Shorey 2021

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The efficacy of mindful parenting interventions: A systematic review

and meta-analysis
Shefaly Shorey PhDRN , Esperanza Debby Ng
PII: S0020-7489(21)00143-7
DOI: https://doi.org/10.1016/j.ijnurstu.2021.103996
Reference: NS 103996
To appear in: International Journal of Nursing Studies
Received date: 1 February 2021

Revised date: 25 May 2021
Accepted date: 30 May 2021
Please cite this article as: Shefaly Shorey PhDRN , Esperanza Debby Ng , The efficacy of mindful
parenting interventions: A systematic review and meta-analysis, International Journal of Nursing Stud-
ies (2021), doi: https://doi.org/10.1016/j.ijnurstu.2021.103996
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The efficacy of mindful parenting interventions: A systematic review and meta-analysis
Authors
Shefaly Shorey, PhD, RN
Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of
Singapore
Esperanza Debby Ng
Singapore
Corresponding author
Dr Shefaly Shorey
Singapore, Level 2, Clinical Research Centre, Block MD11
10 Medical Drive, Singapore 117597, Singapore
Email: [email protected]
Funding
This research did not receive any specific grant from funding agencies in the public, commercial
or not-for-profit sectors.
Conflict of interests
None.
Abstract
Background: Mindful parenting is the process of bringing awareness and attention intentionally
in a non-reactive and non-judgemental way to a child at any present moment. Parenting
mindfulness is believed to influence parenting factors and parental psychological outcomes,
child’s emotional and behavioural outcomes, and family relationships. However, the efficacy of
such interventions on interpersonal mindfulness in parenting and parenting behaviours has
received minimal empirical attention.
Objective: This meta-analysis aims to quantitatively evaluate the efficacy of mindful parenting
interventions on parenting mindfulness and parenting behaviours. Parenting stress, parents’
psychological wellbeing, interpersonal relationships, and child behavioural outcomes were
examined secondarily. When meta-analysis was not possible (due to insufficient data in the
included studies), the narrative approach was taken to present the findings.
Design: A systematic review, meta-analysis, and narrative summary.
Methods: Six electronic databases (PubMed, Embase, PsycINFO, CINAHL, Scopus, and
ProQuest Dissertations and Theses) were systematically searched for articles in the English
language from their respective dates of inception to December 2020. Studies involving clinical
and non-clinical samples of parents with children or youths aged 24 years and below were
included. Only randomised controlled trials were included. Studies were excluded if the
mindfulness intervention did not focus on parenting skills training; that is, it focused on
childbirth, stress reduction or incorporated other forms of therapy (e.g. cognitive behavioural
therapy). Data was synthesised using a random-effects model in RevMan 5.4. The outcomes of
primary interest were parenting mindfulness and parenting behaviours. The secondary outcomes
were parenting stress, parents’ psychological wellbeing, interpersonal relationships, and child
behavioural outcomes.
Results: Eleven studies representing 1,340 parents from six countries were included in the
review. No evidence of intervention effect was found for overall parenting mindfulness and
overall parenting stress. However, mindful parenting interventions demonstrated a moderate
effect size when examining parenting mindfulness scores (standardised mean differences
(d)=0.62, 95% CI: 0.11, 1.13, p=0.02) of parents with non-clinical samples of children. No
intervention effect was found for overall parenting stress. Due to insufficient studies and data,
findings on parenting behaviours, psychological wellbeing, relationships, and child behaviour
were presented narratively.
Conclusion: Mindful parenting interventions are associated with higher parenting mindfulness
scores for parents of typically developing children when compared with a control group. The
limited studies and mixed results on positive parenting behaviours, parental psychological
wellbeing, parental relationship with child and partner, and child behavioural outcomes serve as
an impetus for further research.
Keywords: child; meta-analysis; mindfulness; parenting

Contribution of the paper
What is already known about the topic?
 It is hypothesized that parenting mindfulness is associated with positive parenting
factors, parental wellbeing, positive child management practices and parent-child
interactions, and children’s emotional and behavioural outcomes.
 Mindful parenting interventions have been associated with reduced parenting stress,
increased parental psychological wellbeing, and children’s decreased externalising
and internalising behavioural scores.
What this paper adds?
 Mindful parenting interventions demonstrated a moderate effect size when examining
overall parenting mindfulness scores of parents with non-clinical sample of children but
demonstrated no effect on overall parenting stress scores in parents with clinical and non-
clinical samples of children, respectively, when compared to control groups.
 The narrative summary of evidence highlighted possible associations of mindful
parenting interventions with reduced negative parenting behaviour, improved parent-
child relationships, and marital relationships scores for parents with clinical and non-
clinical samples of children, respectively.
 There is contradictory evidence on the efficacy of mindful parenting interventions in
improving parental psychological wellbeing (i.e., symptoms of depression, anxiety,
general stress) of parents with a non-clinical sample of children, and child behavioural
outcomes, which warrants more research.

