اثربخشی آموزش مداخله دلبستگی محور به مادران پسران دبستانی با استرس بالای والدینی

The Effectiveness of attachment based therapy on decreasing Parenting Stress in mothers with elementary boys

Shirvani B.[1], Monirpoor N.[2]^* Zargham Hajebi M.[3]

[1]. PhD student in Educational Psychology, Islamic Azad University Branch of Qom, Qom, Iran.

[2]. Associate Professor of health psychology, Department of psychology, Islamic Azad University Branch of Qom, Qum, Iran. ( Corresponding Author): monirpoor1357@gmail.com

[3]. Associate Professor of psychology, Department of psychology, Islamic Azad University Branch of Qom, Qom, Iran.

© 2020 The Author(s). This work is published by family and health as an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.

Introduction: Parental stress is a cultural interplay and is subject to specific family and living conditions. Also, parental stress interacts with warmth, affection, and intimacy in parent-child relationships. Attachment-based intervention is a relationship-based approach that strengthens the child-parent relationship. The purpose of this study was to investigate the effectiveness of attachment-based intervention training on reducing parental stress in mothers of primary school boys.

Research Methods: The statistical population of this quasi-experimental study was male students of elementary school (first grade), district 4 of education in Tehran, who were studying in the academic year of 2019. For this purpose, the mothers of 300 students responded to the Parental Stress Questionnaire (Abidin Short Form, 1983). Then, among the mothers who had high parental stress according to the questionnaire (the criteria for entering the study were mothers who had a standard deviation above the mean of the parental stress questionnaire), 30 mothers were selected by available sampling method and They were randomly assigned into two groups of intervention and control (15 patients in each group). Ten sessions of attachment-based intervention (including four 120-minute group sessions and six 60-minute individual sessions) were administered to the intervention group and the control group received no intervention. Data were analyzed using multivariate covariance analysis and time series design.

Results: The results showed that parental stress in mothers of intervention group in all three domains of parental disturbance, dysfunctional parent-child interaction and difficult child had significant decrease.

Conclusion: According to the components of attachment-based intervention, it can be concluded that increasing maternal sensitivity and improving the pattern of mother-child relationship, increasing the sense of maternal competence in solving problems and their parental role, reduce parental stress in mothers.

Key words: Attachment-centered intervention, Elementary boys, parenting stress

Received: 26/June/ 2023                   Accepted: 25/August/ 2023

Introduction:

Parenting stress is a cross-cultural concept and is under the specific conditions of family and life and is strengthened by challenging life situations. Also, parental stress interacts with warmth, affection and intimacy in parent-child relationships. Therefore, training parents and increasing parental resources can reduce parental stress (1). The mother's perceived stress level and her feelings about her health can be important determinants of the mother's parenting behavior and the child's adaptability. Poor and disturbed mother-child interactions lead to more parental stress. Also, high parental stress leads to poor parent-child interactions (2). High levels of parental stress disrupt responsiveness, intimacy, and positive interaction between parents and children, increase risky and impulsive caregiving, and have social, emotional, and cognitive consequences for children. The most effective intervention and prevention programs lead to learning successful coping strategies and positive interactive methods, increase parents' flexibility in parenting, and also reduce parental stress and increase self-efficacy in care. It comes from children. Since the relationship between parents and children changes as a factor in creating parental stress in different periods of children's development, therefore, the skills and abilities of parents to regulate their thoughts and feelings as well as coping skills In order to face stressful factors, they play an important role in reducing parental stress as caregivers (3). Also, parental stress occurs when the demands and responsibilities arising from the parental role cannot be satisfied by the available parental resources, so one way to reduce parental stress is to eliminate this disharmony by increasing parental resources. (4).

