Townshend - Effectivness of Mindful Parents Programs

S YS T E M AT I C R E V I E W
The effectiveness of mindful parenting programs in

promoting parents’ and children’s wellbeing: a
systematic review
Kishani Townshend 1,2 Zoe Jordan 1 Matthew Stephenson 1 Komla Tsey 2
1
Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia, 2Cairns Institute, Faculty of Arts, Education and
Social Sciences, James Cook University, Cairns, Australia
EXECUTIVE SUMMARY
Background
The rationale for undertaking this review was to investigate a potential strategy to address the rising prevalence of
child and adolescent mental health disorders. The central tenants of mindful parenting appear to be emotional
awareness, emotional regulation, attention regulation, intentionality and non-judgmental acceptance.
Objectives
The primary objective of this review was to systematically evaluate the effectiveness of mindful parenting programs
in promoting children’s, adolescents’ and parents’ wellbeing, particularly in relation to the intensity of symptoms
associated with internalizing (depression, anxiety, stress) and externalizing (conduct) disorders. The secondary
objective was to evaluate how effective mindful parenting programs are in improving emotional regulation,
attention regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents
and parents.
Inclusion criteria
Types of participants
Children aged between 0 and 18 years and their parents who have completed a mindful parenting program were the
focus of this review.
Types of intervention(s)/phenomena of interest
Mindful parenting programs included in this review had a minimum duration of one to two hours per week for 6 to
8 weeks, delivered in a group format, by a facilitator with appropriate training. It included parenting programs that
drew upon mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based cognitive
behavior therapy, dialectical behavior therapy or acceptance commitment therapy. The comparator was the control
or waitlist conditions.
Types of studies
This review focused on randomized controlled trials evaluating the effectiveness of mindful parenting programs.
Types of outcomes
Primary outcomes were wellbeing or intensity of symptoms associated with internalizing disorders (depression,
anxiety, stress) and externalizing disorders (conduct disorders) in children, adolescents and parents. Secondary
outcomes were emotional regulation, quality of the parent-child relationship, resilience and mindfulness of the
children, adolescents and parents.
Search strategy
Eight databases were searched for studies evaluating mindful parenting programs from 1997 to November 2014. A
three-step search strategy was utilized to retrieve both published and unpublished studies written in English from
PubMed, PsycINFO, EMBASE, Scopus, Psychological and Behavioral Sciences Collection, CINAHL, Cochrane Library
and ProQuest Dissertations and Theses databases. A logic grid was developed for each of the eight databases to
identify the indexing terms and synonyms for the keywords ‘‘mindful’’ and ‘‘parenting’’.
Correspondence: Kishani Townshend, kishani.townshend@adelaide.edu.au

There is no conflicts of interest in this project.
DOI: 10.11124/JBISRIR-2016-2314
JBI Database of Systematic Reviews and Implementation Reports ß 2016 THE JOANNA BRIGGS INSTITUTE 139
©2016 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.

SYSTEMATIC REVIEW K Townshend et al.
Methodological quality
Methodological limitations included small sample sizes leading to lack of statistical power, multiple testing leading to
increased alpha errors in addition to information bias caused by a lack of blinding in the implementation and
assessment phase.
Data extraction
The data extraction process entailed using the standardized data extraction form from Joanna Briggs Institute Meta-
analysis of Statistics Assessment and Review Instrument to extract data from the selected studies.
Data synthesis
The heterogeneity of the samples, the measurement tools and outcomes measured precluded data synthesis
through meta-analysis. Conclusions on intervention effects were based on comparisons of the overall statistical
significance of the outcomes data.
Results
The search yielded 1232 articles, from which seven randomized controlled trials met the inclusion criteria. The
findings indicate mindful parenting programs may reduce parental stress, increase parents’ emotional awareness of
their 10 to 14-year-old children and reduce preschool children’s symptoms associated with externalizing disorders. A
recurring finding was that the mindful parenting programs reduced parents’ emotional dismissal of their adolescents
and preschoolers.
Conclusions
At present, there is insufficient evidence to conclude that mindful parenting programs can improve parents’ and
children’s wellbeing because of the methodological quality of the few studies that met the inclusion criteria.
Implications for practice
Although there is currently insufficient evidence, mindful parenting programs are increasingly used in a variety of
contexts. It may not be appropriate for psychotic or severely traumatized individuals.
Implications for research
Future studies could make a significant contribution to the field by designing studies with sufficient sample sizes,
adequate statistical power as well as blinding participants, facilitators and assessors.
Keywords Anxiety; conduct disorders; depression; emotional regulation and attention regulation; mindful
parenting; mindfulness
Background detection of mental illness could be one cost-effective

indfulness-based interventions are increas-
M ingly being used to address the rising preva-
lence of child and youth mental health disorders. The
strategy to address the delayed diagnosis of mental
health disorders. Mindful parenting has been defined
as the ability to pay attention to your child and your
primary mental health disorders during childhood parenting in a particular way, which is intentionally,
tend to be internalizing (anxiety, depression) and non-judgmentally while being in the here and
externalizing (aggression, oppositional defiance) now.7,8 This review aims to investigate the effective-
disorders.1 Approximately 25% of Australian and ness of mindful parenting programs in alleviating
international youth, who present with these symptoms associated with internalizing and exter-
disorders, continue to be impacted by the poor out- nalizing disorders.
comes of unemployment, underemployment and The Western concept of mindfulness is qualitat-
social isolation into adulthood.2–4 Internalizing dis- ively different from its apparent Eastern roots. The
orders refer to disorders associated with depression, definition of ‘‘mindfulness’’ as a psychological con-
anxiety and somatic symptoms.5 Externalizing dis- struct appears to have changed over the centuries, as
orders are characterized by impulsive, disruptive it traversed across cultures. Although the modern
conduct and substance use symptoms.5 The annual Western definition of mindfulness is stated to be of
cost of mental health disorders to the Australian Buddhist origin, Wallace9 notices there is no basis
community is approximately $20 billion per for this claim. The traditional Buddhist definitions of
annum.6 Raising parents’ awareness about the early mindfulness as retention, recollection or memory is a

common thread that pervades Theravadan, Zen and interventions tend to focus on being aware of nega-
Indo-Tibetan Buddhism, all of which trace this tive emotions and one’s ability to process them.17,18
meaning back to Buddha’s own recordings in Pali Hence, it appears that paying attention without
and Sanskrit.9 It refers to the memory of the moment judging or challenging one’s negative thinking can
with consideration for the ethics or values under- improve one’s ability to regulate emotions, focus
pinning the eight-fold path. The English term ‘‘mind- attention and react with greater flexibility to events.
fulness’’ is a translation of the Pali, Sanskrit and The integration of mindfulness with parenting
Japanese terms, ‘‘sati’’, ‘‘smRti’’ and ‘‘nen’’.10–12 started to appear in the Western literature around
‘‘Sati’’ means ‘‘memory’’ in English.10 In contrast 1997, when Myla and John Kabat-Zinn7 coined the
to this unified cluster of Buddhist definitions, mod- term ‘‘mindful parenting’’ in their book, Everyday
ern clinical psychology defines mindfulness as a non- blessings: the inner work of mindful parenting.
judgmental present-centered awareness in which Kabat-Zinn developed a manual for a mindful
whatever arises to attention is acceptable as it is.9 parenting program. However, over the past 18 years,
Such attention requires no remembrance, recollec- primary studies on mindful parenting programs
tion, recognition or naming, and it is free from ideas, using other manuals have steadily increased. The
ideals and prejudices.9 The essence of the modern theoretical rationale that underpins other mindful
mindfulness appears to be nothing more than parenting programs tends to be drawn from two
bare attention. broad approaches of mindfulness that have been
Attention appears to be the key active ingredient integrated into psychotherapy, namely, mindfulness
within modern mindfulness interventions that is based and mindfulness oriented. Mindfulness-based
attributed to promoting positive change. However, psychotherapy includes mindfulness-based stress
the modern definitions of mindfulness vary accord- reduction (MBSR), mindfulness-based cognitive
ing to different authors and their views on which therapy (MBCT) and mindfulness-based cognitive
aspects of attention is responsible for stimulating behavior therapy (MBCBT).17 Mindfulness-oriented
change. For instance, Kabat-Zinn13(p.145) defines models include acceptance commitment therapy
mindfulness as ‘‘the awareness that emerges through (ACT) and dialectical behavior therapy (DBT).15,19
paying attention on purpose, in the present moment, Although there are different versions of mindful
and non-judgmentally to the unfolding of experience parenting programs, the content of these programs
moment by moment.’’ According to Kabat-Zinn,13 it is similar as the central focus is on integrating mind-
is the ability to focus on the moment, without judg- fulness with parenting.
ment and running on automatic pilot that facilitates A core similarity among the various mindful
change. Langer’s14(p.40) definition of mindfulness parenting programs is the emphasis on being respon-
emphasizes ‘‘attention to variability’’ as an import- sive to a child’s emotions. Other similarities include
ant contributor to promoting change. Attention to intentionality, emotional awareness, emotional
variability is the ability to be aware of moment-to- regulation, attention regulation and non-judgmental
moment changes in one’s emotions, thoughts and acceptance. Mindful parenting is a meta-concept
surroundings.8 Regardless of the aspects of attention that is a higher level of awareness parents have about
that promotes change, there appears to be a con- their internal states, how they think and feel about
sensus that mindfulness improves wellbeing. A com- their thoughts.20 It goes beyond the simple expres-
prehensive meta-analysis found that mindfulness- sion of emotion to being aware of and reacting to
based therapy is an effective treatment for a variety parenting emotions.21 Interestingly, both Gottman
of psychological disorders, especially for reducing et al.21,22 and Kabat-Zinn7 started writing about
anxiety, depression and stress.13 The key active similar concepts of parenting emotions in 1997. It
ingredient of mindfulness is thought to be the involves both intrapersonal and interpersonal proc-
improved self-observation that promotes better cop- esses of parenting. The intrapersonal processes assist
ing skills.15,16 Mindfulness interventions have often parents change the relationship with their internal
been referred to as the third wave of cognitive states, namely thoughts, feelings, attributions,
behavioral therapies. The traditional cognitive attitudes and values.20 The interpersonal processes
behavioral therapy (CBT), tends to focus on enable empathic responding, perspective taking,
creating psychological change, whereas mindfulness emotional awareness and interpersonal closeness.20

