Improvements in Responsive Parenting Behavior After Following a Mindful Parenting Intervention for
Mothers with Young Children.
Abstract
Responsive parenting behavior to the child’s need for food, security, and comfort is one of the most important aspects of maternal parenting behavior. Especially when mothers experience high levels of negative parenting perceptions, and parenting stress, they are less able to express responsive parenting behavior. Mindful parenting tools support mothers to manage stressful situations, such as parenting, and pay more purposeful non-judgmental attention to the child. Effects on responsive parenting after following a group-based mindful parenting intervention for mothers and their babies/toddlers were investigated. Responsive parenting behavior was divided in three observational measures. Sensitivity measured as the awareness and interpretation of the child’s signal, and appropriateness and promptness of the response. Acceptance measured as the acceptance of the child’s negative mental state and autonomy. Mind-mindedness measured as the capacity to respond appropriately or inappropriately on the child’s mental states and processes. After following a mindful parenting intervention, mothers showed more acceptance in their parenting behavior, used less non-attuned mind-related comments to describe their child, experienced more mindfulness in their parenting, and experienced less parenting stress. No differences were found for sensitivity, and appropriate mind-related comments. Small differences between the baby- and toddler groups were discussed. No effect of parenting stress on responsive parenting was found. Only increased levels of mindfulness in parenting were negatively associated with decreased levels of parenting stress. Limitations and further research suggestions were discussed.
Introduction
Responsivity to the child’s need for food, security, and comfort, is one of the most important aspects of maternal parenting behavior. Sensitivity, a form of responsive parenting, is the capacity to perceive and respond appropriately to the child’s cues, and is predominantly studied by observing maternal parenting behavior (Ainsworth, 1969). Levels of maternal sensitivity to the child’s signals are relatively stable across the child’s first 2.5 years of life (Bigelow, MacLean, Proctor, Myatt, Gillis, & Power, 2010). During the first year infants fully rely on their caregiver, because they are restricted due to their emerging motor development (e.g. only pointing and gazing), and their emerging language development (e.g. unable to communicate in words). Mothers that express high levels of sensitive parenting behavior are highly detective of their child’s signals. One of those signals could be infant cry. In response, highly sensitive mothers will show accurate, appropriate, and prompt responses, resulting in a satisfied child, which will stop the crying. Indeed, infants of sensitive mothers cry less, are held more often, stop crying more readily when picked up, and protest less when put down again (Grossman, Grossman, Spangler, Suess, & Unzner, 1985). During childhood, children of highly sensitive mothers show better social and cognitive development, and express fewer behavioural problems (Stams, Juffer, & Van IJzendoorn, 2002; Leerkes, Blankson, & O’Brien, 2009).
Closely linked, but studied less, is acceptances the capacity to accept and respond appropriately to the child’s emotions and autonomy, and is also predominantly studied by observing maternal parenting behavior (Ainsworth, 1969). Highly accepting mothers express frequent positive feelings towards the child, without striving to make a good impression, respect the child’s desire for autonomy, within a safe environment, and accept the child’s anger or frustration. Highly accepting mothers leave the room less frequently and show more happy greeting when returning to their infant (Stayton & Ainsworth, 1973). Mothers of toddlers who show higher levels of acceptance also show higher levels of sensitivity in their parenting behavior (Hughes, Blom, & Britner, 2005). The other side of the acceptance-scale is called rejection. Children of mothers that are more rejecting towards their children show higher levels of aggression (Chen, Rubin, & Li, 1997). These children are also more likely to experience peer rejection at school. Even perceived and remembered maternal acceptance could affect current (child’s) and later (adult’s) psychological adjustment (Rohner & Khaleque, 2010; Khaleque & Rohner, 2011). This link between perceived and remembered maternal acceptance and psychological adjustment has been found across multiple cultures.
Another way for a parent to be responsive is the ability to ‘read’ the mental states underlying a child’s behavior, which is called mind-mindedness, and is mostly studied by analysing maternal parenting behavior (Meins, Fernyhough, Fradley & Tuckey, 2001). The two measurements of mind-mindedness, appropriate mind-related comments, and non-attuned mind-related comments, are considered two distinctive dimensions (Meins, Fernyhough, Wainwright, Das Gupta, Fradley, & Tuckey, 2002). Appropriate mind-related comments refer to the parental ability to comment appropriately on the child’s mental states and processes. Children of mothers that use more appropriate mind-related comments show better mentalizing abilities, and a better theory of mind performance (Laranjo, Bernier, Meins & Carlson, 2010; Meins, Fernyhough, Wainwright, Clark-Carter, Das Gupta, Fradley, & Tuckey, 2003). Mothers that use more appropriate mind-related comments, when describing their child, are more reflective, show more positive affect, less rejection, less anxiety, less intrusiveness, and show more sensitivity in their parenting behavior (Rosenblum, McDonough, Sameroff & Muzik, 2008; Meins, et al., 2002). Non-attuned mind-related comments refer to the parental tendency to misinterpret the infant’s mental states and processes when commenting on their child. Children of mothers that use more non-attuned mind-related comments show less perspective in symbolic play (Meins, Bureau, & Fernyhough, 2018). Mothers that use more non-attuned mind-related comments, when describing their child, show less parental reflective functioning (Arnott, & Meins, 2007). However, non-attuned mind-related comments have been found unrelated to sensitive parenting behavior (Arnott & Meins, 2007; Meins et al., 2001, 2002, 2012).
