cognitive behavioral parent programs for the treatment of child disruptive...

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

240 © 2011 Springer Publishing Company

http://dx.doi.org/10.1891/0889-8391.25.4.240

Cognitive Behavioral Parent Programs for the Treatment of

Child Disruptive Behavior

Oana A. Gavita, PhDDepartment of Clinical Psychology and Psychotherapy,

Babes–Bolyai University, Cluj-Napoca, Romania

Marie R. Joyce, PhDAustralian 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, RomaniaDepartment 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; cold and 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 impact on the attitudes and practices parents will use in raising their own children. When using

Journal of Cognitive Psychotherapy: An International Quarterly

25

4

2011

© 2011 Springer Publishing Company

10.1891/0889-8391.25.4

241Cognitive Behavioral Parent Programs

the term parent program in this article, we will refer to the group-based programs in which the parents 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-up studies 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 information from 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 (see Hartman, 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 parents on 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 a structured 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 disruptive behavior, 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 regulation 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 how well 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 also Dix & Meunier, 2009) showed that researchers often think that parental emotion regulation defi-cits reflect incompatibility between parental mood and the requirements of effective parenting (Downey & Coyne, 1990; Lovejoy, Graczyk, O’Hare, & Neuman, 2000). Indeed, in line with this,

242 Gavita et al.

great research efforts have started to understand factors that contribute to parental emotional and 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 enhanced by 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/psychopathology and their underlying cognitive self-regulation mechanisms. The most widely researched behavioral parent 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 and or more specific psychopathology (e.g., depression, anxiety disorders; see the National Institute for Health 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, for those who experience emotional dysregulation, generalization of these skills to the ecological environment 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 found that the EPT was more effective in reducing child deviant behavior and maintaining the changes compared 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 that behavioral-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 was extracted 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, an interesting finding of the review is that parents in the EPT condition registered significant


improvements in terms of parenting practices compared to standard programs (d 5 0.25), and they remain significant at follow-up (d 5 0.36) in the same range as parents’ distress level, which is 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 the studies 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 that address parental distress result in better outcomes for children than those achieved from standard parent programs alone (see Bor et al., 2002).

fundamentals of cBt relevant to Parenting interventions for disruPtive Behaviors

Levels of Cognitions Involved in Psychological Disturbances (Based on the Framework 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 negatively experienced 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) of facts. 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 details David & Szentagotai, 2006). Thus, classification of cognitions should take into account the fun-damental distinction between knowing (cold) and appraising (hot), with reference to surface cognitions (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 personal well-being (for details, see David, 2003; Ellis, 1994; Lazarus, 1991; Smith et al., 1993).

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 of an 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 compensating role (e.g., “If I seem tough, my children will listen and will not see that I am weak”) and negative assumptions (e.g., “If I don’t shout loudly, my children will not respect me, and they will not listen to me”), and (c) rules having a compensating role (e.g., “I have to be authoritative with my children and 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 abusive toward child), and pathological psycho-physiological/ biological outcomes; or (b) compensating outcomes 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 and minimization, catastrophizing, personalization, and labeling.

Evaluative (hot) cognitions generate expectancies about reality based on previous experience and 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 they can be rational or irrational; in the literature, they are called hot cognitions, and they condition the affective 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 evaluative cognitive 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 general central irrational belief is the inflexible and absolutistic thinking (demandingness, DEM), from which derive three general intermediary irrational beliefs: awfulizing (AWF), low-frustration tolerance (LFT), and global evaluation (GE). When those general central evaluative structures are associated with specific activating events, they generate local cognitive evaluative structures in the form of automatic thoughts (David et al., 2010).

CBT Approaches in Dealing With Dysfunctional Cognitions

Cognitive Restructuring/Disputation. Techniques for modifying dysfunctional cognitions have been 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, and looking for evidence of distorted thinking (see Longmore & Worrell, 2007). Cognitive therapy in particular is based on the identification of these cognitive distortions within the everyday thinking of the patient and their replacement by alternative, more realistic, and logical reasoning.


