Efficacy of Emotion-Focused Parenting Programs for Children’s Internalizing and Externalizing Symptoms: A Randomized Clinical Study

Figures & data

Figure 1. Consolidated standards of reporting trials (CONSORT) flow diagram of participants during enrollment, allocation, follow-up, and data-analysis. ITT intention-to-treat.

Table 1. Baseline characteristics of children and parents in both conditions.

Parent demographics	EXP (n = 160)	PE (n = 153)	Total (n = 313)	p
Parent age n (m, SD)	160 (40.6, 6.7)	153 (40.5, 6.2)	313 (40.5, 6.5)	.680
Parent n (%) female	120 (75)	115 (75.2)	235 (74.8)	.764
Parent n (%) male	40 (25)	39 (25.4)	79 (25.2)	.905
Single n (%) Married/cohabitants	20 (12.5) 119 (74.4)	17 (11.1) 115 (75.2)	37 (11.8) 234 (74.8)
Separated/divorced	21 (13.1)	21 (13.7)	42 (13.4)	.267
Diploma 1–3 years College/University 3–4 years Post-College degree Norwegian European Other nationalities Christian Non-religious Other religions Heterosexual Homosexual/lesbian/bisexual Full-time employed Part-time employed Unemployed/sick leave	18 (11.3) 83 (51.9) 59 (36.8) 141 (88.1) 11 (6.9) 8 (5) 62 (38.8) 90 (56.2) 8 (5) 149 (93.1) 11 (6.9) 119 (74.4) 25 (15.6) 9 (5.6)	23 (15) 69 (45.1) 61 (39.9) 139 (90.9) 8 (5.2) 6 (3.9) 58 (37.9) 87 (56.9) 8 (5.2) 141 (92.2) 12 (7.8) 108 (70.6) 24 (15.7) 8 (5.2)	41 (13.1) 152 (48.6) 120 (38.3) 280 (89.5) 19 (6.1) 14 (4.5) 120 (38.4) 177 (56.5) 16 (5.1) 290 (92.7) 23 (7.3) 227 (72.5) 49 (15.7) 17 (5.4)	.567 .357 .291 .128
Student/ /resident	7 (4.4)	13 (8.5)	20 (6.4)	.227
No earlier treatment* Earlier treatment ≤ 1–3 times Earlier treatment ≤ 4–7 times	149 (93.1) 7 (4.4) 4 (2.5)	138 (90.2) 13 (8.5) 2 (1.3)	287 (91.7) 20 (6.4) 6 (1.9)	.484
Children demographics	EXP (n = 120)	PE (n = 116)	Total (n = 236)	p
Youth age n (m, SD)	120 (8.9, 2.1)	116 (8.9, 2.0)	236 (8.9, 2.1)	.921
Youth n (%) female	48 (40)	46 (39.7)	94 (39.8)
Youth n (%) male	72 (60)	70 (60.3)	142 (60.2)	.103
INT n (%, m, SD)	19 (15.8, 70.18, 8.8)	21 (18.1, 70.03, 9.2)	40 (16.9, 70.11, 9)	.710
EXT n (%, m, SD)	18 (15, 65.6, 7.2)	15 (12.9, 66.2, 6.8)	33 (14, 65.9, 7)	.906
INT and EXT n (%, m, SD) No earlier treatment* n (%) Earlier treatment 1–3 times Earlier treatment 4–7 times	83 (69.2, 69.8, 8.9) 75 (62.5) 23 (19.2) 22 (18.3)	80 (69, 69.2, 8.6) 73 (62.9) 24 (20.7) 19 (16.4)	163 (69.1, 69.5, 8.4) 148 (62.7) 47 (19.9) 41 (17.4)	.202 .071

EXP, experiential condition, PE, psychoeducational condition. INT internalizing symptoms and EXT externalizing symptoms (T scores 65 or higher on Brief Problem Monitor for parents; Achenbach & Rescorla, 2001). *Due to mental health issues.

Table 2. Mean scores and effect sizes (Cohen’s d) of differences in means across assessment waves.

