Melbourne School of Psychological Sciences - Theses
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ItemAn emotion-focused parenting program for parents of children with chronic illness: a pilot study( 2017)Parents play a critical role in socializing children’s emotional experiences which contribute to children’s emotional, social and behavioural functioning. However, when children have chronic illness, more emotionally intense and distressing situations can impact parents and their children. This PhD used a mixed-method approach to examine the feasibility, acceptability and outcome of an emotion-focused parenting program, Tuning in to Kids (TIK), for parents of school-aged children with chronic illness when compared to standard paediatric care at 3-month follow-up. Participants were 52 parent-child dyads (intervention = 27, 51.9%) recruited from the Royal Children’s Hospital, Melbourne. Outcomes were obtained from observation of an emotion discussion task as well as parent-reported and child-reported questionnaires. The individually delivered TIK was well attended with high satisfaction and acceptance for its contents and format. Qualitatively, intervention parents reported increased emotional knowledge, awareness and acceptance of their children’s emotions and their own, as well as learning emotion regulation and coaching skills while understanding and reflecting more on their parenting. When compared to a standard paediatric care control group at follow-up using ANCOVA, results showed that parental emotion socialization skills improved with large effect sizes for intervention parents as their emotion coaching increased while emotion dismissing reduced. Intervention parents also reported increased acceptance of negative emotions, better sense of parenting competence and less difficulties in their emotion regulation. Children of intervention parents also showed an improving trend in their socio-emotional functioning. Overall, findings suggest that TIK is a promising intervention for parents of children with chronic illness.
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ItemAn investigation of parent posttraumatic cognitions and mental health outcomes after trauma exposure in children( 2017)Introduction: Parent posttraumatic cognitions have received little attention in the childhood posttraumatic stress literature, yet potentially play an important role in understanding how parents influence children’s recovery after trauma. The manner in which parents respond to their child’s experience is important in the development and treatment of childhood posttraumatic stress disorder (PTSD), and a range of parenting behaviours and parent psychological problems have been linked to childhood posttraumatic stress (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012; Williamson et al., 2017). To date, limited empirical attention has been given to the nature of cognitions in parents of trauma-exposed children, and the research has been restricted to the use of small item pools, as a multidimensional measure of parent posttraumatic cognitions related to the child’s recovery had yet to be operationalised. The overall aim of this program of research was to develop a measure of parent posttraumatic cognitions for use after a child has experienced a traumatic event, and to examine whether these parent cognitions related to child and parent mental health outcomes. Method: This research had two parts. In Part A, a parent-report questionnaire, the Thinking About Recovery Scale (TARS), was developed to assess specific negative posttraumatic cognitions parents may have after their child is exposed to trauma. The theoretical-rational approach to scale development was used to generate items, which were then subjected to review by experts in the field of childhood trauma. In Part B, the TARS was used in a cross-sectional study, the Thinking About Recovery Project, to examine whether parent posttraumatic cognitions were related to mental health outcomes using a sample of parents and children after children’s experience of accidental injury. Participants were 116 parents and 88 children aged 8-16 years who had been physically injured (e.g., sporting injury, burns, motor vehicle accident) and subsequently admitted to hospital for at least 24 hours. Data collection involved questionnaires to assess parent and child posttraumatic cognitions and mental health outcomes (posttraumatic stress, depression, anxiety, externalising symptoms) between 3 and 6 months post injury. Results: The development and psychometric evaluation of the TARS is reported. The 33-item scale measuring three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated sound internal consistency and convergent validity when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. Posttraumatic cognitions parents had about themselves, the world, and their child’s recovery were significantly associated with both parent and child posttraumatic stress symptoms (PTSS), and a range of other mental health outcomes. A range of parent posttraumatic cognitions were significantly associated with child posttraumatic cognitions. Parent cognitions related to the child mediated the relationship between parents and child PTSS. Discussion and Conclusion: This research was a necessary step in advancing knowledge about parental influences on children’s recovery from traumatic events. Findings provide an empirical basis for ongoing investigation into how parent posttraumatic cognitions may be contributing to the development and maintenance of PTSD symptomatology in parents and children, with particular consideration to cognitions parents have related to their child’s recovery.
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ItemThe role of candidate gene x environment interactions in eating pathology: an investigation of the 5-HTTLPR polymorphism( 2017)The present thesis with publication aimed to clarify current scientific understanding of candidate gene x environment (GxE) interactions in the eating disorder (ED) field, and to build upon existing findings through specific investigation of adolescent disordered eating and the 5-HTTLPR polymorphism. Study 1 involved a systematic review of published studies of GxE interactions involving 5-HTTLPR in the ED field, followed by four meta-analyses involving the combination of raw data from the original studies. From the four analyses undertaken (investigating the environmental variables traumatic life events, N = 909, sexual and/or physical abuse, N = 1,097, and the psychological variables depression, N = 1,254, and impulsivity, N = 1,122), results supported moderation by 5-HTTLPR in the relationship between sexual and physical abuse and bulimic spectrum pathology, with some support for moderation by 5-HTTLPR in the relationship between traumatic life events and overall EDs. No interactions between 5-HTTLPR and psychological factors were identified. Study 2 aimed to conceptually replicate these results in a large, independent sample drawn from the Australian Temperament Project (N = 650). Results showed no interaction between 5-HTTLPR and psychological factors (depressed mood or emotional control), but revealed a severity-dependent effect whereby there was some evidence of moderation by 5-HTTLPR in the relationship between severe, but not moderate-to-mild, parental physical punishment and adolescent EDI-2 Bulimia scores. The final investigation, Study 3, examined potential direct effects and GxE interactions between parenting and 5-HTTLPR to predict disordered eating from a ‘plasticity’ perspective, across two samples. Study 3a found an association between self-reported parental warmth and lowered EDI-2 Bulimia scores, and between self-reported parental use of physical punishment and greater EDI-2 Drive for Thinness scores (N = 650), however no moderation by 5-HTTLPR was identified. Study 3b aimed to replicate these findings using an observational measure of parenting behaviours, and constituted the largest study of observed parenting behaviours in the ED field (N = 304), as well as the first GxE interaction study in the field to include observational measurement of parenting behaviours. Results showed an association between parental warmth and lower EDI-2 Drive for Thinness scores, but no association between parental hostility and disordered eating, or any GxE interactions. Overall, results across the three studies of the present thesis supported moderation by 5-HTTLPR in the relationship between severe environmental stressors and eating pathology, but not between less severe environmental factors or psychological factors and ED outcomes. These results illustrate the important role of genetic factors in ED aetiology, carry implications for understanding the individual differences in response to potential environmental risk factors for EDs, and can be used to help inform ED prevention initiatives. Outstanding issues in investigation of candidate gene research in the ED field include sample size, publication bias, and multiple testing. Continued collaboration to increase sample sizes and careful selection of environmental and psychological measures is recommend for future GxE investigations, along with a move towards polygenic and genome wide investigative approaches.