International Journal of Clinical and Health Psychology 23 (2023) 100365

Contents lists available at ScienceDirect

International Journal of Clinical and Health Psychology

journal homepage: www.elsevier.es/ijchp

Original article

Cognitive behavioral stress management for parents: Prevention and

reduction of parental burnout
Agata Maria Urbanowicz a,c,*, Rebecca Shankland b, Jaynie Rance c, Paul Bennett c,
Christophe Leys d, Aur
elie Gauchet e
a
Grenoble-Alpes University, 621 Avenue Centrale, 38400 Saint-Martin-d’Heres, France
b
University Lumieres Lyon 2, 86 Rue Pasteur, 69007 Lyon, France
c
Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
d
Universit

e Libre de Bruxelles, Campus du Solbosch, Avenue F.D. Roosevelt, 501050 Bruxelles, Belgium
e
Savoie Mont Blanc University, 27 rue Marcoz, 73011 Chamb
ery, France

A R T I C L E I N F O A B S T R A C T

Keywords: Context: Parental burnout increases the risk of deleterious consequences on parents’, couples’, and children’s
Parental burnout physical and mental health.
CBSM Methods: The current study (N = 134) aimed to assess the effectiveness of a Cognitive Behavioural Stress Manage-
CBT
ment (CBSM) group programme in terms of parental burnout reduction. In total 67 parents attended the 8-week
Intervention
Parental stress
CBSM intervention groups, and another 67 parents were assigned to the waiting-list control group. We compared
the effectiveness of the CBSM intervention with a waiting-list control group directly after the end of the pro-
gramme and at three-months follow-up.
Results: The results showed that compared to the control group the CBSM programme contributed to the reduction
of parental burnout symptoms with statistically significant and small effect size. Moreover, the contrast analyses
showed that the reduction in parental burnout severity was maintained at 3 month-follow-up. The reduction in
parental burnout scores was mediated by the decrease in stress and the increase in unconditional self-kindness.
Conclusions: These results highlight the potential benefits of the CBSM programme for parental burnout preven-
tion and reduction.

Introduction parental self, that is, an impression of not being a good parent anymore
(Roskam et al., 2018). In the general population, the prevalence of
Being a parent presents both challenging and rewarding experiences parental burnout varies across countries from 0% in Cuba, 3.3% in
(Deater-Deckard, 1998). In that sense, all parents are exposed to parent- United Kingdom, 6.2% in France, 8.9% in USA and up to 9.8% in Bel-
ing stress to a different degree and with various consequences on family gium (Roskam et al., 2021). However, the prevalence of parental burn-
functioning and well-being (Crnic & Greenberg, 1990). Parenting stress out can reach even 36% among the parents of children with chronic
is a dynamic process involving an interaction between parent, child, and diseases (Lindstr€om et al., 2010). The consequences of parental burnout
environment (Berry & Jones, 1995). The experience of parenting strain can lead to multiple impacts on parents’ physical and mental health,
relates to the multiple demands, constraints, and opportunity costs couple functioning, and the child’s development (Mikolajczak et al.,
entailed by parental role (e.g., mental load, limited time for oneself, 2018). More specifically, at the parental level, burnout severity increases
sense of responsibility) which can be balanced by the rewards of parent- the incidence of suicidal ideation, sleep disorders, and addictive behav-
ing, such as the sense of fulfilment and personal growth (Sheldon et al., iours. Moreover, the emotional distancing symptoms of parental burnout
2021), and an individual’s ability to cope with stress (Lazarus, 1993). are likely to contribute to couple conflicts, and neglectful and violent
Yet, chronic imbalance between parenting stress and rewards increases behaviours toward the child. Given that parental burnout could
the risk of parental burnout (Mikolajczak & Roskam, 2018). “constitute direct threat to children’s psychological and physical safety”
Parental burnout is a context specific syndrome characterised by as well as parents’ health (Mikolajczak et al., 2018, p. 143), it appears
emotional and physical exhaustion, decreased sense of accomplishment crucial to prevent and treat parental burnout in order to limit its nega-
in parental role, emotional distancing from a child, and a contrast in tive consequences on parents’ and children’s well-being.

* Corresponding author at: Grenoble-Alpes University, 621 Avenue Centrale, 38400 Saint-Martin-d’Heres, France.
E-mail address: [email protected] (A.M. Urbanowicz).

https://doi.org/10.1016/j.ijchp.2023.100365
Received 20 June 2022; Accepted 2 January 2023

1697-2600/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/)
A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

