Nurturing Family Environments for Children: Compassion-Focused Parenting as a Form of Parenting Intervention

Round 1

Reviewer 1 Report

Although the authors make a good theoretical case for changing parental behavior when they deal with children's undesired behavior, there are a few problems with the manuscript. Here are some of them:

The authors talk about "vagal tone" and "regulated activity" but they do not really give good definitions of these terms or give examples that readers who are unfamiliar with these concepts can understand. Either these terms should not be used or they should be described better with examples so that readers unfamiliar with the terms truly understand them. Although the authors mention brain development knowledge as crucial for deciding on alternative methods for dealing with child poor behavior (instead of behaviorism), they don't have even a paragraph about what child brain development is like and how synaptic development may be affected by children's early experiences. The article should have at least a paragraph giving readers who are unfamiliar with brain development literature some knowledge of how crucial early experiences affect both lower and higher brain development and higher reasoning brain areas. The statements about "positive behavior support" (a behaviorist model of behavior change) also are not fully discussed. The authors should explain why this model does and does not affect brain development and development of mature socioemotional/moral concerns. A few specific suggestions comparing how parents might react to specific child behavior from the pbs model and from the compassioned focus model would be very helpful. There is sufficient theoretical information but little practical information in the article and if it is addressed to parents and teachers, some comparative examples would be helpful.

Author Response

Comment 1: Although the authors make a good theoretical case for changing parental behavior when they deal with children's undesired behavior, there are a few problems with the manuscript. Here are some of them:

Response 1: Thank you for the overall positive comment

Comment 2: The authors talk about "vagal tone" and "regulated activity" but they do not really give good definitions of these terms or give examples that readers who are unfamiliar with these concepts can understand. Either these terms should not be used or they should be described better with examples so that readers unfamiliar with the terms truly understand them.

Response 2: We thank the Reviewer for this comment. We have now provided a definition on what vagal tone is across lines 119-134 or please see text below:

“During the last 20-30 years there have been significant insights made into evolutionary approaches and understanding physiology and the importance of affiliative approaches in helping understand autonomic functioning and regulation between sympathetic and parasympathic systems, specifically for vagal tone [23,24]. Polyvagal theory, outlined by Porges (14), details how the activation of the myelinated parasympathetic nervous system helps in the regulation of the fight/flight response (autonomic sympathetic nervous system) in contexts of threat, thus enabling calmness and soothing to be achieved through having close proximity to others, giving/receiving affiliative, caring, and prosocial behaviour (5, 15, 16). The influence of the parasympathetic system on physiology is often measured using vagal tone, which is a measure of the activity the vagus nerve exerts. If one has high vagal tone that indicates their parasympathetic system is exerting pressure on the autonomic nervous system regulating the fight/flight tendency. If vagal tone is low, one will have difficulty engaging in calming affiliative behaviour, as the fight/flight mechanism is dominant. It is now known that the strength of vagal tone influences our emotions, health, and well-being [23, 24]. Indeed, therapy aimed to address client suffering is beginning to recognise that it must be anchored in an integrative, evolutionary, contextual, biopsychosocial approach [25] if it is to be of any help at alleviating distress.”

 

Comment 3: Although the authors mention brain development knowledge as crucial for deciding on alternative methods for dealing with child poor behavior (instead of behaviorism), they don't have even a paragraph about what child brain development is like and how synaptic development may be affected by children's early experiences. The article should have at least a paragraph giving readers who are unfamiliar with brain development literature some knowledge of how crucial early experiences affect both lower and higher brain development and higher reasoning brain areas.

Response 3: This is an important point made by the Reviewer. We have removed the brain development aspect, as this paper focuses specifically on physiology and affiliative behaviors as being the key underpinnings of compassion focused parenting. However, we still discuss brain functioning from an evolutionary perspective in the manuscript, a crucial theoretical difference between behavioral programs and compassion focused parenting.

Comment 4: The statements about "positive behavior support" (a behaviorist model of behavior change) also are not fully discussed. The authors should explain why this model does and does not affect brain development and development of mature socioemotional/moral concerns.