In a research that was conducted with the aim of investigating parental conflict and behavioral problems of preschool children and with the mediation of parental stress on Chinese mothers, it was shown that parental stress leads to an increase in conflict between parents and also to an increase in behavioral problems in children. 5). Also, the research of Garrett, Pas Joyce and Lee Heiter (6) showed that increasing the warmth and affection of parents in their interaction with children reduces parental stress and reduces behavioral problems in children. Balzarotti et al.'s research (7) in 2018 showed that increasing mothers' and fathers' understanding of their children's behaviors reduces parental stress. In other words, parents' understanding of children's behavioral motives can reduce parental stress in parents. Most of the research findings show that empowering the mother or caregiver to understand the child's emotions and feelings, causes different acceptance of the child's behaviors and needs, and further leads to the mother's favorable response. That is, the mother or caregiver can see the child differently and respond to his needs correctly, and this reduces parental stress (8). Through attachment-based intervention training, the mother's knowledge of the child's communication and emotional needs increases, and the mother achieves more efficient responses in relation to the child's negative behaviors. On the other hand, by increasing the mother's insight into the underlying motives of the child's behavior, as well as knowing her defensive processes in relation to the child, it is expected that the mother will find more acceptance towards the child's characteristics and the mother's attachment to the child will increase. . By providing appropriate answers from the mother, the child's positive emotional responses towards the mother will gradually increase, and this will strengthen the relationship between the mother and the child and reduce parental stress (9).

Attachment-oriented intervention (child-therapy) is a relationship-oriented approach. Research shows that attachment-based intervention is an effective intervention to establish a relationship with children's feelings and thoughts through play (10, 11, 12). The child-centered attachment-therapy approach is an effective method for improving child-parent relationships and increases secure attachment between them and reduces children's negative behaviors (13). In child therapy, parents are taught skills such as structuring play sessions, active listening, empathy, and child-centered play. Through child therapy, parents learn better communication patterns with their children, family cohesion increases and parental stress decreases (11). Child therapy is very clear and far from complications and the therapist simply teaches skills to the parents and the parents use them in play sessions with the child. Mother-centered attachment intervention training increases the child's adaptation and reduces children's behavioral problems and parenting stress. The adaptability of this treatment method to other cultures has also been shown through researches in this field (14). The purpose of this method is to give the child a chance to be heard and to identify, express and accept the child's feelings by the parents. Likewise, it increases the necessary skills to deal with stressful situations and thus reduces incompatible behaviors. On the other hand, it is expected that parents can have a better understanding of the child, learn proper play and parenting skills, and feel more competent in front of the child. By achieving these goals, the main and central goal of child therapy, which is to improve the relationship between parents and children, followed by reducing parental stress, is achieved due to the increase in parenting skills (15). According to the mentioned researches regarding the necessity and importance of improving mother-child relations by spending quality time for the child, having positive interactions and increasing intimacy with the child, which will reduce the child's behavioral problems and also reduce parental stress. In this research, child-centered attachment-therapy intervention, which is one of the ways to improve parent-child relationships through play, was used to improve the relationship between mother and child and thereby reduce the stress of mothers' parenting.

Research method:

This semi-experimental research was conducted using a pre-test-post-test design with a control group. The research design is a time series design in which observation is done with repeated measurements and two follow-ups were done at intervals of one month and then two months. The statistical population of this research was the male students of the primary school (first period) in the 4th education district of Tehran in the academic year of 2017-2018. The sample group consisted of 30 mothers of elementary school boys who were selected by convenience sampling and were randomly assigned to two intervention and control groups (15 people per group). The criteria for entering the research were mothers who had high parental stress according to the parenting stress questionnaire (short form Abidin, 1983). And the criteria for leaving the research include the absence of more than one session of group training sessions or mothers who were trained in another program in the field of children and families in the last few months. Then, the mothers of the intervention group received the attachment-oriented intervention in ten sessions (four 120-minute group sessions and six 60-minute individual sessions) and at the end of the post-test, it was performed for two intervention and control groups. After one month and then after two months, follow-up tests were conducted for the intervention group in order to investigate the effect of attachment-based intervention training. Then, after checking the relevant assumption, the scores were analyzed by covariance analysis and repeated measurements.

