Flujas-Contreras et al., 2023.pdf

Journal Pre-proof The relationship between parental stress and psychological adjustment of the children: The role of parental psychological flexibility as a mediator Juan M. Flujas-Contreras, Álvaro Recio-Berlanga, Magdalena P. Andrés, Mercedes Fernández-Torres, Pilar Sánchez-López, Inmaculada Góm...

Journal Pre-proof The relationship between parental stress and psychological adjustment of the children: The role of parental psychological flexibility as a mediator Juan M. Flujas-Contreras, Álvaro Recio-Berlanga, Magdalena P. Andrés, Mercedes Fernández-Torres, Pilar Sánchez-López, Inmaculada Gómez PII: S2212-1447(23)00092-3 DOI: https://doi.org/10.1016/j.jcbs.2023.07.006 Reference: JCBS 687 To appear in: Journal of Contextual Behavioral Science Received Date: 6 March 2023 Revised Date: 3 July 2023 Accepted Date: 18 July 2023 Please cite this article as: Flujas-Contreras J.M., Recio-Berlanga Á., Andrés M.P., Fernández-Torres M., Sánchez-López P. & Gómez I., The relationship between parental stress and psychological adjustment of the children: The role of parental psychological flexibility as a mediator, Journal of Contextual Behavioral Science (2023), doi: https://doi.org/10.1016/j.jcbs.2023.07.006. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2023 Published by Elsevier Inc. on behalf of Association for Contextual Behavioral Science.  1 The relationship between parental stress and psychological adjustment of the children: the role of parental psychological flexibility as a mediator Juan M. Flujas-Contreras 1,2, Álvaro Recio-Berlanga 3,4, Magdalena P Andrés 4, Mercedes Fernández-Torres 4, Pilar Sánchez-López 4 & Inmaculada Gómez 4,2* 1 University of Seville, Spain; 2 Health Research Center University of Almería, Spain; 3 o f Andalusian School of Public Health, Spain; 4 University of Almeria, Spain ro -p re * Correspondence to: Professor Inmaculada Gómez Becerra lP University of Almeria. Department of Psychology La Cañada de San Urbano s/n. Engineering School, 0.50. 04120. Almeria. Spain. Phone: +34 950214414 na Email: [email protected] ur Jo Data sharing statement: Data is available upon request Conflict of Interest: All authors declare that they have no conflicts of interest. Ethical declaration: Ethical committee of Council of Andalusia approved the study. Informed consent was obtained from participants. All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Funding: This work is supported by the Spanish Ministry of Science and Innovation (Project refer- ence/AEI/10.13039/501100011033) awarded to I.G. Acknowledges. JMFC acknowledges funding from Juan de la Cierva program (Spain) under Contract No. FJC2021-047648-I The relationship between parental stress and psychological adjustment of the children: the role of parental psychological flexibility as a mediator f r oo -p re lP na ur Jo  Abstract There is growing interest in parental psychological flexibility, understood as parents’ ability to enjoy an optimal relationship with their children by accepting their negative emotions and thoughts in the present moment, while remaining child-conscious, in value-based parenting. Parenting can sometimes be stressful, especially when faced with the varied and changing challenges of parenthood. Parental stress, in turn, has been related to high levels of psychological inflexibility. So, this study aimed to analyze the relationship of parental psychological flexibility with parental stress and its impact on children's psychological f adjustment. The sample consisted of 909 families with children aged 3 to 18 years who oo answered the following questionnaires: The Parental Acceptance Questionnaire (6-PAQ), which r measures psychological flexibility, the Parental Stress Scale (PSS), and the Strenght and -p Difficulties Questionnaire (SDQ), which studies the general psychological state of children and re adolescents by screening for emotional and behavioral difficulties. These variables were lP analyzed by difference analysis according to the level of psychological flexibility, regression analysis, and mediation analysis. The group of parents who scored highest on psychological na inflexibility scored high on parental stress and the child psychological adjustment scales, except ur for the prosocial behavior subscale. The results show that parental psychological inflexibility is Jo related to higher levels of parental stress, and in turn, has an impact on greater psychological maladjustment in children. These relationships are analyzed from their clinical and educational implications as factors and objectives to be incorporated into family intervention. Keywords: psychological parental flexibility, parenting stress, psychological adjustment in children  Introduction Intervention in parenting aims to promote actions of parents in the interaction or management of their children's behavior, this aspect has been determined as a protective factor in the development and maintenance of problems and difficulties of their children (Gorostiaga, et al., 2019; Masud et al., 2019; Pinquart, et al., 2017). In turn, the actions taken by parents to manage their children's behavioral or emotional problems may be influenced by factors such as emotional regulation skills (Rutherford, et al., 2015), Sense of parental competence (Egberts et al.,2015), or personality (Oliver et al.,2009), among others. This makes it relevant