Responsive parenting can predict the forming of a secure attachment bond (Meins, et al., 2001). A secure attachment bond reflects a trusting orientation toward the caregiver, themselves and the world (Belsky & Fearon, 2002). Bowlby (1973) hypothesized that early relationship experience with the primary caregiver eventually leads to more generalized expectations about the self, others, and the world. Infants with a secure attachment bond consider their caregiver as a safe haven to seek comfort when in distress, and they consider their caregiver as a secure base for exploration of the environment (Ainsworth, 1967). The child’s secure attachment bond is positively related to higher levels of sensitivity, appropriate mind-related comments, and negatively to non-attuned mind-related comments (Laranjo, Bernier & Meins, 2008; Meins, Fernyhough, Rosnay, Arnott, Leekam, & Turner, 2012; Meins, et al., 2001). Especially in the case of an insecure attachment bond, increasing high quality sensitive parenting could be of much importance, since infants with an insecure attachment bond, receiving high qualitative sensitive parenting, outperform infants with a
secure attachment bond, receiving low quality sensitive parenting, on behavior problems, social competence, language comprehension, expressive language, and school readiness (Belsky & Fearon 2002). Children that change from a secure to an insecure attachment bond often show lower perspective-taking abilities, which is predicted by higher levels of maternal non-attuned comments (Meins, et al., 2018). Therefore, it is important to focus on increasing responsive parenting behavior.
A risk factor for non-responsive parenting behavior is stress, which can be derived from various factors. Infants growing up in a highly stressful environment experience more father-mother conflict, which is in turn, is associated with non-responsive parenting behavior (Finger, Bernstein, & Cox, 2009). Cumulative stress, resulting from daily parenting hassles or major life events, negatively affects parenting behavior, child behavior, and the dyadic parent-child interactions (Crnic, Gaze, & Hoffman, 2005). Especially in high demand situations, for example when raising triplets, mothers show less sensitive parenting behavior, which in turn affects the infants’ cognitive and symbolic growth, even when matched with singletons and twins for medical and environmental conditions (Feldman, Eidelman, & Rotenberg, 2004). Mothers that use less appropriate mind-related comments to describe their child, also show higher levels of parenting stress, and more hostility in their interaction with the child (McMahon & Meins, 2011). Higher levels of stress also associates with more negative parenting perceptions (Respler-Herman, Mowder, Yasik, & Shamah, 2011). When parents show more negative emotions, and are more self-focused on their goals, instead of infant-oriented goals, they are less able to express sensitive parenting behavior when the infant is in distress (Leerkes, 2010).
Mindful parenting, paying purposeful and non-judgmental attention to the child, the self, and parenting practices in the present moment, could be applied to manage stressful situations, such as parenting (Kabat-Zinn, 1997; Kabat-Zinn, 1990). Mindfulness in parenting provides parents with tools to stay away from the ‘automatic pilot’ (Duncan, 2009). The ‘automatic’ pilot could be described as negative, disengaged, self-focused behavior that negatively affects parenting. In contrast mindful parenting consists of more aware, consistent, positive, and child-focused parenting behavior. Parents that are more mindful in their parenting behavior are also more responsive and less hostile towards their child (Parent, McKee, Rough, & Forehand, 2016). These associations are similar for parenting behavior in three different developmental stages (young childhood: 3-7 years; middle childhood: 8-12 years; adolescence: 13-17 years). At the physiology level, higher levels of mindful parenting associates with steeper cortisol recovery slopes, and lower mother and infant cortisol levels
(Laurent, Duncan, Lightcap, & Khan, 2017). In other words, mothers that parent more mindful are more able to cope with high levels of stress. Key mindful parenting tools include: increasing communication, self-regulation, responding in accordance to goals and values, creating realistic expectations about the self and the child, and showing more positive affection (Duncan, 2009).
Interventions, specifically designed to increase mindfulness in parenting, are valued by parents to bring long-term transformational changes in their parenting behavior (Bögels, Hellemans, Van Deursen, Römer, & Van der Meulen, 2014). Even though, little research exists on how mindfulness-based parenting interventions benefit children and their parents, preliminary research suggests that this approach may reduce parenting stress, child aggression, and increase parenting satisfaction, and children’s prosocial behavior (Cohen & Semple, 2010). Bögels and colleagues (2014) show that mothers report less symptoms of their psychopathology, a reduction of parenting stress, and improvements in their (co-)parenting behavior, after following the mindful parenting intervention. Benefits are even found for mothers with an infant, as mothers report more responsivity, less hostility, and less parenting stress, after following the intervention (Potharst, Aktar, Rexwinkel, Rigterink, & Bogels, 2017). They also show more self-compassion, higher levels of well-being, and more confidence in general. Especially the group-based intervention format provides and evokes onsite examples in which both parents and their children are able to immediately apply and benefit from the mindful parenting tools (Reynolds, 2003).
Even in the presence of psychopathology, mindful parenting interventions show beneficial effects in decreasing symptoms of both child’s and parents’ psychopathology (Meppelink, De Bruin, Wanders-Mulder, Vennik, & Bögels, 2016). Mothers, diagnosed with depression, report positive changes their emotional reactivity and regulation, empathy and acceptance, involvement, emotional availability and comfort, and recognition of their own needs, after following a mindful parenting based cognitive training (MBCT; Bailie, Kuyken, & Sonnenberg, 2011). Parents of children with developmental disabilities show increased skills to decrease aggressive behavior of their child, and increase their children’s social skills (Singh, Lancioni, Winton, Fisher, Wahler, Mcleavey, Sing, & Sabaawi, 2006). These children even show increased positive and decreased negative social interactions with their siblings. Mothers of children with ADHD report less over-reactive parenting and parenting stress after following a mindful parenting intervention (Van der Oord, Bögels, & Pijnenburg, 2012). Even educators of children with special needs show reductions in stress, and enhancement of
positive psychological functioning, after following a mindful parenting intervention (Benn, Akiva, & Arel, 2012).
It is hypothesized that after the mindful with your baby/toddler intervention levels of responsive parenting behavior, which are sensitivity, acceptance, appropriate mind-related comments, and levels of mindful parenting, will increase. Levels of parenting stress and non-attuned mind-related comments are expected to decrease. Second, associations between mindful parenting and responsive parenting behavior are investigated. It is hypothesized that increased levels of mindful parenting associates with increased levels of sensitivity, acceptance, and appropriate mind-related comments. It is also hypothesized that increased levels of mindful parenting associates with decreased levels of non-attuned mind-related comments. Third, associations between parenting stress and responsive parenting behaviors are investigated. It is hypothesized that decreased levels of parenting stress associates with increased levels of responsive parenting behavior, precisely sensitivity, acceptance, and appropriate mind-related comments. It is also hypothesized that that decreased levels of parenting stress associates with decreased levels of non-attuned mind-related comments. Fourth, differences between the baby- and toddler-groups are being investigated for all above hypotheses.