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 CBT process (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 (cognitive behavioral 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, logical disputing, 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) that their 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 automatic thoughts habitually tend to be minimal and to be replaced by rational cognitions. Determined and 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, and stay better” (Ellis, 1994, 2003, 2005).

Cognitive Defusion or Third Wave CBT Processes. Cognitive behavioral interventions were targeted at getting people to control their thinking (be it conscious and/or unconscious) and change their dysfunctional and irrational thinking to manage their distress and disturbances. The third wave CBT approaches—acceptance and commitment therapy and mindfulness-based interventions—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 continue to 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 and accepting 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 that are 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 are born 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 (a) the ways things are perceived to be in the parent role (descriptive cognitions), (b) the perceived

246 Gavita et al.

reasons for child behavior (inferential cognitions), (c) the way things “should” be with respect to the child (evaluative–prescriptive cognitions), or (d) the evaluation of their own competence as 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 nature of 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’ direct perceptions of child behavior (e.g., Krech & Johnston, 1992; Webster-Stratton, 1990a, 1990b).

Parental Cold Cognitions. Cognitive biases are associated with the use of specific parenting behaviors, 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 about parent’s own functioning in that role, knowledge of children in general (i.e., how they develop and 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 and increase the child’s risk for conduct problems. Consistent with the developmental literature on problematic 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 parental attributions 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 causes such as parental competence and skill in managing child behavior. Parental interpretations (i.e., inferences) concerning child age, competence, and intentionality influence reactions to child’s negative behavior (Dix & Reinhold, 1991). Indeed, mothers who interpret the child’s behavior 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 successful outcomes 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 control at the end of treatment, changing their attributions from the belief that they have no control to the belief that they are able to manage their children’s behavior, tend to also have a greater success in the treatment (see Morrissey-Kane & Prinz).

Parental distress and depressed mood are negatively associated with parenting self-efficacy or parents’ 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’s treatment outcome, it has been associated with various characteristics that may be expected to influence 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 (i.e., unrealistic) expectations of the social cognitive and physical abilities of children than do


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 has been 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 and values are poor predictors of parental practices (Holden & Edwards, 1989). However, more recently, there has been a rebirth of such concerns with the introduction of the notion of parental goals (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 rational and 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 that beliefs 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 reflect on 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 and firm patterns of parental behavior were specific to parents who held the belief “Children must never 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’s problems 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 (after Hauck, 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 “Children should 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 fair to me all the time,” “My child shouldn’t be so difficult to help,” and “Parenting shouldn’t be 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 on my child’s performance.” Beliefs accompanying parental guilt are “It is awful for my child to suffer, 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 about children’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). The REBT parent programs focused mainly on reducing emotional distress through disputing

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 in parent irrationality, parent guilt, and parent anger. An exploratory 10-month follow-up, although limited by lack of a control group and by the use of change scores, suggested maintenance of effects, 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—is to help parents recognize those factors that prime or activate their maladaptive schemas. Once we 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 the tendency 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 my child disrespects me”) into a less irrational and personally relevant one (e.g., “It is bad if my child disrespects 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 that by changing the negative appraisal, the parent will indirectly change the distorted representations as well (David & Szentagotai, 2006; Ellis, 1994). Supposing that distorted cognitions are initially influenced 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 appraisals could be a better one (David, 2003).

Azar et al. (2005) argued that executive functioning (i.e., the ability to use information in a 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 is triggered at all. According to Azar et al., parenting schemas can be sometimes so rigid that they affect automatically/unconsciously the generation of multiple alternative explanations of child behavior problems and thus block the possibility that parents choose appropriate responses. Data from 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 thoughts and 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 but I 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 express them 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 REBT theory (Dryden & David, 2008).

These three new advances (“changing cold versus hot cognitions,” “unconscious processing in cognitive restructuring,” “cognitive defusion and/or restructuring”) can be easily integrated in


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 much that 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 enduring and 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 draw reliable 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 are a 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 helping clients to thinkingly, emotionally, and actively make three major acts of acceptance (Ellis, 1994, 2003, 2005): unconditional self-acceptance (USA), unconditional other acceptance (UOA), and unconditional 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 the approval of significant others and (b) parents aim to improve their own behaviors. Unconditional other 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 improve the 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 rational beliefs with positive impact their emotional, cognitive, and behavioral responses. Framework provided will need to focus on empirical, pragmatic, and logical disputing in order to change the process of parental evaluative cognitions.