Although various theorists propose different models emotional awareness of self and child involves
of mindful parenting, a fundamental similarity building parent’s capacity to become aware of
between the mindful parenting programs is the integ- emotions within themselves and their youth
ration of mindfulness with parenting. self-regulation in the parenting relationship
Emotional awareness, emotional regulation, inten- requires becoming less reactive and calmly select-
tionality, attention regulation and non-judgmental ing behaviors in accordance with parenting
acceptance appear to be central tenants of these mind- values
ful parenting programs. Two mindful parenting compassion for self and child involves helping
programs are the Mindfulness-based Strengthening parents develop a genuine empathic concern for
Families Program (MSFP) and Tuning Into Kids their child and themselves as parents.
(TIK). Mindfulness-based Strengthening Families The development of this psychometric assess-
Program has been used to prevent alcoholism and ment is a substantial contribution to this field as it
substance abuse among adolescents.23 The TIK pro- helps researchers to investigate which dimensions
gram uses Gotman’s emotion coaching technique to of mindful parenting are most effective in facili-
reduce parental stress among parents of preschoolers tating positive change. At present, there is no
from the general community and preschoolers evidence that mindfulness has an impact on the
diagnosed with autism. Although emotion coaching24 child’s brain development. However, there is a
is not specifically claimed to be a mindful parent- wealth of evidence demonstrating how neglect
ing technique, it upholds the central tenants of impairs the hippocampus and brain development
mindful parenting. The five steps of emotion coach- in children.
ing24 are: Mindful parenting has the potential to offer serv-
becoming aware of a child’s emotion, particu- ice providers with additional resources, namely
larly when it is at a lower intensity parents, in the early detection of mental health
viewing a child’s emotion as an opportunity for disorders. Unlike vaccination campaigns for physical
intimacy and teaching health conditions such as polio, parents are often not
communicating and understanding and accept- involved in the prevention or early detection of a
ance of the emotion child’s mental health disorders. One of the most
helping the child to use words to describe how significant mediators in promoting wellbeing within
they feel infant and youth mental health services are programs
if necessary, assisting them with problem solving that focus on parenting and the quality of the parent-
(while setting limits). child relationship.27 A wealth of evidence now dem-
Reperceiving is thought to be a key change proc- onstrates the effectiveness of parenting programs in
ess that facilitates mindfulness. It refers to the addressing children’s emotional and behavioral
fundamental ability to reduce automatic response problems. Some of these programs include the
patterns and the ability to distance themselves from Incredible Years, Stepping Stone Triple P, Signposts
negative affect.25 These programs provide new for Building Better Behavior, Research Units in
insights into how to be responsive to children’s Pediatric Psychopharmacology Parent Training, Sign
needs. and Grow Music Therapy, Mindfulness Training,
The Interpersonal Mindfulness in Parenting (IM- Parent-Child Interaction Therapy, the Autism Spec-
P) scale measures five dimensions of mindful parent- trum Conditions – Enhancing Nurture and Develop-
ing.26 These five dimensions of mindful parenting ment program, Parent Training for Smaller Groups
are: and Shorter Schedules, video modeling and feedback
listening with full attention involves training parent training and parent management training.28
parents to listen to their children with focused However, there is also a significant group of parents
attention in which the standard parent training is not effective
non-judgmental acceptance of self and child in addressing parental anger or capacity for self-
emphasizes training parents to become aware regulation.29 Furthermore, various authors have
of judgments and adopt a non-judgmental advocated for the development of additional com-
acceptance of traits, behaviors of self and ponents to parent programs to consolidate treatment
their youth gains as the effects do not appear to be long-lasting.

Mindful parenting programs offer a range of tech- be descriptive case series.35–37 The settings tend to
niques to break automatic patterns, also referred to be mostly home based with parents attending one to
as ‘‘automaticity’’ of negative emotions, thoughts two-and-a-half hours per week for six to 12 weeks.
and behavior that traditional behavioral parent There are also a few randomized controlled trials
training alone does not impact.30 The focus seems (RCTs)38,39 using small sample sizes. These studies
to be on interpersonal rather than intra-psychic, are mainly conducted in America, Australia or
wherein parents are encouraged to ‘‘slow down’’, Europe. Although all the participants are parents,
enhance their emotional states and respond with the target group of parents tends to vary from
more compassion to their children. Hence, reviewing pregnant mothers, parents of children presenting
the evidence on mindful parenting programs can with autism, parents of children diagnosed with
contribute to the broader debate on the role and conduct disorders and parents of children from the
effectiveness of these programs in the timely diag- age 10 to 14, to parents on a methadone program
nosis of mental health conditions. with preschoolers. Both experimental and descrip-
Parental mental health plays a significant role in tive studies indicate that mindful parenting pro-
promoting their children’s mental health. Evidence grams can improve the parent-child relationship,
shows that 23% of Australian children live with a parenting skills and the child’s wellbeing with regard
parent that has a mental illness.27 These children are to social and emotional competence.40 The results
identified as a vulnerable, high-risk population from these primary studies indicate some consistency
because of predisposed mental health concerns of positive effects.
and the stressors associated with living with parents While a preliminary search conducted in April
diagnosed with a mental health disorder.27 The 2014 found no completed systematic reviews or
stressors may include the social, emotional, environ- review protocols in the major bibliographical data-
mental and financial stressors. The etiology of men- bases, a later search found a similar review proto-
tal health disorders appears to be bidirectional, col,41 which was written in 2012 and published in
wherein parents and children influence each other’s September 2014. The databases that were searched
thinking and behavior.31 Parental mental illness, in April 2014 included the Joanna Briggs Institute
poor quality parenting, substance abuse and dis- Database of Systematic Reviews and Implementa-
rupted family life are all involved in the development tion Reports, PubMed, CINAHL, Cochrane Data-
of childhood conduct disorders.32 Poor parenting base of Systematic Reviews, Database of Abstracts of
has been found to be one of the most important Reviews of Effects, EMBASE, PsycINFO and PROS-
precursors to early onset of conduct disorders.33 PERO, the international database of prospectively
Inadequate parenting is characterized by ineffective registered systematic reviews in health and social
parenting skills such as punitive and inconsistent care. The similar protocol states the systematic
discipline, low levels of parental supervision and review was planned to be completed by the end of
low levels of involvement.34 In addition, children’s January 2013. However, no completed systematic
behavioral difficulties contribute to the development review has been published on the topic by the
of parental mental illness. The cyclical nature associ- authors to date. This protocol was not found on
ated with the development of mental illness means PROSPERO. Similarities between the studies are
that any form of early intervention needs to address that both protocols are evaluating the effectiveness
parental mental health and parenting skills. of mindful parenting interventions on children’s
Studies evaluating mindful parenting programs outcomes. Although the title of Macvean et al.’s41
generally tend to be group-based programs and a protocol states the review is focusing on the psycho-
few studies focus on programs delivered through the social outcomes for children, the protocol specifies it
one-to-one format. Group programs are qualitat- will also be evaluating parental psychosocial out-
ively different from the individual sessions as the comes such as depression, anxiety, stress, family
group dynamics play a key role in the therapeutic functioning and adverse effects.
process. Results also show that parents in the indi- The main differences between the two protocols
vidual therapy session appear to have better are that the primary outcomes of Macvean et al.’s41
outcomes. The majority of the studies evaluating protocol are psychosocial outcomes for the children.
group-based mindful parenting programs tend to In contrast, the primary outcomes of this systematic

review are both parents’ and children’s outcomes psychological distress. In fact, there was no evidence
related to internalizing and externalizing disorders. to show that reduced hours were less effective than
Another difference between the protocols is that standard hours in reducing psychological distress.43
Macvean et al.’s41 study excludes discrete studies Finally, the limited use of psychometrically sound
wherein parents present with clinical diagnosis such measures of mindfulness, as it relates to parents and
as mental illness or substance dependency. The cur- children, leads to difficulties in articulating and
rent review included studies wherein parents had a measuring the active agent responsible for positive
clinical diagnosis. Another major difference between change.
the studies is that although the Macvean et al.’s41 This systematic review aims to select studies with
protocol excludes perinatal studies wherein child- similar theoretical rationale content, dose and vali-
ren’s outcomes had not been measured, this review dated scales to investigate whether mindful parent-
includes perinatal studies that have and have not ing programs are effective in promoting wellbeing.
measured children’s outcomes. The Macvean The definitions of both wellbeing and mindfulness
et al.’s41 protocol focuses on brief, group-based are just as controversial as its measurement. This
interventions typically less than 20 sessions. The study draws upon the Western definition of mind-
inclusion criteria for this review is slightly different fulness as the ability to be attentive to the present.7,13
as it focuses on group-based mindful parenting pro- More specifically, mindfulness was defined as the
grams with a minimum duration of one to two hours non-judgmental attentional process of being present
per week for six to eight weeks, delivered in a group in the moment without running on automatic pilot.
format, by a facilitator with appropriate training. It focuses on the clarity of thinking and flexibility
The secondary outcomes for the current study were of thinking. Wellbeing was defined according to
emotional regulation, quality of the parent-child the definition provided by Dodge et al.,44 that is
relationship, mindfulness and resilience. The secon- wellbeing as the state of equilibrium or balance that
dary outcomes for the Macvean et al.’s41 protocol can be affected by life events or challenges. Given
were parental psychosocial outcomes. So although the scarcity of studies with validated wellbeing
there are similarities between the two protocols, measures, this review also measured wellbeing in
there are many differences in the inclusion criteria. terms of the reduction in the intensity of symptoms
Both the systematic reviews can complement each associated with internalizing and externalizing dis-
other and contribute to collecting the best available orders. This review can add to the broader debate on
evidence on mindful parenting programs and may be whether mindful parenting programs could be added
used collaboratively to work with parents, children to the repertoire of tools used in the prevention and
and service providers to promote the timely diag- early intervention of mental illness. This systematic
nosis of children’s mental health disorders. review was conducted in accordance with the
Several systematic reviews have been completed protocol45 registered on PROSPERO (www.crd.
on group-based parenting programs. However, there york.ac.uk/PROSPERO) with the registration
appears to be no completed reviews on mindful number CRD42014015164.
parenting programs. A recent systematic review on
the effectiveness of mindfulness practices on parents Objectives
and professionals caring for children with develop- The primary objective of this review was to system-
mental delays found that mindful practices improved atically evaluate the effectiveness of mindful parent-
care providers’ experiences and supported them, ing programs in promoting children’s, adolescents’
providing a better standard of care to the recipi- and parents’ wellbeing, particularly in relation to the
ents.42 The proliferation of mindfulness-based inter- intensity of symptoms associated with internalizing
ventions targeting children and families tend to have (depression, anxiety, stress) and externalizing (con-
conceptual and methodological limitations. First, duct) disorders. The secondary objective was to
there appears to be no consistent model of mindful evaluate how the effectiveness of mindful parenting
parenting. Second, the studies vary in content, dose programs in improving emotional regulation, quality
and theoretical underpinnings. A recent review of the parent-child relationship, resilience and mind-
found no significant relationship between class fulness of the children, adolescents and parents. The
hours for a MBSR program and the effect sizes for comparator was the control or waitlist conditions.