Method Participants
Participants, all mothers, and their babies (0-1.5yr.) or toddlers (1.5-4.0yr.), were recruited through referral by a health clinician or by a sign-up form at the health clinic, in the district of Amsterdam. The interventions included in this study started between October 2015 and October 2017. Firstborns consisted 63.9% of the baby-groups, and 71.4% of the toddler-groups. Mothers experienced diverse difficulties in parenting (e.g. problems with the baby’s/child’s sleeping, eating, self-regulation, temperament, and parenting stress), or even experienced additional symptoms of depression (40%). The educational attainment of the mothers was at least upper secondary school level, and mostly at higher education level (Dutch HBO) or Bachelor degree (WO; together 82.0%). The nationality was mostly Dutch for the mothers of the baby-groups (75.0%), and their babies (83.3%). The nationality was also mostly Dutch for the mothers of the toddler-groups (57.1%) and their toddlers (57.1%). For both groups, most foreign nationalities came from Western Europe (26.0%). Interventions were led by a professional mindfulness trainer, educated for clinical care, supported by an assistant for the closed meditation sessions. This assistant was mostly an Infant Mental Health specialist (68.3%). The other groups were led by the Infant Mental
Health specialist, supported by a student with a bachelor degree in the field of child development. The most important inclusion criterion was that mothers completed the full intervention, which resulted in 50 mother-child dyads, which excluded 8 participants. These consisted of 36 mother-baby, and 14 mother-toddler dyads, spread over 10 groups. The average amount of mother-baby dyads analysed per group was (SD = .94, min = 2.00; max = 5.00). Of the total 5 groups, the average amount of mother-toddler dyads analysed per group was 3 (SD = .36, min = 2.00; max = 3.00). Most babies (55.6%), and toddlers (64.3%) were male. The average age of the participating mothers in the baby-groups was 35 years (SD = 4.23; min = 25; max = 46), and the average months of their infants was 9 months (SD = 4.11; min = 3; max = 20). The average age of the participating mothers in the toddler-group was 37 years (SD = 3.45, min = 33, max = 42), and the average age of their toddlers was 2 year and 3 months (SD = 7.55 months, min = 1.41 years, max = 3.33 years).
Ethics
This study has received approval of the ethics committee of the FMG faculty of the University of Amsterdam. After being informed, participants signed an informed consent. Participants were allowed to drop out at any given moment in the study. Wait-list and pre-test data of participants that dropped out of the intervention were not used. Data of participants with missing data on certain measurement points (e.g. technical problems, holidays, miscommunication, etc.) was still used, and were stated missing at random.
Procedure
Prior to the commencement of the research, information was provided to parents that participated in the Mindful with your baby/toddler intervention. Measurements for the Mindful with your baby intervention took place at waitlist (8 weeks before the intervention), pre-test (one week before the intervention), and post-test (directly after the intervention). Measurements for the Mindful with your toddler intervention took place at waitlist (9 weeks before the intervention), pre-test (one week before the intervention), and post-test (directly after the intervention). Questionnaires measuring parenting stress, and mindful parenting had to be filled out online and were administered through internet questionnaires.
Video-observations
Video-observations measuring sensitivity, acceptance, and mind-mindedness were predominantly taken in the home-environment or sometimes for convenience at the clinical health centre. Video-observations were executed by interns that were trained, and followed a video-observation protocol. At first, the person recording would introduce him/herself to the child, and show him/her the camera to avoid excessive curiosity. Video-observations
consisted of three stages. First, five minutes free-play interaction between the mother-baby/toddler dyads with no toys, to investigate the interaction without a focused attention to the toy. Playing without toys could bring more frustration to the mother or to the baby/toddler, because the child could lose its attention more quickly or become frustrated or angry when he/she could not play with his/her favourite toy. After the first phase the recorder would let the mother know that they could play with toys, or hand them a bag with toys. The free-play interaction between mother-baby/toddler dyads would also last approximately five minutes. After play, the recorder would ask the mother the following question: “could you describe (name child)”. The first two stages were used to measure sensitivity, and acceptance. Mind-mindedness was measured using all three stages. Mothers were told to interact with their baby/toddler as usual during play. In order to guarantee confidentially and anonymity, names of mothers and their baby/toddler were transformed into codes. Each video-observation received a specific random number, in order to avoid coding on prior knowledge (e.g. knowing the video is waitlist, pre-intervention, or post-intervention). The coders were blind to the information about the mother, and stored the videos anonymously. Video-observations were transcribed and coded by two independent coders that received at least interrater reliability above .80, measured by rating 33.3% of all the videos. After receiving this interrater reliability, all videos (100%) were discussed with a specialist in infant or child mental health in order to achieve the most reliable scores. Therefore, inter-rater reliability scores per material are not given below.
Materials
All measurements apply to the baby- and toddler-groups, therefore they are referred to as children, not as babies/toddlers.
Maternal sensitivity was measured with the first scale (sensitivity versus insensitivity) of the Ainsworth coding scheme (Ainsworth, 1969). Maternal sensitivity was coded on the basis of video-observations using the following observations: awareness of child’s signals, interpretation of the signals, appropriateness of the response, and the promptness of the response. Rather than using the minutes certain behavior was showing in the video, an overall rating of sensitivity over the 10 minute video was scored. No distinctions were made between the first and second five minutes of the video, because some videos were shorter due to frustration of the child. Video-observations were coded using a 9-points Likert scale, with five anchor points (1 = highly insensitive; 3 = insensitive; 5 = inconsistent; 7 = sensitive; 9 = highly sensitive). Higher scores reflected higher levels of sensitivity. A highly sensitive mother responded even to small signals of the child, used an accurate interpretation,
responded appropriately to the child’s wishes, and showed a prompt response. An inconsistent mother responded depending on the situation, therefore the awareness, and interpretation of the signal, and the appropriateness, and promptness of the response was inconsistent sensitive or insensitive. A highly insensitive mother ignored the child’s signals, used an inaccurate interpretation, responded inappropriate, and showed a delayed response that was no longer contingent with the child.