Response 4: We are uncertain as to what the Reviewer is referring to here exactly. We have made the argument that current evidence-based parenting programs are focused on reductions on behavioral outcomes, and are less interested in prosocial behaviors and physiological measures. We do not state that these programs may not influence brain development and development of mature socioemotional/moral concerns. Rather these outcomes are not measured by current behavioral programs, as they are not the focus.

Comment 5: A few specific suggestions comparing how parents might react to specific child behavior from the pbs model and from the compassioned focus model would be very helpful. There is sufficient theoretical information but little practical information in the article and if it is addressed to parents and teachers, some comparative examples would be helpful.

Response 5: We have provided a little example across lines 408-433 on a compassion focused approach compared to an evidence based parenting program approach, or see text below:

To provide a practical example on some possible differences between compassion focused parenting and typical evidence-based parenting programs take the example of going shopping with a 4-year old child. Going shopping with children aged 3-9 is often regarded as a stressful parenting activity (Baker et al., 2014). In most EBPPs the key would be to prepare in advance and engage in a technique approach where you might, 1) have activities prepared for your child as you engage in the shop (e.g., child has their own shopping list), 2) go at an appropriate time of day rather than when you are in rush, 3) you might decide on discuss ground rules with the child before going shopping (e.g., stay close to mom/dad), 4) ensure you praise good behavior whilst shopping, and 5) let the child know what consequences there might be if he/she does not follow your instructions (e.g., quiet time). A compassion focused parenting approach would also engage in the same techniques, however, it would also focus on grounding behaviors for the parent. For example, before going shopping the parent might engage in soothing rhythm breathing – a technique which increases heart rate variability, so that the parents vagal tone is strengthened before going into the threatening context (e.g., the shops). With the increase in vagal tone, parent emotional reactions to challenging child behavior would be minimized, and parents can respond in more helpful ways, like remembering the planned routines as opposed to yelling or shouting at the child. The parent might focus on what ‘green circle’ strategies they might be able to do when stressed, for example, focus on body posture or tone of voice. Given the context of shopping is stressful, a compassion focused parenting approach would also aim to normalize this, and recognize that it is not the fault of the parent that it is stressful, indeed shops have many design features that aim to take advantage of children asking for chocolate or toys. A final aspect that a compassion focused parenting approach would be to consider how the parent is self-monitoring and judging themselves as they engage in this activity, paying particular attention to tone of inner voice. Indeed, activating a compassionate mind before going into the shops, one textured by the qualities of wisdom, strength and commitment, would be key, and is the focus of compassionate mind training (e.g., Matos et al., 2017). These are just some small practical examples of what a compassion focused parenting approach would include.

Reviewer 2 Report

The manuscript contains several good ideas and thoughts but overall the content is very difficult to understand, there is lacking a clear and logical structure. Although I have some knowledge in the area of parenting it was not possible for me to understand the aim of the manuscript, the concept of compassion-focused parenting, its derivation, its relation to common parenting models / theories and how it could improve EBPPs. This could be due to a lack of expertise in this area but it feels that the reason is the structure, the missing foundation (in theory and evidence) and carefully considered derivation of the concept and its implications.

Please find below, some remarks in detail:

Firstly, the category „Review“ seems not to be adequate. The work presented here is not a Review, the authors should use another category.

line 55: in my opinion it makes no sense to write “The question, therefore, is…” in italics, there are several other examples throughout the paper where phrases are highlighted that are not that important in my opinion, e.g. verbatim quotes

line 73: the authors should avoid phrases such as “the next big innovation” etc. The concept presented here is new (?), there is no empirical evidence etc. that could support such statements

line 83: there has to be a “,” between the numbers / references -> 18,19 instead of 18.19

line 87: “reductions in child behaviour” -> do the authors mean “child problem behaviour”?

It is difficult for the reader to understand the paragraph “An Evolutionary Background to Family Environments”, firstly the relation to the aim of the paper / to the concept of compassion-focused parenting is not clear and secondly in my opinion the title does not fit to what is described here

line 124: for what reason is the verbatim quote in italics?