The populations of interest in this study were chil- internalizing disorders (depression, anxiety, stress)
dren aged between 0 and 18 years and their parents and externalizing disorders (conduct disorders) of
who have completed a mindful parenting program. the children, adolescents and parents. Secondary
outcomes included emotional regulation, quality
Inclusion criteria of the parent-child relationship, resilience and mind-
Types of participants fulness of the children, adolescents and parents.
This review considered studies that included children These outcomes were measured on validated tools
aged 0–18 years old, whose parents have completed with known psychometric properties such as the
a mindful parenting program. The participants were Depression, Anxiety and Stress Scale46 and other
the children or adolescents and their parents. Most relevant scales. Time points of measurements such
countries across the world consider a child to be an as pre, post and follow-up were also relevant to the
adult when they become 18 years old. This study durability of the outcomes.
considered an individual younger than 18 years old
as a child. The inclusion criteria encompassed chil- Types of studies
dren with or without a mental health diagnosis and The primary study design of interest for this review
those from culturally diverse, adopted or fostered was RCTs. In the absence of RCTs, other study
backgrounds. designs such as quasi-experimental, observational
and descriptive study designs were considered. As
Types of intervention(s) RCTs meeting the inclusion criteria and of sufficient
A minor amendment was made to the inclusion methodological quality were identified, this review
criteria regarding the types of interventions specified did not include other study designs.
in the protocol, as it was too restrictive and would
have excluded the majority of the studies in the field. Search strategy
The intervention duration and facilitator qualifica- A three-step search strategy was utilized to find
tions were expanded to include mindful parenting published and unpublished studies written in English
programs with a minimum duration of one hour per from 1997 to November 2014. The timeframe was
week over a minimum of six weeks, delivered by a selected because ‘‘mindful parenting’’ started to
facilitator with appropriate training to maintain appear in literature from 1997, with Myla and
treatment fidelity. The duration of mindful parent- Jon Kabat-Zinn’s7 publication on the topic. Eight
ing programs in included studies ranged from six to databases were searched for the keywords ‘‘mind-
12 weeks with parents attending a group workshop ful’’ and ‘‘parenting’’ from April to November 2014.
for one to one-and-a-half hours each week. The The databases that were searched included PubMed,
review selected studies with consistency in the vari- PsycINFO, EMBASE, Scopus, Psychology and
ables such as program duration, timing, frequency, Behavioral Sciences Collection, CINAHL, Cochrane
intensity and facilitator training to maintain treat- Library and ProQuest Dissertations and Theses data-
ment fidelity. It included parenting programs that base. The initial search for keywords in the first eight
drew upon MBSR, MCT, MCBT, DBT or ACT. The databases was followed by an analysis of the text
focus was on interventions that combined mindful- words contained in the title, abstract and index terms
ness and parenting. used to describe the articles. A second search using
all identified keywords and index terms was then
Comparator undertaken across all included databases. Third, the
The mindful parenting programs were compared reference list of all identified reports and articles was
with the control group of standard care or usual care. searched for additional studies. As specified in the
protocol, the search for gray literature focused on
Outcomes searching ProQuest Dissertations and Theses data-
This review included studies that reported on out- base, as there was an absence of high-quality pub-
comes for children, adolescents and parents that lished studies. Scopus also finds EMBASE and
were measured with validated instruments. The PubMed articles. The search deliberately searched
primary outcomes were wellbeing in addition these different databases with the acknowledgment
to the intensity of symptoms associated with that a high number of duplicates will be found. This

was primarily to find additional material from the third reviewer. The primary reviewer allocated a
social sciences material. final critical appraisal rating for each study after
A logic grid was developed for each of the eight considering the assessments provided by the primary
databases to articulate the synonyms and indexing and secondary reviewers. A rating of 5/10 or above
terms associated with the initial keywords of ‘‘mind- on the JBI Critical Appraisal Checklist (Appendix II)
ful’’ and ‘‘parenting’’. Keywords associated with was considered to be the cut-off to be included into
‘‘mindful’’ included mindfulness, MBSR, MBCT, the review. Studies were considered to be of weak
MBCBT, DBT or ACT. Some keywords associated methodological quality if they scored 5/10 or 6/10,
with ‘‘parenting’’ included parent, parent-child moderate methodological quality if they scored 7/10
relationship, father, mother, parental, maternal, and strong methodological quality if they scored
paternal, perinatal, prenatal and antenatal. Com- 8/10 or above. This systematic review also assessed
plete search strategies for each database, including the methodological quality of the selected studies by
all search terms, are provided in Appendix I. The analyzing the strengths and weaknesses. The ration-
search may appear simple, but repeated testing con- ale for presenting the strengths and weaknesses in a
firmed that the use of truncations yielded a more table format is to summarize the methodological
efficient and consistent search. Rather than listing quality of the selected studies.
individual possibilities for keywords, truncations
allowed for all possible variations. For example Data extraction
mindful allowed for all possible variations such The data extraction process entailed using the stand-
as mindfulness, mindfulness-based, mindfully and ardized data extraction form from JBI-MAStARI
all other variations, which was confirmed through (Appendix III) to extract data from the selected
repeated testing. A comprehensive search was con- studies. The first author extracted and analyzed
ducted by utilizing a wide range of field codes that the data from the studies that met the inclusion
were used to conduct. For instance, text word [tw], criteria and were of sufficient methodological qual-
mesh term [mh], [mp] and many more. The field ity. The extracted data included specific details
code [tw] includes all words and numbers in the title, about the interventions, populations and study
abstract, MeSH terms, MeSH subheadings, publi- methods in addition to the outcomes of significance
cation types, substance names, personal name as to the review question and specific objectives. The
subject, corporate author, secondary source and authors of the selected articles were not contacted to
other terms. Mindfulness was only listed as a obtain additional data, as this was not required for
PubMed mesh term in 2014. Nevertheless, various data synthesis. Data items were sought for the list of
field codes, truncations and keywords were used to variables specified in the population, intervention,
cast a wide search net. The field code [mh] captures outcome and comparator (PICO). No assumptions
mesh terms. The field code mp was used for exhaus- or simplifications were made to the predefined vari-
tive searching of multiple fields such as title, ables. The principle summary measures that were
abstract, heading word, table of contents, key con- extracted included means (M), standard deviations
cepts, original title, tests and measures. Appendix I (SDs), standard errors (SEs), between group mean
outlines all the various field codes used in the logic differences, effect sizes (Cohen’s d, Cohen’s f2) and
grids. All selected articles were reviewed to deter- statistics from general linear models together with
mine if they met the inclusion criteria. respective P values.
Assessment of methodological quality Data synthesis

Articles selected for retrieval were assessed by two The selected studies were initially assessed for meth-
independent reviewers for methodological validity odological and conceptual similarities. As the age
prior to inclusion in the review using standardized groups, outcome measures, presenting conditions
critical appraisal instruments from the Joanna Briggs and sample characteristics widely varied in the
Institute Meta-analysis of Statistics Assessment and selected studies, a meta-analysis was rendered inap-
Review Instrument (JBI-MAStARI) (Appendixes II propriate because of the heterogeneity of the studies.
and III). Any disagreements that arose between the Hence, a narrative summary was presented. To
reviewers were resolved through discussion or with a account for confounding factors that age, mental

illness, cultural diversity and adoption may have program. However, some studies did not report
on outcomes, the protocol planned to conduct standard deviations of the differences, pre-program
sub-group analyses. The protocol aimed to conduct means or post-program means. For some studies and
sub-group analyses according to Erikson’s age some outcome measures, the baseline differences
brackets for psychosocial development, to address were quite substantial, which would need to be taken
the large developmental differences between the ages into account. All between group differences were
of 0 and 18. Erikson’s psychosocial developmental calculated by subtracting the control group Cohen’s
stages are infancy (0–18 months), early childhood ds from the intervention group Cohen’s ds. So the
(2–3 years), preschool (3–5 years), school age (6–11 sign and size of the Cohen’s d is a reflection of the
years) and adolescence (12–18 years).47 Insufficient between-group difference.
articles were found to conduct subgroup analysis In addition, Cohen’s f2 was presented as the effect
according to Erikson’s age groups, ethnic diversity measure for the study by Felver et al.49 as it includes
(Indigenous, migrant or African American), adopted an adjustment for differences in values at baseline.
or fostered children and internalizing disorders. Cohen’s f2of sizes 0.02, 0.15 and 0.35 are termed
Sufficient studies were found to conduct subgroup small, medium and large, respectively.48 Other stat-
analyses for externalizing disorders among children istics based on results from multivariable analysis
with autism and preschool children. The studies were presented as appropriate. A difficulty in
were analyzed according to three sub-groups: 1) synthesizing results is that some studies compared
mothers and 10–14-year olds from a community the effect of the intervention at one point in time
sample; 2) parents of children with autism, and 3) whereas other studies took into account their com-
parents of preschool children. These categories are parisons for the entire follow-up period. Those
clinically more meaningful as they combine studies authors that took into account the entire follow-
with similar characteristics of age, diagnoses, treat- up period, calculated the slope of the outcome
ments and co-morbidities. variable as it developed over time. This is also known
Methods used for handling data and combining as SLOPE or group-by-time interaction that analyzes
results of studies included using consistent measures the intervention effects over the entire time of
for measuring primary and secondary outcomes. As follow-up period (pre-program, post-program and
statistical pooling was not possible, the findings were follow-up scores).
presented in narrative form including tables and
figures to aid in data presentation if appropriate.
Means and standard deviations were analyzed for Results
continuous scales items. All results were subjected to Description of studies
double data entry. Standard errors were converted to A total of 1232 potentially relevant articles were
standard deviations when necessary. Between-group retrieved from searching the eight databases.
Cohen’s ds were calculated from mean values post- Endnote removed 601 duplicates. After duplicates
intervention and at follow-up compared with the were removed, 631 studies remained (Figure 1). As
control group without any intervention. The com- previously stated, the searching of EMBASE and
monly accepted criteria for effect sizes is small effect Scopus, in particular, would have captured dupli-
(d ¼ 0.20), moderate effect (d ¼ 0.50) and strong cates. However, these eight databases were deliber-
effect (d ¼ 0.80).48 The P values were calculated ately searched to capture all relevant articles. Of
for the calculated Cohen’s ds by using independent those remaining, 595 articles were excluded after
t tests. titles and abstract screening. From the 36 articles
For Tables 1–3, the differences between the inter- that advanced to the full article review, 29 did not
vention and control groups were calculated by com- meet the inclusion criteria (Appendix IV). Seven
paring post-program Cohen’s ds and follow-up articles were assessed for methodological quality
Cohen’s ds for the two conditions. So these and subsequently included in this review. Mindful
between-group differences do not take into account parenting research is still an emerging new field.
baseline differences. For that, Cohen’s d would need All selected studies evaluated the impact of group-
to have been calculated on the average differences based mindful parenting programs on parents’ or
and their standard deviations between pre- and post- children’s outcomes.