Maternal acceptance was measured with the fourth scale (acceptance versus rejection) of the Ainsworth coding scheme (Ainsworth, 1969). Maternal acceptance was coded on the basis of video-observations using the following observations: the emotional spectrum of the mother, maternal patience, acceptance of the babies/toddler’s negative mental state, and respect for the autonomy of the infant. Rather than using the minutes certain behavior was showing in the video, an overall rating of acceptance over the 10 minute video was scored. No distinctions were made between the first and second five minutes of the video, because some videos were shorter due to frustration of the child. Video-observations were coded using a 9-points Likert scale, with five anchor points (1 = highly rejecting; 3 = rejecting; 5 = detached; 7 = accepting; 9 = highly accepting). Higher scores reflected higher levels of acceptance. A highly accepting mother showed predominantly positive emotions and verbally accepted the child’s needs, was very patient, accepted the child’s negative mental state, and allowed the child to explore the environment. A detached mother predominantly showed a blank face (e.g. very little negative or positive emotions), ignored the child’s negative mental state, and seemed to not care about the exploration of the child. A highly rejecting mother showed a lot of negative emotions and verbal rejections to the child’s needs, was very impatient, did not accept the child’s negative mental state, and did not respect the autonomy of the child by only relying on her own wishes.
Maternal mind-mindedness was measured with the mind-mindedness coding scheme (Meins, et al., 2002). Mind-mindedness was coded using mind-related comments that refer to the infant’s mental states (e.g. knowledge, thoughts, desires, and interests). Mind-mindedness was measured creating a total score of comments on basis of the 10 minute free-play interaction (5 minutes with toys; 5 minutes without toys), and the comments based on the question “can you describe (name child)?” First, a distinction was made between mind-related comments and not mind-mind-related comments. Mind-mind-related comments could focus on the child’s interest or intellect: “he’s very creative”, mental processes: “do you remember seeing an elephant?”, emotional engagement: “are you bored?”, attempts to manipulate other people’s beliefs: “are you joking?”, or mothers putting words into their child’s mouth: “I am
not interested in that ball, I am happy playing with the blocks”. Not mind-related comments could focus on behavior: “she likes to stand up”, appearance: “he’s got blond hair”, or general comments: “she’s cute”. Second, mind-related comments were evaluated as appropriate (e.g. correct use of the comment in the context), or non-attuned (e.g. incorrect use of the comment in the context; Meins, et al., 2012). To illustrate: the mind-related comment: “you look like you don’t want to play with that toy anymore”, could be appropriate if the child shows signals of interest in other things, or inappropriate when the child is still fully engaged in playing with the toy. Third, all appropriate mind-related comments and attuned mind-related comments were standardized in proportion scores. Appropriate and non-attuned mind-related comments were treated as two distinct aspects of mind-mindedness (Meins, et al., 2002). Higher levels of the proportion of appropriate mind-related comments, and lower levels of the proportion of non-attuned mind-related comments reflected greater mind-mindedness.
Mindful parenting was measured using the Dutch version (IM-P; De Bruin, Zijlstra, Geurtzen, Zundert, Van de Weijer-Bergsma, Hartman, Nieuwesteeg, Duncan, & Bögels, 2014) of the Interpersonal Mindfulness in Parenting Scale (IM-P; Duncan, et al., 2009). Four items from the IMP, not applicable to the baby-groups, were removed, to compare the scores from the baby-groups to the scores from the toddler-groups in the analyses. The four items that were removed, were: IMP-4: “I listen carefully/attentively to the ideas of my child, even when I don’t agree”, IMP-7: “Even when I feel uncomfortable, I allow my child to express his/her feelings”, IMP-8: “When I feel upset/agitated towards my child, I tell him/her how I feel”, IMP-28: “I try to understand my child’s point of view, even if his/her opinions do not make sense to me”. A total number of 27 items was used, measured on a 5-point Likert scale (1 = never true; 5 = always true), on six different scales. These scales included: 1) listening with full attention 2) compassion for the child 3) non-judgmental acceptance of parental functioning 4) emotional non-reactivity in parenting 5) emotional awareness of the child 6) emotional awareness of the self. One mean-score of total mindful parenting was computed per measurement point. Mean-scores per scale were executed, but not used in further analyses in this study. Higher scores reflected more mindfulness in parenting, including higher scores on the scales. The IM-P contains good internal consistency (α=0.89; De Bruin, et al., 2014). Parenting stress was measured using the short version of the Nijmeegse Ouderlijke Stress Index (NOSI-K; De Brock, Vermulst, Gerris, & Abidin, 1992), which is a Dutch version of the Parenting Stress Index (PSI; Abidin, 1983). The NOSI-K, a self-report questionnaire for the parent, consists of 25 items, measured on a 6-point Likert scale (1 =
totally disagree; 6 = totally agree). Statements provided are expected to measure parental experiences of stress in the parent-child relationship. Two major domains are reflected. The parent domain included: sense of competence, attachment, depression, and parental health. The child domain included: adaptability, acceptability, demandingness, mood, distractibility-hyperactivity, and reinforcement to the parent. One mean-score of total parenting stress was computed per measurement point. The two major domains were not used in analyses in this study. Higher scores reflected higher levels of parenting stress. The reliability of the NOSI-K has been evaluated between .92 and .95 (De Brock, et al., 1992), and construct validity, and criterion validity were evaluated as good (COTAN, 1996; Evers, Van Vliet-Mulder, & Groot, 2000).