A recent meta-analysis identified currently used interventions for The CBSM programme has been widely assessed and has shown its
parental burnout among the parents of chronically ill children and effectiveness in many stress-related disorders, including among patients
parents from the general population (Urbanowicz et al., under review). suffering from chronic illnesses, in the reduction of depressive, anxious,
The results of this meta-analysis suggested that psychological group and stress-related symptoms (Antoni et al., 2000; Phillips et al., 2011).
interventions significantly contributed to the reduction of parental burn- Given the stress-related nature of parental burnout the CBSM pro-
out symptoms compared to a control group. Among the interventions gramme could be effective in terms of parental burnout prevention and
which showed their effectiveness were mindfulness, cognitive-behaviou- treatment. Yet, in the context of parenting, the efficacy of CBSM inter-
ral therapy (CBT), acceptance and commitment therapy (ACT), psycho- vention has been evaluated in only one study among Iranian mothers
education, active-listening, and interventions targeting the development (Karamoozian et al., 2015). The study measured the efficacy of a CBSM
of parenting resources and the reduction of stress. Although these find- programme on anxiety and depression levels during pregnancy
ings are very promising, existing evidence is still limited: the meta-anal- (N = 30). Compared to the control group, the results suggested the
ysis only identified 8 studies evaluating 11 interventions for parental effectiveness of CBSM both in terms of mothers’ anxiety and depression
burnout treatment. In addition, all identified studies focused on the reduction during pregnancy, as well as on the new-born babies’ physical
parents presenting severe parental burnout symptoms: there is no evi- health. However, the study design lacked a follow-up evaluation, and
dence of these programmes playing a preventative role among the did not evaluate the mothers’ burnout, or depressive and anxiety symp-
parents at risk. Therefore, there is a need to further evaluate these types toms following childbirth. Despite the promising results of this study,
of interventions both for parental burnout prevention and treatment. we cannot conclude on the effectiveness of the CBSM programme in
The present study assessed the effectiveness of an 8-session Cognitive terms of parental burnout reduction. To our knowledge no other study
Behavioural Stress Management (CBSM) programme among parents adapted the content of the CBSM programme to the context of parental
from general population. The CBSM is a group intervention based on burnout and evaluated its effectiveness. Given the high prevalence of
cognitive-behavioural therapy (CBT) and relaxation techniques aiming parental burnout and its deleterious consequences it seems crucial to
to develop appropriate stress management skills for affective, behaviou- assess to what extent already existing programmes based on empirically
ral, cognitive, physiological, and social stress responses (see Fig. 1; supported techniques contribute the prevention and treatment of paren-
Antoni et al., 2000; Gauchet et al., 2012). CBT interventions are consid- tal burnout, and through which mechanisms of action. This would help
ered as a gold standard in the field of psychotherapy and use empirically to determine the need for creating new programmes specific for parental
supported techniques and standardised treatment protocols for specific burnout and/or to continue the validation and dissemination of the
disorders (David et al., 2018). CBSM programme to the population of parents at risk of burnout by
During the CBSM programme participants learn to identify differ- already trained psychologists.
ent sources of stress in their daily life and to increase their self-
awareness of stress responses. The CBSM programme uses cognitive Present study
and behavioural techniques aiming to modify maladaptive cognitive
and emotional regulation strategies (e.g., cognitive reframing, anger The aim of the present study was to assess the effectiveness of the
management, coping strategies, assertiveness techniques), as well as CBSM parenting programme in terms of parental burnout severity fol-
relaxation and meditation techniques to reduce physical stress and lowing an 8-week programme at three-months follow-up compared to a
enhance self-awareness and psychological flexibility. In addition, a waiting-list control group. The 8-sessions design and the follow-up at
group format of the intervention favours social ties between partici- three-months was chosen based on the previous interventional studies
pants which in turn may contribute to well-being and health (Kemp in the context of parental burnout (Anclair et al., 2018; Bayot et al.,
et al., 2017). Moreover, during the sessions participants learn to dis- €m et al., 2016). Based on these previ-
2021; Brianda et al., 2020; Lindstro
tinguish controllable and uncontrollable aspects of their difficulties, ous studies, the duration of 8-sessions seemed adequate to observe the
how to mobilise coping resources and social support, and how to change in parental burnout severity and to maintain the involvement of
identify, express, understand, regulate, and use overwhelming diffi- participants: shorter programmes could not be enough to develop the
cult emotions in a constructive way. Both during sessions and in stress management competencies, and longer programmes could
between the sessions, participants practice self-monitoring of their increase the drop-out rate. Moreover, the choice of similar duration of
responses to stress, relaxations, and cognitive reframing exercises the programme and of the follow-up enables the comparison of effective-
based on their daily life situations. All these practices aim to ness across the studies. We hypothesised that compared to the control
develop stress management resources and help to choose the behav- group, the programme would contribute to a reduction in parental burn-
iour rather than responding automatically. out scores. Our second hypothesis was that the decrease in parental

Fig. 1. Cognitive Behavioural Stress Management (CBSM) Model (adapted from Antoni et al., 2007).