Verbatim quotes, subtitles and highlights are in italics which is confusing for the reader. The author should carefully think about what should be highlighted in the text and how

Line 152-153: this statement needs a reference

Line 161-164: the sentence is difficult to understand, the authors should revise it (For example,…, both examples of…)

152-178: The section is difficult to understand, the authors should make the structure more clear

I really cannot understand what the aim of the paper is – to introduce the new concept “Compassion-focused parenting”? It is not clear to me who developed / introduced the concept – the author? If yes, in my opinion the whole manuscript has to have a different structure

line 183-184: “two psychologies of compassion” – how can there be two “psychologies of compassion”? What does the author mean?

In the paragraph “Compassion-focused parenting” the concept is not explained, it focuses on CFT which is very confusing for the reader

After reading the section 179-230 I still do not understand what Compassion-focused parenting is. What is the theory behind this model? What is the evidence of this concept? How is it related to common parenting models such as Darling & Steinberg? The authors use only one reference Gilbert, 2014 which is – in my opion – not enough to develop and introduce a new concept

209-210: This statement needs a reference

Line 227-230: This statement needs a reference or link to theoretical models or empirical evidence. Why does compassion-focused parenting promote well-being in children and parents?

line 231-247: It is not clear how this section is related to compassion-focused parting or how compassion-focused parenting is related to this section

line 307-308: Why could the effectiveness of EBPPs could be improved and how? This is still not clear to me

In my opinion the major aim of the paper as stated by the author “to demonstrate how the next generation of EBPPs need to be grounded …” (line 16-18) has not been addressed or at least I cannot see and understand it

the authors should check the references, e.g Kirby& Baldwin (377) –> Kirby and Baldwin; Kirby and Baldwin [53] (2016) -> Kirby and Baldwin [53]

Author Response

No response necessary, as indicated by Editor

Reviewer 3 Report

Manuscript education-597785

Title: “Nurturing Family Environments for Children: Compassion Focused Parenting

In present paper identify relevant domains of parental socialization that could be addressed with parents in order to improve the quality of parent-child relationship, getting better parents but also improving developmental outcomes of children and adolescents. Importantly, *Compassion Focused Parenting* is focused in element of parental socialization normative (i.e., common in most families) such as reasoning, dialogue, and warmth.

 

* An crucial question is, *Compassion Focused Parenting* is a parenting program addressed for normative families or for non-normative families (e.g. alcoholic parents, families with physical abuse or even with sexual abuse)??

 

* An important theoretical in present paper weakness is the previous justification of parental socialization, referred as “The style of parenting a child receives”, line 7; “The family environment in which children are raised”, line 28).

Non-normative (or disruptive) parental socialization can include physical abuse, sexual abuse, drugs in home… unfortunately, it remains until nowadays, but is not common in most families. In a normative parental socialization (in which parents act as a parents), when child follows the family and social norms, or when child not follow the family rule, parents (i.e., indulgent, authoritative, authoritarian and neglectful) act contingent to child behaviors (Steinberg, Lamborn, Darling, Mounts, & Dornbusch, 1994; Darling & Steinberg, 1993)

Authors should include a short rationalization of the focus on parenting styles.

Authors should work in the rationalization of the normative parental socialization before the review of intervention programs the parenting styles. Families can be examined theoretically and empirically by the four-parenting style model with two dimensions: Warmth and Strictness (Maccoby, & Martin, 1983; Martinez, Garcia, Fuentes, Veiga, Garcia, Rodrigues, Cruise, & Serra, 2019). This theoretical model is followed in research across the world (Garcia, Serra, Garcia, Martinez, & Cruise, 2019). Another crucial point is that parenting styles not only have a crucial impact in negative outcomes, but also in positive outcomes (this point is crucial when authors discuss positive and negative outcomes in parenting programs research). For example, parents who use parental practices of warmth and reasoning but not those of imposition protect their adolescents against problems as bullying victimization (traditional bullying and cyberbullying), antisocial behavior, and also promote positive competences as school adjustment and self-esteem (Martínez, Murgui, Garcia, & Garcia, 2019).

 

The major concern of the weak theoretical review about parenting should be considered in order to improve this point with these relevant previous studies.