Statistics
A total of five continuous variables were investigated in this study. The measurement level for variables sensitivity, acceptance, mindful parenting, and parenting stress is interval, due to Likert scales. The measurement level for variables proportion mind-related comments and proportion non-attuned mind-related comments is ratio, with a true meaningful score of zero. Some outliers were detected, but no outliers were meaningful, and therefore not excluded from the data. The distribution of the variables was evaluated using skewness, kurtosis, histograms, and boxplots. All values of kurtosis and skewness between -2, and +2, were accepted, and the assumption of normal univariate distribution for all variables was accepted (George, & Mallery, 2010).
Time-effect group-level changes for all variables were investigated using multilevel for longitudinal data. Wait-list, post-intervention, follow up 1, and follow up 2 measurement standardized scores were compared to pre-intervention measurement scores. Standardized parameter estimates were calculated and interpreted as Cohen’s d effect size of change. No change was expected for all variables between wait-list and pre-intervention. Positive change was expected between pre-intervention and post-intervention for sensitivity, acceptance, appropriate mind-related comments, and mindful parenting. Negative change was expected between pre-intervention and post-intervention for non-attuned mind-related comments, and parenting stress.
Associations between all variables were investigated using Pearson correlations, with an alpha level of .05. The associations were investigated at each time point, at waitlist, pre-intervention, post-pre-intervention, follow up 1, and at follow up 2. Associations were also investigated using difference scores per variable between post- and pre-intervention. The
strength of the associations is compared using the following guidelines for a small (r=.10), medium (r=.30), or large (r=.50) effect sizes (Cohen, 1988).
Differences between the baby- and toddler-groups were investigated using independent samples t-tests, per measurement point (waitlist, pre-intervention, post-intervention, follow up 1, follow up 2), for all variables. Also difference scores (post-intervention minus pre-(post-intervention) were compared using independent samples t-tests, between baby- and toddler groups.
Results
Means and standard-deviations of variables mindful parenting, sensitivity, acceptance, mind-mindedness, and parenting stress, at waitlist, pre-intervention, post-intervention, follow up 1, and follow up 2, are displayed in table 1.
First, multilevel longitudinal outcomes are displayed in table 1. The results show treatment outcomes predicted by time (deviations from pre-intervention). For Ainsworth scales of sensitivity, only acceptance did significantly increase after following the mindful parenting intervention. The slight increase in sensitivity was not significant. For the Meins scales of mind-mindedness, only the proportion of non-attuned mind-related comments did significantly decrease. The slight decrease in the proportion of appropriate mind-related comments was not significant. Mindful parenting did significantly increase after following the mindful parenting. On top of that, the increase between both follow up 1, and follow up 2, compared to pre-intervention scores was significant. Parenting stress did also significantly decrease after following the intervention. On top of that, the decrease between both follow up 1, and follow up 2, compared to pre-intervention scores was significant.
Second, Pearson correlations at waitlist, pre-intervention, post-intervention, follow up 1, and follow up 2, are displayed in tables 3, 4, 5, and 6. Correlations between the variables at waitlist, pre-intervention, post-intervention, follow up 1, and follow up 2 showed similar results. Significant associations have been found for levels of sensitivity with levels of acceptance. Higher levels of sensitivity associated with higher levels of acceptance, at waitlist (r = .92, p<.001), pre-intervention (r = .90, p<.001), post-intervention (r = .86, p<.001). For levels of acceptance, a trend was found at pre-intervention with levels of mindful parenting (r = .29, p = .057). This trend was not found at waitlist (r = .15, p = .413), or post-intervention (r = -.13, p = .396). No significant association was found for the proportion of mind-related comments with any of the other variables (sensitivity, acceptance, non-attuned mind-related comments, mindful parenting and parenting stress), at waitlist, pre-intervention, or post-intervention. Also no significant association was found for the proportion of non-attuned
mind-related comments with any of the other variables (sensitivity, acceptance, appropriate mind-related comments, mindful parenting, and parenting stress). Significant associations were found between mindful parenting and parenting stress. Higher levels of mindful parenting associated with lower levels of parenting stress, at waitlist (r = -.47, p = .01), pre-intervention (r = -.63, p<.001), post-pre-intervention (r = -.51, p<.001), follow up 1 (r = -.50, p = .001), and follow up 2 (r = -.42, p = .041).
Third, difference scores were computed by subtracting post-intervention mean-scores from pre-intervention mean-scores. Pearson correlations are displayed in table 7. A significant association between difference scores of sensitivity and acceptance has been found. Increased levels of sensitivity associated with increased levels of acceptance (r = .67, p<.001). Difference scores of sensitivity did not associate with difference scores of appropriate mind-related comments, non-attuned mind-related comments, mindful parenting, or parenting stress. Difference scores of acceptance also did not associate with difference scores of appropriate mind-related comments, non-attuned min-related comments, mindful parenting or parenting stress. Difference scores of appropriate mind-related comments, did not associated with difference scores of non-attuned mind-related comments, mindful parenting, or parenting stress. Difference scores of non-attuned mind-related comments did not associate with mindful parenting, or parenting stress. Difference scores of mindful parenting did associate with difference scores of parenting stress. Increased levels of mindful parenting associated with decreased levels of parenting stress (r = -.41, p = .005).
