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Journal of Cognitive Psychotherapy: An International Quarterly Volume 25, Number 4 • 2011

Cognitive Behavioral ParentPrograms for the Treatment of

Child Disruptive Behavior

Oana A. Gavita, PhD

Department of Clinical Psychology and Psychotherapy,Babes–Bolyai University, Cluj-Napoca, Romania

Marie R. Joyce, PhD Australian Catholic University,

Quality of Life and Social Justice Research Centre,

Melbourne, Australia

Daniel David, PhDDepartment of Clinical Psychology and Psychotherapy,

Babes–Bolyai University, Cluj-Napoca, Romania

Department of Oncological Sciences,

Mount Sinai School of Medicine, New York

Although the therapeutic effectiveness of behavioral approaches to group parent programs

in reducing child disruptive behavior has been established, about a third of all families do

not benefit from participating. Because unhealthy/maladaptive emotions seem to be a pri-

mary reason why adults fail to engage in correct parenting practices and fail to benefit from

behavioral parent programs, the key would be to bring together the cognitive and behavioral

models of self-regulation to improve the outcomes of parental interventions for child disrup-

tive behavior. Research in cognitive science (see David, 2004) seems to support the idea that

both cognitive and behavioral elements need to be implemented in a structured way in parent

programs, and focus should change from parental cold cognitions, which do not automati-

cally result in parents’ emotional response unless appraised, to hot parental cognitions. This

article proposes changes in parenting interventions for child externalizing behavior based on

advances in cognitive behavioral theory (CBT).

Keywords: cognitive behavioral parent program; child disruptive behavior; parental distress; coldand hot cognitions

Because there is no state license required, we are rarely trained in the most important task

of our lives, namely, raising our children. It is widely accepted (see Children’s Law Office—Beebe James) that adult parenting behaviors are modeled based on parents’ childhood

experience and that both positive and negative family experiences while growing up have a direct



241Cognitive Behavioral Parent Programs

the term parent program in this article, we will refer to the group-based programs in which theparents are included with the aim to actively acquire parenting skills (see Kazdin, 1993; Sanders,

Markie-Dadds, Tully, & Bor, 2000).The evidence that parents have an important role in maintaining children disruptive be-

havior has led to behaviorally based programs for parents. Behavioral approaches to parent

training (BPT) have been investigated over the last 30 years, and their therapeutic efficacy and/or effectiveness in reducing child disruptive behavior is established (Barlow & Stewart-Brown,

2000; Nixon, 2002). BPT are based on classical and operant learning theory and uses the con-structs of positive reinforcement, extinction, time-out and contingency contracting, and so on(Kazdin, 1993). The aim is to reinforce alternative positive behaviors and to reduce unwanted

negative behaviors. Although short-term outcomes are good (Webster-Stratton, Kolpacoff, &Hollingsworth, 1988), long-term benefits of BPT are unknown, and the few longer term follow-upstudies suggest that 30% of those who show significant improvement remain in the clinically im-

paired range of functioning (see Doubleday & Hey, 2004; Kazdin, 1993; Webster-Stratton, 1990a,1990b). These programs also typically report high rates of premature dropout, adding up to a

quarter and half of those referred, according to critical reviews that have analyzed informationfrom various studies (see Assemany & McIntosh, 2002). Moreover, research suggests (see Potier &Day, 2007), considering the fact that a third of all families do not benefit from these programs (seeHartman, Stage, & Webster-Stratton, 2003; Scott, 2001; White, McNally, & Cartwright-Hatton,

2003), that this might be not only because we have to do a better job to engage parents in the al-ready existing evidence-based parent programs, but also that some important components that

are fundamental to parenting practices may be missing from these parent programs (Greenberg,Speltz, DeKlyen, & Endriga, 1991; Potier & Day; Sutton, 2001).

Full integration of cognitive components into behavioral programs has had enormous

benefits in adult populations for various psychological disturbances (see David, 2004). Because

parent programs are working directly with adults, one would expect similar benefits with parentson impacting their self-regulation abilities. Although Webster-Stratton (1992) acknowledges the

importance of dealing with dysfunctional cognitions as they arise within parent program groups,there is no formal framework to help parents identify and challenge dysfunctional cognitions in astructured way (see White et al., 2003). Current cognitive behavioral parent programs are rooted

in the behavioral approach, and the integration of the cognitive techniques are not based on re-cent findings in (clinical) cognitive sciences.

The objective of this article is to use a cognitive behavioral theory (CBT) framework as a

tool to clarify several theoretical confusions in the field of parent programs for child disruptivebehavior, with the aim of (a) stimulating a coherent practice in the field of parent programs and

(b) improving the outcomes of parent programs.