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A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

burnout would be maintained up to three-months post-intervention. We Ta g e dE n T ag e dP F ramework: https://osf.io/f5c7b/?view_only=22472fb65a344e7c

further hypothesised that the reduction in parental burnout would be b52e948d2b39e0ff.
associated with the decrease in stress and abstract ruminations as well Regarding the allocation procedure, we did not implement a rando-
as the increase in unconditional self-kindness and intra-personal emo- mised controlled trial procedure because of the ethical implications
tion regulation competences. related to the risks associated with parental burnout (i.e., increased risk
of suicide, child abuse and neglect; Brianda et al., 2020; Mikolajczak
et al., 2018). Consequently, parents willing to participate in the inter-
Materials and methods vention could immediately attend to the intervention group. Participants
were recruited in ecological context through the community-based
Participants
organisations: they were not followed by doctors and had no other treat-
ment proposed. The control group comprised parents who could not par-
Based on a power analysis calculated with G* Power software the
ticipate in a group at a given time (waiting-list), and who expressed their
required sample size was of 158 participants (i.e., 79 participants for
interest to participate in subsequent intervention groups. New CBSM
both CBSM and control groups). We have determined a medium effect
groups were proposed every 8-weeks. Therefore, participants from the
size (f = 0.25) with 80% power for ANCOVA based on previous inter-
waiting-list control group were invited to participate in the intervention
ventional studies for parental burnout (Bayot et al., under review;
group after T2 measures. We decided not to randomly assign partici-
Brianda et al., 2020). In total, 196 parents participated in the study, out
pants to the CBSM and control groups as this might have resulted in
of which 134 (130 females and 4 males) were included in the analyses
increased risk of drop-out from the study. Parents from the waiting-list
as they responded to at least T1 and T2 measures. The mean age of par-
control group were those who could not attend the intervention immedi-
ticipants was 37.3 years (SD = 5.23), and the median number of chil-
ately: they would therefore have been excluded from the study before
dren living in the same household was 2 (M = 1.88, SD = 0.876). The
the beginning of the intervention if they had been assigned to the experi-
inclusion criteria for participating in the study were: (a) to be a parent
mental group. Similarly, it is possible that parents who were available to
of at least one child living in the same household, (b) being over 18 years
attend the intervention at the moment of signing in for the study but
old, and (c) having accepted an informed consent for participation in the
would have been assigned to the control group would not be available
study. Participants did not receive any financial reward for their partici-
to attend the intervention 8 weeks later. Thus, from a clinical and ethical
pation in the study and they participated in the CBSM group for free.
perspective fewer parents would have received the intervention if the
Flowchart diagram of participation rate at pre-, post-, and follow-up
study had been randomised.
measures is presented in Fig. 2.
Prior to the assignment to an intervention group, participants were
The study received approval from the national ethical committee
informed about the purpose and protocol of the study during an
board (No.: 19.02.06.44810) and was preregistered on the Open Science

Fig. 2. Flowchart diagram of participation rate at pre-, post-, and follow-up measures.

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A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

information meeting. All participants received a written information

sheet and signed the informed consent. Participants were informed

- Round table exchanges - Round table exchanges - Round table exchanges - Round table exchanges

communication. Devel-
communication styles,
non-violent communi-
about their right to withdraw from the study at any moment. Partici-

Enhancing better under- Enhancing constructive

- Psychoeducation on

opment of assertive-
pants signed-up to an intervention group depending on their availabili-

assertive message
- Active listening
- Formulation of
ties: different time slots were proposed every 10 weeks. Participants

assertiveness
- Mindfulness

cation, and
meditation
Assertiveness
who could not participate in the intervention were assigned to the wait-

ness skills.
ing-list control group and invited sign up to one of the newly proposed

Session 8
groups.
The CBSM parenting intervention groups consisted of eight sessions

(its source and triggers)

and emotion regulation
delivered by two trained psychologists once a week over an 8-week

factors amplifying the

ager expression styles

internal and external

- Body scan mediation

standing of the anger

- STOP technique and
- Psychoeducation on

anger management
period. The duration of each session was 2 h and 30 min. The psycholo-

- Self-awareness of
Anger management

- Identification of
gists delivering the intervention had previous experience in group ther-
apy and completed a three-day CBSM training course, they also had
previous experience of working with parents. Participants from the

Session 7

anger

anger

skills
intervention group were asked to respond to an online questionnaire via
a Qualtrics™ online software before (T1) and after (T2) the intervention
as well as at three-month follow-up (T3). Participants from the control

relationships and the

group responded only to the T1 and T2 questionnaires and were invited

emotional, informa-

- Active and passive - Taking care of one’s

Enhancing meaningful
tional, and material
on - Psychoeducation of

sense of belonging.
- Identifying controlla- - Identifying social

support network.
to participate in the CBSM intervention directly after the T2 measure.

support network
coherence - Wave breathing

Enlarging social
- Asking for help

social support
social support
The intervention sessions were video recorded to enable fidelity

Social support

relaxation
checks conducted by the developer of the French intervention, focusing