Fourth, differences scores were investigated between the baby- and toddler-groups. Table 2 displays the multilevel effects divided for the baby-, and toddler- groups. For sensitivity, mean-scores did not differ on waitlist t(31) = -1.43, p = .164, but differed on pre-intervention between baby-groups (M = 5.55, SD = 1.72), and toddler-groups (M = 6.79, SD = 2.15), t(44) = -2.08, p = .044, and differed on post-intervention between baby-groups (M = 5.82, SD = 1.87), and toddler groups (M = 7.43, SD = 1.28), t(44) = -2.93, p = .005. Table 2 shows that the multilevel effect for both baby- and toddler groups is not significant. For acceptance, mean-scores did not differ on waitlist, t(31) = -1.65, p = .110, or on pre-intervention, t(44) = -1.60, p = .116, but differed on post-intervention between baby-groups (M = 6.41, SD = 1.64), and toddler groups (M = 7.86, SD = 1.17), t(44) = -2.98, p = .005. Table 2 shows that acceptance significantly did increase for both groups after the intervention. However, the increase is significantly stronger for the toddler-groups, in comparison to the baby-groups. For appropriate MM comments, mean scores did not differ on waitlist, t(29) = 0.53, p = .600, pre-intervention, t(41) = 0.899, p = .374, or
post-intervention, t(40) = 0.474, p = .638.Table 2 shows that both groups did not show an increase in proportion of the use of appropriate mind-related comments. For non-attuned MM comments, mean-scores did not differ on waitlist, t(29) = -0.10, p = .924, or pre-intervention, t(41) = 1.22, p = .228, but differed on post-intervention, t(40) = 2.37, p = .005, between baby-groups (M = .008, SD = .01), and toddler baby-groups (M = 0.0009, SD = 0.002). Table 2 shows that both groups did significantly show less non-attuned comments after following the mindful parenting intervention. However, this effect was stronger for toddler-groups, in comparison to the baby-groups. For mindful parenting, mean-scores did not differ on waitlist t(34) = -1.24, p = .224, pre-intervention, t(47) = -1.06, p = .296, or post-intervention, t(46) = 0.91, p = .370, follow up 1, t(41) = 0.16, p = .872, or follow up 2, t(22) = 1.82, p = .083. However, table 2 shows that only for the baby-group the increase in mindful parenting is significant, not in the toddler-groups. For parenting stress, mean-scores did not differ on waitlist, t(27) = 0.71, p = .482, pre-intervention, t(47) = 0.66, p = .513, or post-intervention, t(47) = 0.29, p = .776, follow up 1, t(43) = 0.83, p = .413, or follow up 2, t(22) = 0.02, p = .988. However, table 2 shows that only for the baby-group the parenting stress decrease is significant. In the toddler groups the decrease in parenting stress is only significant at follow up 1 (trend), and follow up 2 (significant).
Discussion
This study investigated the potential of a mindful parenting intervention to increase observational responsive parenting behavior of mothers with an infant or toddler. Mindful parenting focuses on paying purposeful, non-judgmental attention to the child, the self, and parenting practices in the present moment. After following the mindful parenting intervention, mothers of both infants and toddlers were more accepting of the emotions and autonomy of the child, used less non-attuned mind related comments, experienced more mindfulness in their parenting, and experienced less parenting stress, in comparison to before the intervention.
For the first time, responsive parenting, after following the mindful parenting intervention, was evaluated using observations of the mother-child interaction, to evaluate sensitivity, acceptance, and mind-mindedness. Previous research of Bögels, and colleagues (2014), or Potharst and colleagues (2017) used questionnaires to evaluate responsive parenting. Most mothers expressed positive feelings towards the addition of video-observations next to the online questionnaires.
Comparing effect sizes in this study to effect sizes of interventions in which they also used the child-parent interaction as outcome, showed that the significant effect sizes of
acceptance (ε = .40), and non-attuned mind-related comments (ε = -.79) are relatively strong compared to effect sizes found in the meta-analysis of Shah and colleagues (2016). The article of Shah and colleagues (2016) report significant effect sizes between .50 to .74, but also a lot of non-significant effect sizes from .02 to .21.
The increase in mindful parenting was only observed in the baby-groups, in which the increase was very strong. For the toddler-groups the increase was also observed, but not significant. Potharst and colleagues (2017) also found this age-difference, in which mothers with an older infant were more mindful. However, it still remains unclear why this difference exists.
The increase in observed acceptance in parenting is supported by most research that found a decrease in hostile, and an increase in acceptance, after following a mindful parenting intervention (Potharst et al., 2017; Bailie, et al., 2011; Parent, et al., 2016). This finding forms an addition to previous research, because previous research used other objective measures, precisely questionnaires. This study used observational data to evaluate acceptance as a measurement of responsive parenting. The increase in acceptance was even stronger for mothers of toddlers. It is possible that especially toddlers that are able to walk are better to explore their environment, in combination with a start to use words to communicate their desires and wishes, which makes it easier for mothers to understand what the child wants.
The decrease in the use of non-attuned mind-related comment has not been studied before. However, Arnott and Meins (2007) showed that mothers with higher levels of reflective functioning show less non-attuned mind-related comments. It is therefore possible that mothers who increased in reflective functioning, as part of mindful parenting, also decreased their non-attuned mind-related comments. However, this association between difference scores (post-intervention – pre-intervention) of mindful parenting and non-attuned mind-related comments was not found in this study. One explanation for this could be that the amount of non-attuned mind-related comments used is very low. This could be supported the total amount of non-attuned mind-related comments at waitlist (M = 2.81, SD = 3.27, min = 0, max = 13), pre-intervention (M = 2.47, SD = 2.41, min = 0, max = 11), post-intervention (M = .88, SD = 1.38, min = 0, max = 6), were much lower in comparison to the amount of not mind-minded comments at waitlist (M = 131.71, SD = 55.93, min = 30, max = 268), pre-intervention (M = 130.14, SD = 46.10, min = 37, max = 229), post-pre-intervention (M = 128.21, SD = 45.32, min = 46, max = 205).
The decrease in parenting stress is also supported by previous research. Crnic and colleagues (2005) found the association between stress and parenting behavior, especially the
parent-child interactions. It is also possible that the mindful parenting intervention decreases negative parenting perceptions, about the self and the child, which could result in less stress as supported by Respler-Herman, et al., 2011). This finding can be supported by the strong association between the difference scores (post-intervention minus pre-intervention) of mindful parenting and parenting stress. Mindful parenting interventions have showed before that they can reduce parenting stress (Bögels, et al., 2014; Potharst, et al., 2017). Parenting stress decreased for both the baby- and toddler-groups. However, parenting stress did decrease earlier for the baby-groups, right after the intervention, and continued at follow up. For the toddler-groups parenting stress did decrease (not significantly) after the intervention. At follow up 1 a trend was seen, which was significant at follow up 2. It should also be noted that the average parenting stress level is already low at start (M = 2.75, SD = 0.85, at waitlist on a 6-point Likert scale). Therefore, a very strong reduction in parenting stress was not even possible.