Introduction
Background
Rooted in the Buddhist tradition, the concept of mindfulness and its definition have been
consistently revised since they were adopted as a psychological construct in the Western context.
In contemporary Western psychology, mindfulness refers to intentionally bringing non-
judgemental awareness to the happenings of the present moment (Kabat‐Zinn, 2003).
Mindfulness exists as a disposition or could be obtained through regular mindfulness meditation
(Baer, 2003; Brown & Ryan, 2003). It is commonly associated with better psychological
outcomes, such as reduced depression, anxiety and stress, and its application in both clinical and
non-clinical settings (e.g. workplace) has been gaining popularity in recent years (Abbott et al.,
2014; Fjorback et al., 2011; Gu et al., 2015; Janssen et al., 2018).
Of particular interest is its introduction in parenting as mindfulness is extended from an
intrapersonal aspect to interpersonal interactions between parent and child (Duncan et al., 2009).
The concept of mindful parenting was coined by Kabat-Zinn and Kabat-Zinn (1997), described
as bringing awareness and attention intentionally in a non-reactive and non-judgemental way to a
child at any present moment. Duncan and colleagues (2009) further expanded on this concept by
developing a mindful parenting model with five key points of what mindful parenting entails: 1)
listening with full attention (providing quality attention and being able to accurately perceive
what the child is trying to communicate), 2) non-judgmental acceptance of self and child
(appreciating the child’s traits; recognising that there will be challenges, mistakes, and unmet
expectations, but also establishing clear standards for the child’s behaviour), 3) emotional
awareness of self and child (less dismissing and greater responsiveness to child’s emotional
needs; correctly identifying emotions in self and child to reduce emotionally driven discipline),
4) self-regulation in the parenting relationship (practicing emotional regulation, self-control, and
having lower reactivity towards the child’s emotional displays; reduced impulsiveness; parenting
in accordance with goals and values), and 5) compassion for self and child (being more forgiving
and less self-blame of own parenting efforts; positive affection in parent-child relationship).
According to Bogels et al. (2010), mindful parenting may reduce negative outcomes and
promote positive outcomes in parent and child through the following six mechanisms: 1)
reducing parental stress and resultant reactivity, 2) reducing parental preoccupation with
ruminative negative thinking, 3) improving parental executive functioning especially in
impulsive parents, 4) disrupting the intergenerational transmission of dysfunctional parenting
habits, 5) increasing self-nourishing attention, and 6) improving marital relationships and
functioning. Similarly, in Duncan et al.’s four-tiered framework (2009), parenting mindfulness is
proposed to be positively associated with parenting (e.g. communication, parenting self-efficacy)
and parental wellbeing (psychological symptoms), that are positively related to child
management practices (e.g. consistent discipline, use of inductive reasoning) and parent-child
interactions (e.g. responsiveness, positive affect), which are negatively associated with youth
problems (e.g. less substance use) and related to positive youth outcomes (e.g. self-regulation,
emotional wellbeing). Therefore, it is crucial to first examine the efficacy of mindful parenting
interventions on parents’ level of parenting mindfulness as it is associated with parenting and
parental wellbeing, and these factors will have a domino effect on child management practices,
parent-child relationships, and child behavioural outcomes. For purposes of this review,
parenting styles (e.g., coercive, harsh, overreactive) and child management practices will be
classified as parenting behaviours.
Existing literature
Currently, mindful parenting interventions have been widely used in varied population
groups (e.g., parents of youth with mental disorders, parents of children with developmental
disorders or chronic illnesses, community recruited parents), but the efficacy of such
interventions on parenting stress, psychological outcomes (Altmaier & Maloney, 2007; Eames et
al., 2015; Potharst et al., 2018; Potharst et al., 2019), child emotional and behavioural problems
(Bögels et al., 2008; Bögels & Melick, 2004; van de Weijer-Bergsma et al., 2012; de Bruin et al.,
2015; Jones et al., 2018), parent-child, and parent-spouse relationships (Coatsworth et al., 2010;
Potharst, Baartmans, et al., 2018) are mixed. Therefore, a systematic review is necessary to
consolidate existing evidence on various mindful parenting interventions.
The increased number of studies on mindful parenting interventions and conflicting
results on parental and child outcomes highlight a necessity to pool and analyse these findings
quantitatively. Given that the only meta-analysis done to date by Burgdoff and colleagues (2019)
only examined the effects of mindfulness-based interventions on parenting stress and youth
psychological outcomes, other parental outcomes such as level of mindfulness, parenting
behaviours, or parent-child relationships were not examined. Moreover, since psychological
outcomes were the focus of the study by Burgdoff et al. (2019), face-to-face mindfulness-based
stress reduction (MBSR) therapy that did not focus on parenting behaviour was also investigated.
Burgdoff et al.’s review (2019) reported a larger reduction in parenting stress in the mindfulness
intervention group compared to the control group, and a moderate reduction in parenting stress
from pre- to post-intervention. An older review by Townshend and colleagues (2016) intended to
conduct a meta-analysis of mindful parenting interventions on parent and child wellbeing, and
symptoms of internalisation and externalisation disorders. However, the heterogeneity of
included studies resulted in a narrative review. Other recent narrative reviews were either
focused on parental depression (Alexander, 2018), parents of non-clinical sample of children (Kil
& Antonacci, 2020), or parents of children with chronic illness or disability (Cachia et al., 2016;
Hwang et al., 2014). Furthermore, parental psychological outcomes have often been emphasised
in reviews, but none has examined the efficacy of mindful parenting interventions on parents’
level of interpersonal mindfulness in parenting and parenting behaviour.
Aim
To provide an overview of the efficacy of existing mindfulness parenting interventions, the
present meta-analysis aims to quantitatively evaluate the pooled efficacy of parenting-focused
mindfulness interventions on parenting mindfulness and parenting behaviours. Other outcomes
such as parenting stress, parents’ psychological wellbeing, interpersonal relationships (e.g.,
parent-child, parent-partner) and child behavioural outcomes were examined secondarily. Using
the PICO (Population, Intervention, Comparison, Outcome) framework, the following research
question was generated:
What is the efficacy of mindful parenting interventions in improving parenting mindfulness and
positive parenting behaviours in parents with either a clinical or non-clinical sample of children,
as compared with no intervention or non-mindful parenting interventions?
Methods
Search strategy
A systematic electronic search was conducted across six databases (PubMed, Embase,
PsycINFO, CINAHL, Scopus, and ProQuest Dissertations and Theses) from their respective
inception dates to December 2020. Bibliography of relevant reviews and studies were hand-
searched for potential studies to be included. Key search terms used were variations of
(“mindful” OR “mindfulness”) AND (“parent” OR “parenting”). The detailed search strategy for
each database is available in Supplementary material 1. Only peer-reviewed primary journal
articles and unpublished dissertations in the English language were included. Other types of grey
literature (e.g. conference abstracts) were excluded due to the lack of details on study
methodology or findings.
Eligibility criteria
A list of inclusion and exclusion criteria was generated prior to identifying relevant studies. 1)
Parents with children aged 24 years and below were included. According to the United Nations,
youths are individuals aged 15 to 24 years hence the cut-off age for a child was set to 24 years.
2) Both clinical and non-clinical samples of parents or children were included. 3) Studies that
used a mindfulness-based parent training intervention with a primary aim to improve parenting
mindfulness or parenting practices were included regardless of the mode of delivery (online or
face-to-face). Studies that delivered a parallel arm of intervention for children of the parent
participants were also included. Studies were excluded if the mindfulness intervention was
focused on childbirth, stress reduction or intervention that incorporated other forms of therapy
(e.g. cognitive behavioural therapy). 4) Only randomised controlled trials (RCTs) were included.
Studies were excluded if they used a qualitative, case series, quasi-experimental or uncontrolled
trial design. 5) Included studies must include either self-reported parenting mindfulness,
parenting behaviour outcomes, parental psychological wellbeing, interpersonal relationships
(e.g., parent-child, parent-partner), or child behavioural outcomes pre- and post-intervention. The
immediate post-intervention data was of primary interest as not all studies conducted a secondary
follow-up after the completion of the intervention.
Study selection
The database search was conducted by the second author and results were exported to Endnote
version X9 (Clarivate Analytics), which was used to remove duplicates. Two reviewers
independently screened the titles and abstracts of the articles for relevance, and full texts of
shortlisted articles were further examined against the eligibility criteria. Any discrepancies were
resolved through discussion and mutual agreement between the two reviewers. The percentage
agreement between the two reviewers on the studies to be included was 85% and Cohen’s kappa
was 0.95.
Data extraction
A data extraction form was used to extract the following study characteristics: first author, year
of publication, country of study, study design, sample characteristics, intervention details, and
outcomes measured. All parental and child outcomes were reported using continuous data hence
the mean, standard deviation and sample size of intervention and non-intervention groups were
extracted. The primary outcomes of interest were parenting mindfulness and parenting
behaviours. Other secondary outcomes such as parental psychological wellbeing, parenting
stress, parent-child relationships, and child behavioural outcomes were also reported.
Quality appraisal
The Cochrane’s Risk of Bias tool was used to appraise the risks of bias (selection bias,
performance bias, detection bias, attrition bias, and reporting bias) of all included studies
(Higgins et al., 2019). Each component was graded ‘low’, ‘high’, or ‘unclear’ depending on the
study details provided. The risk of bias summary and graph are available in Supplementary
material 2. As a minimum of 10 studies for each outcome is required to produce a meaningful