 

 

* Authors should review the tittle of present paper. It is important to include “Intervention Program” or “paradigm for parenting programs” or “parenting interventions”. So the idea of program or intervention should be included.

 

* Authors should indicate more explicitly that their model for parenting programs should be tested empirically before applying interventions with this program.

References

Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological Bulletin, 113, 487-496. doi:10.1037/0033-2909.113.3.487

Garcia, F., Serra, E., Garcia, O. F., Martinez, I., & Cruise, E. (2019). A third emerging stage for the current digital society? Optimal parenting styles in Spain, the United States, Germany, and Brazil. International Journal of Environmental Research and Public Health, 16(2333), 1-20. doi:10.3390/ijerph16132333

Maccoby, E. E., & Martin, J. A. (1983). Socialization in the context of the family: Parent-child interaction. In P. H. Mussen (Ed.), Handbook of child psychology (Vol. 4, pp. 1-101). New York: Wiley.

Martinez, I., Garcia, F., Fuentes, M. C., Veiga, F., Garcia, O. F., Rodrigues, Y., Cruise, E., & Serra, E. (2019). Researching parental socialization styles across three cultural contexts: Scale ESPA29 bi-dimensional validity in Spain, Portugal and Brazil. International Journal of Environmental Research and Public Health, 16(197), 1-14. doi:10.3390/ijerph16020197

Pinquart, M., & Kauser, R. (2018). Do the associations of parenting styles with behavior problems and academic achievement vary by culture? Results from a meta-analysis. Cultural Diversity and Ethnic Minority Psychology, 24, 75-100. doi:10.1037/cdp0000149

Steinberg, L., Lamborn, S. D., Darling, N., Mounts, N. S., & Dornbusch, S. M. (1994). Over-Time changes in adjustment and competence among adolescents from authoritative, authoritarian, indulgent, and neglectful families. Child Development, 65, 754-770. doi:10.2307/1131416

Author Response

Comment 1: In present paper identify relevant domains of parental socialization that could be addressed with parents in order to improve the quality of parent-child relationship, getting better parents but also improving developmental outcomes of children and adolescents. Importantly, *Compassion Focused Parenting* is focused in element of parental socialization normative (i.e., common in most families) such as reasoning, dialogue, and warmth.

* An crucial question is, *Compassion Focused Parenting* is a parenting program addressed for normative families or for non-normative families (e.g. alcoholic parents, families with physical abuse or even with sexual abuse)??

Response 1: I’d like to thank the reviewer for this question. Compassion Focused Therapy (CFT), which Compassion Focused Parenting is modelled from, was developed initially for the non-normative populations the Reviewer mentions (see Leaviss & Uttley, 2012). Individuals from these past backgrounds often present with high levels of self-criticism and shame, for which Gilbert (2014) then developed CFT (Gilbert & Procter, 2006; Judge et al., 2012; Lucre & Corten, 2013).  

So CFT was developed for those individuals who were raised in non-normative families where complex trauma takes place, for example, many experience adverse childhood experiences, such as having alcoholic parents or parents who physically and sexually abuse children. A recent paper was published examining CFT as an intervention for adult survivors of sexual abuse (McLean, Steindl, & Bambling, 2017). Thus, I now make clearer in the introduction that CFT was developed for these very populations. See lines 243-277 or see text below:

“Importantly, CFT was initially developed for those who were not responding to cognitive-behavior therapy in the treatment of depression [32]. Gilbert [32] found that many of the adults he was treating were raised in non-normative family of origins, where the child was subjected to physical and emotional abuse from their parents. Thus, he found many of his clients were fearful of compassion, as they were not raised in family environments characterized by warmth and affiliative behaviors. To understand how fears of compassion can manifest, Gilbert (2019) draws upon evolutionary models, attachment theory and classical conditioning. For example, when a child is distressed, parental affiliative behaviors such as a warm, caring voice-tone and physical touch help regulate the child's distress, enabling secure attachments (Bowlby, 1969; Gilbert, 2014; Yaman, Mesman, van Ijzendoorn, & Bakermans-Kranenburg, 2010). However, the attachment system can close down or ‘shut’ if the child does not have the opportunity to learn how affiliative and affectionate behaviors help regulate distress. That is, the parasympathetic system is not activated in order to down-regulate threat processing, and this can lead to a heightened fear or anxiety towards affiliative behaviors (Porges, 2007; Thayer & Lane, 2000). Moreover, punitive parenting practices (e.g., over-reactive anger, criticism), particularly when children are joyful and loud, can also lead to a classically conditioned response for the individual, where positive emotions (e.g., joy, happiness) are paired with some form of punishment (e.g., being yelled at or physically hit in order to quiet down; Kirby, 2017). Gilbert (2014) proposes that in therapy, individuals can become quite fearful of positivity, kindness, and compassion from their therapist, as it can activate conditioned memories of aloneness, vulnerability, or shame (Gilbert, 2014). It is hypothesized that kindness and compassion can be perceived as a source of a potential threat, due to past aversive emotional memories (e.g., neglect, trauma), thus leading to fight, flight or shut-down responses by the individual. Thus, the focus of CFT is to work with the fears people have of compassion, and indeed meta-analyses have found that fears of compassion are strongly associated with depression, self-criticism and shame (Kirby, Day, & Sagar, 2019). Indeed, research today is examining the impact of CFT for individuals who were raised in such non-normative environments, for example, CFT is now being used to help with complex trauma and adult survivors of sexual abuse (McLean, Steindl, & Bambling, 2018).

Compassion focused parenting is the application of CFT to a parenting context. Currently, parenting interventions are ‘technique’ oriented, aimed at reducing problematic behavior [16], and are not grounded in the understanding of physiology and emotional function from an evolutionary perspective [31]. My premise is that many of the techniques in EBPPs will remain the same (e.g., attention, praise), but the model of how to facilitate positive parent-child relationships will shift to focus on evolved caring motivational systems and affiliative emotion processing, which requires an understanding of the evolved processes involved in parent-offspring caring and physiological regulating systems.“

Secondly, the Reviewer alludes to a very important point and that is the difference between parenting a child compared to adolescents. This paper is focused on children, not adolescents. I have now make that point – and that the focus at the moment is on children. See lines 80-81.

“Importantly this paper will be focused predominantly on examining the parent and child relationship (under 12 years of age).”

Comment 2: * An important theoretical in present paper weakness is the previous justification of parental socialization, referred as “The style of parenting a child receives”, line 7; “The family environment in which children are raised”, line 28).

Non-normative (or disruptive) parental socialization can include physical abuse, sexual abuse, drugs in home… unfortunately, it remains until nowadays, but is not common in most families. In a normative parental socialization (in which parents act as a parents), when child follows the family and social norms, or when child not follow the family rule, parents (i.e., indulgent, authoritative, authoritarian and neglectful) act contingent to child behaviors (Steinberg, Lamborn, Darling, Mounts, & Dornbusch, 1994; Darling & Steinberg, 1993)

Authors should include a short rationalization of the focus on parenting styles.

Authors should work in the rationalization of the normative parental socialization before the review of intervention programs the parenting styles.

Families can be examined theoretically and empirically by the four-parenting style model with two dimensions: Warmth and Strictness (Maccoby, & Martin, 1983; Martinez, Garcia, Fuentes, Veiga, Garcia, Rodrigues, Cruise, & Serra, 2019). This theoretical model is followed in research across the world (Garcia, Serra, Garcia, Martinez, & Cruise, 2019).

Response 2: This is an important point made by the Reviewer, and we are grateful for this suggestion. We have now provided a section on parenting studies and refer to the research provided. Thank you. See lines 82-113 or see text below.

A Brief History of Parenting Styles

There have been over five decades of experimental, clinical and developmental psychology research classifying parenting styles and demonstrating the impact of parenting styles on child outcomes (Patterson, 2005; Sanders & Kirby, 2014). Baumrind (1966) originally classified three different styles of parenting: authoritative (i.e., firm boundaries but flexible, responsive to child, recognizes the rights of the child), authoritarian (i.e., controlling, non- responsive, values obedience, uses punitive practices), and permissive parenting (i.e., not demanding, child allowed to self- regulate). Maccoby and Martin (1973), extended this work, and classified parenting as being along the two dimensions of responsive or demanding (also known as warmth and strictness), which resulted in four parenting styles, authoritative (demanding and responsive), authoritarian (demanding and unresponsive), indulgent (undemanding and responsive), and neglectful (undemanding and unresponsive). The classification of parenting styles was an important step for the field, as it permitted developmental and parenting researchers to examine how parenting practices influenced childhood social, emotional, and behavior outcomes.

There have been continued advances in understanding parenting style and family interactions, and researchers from around the world have examined cultural differences (Garcia, Serra, Garcia, Martinez, & Cruise, 2019). Moreover, researchers are starting to suggest that a third dimension to add to warmth and strictness, which is the ecological context in which the child grows. That is, children may respond more positively to different styles depending on context, and that perhaps regardless of context parental warmth is the most important aspect to focus on (Garcia et al., 2019). Recent research has examined the associations of parenting style and social competence among Spanish, North American, German and Brazilian adolescents in middle-class families (Garcia et al., 2019). The study had a large sample comprising 2,455 adolescents, and examined parenting style and socialization outcomes (measures of self-esteem and internalization of values). Surprisingly, adolescents from indulgent families obtained equal or higher scores on well-being than those from authoritative families, with neglectful and authoritarian families consistently reporting poor levels of self-esteem. Moreover, indulgent parenting outperformed authoritative parenting in the academic, emotional and family self-esteem domains. Moreover, recent research has also found that indulgent and parenting characterized by warmth led to increases in positive adolescent development, such as school adjusgment and self-esteem (Martinez, Murgio, Gracia, & Garcia, 2019). Yet despite these important emerging findings highlighting the importance of warmth and indulgent parenting styles, the majority of evidence-based parenting programs focuses on developing authoritative styles.

Comment 3: Another crucial point is that parenting styles not only have a crucial impact in negative outcomes, but also in positive outcomes (this point is crucial when authors discuss positive and negative outcomes in parenting programs research). For example, parents who use parental practices of warmth and reasoning but not those of imposition protect their adolescents against problems as bullying victimization (traditional bullying and cyberbullying), antisocial behavior, and also promote positive competences as school adjustment and self-esteem (Martínez, Murgui, Garcia, & Garcia, 2019).

Response 3: We agree, and think that our response to comment 3 addresses this comment as well. Although we added more detail across lines 146-149 or see text below:

Importantly, emerging research is starting to find that parenting style characterized by warmth compared to authoritative can have positive impacts on adolescent outcomes such as self-esteem and school adjustment (Martínez, Murgui, Garcia, & Garcia, 2019). However, further insights from evolutionary psychology can be helpful at furthering this impact.

Comment 4: The major concern of the weak theoretical review about parenting should be considered in order to improve this point with these relevant previous studies.

Response 4: Yes we agree, and we think with the inclusion of parenting styles section we have now addressed this.

Comment 5: * Authors should review the tittle of present paper. It is important to include “Intervention Program” or “paradigm for parenting programs” or “parenting interventions”. So the idea of program or intervention should be included.

Response 5: This is a good point, and we have updated the title, “Nurturing Family environments for Children: Compassion Focused Parenting as a Form of Parenting Intervention”

Comment 6: * Authors should indicate more explicitly that their model for parenting programs should be tested empirically before applying interventions with this program.

Response 6: Yes completely agree, and state this on lines 390-391.

 “However, randomized controlled trials are necessary to empirically test this proposition.”

Round 2

Reviewer 1 Report

This paper is well written, is revised appropriately, and makes a strong case for the author's view that a parenting style including "compassion" will result in better long term outcomes for children. Although the specific research base of the author is not extensive, there are many excellent references that support the author's view. There is only one issue that might be addressed more and that is whether parents who have not been raised compassionately have the capacity to raise their children in this style. The author mentions this issue briefly but it would be worth more discussion, especially in dealing with therapeutic interventions for children who have not been raised compassionately. The paper points out many issues worthy of discussion by readers so it provides an interesting point of view for professionals in a range of fields related to family and child development.