P = 0.37, I2 = 16%; 3 studies, 319 participants); and parent mindfulness (SMD 0.11, 95% CI −0.19 to 0.41; P = 0.48, I2 = 44%; 4 studies, 412 participants). There may be a slight decrease in parental depression or anxiety (SMD −0.24, 95% CI −0.83 to 0.34; P = 0.41; 1 study, 45 participants; very low certainty evidence), though we cannot exclude little to no effect, and a moderate decrease in parenting stress (SMD −0.51, 95% CI −0.84 to −0.18; P = 0.002, I2 = 2%; 3 studies, 150 participants; low certainty evidence). Authors' conclusions: Mindfulness-enhanced parenting training may improve some parent and child outcomes, with no studies reporting adverse effects. Evidence for the added value of mindfulness training to skills-based parenting training programmes is suggestive at present, with moderate reductions in parenting stress. Given the very low to low certainty evidence reviewed here, these estimates will likely change as more high-quality studies are produced. Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Integrity signals

Registry

Crossref · 10.1002/14651858.cd012445.pub2

Cites

185 of 185 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 25 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Background

    Bögels 2010 reviewed six possible mechanisms by which mindful parenting may change parent-child interactions in mental health contexts.

    “Bögels 2010 reviewed the evidence for six possible mechanisms through which mindful parenting may bring about change in parent-child interactions in the context of mental health challenges.”
    Quote in the paperNot yet classified1 of 1 sources checked
    • cites Bögels 2010 source
  • Background

    Concerns about the long-term effectiveness of parenting programmes have led to recommendations for supplementary interventions such as booster sessions.

    “Furthermore, concerns remain about the longterm effectiveness of such programmes, and recommendations for a variety of supplementary interventions to support treatment gains (e.g.booster sessions) are common (Barlow 2012;Eyberg 1998;Hudson 1986;Nock 2003).”
    Quote in the paperNot yet classified1 of 3 sources checked
    • cites Barlow 2012 source

      The Authors’ Conclusions (Implications for practice; page unavailable) say the benefits may be short-term and parents may need additional support to maintain improvements. Implications for research calls for investigation of post-intervention support. The review describes a trial with a booster session (Bradley 2003), but does not itself recommend booster sessions or establish that such recommendations are common. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Eyberg 1998 source
    • cites Hudson 1986 source
  • Background

    Systematic reviews show that parenting programmes can improve children's emotional and behavioural adjustment and several aspects of parental mental health.

    “Evidence from systematic reviews of parenting programmes demonstrates that they can improve the emotional and behavioural adjustment of children (Barlow 2010;Barlow 2018;Dretze 2005), and such programmes can also significantly improve a range of aspects of parental mental health, including anxiety, depression, and self-esteem (Barlow 2012;Barlow 2018).”
    Quote in the paperNot yet classified1 of 3 sources checked
    • cites Barlow 2010 source
    • cites Barlow 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Dretze 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Background

    Mindfulness-based therapies are often classified as part of the 'third wave' of cognitive behavioural therapy.

    “Mindfulness-based therapies are part of a relatively new generation of behavioural treatments and are commonly grouped together under the heading of 'the third wave' of cognitive behavioural therapy (CBT) (Hunot 2010).”
    Quote in the paperNot yet classified1 of 1 sources checked
    • cites Hunot 2010 source
  • Finding

    The review included 11 studies with data from 2118 participants.

    “We included 11 studies and data from 2118 participants in the review.”
    Quote in the paperNot yet classified

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Gershy randomised-group counts do not match the stated total

    Minor

    The two reported randomised groups contain 57 families in total, not the stated 79. The text does not account for the remaining 22 families.

    Reported 79 · recomputed 57

  • Gewirtz completion counts exceed the stated total

    Minor

    The reported group completion counts add to 287 families, whereas the stated overall completion count is 255.

    Reported 255 · recomputed 287

  • Whittingham randomised-group counts fall short of the stated total

    Minor

    The three reported group sizes add to 67 parents, rather than the stated 80.

    Reported 80 · recomputed 67

  • Rocheleau attrition percentage conflicts with its participant counts

    Minor

    The study reports 15 parents randomised and 14 completed, implying one loss out of 15, or about 6.7%, rather than the overview's 0.1%.

    Reported 0.1 · recomputed 6.666667

  • Follow-up study is misidentified for the child-adjustment analysis

    Minor

    The results text says Whittingham 2013 supplied the two-year follow-up, but the analysis identifies Gewirtz 2018 as that study. This changes which study is credited with evidence for the follow-up result.