Session 6
on adherence to the treatment manual. Any deviations were discussed
and corrected in subsequent sessions.

bility and awareness of

ble and uncontrollable
emotion-focused coo-
problem-focused and

Enhancing coping flexi-

aspects of situation

one’s behavioural
- Psychoeducation

coping strategies

stress-responses.
Coping strategies
Intervention

ing strategies
relaxation
- Cardiac
We translated the CBSM protocol (Antoni et al., 2007) to the French
Session 5

language and adapted the psycho-educative content of each session and

proposed practices to the context of parenting stress and parental burn-
- Round table exchanges

out based on recommendations of Roskam and Mikolajczak (2018). The

- Taking perspective on

- Cognitive reframing
final intervention protocol consisted of eight weekly sessions, see - Psychoeducation on

cognitive reframing
training relaxation
- Schultz’s autogenic

finding alternative

stressful situations

flexibility through
Cognitive reframing

Table 1. Each session focused on a different stress management compe-

Enhancing one’s
psychological
tency and followed a structured plan starting with a roundtable

exercises
thoughts

exchange between participants and therapist about participants’ experi-

Session 4

skills
ences during the week, as well as their achievements and difficulties in
the application of relaxation and other newly learned skills in the family
context. Following this, participants were invited to a guided relaxation
- Identification of one’s
- Guided visualisation
- Round table exchanges

Enhancing auto-observa-
relaxation (colourful

cognitive distortions

cognitive distortions

exercise and to share their experience of whether the practice was per-
tion of one’s thought
- Psychoeducation on
Cognitive distortions

different types of

ceived as enjoyable or difficult. The third part of each session consisted

of a psycho-education training during which participants were intro- and emotions
duced to a series of stress management skills (e.g., cognitive distortions,
patterns
garden)
Session 3

cognitive reframing, coping strategies, anger management, assertive-

ness). The psycho-education part consisted also of structured exercises
based on participants’ individual experiences to put the theory into prac-
- The link between the
- Round table exchanges

Objectives Enhancing self-awareness Enhancing intra-personal

cies: identification and

tice using real life situations. The last part of each weekly meeting was
thought and affective

emotional competen-
The link between stress

- Psychoeducation on
automatic thoughts

emotions and their

the summary of the session’s content and planning self-monitoring and

- Self-awareness of

understanding of
- Deep breathing

relaxation exercises to practice at home in between the sessions. Each

and emotions

relaxation

session ended with a roundtable exchange about the experience that

emotions.

each person had during the session. The additional two follow-up ses-
Session 2

states
Overview of the CBSM programme protocol.

role

sions were proposed: one month and three months after the end of the
intervention. The follow-up sessions consisted of round table exchanges
identifying daily stress

between participants and the therapist and the guided relaxation.

- Presentation of CBSM

- Progressive muscular

- Auto-observation of

of stress factors and

Stress-reactions and

- Parenting stress:

stress responses

stress responses
programme
- Round table
self-awareness

relaxation

Measures
factors
Session 1

To assess the intervention’s effectiveness, we used self-administrated

questionnaires measuring severity of parental burnout and stress symp-
Practices

toms, abstract ruminations, self-kindness, and emotion regulation

Theme
Table 1

before, after, and at 3-month follow up. We also measured socio-demo-

graphic characteristics (i.e., age, gender, number and age of children,
family and professional situation, level of education) and the motivation
to participate in the programme.

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A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

Parental burnout Emotion regulation

The severity of parental burnout was measured using the Parental Emotion regulation was measured with intrapersonal emotion regu-
Burnout Assessment (PBA, Roskam et al., 2018). PBA is 23- item scale lation dimension of The Profile of Emotional Competence scale (PEC, Bras-
measuring four dimensions of parental burnout: (a) physical and emo- seur et al., 2013). The PEC scale measures five dimensions of emotional
tional exhaustion (e.g., Item 3: “I feel completely run down by my role competencies, i.e., identification, expression, comprehension, regula-
as a parent”), (b) emotional distancing from the child (e.g., Item 20: tion, and utilisation of emotions both on intrapersonal and interpersonal
“I’m no longer able to show my children how much I love them”), (c) levels. The intrapersonal emotion regulation subscale consisted of 5
the loss of fulfilment and pleasure in parental role (e.g., Item 11: “I don’t items assessed on a five-point Likert scale from 1 (the statement does
enjoy being with my children”), and (d) contrast in the perception of not describe me at all) to 5 (the statement describes me very well). The
parental self (e.g., Item 17: “I’m ashamed of the parent that I’ve examples of items are, Item 12: “I easily manage to calm myself down
become”). The responses are assessed on a 7-point Likert scale: never after a difficult experience”; Item 15: “When I am sad, I find it easy to
(0), a few times per year or less (1), a few times per month (2), once per cheer myself up”; Item 37: “I find it difficult to handle my emotions”. In
month or less (3), once per week (4), a few times per week (5), every this study, the scale showed a suboptimal internal consistency at time 2
day (6). The scale enables the assessment of the risk and severity of with a Cronbach’s α = 0.69 at T1 and α = 0.65 at T2.
parental burnout using five cut-off scores (Roskam et al., 2018). The
total score below 30 is considered as no risk of parental burnout. Scores Data analyses
between 30 and 45 are considered as a low risk to parental burnout,
those between 46 and 60 are considered as a moderate risk to the paren- All collected data were processed using the Jamovi statistical soft-
tal burnout, those between 61 and 75- the high risk of parental burnout, ware (The jamovi project, 2020). We applied one-way ANOVA to exam-
and scores above 75 are considered to indicate severe parental burnout. ine the differences in age between participants from the intervention
In the present study, the total scale had an excellent internal consistency and the control groups. We also applied χ² tests for independence on cat-
with a Cronbach’s 2at T1, α = 0.98 at T2, and α = 0.97 at T3. egorical and discrete variables: gender, family situation, professional
occupation, education level, and number of children. The prevalence of
Stress parental burnout in intervention and control groups was calculated
using five cut-off scores following Roskam et al. (2018) recommenda-
The severity of stress symptoms was measured with one dimension of tion.
Depression, Anxiety, Stress Scale (DASS-21; Lovibond & Lovibond, To test our main hypothesis comparing the effects of the control
1995). The DASS-21 contains three 7-items subscales measuring the group with the CBSM intervention on parental burnout at T2 we applied
emotional states of depression, anxiety, and stress over the past week. ANCOVA with the PBA score at T1 as covariate to statistically control
The items are rated on 4-point Likert scale from 0 (“Did not apply to me for the effect of the pre-test differences between the groups. To test our
at all”) to 3 (“Applied to me very much or most of the time”). The stress second hypothesis that the results of the intervention were maintained
subscale assesses the difficulty to relax (e.g., Item 12: “I found it difficult within CBSM group at 3 months follow-up we applied one sample t-tests
to relax”), agitation and over-reactivity (e.g., Item 14: “I was intolerant applying Helmert contrasts within the intervention group. The first con-
to anything that kept me from getting on with what I was doing”). In the trast compared unilaterally the baseline measure (T1) with the post-
present study, the stress sub-scale showed a good internal consistency intervention (T2) and 3-months follow-up measures (T3). The second
with a Cronbach’s α = 0.86 at T1 and α = 0.89 at T2. contrast compared unilaterally the 3 months follow-up (T3) with the
post-intervention measure (T2). The choice of the analyses was guided
Abstract ruminations by the fact that we could not apply repeated measures ANOVA with
three measurement times as we assessed the follow-up measures only in
The frequency of abstract ruminations was evaluated with 8-items the CBSM group: participants from the control group could assign to the
subscale of Mini-Cambridge Exeter Repetitive Thought Scale (Mini-CERTS; intervention group directly after the T2 measure. To test our third
Douillez et al., 2014). Mini-CERTS is 16-item questionnaire measuring hypothesis that within the intervention group the decrease of parental
abstract and concrete ruminations with 8 items for each dimension. The burnout between T1 and T2 would be associated to the increase of
responses are rated on 4-point Likert scale from (1) almost never to (4) unconditional self-kindness and emotion regulation as well as the
always. Abstract ruminations are unconstructive repetitive thoughts decrease of stress and abstract ruminations we conducted correlation
which are often overgeneralised to many different topics. Whereas con- analyses on centred variables representing the difference of scores
crete ruminations are considered as constructive repetitive thoughts as between T2 and T1 (ΔT2-T1) in: (1) parental burnout, (2) stress, (3)
they are focused on a specific problem and can enhance the problem abstract ruminations, (4) unconditional self-kindness, and (5) emotion
solving strategies. In this study, the subscale showed satisfying internal regulation.
consistency with Cronbach’s α = 0.66 at T1 and α = 0.72 at T2.
Results
Self-Kindness
Descriptive analyses
Self-kindness was measured with the Unconditional Self-Kindness scale
(USK; Smith et al., 2018). The USK is a 6-item scale assessed using a The socio-demographic characteristics of the participants are pre-
series of 7-point Likert items, with scores ranging from 0 (not at all) to 6 sented in Table 2. The results of one-way ANOVA - F(1, 131) = 6.93,
(a great deal) measuring the ability to be kind to oneself in challenging p = .01, η2p = 0.05 - showed that participants from the intervention
situations e.g., in the context of rejection, failure or mistake, awareness group (M = 38.45, SD = 5.35) were on average older then participants
of personal flaws and imperfections. The examples of items are: Item 1: from the control group (M = 36.12, SD = 4.89). There was also a statis-
“How much are you patient and tolerant with yourself when you are crit- tically significant difference between the groups in gender -
icized or rejected by another person”? Item 6: “How much are you lov- χ²(1) = 4.12, p = .04, V = 0.18, and professional occupation -
ing and kind to yourself when you fail or make a mistake”? The higher χ²(2) = 9.45, p = .01, V = 0.27. There was no statistically significant
scores show the higher levels of unconditional self-kindness. The scale difference between the groups in terms of family situation -
showed excellent internal consistency with a Cronbach’s α = 0.92 at T1, χ²(2) = 2.67, p = .26, V = 0.14, education level - χ²(5) = 3.32,
α = 0.94 at T2. p = .66, V = 0.16, and number of children - χ²(5) = 4.40, p = .49,

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A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

Table 2 contrast, testing our hypothesis, compared unilaterally the baseline mea-
Demographic characteristics of participants. sure (T1) with the post intervention (T2) and 3-month follow-up meas-
ures (C1 = 2*T1-T2-T3). The second contrast, supposed to be non-
CBSM group Control group p value a
significant, compared (therefore bilaterally) the 3 month-follow up with
N % N % the post intervention measure (C2 = T3-T2). The analysis showed a sig-
Gender p = .04 nificant mean difference in PBA scores between T1 and T2, and T3
Female 63 94 67 100 (Mdiff = 15.66, t(34) = 1.89, d = 0.32, 95%CI [−0.02, 0.66], p = .03),
Male 4 6 0 0 and statistically non-significant mean difference between T2 and T3
Education p = .66
measures (Mdiff = −1.83, t(34) = 0.76, d = - 0.13, 95%CI [−0.45,
Less than a high school diploma 1 1.5 3 4.4
High school degree or equivalent 5 7.5 6 9 0.206], p = .23) which confirmed our second hypothesis.
Bachelor’s degree 17 25.4 20 29.9 To test our third hypothesis that within the intervention group the
Master’s degree 39 58.2 30 44.8 decrease in parental burnout between T1 and T2 would be associated to
Above Master’s degree 5 7.4 8 11.9 the decrease in stress and ruminations, as well as the increase in uncon-
Family situation p = .26
Single (never married) 4 6.0 2 3.0
ditional self-kindness and emotion regulation we conducted correlations
Living in couple (married, domes- 59 88.1 64 95.5 with centred variables (see Table 4). The findings suggested that the dif-
tic partnership) ference in parental burnout between T2 and T1 was significantly associ-
Divorced 4 5.9 1 1.5 ated to the decrease in stress (r = 0.62, p < .001), and the increase in
Widowed 0 0 0 0
self-kindness (r = −0.39, p = .001). In addition, the increase in self-
Professional situation p = .01
Full time professional activity 25 37.3 33 49.3 kindness was significantly associated with the decrease in stress
Part time professional activity 19 28.4 26 38.8 (r = −0.29, p = .02). and abstract ruminations (r = −0.38, p = .002).
Unemployed 23 34.3 8 11.9
Retired 0 0 0 0 Discussion
Note.
a
X2 test. This study aimed to evaluate the effectiveness of CBSM intervention
for parental burnout reduction compared to a waiting-list control group.
We evaluated the evolution of parental burnout symptoms before and
after 8 weeks of the intervention. In addition, we compared the mean
V = 0.18. A total of 35.8% of the participants had one child under scores in parental burnout between T2 and the 3-month follow-up
18 years old (N = 48), 46.3% of the participants had two children within the CBSM group. We also assessed the variables potentially
(N = 62), 14.2% had three children (N = 19), 3.62% had more than implied in the reduction of parental burnout: the decrease in stress and
three children (N = 5). In addition, 15.7% of the participants reported a abstract ruminations between T1 and T2, as well as the increase in
current diagnosis of a child’s chronic illness or developmental problems, unconditional self-kindness and emotion regulation between T1 and T2.
while 3.7% of the parents reported a past problem. The results of our study showed that CBSM intervention contributed to
Regarding the prevalence of parental burnout in the experimental the reduction in parental burnout and that the decrease in parental burn-
(CBSM) group, 22.4% of the participants did not present symptoms of out was associated with the decrease in stress and the increase in uncon-
parental burnout (total BPA score below 30), 22.4% were at low risk of ditional self-kindness.
parental burnout (total PBA score between 30 and 45), 19.4% of parents Regarding the effectiveness of the CBSM intervention in terms of
were at moderate risk of burnout (total PBA score between 46 and 60), parental burnout severity reduction, we observed that after controlling
and 35.8% of participants presented severe symptoms of parental burn- for the pre-test differences between the intervention and control groups
out (total PBA score above 61). In the control group, 47.8% of partici- the scores of PBA were significantly lower in the CBSM group following
pants did not present the symptoms of parental burnout (total BPA score the intervention. The comparison with a waiting-list control group
below 30), a total of 13.4% were at low risk of parental burnout (total showed that the decrease in parental burnout with a small effect size
PBA score between 30 and 45), 11.9% of parents were at moderate risk was due to the intervention’s effects and not the spontaneous remission
of burnout (total PBA score between 46 and 60), and 26.9% of partici- over time. Indeed, the CBSM intervention provides a complex range of
pants presented severe symptoms of parental burnout (total PBA score tools for the management of cognitive, emotional, behavioural, physical,
above 61). Parents from the intervention group (M = 53.9, SD = 28.6) and social stress responses (see Table 1 and Fig. 1) which seem to con-
presented on average a higher score of parental burnout at T1 then par- tribute to the reduction of parental burnout and stress symptoms. Paren-
ticipants from the control group (M = 45.3, SD = 33.6). However, this tal burnout is considered as a consequence of a chronic imbalance
difference was not statistically significant - F(1, 129) = 2.53, p = .11, between stress factors and parental resources (Mikolajczak & Roskam,
η2p = 0.02. Table 3 presents the mean scores, standard deviations of the 2018) and the CBSM intervention significantly reduced parental burnout
studied variables in the intervention and control groups. severity. These findings are also in line with previous research showing
that CBSM intervention reduces stress symptoms across different popula-
Effectiveness analyses tions including patients suffering from chronic illnesses (Antoni et al.,
2000; Phillips et al., 2011) and pregnant women (Karamoozian et al.,
To test our first hypothesis that compared to the control group CBSM 2015). Beyond the previous research, the present study revealed the
intervention reduced the severity of parental burnout symptoms, we per- beneficial effects of the CBSM intervention also in terms of parental
formed ANCOVA with PBA scores at T1 as a covariate to control for the burnout severity reduction in parents from the general population.
difference of PBA scores at pre-test. Results indicated that when control- These findings give empirical evidence for the application of CBSM for
ling for differences between pre-test scores, the CBSM group scored sig- parental burnout reduction and prevention. Although, the effect size of
nificantly lower on parental burnout severity (M = 42.90, SD = 27.60) the intervention is small, the significative reduction of parental burnout
than the control group (M = 45.40, SD = 38.00), with (F(2, severity among the parents at risk is an important implication. It remains
131) = 77.30, p < .00, and d = 0.41. These findings supported our first fundamental to assess the effect size of the intervention depending on
hypothesis. the severity of parental burnout. To our knowledge it is the first study
To test our second hypothesis that the reduction in parental burnout evaluating the intervention for parental burnout prevention among the
scores was maintained within the intervention group at 3-month follow- parents form the general population and not solely among the parents
up, we applied a one-sample t-test with Helmert contrast. The first identified with severe burnout. It is possible that the effect size of the

6
A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

Table 3
Means, standard deviations of studied variables.

CBSM Control Group

T1 (N = 67) T2 (N = 67) T3 (N = 35) T1 (N = 67) T2 (N = 67)

Parental Burnout 53.9 (28.62) 42.9 (27.57) 44.5 (24.99) 45.3 (33.58) 45.4 (37.96)
Stress 17.1 (4.24) 14.8 (3.91) 14.1 (4.39) 16.4 (4.59) 15.3 (5.06)
Abstract Ruminations 21.6 (3.68) 20.0 (4.00) 16.6 (3.4) 19.7 (3.48) 20.1 (4.87
Unconditional Self-Kindness 12.6 (6.83) 15.4 (7.12) 17.6 (3.95) 14.2 (7.08) 13.9 (7.61)
Emotion Regulation 13.0 (3.76) 14.2 (2.99) 14.6 (3.95) 13.04 (3.45) 13.5 (4.08)

Note. Standard deviations are presented in brackets. T1, T2, and T3 correspond to pre-, post-, and follow-up
measures.

Table 4 significantly associated with the reduction of abstract ruminations and

Correlations between the differences of scores (T2 -T1) in study variables stress. These findings are in line with previous research suggesting that
amongst the CBSM group. self-compassion plays a protective role in parental burnout development
Variable n 1 2 3 4 5
(Paucsik et al., 2021). Indeed, self-compassion is likely to buffer against
perfectionism (Mehr & Adams, 2016) which was identified in the litera-
1. Parental burnout symptoms 67 — ture as a risk factor for parental burnout (Kawamoto et al., 2018; Lin et
(T2-T1)
2. Stress (T2-T1) 67 .62*** —
al., 2021; Sorkkila & Aunola, 2020). Similarly, self-compassion has been
3. Abstract Ruminations 67 .20 .13 — shown to contribute to parental well-being (Neff & Faso, 2015), lower
(T2-T1) levels of parental burnout (Paucsik et al., 2021), and self-efficacy (Liao
4. Self-Kindness (T2-T1) 67 −0.39** −0.29* −0.38** — et al., 2021). Unconditional self-kindness is likely to play a similar pro-
5. Emotion Regulation 67 −0.05 −0.22 −0.05 .04 —
tective role as self-compassion, as it reflects the capacity to be kind to
(T2-T1)
oneself in challenging situations (e.g., in the context of rejection, failure,
Note. awareness of personal imperfections; Smith et al., 2018).
* p < .05,. In contrast to previous findings on the protective role of emotional
** p < .01,.
competencies and emotional intelligence in the context of parental burn-
*** p < .001.
out (Bayot et al., 2021; Lin et al., 2021; Mikolajczak et al., 2018), the
findings of our study did not confirm our last hypothesis that reduction
of parental burnout would be mediated by increases in emotion regula-
tion competencies. There are two possible explanations for the discrep-
programme would be larger among participants with more severe paren- ancy between the findings of our study and previous research. First,
tal burnout. emotion regulation as a trait is one’s ability to apply an adaptive emo-
Moreover, the contrast analyses within the intervention group tion regulation strategy in emotional demanding situations (Brasseur et
showed that whilst the parental burnout severity before the intervention al., 2013). The 8-week period of time may not be long enough to achieve
at T1 significantly differed from post intervention (T2) and 3-month fol- a significant change in participants’ emotion regulation capacity. Sec-
low- (T3), there was no statistically significant difference between T3 ond, in our study we focused on intrapersonal emotion regulation traits
and T2. This confirmed our second hypothesis that the effects of the which constitute only one dimension of emotional competencies (Bras-
intervention maintained at 3-month follow up. These findings can be seur et al., 2013). This may suggest that other emotional competencies
explained by the fact that parents may continue to develop their stress (i.e., emotion identification, expression, comprehension, and utilisation)
management skills after the end of the intervention (Walton, 2014). could be involved in parental burnout to a larger extent than intraper-
This can be possible when the intervention targets psychological pro- sonal emotion regulation skill alone. Indeed, emotional competencies
cesses underlying parental burnout symptoms. The CBSM programme describe a wide range of intra- and inter-personal skills which may
may have acted on numerous mechanisms of action such as negativity buffer against or predict parental burnout on different levels (Lin et al.,
bias, repetitive negative thinking, self-critical thinking, perfectionism, 2021). According to Lin et al. (2021) research should evaluate the inde-
or avoidance of expressing one’s emotions and/or needs. In addition, pendent effects of each dimension of emotional competencies while sys-
during the 8 weeks of the intervention, parents developed their self- tematically controlling for the effects of others. Further studies are
awareness skills, emotional competencies, and social support network necessary to identify which emotional competencies should be targeted
which can also contribute to better stress management over time. It is by psychological interventions.
possible that a person who found it difficult to express their needs or ask In addition, the results of our study are not consistent with previous
for help, for example, may find it easier with every positive experience findings regarding the role of abstract ruminations in the development
(i.e., positive reinforcement). Therefore, the person’s stress management and maintain of parental burnout. Indeed, (Paucsik et al., 2021) identi-
skills may continue to increase following the intervention. This observa- fied abstract ruminations as a risk factor for parental burnout. Whereas
tion is in line with the results of the meta-analysis on parental burnout in our study the decrease in parental burnout did not seem to be directly
psychological interventions which showed that parental burnout sever- associated with the decrease in parental burnout. This discrepancy can
ity continued to decrease even after the end of the interventions (Urban- be potentially explained by the fact that the decrease in abstract rumina-
owicz et al., under review). tions between T1 and T2 within the intervention group was not suffi-
Regarding our third hypothesis that the decrease of parental burnout ciently important to significantly contribute to the reduction of parental
at T2 would associated to with the decrease in stress and abstract rumi- burnout. As illustrated in Table 3 the scores of abstract ruminations con-
nations, as well as by the increase in unconditional self-kindness and tinued to decrease at T3 (at three-month follow up). Therefore, the role
emotion regulation, the correlation analyses revealed significant associa- of abstract ruminations can be potentially more important in the long-
tions of parental burnout reduction with stress reduction and the term perspective. In addition, the decrease in abstract ruminations was
increase in self-kindness. Moreover, the increase in self-kindness was associated with the increase of self-kindness (see Table 4) which in can

7
A.M. Urbanowicz et al. International Journal of Clinical and Health Psychology 23 (2023) 100365

indirectly explain the reduction in parental burnout severity in the intervention was mediated by the decrease in stress and the increase in
CBSM group. unconditional self-kindness.
The findings of this study should be interpreted with caution, as
the study presents several limitations. First, the sample comprised
mostly mothers (97%). A similar issue was identified in other studies Declaration of Competing Interest
on parental burnout, in which the participation of mothers was sig-
nificantly higher compared to fathers (Brianda et al., 2020; Paucsik The authors declare that they have no known competing financial
et al., 2021; Sorkkila & Aunola, 2020). Future research should assess interests or personal relationships that could have appeared to influence
to what extent the findings of this study can be generalised to the the work reported in this paper.
population of fathers.
Second, regarding the design of this study, we did not implement a
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