funnel plot, a funnel plot was not used to examine publication bias in this review due to the
limited number of studies.
Data synthesis
Meta-analyses were conducted using RevMan 5.4 to pool data of identical outcomes. A random-
effect model was used as it accounts for the variance in effect sizes between studies and results
in a conservative null hypothesis (Han & Eskin, 2011). Since each outcome was measured by
different scales, the inverse-variance method was adopted with the standardised mean differences
(d) and 95% confidence interval (CI) being used as the effect measure. Effect sizes were defined
as very small (0.01), small (0.2), medium (0.5), and large (0.8) (Sawilowsky, 2009). The results
of the meta-analyses were presented as a forest plot displaying the effect size and 95% CI of
each study. Unique outcomes that were reported in a single study were presented narratively due
to insufficient studies to conduct a meta-analysis.
Heterogeneity between studies was measured using Cochran’s Q Chi2 test and I2 statistic.
For the Cochran’s Q Chi2 test, a statistically significant p-value of <0.10 indicated heterogeneous
studies of different distributions, whereas I2 estimates of heterogeneity were interpreted as low
(25%), moderate (50%), and high (75%) (Higgins et al., 2019). If high heterogeneity between
studies was detected, subgroup analysis was conducted based on the stratification of clinical and
non-clinical samples of children.
Results
The preliminary search resulted in 2,893 articles. After the removal of 1,277 duplicates, 1,616
article titles and abstracts were screened for relevance. Fifty-seven full-text articles were
shortlisted and assessed for eligibility. Eleven RCTs were finalised and included in the review.
The study selection PRISMA flow diagram is presented in Figure 1.
A total of 1,340 parents from six countries were represented in the 11 RCTs: Canada
(n=1), Chile (n=1), Hong Kong (n=2), Iran (n=1), Israel (n=1), and the United States of America
(n=5). RCTs were published between 2010 and 2020. The mean age of parents ranged from 31.2
to 47.4 years. Parents in the included studies were non-clinical, with only one study including
mothers with self-report elevated stress (Chaplin et al., 2018). Five studies were on parents of
children with developmental disabilities, five studies were on parents with children from a non-
clinical sample, and one study included a mixed sample of parents of children with clinical
attention-deficit hyperactivity disorder (ADHD) and parents of children without clinical ADHD
(Lo et al., 2020). Three studies had no intervention control group, four had a waitlist control
group, and four studies had an active control group (skills-based training, parent education).
Three studies had a parallel parent-child mindfulness intervention (Coatsworth et al., 2010;
Coatsworth et al., 2015; Lo et al., 2020). One study was an online mindful parenting course
(Potharst et al., 2019), whereas the rest were face-to-face group sessions. Overall, the duration of
mindful parenting training ranged from four to 12 weekly sessions, with each session lasting 75
minutes to 2 hours. Only five out of the 11 included studies reported an extended post-
intervention follow-up ranging from four weeks to one year. Further details on the characteristics
of included studies are shown in Table 1.
Quality assessment
According to the Cochrane risk of bias tool, while most studies had a low risk of selection bias,
two studies had a high risk of selection bias as randomization was eventually not possible due to
small sample size, participants lacking interest in the intervention or clashing of parents’
schedule with the intervention program. Blinding of participants and personnel was not
mentioned in most of the studies, and since outcome measures are mostly self-reports, blinding
of out outcome assessors was not possible. As the lack of blinding is highly likely to influence
outcomes and measures, there is an overall high risk of performance and detection bias. Only
five studies mentioned treatment of missing values during data analysis mostly through multiple
imputations, four studies only did a complete-case analysis, and treatment of missing data was
unclear in two studies. Reporting of results in six studies adhered to published protocols and trial
registrations presenting a low risk of reporting bias, while there are no available protocols or trial
registrations for five studies. Please refer to supplementary file 2 for more details.
Parental outcomes
Parenting mindfulness
Seven out of 11 studies reported on parenting mindfulness (Coatsworth et al., 2010; Coatsworth
et al., 2015; Corthorn et al., 2018; Lo et al., 2017; Lo et al., 2020; Mah et al., 2020; Williams,
2020). However, one study did not have sufficient data (Coatsworth et al., 2015), and another
study consisted of a mixed sample of parents of clinical and non-clinical children (Lo et al.,
2020), hence both were excluded from the meta-analyses. In both studies, no significant
difference in improvement of parenting mindfulness scores was reported between the
intervention and control group immediately post-intervention (Coatsworth et al., 2015; Lo et al.,
2020).
A meta-analysis of five studies (Coatsworth et al., 2010; Corthorn, 2018; Lo et al., 2017;
Mah et al., 2020; Williams, 2020) was conducted to assess overall levels of parenting
mindfulness immediately after the intervention. All studies used the Interpersonal Mindfulness
Parenting (IM-P) scale as a measure of parenting mindfulness. A statistically non-significant
effect was found for overall parenting mindfulness scores among 401 participants (d=0.37, 95%
CI: -0.02, 0.76, Z=1.87, p=0.06) (Figure 2). However, high heterogeneity between studies was
detected (I2=70%; Chi2 =13.35, p=0.01), therefore a subgroup analysis was conducted.
Subgroup analyses based on stratification of clinical and non-clinical children sample
were significant (I2=74.3%; Chi2 =3.89, p = 0.05), revealing a significant moderate effect for
studies with non-clinical children sample (d=0.62, 95% CI: 0.11, 1.13, Z=2.38, p=0.02), in which
the intervention group demonstrated higher scores on parenting mindfulness post-intervention
compared to the control group (Coatsworth et al., 2010; Corthorn et al., 2018; Williams, 2020).
However, no statistically significant effect was observed between groups for parenting
mindfulness scores among studies with clinical children sample (d=0.05, 95% CI: -0.21, 0.30,
Z=1.87, p=0.72) (Lo et al., 2017; Mah et al., 2020).
Two studies on parents with non-clinical sample of children reported post-intervention
follow-up results for overall parenting mindfulness at two months (Corthorn et al., 2018) and
four to six weeks after completion of the intervention (Williams, 2020). One reported similar and
maintained scores for parenting mindfulness in both groups from immediate post-intervention to
two months post-intervention (Corthorn et al., 2018), whereas William’s study (2020) reported a
significant increase in parenting mindfulness scores in the intervention group from immediate
post-intervention to six weeks post-intervention.
Parenting behaviour
Six out of 11 studies reported on parenting behaviour (Chaplin et al., 2018; Coatsworth et al.,
2010; Coatsworth et al., 2015; Gershy et al., 2017; Mah et al., 2020; Potharst et al., 2019). Two
studies included parents of children clinically diagnosed with ADHD (Gershy et al., 2017; Mah
et al., 2020), and four studies included parents of typically developing children (Chaplin et al.,
2018; Coatsworth et al., 2010; Coatsworth et al., 2015; Potharst et al., 2019). The studies either
reported parenting behaviours using the Escalation Questionnaire – coercive behaviour, negative
feelings and parental submission (Gershy et al., 2017), the Parenting Scale – laxness, over-
reactivity and verbosity (Mah et al., 2020; Potharst et al., 2019), the differential emotions scale
(Chaplin et al., 2018), or self-constructed scales (Coatsworth et al., 2010; Coatsworth et al.,
2015). Since different parenting behaviour scales were used without the provisions of an
aggregate score, meta-analysis was not conducted for this outcome.
In Gershy et al.’s study (2017), fathers of children with ADHD who received the
intervention reported reduced parental submission than fathers in the control group immediately
post-intervention. However, no significant difference in parenting behaviour was reported
between both groups of mothers. Similarly, in another study, parents of children with ADHD
who received mindfulness behavioural parent training reported a reduction in overall harsh
parenting practices immediately post-intervention as compared to those who received standard
behavioural parent training (Mah et al., 2020).
For parents of a non-clinical sample of children, parents in one study (Potharst et al.,
2019) who received the intervention indicated a reduction in over-reactive parenting discipline
scores immediately post-intervention. Mothers in another two studies reported improved rules
control and rule communication (Coatsworth et al., 2010; Coatsworth et al., 2015), better
inductive reasoning, and monitoring of their child (Coatsworth et al., 2015) immediately post-
intervention. In Coatsworth et al.’s study (2015), fathers of typically developing children who
received the intervention similarly reported better scores on inductive reasoning, monitoring, and
alcohol rule communication with their child than fathers in the control group. Interestingly, in
Chaplin et al.’s study (2018), only mothers of girls in the intervention group were observed to
have decreased self-perceived negative parenting behaviour towards their child.
Parenting stress
Eight studies reported parenting stress as an outcome (Behbahani et al., 2018; Chaplin et al.,
2018; Corthorn, 2018; Lo et al., 2017; Lo et al., 2020; Mah et al., 2020; Potharst et al., 2019;
Williams, 2020). Parenting stress was either measured using the PSI (Behbahani et al., 2018;
Corthorn, 2018; Lo et al., 2017; Lo et al., 2020; Mah et al., 2020; Williams, 2020), Stress Index
for Parents of Adolescents (Chaplin et al., 2018), or the Parental Stress Questionnaire (Potharst
et al., 2019). However, one study included a mixed clinical and non-clinical sample of children
(Lo et al., 2020), and three studies only reported subscale scores without an aggregate score
(Chaplin et al., 2018; Mah et al., 2020; Potharst et al., 2019), therefore they were excluded from
the meta-analyses. For studies without an aggregate score, one study reported no significant
difference between groups in terms of parental distress scores and parent-child dysfunctional
interaction scores immediately post-intervention (Mah et al., 2020), while another study reported
reduced parenting stress scores in terms of perceived life restrictions in the intervention group as
compared to the control group (Chaplin et al., 2018). The last study reported no improvement in
parenting stress scores in the intervention group immediately post-intervention, but a reduction
in parents’ perceived role restriction was reported 10 weeks after the completion of the
intervention (Potharst et al., 2019). For the study with a mixed sample, as compared to the
control group, a larger reduction in overall parenting stress scores in terms of parental distress,
parent-child dysfunctional interaction, and difficult child was reported for the intervention group
immediately post-intervention (Lo et al., 2020).