  • Weitlauf completion counts exceed the stated total

    Minor

    The two reported group completion counts add to 54 families, not 53.

    Reported 53 · recomputed 54

  • Coatsworth 2010 arm sizes appear reversed in the parenting-skills analysis

    Minor

    The study description assigns 23 families to mindfulness-enhanced training and 25 to standard training. Analysis 2.3 places 25 in the mindfulness-enhanced arm and 23 in the parent-training arm for that study.

  • Whittingham mindfulness-session descriptions disagree

    Minor

    The overview describes one two-hour mindfulness session, whereas the study description specifies two two-hour ACT group sessions.

  • Dawe trial arm counts fall short of the stated randomised total

    Minor

    The three listed arms contain 64 parents, not the stated 77 randomised parents.

    Reported 77 · recomputed 64

  • Follow-up child effect is labelled both standardised and unstandardised

    Minor

    The narrative reports Analysis 2.2 as a standardised mean difference, while the analysis table identifies the same pooled effect as a mean difference. These are different effect measures for a conclusion-bearing child outcome.

  • Weitlauf randomised-arm counts do not match the total

    Minor

    The two arm counts sum to 61 families, two fewer than the stated randomised total.

    Reported 63 · recomputed 61

  • Search total treats additional records inconsistently

    Minor

    The flow diagram lists 7,524 database records plus 18 from other sources. The results instead call 7,524 the total while saying it includes the 18 additional records.

  • The first child-outcome follow-up names the wrong study

    Minor

    The narrative names Whittingham 2013 as the two-year follow-up study in Analysis 1.2, but that analysis lists Gewirtz 2018 instead.

13 of 13

Cites

Flagged first, then by citations

Research works printed but not linked: 41

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  2. Rocheleau, 2001, Mindfulness-Based Intervention as an Adjunctive Treatment for Enhancing Outcomes Obtained with Traditional Parent Training for Conduct Problem Children [PhD Dissertation]
  3. Brown, 2016, A mindfulness-based intervention to improve family functioning among child welfare-involved families with substance use [PhD Dissertation]
  4. Chan, 2018, Parenting Stress and Emotion Dysregulation in Children with DD: The Role of Parenting Behaviors [PhD Dissertation]
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  6. Dennis, 2018, The Influence of Parental Mental Health on Child Outcomes: The Role of the Parenting Process [PhD Dissertation]
  7. Fisher, 2012, Mindfulness-based stress reduction: Overall findings from the Parent-Stress Intervention Project (PSIP), Journal of Intellectual Disability Research, 56, 737, 10.1111/j.1365-2788.2012.01583_8.x · DOI
  8. Miodrag, 2012, MBSR: mental health outcomes for parents of children with autism spectrum disorders and other I/DD conditions, Journal of Intellectual Disability Research, 56, 737, 10.1111/j.1365-2788.2012.01583_8.x · DOI
  9. Iadarola, 2011, Comparative Effects of Mindfulness and Skills-Based Parent Training Programs: Feasibility and Preliminary Outcome Data [PhD Dissertation]
  10. Friedmutter, 2015, The Effectiveness of Mindful Parenting Interventions: A Meta Analysis [PhD Dissertation]
  11. Jespersen, 2019, Evaluation of a Parent Education Program Emphasizing Responsive Parenting, Executive Function, and Mindfulness [PhD Dissertation]
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Cited by

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Related

Authors
Featherston, R., Barlow, J., Song, Y., Haysom, Z., Loy, B., Tufford, L., & Shlonsky, A.
Affiliations
  • Monash University (AU)
  • University of Oxford (GB)
  • Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences; Monash University; Caulfield Australia
  • Laurentian University (CA)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2024-01-10
Volume
2024
Issue
1
Pages
CD012445-CD012445
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd012445.pub2
PMC
PMC10777456
OpenAlex
W4390696254
Cited by
17
References
185
Citations by year
2026: 7 · 2025: 5 · 2024: 5
FWCI
1.51
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
mindful parenting, parent training, child psychosocial functioning, parental emotional regulation, parent-child interaction, child behavior problems, parenting skills, child mental health outcomes
MeSH terms
Adolescent, Child, Emotions, Humans, Parents, Parenting, Drug-Related Side Effects and Adverse Reactions, Mindfulness

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