PARENTAL EMOTION R EGULATION AND ENHANCEMENTS FOR

PARENTING PROGRAMS

Mothers of children with disruptive behavioral problems are more likely to be emotionally af-fected (e.g., distressed, depressed), with strong impact on how they respond to their child and howwell they engage with and make use of parent programs (see Cornah, Sonuga-Barke, Stevenson,

& Thompson, 2003; Dadds & McHugh, 1992; Dix, 1991; Krech & Johnston, 1992; Patterson,

Dishion, & Chamberlain, 1993; Webster-Stratton & Hammond, 1990). Major reviews (see alsoDix & Meunier, 2009) showed that researchers often think that parental emotion regulation defi-

cits reflect incompatibility between parental mood and the requirements of effective parenting



242 Gavita et al.

great research efforts have started to understand factors that contribute to parental emotionaland behavioral self-regulation processes. There are increasing efforts to address parental self-

regulation aspects (e.g., emotional and behavioral) in parent programs for reducing child dis-ruptive behavior, and it was proposed (Ben-Porath, 2010) that such programs could be enhancedby additional investigation of parental self-regulation as a distal etiopathogenetic mechanism of

children disruptive problems.Based on this approach, there have been developed so-called enhanced or cognitively en-

hanced versions of BPT, with modules that are focused on both parental distress/psychopathologyand their underlying cognitive self-regulation mechanisms. The most widely researched behavioralparent programs have tried to add a cognitive component to the training and compare the efficacy/

effectiveness of this enhanced parent program with the standard behavioral parent intervention.Indeed, the enhanced parenting training/programs (EPT) include the data (see Hutchings, Lane, &Kelly, 2004) showing that maternal mental health difficulties (be they more general distress or spe-

cific psychopathology) are associated with child disruptive behavior (Kazdin & Wassell, 1999); 50%of conduct problem children having parents with mental health difficulties, especially maternal

depression (Hutchings, 1996). As cognitive behavioral approaches are the best-validated psychoso-cial interventions for various emotional disorders, namely, distress relating various conditions andor more specific psychopathology (e.g., depression, anxiety disorders; see the National Institute forHealth and Clinical Excellence, 2006), it is understandable that the focus of enhancing is on cogni-

tive components. Such a focus is hoping to bring powerful changes in self-regulation mechanisms(e.g., dysfunctional cognitions) and their emotions in both parents and children.

Although parents are able to learn behavioral skills in a controlled therapy setting, forthose who experience emotional dysregulation, generalization of these skills to the ecologicalenvironment is challenging (see Ben-Porath, 2010). According to Ben-Porath, during times

of high-intense emotional arousal, good parenting behaviors are inhibited and bad parenting

behaviors are likely to occur (e.g., hitting, excessive criticism, and berating; see also Mammen,Kolko, & Pilkonis, 2002). Ben-Porath has also showed that parents report a wide range of negative

emotions in response to their child’s difficulties, including guilt/remorse, depression, sadness,anger/annoyance, and anxiety/concern (see also Cameron, Snowdon, & Orr, 1992; Carpenter &Halberstadt, 2000). All of these negative emotions in parents are considered to interfere with the

generalization of traditional behavior skills taught in parent programs (see Ben-Porath).Several studies have compared the results of the enhanced versions of parent programs with

those of behavioral or so-called standard cognitive behavioral programs, with results showing

somewhat mixed data. There is some empirical support for parent distress focused adjunctive inter-ventions, but there are also conflicting findings. One of the first EPT for noncompliant children was

proposed by Griest and colleagues (Griest et al., 1982; Wells, Griest, & Forehand, 1980) and foundthat the EPT was more effective in reducing child deviant behavior and maintaining the changescompared to the standard parent group. Although findings showed initial promising results, the

enthusiasm of targeting parent distress in parent programs was reduced after studies showing thatbehavioral-based parent programs, without any cognitive strategies added, are reducing parent dis-tress and increasing parental self-efficacy (see Sanders et al., 2000). However, when put together, all

the evidences seem to point to only short-term benefits (Barlow & Coren, 2001).Gavita and Joyce (2008) have recently conducted a review of the effectiveness of group-based

cognitively enhanced behavioral parent programs (EPT) in reducing children’s disruptive behavior

and parent distress. The overall effect of EPT in comparison with the control condition (i.e., wait-

ing list and the standard behavioral-based parent program) on all the dependent variables wasextracted from a sample of 238 parents. In terms of child disruptive behavior, the enhanced con-

dition has slightly superior outcomes compared with standard programs (d 5 0 25) However




improvements in terms of parenting practices compared to standard programs (d 5 0.25), andthey remain significant at follow-up (d 5 0.36) in the same range as parents’ distress level, whichis claimed to be the actual enhancement target (Gavita & Joyce). The authors’ conclusion was that

the results are promising for impacting child disruptive behavior, while acknowledging that thestudies did not target or measure specific mechanisms of stress and that the incorporation proce-

dure for the cognitive enhancement was not based on the recent research findings in CBT.Within the research investigating the effects of adjunctive treatments on children’s disruptive

behavior, adjunctive procedures have varied considerably. Adjunctive procedures (see Bor, Sanders,

& Markie-Dadds, 2002) have ranged from relatively short to long (e.g., between 3 and 16 sessions)and have targeted various risk variables identified in a particular family (e.g., maternal depression),whereas others constituted multicomponent procedures that target various risk variables regardless

of whether the risk variable is present in a participating family. Taking into account these inconsis-tencies in the literature, it is difficult to evaluate whether cognitively enhanced interventions thataddress parental distress result in better outcomes for children than those achieved from standard

parent programs alone (see Bor et al., 2002).