Data from four studies (Behbahani et al., 2018; Corthorn, 2018; Lo et al., 2017; Williams,
2020) were meta-analysed to examine overall levels of parenting stress immediately after the
intervention. A statistically non-significant small effect size was found for overall parenting
stress scores among 346 parents (d=-0.17, 95% CI: -0.84, 0.50, Z=0.50, p=0.62), where the
control group had higher parenting stress scores than the intervention group. High heterogeneity
was detected between studies (I2=87%; Chi2=23.96, p<0.001), therefore a subgroup analysis was
conducted.
There was no subgroup difference based on the grouping of clinical and non-clinical
sample of children (I2=3.7%; Chi2 =1.04, p=0.31). In the clinical group, no significant effect was
found (d=-0.57, 95% CI: -1.25, 0.11, Z=1.64, p=0.10), and similarly for the non-clinical group
(d=0.30, 95% CI: -1.24, 1.84, Z=0.39, p=0.70).
Parental psychological wellbeing
One study reported on parents’ overall psychological wellbeing (Lo et al., 2020), two examined
general stress (Chaplin et al., 2018; Corthorn, 2018), two on depression (Corthorn, 2018; Lo et
al., 2017), one on anxiety (Corthorn, 2018), and one reported on both depression and anxiety
(Potharst et al., 2019). Due to the heterogeneity in the examined outcomes, a meta-analysis was
not conducted.
A family-based mindfulness program was found to be efficacious in improving the
overall subjective wellbeing of a majority sample of parents of children with ADHD
immediately post-intervention (Lo et al., 2020). Likewise, in another study, when compared to
the no intervention controls, a mindful parenting intervention also reportedly reduced depression
and anxiety scores in parents of children with ADHD (Lo et al., 2017).
For parents of typically developing children, mixed efficacy results were observed for
general stress levels, depression, and anxiety scores immediately post-intervention. There were
studies reporting a significant reduction in stress (Corthorn et al., 2018), depression and anxiety
scores in the intervention group (Potharst et al., 2019), and others reporting no significant group
effects for stress (Chaplin et al., 2018), depression, and anxiety scores (Corthorn et al., 2018).
Relational outcomes
Five studies reported on parent-child relationship or parent-spouse relationship scores
immediately post-intervention (Chaplin et al., 2018; Coatsworth et al., 2010; Coatsworth et al.,
2015; Gershy et al., 2017; Lo et al., 2017). Since no aggregate scores were provided, a meta-
analysis was not possible.
The quality of parent-child relationships was usually determined by measures of
behavioural expression of affect in their relationships and communication (Chaplin et al., 2018;
Coatsworth et al., 2010; Coatsworth et al., 2015; Gershy et al., 2017). In two studies, parents
with non-clinical sample of children who received the intervention reported improvement in
parent-child relationships scores, in terms of reduced for negative feelings towards their child
(Chaplin et al., 2018), and better affective/interaction quality (Chaplin et al., 2018; Coatsworth et
al., 2015). However, one study reported no significant difference in parent-child relationship
quality between groups (Coatsworth et al., 2010). Only one study (Gershy et al., 2017) on
parents of children with ADHD reported reduced scores for parents’ negative feelings towards
their child after receiving the intervention.
In terms of relationship with their partner, mothers who received the mindfulness parent
training in Chaplin’ study (2018) reported lower stress scores, whereas parents who received
intervention in Lo et al.’s study (2017) reported higher marital satisfaction scores than those in
the control group.
Child behavioural outcomes
Only three studies (Gershy et al., 2017; Lo et al., 2020; Potharst et al., 2019) reported child
behavioural and emotional problems using the full Child Behaviour Checklist or its subscales
(i.e., externalising problems, aggression) immediately post-intervention. One study reported on
children clinically diagnosed with ADHD (Gershy et al., 2017), one had a mixed clinical and
non-clinical sample of children (Lo et al., 2020), and one had a non-clinical sample of children
(Potharst et al., 2019). Due to limited studies and heterogeneity of methodologies, a meta-
analysis was not conducted.
Children in Gershy’s study (2017) did not receive any parallel intervention, but parents in
the control group received standard parenting training. Despite observing significant within-
group effects, no significant between-group effects were observed for externalising behaviour in
children with ADHD. The children in Lo et al.’s study (2020) received a parallel family-based
mindfulness program. The parent-report demonstrated that there was a significant improvement
in children’s behaviour in terms of reduced anxiety, somatic complain, aggression, internalizing
and externalizing problems, and improved attention scores in the intervention group as compared
to the control group. In Potharst’s study (2019), parents who received the online mindful
parenting training reported a reduction in child aggressive behaviour and emotional reactivity
scores as compared to parents in the waitlist control group.
Discussion
This review examined and consolidated the findings of 11 mindful parenting RCTs on parents’
parenting mindfulness, parenting behaviour, parenting stress, psychological wellbeing, relational
outcomes, and child behavioural outcomes, using meta-analyses and a narrative summary
approach. From the meta-analyses of nine studies, mindful parenting interventions were found to
have a moderate effect on overall parenting mindfulness scores among parents of typically
developing children, but such interventions did not have an effect on parenting stress scores. The
narrative summary of current evidence on mindfulness parenting interventions seems to indicate
a general association with positive parenting behaviours, psychological wellbeing of parents of
children with ADHD, and parent-child and parent-partner relationships.
Parenting mindfulness
Since this is the first meta-analysis that investigates the efficacy of mindful parenting
interventions in improving parenting mindfulness, a comparison of the effect sizes seen in this
review with other similar studies was not possible. Although no overall significant effect was
found, our subgroup analysis revealed a moderate effect of mindful parenting interventions on
parenting mindfulness scores of parents with typically developing children. Based on previous
research, the lack of intervention efficacy for parents with clinical sample of children may be
attributed to low parental willingness and motivation to uptake mindful parenting, the lack of
time and capacity to actively engage in mindful parenting in addition to their demanding
caregiving duties, and the experience of negative emotions being elicited (Castells, 2020;
Ruuskanen et al., 2019). Therefore, current mindful parenting programs may be more acceptable
and feasible for parents with typically developing children, and healthcare providers and
researchers need to develop more tailored mindful parenting programs for parents with a clinical
sample of children.
Interpersonal parenting mindfulness focuses on the experience of presence in parents,
enhancing their ability to sense their own participation during the interaction, hence promoting
emotional awareness within themselves and in their child (Siegel, 2007; Wallin, 2007). Increased
non-judgemental acceptance of a child suggests that mindfulness parenting interventions reduce
parents’ subconscious judgement on their child’s attributes, competence and behaviour, but
promotes psychological flexibility and acceptance of the child instead (Brown & Ryan, 2003;
Duncan et al., 2009). These elements of parenting mindfulness are believed to have an impact on
parental and child psychological, relational, and behavioural outcomes which will be discussed
in the following sections. However, the lack of RCTs and quantitative reviews, and conflicting
results warrant a need for more rigorous intervention research examining the outcome of
parenting mindfulness, especially between parents of a clinical and non-clinical sample of
children.
Additionally, studies that conducted extended follow-up assessments for parenting
mindfulness showed either a sustained or improvement in levels of parenting mindfulness scores
up to 2 months after the completion of the intervention, which suggests the durability of
intervention effects on parenting mindfulness. However, further research is required to ascertain
the sustained effects of mindfulness parenting interventions even after its completion.
Parenting behaviours
The consolidation of existing evidence revealed a generally positive association of mindfulness
parenting interventions with the parenting behaviours of parents of both typically developing and
children with ADHD. This corresponds with Bogels et al. (2010) hypothesis, where mindful
parenting is associated with improved parental executive functioning or reduced parental
reactivity, especially in parents of children with executive functioning disorders (i.e., ADHD)
who are highly likely to have impaired executive functioning themselves due to strong genetic
component of such disorders (Tharpar et al., 1999). This is because mindfulness training helps to
build one’s tolerance to strong emotions and reduces inappropriate automatised reaction or
behavioural responses (Bialy, 2006). Automatised behavioural responses are often mindless and
performed with little intentional attention to happenings in the present moment (Dumas, 2005).
Therefore, the practice of mindful parenting can increase self-awareness and allow parents to
pause, self-reflect, and choose an appropriate response from a mindful place as opposed to
reacting immediately and inappropriately, such as in charged situations (Bishop et al., 2004). By
promoting a responsive instead of reactive parenting style using mindfulness, parents can tend to
their own reactions and their child’s expressions effectively (Siegel, 2007; Siegel & Hartzell,
2013).
Additionally, our review discovered two studies that reported varied efficacy of
mindfulness parenting interventions on parenting behaviour depending on the gender of parent
(intervention favoured fathers) and child (intervention favoured daughters). Gender difference in
mindful parenting behaviour has been established in previous literature, where mothers were
observed to practice more mindful parenting than fathers (Medeiros et al., 2016; Parent et al.,
2016), whereas fathers reportedly have a lower ability to recognise children’s needs and
presented lower levels of mindful parenting than mothers (Moireira and Canavarro, 2015).
Medeiros and colleagues (2016) have suggested that biological and cultural differences may have
contributed to mothers’ willingness to adopt a more mindful parenting approach. The stark
gender difference in baseline mindfulness may have resulted in more apparent improvement in
parenting mindfulness and behaviours in fathers after a mindful parenting intervention. However,
more thorough research on gender effects and mindful parenting is warranted due to the paucity
of studies.
Parenting stress
Mindfulness parenting interventions was not associated with overall parenting stress
immediately post-intervention, and no subgroup differences were observed for parents of clinical
and non-clinical samples of children. Interestingly, our narrative summary highlighted a study
that reported delayed reduction in parenting stress at 10 weeks post-intervention (Potharst et al.,
2019). This corresponds with a finding from Burgdoff et al’s meta-analysis (2019), whereby
parents in mindfulness groups only reported a moderate reduction (g=0.44) in parenting stress
scores two months after the completion of the intervention. Additionally, a study comparing the
effects of mindful parenting training for parents of children in clinical and non-clinical settings
reported no difference in levels of parenting stress between settings (Potharst, Baartmans et al.,
2018). However, parenting stress scores of parents in both settings decreased from pre- to
immediate post-intervention, and this decrement was maintained for eight weeks post-
intervention (Potharst, Baartmans et al., 2018). This suggests potential long-term benefits and
durability of mindfulness parenting interventions in reducing parenting stress in parents with
children from clinical and non-clinical settings. However, more longitudinal research is needed
to ascertain this.
Although our analysis on overall parenting stress was non-significant, individual studies
that reported on the subscales of parenting stress discovered significant improvements in
parenting stress in terms of perceived life restriction, parental distress, parent-child dysfunctional
interaction, and difficult child (Lo et al., 2017; Chaplin et al., 2018). This suggests that instead of
parenting stress as a whole, mindful parenting interventions may be efficacious in addressing

