A Case Study on Integrating DBT Skills and Parent Training for Emotionally Dysregulated Parent-Child Dyads

• In Event: Dual-Generation Treatments: Addressing Parent Mental Health in Parenting and Child-Focused Prevention and Intervention Programs

Abstract

Mental health disorders highly co-occur in parents and children (Middeldorp et al., 2016). Parenting quality is one of the few modifiable mechanisms that contribute to the rates of transmission (Goodman & Gotlib, 1999). Few interventions address transactional links between parent mental health, parenting and child mental health in parents and children who both experience clinical-level symptoms (Everett et al., 2021). Emotion dysregulation (ED) is a promising intervention target, as it is a transdiagnostic feature of psychopathology in adults and children (Aldao et al., 2010; Compas et al., 2017), which impedes effective parenting (Rutherford et al., 2015). Dialectical Behavior Therapy (DBT) Skills targets and improves ED (Neacsciu et al., 2014). There is growing interest in integrating DBT Skills with parent training (PT) to improve parent and child outcomes. This single-case experimental design study of a DBT Skills + PT intervention for emotionally dysregulated parent-child dyads uses idiographic statistical analyses of repeated measures to examine weekly changes in parental ED, parent-reported child ED, and parenting quality. We hypothesized there would be cascading effects, such that changes in parental ED would precede changes in parenting quality and children’s ED.

Three parents who met a clinical cutoff for ED and whose preschool aged child (ages 4-6) also had elevated emotional difficulties, were enrolled in a 24-week DBT Skills + PT group intervention. Measures of parental emotion dysregulation, child emotion dysregulation, and parenting quality were assessed at 26 weekly timepoints. We examined the effect sizes of person-specific linear trajectories over time. Measures which showed large linear effects (d ≥ 0.8) were examined for significant time-lagged effects, in an exploratory effort to identify potential transactional relationships among the three main outcomes.

Parents A and B reported large reductions in their own ED (d =1.23 and .81, respectively). Parents A, B and C reported large increases in supportive parenting behaviors (d =1.06, .90, and .86, respectively). Parents A and B reported large reductions in their children’s ED (d = 1.77 and 1.30, respectively), while Parent C reported large increases in child ED (d = .92). We found partial support for a cascading effect: Parent A’s improvement in ED and increases in supportive parenting each significantly predicted subsequent improvements in child ED (p<.05, d=.64). Parent B’s improvements in ED did not significantly predict their increases in supportive parenting (p=.077, d=.52), but increases in supportive parenting did predict subsequent improvements in their child’s ED (p<.001, d=1.13). Parent C did not show significant lagged effects. Parent A’s results are plotted (Figure 1) to illustrate rates of change and key inflection points.

Integrating DBT Skills and parent training may be a promising transdiagnostic intervention approach for families in which both parents and children are experiencing emotion dysregulation. This case study contributes to efforts to integrate DBT and parenting (Zalewski et al., 2020) by addressing the needs of dually dysregulated parent-child dyads, and by using repeated measures to take a personalized, idiographic approach to elucidating processes of change. Larger scale clinical trials are needed to test the effectiveness of DBT Skills +PT.

Authors

• Yoel Everett, University of Oregon
  Presenting Author

• April Lightcap

• Jacqueline O'Brien, University of Oregon

• Netanel Weinstein

• Maureen Zalewski, University of Oregon