Records identified through Additional records identified through

Identification database searching other sources
(n = 1227) (n = 5)
Total records identified Duplicates removed

(n = 1232) (n = 601)
Records after duplicates

removed (n = 631)
Screening
Titles and abstracts of Records excluded

records screened (n = 595)
(n = 631)
Full-text articles
Full-text articles assessed
excluded, did not
Eligibility
for eligibility
meet inclusion criteria
(n = 36)
(n = 29)
Studies excluded,
Studies assessed for insufficient
methodological quality methodological quality
(n = 7) (n = 0)
Included
Studies included in
quantitative synthesis
(no meta-analysis)
(n = 7)
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for
Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097.
doi:10.1371/journal.pmed1000097
50
Figure 1: PRISMA flow diagram
Study characteristics children. Results for the predefined primary and

Table 4 describes the characteristics of studies secondary outcomes for these three subgroups are
included in this review. It highlights the variation reported in Tables 1–3. A post-hoc decision was
of participant groups, programs, measurement times made to summarize findings on Attention Regula-
and the use of different outcome measures. The tion and Maternal Emotional Regulation as it may
studies were conducted in Australia or the United be of clinical significance, in understanding both
States. All studies used a modified intention-to-treat internalizing and externalizing disorders.
analysis and did not blind their facilitators or asses-
sors. Although the programs had different names, all Methodological quality
the programs integrated mindfulness with parenting Table 5 summarizes the critical appraisal ratings for
either by specifically drawing on Kabat-Zinn’s the included studies. The ratings ranged from 5/10
MBSR (Studies 1, 2, 3 and 6)20,23,49,51 or Gotman’s (low) to 7/10 (moderate). So the strength of the
work on emotional awareness (Studies 4, 5 and evidence from these studies could be considered
7).52–54 When the selected studies were categorized low to moderate. Although all studies did randomly
according to clinical characteristics, age groups and allocate participants to treatment and control
types of participants, three sub-groups emerged. groups, none of the studies blinded their partici-
These subgroups were 1) mothers and 10–14-year pants, facilitators or assessors. Randomization aims
olds from a community sample, 2) parents of chil- to address confounding bias. Many selected studies
dren with autism, and 3) parents of preschool conducted tests to check if randomization was

Table 1: Characteristics of included studies
Outcome
measures
relevant
to this
Study Participant systematic
Authors Country N design type Age of youth Program Control review Timing Blinding ITT analysis
1 Coatsworth USA 432 3-armed Grade 6 and 10–14-year 1. MSFP 2 2. SFP 2 hour 1. IM-P; 2. T1 – baseline; Open Modified ITT
SYSTEMATIC REVIEW
et al. RCT 7students and olds hours per session for 7 PYRQ T2 – post
(2015)23 their parents week for 7 weeks; 3. (week 7); T3 –
from the general weeks Home-study 1 year
population control
2 Coatsworth USA 65 3-armed Grade 5 and 6 10–14-year 1. MSFP 2 2. SFP (n U 23) 1. IM-P; 2. T1 – baseline; Open Modified ITT
et al. RCT students and olds hours per 2hr session for 7 PYRQ T2 – post
(2010)20 their mothers week for 7 weeks; 3. Wait- (week7)
from the general weeks list control
population (n U 17)
3 Havighurst Australia 54 2-armed Parents of chil- 4–5.11 years 1. TIK 2. Waitlist con- Parent out- T1 – baseline; Open Modified ITT
et al. RCT dren with exter- (n U 31) 2 trol (n U 23) comes 1. DER- T2 – post
(2013)52 nalizing beha- hours per waitlist control S; Child (week 6); T3 –
vior difficulties week for 6 offered the pro- outcomes 2. 6 months
weeks gram after fol- EBCI
JBI Database of Systematic Reviews and Implementation Reports

low-up data
collection
4 Havighurst Australia 216 2-armed Parent and pre- 3–5 years 1. TIK 2. Waitlist con- Parent out- T1 – baseline; Open ITT using last
et al. cluster school children (n U 106); 2 trol (n U 110) comes 1. DER- T2 – post available data
(2010)53 RCT from com- hours per S; Child (week 6); T3 – and Modified
munity sample week for 6 outcomes 2. 6 months ITT
weeks ECBI

Blinding: Open ¼ participants, researchers, outcome assessors were all non-blinded.

ITT analysis: Modified ITT ¼ ITT but with reduced sample size of 50 based on multiple imputation of missing values.

Modified ITT U ITT with reduced sample size due to follow-up loss.
Program: MSFP – Mindfulness-Enhanced Strengthening Families Program; TIK – Tuning to Kids
Control: SFP – Strengthening Families Program (SFP)
Outcome measures: IM-P Interpersonal mindfulness in parenting (Duncan, 2007)26
PYRQ – Parent–youth relationship quality (combination of scales)
DERS – Difficulty in Emotional Regulation Scale (Gratz & Roemer 2004)
ECBI- The Eyberg Child Behavior Inventory 6 (Eyberg & Pincus 1999) – behavior
Detailed results are only reported for outcomes that are relevant to the primary and secondary outcomes measured by psychometrically validated scales as specified in the
protocol.
ß 2016 THE JOANNA BRIGGS INSTITUTE

K Townshend et al.
149
Outcome
measures
relevant to
Study this systematic
Authors Country N design Participants Age of youth Program Comparison review Timing Blinding ITT analysis
5 Neece USA 46 2-armed Parents of chil- 2.5–5 years 1. MAPS (n U 21); 2. Waitlist Parent out- T1 – baseline; Open Modified ITT
(2014)51 RCT dren with devel- 2 hours per week control comes 1. PSI- T2 – post
opmental delays for 8 weeks þ 1 (n U 25) wait- SF; Child out- (week 8)
(DD) day long medita- list control comes 2.
tion retreat MBSR offered the CBCL
SYSTEMATIC REVIEW
module, March program in

2012 June 2012
6 Wilson Australia 128 2-armed Parents of you- 4–5.11 years 1. TIK (n U 62); 2 2. Waitlist 1. DERS; 2. T1 – baseline; Open Modified ITT
et al. cluster ng children in hours per week for control ECBI T2 – 7 months assumed
(2012)54 RCT the general 6 weeks þ 2 fol- (n U 66) wait-
population low-up booster list control
sessions offered the
program after
T2
(7 months
post-program)
7 Felver et al. USA 41 2-armed Parent–child 9–12 years 1. MFSR (n U 24) 2. Waitlist 1. ANT; 2. T1 – baseline; Open Modified ITT
(2014)49 RCT dyad, children 2 hours per week control Conflict T2 – post

aged 9–12 years for 7 weeks (n U 23) Monitoring; 3. (week 7)
from normative Orienting; 4.
community Alerting
sample

Blinding: Open ¼ participants, researchers, outcome assessors were all non-blinded.

ITT analysis: Modified ITT ¼ ITT but with reduced sample size of 50 based on multiple imputation of missing values.

Modified ITT UITT with reduced sample size due to follow-up loss.
Program: MAPS, Mindful Awareness for Parenting Stress (Neece, 2013)57 based on Mindfulness-based Stress Reduction (MBSR) by Kabat-Zinn (1990)58; MFSR, Mindful Families Stress Reduction (Felver & Tipsord,
2011)60 adapted from Mindfulness-based Stress Reduction (MBSR) by Kabat-Zinn (1990)58; TIK, Tuning To Kids (Havighurst & Harley, 2007).59
Outcome measures: ANT, Attention regulation (Fan et al., 2002)63; Conflict Monitoring, Orienting, Alerting; CBCL, Child Behavior Checklist (Achenbach, 2000)62 (1.5–5-year-old child items); DERS, Difficulty in Emotional
Regulation Scale (Gratz & Roemer, 2004)55; ECBI, The Eyberg Child Behavior Inventory 6 (Eyberg & Pincus, 1999)56 – Behavior; PSI-SF, Parenting Stress Index Short Form 3 ed. (Abidin, 1995)61-36 items.
Detailed results are only reported for outcomes that are relevant to the primary and secondary outcomes measured by psychometrically validated scales as specified in the protocol.

K Townshend et al.
150
Table 2: Summary of critical appraisal
Q9,
Q1, Q6, Q8, outcomes Q10,
random Q2, Q3, Q5, comparable Q7, outcomes measured appropriate
assignment participants allocator Q4, assessor groups at identical measured reliable statistical
Authors of groups blinded blinded ITT blinded entry treatment same way way analysis Total
SYSTEMATIC REVIEW
1 Coatsworth Y N U Y N U Y Y Y U 5/10
et al. (2015)23
2 Coatsworth Y N N Y N U Y Y Y U 5/10
et al. (2010)20
3 Havighurst Y N U Y N U Y Y Y Y 6/10
et al. (2013)52
4 Havighurst Y N Y Y N U Y Y Y Y 7/10
et al. (2010)53
5 Neece Y N N Y N U Y Y Y Y 6/10
(2014)51

6 Wilson et al. Y N U Y N U Y Y Y Y 6/10
(2012)54
7 Felver et al. Y N N Y N N Y Y Y Y 6/10
(2014)49
Q1 – Was the assignment to treatment groups truly random?
Q2 – Were participants blinded to treatment allocation?
Q3 – Was allocation to treatment groups concealed from the allocator?
Q4 – Were the outcomes of people who withdrew described and included in the analysis?
Q5 – Were those assessing outcomes blind to the treatment allocation?
Q6 – Were the control and treatment groups comparable at entry?
Q7 – Were groups treated identically other than for the named interventions?
Q8 – Were outcomes measured in the same way for all groups?
Q9 – Were outcomes measured in a reliable way?
Q10 – Was appropriate statistical analysis used?

Blinding refers to comparison between mindfulness intervention and home study or waiting list control.

ITT ¼ modified ITT based on analysis of participants with respective complete data.

K Townshend et al.
151
Table 3: Strengths and weaknesses of included studies
Authors N Design Strengths Weaknesses

23
1 Coatsworth et al. (2015) 432 3-armed RCT 1) By comparison large sample size; however 1) No sample size calculation and hence potentially low
might have been reduced to 50; statistical power;
2) Participants from rural and urban areas in 2) No adjustment for multiple testing; no control of alpha
Pennsylvania with varied ethnical and beta errors;
SYSTEMATIC REVIEW
backgrounds; 3) Missing data – imputed missing values – reducing data

3) Use of IM-P scale; set to 50; sample size in analysis unclear; No
4) Model clearly articulates five dimensions of comparison of results to un-imputed data;
mindful parenting; 4) Confounding bias: randomized study but success of
5) Hypothesis testing; randomization cannot be assessed as data is not given;
6) Implementation fidelity analysis adjusted for some characteristics – reasoning
unclear;
5) Information bias: self-assessment of outcome
characteristics; study is not blinded, i.e. the
comparison between mindfulness intervention and
home study control group is from an open study;

6) Selection bias: loss to follow-up is not described
20
2 Coatsworth et al. (2010) 65 3-armed RCT 1) Hypothesis testing; 1) Small sample size; no sample size calculation and hence
2) Inclusion of fathers potentially low statistical power;
2) No adjustment for multiple testing; no control of alpha
and beta errors;
3) Missing data – imputed missing values; no comparison
of results to un-imputed data;
4) Confounding: Urn-randomization of matched pairs
(triplets?); matched on five characteristics; procedure
not removed from researchers; success of
randomization cannot be assessed as data is not given;
characteristics; study is not blinded, i.e. the
waiting list control is from an open study;
6) Selection bias: participants from rural towns in

Pennsylvania only; loss to follow-up is not described
in detail

K Townshend et al.
152
Table 3. (Continued)

52
3 Havighurst et al. (2013) 54 2-armed RCT 1) Teacher and external observer assessment in 1) Small sample size; no sample size calculation and hence
addition to parental assessment could reduce potentially low statistical power;
information bias as they could be blinded 2) No adjustment for multiple testing; no control of alpha
and beta errors;
SYSTEMATIC REVIEW
3) Study showed one-sided P values which additionally

inflated the overall alpha error;
4) Confounding: randomization may have been
unsuccessful; large differences in pediatric treatment
between Control and Intervention groups (81–52%);
5) Success of randomization for other characteristics
cannot be assessed – data not presented;
6) Randomization took place before exclusion criteria
were applied – a flaw in the design which may explain
baseline differences between groups;

characteristics by parents; study is not blinded, i.e. the
waiting list control is from an open study – also true
for teacher and observer assessment;
8) Selection bias: participants from two hospitals in one
metropolitan center in Australia; Loss to follow-up:
parents 28% at post and 24% at 6 months; teachers
22% at post and 30% at 6 months; no sensitivity
analysis was conducted