250 Gavita et al.

The emotion self-regulation approach need to be also based on findings from unconscious information 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 impact on 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 their influences.

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, the problem of parent programs for child disruptive disorders is that, although parents want to see their 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 may be 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 practical problem, [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 parenting training or to challenge a few distorted cognitions to enhance its effect because this is not in line with 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 mentioned previously, 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 impulsively and their emotional problems, in which parents learn about the role that their own emotional reactions 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 and what not to do, but if they do this angrily, the child also learns that when frustrated, the way is to be angry (Vernon, 2006a, 2006b; Vernon & Bernard, 2006). It is common for children with anger and aggressive problems to have a parental model for their anger. We consider that an important aspect to be made explicit is to teach parents the distinction between their own practical skills needed to help their children behave less impulsively and their emotional problems, in which parents learn about the role that their own emotional reactions 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 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 be treated; therefore, the cognitive behavioral parent programs need to address specific cognitions about child-rearing practices, children, and parents (Kazdin, 1997). Thus, it is important that


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 get profound 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 the specific 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 that the 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 to treatment 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 new component improves child disruptive behaviors).

Another important aspect to be kept in mind is using the right amount of ingredients and the 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 personality disorders, 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 the addition 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 needed to examine the effects of designing cognitive behavioral parent programs, incorporating the module 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 parental cognitions will lead to an increased parental ability to benefit from parent program and if this 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 cognitions).

252 Gavita et al.

Finally, these lines of research should be strongly related to various line of research about parental emotion socialization (e.g., emotional regulation paradigm) and the role of parents in teaching children how to regulate their feelings. At this moment, they are not well integrated and/or connected. Our model would suggest that a cognitive self-regulatory component could help parent to regulate their distress (first in the treatment sequence) and that, in turn, would help them not only to be better parents in terms of behavioral outcome of their children (i.e., show them what to do), but also to be effective “teachers” by training children to use various strategies to regulate their own feelings and behaviors. Knowing that there is a tendency for children to imitate parents’ behaviors, this will be relevant for children’s emotions and behaviors.

references

Abelson, R. P., & Rosenberg, M. J. (1958). Symbolic psychologic: A model of attitudinal cognition. Behavioral

Science, 3(1), 1–13.

Assemany, A. E., & McIntosh, D. E. (2002). Negative treatment outcomes of behavioral parent training

programs. Psychology in the Schools, 39(2), 209–219.

Azar, S. T., Nix, R. L., & Makin-Byrd, K. N. (2005). Parenting schemas and the process of change. Journal of

Marital and Family Therapy, 31(1), 45–58.

Azar, S. T., & Rohrbeck, C. A. (1986). Child abuse and unrealistic expectations: Further validation of the

parent opinion questionnaire. Journal of Consulting and Clinical Psychology, 54(6), 867–868.

Bandura, A. (1977). Social learning theory. Engelwood-Cliffs, NJ: Prentice-Hall.

Barlow J., & Coren, E. (2001). Parent-training programmes for improving maternal psychosocial health.

Cochrane Database of Systematic Reviews,(2), CD002020.

Barlow, J., & Stewart-Brown, S. (2000). Behavior problems and group-based parent education programs.

Journal of Developmental and Behavioral Pediatrics, 21(5), 356–370.

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy for depression. New York: The

Guilford Press.

Ben-Porath, D. D. (2010). Dialectical behavior therapy applied to parent skills training: Adjunctive treatment

for parents with difficulties in affect regulation. Cognitive and Behavioral Practice, 17(4), 458–465.

Bernard, M. E. (2004). The REBT therapist’s pocket companion for working with children and adolescents.

New York: Albert Ellis Institute.