Parenting stress scale (short form). Parenting stress scale (short form) (PSI) was prepared directly from the long form of this scale by Abidin (16). The short form of the parenting stress scale has 36 questions and includes questions with the same phrases that are directly in the main long form of 101 questions (17). This scale is designed to evaluate three subscales (parental confusion, ineffective parent-child interactions, difficult child) and general stress. The scoring method is done on the Likert spectrum from 1 to 5 (completely agree to completely disagree). In scoring this questionnaire, it should be noted that the order of sub-scale questions are spread throughout the entire scale and the scoring method of all questions is not the same (Fedai, Dehghani, Tahamasian and Farhadi, 2019). The concurrent validity with the combined score of the long form of 101 questions of parenting stress was 0.95(18). Reliability estimates from two methods of retesting and internal consistency are available for the subscales. Cronbach's alpha coefficient for the combined scale was reported as 0.91 (16). Also, the reliability of the short form of parental stress in Strachan's study in 2005 was 0.96. In a study conducted by Rogman, Mu, Hart and Forson (19), the reliability of the short form of parental stress was 0.79 for the parental distress scale, 0.80 for the ineffective parent-child interaction scale, 0.78 for the difficult child scale, and 0.90 for the overall stress. was 0. According to Abidin (16), this value is exceptionally high and was comparable to the reliability of the long form of the parental stress questionnaire, which was 0.95. In Iran, the reliability of this questionnaire was tested on 530 mothers with a six-month interval. The internal consistency coefficient for total stress was 0.84 (17).

Attachment-oriented intervention. Based on the attachment-oriented intervention program (15), the subjects of the intervention group received ten sessions, including four 120-minute group sessions and six 60-minute individual sessions. Each group meeting included the introduction of the goals and related skill training, and in the individual meetings, the mother's report on the game sessions at home was reviewed, the skills learned in the group meetings were reviewed, and how to generalize the skills outside of the game sessions was practiced. Table 1.

Table 1- Guide to attachment-oriented intervention (child therapy)

Findings:

In Tables 2, the descriptive information of the variables, including the mean and standard deviation, is given. These tables show the descriptive characteristics of the research variables in the pre-test and post-test and the first and second follow-up tests, separately for the control and experimental (intervention) groups. Also, in order to test the effectiveness of the attachment-based intervention on the parenting stress of mothers of elementary school boys, after separating the contribution of the measures attributed to the pre-test for each of these multiple domains, a mixed repeated measures analysis plan was used.

Table 2- Mean and standard deviation of stress of parents of elementary school boys in experimental and control groups in pre-test, post-test (n=30)

In the first part, the results of the statistical technique of multivariate covariance analysis to determine the effectiveness of the attachment-oriented intervention in the sample people in the short-term and long-term showed that the attachment-oriented intervention reduced the parental stress of mothers of elementary school students in the post-test [=0.48 P < 0.05, Wilkes-Landa = 0.518, 12.08 = (28 and 1) F] is statistically significant. Also, the results of Table 2 show that attachment-based intervention was statistically significantly effective in reducing mothers' parenting stress in the first post-test and follow-up (one month later) and in the second follow-up (two months later).

Table 3- The results of the four F characteristics related to the analysis of repeated measurements regarding the follow-up test of the effectiveness of the attachment-based intervention on reducing the overall stress of parents of mothers of elementary school boys (experimental group)

As can be seen from the above table, the value of the statistical characteristic F with the value of 403.884 in the time factor is significant at the significance level of α=0.05. That is, with a probability of 95%, we can conclude that the change (decrease) in different stages of the test is significant. The results of the post-test in the different stages of the test in the experimental group also show that the average of the three stages of pre-test, post-test and follow-up has a significant difference. Therefore, the effectiveness of attachment-based intervention in reducing mothers' parenting stress is permanent after two months of follow-up.