K Townshend et al.
153

53
4 Havighurst et al. (2010) 216 2-armed cluster RCT 1) By comparison, medium-sized study; 1) No sample size calculation and hence potentially low
2) Recruitment from 61 schools in Melbourne; statistical power;
3) Analysis took cluster design into account; 2) No adjustment for multiple testing; no control of alpha
4) ITT analysis; and beta errors;
5) Random allocation via computerized random 3) Confounding: success of randomization cannot be
SYSTEMATIC REVIEW
number allocation assessed as data not presented; would however be

important because of cluster design;
waiting list control is from an open study – also true
for teacher and observer assessment;
5) Selection bias: all participants are from one
metropolitan center in Australia;
6) Loss to follow-up: 20 and 17% post-intervention and
follow-up for intervention group and 13 and 7% for

control group, respectively; no sensitivity analysis
was conducted
51
5 Neece (2014) 46 2-armed RCT 1) Hypothesis testing; 1) Small sample size; no sample size calculation and hence
2) Innovative approach to treating comorbid potentially low statistical power;
behavior problems; 2) No adjustment for multiple testing; no control of alpha
3) Random allocation – number drawn and beta errors;
from a box 3) Data were altered: ‘‘outliers’’ were set to 3SD; no
estimations of variability (SD or SE) were given in
manuscript;
4) Confounding: randomization may have been
unsuccessful; large differences marital status (81 versus
64%) and family income (57.1 versus 36%);
5) No adjustment for confounding during data analysis;

7) Selection bias: initially five of 51 parents drop out of

study; differential loss of data in the control group:
K Townshend et al.
154
16 of 25 (64%) report child behaviors compared to
19 of 21 (90%) in the intervention group

54
6 Wilson et al. (2012) 128 2-armed cluster RCT 1) By comparison medium-sized study; 1) No sample size calculation and hence potentially low
2) All 28 local government area pre-schools in statistical power;
the city of Knox participated; 2) No adjustment for multiple testing; no control of alpha
3) Analysis took cluster design into account and beta errors;
SYSTEMATIC REVIEW
3) Confounding bias: success of randomization cannot be

assessed as data was not presented. However, this
would be important because of cluster design;
5) Selection bias: the study recruited participants from
higher socio-economic strata of society
49
7 Felver et al. (2014) 41 2-armed RCT 1) Hypothesis testing; 1) Small sample size; no sample size calculation and hence

2) Treatment fidelity; potentially low statistical power;
3) Breathing, meditation and yoga component 2) Confounding: randomized study but success of
randomization cannot be assessed as data is not given;
note that non-significant results are not indicative
because of lack of statistical power; randomization did
not work for two of the three outcome measures;
however, statistical analysis took these baseline
differences into account;
3) Information bias: study not blinded; however, outcome
assessment was removed from participants;
4) Selection bias: participants from one medium-sized
town in Oregon

K Townshend et al.
155
Table 4: Results for mothers and 10–14-year-old community sample
Between group comparison: mindfulness intervention versus control;
Author Sample size (n) effect size: Cohen’s d or Cohen’s f2
Post-intervention Follow-up
Significant scale Significant scale

items; P value items; P value
Range of effect sizes (significant items Range of effect (significant items
SYSTEMATIC REVIEW
for scale items on the scale) sizes for scale items on the scale)
1 Coatsworth et al. (2015)23 N ¼ 432; MSFP 1-year follow-up
(n ¼ 154); SFP
(n ¼ 160) Control
(n ¼ 118)
Interpersonal mindfulness in 5 items/4 items for youth 5 items/4 items for youth
parenting (I-MP)
Mother d range: 0.05 to 0.17 ns d range: 0.01 to 0.26 Emotional awareness of youth
d ¼ 0.26; P < 0.05
Youth on mother d range: 0.11 to 0.12 ns d range: 0.03 to 0.25 Listening with full attention: d ¼ 0.25;
P < 0.05; Compassion/acceptance for
youth: d ¼ 0.23; P < 0.05

Father d range: 0.10 to 0.28 Emotional d range: 0.15 to 0.51 Emotional awareness of youth
awareness of d ¼ 0.51; P < 0.001; Compassion/
youth d ¼ 0.28; acceptance for youth: d ¼ 0.25;
P < 0.05 P < 0.05; Compassion/acceptance for
self: d ¼ 0.37; P < 0.001
Youth on father d range: 0.19 to 0.17 ns d range: 0.03 to 0.34 Emotional awareness of youth
d ¼ 0.34; P < 0.05
Parent-youth relationship 4 items 4 items
quality
Mother d range: 0.06 to 0.18 ns d range: 0.17 to 0.26 Family involvement d ¼ 0.26; P < 0.05
Youth on mother d range: 0.01 to 0.11 ns d range: 0.02 to 0.28 Approach to emotions d ¼ 0.28;
P < 0.01
Father d range: 0.02 to 0.32 Family involvement d range: 0.00 to 0.27 Support/understanding d ¼ 0.27;
d ¼ 0.32; P < 0.05 P < 0.05
Youth on father d range: 0.07 to 0.15 ns d range: 0.10 to 0.27 Approach to emotions d ¼ 0.27;
P < 0.05
2 Coatsworth et al. (2010)52 N ¼ 65; NA
n ¼ 50 in analysis;
MSFP (n ¼ 25);
SFP (n ¼ 23);

Control (n ¼ 17)
IM-P 7 items/3 items for youth

K Townshend et al.
156
Author Sample size (n) effect size: Cohen’s d or Cohen’s f2
SYSTEMATIC REVIEW
Significant scale Significant scale

items; P value items; P value
Range of effect sizes (significant items Range of effect (significant items
for scale items on the scale) sizes for scale items on the scale)
Mother d range: 0.15 to 0.76 Mindful parenting d ¼ 0.66;
P < 0.05; Rules communication
d ¼ 0.76; P 0.01
Youth on mother d range: 0.04 to 0.36 ns
Parent-youth relationship 4 items
quality
Mother d range: 0.18 to 0.32 ns
Youth on mother d range: 0.36 to 0.30 ns

3 Felver et al. (2014)49 N ¼ 47; NA
n ¼ 41 in analysis;
MFSR (n ¼ 22);
Control (n ¼ 19)
Attention regulation of 3 items
youth
Conflict monitoring f2 ¼ 0.16 P < 0.01
Orienting f2 ¼ 0.09 P ¼ 0.01
Alerting f2 ¼ 0.10 ns
MFSR, Mindful Families Stress Reduction; MSFP, Mindfulness-based Strengthening Families Program; SFP, Strengthening Families Program.
ns ¼ not significant.
NA ¼ not available.

K Townshend et al.
157
Table 5: Results for parents/mothers of children with autism
Author Sample size (n) effect size: Cohen’s d and slope of growth curve models between groups
Significant items;
Range of effect sizes Significant items; P value Range of effect size P value (significant
for scale items (significant items on the scale) for scale items items on the scale)
SYSTEMATIC REVIEW
1 Neece (2014)51 N ¼ 46 in analysis; MAPS (n ¼ 21); NA

Waiting list control (n ¼ 25)
PSI-SF (parental) d ¼ 0.70 P < 0.05
CBCL (youth)
Syndrome scales 7 items; ns
d range: 0.31 to 0.71
Broadband and total scores 3 items; ns
d range: 0.13 to 0.45
DSM-oriented scales 5 items; Attention deficit/hyperactivity
d range: 0.20 to 0.85 problems, d ¼ 0.85; P < 0.05
2 Havighurst et al. (2013)52 N ¼ 54; ‘‘Tune into kids’’ (n ¼ 31); 6-month follow-up

pediatric waitlist control (n ¼ 23);
in analysis:
n ¼ 23 versus 16 post;
n ¼ 24 versus 17 6 months
DERS (parental) d ¼ 0.17$ ns d ¼ 0.12; Slope ¼ 0.005 ns; P ¼ 0.448
ECBI (parental-rated
child outcomes)
Behavior intensity d ¼ 0.60 ns d ¼ 0.003; Slope ¼ 2.03 ns; P ¼ 0.208
Behavior problem d ¼ 0.45 ns d ¼ 0.07; Slope ¼ 1.00 ns; P ¼ 0.098
$
Between group Cohen’s ds were calculated for Havighurst et al. (2013)52 based on post and follow-up means and weighted averaged standard deviations.
CBCL, Child Behavior Checklist (Achenbach, 2000)62 (1.5 to 5-year-old child items; DERS, Difficulty in Emotional Regulation Scale (Gratz & Roemer, 2004)55; ECBI, The Eyberg Child Behavior Inventory 6 (Eyberg & Pincus,
1999)56 – Behavior; MAPS, Mindful Awareness for Parenting Stress (Neece, 2014)51; PSI-SF, Parenting Stress Index Short Form 3ed (Abidin, 1995)61-36 items.

K Townshend et al.
158
successful. It was unclear if the groups were com- parenting program called MSFP appears to have
parable at entry for six of the seven included studies significantly improved fathers’ and mothers’
even after randomization in Table 5. The seventh emotional awareness of their youth. One study
study by Felver et al.49 stated that the groups were found fathers experienced significant increases in
not comparable at entry. One reason for this may be the emotional awareness of their youth (d ¼ 0.28,
because of the cluster randomization wherein certain P < 0.05) (small effect) directly after the interven-
preschools were allocated to the intervention group tion.23 At one-year follow-up, both the fathers
or the waitlist control group. For instance, the study (d ¼ 0.51, P < 0.001) and mothers (d ¼ 0.26,
by Havighurst et al.53 found more sole parents in the P < 0.05) reported significant improvement in their
intervention group (n ¼ 17) than the waitlist (n ¼ 6) emotional awareness of their youth.23 The youth
even after randomization. Implications of this are also agreed that their fathers had improved
that other confounding factors may be responsible emotional awareness of them (d ¼ 0.34, P < 0.05)
for the intervention effect. Havighurst et al.53 took (small effect). At one-year follow-up, the fathers
these differences into account in their analysis by reported a significant increase in their compassion/
adjusting for the differences in marital status acceptance of their youth (d ¼ 0.25, P < 0.05) (small
between the groups. Similarly, although Havighurst effect) and compassion/acceptance for self (d ¼ 0.37,
et al.52 randomly allocated children attending two P < 0.001) (small effect).23 Another study by Coats-
behavior clinics to either the intervention or waitlist worth et al.20 found MSFP increased mothers’ self-
control groups, the sample characteristics show that reported scores on the IM-P scale by a moderately
the children whose parents were in the intervention significant effect (d ¼ 0.76, P < 0.01). So this mind-
group had significantly greater verbal ability at time ful parenting program appears to significantly
1 compared with the children in the waitlist control improve parents’ emotional awareness of their
condition. Havighurst et al.52 accounted for these children.
differences by co-varying verbal ability in their There is also tentative evidence to indicate that
analyses. Strengths of these studies include outcomes the Mindful Family Stress Reduction (MFSR) inter-
being measured in a reliable and identical manner. vention appeared to improve children’s attentional
The identical treatment of both the groups other processes.49 Table 1 shows that MFSR significantly
than the named intervention is another strength of decreased children’s conflict monitoring with a
these selected studies. medium effect size ( f2 ¼ 0.16, P < 0.01).49 There
Table 6 describes the methodological strengths was also a significant improvement on orienting
and weaknesses of the studies included in this ( f2 ¼ 0.09, P ¼ 0.01; small effect) and no signifi-
review. Limitations of the selected studies included cant impact on alerting ( f2 ¼ 0.10, not significant).49
small sample sizes, selection bias, information bias This systematic review used the f2 reported by Felver
and confounding bias. The majority of the included et al.49 rather than calculating Cohen’s d because f2
studies had small sample sizes and no sample size allowed adjustment for baseline values, which were
calculations, which can lead to potentially low sta- quite different for the intervention and the control
tistical power to detect the impact of the inter- groups. The three domains underpinning attention
vention. Selection bias was another limitation that regulation include conflict monitoring, orienting and
resulted from participants being selected from a alerting.49 Conflict monitoring is a process of regu-
particular geographical area or loss to follow-up lating one’s attention. It is the ability to focus on
not being described. None of the selected studies certain information while deliberately ignoring
blinded the participants. This may lead to infor- other information.
mation bias, because although some participant Results from Neece57 in Table 2 found that mind-
groups were not aware there were two groups (inter- ful parenting significantly reduces parental stress
vention and control), the outcome measures were (moderate effect) at post-intervention (d ¼ 0.70,
self-assessed by the participants. P < 0.05) among parents with autistic children.
Neece57 also found that the mindful parenting
Findings of the review program called TIK significantly reduced one item
Table 1 summarizes studies on parents and 10–14- namely attention-deficit/hyperactivity problems
year olds from a community sample. The mindful (strong effect) (d ¼ 0.85, P < 0.05) in children at