FUNDAMENTALS OF CBT R ELEVANT TO PARENTING INTERVENTIONS FOR

DISRUPTIVE BEHAVIORS

Levels of Cognitions Involved in Psychological Disturbances (Based on theFramework of David & Szentagotai, 2006)

There are several cognitions that are discussed in cognitive psychotherapies (see for details David

& Szentagotai, 2006), among which are anticipation of events (Kelly, 1955), expectancies (Rotter,

1960), attributions (Seligman, 1975), anticipated outcomes (Bandura, 1977), core and interme-diate beliefs, and automatic thoughts (Beck, 1976, 1995). Beck (1995) has shown that failure to

process information logically may lead a person to far different conclusions than the correct pro-cessing of the same information. Ellis (2003) noted that faulty cognitions result in negativelyexperienced emotions if these judgments are negatively appraised. Indeed, faulty cognitions (cold

cognitions) do not automatically result in emotional responses unless appraised (hot cognitions).Research in cognitive science seems to support this idea (e.g., David, 2004; David & Szentagotai,

2006; Smith, Haynes, Lazarus, & Pope, 1993). Abelson and Rosenberg (1958) used the terms hot and cold cognitions to make the distinction between appraisals (hot) and knowledge (cold) offacts. Summarizing, cold cognitions refer to the way people develop representations of relevant

circumstances, whereas hot cognitions refer to the way people further process cold cognitions(see also David, 2003; David & Szentagotai; Smith et al., 1993).

According to the appraisal theory of emotions (Lazarus, 1991; Lazarus & Smith, 1988;

Smith et al., 1993), emotional problems will only emerge in case of (a) distorted representation/negatively appraised and (b) nondistorted representation/negatively appraised (see for detailsDavid & Szentagotai, 2006). Thus, classification of cognitions should take into account the fun-

damental distinction between knowing (cold) and appraising (hot), with reference to surfacecognitions (easy to access consciously) and deep cognitions (more difficult to access consciously;however, consciously accessible).

Surface cognitions refer to descriptions and inferences (e.g., attributions), whereas deep

cognitions refer to core beliefs/cognitions in the form of schemas and other meaning-based rep-resentations (see David, 2003; Eysenck & Keane, 2000). The terms appraisal or evaluative (hot)cognitions are used to define how cold cognitions are processed in terms of their relevance for



244 Gavita et al.

Only the things imagined that seem possible—no matter how slight the possibility—stir emotions(Wessler, 1982; apud David & Szentagotai, 2006). If hot cognitions about it are strong enough,even the most remote possibility may stir emotions. This was proposed (see Wessler, 1982; apud David & Szentagotai) to be one reason why merely convincing someone of the low probability ofan event occurring is insufficient to reduce fear about the event.

The intermediary cognitions are classified in three categories sequentially related (Beck, 1995):attitudes, assumptions, and rules. If the core cognition is dysfunctional (e.g., “I am a weak parent”),then intermediary cognitions will be related to it in a complex etiopathogenetic mechanism:(a) attitudes (e.g., “It is bad not to be listened to”), (b) positive assumptions having a compensatingrole (e.g., “If I seem tough, my children will listen and will not see that I am weak”) and negativeassumptions (e.g., “If I don’t shout loudly, my children will not respect me, and they will not listento me”), and (c) rules having a compensating role (e.g., “I have to be authoritative with my childrenand punish them harshly”). The interaction between those elements of general cognitive vulner-ability (central and intermediary dysfunctional cognitions), acquired in the course of the onto-genetic development, and life’s concrete and related activating events (like child’s disobedience)

can determine the activation of dysfunctional automatic thoughts (e.g., “Nobody respects me”),which then generate (a) affective/subjective outcomes (anger), behavioral outcomes (being abusivetoward child), and pathological psycho-physiological/ biological outcomes; or (b) compensatingoutcomes by engaging in the positive assumptions. In the Beckian conception (Beck, 1995), cog-nitive distortions are represented as one of the following errors of reasoning: emotional reasoning,overgeneralization, jumping to conclusions (or arbitrary inference), dichotomous reasoning, for-tune telling or mind reading, selective abstraction, disqualifying the positive, maximization andminimization, catastrophizing, personalization, and labeling.

Evaluative (hot) cognitions generate expectancies about reality based on previous experienceand influence the way in which this reality is represented, both directly and by means of descriptive

and inferential cognitions (David, Lynn, & Ellis, 2010). Evaluative cognitions are cognitive struc-tures that interact to descriptions and inferences. They have linguistic correspondence, and theycan be rational or irrational; in the literature, they are called hot cognitions, and they condition theaffective outcomes. In this context (see Ellis, 1994), the term irrational refers to their lack of logical,empirical, and pragmatic support. Ellis (1994) described the most important general evaluativecognitive structures (defined pragmatically, logically, and empirically)—involved as etiopathoge-netic mechanisms in pathology—through this association being dysfunctional–irrational cogni-tions and/or in the promotion of health and adaptive behavior (rational cognitions). The generalcentral irrational belief is the inflexible and absolutistic thinking (demandingness, DEM), fromwhich derive three general intermediary irrational beliefs: awfulizing (AWF), low-frustration

tolerance (LFT), and global evaluation (GE). When those general central evaluative structures areassociated with specific activating events, they generate local cognitive evaluative structures in theform of automatic thoughts (David et al., 2010).

