FACULTEIT DER MAATSCHAPPIJ- EN GEDRAGSWETENSCHAPPEN College and Graduate School of Child Development and Education
UNIVERSITY OF AMSTERDAM
The effect of changing experiential avoidance during a mindfulness
parenting intervention on child and parent behavior problems
Name: Aurora Sandu
Student number: 10286667
Master Programme: Pedagogical Science Thesis supervisor: G.J.A. Garst
Thesis supervisor: F.J. Oort Date: 23-07-2013
Table of Contents Abstract……….3 Introduction ……….4 Methods……….7 Participants………....7 Procedures……….8 Measures………....8 Treatment……….10 Modelling Strategy………..10 Results………..12 Discussion..………...19 References………....22 2
Abstract
The aim of this study was to examine whether mindfulness training leads to reduced experiential avoidance and, if so, whether changes in experiential avoidance will affect changes in child and parental behavior problems after mindfulness training. Participants (N = 74) were parents who completed the scales of the PAAQ, CBCL and ASR at pre- and post-intervention in order to test the hypothesis. All hypotheses were tested within a single structural equation model. We predicted that there is a decresed in mean changes for experiantial avoidance, child and parent behavior problems after mindfulness trainning. Also, we anticipated that there is positive relationship between changes in experiential avoidance and changes in child and parent problem behavior. The results shown that after the mindfulness training both the level of experiential avoidance and the level of reported behavioral problems of the parents were significantly reduced, but there was no evidence that child behavioral problems decreased as well. Furthermore, we founded that changes in experiential avoidance during mindfulness intervention were significantly associated with changes in parent behavioral problems while the relationship between changes in experiantial avoidance and changes in child behavior problems was not significant. We can conclude that in our study the level of experiential avoidance had a significant impact on level of parent behaviour problems during mindfulness training.
Keywords: Mindfulness, experiential avoidance, child behavior problems, parent behavior problems, structural equation modeling.
Introduction
Is it possible that parents can deal with the negative emotions of their children if they cannot deal with their own negative emotions? How parents cope with their own negative emotions could play an important role in preventing and treating their children’s behavioral problems. The evidence suggests that parents of children with behavior problems have an inability to accept that child’s distress, and this may be due to their own experience of non-acceptance of negative emotions such as fear, anxiety, irritability, anger and frustration (Tiwari, Podell, Martin, Mychailyszyn, Furr & Kendall, 2008). The question is whether there is particular parenting behavior that causes or contributes to specific child behavior (Barber, Olsen & Shagle, 1994; Aunola & Nurmi, 2005). One of the possible answers is the parent’s inability or hesitance to tolerate his or her own experience of negative emotions and thereby affecting and influencing their child’s behavioral problems; this is defined as experiential avoidance. So, parents who avoid their negative emotions may be more likely to avoid children’s negative emotions. The inability to cope or to tolerate the negative emotion during a stressful situation has significant treatment implications for both adult and child behavioral problems (Podell & Kendall, 2008).
Mindfulness is a new psychological treatment characterized by the way it orients the current experiences of the patient in the present moment and combines that with an attitude of non-judgment and acceptance (Kabat-Zinn, 2003). Mindfulness tries to teach people how to accept their negative emotions and anxious situations using relaxation techniques. These techniques help keep the mind in the present moment without adding more negative thoughts or emotions to the experience. The mindfulness training helps patients to deal with their negative emotions and anxious situations by observing and watching their own minds: the
patient watches how the unwanted experiences appear and then pass out of the mind. The patient learns that by not reacting and judging that they are able to gain best insight into solving their own problems. Weinstein,Brown and Ryan (2009) supported the link between mindfulness and acceptance, as they found that individuals with higher levels of mindfulness reported less use of avoidant strategies during stressful situations.
Mindful parenting tries to foster everyday mindfulness in the context of child-parent interactions. This can be done when parents listen to their children with full attention and respond to them with compassion and non-judgmental acceptance (Duncan, Coatsworth & Greenberg, 2009). Mindful parenting training tries to modify the automaticity of the parent’s response in the parent-child interaction (Bögels, Lehtohnen, & Restifo, 2010). It helps parents to correct their dysfunctional ways of dealing with their own negative emotion as well as of their children’s negative emotion. As presented by Greco and Eifert (2004), mindfulness practice may help parents to attenuate experiential avoidance by experiencing the dynamic nature of negative emotion, unwanted thoughts and bodily sensation. In sum, mindfulness parent training may promote an emotional balance that involves acceptance of the internal and external experiences, facilitates the ability to cope with the negative emotion of themselves and their children and allows healthy choices to be made and greater flexibility in choosing how problems are solved. (Hayes et al., 2004).
A few studies have shown that mindfulness parenting improves parents’ ability to cope with their own negative emotions as well as those of their child’s problem behavior in the context of child-parent interaction (Bögels, Hoogstad, van Dun, Schutter, & Restifo, 2008; Harrison, Manocha & Rubia, 2004; Singh, Singh, Lancioni, Singh, Winton, Singh, 2010; van der Oord, Bögels & Peijnenburg, 2011). It is concluded that parents who use mindfulness practice in the relationship with their children have a less dysfunctional relationship with that
child and feel more satisfaction in the parent-child interaction (Bögels, Lehtonen & Restifo, 2010). Also, mindfulness parenting interventions have been found to strongly help mental health problems in children and prevent the transmission of mental disorders from parents to children (Kovan, Chung & Sroufe, 2009; Egeland, Jacobvitz, & Sroufe, 1988; Bögels et al., 2010). One of the main goals of mindfulness parenting is to teach parents to reduce automatic (negative) reactions to their child’s unwanted behavior (Bogels et al., 2010; Kabat-Zinn & Kabat-Zinn, 1997). Van der Oord et al. (2012), using a waitlist-prepost-follow-up design, found significant reductions in child and parental behavioral problems after mindfulness training. These findings, even if preliminary, support the effectiveness of mindfulness parenting intervention in both children and parents with problem behavior.
Based on this review of empirical research, mindfulness intervention appears to reduce experiential avoidance of negative cognition and emotion for parents with children suffering from problematic behavior. However, more empirical research is needed to examine whether mindfulness training leads to reduced experiential avoidance and, if so, whether changes in experiential avoidance will affect changes in child and parental behavior problems after mindfulness training. In summary, the following three hypotheses can be stated:
Hypothesis 1: After the training experiential avoidance will be lower on average. Hypothesis 2: After the training the child behavior problems will be lower on average. Hypothesis 3: After the training the parent behavior problems will be lower on average.
The first three hypotheses refer to average changes (for the whole group), but another perspective that might be fruitful is looking at relationships between interindividual differences. If the cornerstone of the theory is correct and experiential avoidance is the major cause of behavioral problems, then parents who are able to decrease their level of experiential avoidance to a greater extent, should also achieve higher reductions in their own and their child problem behavior. In summary, because a change in experiential avoidance is a
prerequisite for changes in problem behavior, then the following two hypotheses can be formulated:
Hypothesis 4: There is a positive relationship between changes in experiential avoidance and changes in child problem behavior.
Hypothesis 5: There is a positive relationship between changes in experiential avoidance and changes in parent problem behavior.
Methods
Participants
The study group consisted of 74 participants, where 61 were female, 8 were men and 5 people didn’t declare their gender. Because the sample size was small we didn’t make distinctions between participant’s gender and only report results for all participants. The participants were all parents ranging in the age group from 26 to 59 years of age, M=45.4, SD=6.24, having between 1 and 5 children. Most of the parents (98%) were biological parents, two were adoptive parents and there was one step parent. The ethnic background of participants was predominantly Dutch (82%). The educational level of the parents was as follows: 12 people have completed University education, 17 people attended Higher Professional Education (HBO), 17 people graduated Secondary Vocational Education (MBO), 8 people have pursuit Pre-university Education (VWO/Atheneum), 3 people graduated General Secondary Education (MAVO / VMBO), 3 participants have other Educational studies and 14 people did not declare their level of education.
The children whose parents participated in the study, ranged in age between 6 and 18 years, M=10.94, SD=2.81, where 28 were girls, 36 were boys and for 10 it wasn’t declared. All of the children had a background of emotional and behavioral problems (as reported by
their parents). However, it should be noted that while the history of the children was reported as problematic, only 2 children were clinically diagnosed as being Autistic and 6 were diagnosed as having ADHD without taking any medicine.
Procedures
The inclusion of the participants in the study was done on voluntary basis and by written consent. In order to join the parents had to be present during the first session and another 5 out of the other 7 sessions of treatment. The week before the start of the treatment the pre-test was conducted while the post-test took place at the end of the last session with a follow-up test after another 8 weeks. The study was approved by the University of Amsterdam Ethics Committees.
Measures
Parental Acceptance and Action Questionnaire (PAAQ).
The PAAQ is a 15-item parent-report questionnaire designed to assess the level of experiential avoidance parents experience regarding the problem events of their children. A seven-point Likert-type scale from (Never True) to 7 (Always True) was used. The PAAQ subscales measure both a parent’s unwillingness to tolerate their child’s experience of negative emotion (Unwillingness Subscale) as well as a parent’s inability to effectively manage their own reactions to their child’s negative emotions (Inaction Subscale). The PAAQ Total scale, comprised of a combination of these two subscales, is then calculated to represent the overall degree of parental experiential avoidance. A higher total score indicates a higher level of experiential avoidance.
Child Behavior Checklist (CBCL).
The CBCL (Achenbach & Rescorla, 2001) is a 113-item parental report questionnaire designed to assess children’s behavior and emotional problems. The CBCL consists of two subscales: an Internalizing Subscale and an Externalizing Subscale. The Internalizing Subscale can be derived from the following syndromes: Anxious/Depressed, Withdrawn/Depressed and Somatic Complaints (in the present study, Cronbach's alpha = .91). The Externalizing Subscale is a composite of the Rule-Breaking Behavior and Aggressive Behavior syndromes (in the present study, Cronbach's alpha = .93). Additional subscales include the Social Problems Subscale, Thought Problems Subscale, Attention Problems Subscale and Other Problems Subscale, which are combined with the Internalizing and Externalizing Subscales to form the CBCL Total Scale Score (in the present study, Cronbach's alpha = .97). The results for test-retest reliability were found to be very good (Achenbach & Rescorla, 2001).
Adult Self-Report for Ages 18 - 59 (ASR)
The ASR is a 123-item self-report questionnaire for adults (ages 18–59) assessing aspects of their adaptive functioning and problems. The questionnaire items are divided into eight syndrome scales: Withdrawn, Somatic Complaints and Anxious/Depressed (which form the Internalizing scale), Rule-Breaking Behavior, Aggressive Behavior and Intrusive (which form the Externalizing scale), Thought Problems and Attention Problems. A Total Problem Score, capturing the overall level of the parents’ problems was calculated by summing the individual item scores. A higher total score indicates a higher level of reported problems. The subjects are asked to rate the questions on a 3-point scale: 0 (Not True), 1 (Somewhat or Sometimes True), 2 (Very True or Often True).
Treatment
The training was based on the 8-session mindfulness-based cognitive therapy (MBCT) (see Table 1). Training began first with learning the body scan and then subsequently learning mindful breathing and mindfulness of thoughts and sounds. Additionally, exercises were used in order to apply the mindfulness techniques in the parents’ interactions with their own children. For example, parents were taught mindful and non-judgmental observation of and listening to their child. Parents were encouraged to look at their own past experiences while growing up as well as their current attitudes and often automatic responses to their own children in situations where one or both of them is irritated. In the mindfulness intervention training parents learned to become more aware of the present moment and to pay full attention to the child and to interact with the child with more awareness rather than responding out of habit. Parents were encouraged to use these techniques in their daily life and to also look for other areas of their life where these skills could be applied. Training sessions were conducted by therapists who were experienced in cognitive behavioral therapy and mindfulness meditation techniques.
Modeling Strategy
Because all hypotheses referred to changes and all measures included measurement errors, testing should be performed on latent differences scores. Therefore, the latent difference model in structural equation modeling was used (Steyer, Eid, Schwenkmezger, 1997). Because the sample size was very small, it was not possible to include the complete measurement model. Instead, measurement error was accounted for by fixing the residual of the observed items (scales scores) to (1 – reliability) × variance of the scale score.
Table 1
Short overview of the eight session’s parent mindfulness training:
1. Being attentive: bringing mindfulness to everyday activities like as: eating, walking, looking after children;
2. Home in your body: primary body scan and awareness of changing bodily sensations and thoughts;
3. Breath: 3 minutes of focus on the breath to calm and become more aware of the present moment;
4. Answering: Awareness of thoughts and emotional reality;
5. Acceptance: list of what can/cannot be changed regarding child communication and an action plan for that which can be changed;
6. Identity: how to have a healthy relationship with your child and allow space and freedom for child’s independent growth;
7. Mindful communication: open and honest communication with child and goal setting for child, self and other family members;
8. The future: incorporating mindfulness in daily life and activities, plan for the next months.
Results
Prior to analysis, the data were examined through SPSS 20 program for accuracy of data entry, inspection of potential outliers and the frequencies of missing values. Missing values occurred frequently in the post-test data. To retain a sufficiently large sample size for analyzing the data, missing values on the scales of the PAAQ, CBCL and ASR were imputed using the EM algorithm in SPSS. One case was deleted because it contained no valid data. Means and standard deviations of participants’ pre- and post-test scores on the PAAQ, CBCL and ASR are reported in Table 2.
Table 2
Means and Standard Deviations of the Scale Scores of all Measures
Measures Pre-test Post-test M SD M SD PAAQ Inaction 30.69 5.86 28.76 3.37 PAAQ Unwilling 23.72 5.60 21.6 2.81 PAAQ Total 54.42 10.35 50.36 5.06 CBCL Internalizing 14.16 9.10 11.83 7.22 CBCL Externalizing 13.61 9.54 13.43 7.38 CBCL Total 46.93 27.06 43.10 20.47 ASR Internalizing 18.44 11.96 11.33 6.47 ASR Externalizing 10.36 6.70 7.33 4.29 ASR Total 48.78 28.26 33.03 17.45
Table 2 shows that for all scales a decrease in the means can be observed. The mean of Experiential Avoidance scale decreased from pre-test (M = 54.42, SD = 10.35) to post-test (M = 50.36, SD = 5.06). The mean of Child Behavior Problem scale decreased from pre-test (M=46.93, SD=27.06) to post-test (M=43.10, SD=20.47). Also, the mean of Parent Behavior 12
Problem decreased from pre-test (M=48.78, SD=28.26) to post-test (M=33.03, SD=17.45). In summary, all the changes in the means of the scales were in the predicted direction.
It is remarkable that for all scales the standard deviations decreased as well. This suggests that the sample became more homogeneous, but a plausible alternative explanation is that the shrunken variances were a side-effect of the use of the EM algorithm.
Pearson correlation coefficients were computed in order to assess the relations between variables at each time point. The correlations between the pre-test scale scores can be found in Table 3 and the intercorrelations of post-test scores are shown in Table 4. Using Cohen’s (1977) recommendations, correlations are termed weak (r =.1 -.3), moderate (r =.3 -.5), or strong (r ≥.5).
Table 3
Correlations Between Scale Scores at Pre-Test
1 2 3 4 5 6 7 8 9 1. PAAQ Inaction (.55) 2. PAAQ Unwillingness .63 (.63) 3. PAAQ Total .91 .90 (.75) 4. CBCL Internalizing .02 -.02 -.00 (.91) 5. CBCL Externalizing .00 .02 .01 .55 (.93) 6. CBCL Total .03 .01 .02 .87 .85 (.97) 7. ASR Internalizing .19 .17 .20 .44 .43 .51 (.94) 8. ASR Externalizing .10 .13 .13 .58 .52 .64 .70 (.88) 9. ASR Total .16 .15 .17 .54 .47 .60 .94 .84 (.97)
Notes: N = 74; Correlations higher than |.23| were significant (two-sided). Cronbach’s alpha reliability coefficients are shown in parentheses on the diagonal.
First, as demonstrated in Table 3 the correlations between the scale scores of the PAAQ and both problem scales were not significantly at the pretest (PAAQ and CBCL: r = .02;
PAAQ and ASR: r = .17) whereas the correlation between both problem scales was significantly positive (CBCL and ASR: r = .60; strong effect). Second, the same pattern of intercorrelations reappeared at the post-test (Table 4). Neither the correlation of the PAAQ with the CBCL, nor the PAAQ – ASR correlation was significant at T2, whereas the correlation between the CBCL and the ASR was significant and strongly positive (r = .75).
Table 4
Correlations Between Scale Scores at Post-Test
1 2 3 4 5 6 7 8 9 1. PAAQ Inaction (.59) 2. PAAQ Unwillingness .33 (.58) 3. PAAQ Total .85 .78 (.67) 4. CBCL Internalizing -.08 .05 -.02 (.94) 5. CBCL Externalizing -.02 -.13 -.09 .58 (.94) 6. CBCL Total -.06 -.05 -.07 .89 .86 (.97) 7. ASR Internalizing .07 .05 .08 .66 .52 .71 (.93) 8. ASR Externalizing .02 .07 .05 .73 .60 .77 .75 (.89) 9. ASR Total .02 .05 .04 .73 .53 .75 .94 .88 (.96)
Notes: N = 74; Correlations higher than |.23| were significant (two-sided). Cronbach alpha reliability coefficients are shown in parentheses on the diagonal.
Third, as shown in Table 5 the stabilities of the three total scale scores were small: The correlation between the pre- and post-test scale score of the PAAQ was very small (r = .26), indicating that a lot of changes occurred in this period. The stabilities of both problem scales were higher (r = .52 for the CBCL and r = .58 for the ASR).
All measures had medium to higher reliability, which is particularly relevant for the importance of change scores during the mindfulness intervention.
Table 5
Correlations Between Pre-Test and Post-Test Scale Scores
PAAQ Inaction (T2) PAAQ Unwilling (T2) PAAQ Total (T2) CBCL Internalizing (T2) CBCL Externalizing (T2) CBCL Total (T2) ASR Internalizing (T2) ASR Externalizing (T2) ASR Total (T2) PAAQ Inaction (T1) .16 .24 .24 .07 .17 .13 .02 .15 .05 PAAQ Unwilling (T1) .14 .25 .23 .08 .14 .12 .00 .08 .02 PAAQ Total (T1) .17 .27 .26 .08 .17 .14 .01 .13 .04 CBCL Internalizing (T1) -.05 -.05 -.06 .53 .34 .51 .44 .50 .45 CBCL Externalizing (T1) .06 .08 .00 .30 .44 .41 .37 .38 .34 CBCL Total (T1) .02 .00 -.01 .48 .42 .52 .49 .53 .49 ASR Internalizing (T1) -.06 -.11 -.10 .36 .32 .41 .48 .37 .47 ASR Externalizing (T1) .04 -.06 -.01 .48 .40 .53 .48 .56 .54 ASR Total (T1) -.08 -.09 -.11 .45 .38 .50 .54 .50 .58
Note: N = 74; Correlations higher than |.23| were significant (two-sided).
Comparison of the mean scales of the present study with reported means in the literature The means of the PAAQ, CBCL and ASR scales were compared with means found in the literature from previous studies (see Table 6). The number of items and the calculation of the scale scores in the studies used for comparison were exactly the same as in the present study. For comparing the means of the PAAQ we used the means reported by Cheron et al. (2009). The means reported by Kelley et al. (2011) were used for Child behavior problems (CBCL) and the means found in Iverach et al. (2011) study were used for comparing the means of the ASR in the present study.
Table 6
Mean scores on PAAQ, CBCL, ASR for the present sample compared with previous studies
Measure Sample N t-value Mean SD
PAAQ Total Present group 74 0.46 54.42 10.35
Cheron et al. (2009) 148 53.80 9.00
CBCL Total Present group 74 -2.82 46.93 27.06
Kelley et al. (2011) 230 53.31 12.02
ASR Total Present group 74 0.02 48.78 28.26
Iverach et al. (2011) 140 48.70 29.60
As shown in Table 6 only the means for the CBCL were significantly different from the means as reported in the literature. The data from the above mentioned studies were also referring to pre-intervention data. Therefore, for the PAAQ and the ASR we can conclude that our sample was comparable with studies found in the literature, but somewhat healthier than the study of Kelley et al (2011) for the CBCL.
Testing the hypotheses
All hypotheses were tested within a single SEM model. Because calculation of change scores only implies a transformation of the data, the estimated model was saturated and as a result fitted the data perfectly. However, an advantage of the Latent Difference Model is that measurement error could be incorporated and that all tests were performed at the latent level. In Figure 1 the relevant aspects of the model are represented. The triangle sign refers to the mean part of the model and the double-headed arrows refer to the relations between the latent change variables. All the mean changes (T2 minus T1) for the latent variables were negative and thus in the predicted direction. However, the decrease of the latent mean for the CBCL did not reach statistical significance (t value = -1.37). Therefore, hypotheses 1 and 3 were supported by the data, but hypothesis 2 had to be rejected. In summary, after the mindfulness training both the level of experiential avoidance and the level of reported behavioral problems of the parents were significantly reduced, but there was no evidence that child behavioral problems decreased as well.
Hypotheses 4 and 5 do not refer to changes in latent means, but to relationships between latent changes. The covariance between latent changes of the PAAQ and latent changes of the ASR was positive and statistically significant (r = 0.34). This means that in general changes of both constructs occurred in the same direction. On the contrary, the covariance between latent changes of the PAAQ and latent changes of the CBCL was not significant (and in the unpredicted direction: r = -0.17).
Although there were no hypotheses formulated for the subscales, we estimated an additional model in which we replaced the total score of the CBCL with the Internalizing Behavior Problems subscale for the children. In this model there was also a significant decrease in the latent mean for the Internalizing subscale of the CBCL.
Figure 1 Latent Difference Model
NB. To prevent cluttering only the covariances between the latent changes are presented.
Effect sizes
Effect sizes were computed for all measures after the mindfulness treatment according to the Cohen d statistic (1977). Calculation of these effect sizes were based on the observed scale scores and therefore measurement error was not included. Results indicate a medium effect sizes for PAAQ Total (.50), a medium-large effect sizes for ASR Total (.67) and a small effect size for CBCL Total (.16) (see Table 7).
T1 PAAQ T2 PAAQ T1 ASR T2 ASR T1 CBCL T2 CBCL 1 1 1 1 1 1 1 ∆T1-T2 ASR 1 1 1 -4.06* ∆T1-T2 CBCL ∆T1-T2 PAAQ -15.75* -3.83 0.34* - 0.17 0.41* 18
Table 7
Effect Sizes for Pre-Post Effects
Measure d Effect Size PAAQ Total 0.50 Medium CBCL Total 0.161 Small
ASR Total 0.67 Medium-large
Discussion
In the present study, participants completed questionnaires before and after mindfulness intervention, in order to examine the effect of changing experiential avoidance on child and parent behavior problems. The five hypotheses of the study were as follow:
Hypothesis 1: After the training experiential avoidance will be lower on average. Hypothesis 2: After the training the child behavior problems will be lower on average. Hypothesis 3: After the training the parent behavior problems will be lower on average. Hypothesis 4: There is a positive relationship between changes in experiential avoidance and changes in child problem behavior.
Hypothesis 5: There is a positive relationship between changes in experiential avoidance and changes in parent problem behavior.
Concerning the first three hypotheses referring to the means, only hypothesis 2 had to be rejected although there was a change in the predicted direction (but not significantly so). Thus, after the training there was a significant reduction in perceived experiential avoidance and reports of the parent behavioral problems. The effect sizes ranged from medium (for the 1 The change of the latent mean was not significant in the LISREL model
19
PAAQ) to medium/large (for the ASR). These results partly support previous results on mindfulness training (Van der Oord et al., 2012). Using a waitlist-pre-post-follow-up design, Van der Oord et al., found significant reductions after mindfulness training for both child and parent behavioral problems. The discrepancy for the CBCL may be resolved after analysing the complete dataset (only a first subset of the data were available for this study) and more statistical power can be utilized.
Concerning the last two hypotheses, changes in experiential avoidance during mindfulness intervention were significantly associated with changes in parent behavioral problems. Although the size of the correlation was rather modest (r = .34), this supports the role of reducing experiential avoidance in alleviating behavioral problems for the parents themselves. It is however clear that a causal agency of experiential avoidance cannot be claimed with the present study. In fact, in the present study interpreting relationships as causal is not possible because of the correlational design of the study.
The results of the present study have certain limitations. First, the main limitation of this study was the lack of a control group. Participants in the present study showed changes from pre-test to post-test on experiential avoidance, child and parent behavior problems but the changes cannot be decisively attributed to the mindfulness training due to the lack of a comparison group. Also, comparisons with means found in the literature were not possible, because no post-treatment results were reported.
Second, generalizing the findings of this study is hampered because the sample was homogenous with respect to the ethnic background of the participants (predominantly Dutch (82%)). Furthermore, the majority of participants were female (82%).
Third, the sample size was relatively small (n=74), which reduced statistical power to detect small effects.
Fourth, this study completely relied on self-report data. We didn’t have access to observations of teachers or others in the child’s environment to observe the progress.
In future, it would be advised to replicate the current methodology with a larger sample consisting of participants with different ethnic backgrounds and a relatively equal number of men and women. Also, a larger battery of measures can be included to objectively assess changes in experiential avoidance and changes in child and parent behavior problems during mindfulness training. In addition, further research is necessary, especially to examine how mechanisms of experiential avoidance change during mindfulness training for parents with different psychological diagnostics and serious medical illness.
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