Table 4- The results of the Bonferroni post hoc test regarding the results of the repeated measures analysis in the follow-up test

Discussion and conclusion:

The present study was conducted in order to investigate the effectiveness of attachment-based intervention training (child therapy) on reducing parental stress in mothers of elementary school boys. According to the findings of the research, there is a statistically significant difference between the average of the experimental and control groups in all three components of parental disturbance, ineffective parent-child interactions, and problematic child characteristics in the post-test, which indicates the effectiveness of the attachment-based intervention on the variable. Parental stress. Also, the results of the follow-up test in the different stages of the test in the intervention group also show that the average of the three stages of pre-test, post-test and follow-up has a significant difference. Therefore, the effectiveness of the attachment-oriented intervention on reducing parents' stress is lasting after two months of follow-up.

Few studies have been conducted to investigate the effectiveness of attachment-based interventions on parental stress, which makes it difficult to compare the results. However, in a controlled experimental study, Epiolaukristi (20) showed that teaching attachment-oriented intervention to parents who adopted children can have a significant effect on improving parent-child relationships. Have empathy and reduce parental stress. The results of this research showed that attachment-based intervention can be used as an effective and efficient intervention in improving parent-child relationships and reducing parental stress. Also, the findings of the present study are in line with Son A's research (21). In a research titled the effectiveness of attachment-based intervention on family functioning, parental stress, and behavioral problems of children with cancer, Sona A. showed that attachment-based intervention increased family cohesion and increased family adaptation, and through increasing the sense of empathy, learning Positive parenting skills and increased self-confidence in mothers reduce parental stress and behavioral problems in children.

One of the reasons for the effectiveness of attachment-based intervention in reducing parental stress is the use of game communication tools and the parents' time to be unconditionally with their children in line with the game. The content of these sessions is such that it increases acceptance and empathy with the child. Therefore, the game is a suitable tool for communication between parents and children, which helps to solve children's needs and conflicts. This has reduced the negative feelings of parents and reduces the stress related to playing the role of parents, and they feel more efficient about their abilities to properly respond to the feelings and emotions of their children. Likewise, in the explanation of the findings, it can be said that one of the causes of parental stress is the lack of coordination between the available resources such as the knowledge and self-efficacy of parents with the real requirements of their parental role, and this lack of coordination causes the experience of negative feelings towards themselves and the child and causes inefficient behaviors in interaction with the child. Attachment-oriented intervention (child therapy) with a focus on strengthening the parent-child relationship, skill training, parent support from other group members and encouragement from the therapist, in turn, a sense of intimacy, affection, a sense of competence and support, parental acceptance, Reducing child's problematic behaviors, increasing problem-solving strategies and creating self-confidence and a sense of self-efficacy in parenting lead to reducing parental stress and improving parent-child interaction.

Attachment-oriented intervention is effective in reducing parental stress of mothers of elementary school boys. Increasing the mother's ability to understand the causes of the child's negative behaviors and their management, along with improving the quality of mother-child interaction, makes the mother feel more competent in solving problems and her parental role. Likewise, teaching skills such as empathy with the child, showing attention and being responsive to the child, strengthening positive behaviors, ignoring and suggesting alternative behaviors helped to improve the mother-child relationship and by creating a sense of efficiency in the mother, stress was reduced.

Research limitations:

The most important limitation of this research was the impossibility of random selection of subjects. Also, considering that the present study was conducted on the mothers of elementary school boys, it is suggested that the effectiveness of this method on the mothers of elementary school girls should also be investigated in other studies. It is also suggested that this approach be compared with other child-rearing approaches in future researches so that its effectiveness and results are further analyzed and investigated and a more comprehensive view of this approach is obtained.

Conflict of interest

In this study, no conflicts of interest were reported by the authors.

Contribution of the authors

Bahare Shirvani participated in data collection, data analysis, and writing the research report, and Nader Monirpour participated in guiding the research stages. Majid Zargham Hajabi helped in consulting the research stages.

Acknowledgement:

This article is extracted from the doctoral thesis of the first author approved at the Islamic Azad University of Qom with code of ethics number IR.IAU.QOM.REC.1398.009, which was done at personal expense. The authors consider it necessary to express their appreciation and thanks to all the people who helped in conducting the research.

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