Surprisingly, no significant increase in sensitivity after following the intervention was found for both toddler- and baby-groups. This is in contradiction to previous research. Parent and colleagues (2016) found that parents that are more mindful in their parenting are also more responsive towards their child. Potharst and colleagues (2017) found that after following a mindful parenting intervention, mothers report more responsivity in their parenting. One explanation for this could be that levels of maternal sensitivity are relatively stable across the child’s first 2.5 years of life (Bigelow, 2010). Therefore, an intervention not specifically designed to increase sensitivity may not have the power to increase levels of sensitive parenting behavior. Another intervention, video-feedback training also showed no significant effects on observed sensitive parenting behavior (Groeneveld, Vermeer, Van IJzendoorn, & Linting, 2011). Even though sensitivity is very important for the development of the child, it may be an aspect that is not directly affected by a mindful parenting intervention. Differences between toddler- and baby-groups were observed, from which toddler-groups showed higher levels of sensitive parenting behavior, both at pre-intervention and post-intervention.
Also, no significant increase in appropriate mind-related comments was observed in both baby- and toddler-groups. Also here the explanation could be that the amount of appropriate mind-related comments is very low, at waitlist (M = 7.16, SE = 5.69, min = 0, max = 21), pre-intervention (M = 6.53, SE = 4.52, min = 0, max = 18), and post-intervention (M = 6.12, SE = 3.74, min = 0, max = 14), were much lower, in comparison to the amount of not mind-minded comments at waitlist (M = 131.71, SD = 55.93, min = 30, max = 268),
pre-intervention (M = 130.14, SD = 46.10, min = 37, max = 229), post-pre-intervention (M = 128.21, SD = 45.32, min = 46, max = 205). Another explanation could be that this mindful parenting intervention was not specifically designed to learn, and apply mind-related comments to parenting. The slight decrease in appropriate mind-related comments could be explained by staying away from the automatic pilot and observe more without interfering, as learned during the mindful parenting intervention, which could have resulted in using on average less comments towards the child
One important limitation to this study is that only participants that finished the complete mindful parenting intervention were included. A lot of participants applied and provided waitlist data and pre-intervention data, but quit the intervention preliminary due to various circumstances. The reason why this study did not include those participants is because otherwise this study could not make assumptions about the effects after following a mindful parenting intervention. On top of that all the dependent variables were at least at post-intervention or at follow up and therefore most information came from data provided by participants that finished the full intervention.
A second limitation is that this study did not use a control group. It is possible that changes are not entirely subjected to the mindful parenting intervention. Some mothers received additional treatment for their symptoms of psychopathology. Also, some effects could be due to co-parenting or environmental factors. Some examples include, number of siblings, relationship quality with the co-parent, social network being a stay-at home parent or a working mother, day care facilities, etc. However, all these mothers were in desperate need for an intervention. Extending their waiting time, or giving them just information without the intervention, could possibly result in detrimental outcomes. Especially, considering the children were really young, infants or toddlers. A true control group may especially be hard to achieve with this age-group.
A third limitation is that the sample sizes of toddlers is too small (N<15). Therefore, analyzes made to compare baby- to toddler-groups were not entirely reliable. This provides an extra explanation why the strength of the effect of the mindful parenting intervention in decreasing parenting stress, and increasing mindful parenting, is much stronger for the baby-groups in comparison to the toddler-baby-groups. More participants should be included to provide reliable results. However, the preliminary analyzes between infants and toddlers should be made in future research, since these two groups are at a very distinctive developmental age.
In conclusion, the mindful parenting intervention showed great benefits for mothers to increase the capacity to be more accepting of the child’s emotional state and autonomy, be
more mindful in their parenting, experience less parenting stress, and to a small extend increase the capacity to understand the child’s mental state. However, more research is needed especially in measurement points at (half) a year after the mindful parenting intervention to fully understand the benefits. Long-term effects seem to be getting stronger, because parents are able to integrate the mindful parenting tools better into their parenting behavior, which could benefit their responsive parenting behavior. Next to previous suggestions, future research should also focus on the differences between fathers and mothers, since previous research found difference between them in their parenting behavior (Arnott & Meins, 2007).
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.Table 1 Means and standard deviations of all measures at measurement occasions
Data are presented as mean (standard deviation) of scales ranging 1-9 for Ainsworth, 0-1 for Meins, 1-5 for IM-P, and 1-6 for NOSI-K.
Waitlist Pre-intervention Post-intervention Follow-up 1 Follow up 2
Outcome variable N M (SD) N M (SD) N M (SD) N M(SD) N M(SD)
Sensitivity scales (Ainsworth)
- Sensitivity 33 6.12(1.83) 46 5.92(1.93) 46 6.30(1.86)
- Acceptance 33 6.55(2.02) 46 6.02(1.97) 46 6.85(1.65)
Mind-Mindedness scales (Meins) - Proportion appropriate
mind-related comments
31 .05(0.04) 43 .05(0.03) 42 .05(0.03)
- Proportion non-attuned mind-related comments
31 .02(0.02) 43 .02(0.02) 42 .006(0.01)
Mindful parenting (IM-P)
Overall Mindful Parenting 36 3.29(0.41) 49 3.33(0.48) 48 3.55(0.51) 43 3.63(0.39) 24 3.87(0.46)
- Listening with full attention 36 3.09(0.66) 49 2.96(0.62) 47 3.38(0.66) 43 3.42(0.62) 24 3.66(0.78)
- Compassion for the child 36 4.33(0.55) 49 4.35(0.52) 48 4.39(0.65) 43 4.36(0.63) 24 4.69(0.35)
- Non-judgmental acc. of par. func. 33 2.56(0.66) 46 2.51(0.75) 45 2.95(0.82) 43 3.12(0.66) 24 3.26(0.70) - Emotional non-reactivity in par. 36 3.58(0.62) 49 3.69(0.65) 47 3.78(0.75) 43 3.83(0.52) 24 3.96(0.81) - Emotional awareness of the child 33 3.44(0.71) 46 3.54(0.86) 45 3.76(0.59) 43 3.85(0.63) 24 4.13(0.67)
- Emotional awareness of the self 36 3.21(0.68) 49 3.40(0.68) 47 3.59(0.66) 43 3.62(0.62) 24 3.97(0.60)
Parenting stress (NOSI-K)
Table 2 Parameter estimates (standard errors) and t values of multilevel models of treatment outcome sensitivity, acceptance, and mind-mindedness, per age-group, predicted by measurement
occasion (deviations from pre-intervention)
†p<.10; * p < .05; **p<.01;***p<.001, B = Parameter estimate; can be interpreted as Cohen’s d effect size of change.