to know what f processes or skills are involved in parenting and how parental interventions can be facilitated. A oo better understanding of how parental characteristics can affect child development and parental r stress is needed. -p Parental stress and its impact on child’s outcomes re Parenting can sometimes be stressful, especially in facing the various and changing lP challenges of breeding, such as educational demands or having to adapt to their children’s na developmental needs (Crnic & Low, 2002). Deater-Deckard (2004, p.6) defined parental stress as "a set of processes leading to aversive psychological and physiological reactions arising from ur attempts to adapt to the demands of parenting. This is often experienced as negative feelings and Jo beliefs toward self and child". Previous research has shown relationships between parental stress levels and psychological problems in children. This relationship has also been found with an increase in symptoms related to behavioral problems (Miranda et al., 2019), children's cognitive development, prosocial behavior (Ward & Lee, 2020), sleep problems (Martin et al., 2019), or child functioning (Rodriguez et al., 2019). On the other hand, bidirectional relationships have been found between parental stress level and family functioning (Zeng et al., 2020) and with mediating effects on mothers' depressive symptomatology (Fredriksen et al., 2019). The specific personal and contextual characteristics of each family, the family climate, and the socioeconomic situation can influence parental stress differently (Hayes & Watson 2013). In this sense, parental stress is going to be influenced by parental demands (Oronoz et al., 2007), how the parents perceive their abilities and efficiency (Raikes & Thompson, 2005), family and parental particularities (Farmer & Lee, 2011), work overload (Östberg and Hagekill, 2000), parental beliefs (Stelter & Halberstadt, 2011), the social support provided by their environment (Drogomyretska et al.,2020), and their self-compassionate skills (Bohadana et al., 2019), among others. Similarly, the coping strategies employed may report differential results concerning the level of parental stress. Thus, previous research has shown that avoidance-related or emotion- f focused coping strategies report higher levels of parental stress (Cuzzocrea et al., 2015; Jarvis et oo al.,1991; López et al., 2008; Shea & Coyne, 2011). Given that there are personal and coping r style characteristics that may influence or mitigate the level of parental stress, we wondered -p whether psychological flexibility may also be a mediating variable. re Psychological flexibility within parenting. lP Psychological flexibility is defined as the ability to be consciously in contact with the present moment, completely and without judging or trying to change the thoughts and emotions na that occur at that moment, and persistently keeping in mind personal values and goals (Hayes, et ur al., 2012). Kashdan and Rottenberg (2010) related psychological flexibility to a self-control Jo variable, self-regulation, and emotion regulation. Psychological flexibility is also understood as a factor in overall well-being (Kuba et al., 2019), as a protective factor to help to struggle with psychological problems by accepting and promoting desirable behavior (Fledderus et al., 2010). In the field of parenting, psychological flexibility is defined as the capacity of parents for enjoying a good relationship with their children is understood to lie in their acceptance of negative emotions and thoughts about them in the present moment while remaining aware of their needs, and thereby applying optimum parenting based on values (Burke & Moore, 2015). Parents with less psychological flexibility had ineffective parenting practices, such as very severe discipline or inconsistent rules (Burke & Moore, 2015). Also, it has been related to anxiety (Emerson et al., 2019) and depression (Biglan et al., 2015) in both parents and children. Experiential avoidance, that is, the tendency to avoid, suppress, or modify uncomfortable experiences or private events (contrary to psychological flexibility), has been related to greater depressive symptomatology in parents, greater distress, and internalizing problems in children (Coyne & Thomson, 2011; Moyer & Sandoz, 2014; Williams et al., 2012). Similarly, Withinghamm et al. (2019) showed the importance of psychological flexibility as a mediator in parental intervention to improve parenting styles and parent-child interaction. Psychological flexibility is the main topic of interest in Acceptance and Commitment Therapy (ACT; Hayes et al., 2012). In a triadic model of ACT, psychological flexibility is identified with three response styles. A style open to experience with acceptance and f perspective on the events experienced (open). A response style focused on the present moment oo (aware). And a response style committed to value-directed actions (active) (Hayes et al., 2012). r An open response style is defined as the willingness to be in complete and non-judgmental -p contact with one's own experiences (acceptance), while taking a flexible perspective on private re events, i.e., without following thoughts literally (defusion). On the other hand, we refer to an lP aware response style when a person focuses on the present moment in a deliberate and non- evaluative manner (mindfulness), consciously observing their own private events and taking a na perspective from the self (self as context). Finally, an active style is defined in terms of actions ur oriented to the construction of flexible repertoires (committed action) that are framed and Jo motivated in a context of values (values) (Hayes et al.,2012). However, all these processes must be understood as interconnected from a functional analysis of behavior. A systematic review by Byrne et al. (2020) found that ACT was useful to parents of children with Autistic Spectrum Disorder (ASD) and other chronic medical or health conditions. Previous studies show that ACT interventions in families with children with autism, post-traumatic stress disorder, or brain injury reduced experiential avoidance, parental stress, and disorder symptoms (Andrews et al., 2022; Brown et al., 2015; Polusny et al., 2011). In a review by Gur and Reich (2023) on the psychological flexibility in parents of children with disabilities they found that psychological flexibility is a relevant skill for both parent and child functioning.  In conclusion, psychological flexibility is a skill that has an important influence on parenting practices and children's development. Previous studies have described the relationship between psychological flexibility and parental stress, which are described below. Parental stress and psychological flexibility. Parental stress has been related to high psychological inflexibility levels. Parents who have low psychological flexibility usually evaluate the internal experiences of stress negatively, which leads them to practice avoidance, suppression, and control strategies (Burke & Moore, 2015; Fonseca et al., 2020). These avoidance strategies may seem effective in the short-term, f however, in the long-term, they magnify negative internal experiences (Hayes et al., 2012), oo which can lead to increasing parental stress and applying maladaptive parenting practices r (Sairanen et al., 2018). -p Previous studies have shown that psychological flexibility functions as a resource for re more adaptive parenting styles, thereby helping parents regulate and manage parental stress lP (Fonseca et al., 2020). In a study by Fonseca et al (2020), they found that parental psychological flexibility is a mediating factor for authoritarian parenting practices when the level of parental na stress is high. In this sense, when parents must manage her child's behavior in stressful ur situations, they employ discomfort avoidance and situational control strategies that, without a Jo sufficient level of acceptance and flexibility, may lead to maladaptive parenting practices. On the other hand, a study by Lobato et al. (2020) showed that self as context, committed actions, and cognitive fusion are predictors of parental stress in parents with children with intellectual disabilities. Likewise, as we have previously commented, regulation strategies based on avoidance of experiences have been associated with higher levels of parental stress. The present study. The objective of this study is to analyze the relationship of parental psychological flexibility with parental stress and its repercussion on the psychological adjustment of their children. From the above background, it seems that both parental stress and psychological flexibility have a direct relationship. Parental perceptions of stressful situations will have an impact on the development of problems in children and parenting practices. This study aims to assess to what extent psychological flexibility is a mediator between parental stress and adjustment and which variables will be relevant. The results will provide some idea of what key aspects may be of importance for interventions from a contextual-functional perspective. The initial hypothesis is that a direct relationship will be found between parental stress and children's problems and vice versa, consistent with previous studies. And that psychological flexibility will buffer the effects of parental stress and problems. Method f Participants oo The inclusion criteria were: (a) father, mother, or guardian; (b) have at least one child r aged 1 to 18 years old, and (c) have no linguistic barriers to understanding the questionnaire. -p The exclusion criterion was that the children had a clinical diagnosis of a psychological and/or re medical condition since this can be an additional parental stress factor. These inclusion and lP exclusion criteria were checked using the information reported by the parents in the sociodemographic data and questions regarding the level of Spanish comprehension at the na beginning of the assessment. Self-selection sampling was used. ur The final sample was made up of 902 families with parents aged 25 to 69 (M = 40.39; Jo SD = 6.12). The majority were mothers (94.23%) with Spanish nationality (95.6%) and a university or above secondary education (74.39%). The majority had a two-parent family structure (81.81%), and 53.65% had two children, 35.58% had one child, 10.64% of the families had three children or more children. Most of the parents work in the tertiary sector (services) (45.01%) and the education, health, or culture sector (37.47%). Of the total number of children in the sample (n = 1593), most 52.66% (n = 839) were boys and the remaining 47.33% (n = 754) were girls. The mean age of the children is between 4.72 and 9.34 years old (Table 