Table 6: Results for parents of preschool children
Between group comparison: mindfulness intervention versus control; effect size: Cohen’s
Author Sample size (n) d and group time interaction from general linear modeling
Significant items; Significant items;

P value (significant P value (significant
Effect size items on the scale) Effect size items on the scale)
SYSTEMATIC REVIEW
1 Havighurst et al. (2010)53 N ¼ 216; Tuning Into Kids – TIK (n ¼ 106); 6-month follow-up
waiting list controls (n ¼ 110)
N ¼ 78 versus 93 DERS;
N ¼ 79 versus 94 ECBI
Emotion regulation
DERS d ¼ 0.10$ ns d ¼ 0.41; P ¼ 0.008; P< 0.002
Group time interaction:
F ¼ 10.52
Emotion dismissing d ¼ 0.81 P < 0.001 d ¼ 0.79; P < 0.001; P < 0.001
F ¼ 52.83
Emotion coaching d ¼ 0.75 P < 0.001 d ¼ 0.63; P < 0.001; P < 0.001

F ¼ 12.97
Empathy/connection d ¼ 1.02 P < 0.001 d ¼ 0.93; P < 0.001; P < 0.001
F ¼ 24.44
ECBI (parental-rated child outcomes)
Behavior intensity d ¼ 0.40 P ¼ 0.009 d ¼ 0.34; P ¼ 0.027; P < 0.001
F ¼ 11.14
Behavior problem NA NA
2 Wilson et al. (2012)54 N ¼ 128; TIK (n ¼ 62) NA 7-month follow-up
waiting list controls (n ¼ 66);
varying sample sizes in analyses NA
Emotion regulation
DERS NA
Emotion dismissing d ¼ 0.66; P < 0.001; P < 0.001
F ¼ 17.58
Emotion coaching d ¼ 0.073; ns; P ¼ 0.733

F ¼ 0.12
Empathy/connection NA

K Townshend et al.
160
post-intervention.57 The Child Behavior Check List

Between group comparison: mindfulness intervention versus control; effect size: Cohen’s
P ¼ 0.007; P ¼ 0.104
P value (significant
items on the scale)
Significant items;
(CBCL) uses the Diagnostic Statistical Manual
(DSM)-oriented scale to assess conduct disorders.
ns; P ¼ 0.097
The five items of the CBCL DSM-oriented scale for
conduct disorders include affective problems,
d and group time interaction from general linear modeling
anxiety problems, pervasive developmental prob-

lems, attention-deficit/hyperactivity problems and
Follow-up
oppositional defiant problems. Among the five items
¼ Between group Cohen’s ds were calculated for Havighurst et al. (2010)53 and Wilson et al. (2012)54 based on post and follow-up means and weighted averaged standard deviations.
on the CBCL DSM scale, the mindful parenting
program called TIK appears to have significantly

Effect size
reduced one item namely attention-deficit/hyper-

activity problems.
Table 3 summarizes findings on parents of pre-
school children from the general community. Two
d ¼ 0.32;
d ¼ 0.48;
F ¼ 2.80
F ¼ 2.68
studies53,54 reported conflicting results on how

DERS, Difficulty in Emotional Regulation Scale (Gratz & Roemer, 2004)55; ECBI, The Eyberg Child Behavior Inventory 6 (Eyberg & Pincus, 1999)56 – Behavior.
parents viewed their child’s behavior at six months

follow-up. TIK targets parents’ emotional aware-
P value (significant
Effect size items on the scale)
Significant items;
ness, regulation and communication with their child.

Results from Maternal Emotional Scale Question-
Post-intervention
naire were not reported as they were not identified in

the predefined primary and secondary outcomes.
Emotional regulation was a predefined secondary
outcome. Table 3 describes the emotion regulation
outcome as measured by the Difficulties in
Emotional Regulation Scale that is a 36-item self-
reported questionnaire measuring various aspects of
emotional awareness and regulation.53 Parents in the
intervention group reported moderately significant
decreases in emotionally dismissive behaviors and
beliefs (d ¼ 0.79, P < 0.001), moderately signifi-
Sample size (n)
cant increases in emotion coaching (d ¼ 0.63,

P < 0.001) and significant improvements in empathy
(d ¼ 0.93, P < 0.001) (strong effect) at six months
follow-up.53 Similarly, a study by Wilson et al.54
found that parents reported moderately significant
reductions in emotionally dismissing behaviors and
beliefs (d ¼ 0.66, P < 0.001). However, unlike the
study by Havighurst et al.,53 Wilson et al.54 found no
significant improvement in emotion coaching
ECBI (parental-rated child outcomes)
(d ¼ 0.073, not significant). With regard to child-

ren’s behavior, there were conflicting results. Wilson
et al.54 found significant reductions in parents’
perceptions of their child’s problem behavior

Author
(d ¼ 0.48, P ¼ 0.007) (small effect), but no signifi-

Behavior intensity
Behavior problem
cant improvements in parents’ perceptions of their

child’s behavior intensity (d ¼ 0.32, not signifi-
cant). In contrast, Havighurst et al.53 did find sig-

nificant improvements in parents’ perceptions of
their child’s behavior intensity (d ¼ 0.34,
P ¼ 0.027) but no significant reductions in parents’
$

perceptions of their child’s problem behavior. So the highlighting favorable outcomes. Some systematic
main findings from the subgroup of parents with review tools are better than others in reducing
preschool children are that this mindful parenting the subjectivity of the critical appraisal process.
program significantly reduces parents’ emotionally The JBI-MAStARI Critical Appraisal Checklist
dismissive behavior. However, there were conflict- does not have a data dictionary that clearly articu-
ing findings with regard to parents’ perceptions of lated what types of statistical analysis were con-
their children’s problem behavior and behavior sidered to be appropriate or what constituted
intensity. strong, moderate or weak evidence. The primary
reviewer made subjective decisions on defining
Discussion how to rate what constituted strong, moderate
This systematic review aimed to synthesize the small and weak evidence. Other critical appraisal tools
body of literature on mindful parenting. Given the such as the Canadian Quality Assessment Tool for
methodological quality of the included studies, it is Quantitative Studies by the Effective Public Health
difficult to draw definitive conclusions about the Practice Project clearly defines how to rate the evi-
effectiveness of mindful parenting programs. The dence and has a data dictionary.66 Although nine out
tentative findings indicate that mindful parenting of the 10 questions in the JBI-MAStARI Critical
programs may reduce parental stress and reduce Appraisal Checklist are useful, the addition of a data
symptoms associated with attention deficit and dictionary to clarify appropriate statistical analysis
hyperactivity in their preschoolers diagnosed with could reduce the subjectivity associated with the
autism spectrum disorder. Chronic stress impairs tool. It is evident from an analysis of the study
wellbeing, health and the ability to learn.65 The characteristics that the quality of the study designs
mindful parenting program called MSFP appears tends to be weak. Mindful parenting research
to improve parents’ emotional awareness of children appears to be plagued by a range of methodological
aged 10–14 years, particularly fathers’ emotional limitations such as inadequate research design, lack
awareness of their adolescents. A practical implica- of statistical power to detect treatment effects in
tion of these findings is that MSFP could be used to addition to lack of blinding in the implementation
encourage fathers to become more emotionally and assessment.
aware of their adolescents. Parents, particularly An additional major limitation with all of the
fathers, reported they were less emotionally dismis- included studies was the small sample sizes and
sive and more aware of their adolescent’s emotions. limited power. Small sample sizes increase Type 1
Furthermore, the mindful parenting program called error, compromises the ability to make meaningful
TIK appears to reduce parents’ tendency to dismiss conclusions and reduces external validity of treat-
their preschool child’s emotions. Most of the find- ment effects. Second, all the studies were conducted
ings from the included studies demonstrated small- in developed countries with mainly middle-class
to-moderate effects according to different measures Caucasian families. It is unclear if these findings
of significance (Cohen’s d, f2 and F). Hence, the can be generalized to diverse populations in devel-
findings presented in this review can guide future oping countries. Future studies with larger sample
hypotheses rather than declare definitive conclusions sizes could reduce the potential threat of Type 1
about intervention effects. error and increase the generalizability of the
findings.
Methodological limitations Another limitation with the selected studies is that
The interpretations of the findings need to be none of the studies blinded their participants, asses-
considered in light of key limitations. The three sors or facilitators during the implementation stage.
main limitations of this review include acknowledg- Information bias may arise from not blinding the
ing the subjective decisions inherent in the critical participants, facilitators or assessors. Failure to blind
appraisal tool, the methodological quality of the the participants can lead to information bias with
included studies and the lack of clarity on participants over estimating treatment effects or
which aspects of mindfulness facilitate change. All under reporting symptoms. All the selected studies
systematic reviews are based on subjective decisions attempted to reduce selection bias and confounding
that are clearly stated at the outset to avoid only bias by using computer-generated numbers to

randomly allocate participants to the treatment and for articles in the psychology, social and behavioral
control conditions. sciences. It outlines a format to report results so that
It was not possible to conduct a meta-analysis readers can easily extract data for verification and
because of the heterogeneity of the studies and the easily understand the findings. The APA publication
failure of some studies to report summary statistics. manual recommends the reporting of sample sizes,
Some of the included studies did not report standard means, standard deviations and effect sizes. Some of
deviations, pre-program means and post-program the selected studies did not report all necessary
means. These studies did not follow American summary statistics so a meta-analysis could not be
Psychological Association’s (APA)67 publication conducted. The main aim of a RCT is to focus on
manual for reporting summary statistics. The APA comparing between-group differences to infer con-
publication manual is the primary referencing guide clusions about causation. The field of mindful
Table 7: JBI levels of evidence for effectiveness55
Level of evidence Study design