Bernard, M. E., & Joyce, M. R. (1984). Rational-emotive therapy with children and adolescents. New York:

Wiley.

Bor W., Sanders M. R., & Markie-Dadds C. (2002). The effects of the Triple P-Positive Parent program

on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties.

Journal of Abnormal Child Psychology, 30(6), 571–587.

Bugental, D. B., & Johnston, C. (2000). Parental and child cognitions in the context of the family. Annual

Review of Psychology, 51, 315–344.

Cameron, S. J., Snowdon, A., & Orr, R. R. (1992). Emotions experienced by mothers of children with

developmental disabilities. Children’s Health Care, 21(2), 96–102.

Carpenter, S., & Halberstadt, A. G. (2000). Mothers’ reports of events causing anger differ across family

relationships. Social Development, 9(4), 458–477.

Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applica-

tions. Developmental Review, 18(1), 47–85.

Cornah, D., Sonuga-Barke, E., Stevenson, J., & Thompson, M. (2003). The impact of maternal mental health

and child’s behavioural difficulties on attributions about child behaviours. The British Journal of Clinical

Psychology, 42(Pt. 1), 69–79.


Dadds, M. R., & McHugh, T. A. (1992). Social support and treatment outcome in behavioral family therapy

for child conduct problems. Journal of Consulting and Clinical Psychology, 60(2), 252–259.

David, D. (2003). Rational emotive behavior therapy: The view of a cognitive psychologist. In W. Dryden

(Ed.), Rational emotive behaviour therapy: Theoretical developments (pp. 130–160). New York: Brunner-

Routledge.

David, D. (2004). Special issue on the cognitive revolution in clinical psychology: Beyond the behavioral

approach-conclusions: Toward an evidence-based psychology and psychotherapy. Journal of Clinical

Psychology, 60(4), 447–451.

David, D., Lynn, S. J., & Ellis, A. (Eds.). (2010). Rational and irrational beliefs: Research, theory, and clinical

practice. New York: Oxford University Press.

David, D., McMahon, J., Macavei, B., & Szentagotai, A. (2005). Cognitive restructuring and mental con-

tamination: An empirical re-conceptualization. Journal of Rational-Emotive and Cognitive-Behavior

Therapy, 23(1), 21–56.

David, D., & Szentagotai, A. (2006). Cognition in cognitive-behavioral psychotherapies; toward an integrative

model. Clinical Psychology Review, 26(3), 284–298.

DiGiuseppe, R., & Kelter, J. (2006). Treating aggressive children: A rational-emotive behavior systems

approach. In A. Ellis, & M. E. Bernard (Eds.), Rational emotive behavioral approaches to childhood

disorders: Theory, practice and research (pp. 257–280). New York: Springer.

Dix, T. (1991). The affective organization of parenting: Adaptive and maladaptive processes. Psychological

Bulletin, 110(1), 3–25.

Dix, T., & Meunier, L. N. (2009). Depressive symptoms and parenting competence: An analysis of 13 regulatory

processes. Developmental Review, 29(1), 45–68.

Dix, T., & Reinhold, D. P. (1991). Chronic and temporary influences on mothers’ attributions for children’s

disobedience. Merrill-Palmer Quarterly, 37, 251–271.

Doubleday, E., & Hey, C. (2004). Is statistical significance enough? Behavioural parent training programmes

in real life. Clinical Psychology, 37, 5–9.

Downey, G., & Coyne. J. C. (1990). Children of depressed parents: An integrative review. Psychological

Bulletin, 108(1), 50–76.

Dryden, W., & David, D. (2008). Rational emotive behavior therapy: Current status. Journal of Cognitive

Psychotherapy: An International Quarterly, 22, 195–210.

Dumas, J. E. (2005). Mindfulness-based parent training: Strategies to lessen the grip of automaticity in families

with disruptive children. Journal of Clinical Child and Adolescent Psychology, 34(4), 779–791.

Ellis, A. (1994). Reason and emotion in psychotherapy. Secaucus, NJ: Birch Lane Press.

Ellis, A. (2003). Similarities and differences between rational emotive behavior therapy and cognitive therapy.