1). [Table 1] Instruments The Spanish version of the Parental Acceptance Questionnaire (6-PAQ; Greene et al., 2015) by Flujas-Contreras et al. (2020), was used to measure the psychological flexibility of parents in raising their children. It is comprised of 16 items on a four-point Likert scale that measures three subscales corresponding to the response styles associated with psychological flexibility: open, aware, and active (e.g., “If someone criticizes my parenting, I must be a bad parent”; “I feel like my mind is somewhere else when I play with my child”; “My actions as a parent are consistent with my values”) Higher scores are interpreted as greater psychological inflexibility. The Spanish version of the questionnaire has a Cronbach’s alpha of.88 on the total scale and from.68 to.72 on the subscales (Flujas-Contreras et al.,2020). The Spanish version of the Parental Stress Scale (PSS; Berry & Jones, 1995) by Oronoz f et al. (2007) was used to evaluate parental stress. This scale is composed of 12 items on a five- oo point Likert-type scale which evaluate parental stress on two subscales: rewards from the child r and stressful events (e.g., “Taking care of my child sometimes takes more time and energy than I -p have”; “The biggest source of stress in my life is my child”). A higher score means a higher level re of stress. Internal consistency of the Spanish scale is a Cronbach’s alpha of.77 for rewards from lP the child and.76 for stressful events (Oronoz et al., 2007). The Spanish version of the Strengths and Difficulties Questionnaire (SDQ; Goodman, na 1997) by Rodríguez-Hernández et al (2014) was used to evaluate the general psychological state ur of children and adolescents. It is a screening instrument for emotional and behavioral problems Jo and a dimensional measure of mental health (e.g., “Restless, overactive, cannot stay still for long”; “Thinks things out before acting”; “Many fears, easily scared”). It is comprised of 25 items rated on a three-point Likert scale and has five scales: emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behavior. The version applied in this study is filled out by parents. The Spanish-validated version of the questionnaire has an internal consistency of.58 to.80 (Español-Martín et al., 2021). A cutoff point was set at the 80th percentile for the subclinical range and at the 90th for the clinical range, except for the prosocial conduct scale where they were set at the 10th and 20th percentiles respectively (Español-Martín et al., 2021). Procedure  The present study employed a non-probability self-selection type of sampling (convenience sample), i.e., volunteers who agreed to participate in the online survey were accepted. The survey was disseminated on social networks (profiling for the target population), through dissemination in associations, professionals, and educational centers. The survey was conducted using the Lime-Survey platform. Before starting the online survey, participants consented to participate in the study. The information sheet indicated the general objectives of the study. All data were collected anonymously, so there was no follow-up of participants who dropped out of the survey. The study was approved by the **** Bioethics Committee. f Statistical Analysis oo The statistical analysis was performed using JASP 0.17 for Mac OS. Outliers with a r deviation score above 3 were eliminated from the analysis. Assumptions were checked for each -p statistical analysis. First, a descriptive analysis was made of all the variables. Then the sample re was divided into two groups, high and low psychological inflexibility, according to a cutoff lP point of 29.14 in the total 6-PAQ score. This kind of analysis has been applied in previous studies to explore differences in variables (parental stress and children's adjustment in the na present study) according to the level of psychological flexibility (Fonseca et al., 2020; Lobato et ur al., 2022). When this division had been made, a descriptive analysis (mean and standard Jo deviation) was made of all the variables in each group, and the Student’s t for independent samples was calculated to compare the mean scores for the variables evaluated. The effect size was measured using Cohen’s d (1988). To explore how psychological inflexibility explains the variance in the other variables, a stepwise linear regression analysis was calculated with parental stress and psychological adjustment of the children as the dependent variables and parental psychological inflexibility as the independent variable. Finally, a mediation analysis was performed to examine the direct relationships between parental stress and the psychological adjustment of their children (and vice versa), entering parental psychological inflexibility as the mediator. The total effect represents the sum of the direct and indirect effects. Bootstrap procedures were used to test the significance of indirect effects, estimating 95% bias-corrected confidence intervals (95% CI). A maximum likelihood estimator was used.  Results Preliminary analysis Table 2 shows the mean scores and standard deviations of the variables in the total sample. It also shows the differences in mean scores and the effect size by parental psychological inflexibility level. Significant differences were found in parental stress on all the scales, specifically, on the total parental stress scale (t=13.34; p