certain specific components of parenting stress, which future studies should consider looking
into.
Psychological wellbeing
Substantial literature has mentioned the benefits of mindfulness interventions on psychological
outcomes, such as depression and anxiety symptoms, and depression relapse (Creswell, 2017).
This is mirrored by two studies included in the narrative summary, which reported a greater
reduction in general stress, depression, and anxiety symptoms in parents of children with ADHD
who received the intervention, but conflicting results were observed between control and
intervention groups of parents of typically developing children. According to Ducan et al.
(2009), mindful parenting supposedly serves as a psychological resource that allows parents to
exercise more adaptive coping and avoid the disruptive influence of negative appraisal on their
parenting and own psychological wellbeing. This corresponds with Bogels et al.’s (2010)
hypothesis, where mindfulness is associated with improved parenting by reducing negative bias
and parental preoccupation with repetitive negative thinking. Despite the assumed mechanisms
of mindfulness on parental psychological wellbeing, it is unclear how the efficacy of mindfulness
parenting interventions differs between parents of clinical and non-clinical sample of children
due to the paucity of studies; hence more research is warranted.
Relational outcomes
Most studies in the narrative summary reported better parent-child relational outcomes in terms
of interaction and expressions of affection after receiving the intervention. The reciprocal
relationship between parent and child mutually reinforces the type of interaction and expressions
of affect, for instance, escalating negativity from a single person may trigger subsequent
negativity in the other party, resulting in a vicious cycle (Kim et al., 2001). Therefore, the
practice of mindful parenting (full parental attentiveness, non-judgmental acceptance of self and
the child, being emotionally aware of self and the child, self-regulation, and compassion for self
and child) is crucial for enhancing parents’ capacity for more responsive, warm, nurturing, and
calm parenting that will undeniably contribute to more positive parent-child relationships
(Duncan et al., 2009).
Based on our narrative summary, higher marital satisfaction scores and a lower parenting
stress scores were reported in the mindfulness group than control (Chaplin et al., 2018; Lo et al.,
2017). This imply that the practice of mindful parenting can potentially extend to the context of
parent-partner relationships, whereby interparental conflict can be reduced by lowering
automatic, emotional reactivity between partners (Bogels et al., 2010). Instead of mindful
parenting per se, the general techniques of mindfulness may help increase couples’ open-
mindedness and flexibility which may help foster more satisfying marital relationships.
However, further studies are required to elucidate the underlying mechanism of mindfulness and
marital relationship. Overall, relational outcomes are often reported solely by the participating
parent, but the effects on interpersonal relationships should include reports from the child and
non-participating parent to encourage triangulation and better justification of findings.
Child behavioural outcomes
RCTs included in the narrative summary generally showed improvements in parent-reported
child behaviour scores in terms of aggressiveness, emotional reactivity, and pre- and post-
intervention externalising behaviour (Gershy et al., 2017; Lo et al., 2017; Potharst et al., 2019).
In other studies, where only parents received mindful parenting training, children’s behaviours
were significantly affected in terms of reduced aggression, non-compliance, self-injury, anxious
behaviour, hyperactivity and disturbed behaviour (Singh et al., 2006; Srivastava et al., 2011).
Due to limited RCTs, this review was unable to consolidate in-depth information on the impact
of mindful parenting on children’s internalising and externalising behaviours.
Limitations and future implications
The main limitation of this review is the limited availability of RCTs and the high heterogeneity
of study methodologies, intervention protocols, outcome measures and study contexts, which
may have contributed to the insignificant effect sizes and the inability to conduct a meta-analysis
for all outcomes. Additionally, the small number of studies from only six countries reduces the
generalisability of the findings. As most mindful parenting intervention studies were single-
group studies, the inclusion of only RCTs in this review may lend rigour to the meta-analysis but
result in loss of significant findings. Furthermore, outcomes in this review were only based on
parent-report, which could have resulted in reporting bias or parent-observer discrepancies,
especially in terms of parent-child relationship and child behaviour.
Since non-therapy-based mindful parenting interventions are relatively novel, subsequent
studies are warranted to investigate detailed outcomes (both total score and subscales) to provide
better insights. In addition, mindful parenting interventions appear to have sustained positive
effects after completion of the intervention, but less than half of the included RCTs included
extended follow-up data for analysis, hence future studies should include follow-up data to allow
examination of sustained or long-term effects. Future reviews should also consider conducting a
within-group analysis given the high availability of single-group studies, and more third-party
observations, child-reports and reports from non-participating partners are recommended to
triangulate findings on interpersonal outcomes. Lastly, future reviews can consider comparing
and discussing intervention effects on mindfulness versus reflective functioning in parents,
which have been shown to be correlated (Falkenstrom et al., 2014).

The incorporation of mindfulness into parenting training is promising and can potentially
improve interpersonal parenting mindfulness, parenting behaviours, relationship with child and
partner, parenting stress and psychological wellbeing of parents, which in turn have an impact on
a child’s emotion and behaviour. Positive findings were generally observed in parents of both
clinical and non-clinical samples of children, and youths. This indicates the usability of such
interventions in both clinical and non-clinical family settings, thus joint effort between
interdisciplinary healthcare providers, researchers and policy makers is recommended for the
development and implementation of mindful parenting interventions to ensure optimal outcomes
for both parents and children. The research gaps highlighted in this review provide healthcare
providers and researchers the information they need to develop and implement more mindful
parenting training which promote more holistic family functioning and wellbeing, especially for
families with children with chronic illnesses or psychological disorders.
Conclusion
This is the first meta-analysis to examine the efficacy of non-therapy-based mindful parenting
interventions on interpersonal parenting mindfulness, parenting behaviours and other parent and
child outcomes. Mindfulness parenting interventions have a moderate effect on parenting
mindfulness in parents of typically developing children. No significant effect size was observed
for overall parenting stress. The narrative consolidation of existing evidence suggests that
compared with no interventions or non-mindful parenting interventions, mindful parenting
interventions generally enhance positive parenting behaviours, the psychological wellbeing of
parents of children with ADHD, and parent-child and parent-partner relationships. The effects on
child behavioural outcomes remain inconclusive. The potential benefits of mindful parenting
interventions on parent and child outcomes serve as an impetus for more in-depth and
longitudinal research to be conducted.
Funding: None
Conflict of Interest: None

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Thapar, A., Holmes, J., Poulton, K., & Harrington, R. (1999). Genetic basis of attention deficit
and hyperactivity. British Journal of Psychiatry, 174, 105–111.
Townshend, K., Jordan, Z., Stephenson, M., & Tsey, K. (2016). The effectiveness of mindful
parenting programs in promoting parents' and children's wellbeing: A systematic review.
JBI database of systematic reviews and implementation reports, 14(3), 139-180.
https://doi.org/10.11124/JBISRIR-2016-2314
van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bögels, S. M. (2012). The
effectiveness of mindfulness training on behavioral problems and attentional functioning
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Wallin, D. J. (2007). Attachment in psychotherapy. Guilford press.

*Williams, C. J. (2020). Training for parents of head start preschoolers: A mindful parenting
approach [Dissertation].
*Included study in the systematic review.

Records identified through
Identification
PubMed, CINAHL, PsycInfo, Additional records

Embase, Scopus, ProQuest identified through
Dissertations and Theses reference lists
(n=16)
(n=2,877)
Records screened
(n=2,893)
Duplicates removed
(n=1,277)
Screening
Titles and abstracts

screened
(n=1,616)
Records excluded
(n=1,559):
- Irrelevant article type (i.e.,
conference abstracts,
reviews, book chapters,
editorials)
- Irrelevant context (i.e.,
Full-text articles assessed microbiology, mindful
for eligibility childbirth, parent-child
(n=57) interactions, sample with
Eligibility
chronic illnesses)
Records excluded (n=46):

- Non RCT studies (i.e.,
qualitative, uncontrolled
trial, case-series, conference
abstract)
- Child not within age range
- Intervention focused on
Included
Studies included in the childbirth and stress

systematic review (n=11) reduction
- Instrument validation
Figure 1 PRISMA flow diagram

Figure 2 Forest plot of effect sizes of parenting mindfulness
Table 1. Characteristics of included studies (n=11)
Author Study design Sample Intervention Outcome measures; Description of results
(Year), and characteristics Time points and Analysis
Country conditions
Behbahani RCT: Parents Mindful parenting training: - Outcomes: Parenting stress
(2018), Iran 1. Mindful - N=56 (30 Based on Kabat-Zinn protocol. 1. Parenting Stress – - Reduction in overall parenting stress and
parenting control 26 Include a CD with mindfulness Parenting Stress Index (PSI SF subscales (negative parent-child interactions,
2. No intervention) exercise for home practice 36) children’s problematic
intervention - Non-clinical - Parents only 2. ADHD symptoms - Characteristics) in the mindful parenting
control - 8 weekly sessions (each Swanson, Nolan, and Pelham training group compared with the control
Children session lasting 90 minutes) Parent and Teacher rating group in the post-intervention and follow-up.
- N=56 scale (SNAP-IV)
- 19 females 37 ADHD symptoms
males Analysis: - Significant improvement in ADHD
- Aged 7 to 12 - Pretest, post-intervention, 8 symptoms in the intervention group by
years weeks follow up post- comparison with the
- ADHD intervention control group in the post-intervention and
- All received - Repeated measures ANOVA follow-up.
pharmacotherapy and the nonparametric
with Ritalin or Friedman test
risperidone
Chaplin RCT: Parents: Intervention: Parenting Outcomes: As compared to mothers in the Parenting
(2018), USA 1. Mindful - N=83 mothers Mindfully (n=41): Questionnaires: Education group at post-intervention:
parenting - Mean Age 47.4 - 8 weekly 2h sessions 1. Parental stress – Perceived
2. Parent years - Include 1) formal stress scale Parental stress
education - All females mindfulness practice 2. Parent dispositional No significant results between groups
control - Non-clinical; (meditation or gentle yoga), 2) mindfulness – Mindfulness
self-report high discussion of and practice in Attention Awareness Dispositional mindfulness
stress activities to foster informal Scale (MAAS) - Mothers in Parenting Mindfully group had
mindfulness practice including 2. Parenting stress – Stress higher mindfulness
Children cultivating present-focus in Index for parents of
- N=83 daily life and while parenting, adolescents (SIPA) Parenting stress
- Aged 12 to 17 3) group discussions of 3. Interpersonal mindfulness - Mothers in Parenting Mindfully group had
years (Mean mindfulness applications to – Interpersonal Mindfulness reduced parenting stress in terms of parent
14.04 years) parenting, and 4) group in Parenting Scale (IM-P) life restrictions
- 40 boys 43 girls discussion of homework 4. Parent-adolescent
- Non-clinical (30min formal mindfulness relationship quality –
Country conditions
and 15-30min informal adolescent parent Parent-partner relationship
mindfulness 6 days per week) relationship domain subscale - Mothers in Parenting Mindfully group had
from the Stress Index for reduced stress in terms of relationship with
Control: Parenting Education Parents and Adolescents spouse/partner
(n=42)
- Brief Parent-Adolescent Interaction Interpersonal mindfulness
interventions/informational (PAIT) Laboratory Task - Mothers in Parenting Mindfully group had
handouts that were successful (during pre- and post- increased mindful parenting related to
previously intervention assessment): emotional awareness
- 3 sessions 30min each 1. Observed parenting
- 3-page packet of behaviours Parent-adolescent relationship quality
information, PowerPoint 2. Parent negative emotional - Mothers in Parenting Mindfully group
presentation, and answered response - Differential reported improved parent-adolescent
parents’ questions Emotions Scale-Short form relationship quality.
Analysis: PAIT Lab Task

- pre-, post-intervention - Mothers of girls (not boys) in Parenting
ANCOVA Mindfully group had decreased negative
parenting behaviour and decreased negative
emotional responses.
Coatsworth RCT: Parents: Strengthening Families Outcomes: Interpersonal mindfulness in parenting
(2010), USA 1. - N=65 Program 10-14 (n=23) 1. Interpersonal mindfulness - Mothers in the Mindfulness-enhanced
Strengthening - Mean age 39.4 - Seven weekly, 2 hours in parenting – IM-P Strengthening Families Program reported
Families years sessions 2. Child management mean level improvements in mindful
Program - All females - Both parents and youths practices – self-constructed parenting as compared to control
2. (separate first hour, conjointly scale from previous
Mindfulness- Children: for the second hour) Strengthening Families Child management practices
enhanced - Mean age 11.65 - prevent adolescent problem Program studies (both parent - Mothers in the Mindfulness-enhanced
Strengthening - 38% female behaviour and substance and youth report) Strengthening Families Program reported
Families - Non-clinical abuse 3. Parent youth relationship mean level improvements in rules control as
Program quality – self-constructed compared to control
3. Waitlist Mindfulness-enhanced scale from previous
control Strengthening Families Strengthening Families Parent youth relationship quality
Program (n=25) Program studies - No significant results between groups
- Seven weekly, 2 hours
Country conditions
sessions Analysis:
- Both parents and youths - Pre-, post-intervention
(same as original - ANCOVA
Strengthening Families
Program) This review only compare
- New mindfulness activities: results from Mindfulness-
didactic presentation of enhanced Strengthening
mindfulness principles, Families Program and waitlist
teaching of mindfulness control
practices (e.g., mindful
breathing), practice exercises
and group
interactive activities, and short
reflections
- Encouraged mindfulness
home practices (e.g., fridge
magnet)
Delayed Intervention
(Waitlist, n=17)
- Strengthening Families
Program intervention would
begin in approximately 3
months
Coatsworth RCT: Parents Strengthening Families Outcomes: As compared to the control group at post
(2015), USA 1. - N=432 families Program 10-14 (N=160) 1. Interpersonal mindfulness intervention:
Strengthening 257 males, 432 - Seven weekly, 2 hours in parenting (listening with
Families females sessions full attention, self-regulation, Interpersonal mindfulness in parenting
Program - Non-clinical - Both parents and youths emotional awareness, - No significant difference between groups
2. (separate first hour, conjointly compassion/acceptance for
Mindfulness Children for the second hour) youth and self) – IM-P Parent-youth relationship quality
enhanced - Mean age 12.14 - Prevent adolescent problem 2. Parent-youth relationship - Mothers in the Mindfulness enhanced
th th
Strengthening years (6 and 7 behaviour and substance quality (affective/interaction Strengthening Families Program reported
Families grade) abuse quality, approach to better affective/interaction quality with their
Program - 54% females emotions, support, family youth
Country conditions
3. Control - Non-clinical Mindfulness Strengthening involvement) – measures
(minimal Families Program (N=154) from previous studies Youth behaviour management
treatment- - Seven weekly, 2 hours 3. Youth behaviour - Mothers in the Mindfulness enhanced
information sessions management (inductive Strengthening Families Program reported
only) - Both parents and youths reasoning, monitoring, better inductive reasoning, monitoring, and
(same as original alcohol rule communication) alcohol rule communication with their youth
Strengthening Families – measures from previous - Fathers in the Mindfulness enhanced
Program) studies Strengthening Families Program reported
- New mindfulness activities: 4. Parent well-being better inductive reasoning, monitoring, and
didactic presentation of (parenting satisfaction and alcohol rule communication with their youth
mindfulness principles, efficacy, daily hassle, anger
teaching of mindfulness management) – measures Parent well-being
practices (e.g., mindful from previous studies - No significant difference between groups
breathing), practice exercises
and group Analysis:
interactive activities, and short - Pre-, post-intervention, 1
reflections year follow up post-
intervention
Information-only home study
(N=118)
- Two short booklets mailed to
families (information about
emotional changes in
adolescence and family life
with adolescence)
Corthorn Controlled Parents Mindful Parenting (N=21) Outcomes: As compared to the control group at post
(2018), Chile trial: - N=43 mothers (adapted from Mindfulness- 1. Parenting mindfulness – intervention:
1. Mindful - Non-clinical based Stress Reducation) IM-P
parenting - 8 weekly 2-hour sessions 2. Five mindfulness domains Parenting mindfulness
2. No Children - Mindfulness meditation, (observing, describing, - Mothers in the intervention group reported
intervention - Age 2 to 5 years yoga, and group discussions awareness, non-judging, non- an increase in overall mindful parenting
control - Non-clinical - Home practice of 30-40min reactivity) – FFMQ and in terms of non-judgmental acceptance,
daily and mindful parenting 3. Parenting Stress – PSI listening with full attention. Self-regulation in
exercises 4. Parent mental well-being – parenting, empathy and acceptance
DASS-21
Country conditions
No intervention control General mindfulness
(N=22) Analysis: - Mothers in the intervention group reported
- Pre-, post-intervention, 2- an increase in general mindfulness in terms of
month follow up post- observing and non-judging
intervention
- ANOVA/t-test Parenting stress
- Mothers in the intervention group had
decreased overall parenting stress and in
terms of parental distress and difficult child
Parent mental well-being

decreased levels of general stress
Gershy RCT: Parent Nonviolent resistance and Outcomes: As compared to the standard parent training
(2017), 1. Mindful - N=57 families mindfulness (N=23) - Mother and father separate group at post intervention:
Israel parenting - 79 mothers 73 - 10-12 therapy sessions with 1. Parental emotional
2. Parent fathers one additional 90-min regulation – Difficulty in Parental emotional regulation
training - Non-clinical mindfulness skills session Emotional Regulation scale - Mothers in the intervention group reported
rd
(after 3 session) 2. Parenting behaviours – reduced emotional dysregulation
Children - Adapted from dialectical Escalation questionnaire
- Aged 6 to 15 behaviour therapy (Linehan 3. Child problem behaviour – Parenting behaviours
years 1993, 2000) CBCL - Mothers in the intervention group reported
- ADHD - Record home practice reduced coercive behaviours and negative
frequency for the subsequent Analysis: feelings
weeks - Pre-, post-intervention - Fathers who received the intervention
- Multilevel linear modelling reported reduced parental submission than
Control: Nonviolent fathers in the control group
resistance (N=34)
- 10-12 therapy sessions Child problem behaviour
- Manual based intervention - Mothers in the intervention group reported a
reduction in child externalizing symptoms
Lo (2017), RCT: Parent Intervention: Mindful Outcomes: As compared to the control group at post
Hong Kong 1. Mindful - N=180 parents parenting (N=91) 1. Parenting stress – PSI intervention:
parenting - 169 female, 11 - 6 weekly 1.5h sessions, 10 2. Depression – Center for
Country conditions
2. No males min of daily home practice Epidemiologic Studies Parenting stress
intervention - Mean age - 6 groups of 10-15parents Depression scale - Parents in the intervention group had a
38.8years - Adapted from Bogels and 3. Child behaviour – Eyberg larger reduction in overall parental stress
Restifo (2014) and Coatsworth Child Behaviour Inventory especially for parent-child dysfunctional
Children (2010) 4. Interpersonal mindfulness interaction
- Mean age 5 - Mindfulness practice, – IM-P
years practice enquiry and 5. Marital satisfaction – Depression
- Developmental psychoeducation Kansas Marital satisfaction - Parents in the intervention group had a
delay, ASD, scale larger reduction in depression scores
ADHD, other Control: No intervention
developmental (N=89) Analysis: Child behaviour
disability - (1-day mindfulness workshop - Pre-, post-intervention - No significant difference between groups
after intervention) - Repeated measures ANOVA
Interpersonal mindfulness for parenting
- No significant difference between groups
Marital satisfaction
Lo (2020), RCT: Parents Family-based Mindfulness Outcomes: As compared to the waitlist control group:
Hong Kong 1. Mindful - N=123 families Program 1. Child functioning – SWAN,
parenting - Mean age 39.2 - 6 weekly 1.5h sessions, 10 CBCL, Child Attention Child functioning
2. Waitlist years min of daily home practice Network test - Children in the intervention group had larger
control - 96% female - Adapted from Bogels and 2. Parenting stress – PSI reduction in inattention and hyperactivity
- Non-clinical Restifo (2014) and Coatsworth 3. Interpersonal mindfulness (SWAN), and larger improvement in behaviour
(2010) – IM-P in terms of reduced anxiety, somatic
Children - Has parallel session for the 4. Psychological wellbeing – complain, aggression, internalizing and
- N=100 child (“Mindfulness matters”) WHO Wellbeing Index externalizing problems, and improved
- Aged 5 to 7 5. Parent heart rate attention from pre-intervention
years variability
- Mixed sample Parenting stress
(with and without Analysis: - Parents in the intervention group reported
clinical ADHD) - pre-, post-intervention larger reduction in overall parenting stress
- Need to meet a - ANCOVA, mediation especially in terms of parental distress,
minimum SWAN parent-child dysfunctional interaction, and
score cut off for difficult child from pre-intervention
Country conditions
inattention and
hyperactivity Interpersonal mindfulness for parenting
Psychological wellbeing
- Parents in the intervention group reported
larger improvement in subjective wellbeing
from pre-intervention
Parent heart rate variability