Journal of Cognitive Psychotherapy: An International Quarterly, 17(3), 225–240.

Ellis, A. (2004). Why rational-emotive behavior therapy is the most comprehensive and effective form of

behavior therapy. Journal of Rational Emotive & Cognitive-Behavior Therapy, 22(2), 85–92.

Ellis, A. (2005). Can rational-emotive behavior therapy (REBT) and acceptance and commitment therapy

(ACT) resolve their differences and be integrated? Journal of Rational-Emotive and Cognitive-Behavior

Therapy, 23, 153–168.

Ellis, A., & Bernard M. E. (Eds.). (2006). Rational emotive behavioral approaches to childhood disorders:

Theory, practice and research. New York: Springer.

Ellis, A., Wolfe, J. L., & Moseley, S. (1966). How to raise an emotionally healthy, happy child. New York:

Crown.

Eysenck, M. W., & Keane, M. T. (2000). Cognitive psychology: A student’s handbook (4th ed.). Hove, United

Kingdom: Psychology Press.

Gavita, O. A., & Joyce, M. R. (2008). A review of the effectiveness of group cognitively enhanced behavioral

based parent programs designed for reducing disruptive behavior in children. Journal of Cognitive and

Behavioral Psychotherapies, 8(2), 185–199.

254 Gavita et al.

Greenberg, M. T., Speltz, M. L., DeKlyen, M., & Endriga, M. C. (1991). Attachment security in preschoolers

with and without externalizing behavior problems: A replication. Development and Psychopathology,

3, 413.

Grieger, R., & Boyd, J. (1980). Rational-emotive therapy: A skills based approach. New York: Van Nostrand

Reinhold.

Griest, D. L., Forehand, R., Rogers, T., Breiner, J., Furey, W., & Williams, C. A. (1982). Effects of parent

enhancement therapy on the treatment of outcome and generalization of a parent training program.

Behaviour Research and Therapy, 20(5), 429–436.

Hackmann, A. (1997). The transformation of meaning in cognitive therapy. In M. Power, & C. R. Brewin

(Eds.), The transformation of meaning in psychological therapies (pp. 125–140). Chichester, United

Kingdom: Wiley.

Hartman, R. R., Stage, S. A., & Webster-Stratton, C. (2003). A growth curve analysis of parent training

outcomes: Examining the influence of child risk factors (inattention, impulsivity, and hyperactivity

problems), parental and family risk factors. Journal of Child Psychology and Psychiatry, and Allied

Disciplines, 44(3), 388–398.

Haskett, M. E., Smith Scott, S., Grant, R., Ward, C. S., & Robinson, C. (2003). Child-related cognitions and

affective functioning of physically abusive and comparison parents. Child Abuse & Neglect, 27(6),

663–686.

Hauck, P. (1967). The rational management of children. New York: Libra.

Hauck, P. (1983). Working with parents. In A. Ellis & M. E. Bernard (Eds.), Rational emotive approaches to the

problems of childhood (pp. 333–365). New York: Plenum Press.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy:

Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25.

Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically

oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35–54.

Holden, G. W., & Edwards, L. A. (1989). Parental attitudes toward child rearing: Instruments, issues, and

implications. Psychological Bulletin, 106, 29–58.

Hoza, B., Owens, J. S., Pelham, W. E., Swanson, J. M., Conners, C. K., Hinshaw, S. P., et al. (2000). Parent

cognitions as predictors of child treatment response in attention-deficit/hyperactivity disorder. Journal

of Abnormal Child Psychology, 28(6), 569–583.

Hutchings, P. (1996). The peer review of teaching: Progress, issues and prospects. Innovative Higher Education,

20(4), 221–234.

Hutchings, J., Lane, E., & Kelly, J. (2004). Comparison of two treatments for children with severely disruptive

behaviours: A four year-follow-up. Behavioral and Cognitive Psychotherapy, 32(1), 15–30.

Joyce, M. (1995). Emotional relief for parents: Is rational-emotive parent education effective? Journal of

Rational-Emotive & Cognitive-Behavior Therapy, 13, 55–76.

