(PS12-13) Augmenting Behavioral Parent Training with Brief Cognitive-behavior Therapy for Parents: results from a Pilot Randomized Trial

Young children with disruptive behavior disorders (DBDs) experience significant school readiness impairments (behavioral, social-emotionally, academically) that are associated with high levels of parenting stress. Behavioral parent training (BPT) programs such as Parent-Child Interaction Therapy (PCIT) are gold-standard interventions that reduce symptoms of DBDs by promoting positive parent-child interactions and consistent discipline. Indirectly, these BPT programs can also help to reduce parenting stress. However, a significant portion of parents continue to exhibit high levels of parenting stress following BPT which can impact child outcomes. It remains unclear, and of interest to the current study, whether augmenting BPT programs with brief cognitive behavioral therapy (CBT) for parents would more effectively target parenting stress.

We developed three one-hour cognitive-behavioral therapy (CBT) modules that included information and assignments related to stress management, distress tolerance, acceptance, and social support. These CBT modules augmented participation in the School Readiness Parenting Program (SRPP; Graziano et al., 2014), an 8-session group adaptation of PCIT. Hence, this study was a pilot randomized clinical trial in which 44 young children with DBDs (M_age = 5.07; 89% male, 84% Hispanic) and their parents were randomized to receive only the SRPP (n=20) or the SRPP+CBT (n=24). Both groups attended the 8 weekly SRPP sessions while those in the SRPP+CBT group attended three bi-weekly CBT sessions. This study examined: 1) the feasibility and acceptability of the CBT modules and 2) the promise of the SRPP+CBT vs. SRPP in terms of improving parenting stress. Prior to the interventions, parents completed an intervention quiz assessing their content knowledge related to BPT (19 items) and CBT (6 items) as well as the Parenting Stress Index (PSI). Intervention attendance and fidelity were tracked, and, following completion of the interventions, parents completed a treatment satisfaction survey, PSI, and the intervention quiz.  

Of those who participated (n=36), SRPP and SRPP+CBT groups attended nearly all SRPP sessions (M=7.06, SD=.93; M=7.00, SD=.97, respectively). Among the SRPP+CBT group, 75% (n=15) of families participated in at least one CBT session (87% attended all sessions). The interventions were administered with high fidelity (SRPP=98%; CBT=100%). High treatment satisfaction were observed for SRPP and SRPP+CBT groups (94%, M=4.81, SD=.54; 100%, M=4.89, SD=.32). Linear regression analyses revealed that number of CBT sessions attended predicted greater change in learned CBT knowledge (p< .001) but not BPT knowledge (p=.48). As it relates to stress, both the SRPP and SRPP+CBT groups experienced similar levels of overall parenting stress reductions (Cohen’s d=0.49 and 0.38, respectively). Although this study presents the data of only the first of two cohorts in our study, the initial results indicate that the CBT modules are feasible and acceptable among those participating in a BPT program. CBT modules may facilitate the acquisition of stress management skills and improve parenting stress; the additional data acquisition may further highlight significant group differences.