	Baseline-T0	After group training-T1	Post-Intervention-T2	4-Month FU-T3	8-Month FU – T4	12-Month FU – T5	d [95%CI]
	Mean (n, SD) p	Mean (n, SD) p	Mean (n, SD) p	Mean (n, SD) p	Mean (n, SD) p	Mean (n, SD) p	T2; T0	T0; T5
Internalizing
Parent reports
PE	70.09 (116;9.2)	66.24 (92; 5.9)	66.95 (59; 7.8)	65.33 (62; 5.8)	63.45 (58; 5.9)	64.70 (49; 6.2)	0.53 [0.69–0.10]	0.76 [0.31, 0.90]
EXP	70.27 (120;8.8) .710	65.60 (109;5.1) .503	65.70 (106;7.9) .503	63.29 (101;5.3) .332	63.03 (79; 5.3) .115	62.99 (53; 6.1) .901	0.77[0.99–0.46]	1.09 [0.50, 1.26]
Teacher reports
PE	60.01 (60; 5.5)	_	60.27 (56; 5.8)	_	59.74 (56; 6.4)	60.07 (49; 5.9)	0.20 [0.61–0.10]	0.28 [0.13, 0.63]
EXP	59.23 (53; 5.9) .252	_	57.53 (45;6.4) .047*	_	58.82 (43; 6.2) .667	57.37 (44; 6.3) .057	0.01[0.42–0.39]	0.05 [0.38, 0.49]
Externalizing
Parent reports
PE	65.72 (116; 10.1)	61.15 (92; 6.0)	61.38 (59; 9.0)	60.02 (62; 7.3)	56.84 (58; 5.9)	61.09 (49; 5.6)	0.74 [0.98–0.37]	0.79 [0.09, 1.05]
EXP	66.12 (120;10.6) .906	60.10 (109;6.6) .293	59.47 (106;8.1) .170	57.32(101;6.2).019**	57.28 (79; 6.1) .679	57.83 (53; 6.1) .011**	0.99 [1.14–0.58	1.21 [0.55, 1.28]
Teacher reports
PE	61.35 (60; 6.4)	_	59.55 (56; 6.0)	_	58.44 (56; 5.7)	58.94 (49; 7.2)	0.28 [0.70-0-03]	0.38 [0.08, 0.89]
EXP	61.83 (53;6.0) .686	_	60.11 (45;6.4) .619	_	57.42 (43; 6.0) .453	59.18 (44; 6.8) .853	0.28 [0.78–0.06]	0.46 [0.32, 1.33]

n sample size, SD standard deviation, d Cohen’s d, 95% confidence intervals (CI) with lower and upper bound and p-values of differences between conditions. Primary outcome on internalizing and externalizing symptoms in children measured by parents with Brief Problem Monitor (BPM-P) and teachers with Brief Problem Monitor for teachers (BPM-T). FU follow-up, PE psychoeducation, EXP experiential.

Table 3. Growth curve model for primary outcome variables across T0–T5.

Growth curve model
Variable	Model 1			Model 2
	Est.	S.E.	95% CI	Est.	S.E.	95% CI
Parent ratings Internalizing Fixed effects Intercept	70.18***	.374	[69.09, 71.14]	69.64***	.583	[68.49, 70.78]
Slope	−1.71***	.127	[−1.97, −1.47]	−1.69***	.136	[−1.95, −1.42]
Condition				.304	.759	[−1.94, .46]
Condition*Slope				.320	.260	[−1.08, .054]
Model fit AIC	6262.236			6190.550
Externalizing Fixed effects Intercept	65.92***	.413	[64.81, 67.44]	64.91***	.637	[63.66, 66.17]
Slope	−1.72***	.113	[−1.94, −1.50]	−1.51***	.184	[−1.87, −1.15]
Condition				.530	.834	[−2.16, 1.1]
Condition*Slope				.165	.233	[−.78, .13]
Model fit AIC	6170.130			6001.813
Teacher ratings Internalizing Fixed effects Intercept	59.62***	.549	[58.39, 60.56]	57.44**	.657	[54.14, 60.74]
Slope	−.13	.178	[−.48, .21]	−.23	.192	[−1.31, .84]
Condition				.20	.637	[−.75, 3.57]
Condition*Slope				.853	.367	[−.64, .77]
Model fit AIC	2438.568			2442.567
Externalizing Fixed effects Intercept	61.59***	.561	[59.91, 62.11]	60.38***	1.782	[56.86, 63.89]
Slope	−.96***	.202	[−1.34, −.57]	− 1.13	.599	[−2.31, .05]
Condition				.71	1.172	[−1.87, 2.74]
Condition*Slope				.76	.396	[−1.67, 2.52]
Model fit AIC	2449.268			2445.569

*p < .05; **p < .01; ***p < .001. Estimates for primary outcome measures of internalizing and externalizing symptoms in children measured by parents with Brief Problem Monitor (BPM-P) and teachers with Brief Problem Monitor for teachers (BPM-T). Estimates (Est.) 95% confidence intervals (CI) with lower and upper bound and standard error (S.E.). AIC Akaike information criterion. Model 1: Intercept and slope, no covariates. Unstructured covariance matrices show significant differences in growth curves between internalizing and externalizing symptoms and slope reported by parents, and significant differences in externalizing symptoms, but not on internalizing symptoms, reported by teachers. Model 2: adding treatment condition improve model fit on both internalizing and externalizing symptoms based on both parent and teacher reports.

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school age forms and profiles. Research center for children, youth, and families, University of Vermont.

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