Joyce, M. R. (2006). Rational-emotive behavioral approaches to childhood disorders: History, theory, practice,

and research. In A. Ellis, & M. E. Bernard (Eds.), Rational emotive behavior approaches to childhood disorders

(pp. 177–211). New York: Springer.

Kazdin, A. E. (1993). Adolescent mental health. Prevention and treatment programs. The American Psychologist,

48(2), 127–141.

Kazdin, A. E. (1997). Parent management training: Evidence, outcomes, and issues. Journal of the American

Academy of Child and Adolescent Psychiatry, 36(10), 1349–1356.

Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among

children referred for conduct disorder. Journal of Clinical Child Psychology, 28(2), 160–172.

Kazdin, A. E., & Whitley, M. K. (2003). Treatment of parental stress to enhance therapeutic change among

children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology,

71(3), 504–515.

Kelly, G. A. (1955). The psychology of personal constructs. New York: Norton.


Krech, K. H., & Johnston, C. (1992). The relationship of depressed mood and life stress to maternal perceptions

of child behavior. Journal of Clinical Child and Adolescent Psychology, 21, 115–122.

Kuhn, J. C., & Carter, A. S. (2006). Maternal self-efficacy and associated parenting cognitions among mothers

of children with autism. The American Journal of Orthopsychiatry, 76(4), 564–575.

Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.

Lazarus, R. S., & Smith, C. A. (1988). Knowledge and appraisal in the cognition-emotion relationship.

Cognition and Emotion, 2, 281–300.

Longmore, R. J., & Worrell., M. (2007). Do we need to challenge thoughts in cognitive behavior therapy?

Clinical Psychology Review, 27(2), 173–187.

Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior:

A meta-analytic review. Clinical Psychology Review, 20(5), 561–592.

MacKinnon-Lewis, C., Lamb, M. E., Arbuckle, B., Baradaran, L. P., & Volling, B. L. (1992). The relationship

between biased maternal and filial attributions and the aggressiveness of their interactions. Development

and Psychopathology, 4, 403–415.

Mammen, O. K., Kolko, D. J., & Pilkonis, P. A. (2002). Negative affect and parental aggression in child physical

abuse. Child Abuse & Neglect, 26(4), 407–424.

Mash, E. J., & Johnston, C. (1990). Determinants of parenting stress, illustrations from families of hyperactive

children and families of physically abused children. Journal of Clinical Child Psychology, 19, 313–328.

Maultsby, M. C. (1984). Rational behavior therapy. Englewood Cliffs, NJ: Prentice-Hall.

Morrissey-Kane, E., & Prinz, R. J. (1999). Engagement in child and adolescent treatment: The role of parental

cognitions and attributions. Clinical Child and Family Psychology Review, 2(3), 183–198.

Murphey, D. A. (1992). Constructing the child: Relations between parents’ beliefs and child outcomes.

Developmental Review, 12, 199–232.

National Institute for Health and Clinical Excellence. (2006). Parent-training/education programmes in the

management of children with conduct disorders (NICE technology appraisal guidance 102). London:

Author. Retrieved February 2011, from http://www.nice.uk.org

Nixon, R. D. (2002). Treatment of behavior problems in preschoolers: A review of parent training programs.

Clinical Psychology Review, 22(4), 525–546.

Patterson, G. R., Dishion, T. J., & Chamberlain, P (1993). Outcomes and methodological issues relating to

treatment of antisocial children. In T. R. Giles (Ed.), Handbook of effective psychotherapy (pp. 43–88).

New York: Plenum Press.

Potier, J., & Day, C. (2007). Childhood onset conduct problems: A preliminary investigation into the role

of mothers’ interpersonal schemas and their relationship to parenting behaviour. Behavioural and

Cognitive Psychotherapy, 35, 457–472.

Roberts, M. W., Joe, V. C., & Rowe-Hallbert, A. (1992). Oppositional child behavior and parental locus of

control. Journal of Clinical Child Psychology, 21, 170–177.