Level 1 Level 1 – Experimental Designs
Level 1.a Systematic review of randomized controlled trials (RCTs)
Level 1.b Systematic review of RCTs and other study designs
Level 1.c RCT
Level 1.d Pseudo-RCTs
Level 2 Level 2 – Quasi-experimental Designs
Level 2.a Systematic review of quasi-experimental studies
Level 2.b Systematic review of quasi-experimental and other lower study designs
Level 2.c Quasi-experimental prospectively controlled study
Level 2.d Pre-test – post-test or historic/retrospective control group study
Level 3 Level 3 – Observational: Analytic Designs
Level 3.a Systematic review of comparable cohort studies
Level 3.b Systematic review of comparable cohort and other lower study designs
Level 3.c Cohort study with control group
Level 3.d Case-controlled study
Level 3.e Observational study without a control group
Level 4 Observational – Descriptive Studies
Level 4.a Systematic review of descriptive studies
Level 4.b Cross-sectional study
Level 4.c Case series
Level 4.d Case study
Level 5 Level 5 – Expert Opinion and Bench Research
Level 5.a Systematic review of expert opinion
Level 5.b Expert consensus
Level 5.c Bench research/single expert opinion

parenting would immensely benefit from future the present.25 Focusing on one’s breath or non-
studies that report between-group means, standard judgmental awareness does magically alleviate dis-
deviations, pre-program means, post-program means, tress. Reperceiving is the fundamental ability to
effect sizes and other findings according to APA reduce automatic response patterns and intensity
guidelines. of strong emotions.25 It has been emphasized for
further discussion in this article as different mind-
Challenges of mindfulness fulness theories acknowledge that reperceiving is a
Some of the challenges of mindfulness research key change process that facilitates mindfulness and
include the lack of clarity about which aspects of reduces distress.25 Overcoming highly conditioned
mindfulness are responsible for facilitating positive responses and cognitive biases require insight and
health benefits. Different scholars propose that practice. This could be challenging for parents who
different processes are responsible for promoting lack insight or the motivation to practice the new
behavior change. Some of these processes include techniques in emotional self-regulation. A commit-
reperceiving, attention to variability, intentionality, ment to maintaining a warm, affectionate relation-
breath awareness and non-judgmental awareness of ship with a discipline not to react requires consistent
Table 8: Application of JBI Grades of Evidence to the mindful parenting programs
JBI grade Explanation for JBI grade of evidence

Grade B According to the JBI Grade of evidence, there is currently a ‘weak’ recommendation for
the use of Mindful Parenting Programs for the following reasons:
(1) although desirable effects appear to outweigh undesirable effects, it is not clear;
(2) the evidence supporting its use is not of high quality;
(3) there is a benefit, no impact or minimal impact on resource use, and;
(4) values, preferences and the patient experience have been taken into account.
Feasibility It has the potential to be cost effective in the prevention or early
detection of depression and anxiety. However, this systematic review
did not conduct a cost-benefit analysis. Furthermore there is also a lack
of longitudinal prevention and early intervention studies on Mindful
Parenting programs.
Resource constraints include lack of funding and time restrictions on
parents to attend group-based training.
Facilitators trained in Mindfulness-based Stress Reduction (MBSR) and
Mindful Parenting could provide consistency in program content and
competence.
Appropriateness It is culturally acceptable across a diversity of cultures, Eastern, First
Nations and more recently Western individuals.
The critical factor is the individual’s interest and motivation to practice
the techniques.
It is transferable to the majority of the population and a variety of
circumstances. It may not be appropriate for psychotic or highly
traumatized individuals.
Meaningfulness Findings indicate it is associated with positive experiences. No negative
experiences have been reported in the studies.
Effectiveness The preliminary findings indicate it has a beneficial effect, is safe and
has no harm associated with the practice. However there is a need for
rigors randomized control trials to verify the effects.

daily effort.68 Mindfulness training alone may not be included studies. Applying the scale that rates the
powerful enough to consistently reduce levels of feasibility, appropriateness, meaningfulness and
distress.69 A physical component to mindfulness effectiveness64 of the results, the evidence appears
such as yoga, breath awareness and other techniques to be ‘‘weak’’ because of the lack of rigorous studies
may strengthen behavior change. Another challenge measuring mental health outcomes (Table 8). So,
of mindfulness is that different mindful parenting futures studies need to utilize more rigorous research
models are practiced from the purely psychological designs to clarify the effectiveness of mindful
techniques to those that include breath awareness, parenting programs.
yoga and video feedback. Despite the limitations of Although there is no conclusive evidence for the
this systematic review, it highlights an intervention recommendation of mindful parenting programs,
that could ameliorate significant mental health these programs are growing in popularity among a
problems and family violence. As such, it holds variety of contexts and cultures. It appears to be
the potential to be an innovative intervention that having a positive, beneficial impact on raising the
provides parents with an opportunity to exercise emotional awareness of both the parents and their
choice over responses rather than engaging in auto- children. The cognitive requirements of these pro-
matic, habitual reactions. grams would make them unlikely to be effective
among parents with florid psychosis or severe
trauma. The selected studies in this review did not
Conclusions
report on side-effects. Hence, mindful parenting
This systematic review aimed to synthesize the cur- programs appear to be an appropriate psycho-edu-
rent evidence on the effectiveness of mindful parent- cation tool for parents in the general community
ing programs. A comprehensive search of eight who are interested in reducing their own stress levels
databases retrieved 1232 articles, from which seven and increasing their emotional awareness of their
studies met the inclusion criteria. At present, there children.
is insufficient evidence to conclude that mindful
parenting programs can improve children’s and Implications for research
parents’ wellbeing. The findings indicate mindful Future mindful parenting research would benefit
parenting programs may reduce parental stress, from designing more methodologically rigorous
increase parents’ emotional awareness of their chil- studies that blind the random allocation, imple-
dren and reduce children’s symptoms associated mentation and assessment of both experimental
with externalizing disorders. However, these find- conditions. Using a critical appraisal checklist could
ings are tentative because of the major limitations assist with designing a robust study. Conducting a
with the selected studies, namely the small sample power analysis could justify the recruitment of suf-
sizes, limited power and lack of methodological ficient sample sizes to detect intervention effects.
rigor. Future studies could make a substantial con- Effect size estimates provide important information
tribution to the field, if methodologically rigorous about treatment effects particularly when small
study designs with sufficient sample sizes tested the sample sizes reduce the power to detect statistically
effectiveness of a mindful parenting program for significant effects. Articulating clear hypotheses and
internalizing and externalizing disorders. implementing a consistent model of mindful parent-
ing could assist with articulating and testing which
Implications for practice aspects of attention/mindfulness promote change.
A systematic review of RCTs is considered to yield Reporting results according to APA guidelines could
the highest level of evidence in evaluating the effec- enable meta-analysis of the future studies. The use of
tiveness of a health strategy (Table 7). However, psychometrically validated tools to measure aspects
according to JBI Grades of Evidence and Recom- of attention responsible for facilitating change is
mendations,64 the current evidence on mindful essential in understanding the rich tapestry of mind-
parenting programs would receive a Grade B or a fulness. Investigations on mindful parenting should
‘‘weak’’ recommendation (Appendix V). That is, the not just focus on the psychological measures of
strength of the evidence is considered to be ‘‘weak’’ mindfulness but would also benefit from measuring
because of the methodological quality of the biomarkers of stress, brain development and

physical health. It is important for future studies to 10. Digital Dictionaries of South Asia. Pali–English Dictionary.
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ual of the American Psychological Association. 6th ed. 81. Felder JN, Dimidjian S, Goodman SD, Gallop R. How might
.Washington DC: American Psychological Association; 2009 mindfulness based cognitive therapy help prevent perinatal
68. Duncan L, Coatsworth J, Greenberg M. A model of mindful depression: the role of mindfulness, decentering, and rumi-
parenting: implications for parent-child relationships and nation. Arch Womens Ment Health 2013;16:S49–50.
prevention research. Clin Child Fam Psychol Rev 2009;12(3): 82. Ferraioli SJ, Harris SL. Comparative effects of mindfulness
255–70. and skills-based parent training programs for parents of
69. Guardino C, Dunkel S, Bower J, Lu M, Smalley S. Randomised children with autism: feasibility and preliminary outcome
controlled pilot trial of mindfulness training for stress data. Mindfulness 2013;4(2):89–101.
reduction during pregnancy. Psychol Health 2014;29(3): 83. Gershy N. Mentalization, mindfulness and emotion regula-
334–49. tion do parents need to mind themselves in order to mind
70. Barber CC, Clark M, Williams S, Isler RB. Relaxation and their children [PhD]. Ann Arbor: Long Island University, The
mindfulness to manage stress in pregnancy: initial studies Brooklyn Center; 2014.
of a computerised self-help programme. MIDIRS Midwifery 84. Geurtzen N, Scholte RHJ, Engels RCME, Tak YR, van Zundert
Digest 2013;23(4):449–54. RMP. Association between mindful parenting and adoles-
71. Bencuya NL. Acceptance and mindfulness treatment for cents’ internalizing problems: non-judgmental acceptance
children adopted from foster Care [PhD]. Ann Arbor: Uni- of parenting as core element. J Child Fam Stud
versity of California, Los Angeles; 2013. 2015;24(4):1117–28.

85. Iadarola SJ. Comparative effects of mindfulness and skills- problems and attentional functioning in adolescents with
based parent training programs: feasibility and preliminary ADHD. J Child Fam Stud 2012;21(5):775–87.
outcome data [PhD] Ann Arbor: Rutgers, The State Univer- 92. Werner E, Miller M, Howard M, Monk C. Behavioral change in
sity of New Jersey – New Brunswick; 2011. the mother-infant dyad: preventing postpartum depres-
86. Lee J. Mindfulness-based cognitive therapy for children: sion. Arch Womens Ment Health 2013;16:S40–1.
feasibility, acceptability, and effectiveness of a controlled 93. Whitebird RR, Kreitzer M, Crain AL, Lewis BA, Hanson LR,
clinical trial [PhD] Ann Arbor: Columbia University; 2006. Enstad CJ. Mindfulness-based stress reduction for family
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parents of children with autism spectrum disorders and other 2013;53(4):676–86.
I/DD conditions. J Intellectual Dis Res 2012;56(7–8):737. 94. Whittingham K, Sanders M, McKinlay L, Boyd RN. Stepping
88. O’Brien KM. Evaluating the effectiveness of a parent training stones triple p and acceptance and commitment therapy
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Appendix I: Search strategies