CBT Approaches in Dealing With Dysfunctional Cognitions

Cognitive Restructuring/Disputation. Techniques for modifying dysfunctional cognitions havebeen described across many years (e.g., Beck, Rush, Shaw, & Emery, 1979; Beck, 1995; Ellis, 1994).Various authors (see for details Beck 1995; Ellis, 1994) presented specific techniques for challeng-ing dysfunctional cognitions based on their internal logic; for example, evaluating the evidence

for and against a thought using written thought records, eliciting more realistic cognitions, andlooking for evidence of distorted thinking (see Longmore & Worrell, 2007). Cognitive therapyin particular is based on the identification of these cognitive distortions within the everyday




According to Beck et al. (1979) and Ellis (1994), cognitive restructuring consists of three phases:

(a) identifying dysfunctional cognitions, (b) modifying dysfunctional cognitions, and (c) assimi-lating functional cognitions (see also David, McMahon, Macavei, & Szentagotai, 2005). In the CBTprocess (see also David et al., 2005), the client (a) becomes aware of his or her dysfunctional cogni-

tions, (b) learns alternative ways of thinking, and (c) begins to think rationally. At the end of this

process, however, some clients may still feel (cognitive–emotive dissonance) and behave (cognitivebehavioral dissonance) according to their past beliefs (Grieger & Boyd, 1980; Maultsby, 1984).

Rational emotive behavior therapy (REBT; Ellis, 1994) promotes change by using the dis-putation (D) method—questioning rigid thinking and actively and directively encouraging

more functional answers of effective new philosophy (E) by means of realistic disputing, logicaldisputing, and functional disputing. Disputing is helping clients understand (after Ellis, 2005):(a) that they generate their distorted cognitions, (b) that they can choose to think differently and

thus that they can choose to feel concerned and sad instead of anxious and depressed, (c) thattheir dysfunctional thinking–feeling–behaving pattern follows when they turn healthy prefer-ences into dysfunctional demands, and (d) that they can continue to be aware of their destructive

cognitions–emotions–behaviors and work hard at disputing them until their common automaticthoughts habitually tend to be minimal and to be replaced by rational cognitions. Determinedand persistent disputing/restructuring of evaluative cognitions is a way to minimize them, thera-

peutically and prophylactically, and it consciously aims to help clients “feel better, get better, andstay better” (Ellis, 1994, 2003, 2005).

Cognitive Defusion or Third Wave CBT Processes. Cognitive behavioral interventions weretargeted at getting people to control their thinking (be it conscious and/or unconscious) andchange their dysfunctional and irrational thinking to manage their distress and disturbances.

The third wave CBT approaches—acceptance and commitment therapy and mindfulness-basedinterventions—bring the idea that control is the problem. They argue that as long as people try

to control cognitions and emotions, as previously targeted in CBT, they are likely to continueto experience emotional suffering. What is proposed instead is a comprehensive cognitive defu-sion or distancing from our cognitions, emotions, and body sensations in a nonjudgmental andaccepting manner (see Hayes, Luoma, Bond, Masuda, & Lillis, 2006). There is evidence suggesting

the potential that those approaches have not only when ameliorating severe and chronic distur-bances, but also when working with human development/optimization (Hayes et al., 2006; Hayes,Masuda, Bissett, Luoma, & Guerrero, 2004).

IMPLICATIONS OF ANALYSIS FOR THE THEORETICAL LEVEL OF COGNITIVE

BEHAVIORAL PARENT PROGRAMS

Parental Cognitions Addressed in the Literature

All parents develop cognitions that include thoughts about their children and parenting role thatare based on their own childhood, parenting experiences, and/or interactions with particular chil-

dren (see Kuhn & Carter, 2006). Parents’ cognitions about parenting exist before their children areborn and are modified through interactions with their developing children.

Parenting literature suggests that parent cognitions differ in terms of their specificity, pro-

cessing level, and/or contents. According to Murphey (1992), parent cognitions can be global in

nature—cognitions that can be acquired vicariously, even by nonparents—or particular in nature,referring to cognitions associated with the specific parenting role and child behavior. According

to Bugental and Johnston (2000) in parenting context these cognitions may be concerned with



246 Gavita et al.

reasons for child behavior (inferential cognitions), (c) the way things “should” be with respect tothe child (evaluative–prescriptive cognitions), or (d) the evaluation of their own competenceas parents to deal with child behavior (inferential cognitions). Much of the early literature con-cerned with parent cognitions focused on parental beliefs and expectations regarding the natureof children (see Bugental & Johnston). For Bugental and Johnston, these formulations were typi-

cally centered on the conscious analyses of family members, that is, what family members knew,thought about, and could talk about. Current work also added a stronger focus on parents’ directperceptions of child behavior (e.g., Krech & Johnston, 1992; Webster-Stratton, 1990a, 1990b).

Parental Cold Cognitions. Cognitive biases are associated with the use of specific parentingbehaviors, which maintain child behavior problems (see MacKinnon-Lewis, Lamb, Arbuckle,Badaran, & Volling, 1992). Azar and colleagues (Azar, Nix, & Makin-Byrd 2005; Stern & Azar,1998) showed that parenting schemas include beliefs of the caregiving role, cognitions aboutparent’s own functioning in that role, knowledge of children in general (i.e., how they developand what they should be like), and cognitions about one’s own children in particular.

Studies have shown that mothers of conduct problem children are more likely to attribute

defiant intent to their children’s behavior than mothers of healthy children (see Strassberg, 1995).Mothers’ perceptions of child hostile intentions predict observed maternal negativity and coer-civeness when completing play activities with school-age sons (MacKinnon-Lewis et al., 1992).Thus, cognitive distortions may promote coercive exchanges between mother and child andincrease the child’s risk for conduct problems. Consistent with the developmental literature onproblematic child behavior (see Morrissey-Kane & Prinz, 1999), parents of children with psycho-logical disorders tend to attribute their children’s negative behavior to factors external to them-selves and outside their control. Indeed, the literature in this area (see Morrissey-Kane & Prinz),focusing primarily on parents of children with disruptive behavior, shows the impact of parentalattributions on maintaining children problems, namely, decreasing perceived parental compe-

tence and increasing parental distress.According to Morrissey-Kane and Prinz (1999), parental attributions regarding their chil-

dren’s behavior can be divided (see also Bugental & Johnston, 2000) into two categories: (a) child-referent causes such as child disposition, judgment, and/or ability; and (b) parent-referent causessuch as parental competence and skill in managing child behavior. Parental interpretations(i.e., inferences) concerning child age, competence, and intentionality influence reactions tochild’s negative behavior (Dix & Reinhold, 1991). Indeed, mothers who interpret the child’sbehavior as intentional tend to be more upset and indicate a preference for the use of a stern dis-ciplinary style. Data shows (see Morrissey-Kane & Prinz) that those families that had successfuloutcomes in treating their oppositional child had a significant change in parental locus of control

(see also Roberts, Joe, & Rowe-Hallbert, 1992). Parents who have a more internal locus of controlat the end of treatment, changing their attributions from the belief that they have no control tothe belief that they are able to manage their children’s behavior, tend to also have a greater successin the treatment (see Morrissey-Kane & Prinz).

Parental distress and depressed mood are negatively associated with parenting self-efficacy orparents’ perceived feelings of competence in the parenting role (see Coleman & Karraker, 1998).Although parenting self-efficacy has not been typically studied directly as a predictor of children’streatment outcome, it has been associated with various characteristics that may be expected toinfluence treatment response. For example (see Hoza et al., 2000), parenting self-efficacy is asso-ciated with greater parental responsiveness in structured task and greater awareness of opportu-

nities to educate oneself about parenting (see also Mash & Johnston, 1990).Other problematic parenting biases can involve dysfunctional expectancies for children.

Indeed studies showed that abusive and neglectful parents have higher levels of dysfunctional




matched control mothers (Azar & Rohrbeck, 1986; Azar et al., 2005; Haskett, Smith Scott, Grant,

Ward & Robinson, 2003).

Parental Hot Cognitions (this is mainly based on the framework of Joyce, 2006). There hasbeen some recognition of the importance of parent evaluative cognition in influencing parental

and child emotion and behavior. Empirical interest in the parental evaluative cognitions con-

structs declined once there were some conclusions in the literature that parental attitudes andvalues are poor predictors of parental practices (Holden & Edwards, 1989). However, morerecently, there has been a rebirth of such concerns with the introduction of the notion of parentalgoals (see Bugental & Johnston, 2000).

A systematic means of assessing and intervening with parents is provided by an REBT frame-work (see Ellis & Bernard, 2006), which focuses on evaluative cognitions and proposes rationaland irrational beliefs of parents and children as core constructs in parent programs (e.g., Bernard

& Joyce, 1984; DiGiuseppe & Kelter, 2006; Terjesen & Kurasaki, 2009). REBT also recognizes thatbeliefs of both kinds can be shared by parents and children to create a family culture (see Joyce,2006). Thus, parents and extended families can induct their children into shared ways of thinking

that maintain irrational patterns across generations (Joyce, 2006). In assisting parents to reflecton their beliefs, REBT focuses on both evaluations and inferences but emphasizes the dysfunc-tional effect of irrational evaluations, which often operate as unacknowledged, unconscious phil-

osophical belief systems (Joyce, 2006).Ellis, Wolfe, and Moseley (1966) mentioned in How to Raise an Emotionally Healthy, Happy

Child the role of parental beliefs about their children and the way in which parents beliefs influ-ence their children’s view of the world. Bernard and Joyce (1984) have identified parental irra-tional beliefs that are associated with poor parenting; for example, the parental belief underlying

parental anger, “My child must always behave the way I demand.” Hauck (1967, 1983) has iden-tified several distorted parental beliefs concerning child management that are irrational because

they are inaccurate and they lead to dysfunctional styles of parenting. There are different irra-tional beliefs of parents that lead to distinct dysfunctional styles of parenting. The unkind andfirm patterns of parental behavior were specific to parents who held the belief “Children mustnever disagree with their superiors,” the kind and not firm child-rearing practices were associated

with the parental beliefs “Children must not be frustrated” or “I am responsible for all my child’sproblems and therefore I am hopeless” (see Joyce, 2006).

It was proposed (see for details Bernard, 2004; Ellis & Bernard, 2006) that the evaluative

beliefs of parents have specific emotional consequences. Let us mention some of them (afterHauck, 1967; see also Joyce, 2006). The beliefs that underlie parental anxiety are “I must be a

perfect parent,” “It would be awful if my child didn’t love me all the time,” and “It’s awful if

others disapprove of the way I parent.” Parental beliefs causing parental anger are “Childrenshould always and unequivocally do well and behave correctly,” “It’s awful when children

misbehave or disobey their parents,” “My child must do what I say,” “My child must be fairto me all the time,” “My child shouldn’t be so difficult to help,” and “Parenting shouldn’tbe so hard.” The beliefs underlying parental depression are “If my child misbehaves fre-

quently, it is awful and I am a failure as a parent,” and “My worth as a parent depends onmy child’s performance.” Beliefs accompanying parental guilt are “It is awful for my child tosuffer, and I must prevent it at all costs,” “I am the sole cause of my child’s problems,” and

“I must always do right by my child.” It is considered that extremely demanding beliefs aboutchildren’s behavior lead to extreme anger in parents, which, in turn, leads to intense and non/

constructive disciplinary action.Only a few group format parent programs addressed the evaluative cognitions of parents

in a manner correspondent with REBT but not on clinical populations (see Joyce 1995 2006)



248 Gavita et al.

irrational beliefs, developing rational problem-solving skills, and fostering rational thinking.Results showed that for the experimental group, there was a statistically significant reduction inparent irrationality, parent guilt, and parent anger. An exploratory 10-month follow-up, althoughlimited by lack of a control group and by the use of change scores, suggested maintenance ofeffects, a reduction in perceived child behavior problems, and changes in parental irrational

beliefs regarding self worth (see Joyce, 1995).Challenging Parental Cognitions. From a traditionally CBT point of view, problematic par-

enting schemas can be changed/restructured by challenging and disputing them. One of the fun-damental elements of cognitive behavioral therapy—and many other theories of intervention—isto help parents recognize those factors that prime or activate their maladaptive schemas. Oncewe have assessed cognitive distortions in the form of negative explanatory styles (cold) and ir-rational beliefs (hot), parents are helped to realize the effects these have on their mood (belief[B]–consequences [C] connection) and to learn tools for cognitive restructuring/disputing. By cor-recting logical errors in thinking, parents can change their distorted representation about the chil-dren (e.g., “My child disrespects me”) into an accurate one (e.g., “He does not hate/disrespect me”)

so that the negative emotion (e.g., anger) can be changed into a more neutral and functional emo-tion (e.g. annoyance). However, parents may still be prone to emotional problems because of thetendency to make negative appraisals (e.g., “It is awful that my child disrespects me”) is still present(after David & Szentagotai, 2006). If the parent changes a negative appraisal (e.g., “It is awful if mychild disrespects me”) into a less irrational and personally relevant one (e.g., “It is bad if my childdisrespects me, but it is not awful”), then he or she will likely change the dysfunctional emotions(e.g., anger) into more functional but still negative ones (e.g., annoyance). One may argue thatby changing the negative appraisal, the parent will indirectly change the distorted representationsas well (David & Szentagotai, 2006; Ellis, 1994). Supposing that distorted cognitions are initiallyinfluenced by negative appraisal, they may get functional autonomy from appraisal by practice. It is

suggested that a strategy that would change both distorted representations and negative appraisalscould be a better one (David, 2003).

Azar et al. (2005) argued that executive functioning (i.e., the ability to use information ina planned, strategic manner and to guide responses to it) is not a part of parenting schemas;indeed, the characteristics of parenting schemas may determine whether executive functioning istriggered at all. According to Azar et al., parenting schemas can be sometimes so rigid that theyaffect automatically/unconsciously the generation of multiple alternative explanations of childbehavior problems and thus block the possibility that parents choose appropriate responses. Datafrom unconscious information processing studies show that the use of rational anticipation tech-niques (David et al., 2010), which are based on anticipating the influence that biased information

can have on emotions and behaviors, are effective to block the impact of the unconscious cogni-tive information on our responses.

New lines for changing the function of cognitions and emotions is drawn by the Mindfulness-Based Parent program approaches by means of cognitive defusion or distancing as a form of com-munication with ourselves designed to put some psychological separation between our thoughtsand feelings about a particular situation and the ways in which we react in that situation (Dumas,2005). This self-imposed separation is obvious whenever a mother says to herself, “I am mad butI will remain calm not to make matters worse.” It is also a major objective of socialization because

young children must learn to distance themselves from their negative feelings to be able to expressthem in nondestructive ways (see also Dumas). The connection between the new wave and the

other CBT approaches is the concept of acceptance, as Ellis (2005) made it a cornerstone of REBTtheory (Dryden & David, 2008).

These three new advances (“changing cold versus hot cognitions ” “unconscious processing




the traditional REBT, which analyzes two different functions of cognitions (see Ellis, 2005; Ellis

& Bernard, 2006): First, a helpful/adaptive function, “I don’t like this failure. I prefer very muchthat I could always succeed, but I can stand it if I don’t and still be okay.” Second, an unhelpful/maladaptive function, “Because I hate failing, I absolutely must not fail and am worthless if I do!”

By showing parents how different these two functions of cognitions are, it helps them keep the

first and reduce the second (see also Ellis & Bernard; Joyce, 1995).

IMPLICATIONS OF ANALYSIS FOR THE PRACTICAL LEVEL OF COGNITIVE

BEHAVIORAL PARENT PROGRAMS

Core CBT Components to Be Integrated in Parent Programs

Levels of Cognitions Targeted. Distress reduction need to target different levels of parent cog-nitions (i.e., emotional regulation mechanisms) and to move from surface and cold cognitions

toward the deeper level of unconscious and evaluative parental beliefs in order to get enduringand significant outcomes. Future research in cognitive behavioral parent program needs to inte-grate different types of distress reduction components into standard treatment with a special focus

on the way they are integrated and addressed—changing their content and/or function—to drawreliable conclusions regarding viable mechanisms of change.

The Case of Parental Acceptance. Ellis (2005) had conceived “acceptance” as being a funda-

mental basis of REBT theory. REBT promotes three major forms of acceptance and it hypothe-sizes that when people explicitly or implicitly hold unrealistic and inflexible demands, they create

destructive forms of nonacceptance (Ellis, 2005). People, with this nonaccepting philosophy, cre-ate awfulizing and frustration intolerance cognitions. Based on this theory of nonacceptance,

REBT postulates that self-rating (“I am a good or bad parent”) and/or other rating (“You area bad child”) do not create all human disturbance but create most of it. Contemporary REBT,unlike Beck’s cognitive therapy and most of the other CBTs, uses every possible means of helpingclients to thinkingly, emotionally, and actively make three major acts of acceptance (Ellis, 1994,

2003, 2005): unconditional self-acceptance (USA), unconditional other acceptance (UOA), andunconditional life acceptance (ULA).

Unconditional self-acceptance means (see Ellis & Bernard, 2006) that (a) parents fully accept

themselves whether they succeed at important tasks in being a parent and whether they have theapproval of significant others and (b) parents aim to improve their own behaviors. Unconditionalother acceptance means (see also Ellis & Bernard) that (a) the parent fully accepts (although not

necessarily like) his or her child and all other humans whether they act fairly and competently and(b) parents aim to improve their child’s behaviors. Parents unconditional life acceptance means

(see also Ellis & Bernard) that (a) parents fully accept life whether it is fortunate or unfortu-nate and (b) do their best to discover and enjoy their personally selected satisfactions and plea-sures (Ellis, 2003, 2004, 2005). Therefore, REBT considers it of extreme importance to emphasize

destructive secondary disturbances (i.e., parents feeling angry or depressed about their anger)and to fully accept themselves and their children with all their problems but aiming to improvethe specific problems. This way, parents can achieve a strong thinking–feeling–acting philosophy

of unconditional acceptance (Ellis, 2005).EPTs need to incorporate explicit modalities in which parents will learn to dispute/restructure

(D) both dysfunctional and irrational beliefs and to assimilate more efficient (E), adaptive and rationalbeliefs with positive impact their emotional, cognitive, and behavioral responses. Framework providedwill need to focus on empirical pragmatic and logical disputing in order to change the process of



250 Gavita et al.

The emotion self-regulation approach need to be also based on findings from unconsciousinformation processing to foster the use of rational anticipation techniques (see David et al.,2010), which are based on anticipating the influence that biased information has on parents’behavior to block its impact. This way, parents become aware of their beliefs and their impacton their behavior so that they can prepare behavioral responses to “override” the impact of these

beliefs on their mood and behaviors in the specific moments when they cannot be aware of theirinfluences.

Based on the premise that parents coming to treatment have strong views of themselves—how children must behave or how they should be treated—the EPT aims to dispute specific cog-nitions about child-rearing practices for children and parents to prevent the dropout.

The Enhanced Parent Program Format. From the cognitive behavioral perspective, theproblem of parent programs for child disruptive disorders is that, although parents want to seetheir child’s behavior change, they often have difficulty carrying out behavioral interventions(see for details in Ellis & Bernard, 2006). In this matter, although behavioral parent program maybe the most successful intervention for children with disruptive disorders (Kazdin, 1993), it is

unlikely that parents will apply the techniques for managing their child’s behavior if their emo-tional disturbance (e.g., distress and/or psychopathology) about their child’s behavior interferes(see DiGiuseppe & Kelter, 2006). In this case, we consider that the failure to first address parents’emotional reactions to parenting (the emotional problem from the REBT’s ABC model), by chang-ing evaluative cognitions (B), before approaching children’s behavior problems (the practicalproblem, [A]), may be one of the gaps of present research into cognitive behavioral (or enhanced)parent program.

It is likely to be not a matter of simply adding a cognitive module at the end of the parentingtraining or to challenge a few distorted cognitions to enhance its effect because this is not in linewith the principles of rational emotive and cognitive behavioral theory itself (see Ellis & Bernard,

2006). In this model, a parent’s disturbance is a crucial and primary target of the intervention,and there are specific cognitive distortions for different dysfunctional emotions and behaviors,which need to be explicitly targeted (see Ellis & Bernard; Vernon & Bernard, 2006). Thus, it is nec-essary for the parents to learn how to manage their emotions first, including anger (DiGiuseppe& Kelter, 2006; Vernon & Bernard), and only after that to learn what to do.

Distinction Between Parents’ Practical Versus Emotional Problems. As we mentionedpreviously, another important aspect to be made explicit is to acquaint parents with the dis-tinction between their own practical skills needed to help their children behave less impulsivelyand their emotional problems, in which parents learn about the role that their own emotionalreactions play in their ability to implement an effective child management approach and, very

importantly, in their child’s learning through modeling of inappropriate ways to express emo-tions. Often, the parent’s focus is on behavior lessons, as they are telling the child what to do andwhat not to do, but if they do this angrily, the child also learns that when frustrated, the way is tobe angry (Vernon, 2006a, 2006b; Vernon & Bernard, 2006). It is common for children with angerand aggressive problems to have a parental model for their anger. We consider that an importantaspect to be made explicit is to teach parents the distinction between their own practical skillsneeded to help their children behave less impulsively and their emotional problems, in whichparents learn about the role that their own emotional reactions play in their ability to implementan effective child management approach and, very importantly, in their child’s learning throughmodeling of inappropriate ways to express emotions (see for details Ellis & Bernard, 2006).

The Length and Focus of the Emotion Regulation Enhancement. Parents coming to treat-ment have strong views of themselves—how children must behave or how they should betreated; therefore the cognitive behavioral parent programs need to address specific cognitions




the cognitive module is sufficient and well targeted (i.e., explicit and persistent disputation/restructuring strategies) so that the parent can learn to practice the cognition modifying skills

not only for specific behaviors and emotions but also for general vulnerability factors to getprofound and enduring changes. Specific beliefs of parenting are based on parents’ experi-ences, memories of their own past, and an interest in continuing or discontinuing some prac-

tices to which they were exposed. A structured and comprehensive approach to changing thespecific cognitions is needed in this intervention because they may conflict with strongly held

beliefs (schemas) about child-rearing practices and values about what constitutes good par-enting (Kazdin, 1997).

CONCLUSIONS AND DISCUSSION

We know very little about why parent program leads to changes in children’s behaviors even

among the evidence-based treatments (Kazdin, 1997; Kazdin & Whitley, 2003). This means thatthe parental interventions we are using, without any added components, may not be optimal.

It was also proposed (see Kazdin, 1997) that it may be premature to add further components totreatment without understanding how to optimize change of the treatment to which the compo-nents are added because it is essential to understand mechanisms of change (e.g., why any newcomponent improves child disruptive behaviors).

Another important aspect to be kept in mind is using the right amount of ingredients andthe right moment in intervention for targeting parental distress and for focusing on activating

events of parent’s distress, specifically children’s negative behavior. Research on parental psy-chopathology needs to explore areas other than depression, like parental anger or personalitydisorders, and incorporate specific mechanisms of change from cognitive behavioral models of

psychopathology. Also, it is necessary for the cognitive module to be structured and that a formal

framework is provided for the parents (e.g. the ABC model, the B–C connection, restructuring)so that the parents are enabled to begin to identify their own cognitive patterns and generalize

solutions outside of the session. Having said that, future models in this field should clarify if theaddition of cognitive strategies is necessary for all parent programs or only in those with compli-cating factors (e.g., emotional problems in parents).

There is an important distinction between feeling better, getting better, and staying better(Ellis, 1994). Various techniques can help parents feel better. However, to get and stay better,they would have to change the fundamental etiopathogenetic mechanisms of emotional prob-

lems, and these are related to the last element in the chain, namely, hot cognitions/appraisal(see David & Szentagotai, 2006). An important change that needs to be made in designing the

cognitive component of parent programs is to shift the focus from cold cognitions only (e.g.,attributions, parent efficacy, locus of control) to the entire architecture of parent cognition,specially including the evaluative/hot cognitions (i.e., appraisal), in the effort of finding how

they influence the parent–child relationships. Randomized clinical trials (RCTs) are neededto examine the effects of designing cognitive behavioral parent programs, incorporating themodule centered on modifying different types of parental beliefs on reducing children dis-

ruptive behaviors. In other words, we need to know if defusing from or modifying parentalcognitions will lead to an increased parental ability to benefit from parent program and ifthis will be directly related to a decrease in their children’s behavioral problems. The future

of building strong cognitive behavioral parent programs stays in investigating the cognitive

and behavioral mechanisms through which the treatments are producing the highest and lon-gest lasting changes in children’s disruptive behavior and incorporating those variables as

key components of interventions We analyzed some of these in this article (e g hot vs cold




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Acknowledgments. Oana A. Gavit a was responsible for the writing of the manuscript and parts of the manu-

script were included in her PhD dissertation; Marie R. Joyce had an important contribution to the exposition of

the paper; and Daniel David brought contributions to the design of the analysis.

Correspondence regarding this article should be directed to Oana Gavit a, MA, Department of Clinical Psychology

and Psychotherapy, Babes–Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Cluj, Romania.E-mail: [email protected]



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