Intercept Waitlist Post-intervention Follow up 1 Follow up 2
Outcome variable N B(SE) t B(SE) t B (SE) t B(SE) T B(SE) T
Sensitivity scales (Ainsworth) Sensitivity 48 -.09(0.15) -0.60 0.04(0.14) 0.32 0.18(0.14) 1.35 Baby 34 -0.07(0.17) -0.45 0.10(0.19) 0.51 0.12(0.18) 0.68 Toddler 14 -0.14(0.32) -0.43 -0.06(0.16) -0.39 0.37(0.23) 1.61 Acceptance 48 -0.21(0.15) -1.37 0.24(0.15) 1.60 0.40(0.13) 3.08** Baby 34 -0.17(0.17) -1.02 0.24(0.21) 1.10 0.34(0.16) 2.07* Toddler 14 -0.33(0.33) -1.00 0.28(0.13) 2.14 0.62(0.24) 2.54* Mind-Mindedness scales (Meins) Appropriate mind-related comments 45 -0.01(0.14) -0.11 -0.02(0.19) -0.09 -0.01(0.16) -0.05 Baby 33 -0.01(0.17) -0.05 -0.04(0.23) -0.16 -0.03(0.18) -0.16 Toddler 12 -0.06(0.28) -0.20 0.04(0.40) 0.11 0.08(0.36) 0.22 Non-attuned mind- related comments 45 0.27(0.16) 1.67 0.06(0.20) 0.29 -0.79(0.17) -4.55*** Baby 33 0.28(0.19) 1.46 -0.04(0.23) -0.17 -0.74(0.22) -3.43** Toddler 12 0.21(0.23) 0.93 0.46(0.34) 1.34 -0.94(0.32) -2.98** Mindful parenting 50 -0.36(0.14) -2.63* -0.07(0.14) -0.54 0.45(0.15) 2.96** 0.54(0.15) 3.54** 1.02(0.20) 5.11*** Baby 36 -0.44(0.16) -2.67* -0.07(0.15) -0.45 0.59(0.12) 4.94*** 0.62(0.16) 3.85*** 1.18(0.21) 5.53*** Toddler 14 -0.20(0.24) -0.82 -0.06(0.26) -0.24 -0.05(0.51) -0.09 0.44(0.25) 1.75 0.59(0.42) 1.42 Parenting stress 50 0.31(0.17) 1.89 0.03(0.14) 0.19 -0.40(0.11) -3.54** -0.50(0.17) -3.00** -0.67(021) -3.14** Baby 36 0.34(0.19) 1.85 0.13(0.17) 0.79 -0.46(0.13) -3.53** -0.410.22) -1.87† -0.71(0.29) -2.43* Toddler 14 0.24(0.34) 0.71 0.02(0.26) 0.06 -0.25(0.22) -1.13 -0.51(0.24) -2.18† -0.45(0.19) -2.38*
Table 2 Pearson correlations between sensitivity, acceptance, mind-mindedness, Table 3 Pearson correlations between sensitivity, acceptance, mind-mindedness,
mindful parenting, and parenting stress at waitlist. parenting stress, and mindful parenting at pre-intervention.
Variables 1 2 3. 4. 5. 1.Sensitivity - 2.Acceptance .920*** - 3.App MM .005 .074 - 4. Na MM -.138 -.278 .206 - 5. Mindful parenting .070 .147 .046 -.269 - 6. Parenting stress -.248 -.308 .175 -.039 -.472*** †p<.10; * p < .05; **p<.01;***p<.001 †p<.10 *; p < .05; **p<.01;***p<.001
Table 4 Pearson correlations between sensitivity, acceptance, mind-mindedness, Table 5 Pearson correlations between mindful parenting, and parenting stress,
parenting stress, and mindful parenting at post-intervention at follow up 1, and follow up 2.
Variables 1 2 3. 4. 5. 1.Sensitivity - 2.Acceptance .857*** - 3.App MM .198 .204 - 4. Na MM -.215 -.207 .136 - 5. Mindful parenting -.097 -.131 -.039 -.090 - 6. Parenting stress .066 .017 .123 -.053 -.512** †p<.10 ;* p < .05; **p<.01;***p<.001 †p<.10; * p < .05; **p<.01;***p<.001 Variables 1 2 3. 4. 5. 1.Sensitivity - 2.Acceptance .903*** - 3.App MM -.012 -.037 - 4. Na MM .138 .081 .108 - 5. Mindful Parenting .223 .286† -.142 .034 - 6. Parenting stress .-.198 -.203 .185 .083 -.630*** Variables 1 2 3. 1.Mindful parenting follow up 1 - 2.Parenting stress Follow up 1 -.50** - 3.Mindful parenting Follow up 2 .34 .-.53* - 4. Parenting stress Follow up 2 -.23 .60** -.42*
Table 5 Pearson correlations between difference-scores (post-intervention-pre-intervention)
between sensitivity, acceptance, mind-mindedness, parenting stress, and mindful parenting.
†p<.10; * p < .05; **p<.01;***p<.001 Variables 1 2 3. 4. 5. 1.Sensitivity - 2.Acceptance .67*** - 3.App MM .18 .05 - 4. Na MM .02 -.09 .12 - 5.Mindful parenting .05 .09 .05 .03 - 6. Parenting stress .19 .15 .10 .01 -.41**