- No significant differences between groups
Mah (2020), RCT: Parents Intervention: Mindfulness- Outcomes: Interpersonal mindfulness
Canada 1. Mindful - N=63 parents enhanced Behavioural Parent 1. Interpersonal mindfulness - No significant difference from pretest to
Behavioural - Mean age 40 Training (N=34) – IM-P post-intervention and between groups
Parent years - 12 weekly 2-hour group 2. Sense of competency –
Training - 57 females, 6 sessions; 10-12 participants Parenting send of Sense of competency
2.Standard males per group Competence (Efficacy - Both mindful and standard groups improved
Behavioural - Meditation/Mindfulness subscale) from pretest to post-intervention but had no
Parent Children practice adapted from MBCT 3. Parenting stress – PSI-SF significant differences between groups
Training - Aged 6 to 11 (Segal 2002) and MBSR 4. Parenting practices –
years (Kabat-Zinn 1990), group Parenting Scale Parenting stress
- ADHD check in on home practice, 5. Self-regulation - Behaviour - No significant difference from pretest to
didactic presentation, video Rating Inventory of Executive post-intervention and between groups
review and discussion, Function–Adult Version
question and answer 6. Child ADHD symptoms - Parenting practices
ADHD Rating Scale-IV - Parents in the mindful group reduced in
Control: Standard harsh parenting practices from pretest to
Behavioural Parent Training Analysis: post-intervention, but not in the standard
(N=29) - Pre-, post-intervention group.
- 12 weekly 2-hour group - one way ANOVA - Difference between groups was significant
sessions; 10-12 participants
per group Behavioural self-regulation
- Group check in on home - Parents in the mindful group had improved
practice, didactic behavioural dysregulation, whereas parents in
presentation, video review the standard groups had worsened
Country conditions
and discussion, question and behavioural dysregulation from pretest to
answer post-intervention
- Difference between groups was significant
Child ADHD symptoms

- Child ADHD symptoms improved from
pretest to post-intervention but there were no
differences between groups.
Potharst Randomised Parents Online mindful parenting Outcomes: Parenting stress
(2019), USA waitlist CT: - N=76 mothers training (N=43) 1. Parenting stress – PSQ - No difference in improvement from pretest
1. Mindful - Self-report - Adapted from Bogels (2013) 2. Maternal functioning to post-intervention between waitlist and
parenting elevated stress - 8 weekly online sessions (Overreactive parenting intervention group
2. Waitlist - Meditation, discipline) – Parenting Scale
Children psychoeducation, daily home 3. Self-compassion – Self- Maternal functioning (Overreactive parenting
- Non-clinical exercise, didactic presentation compassion scale discipline)
4. Depression and anxiety - Mothers in the intervention group had
Waitlist (N=33) symptoms – Patient health significant improvement in maternal
questionnaire-4 functioning from pretest to post-intervention
5. Child behaviour – CBCL as compared to the waitlist group
(aggressive behaviour and
emotional reactivity) Self-compassion
Analysis: significant improvement in self-compassion
- Pre-, post-intervention, 10 from pretest to post-intervention as compared
week follow up post to the waitlist group
intervention
- t-test Depression and anxiety symptoms
significant reduction in depression and anxiety
symptoms from pretest to post-intervention
as compared to the waitlist group
Child behaviour
- Mothers in the intervention group reported
improved child emotional reactivity and child
Country conditions
aggressive behaviour from pretest to post-
intervention as compared to the waitlist group
Williams RCT: Parents Mindful parenting (N=31) Outcomes: As compared to the waitlist control group:
(2020), USA 1. Mindful - N=67 parents - 4 weekly 1.25hour sessions 1. Interpersonal mindfulness
parenting - Aged 23 to 48 – IM-P Interpersonal mindfulness
2. Waitlist years (mean 31.2) Waitlist control (N=36) 2. Parenting stress – PSI - Parents in the intervention group had
control - 60 females, 7 increased overall mindfulness in parenting
males Analysis:
- Pre-, post- intervention, 4- Parenting stress
Children 6week follow up post - Parents in the intervention group had
- N=67 children intervention reduced overall parenting stress especially in
- 37 males 30 terms of parental distress
females
- Aged 3 to 6
years (mean 4.1)
- Non-clinical
ADHD = Attention deficit hyperactivity disorder; ASD = Autism spectrum disorder; CBCL = Child Behaviour Checklist; DASS-21 = Depression Anxiety Stress
Scale-21; FFMQ = Five-Facet Mindfulness Questionnaire; IM-P = Interpersonal mindfulness in parenting scale; MBCT = Mindfulness-based cognitive therapy;
MBSR = Mindfulness based stress reduction; PAIT = Parent-adolescent interaction laboratory task; PSI = Parenting stress index; PSQ = Parental stress
questionnaire; SWAN = Strengths and weaknesses of attention-deficit/hyperactivity disorder symptoms and normal behaviour Scale

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Journal Pre-proof

The efficacy of mindful parenting interventions: A systematic review

Shefaly Shorey PhDRN , Esperanza Debby Ng

To appear in: International Journal of Nursing Studies

Received date: 1 February 2021

© 2021 Elsevier Ltd. All rights reserved.

Shefaly Shorey, PhD, RN

Singapore, Level 2, Clinical Research Centre, Block MD11

10 Medical Drive, Singapore 117597, Singapore

in a non-reactive and non-judgemental way to a child at any present moment. Parenting

mindfulness is believed to influence parenting factors and parental psychological outcomes,

such interventions on interpersonal mindfulness in parenting and parenting behaviours has

received minimal empirical attention.

interventions on parenting mindfulness and parenting behaviours. Parenting stress, parents’

psychological wellbeing, interpersonal relationships, and child behavioural outcomes were

Design: A systematic review, meta-analysis, and narrative summary.

overall parenting stress. However, mindful parenting interventions demonstrated a moderate

findings on parenting behaviours, psychological wellbeing, relationships, and child behaviour

were presented narratively.

an impetus for further research.

Keywords: child; meta-analysis; mindfulness; parenting

What is already known about the topic?

 It is hypothesized that parenting mindfulness is associated with positive parenting

factors, parental wellbeing, positive child management practices and parent-child

interactions, and children’s emotional and behavioural outcomes.

increased parental psychological wellbeing, and children’s decreased externalising

and internalising behavioural scores.

What this paper adds?

 Mindful parenting interventions demonstrated a moderate effect size when examining

clinical samples of children, respectively, when compared to control groups.

 The narrative summary of evidence highlighted possible associations of mindful

parenting interventions with reduced negative parenting behaviour, improved parent-

clinical samples of children, respectively.

 There is contradictory evidence on the efficacy of mindful parenting interventions in

improving parental psychological wellbeing (i.e., symptoms of depression, anxiety,

outcomes, which warrants more research.

In contemporary Western psychology, mindfulness refers to intentionally bringing non-

judgemental awareness to the happenings of the present moment (Kabat‐Zinn, 2003).

Mindfulness exists as a disposition or could be obtained through regular mindfulness meditation

2014; Fjorback et al., 2011; Gu et al., 2015; Janssen et al., 2018).

Of particular interest is its introduction in parenting as mindfulness is extended from an

as bringing awareness and attention intentionally in a non-reactive and non-judgemental way to a

ruminative negative thinking, 3) improving parental executive functioning especially in

impulsive parents, 4) disrupting the intergenerational transmission of dysfunctional parenting

habits, 5) increasing self-nourishing attention, and 6) improving marital relationships and

functioning. Similarly, in Duncan et al.’s four-tiered framework (2009), parenting mindfulness is

proposed to be positively associated with parenting (e.g. communication, parenting self-efficacy)

interventions on parents’ level of parenting mindfulness as it is associated with parenting and

classified as parenting behaviours.

consolidate existing evidence on various mindful parenting interventions.

The increased number of studies on mindful parenting interventions and conflicting

psychological outcomes, other parental outcomes such as level of mindfulness, parenting

behaviours, or parent-child relationships were not examined. Moreover, since psychological

symptoms of internalisation and externalisation disorders. However, the heterogeneity of

level of interpersonal mindfulness in parenting and parenting behaviour.

To provide an overview of the efficacy of existing mindfulness parenting interventions, the

present meta-analysis aims to quantitatively evaluate the pooled efficacy of parenting-focused

mindfulness interventions on parenting mindfulness and parenting behaviours. Other outcomes

such as parenting stress, parents’ psychological wellbeing, interpersonal relationships (e.g.,