Rotter, J. B. (1960). Some implications of a social learning theory for the prediction of goal directed behavior

from testing procedures. Psychological Review, 67, 301–316.

Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The triple P-positive parent program: A com-

parison of enhanced, standard, and self-directed behavioral family intervention for parents of children

with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68(4), 624–640.

Scott, S. (2001). Deciding whether interventions for antisocial behaviour work: Principles of outcome assessment,

and practice in a multicentre trial. European Child & Adolescent Psychiatry, 10(Suppl. 1), 59–70.

Seligman, M. E. P. (1975). Helplesness. San Francisco, CA: Freeman.

Smith, C. A., Haynes, K. N., Lazarus, R. S., & Pope, L. K. (1993). In search of the “hot” cognitions:

Attributions, appraisals, and their relation to emotion. Journal of Personality and Social Psychology,

65(5), 916–929.

Stern, S. B., & Azar, S. T. (1998). Integrating cognitive strategies into behavioral treatment for abusive parents

and families with aggressive adolescents. Clinical Child Psychology and Psychiatry, 3(3), 387.

256 Gavita et al.

Strassberg, Z. (1995). Social information processing in compliance situations by mothers of behavior-problem

boys. Child Development, 66(2), 376–389.

Sutton, C. (2001). Resurgence of attachment (behaviours) within a cognitive behavioural intervention:

Evidence from research. Behavioural and Cognitive Psychotherapy, 29, 357–366.

Terjesen, M. D., & Kurasaki, R. (2009). Rational emotive behavior therapy: Applications for working with

parents and teachers. Estudios de Psicologia, 26, 3–14.

Vernon, A. (2006a). Thinking, feeling, behaving: An emotional education curriculum for children (2nd. ed.).

Champaign, IL: Research Press.

Vernon, A. (2006b). Thinking, feeling, behaving: An emotional education curriculum for adolescents (2nd. ed.).

Champaign, IL: Research Press.

Vernon, A., & Bernard, M. E. (2006). Applications of REBT in schools: Prevention, promotion, intervention.

In A. Ellis & M. E. Bernard (Eds.), Rational emotive behavioral approaches to childhood disorders: Theory,

practice and research (pp. 415–460). New York: Springer.

Webster-Stratton, C. (1990a). Long term follow-up of families with young conduct problem children: From

pre-school to grade school. Journal of Clinical Child Psychology, 19(2), 144–149.

Webster-Stratton, C. (1990b). Stress: A potential disrupter of parent perceptions and family interactions.

Journal of Clinical Child Psychology, 19(4), 302–312.

Webster-Stratton, C. (1992). The incredible years: A trouble-shooting guide for parents of children ages 3–8 years.

Toronto, Canada: Umbrella Press.

Webster-Stratton, C., & Hammond, M. (1990). Predictors of treatment outcome in parent training for families

with conduct problem children. Behavior Therapy, 21, 319–337.

Webster-Stratton, C., Kolpacoff, M., & Hollingsworth, T. (1988). Self-administered and systems family

therapy for childhood defiant disorder: Comparative treatment outcomes. Comprehensive Psychiatry,

56, 558–566.

Wells, K. C., Griest, D. L., & Forehand, R. (1980). The use of a self-control package to enhance temporal generality

of a parent training program. Behavior Research and Therapy, 18, 347–353.

Wessler, R. L. (1982). Varieties of cognitions in the cognitively-oriented psychotherapies. Rational Living,

17, 3–10.

White, C., McNally, D., & Cartwright-Hatton, S. (2003). Cognitively enhanced parent training. Behavioural

and Cognitive Psychotherapy, 31, 99–102.

Acknowledgments. Oana A. Gavita 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 Gavita, MA, Department of Clinical Psychology

and Psychotherapy, Babes–Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Cluj, Romania.

E-mail: [email protected]

Copyright of Journal of Cognitive Psychotherapy is the property of Springer Publishing Company, Inc. and its

content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's

express written permission. However, users may print, download, or email articles for individual use.

cognitive behavioral parent programs for the treatment of child disruptive...

Documents