PubMed
Mindful Parenting
Mindfulness [mh] OR Mindful [tw] Parenting [mh] OR Child-rearing [mh:no exp] OR Child-
OR Dialectical Behaviour Therap [tw] rearing [tw] OR Childrearing [tw] OR Parent-child relations
OR Dialectical Behavior Therap [tw] [mh] OR Parent [tw] OR Father [tw] OR Mother [tw]
OR Acceptance and Commitment OR Parental [tw] OR Paternal [tw] OR Maternal [tw] OR
Therap [tw] Perinatal [tw] OR Prenatal [tw] OR Antenatal [tw]
10/11/14
Mindful ¼ 3859
Parenting ¼ 800,629
Mindful Parenting ¼ 175
PsycINFO
Mindful Parenting
Mindfulness.sh OR Mindful.mp OR Parenting.sh OR Parenting Skill.sh OR Parenting Style.sh OR
Dialectical Behaviour Therapy.sh OR Parents.sh OR Child-rearing.mp OR Childrearing.mp OR exp
Dialectical Behavior Therapy.sh OR Parent-child relations OR Parent.mp OR Fathers.sh OR
Dialectical Behaviour Therap.mp OR Father.mp OR Mothers.sh OR Mother.mp OR Paren-
Dialectical Behavior Therap.mp OR tal.mp OR Paternal.mp OR Maternal.mp OR Perinatal
Acceptance and Commitment Thera- Period.sh OR Perinatal.mp OR Prenatal Care.sh OR Pre-
py.sh OR Acceptance and Commitment natal.mp OR Antenatal.mp
Therap.mp
7/11/14
Mindful ¼ 994
EMBASE
Mindful Parenting
Mindfulness:de,ti,ab OR Mindful:ti,ab Parenting:de,ti,ab OR ‘Child rearing’:de,ti,ab OR ‘Child
OR ‘Dialectical Behaviour Therapy’:- parent relation’/syn OR Parent/syn OR Parent:de,ti,ab OR
ti,ab OR ‘Dialectical Behaviour Thera- Parental:de,ti,ab OR Father/syn OR Father:de,ti,ab OR
pies’:ti,ab OR ‘Dialectical Behavior Mother/syn OR Mother:de,ti,ab OR Parental:ti,ab OR
Therapy’:ti,ab OR ‘Dialectical Behavior Paternal:ti,ab OR Maternal:ti,ab OR Perinatal:de,ti,ab OR
Therapies’:ti,ab OR ‘Acceptance and Prenatal:de,ti,ab OR Antenatal:ti,ab
Commitment Therapy’:ti,ab OR
‘Acceptance and Commitment Thera-
pies’:ti,ab
3/11/14
Mindful ¼ 5 225

Scopus
Mindful Parenting
Mindful OR ‘‘Dialectical Behav’’ OR ‘‘Child rearing’’ OR Parent OR Parental OR Parental OR
‘‘Acceptance and Commitment Father OR Mother OR Parental OR Paternal OR
Therap’’ Maternal OR Perinatal OR Prenatal OR Antenatal
3/11/14
Mindful ¼ 8149
Parenting ¼ 1,205,095
CINAHL
Mindful Parenting
MH Mindfulness OR TI Mindful OR MH Parenting OR MH Parentsþ OR MW Parent OR TI
AB Mindful OR TI ‘Dialectical Beha- Parent OR AB Parent OR MH Fathersþ OR MW Father
viour Therap’ OR AB ‘Dialectical OR TI Father OR AB Father OR MH Mothersþ OR MW
Behaviour Therap’ OR TI ‘Dialectical Mother OR TI Mother OR AB Mother OR MW Parental
Behavior Therap’ OR AB ‘Dialectical OR TI Parental OR AB Parental OR MW Paternal OR AB
Behaviour Therap’ OR TI ‘Dialectical Paternal OR TI Paternal OR MW Maternal OR TI
Behaviour Therap’ OR TI Acceptance Maternal OR AB Maternal OR MW Perinatal OR TI
and Commitment Therap’ OR AB Perinatal OR AB Perinatal OR MW Prenatal OR TI
‘Acceptance and Commitment Therap’ Prenatal OR AB Prenatal OR AB Antenatal OR TI
Antenatal
3/11/14
Mindful ¼ 1869
Cochrane Trial Register
Mindful Parenting
Mindfulness OR Mindful OR ‘Dia- Parenting OR Parents OR Parent-Child relations OR Parent
lectical Behaviour Therapy’ OR ‘Dia- OR Father OR Mother OR Parental OR Paternal OR
lectical Behavior Therap’ OR Maternal OR Perinatal OR Prenatal OR Antenatal
‘Acceptance and Commitment Therap’
Cochrane 3/11/14
Mindful ¼ 1016
Parenting ¼ 38,736
Trials ¼ 27
Reviews ¼ 24

Psychology and Behavioral Sciences
Mindful Parenting
Mindfulness OR Mindful OR Parenting OR Parents Parent OR Child rearing OR Parent
‘‘Dialectical Behaviour Therapy’’ OR OR Father OR Mother OR Parental OR Paternal OR
‘‘Dialectical Behavior Therap’’ OR Maternal OR Perinatal OR Prenatal OR Antenatal
‘‘Acceptance and Commitment
Therap’’
6/11/14
Mindful ¼ 1259
Parenting ¼ 59,102
Theses and Dissertations
Mindful Parenting
SU, AB,TI (Mindfulness) OR SU,AB,TI SU,AB,TI (Parenting) OR SU,AB,TI (Parents) OR SU,AB,TI
(Mindful) OR SU,AB,TI (‘‘Dialectical (Parent) OR SU,AB,TI (Fathers) OR AB,TI (Father) OR
Behaviour Therap’’) OR SU,AB,TI SU,AB,TI (Mothers) OR AB,TI (Mother) OR AB,TI
(‘‘Dialectical Behavior Therap’’) OR (Paternal) OR AB,TI (Parental) OR SU,AB,TI (Maternal)
SU,AB,TI (‘‘Acceptance and Commit- OR SU, AB,TI (Perinatal) OR SU, AB,TI (Prenatal) OR
ment Therap’’) AB,TI (Antenatal)
30/10/2014
Mindful ¼ 2 122

Appendix II: Appraisal instruments

MAStARI appraisal instrument

Appendix III: Data extraction instruments

MAStARI data extraction instrument


Appendix IV: Full-text articles excluded
Reference Reason for exclusion

1 Barber, Clark, Williams & Isler It is a computerised stress management program for preg-
(2013)70 ancy, not a mindful parenting program.
2 Bencuya (2013)71 The article is a conference abstract. Researchers were unable
to access fulltext.
3 Britton, Lepp, Niles, Rocha, Fisher The article is a conference abstract. Researchers were unable
& Gold (2014)72 to access the full text of the study.
4 Brown, Whittingham, McKinlay, It is a protocol of a RCT on Triple P plus stress manange-
Boyd & Sofronoff (2013)73 ment. The article is a protocol not the actual RCT results.
5 Coatsworth, Duncan, Berrena, Bam- The study design is not a RCT. Theoretical paper on
berger, Loeschinger & Greenberg mindful parenting.
(2014)74
6 Dawe & Harnett (2007)39 The study does not use a group-based Mindful Parenting
program. The RCT is on intensive home-based intervention
Parents Under Pressure (PUP).
7 Dimidjian & Goodman (2011)75 The article is a conference abstract. Researchers were unable
to access the full text of the study.
8 Dimidjian, Goodman, Felder & The article is a conference abstract. Researchers were unable
Gallop (2013)76 to access the full text of the study.
9 Duncan, Cohn, Chao, Cook, Ricco- The article is a conference abstract. Researchers were unable
bono & Bardacke (2014)77 to access the full text of the study.
10 Duncan & Bardacke (2010)78 The study design is not a RCT. It is mixed method,
observational study design with pre–post measures.
11 Dykens (2012)79 It is not a Mindful Parenting program. This RCT compares
Mindfulness-based Stress Reduction (MBSR) with Positive
Parenting.
12 Dykens, Fisher, Taylor, Lambert & The program was not a Mindful Parenting program. It is a
Miodrag (2014)80 RCT on Mindfulness-based Stress Reduction (MBSR) versus
Positive Adult Development. Peer mentors facilitated the
group-based mindful training for 1.5 hours per week for 6
weeks.
13 Felder, Dimidjian, Goodman & The article is a conference abstract. Researchers were unable
Gallop (2013)81 to access the full text of the study.
14 Ferraioli & Harris (2013)82 No waitlist control group. It is a RCT comparing the
mindful parenting condition with a skills-based parenting
condition. The other included studies in this systematic
review have a waitlist control group.
15 Gershy (2014)83 It is not a group based Mindful Parenting program. It is an
one-to-one program.
16 Geurtzen, Scholte, Engels, Tak & The study design is not a RCT. It is not a RCT. Cross-
van Zundert (2014)84 sectional study design.

(Continued)
Reference Reason for exclusion

17 Guardino, Schetter, Bower, Lu & The intervention is not specifically a Mindful Parenting
Smalley (2014)69 program. It is an antenatal stress reduction program that
could be attended by the general public, pregnant or
otherwise.
18 Iadarola (2011)85 The study does not compare the intervention to control/
waitlist condition.
19 Lee (2006)86 Full thesis is unable to be accessed. Only a preview was
accessed.
20 Miodrag & Dykens (2012)87 The article could not be accessed.
88
21 O’Brien (2013) The article is a protocol, not the RCT results. It has a quasi-
experimental design with interrupted time series measures.
22 O’Hara (2013)89 The article is a conference abstract. Researchers were unable
to access the full text of the study.
23 Sidhu (2014)90 Not a mindful parenting program. It is mindful meditation
program (Still Quiet Place) offered to children aged 7–12
years with Attention-deficit Hyperactive Disorder (ADHD).
24 Van de Weijer-Bergsma, Formsma, RCT on Mindful Kids focused on children aged 8–12 years
de Bruin & Bogels (2014)91 of age not parents.
25 Werner, Miller, Howard & Monk The article is a conference abstract. Researchers were unable
(2013)92 to access the full text of the study.
26 Whitebird, Kreitzer, Crain, Lewis, Population of interest are caregivers for a family member
Hanson & Enstad (2013)93 with dementia. This RCT compares mindfulness-based stress
reduction (MBSR) intervention with community caregiver
education and support (CCES) intervention.
27 Whittingham, Sanders, McKinlay & It is not actual RCT. It is a study protocol for a RCT on
Boyd (2013)94 three groups; Stepping Stones Triple P (SSTP), SSTP þ
Acceptance Commitment Therapy (ACT) and wait-list con-
trol.
28 Woolhouse, Mercuri, Judd & Brown The study aim was to reduce antenatal depression, anxiety
(2014)95 and stress. The pilot RCT compared MindBodyBaby con-
dition with the control condition Care as Usual.
29 Zhang (2013)96 Unable to access dissertation because of embargo.

Appendix V: JBI grades of evidence and recommendations55
JBI grades of evidence

Grade A A ‘‘strong’’ recommendation for a certain health management strategy where
1) it is clear that desirable effects outweigh undesirable effects of the strategy;
2) there is evidence of adequate quality supporting its use;
3) there is a benefit or no impact on resource use and
4) values, preferences and the patient experience have been taken into account.
Grade B A ‘‘weak’’ recommendation for a certain health management strategy where
1) desirable effects appear to outweigh undesirable effects of the strategy, although this is
not as clear;
2) there is evidence supporting its use, although this may not be of high quality;
3) there is a benefit, no impact or minimal impact on resource use and
4) values, preferences and the patient experience may or may not have been taken into
account.

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S YS T E M AT I C R E V I E W

The effectiveness of mindful parenting programs in

Correspondence: Kishani Townshend, kishani.townshend@adelaide.edu.au

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Background detection of mental illness could be one cost-effective

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Assessment of methodological quality Data synthesis

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Records identified through Additional records identified through

Total records identified Duplicates removed

Records after duplicates

Titles and abstracts of Records excluded

Study characteristics children. Results for the predefined primary and

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module, March program in

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Authors N Design Strengths Weaknesses

backgrounds; 3) Missing data – imputed missing values – reducing data

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Authors N Design Strengths Weaknesses

3) Study showed one-sided P values which additionally

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Authors N Design Strengths Weaknesses

number allocation assessed as data not presented; would however be

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Authors N Design Strengths Weaknesses

3) Confounding bias: success of randomization cannot be

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Significant scale Significant scale

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Significant scale Significant scale

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1 Neece (2014)51 N ¼ 46 in analysis; MAPS (n ¼ 21); NA

Group time interaction: