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Two key parental reflective capacities—mindful parenting (MP) and parental reflective functioning (PRF) — have been shown to promote healthy parent-child relationships through parents’ increased sensitivity and responsiveness to their children’s needs in spite of parenting stressors. Despite the theoretical overlap between these two constructs, researchers have continued to examine them independently. Therefore, the purpose of this scoping review was to review the overlapping and distinctive outcomes and correlates in the empirical MP and PRF literatures.
Method
A comprehensive literature search across the MP and PRF literature for studies published from 2005 through early 2020 (pre-COVID-19 pandemic) was conducted.
Results
A review of 301 articles (n = 180 MP and n = 121 PRF) revealed overlapping study outcomes and correlates, including improvement in parent and child well-being, parenting behaviors, and attachment. Both MP and PRF literatures suggest MP and PRF are amenable to intervention-induced changes, although mostly documented in White mothers, which results may not be generalizable to diverse populations.
Conclusions
Researchers should consider the impact MP and PRF have on positive family relationships. Results suggest that scholars should consider investigating and intervening on MP and PRF simultaneously. Specifically, results identified MP and PRF convergent associations and perhaps synergistic impacts on positive parenting behaviors. Limitations and future directions are discussed.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The parent-child relationship is dynamic, and the quality of interactions is critical for early social, emotional, and cognitive development (Keller, 2018; Knauer et al., 2019). Evidence provides support for the important role parenting behaviors and caregiver interactions have on the quality of parent-child relationships (Brody et al., 2005). Mindful parenting and parental reflective functioning are two distinct parenting-related concepts that share theoretical and conceptual overlaps as well as key differences. Over the years, researchers have documented the associations of mindful parenting and parental reflective functioning, independently, with positive parenting (Alvarez-Monjarás et al., 2019; Parent et al., 2011).
Mindful parenting (MP) primarily emphasizes being fully present and attentive in the parenting role, with a focus on the present moment (Duncan et al., 2009a). MP is a multidimensional construct that bridges intrapersonal and interpersonal aspects of parenting. It extends mindfulness, or “the awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003, p. 145)—drawn from Buddhist tradition—into parenting interactions. A commonly used framework for MP incorporates multiple dimensions of listening with full attention, nonjudgmental acceptance, emotional awareness, self-regulation, and compassion for both the child and for oneself as a parent (Duncan et al., 2009a). From this perspective, parents can learn to intentionally practice MP in their day-to-day, moment-to-moment parenting interactions. Intervention research in this area has taken a skills-building approach that involves varying degrees of informal mindfulness practice in daily life (e.g., Coatsworth et al., 2015) and/or training in formal mindfulness meditation (e.g., Potharst et al., 2019).
Parental reflective functioning (PRF), on the other hand, is a psychological construct that describes a parent's ability to mentalize, or to understand their own and their child's inner experiences—thoughts, emotions, and desires—and how those mental states drive behavior (Fonagy et al., 1991; Fonagy & Target, 1997; Sharp & Fonagy, 2008; Slade, 2005). It often involves a more in-depth exploration of the child's inner world and includes a parent's ability to think about and understand the motivations, emotions, and intentions behind their own and their child's behavior. In PRF, parents' reflections on their own and their child's mental and emotional experiences extend beyond the present moment. More specifically, parents draw connections between past experiences and current mental states. PRF is frequently used in therapeutic settings to promote a deeper understanding of parent-child dynamics and promote sensitive and responsive parenting (e.g., Slade et al., 2020; Suchman et al., 2018).
Shaver et al. (2007) proposed that mentalization, or reflective functioning, overlaps with mindfulness because both processes require cognitive resources to openly observe one’s own and the other’s thoughts, needs, and emotions. These overlapping processes are both associated with parenting as well, such that parents with higher MP and PRF are more likely to engage in responsive caregiving and greater sensitivity (Block-Lerner et al., 2007; Suchman et al., 2018). Despite theoretical and conceptual overlap between MP and PRF, there is a lack of research examining the two concepts concurrently in a single study. In one study, Falkenström et al. (2014) found a positive association between dispositional mindfulness and reflective functioning together. However, these constructs were not assessed in relation to parenting, specifically PRF and MP. Although consistent, but separate, bodies of evidence support MP and PRF as promoting positive parenting behaviors and parent-child relationships, a comprehensive scoping review summarizing the overlapping associations across research outcomes and correlates related to parenting is needed.
“Mindful parenting” was first described by Myla Kabat-Zinn and Jon Kabat-Zinn (1997) in their book, Everyday Blessings. Since then, researchers and practitioners have developed an array of interventions for improving parenting or parent-child relationships using mindfulness and MP approaches (e.g., Bögels et al., 2014; Duncan et al., 2009b; Singh et al., 2007). MP involves cultivating awareness of one's thoughts, feelings, and the child's needs, promoting a calm and compassionate parenting style through emotion regulation and values-based intention setting (Bögels & Restifo, 2014; Duncan et al., 2009a; Kabat-Zinn & Kabat-Zinn, 1997). MP is associated with a warm and nurturing parent-child relationship, reduced stress, and improved well-being for both parents and children (Chaplin et al., 2018; Gouveia et al., 2016; Parent et al., 2016a, b). MP is thought to address both intrapersonal and interpersonal aspects of parenting through five core aspects: (a) listening with full attention, (b) emotional awareness of self and child, (c) nonjudgmental acceptance of self and child, including greater awareness of expectations and attributions, (d) self-regulation in the parenting relationship, and (e) adopting compassion toward oneself as a parent and the struggles one’s child faces (Duncan et al., 2009a). From this perspective, the foundation of MP involves practicing moment-to-moment awareness of one’s thoughts and emotions and those of the child. MP also involves suspending judgmental attributions through an open and receptive stance and engaging in more intentional parenting behaviors.
MP is also reflected in parents’ ability to be fully present with their children and to bring an attitude of acceptance, kindness, and compassion to those interactions. Interpersonal processes targeted by mindfulness-based interventions include perspective-taking, empathic responding, communication, and anger management (Block-Lerner et al., 2007; Wachs & Cordova, 2007). MP thus can play an important role in promoting positive parent-child relationships. For example, MP is associated with greater use of authoritative (versus authoritarian or permissive) parenting styles (Gouveia et al., 2016), increased positive parenting behaviors, such as warmth and reinforcement (Parent et al., 2016a, b), and more positive emotions and affective behaviors during parent-child interactions (Duncan et al., 2015; Turpyn & Chaplin, 2016).
A different, but related, parenting construct is reflective functioning, or the operationalization of the mental process known as mentalizing. Mentalizing is the ability to understand our own and other’s behaviors in relation to underlying mental states and intentions (Fonagy et al., 1991; Fonagy & Target, 1997). Importantly, reflective functioning includes the ability to reflect on both one’s own and others’ mental states and connect those feelings to behavior, distinguishing it from similar concepts such as empathy or meta-cognition (Suchman et al., 2010). A high capacity for reflective functioning includes an understanding of the complexity of mental states—that they can be contradictory, ambiguous, changing, hidden, or disguised (Slade, 2005). Developmentally, reflective functioning is essential to affect regulation and the development and sustainability of social relationships, especially parent-child relationships. Parental reflective functioning (PRF) has been proposed as one mechanism that contributes to the intergenerational transmission of attachment, via parenting sensitivity (Fonagy et al., 1995; Fonagy & Target, 1997; Slade et al., 2005a, b).
PRF is important to parent-child relationships for several reasons. First, reflective capacity allows the child and the parent to see that behavior is both predictable and meaningful, and to understand each other’s mental states and intentions (Slade, 2005). Second, PRF has been consistently linked to higher parenting sensitivity (e.g., Buttitta et al., 2019; Slade et al., 2005a, b; Suchman et al., 2010, 2018), and secure attachment in children (e.g., Hoffman et al., 2006; Stacks et al., 2014). Third, reflective functioning helps decipher a person’s inner from outer reality. For example, a child can attribute their parent’s insensitive behaviors to the parent’s emotional or mental states, rather than to themselves as an unlovable child. Fourth, reflective functioning promotes effective communication, which is important in parenting and the parent-child relationship. Reflective functioning allows one to be open to others’ thoughts and emotions and that they may differ from oneself. Indeed, reflective functioning has been linked to perspective-taking (Fonagy et al., 2016a, b). Lastly, reflective functioning connects meaning to internal and external experiences. Children depend on their parents to facilitate processes such as affect regulation and self-organization of thoughts, feelings, and mental states. Parents enacting reflective functioning are actively helping the child construct their sense of self and others. In contrast, parents’ failure to accurately mirror or reflect the child’s emotional needs can lead their child to have a distorted representation of the self and others (Slade, 2005). High levels of PRF are associated with improved parent-child attachment, better child emotional regulation, and more sensitive parenting (e.g., Buttitta et al., 2019; Camoirano, 2017; Slade et al., 2005a, b).
Relatedly, it is important to clarify the focus on PRF independent of other elements of mentalization. Although different aspects of mentalization, including insightfulness and mind-mindedness are conceptually similar to PRF, this scoping review will focus only on PRF. As discussed in Camoirano’s (2017) review, these constructs may not tap into the same mental or cognitive capacity as PRF (Van Ijzendoorn & Bakermans-Kranenburg, 2019). PRF is thought to capture the capacity to mentalize, or an overall cognitive ability, while mind-mindedness and insightfulness captures the extent to which parents accept children's mental states and balance positive and negative aspects of children, as captured by insightfulness (Medrea & Benga, 2021). More research is needed to clearly delineate these constructs (Camoirano, 2017; Medrea & Benga, 2021). However, the mentalization construct most closely aligned with MP is PRF, because both involve reflective mental processes. Given the conceptual similarity, it is important to compare research evidence supporting these two sectors of research and examine their potential overlaps.
Following this framing of the theoretical and empirical backgrounds for MP and PRF, we describe our approach to conducting a scoping review of both literatures. This scoping review is necessary to map the depth and breadth of the existing evidence of MP and PRF in the parenting literature. The results from this review may inform future studies such as systematic reviews, research that compares MP and PRF directly, and the design of parenting programs. Scoping reviews examine the extent, variety, and characteristics of the evidence on a topic and findings from this type of review can help determine if there is value in conducting a systematic review on the same topic (Tricco et al., 2018). Lastly, a scoping review can identify gaps in the existing literature and in turn, present directions for future research. By conducting this study, we aim to cross MP and PRF sub-fields to allow for refinement in our understanding and the potential value of each approach. Our long-term goal is for researchers to consider examining these two constructs together to move our current understanding of their impacts on parenting and parent-child relationships forward. We describe the theoretical background of MP and PRF in the context of parenting in the sections. To begin, we highlight the limitations of existing PRF and MP reviews.
To date, scoping or systematic reviews in this area exist but not without limitations, specifically narrow inclusion criteria (Donovan et al., 2022; Shorey & Ng, 2021; Townshend et al., 2016). For example, the scoping review by Donovan et al. (2022) scoping review excluded qualitative studies and cross-sectional studies, whereas Hidayati and Hartini (2022) only included studies with parents of adolescents. Previous reflective functioning reviews exist, but with important limitations. For example, both Camoirano’s (2017) and Katznelson’s (2014) reviews focused on studies that used certain reflective functioning measures such as the Reflective Functioning Scale (RFS; Fonagy et al., 1998) and/or Adult Attachment Interview (AAI; George et al., 1985), and excluded studies employing the Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017) or other reflective functioning measures, hence, providing an incomplete scope of the field. Additionally, Katznelson’s (2014) review focused primarily on reflective functioning and psychopathology, with a limited focus on adult and child attachment.
The present study focuses on conducting a scoping review, with wider inclusion criteria, to identify and map the existing evidence for MP and PRF from 2005 to mid-January 2020, summarize the study characteristics across both areas and identify future research questions to explore. Specifically, the rationale for this scoping review is to provide fuller coverage of the body of literature on MP and PRF to address the following questions within the parenting literature: (1) What are the overlapping or distinctive outcomes and correlates across the mindful parenting and parental reflective functioning literature? (2) To what extent should these separate theoretical and empirical lines of research be integrated (or not) in future research? What are the gaps in this area to inform future inquiry?
Method
The scoping review was designed and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Review (PRISMA-ScR; Tricco et al., 2018) criteria, which guided our methods and reporting of the findings. Fig. 1 depicts the PRISMA stages of our scoping review process: identification, screening, eligibility, and inclusion. Detailed procedures for each stage of the process are explained below.
Fig. 1
PRISMA flow diagram for the research and inclusion criteria in the review. MP=mindful parenting; PRF=parental reflective functioning
×
Identification
The first step was to obtain consensus on the years to cover in our search (2005-Mid- January 2020), search engines and databases (Google Scholars, PubMed, PsychInfo, EBSCOHost, and MINDRxiv), and search terms to use when conducting the MP and PRF literature searches. Our search strategy included the following search terms, “parenting” “parent-child relationships” “parent-child dyads” with a combination of the search terms “parental reflective functioning,” “parental mentalization”, “paternal/maternal reflective functioning,” “paternal/maternal mentalization.” For the MP literature, we used the search terms, “mindful parenting,” “mindfulness,” and “parenting.” The fifth author (VC) conducted the first PRF and MP literature searches. Then, the first author (TH for PRF studies) and the third author (CK for MP studies) conducted additional literature searches. For the last step of the identification phase, we determined the key data to extract from each article during the full-text assessment such as sample size and demographic information.
Screening
Both TH (PRF studies) and CK (MP studies) independently screened the articles at the title-abstract level to remove duplicates before the full-text assessments of the articles, with guidance from the eligibility criteria for this scoping review.
Eligibility Criteria
To expand beyond past reviews (Camoirano, 2017; Katznelson, 2014), we did not restrict our eligibility criteria to studies using certain measurements of MP or PRF or specific dependent variables (e.g., child attachment or psychopathology). Instead, studies were included in the full-text assessments if they met the following criteria: (1) peer-reviewed (e.g., no dissertations/thesis) in an indexed journal; (2) published in English and between 2005-mid-January 2020; (3) key terms (see above) were included in the title or abstract; (4) empirical articles (e.g., no book chapters); (5) no study protocols; (6) in the scope of parenting (e.g., parent-child relationships; parenting behaviors); and (7) sampled primary caregivers (e.g., not child reflective functioning).
Inclusion
All studies that met our eligibility criteria were assessed at the full-text level by study authors. CK, MLK, and EF reviewed the MP literature while TH and MLK reviewed the PRF literature (Fig. 1 and 2).
Fig. 2
Trends of Mindful Parenting and Parental Reflective Functioning Studies from 2005 through early 2020 (pre-COVID-19 pandemic)
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Results
Tables 1 and 2 present the key extracted data from the total articles included in this review. As mentioned in the stages used to identify and choose the articles for this review, we identified a total of 641 potential studies (n = 360 MP; n = 281 PRF) and removed duplicate articles (n = 6 MP, n = 2 PRF). Next, we ended up with 618 articles after the title-abstract screening (n = 345 MP; n = 273 PRF). After the second screen process, we eliminated 317 articles that did not fit our eligibility criteria (n = 165 MP; n = 152 PRF) (see Fig. 1). After analyzing the data extracted from the included studies (N = 301; n = 180 MP, n = 121 PRF), we identified the key characteristics, commonalities, and differences across the articles, which are described below and presented in Tables 1 and 2.
Table 1
Content analysis of mindful parenting articles (N = 180)
Maternal parenting and interaction satisfaction, and use of mindfulness
Child aggressive behavior and social interaction
Minimal improvement of child behavior and social interaction was found from baseline during the mindfulness training, and much more improvement occurred during the mindfulness practice phase.
Parenting outcomes were low during baseline, increased during mindfulness training, and reached high levels during mindfulness practice.
118 U.S. mothers of middle school adolescents (Majority being White)
MAAS
No
Parenting effort
Youth externalizing and internalizing problems
Mother’s mindfulness was inversely correlated with perceptions of youth problem behavior
Maternal mindfulness mediates the linkage between mother’s effort and their perception of youth internalizing problems and moderates the connection between mother’s effort and youth externalizing problems
Bluth and Wahler (2011b)
50 U.S. mothers of preschooler (82% White)
MAAS
No
Parenting effort
Negative correlation was found between mindfulness and parenting effort
28 Australia parents of children with ASD (85.7% White)
IM-P
No
Parent depressive and anxiety symptom, parenting stress
Child behavior problems
Higher levels of MP were related to lower levels of depressive symptoms and parental stress
MP was significantly negatively related to children’s’ behavior problems; however, it did not mediate the relationship between child behavior problems and parental outcomes
Intervention group showed improvements in maternal self-efficacy, mindfulness (except describing), some self-compassion sub-scales, anxiety, stress, and psychological distress, but not in depression, satisfaction with life, or subjective happiness
86 Netherlands parents referred to a child/youth secondary mental health care (81% born in Netherlands)
None
Yes
Intervention
Parent externalizing and internalizing problems, parental stress, parenting style, coparenting behavior, and marital conflict satisfaction
Child externalizing and internalizing problems
Parental stress, parenting style (encouragement, overprotection, rejection, acceptance), and coparenting behavior improved after intervention
Both children’s and parents’ externalizing and internalizing problems significantly decreased, and these improvements were maintained at 8-week follow-up
140 U.S. parents of children with Autism (90% White)
FFMQ
BMPS
No
Parents’ psychological well-being
Child behavior problems
Psychological acceptance mediated the relationship between child behavior problems and parental well-being (maternal anxiety, depression, stress and paternal depression)
Both dispositional mindfulness and MP had mediating effects in relation to maternal anxiety, depression and stress
Parents who reported increased mindfulness and acceptance also reported greater levels of positivity in relation to their child’s ASD
432 U.S. families with adolescents (69% White, 15% Black, 8% Latino)
IM-P
Yes
Intervention
Parent well-being and parent-youth relationship
Youth behavior management
Mothers and fathers in MSFP showed greater improvements in interpersonal mindfulness in parenting, parent-youth relationship quality, youth behavior management, and parent well-being compared to parents in SFP 10-14
MP was significantly related to greater warmth, positive interaction, positive parenting, consistent discipline, parent communication skills and lower harsh parenting
432 U.S. mothers and their adolescents (72% White)
IM-P
No
Parental solicitation
Adolescents’ perception of mother’ mindful parenting, and levels of disclosure
MP may promote parent-adolescent communication by reducing parental negative reactions to information, adolescent perception of over-control, and by improving the affective quality of parent-adolescent relationship
Negative parental reactions to adolescent’s disclosure and adolescents’ perceptions of the quality of mother-adolescent relationship mediates the association between MP and adolescent disclosure and parental solicitation
Mindfulness were more strongly and consistenly related to more general aspects of mother’s mental health, while MP more strongly and consistently related to aspects of stress specific to their role as a mother, parent-child interactions, and perceptions about their child
Being nonjudgmental about self as a person and mother appeared as main predictive aspect of MP on overall outcome
Parenting stress, parenting style, and self-compassion
Higher levels of dispositional mindfulness and self-compassion are associated with higher levels of MP that, in turn, is associated with lower levels of parenting stress, higher levels of authoritative parenting style, and lower levels of authoritarian and permissive parenting styles
Parents reported significant increase in mindfulness and decrease in stress while children reported increase in the amount of parent monitoring after intervention, however no change in positive family relationship was reported
Parent neural activation from pre to post intervention increased in area related to self-awareness and evaluation, emotional awareness and interception, and emotion regulation
Maternal attachment avoidance and attachment anxiety
Self-compassion mediated the relationship between attachment anxiety and MP, in that higher levels of anxiety was associated with lower SC, which in turn was associated with lower levels of MP
485 U.S. parents of children from three developmental stages (79% White)
IM-P
MAAS
No
Negative and positive parenting
Coparenting relationship quality
Findings across all three youth development stages indicated both direct effects of parent dispositional mindfulness as well as indirect effect through MP and mindful coparenting, with parenting and coparenting relationship quality
615 U.S. parents of children from three developmental stages (72-80% White across three developmental stages)
IM-P
MAAS
No
Child externalizing and internalizing problems
Consistent findings across all three developmental stages
Higher parent dispositional mindfulness was indirectly related to lower youth internalizing and externalizing problems through higher MP and lower negative parenting practices
Parents’ quality of life and positive stress reappraisal
Parents in the intervention group showed improvement in psychological and social health domain of quality of life, mindfulness, and positive stress reappraisal with medium to large effect size after intervention.
Parents in control group improved in overall outcomes with small effect size.
Serkel-Schrama et al. (2016)
215 Netherlands parents and 129 of their adolescents (Majority Dutch)
IM-P
No
Child glycemic control and quality of life
MP is related to more optimal glycemic control in adolescent boys, adolescent girls who were not hospitalized in the last 12 months, and to proxy-reported generic and diabetes-specific quality of life of both male and female adolescents with T1DM
No significant associations wwere found between MP and generic or diabetes-specific quality of life as rated by the adolescents by themselves
Significant association was found between MP and glycaemic control and hospitalization due to ketoacidosis
Maternal mindfulness had positive effect on attachment/involvement/parental confidence and negative effect on discipline practice/relational frustration
Maternal mindfulness had a negative indirect effect to children’s emotional symptoms, conduct problems and positive indirect effect to children’s prosocial behavior
128 U.S. adult parents of children under 18 (82% White)
FFMQ
No
Parenting stress, and parental responsiveness
The more mindful parents are, the more attuned and responsive they are to their child’s needs, and that this is explained by the lower levels of parenting stress associated with higher levels of mindfulness
Results also indicated particular importance of the recursive relational aspect (i.e., parent– child interaction) of the constructs
Chan and Lam (2017)
271 Hong Kong parents of children with ID (100% Hong Kong Chinese)
CAMS-R
No
Parental stress
Child behavior problems
Parental mindfulness partially mediated the association between parent-reported child behavior problems and parental stress
Medium or high level of parental mindfulness buffer the effect of child behavior problems on parental stress
30 U.S. first-time mothers in the late 3rd trimester (59% White, 18% Latina/Hispanic, 17% Asian)
FFMQ
MAIA
Yes
Intervention
Perinatal depression
Childbirth-related appraisals and psychological functioning, use of pain medication in labor, and birth satisfaction
Mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education
Mothers showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms after intervention that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor
152 Israel parents of children with ADHD and behavior problems
None
Yes
Intervention
Parental emotion regulation, hostile and coercive parenting
Child behavioral problems
Mothers’ negative feelings, escalating behaviors, and capacity for emotion regulation improved significantly following treatment. Mothers across treatment conditions reported reduced emotional dysregulation and coercive behaviors
Fathers in the NVRM condition experienced a greater decrease in paternal emotional dysregulation following treatment than did fathers in the NVR condition. There was no change in coercive behavior in father over time in either treatment condition
Parents across treatment conditions reported a significant reduction in child externalizing symptoms
Self-compassion and mindfulness for staff group increased from pre- to post- training, although this was not statistically significant for mindfulness
Significant difference of mindfulness and self-compassion was found for adoptive parents from pre- to post- training
Improvements were reported in total parent stress score, defensive responding, parental distress and perceived difficult child domains
Heifetz and Dyson (2017)
6 Canada adolescents with IDD and 8 of their parents
IM-P
Yes
Intervention
Mood improvement of youth
Social parenting
Youth participants showed more happy, relaxed, and less worried from pre- to post- sessions, while parents reported that their youth’s social behaviors showed a trend to have more social behavior post- group
For parent, only participant 3 showed a great difference between pre- and post-group in MP
Parents reported a range of benefits and positive changes through feedback surveys completed following the final group session
60 Turkey pregnant women with preterm premature rupture of membranes (PPROM)
None
Yes
Intervention
Maternal attachment
Post-partum self-evaluation
Improvement in acceptance of pregnancy, level of readiness to give birth, level of maternal attachment, and level of competence in the role of motherhood was found after intervention
100 Hong Kong children with ADHD symptoms and their parents (100% Chinese)
IM-P
Yes
Intervention
Overall behaviors, and parenting stress and well-being
Families from intervention group had greater improvements in children’s ADHD symptoms, overall behaviors, and parenting stress and well-being than those in wait-list control group
180 Hong Kong parents of children with DD (100% Chinese)
IM-P
Yes
Intervention
Parental stress and stress from parent–child dysfunctional interaction
Parents had significant improvements in parental stress and stress from parent–child dysfunctional interaction
Parents with severe stress and depression reported more significant positive changes, and they reported moderate effect for stress and depression.
Lunsky et al. (2017)
50 Canada parents of adults with ASD
FFMQ
BMPS
Yes
Intervention
Parents in the mindfulness group reported significant reductions in psychological distress, while parents in the support and information group did not
Reduced levels of distress in the mindfulness group were maintained at 20 weeks follow- up
Maughan and Wiess (2017)
57 Canada parents of children with ASD (61% White)
Perceived parenting, early maladaptive schemata and parental sense of competence
Higher levels of perceived aversive parenting are associated with stronger early maladaptive schemata, which in turn are related to lower levels of mindfulness, leading to lower levels of parental sense of competence
104 Jordan parents of children with ASD (100% Arabic speaking)
MAAS
Yes
Intervention
Perceived stress, anxiety and depression
Parents in the intervention group had better outcomes on psychological well-being, mindfulness, and improvements in stress, anxiety, depression than those in the comparison group
11 Hong Kong children with ADHD and one of their parents (100% Chinese)
IM-P
Yes
Intervention
Program feasibility
Parenting stress and children’s attention, behavior, and executive function
MYmind was feasible and well accepted among children with ADHD and their parents as shown in course attendance, evaluation, and qualitative results
Qualitative result showed the parents expressed very positive views on the MYmind course and admitted that they improved through the course. Most children also expressed positive views although some did not comment.
Aalders et al. (2018)
421 Netherlands parents of children with Type 1 Diabetes
FMI
No
Parental fear of hypoglycemia
Parents with an increased ability to be less judgmental of themselves as parents and less reactive to emotions within parenting interactions reported less fear of hypoglycaemia
Mindfulness intervention, compared to parent education increased mothers’ mindfulness, reduced parenting stress in two domains, increased MP related to emotional awareness in parenting, and improved parent-adolescent relationship quality
For mothers of girls (but not mothers of boys), the mindfulness intervention also decreased negative parenting behavior and decreased negative emotional responses
The intervention group showed a significant reduction in general and parental stress and an increase in MP and general mindfulness variables when compared with the comparison group, these improvements were maintained after 2 months
MP were associated with lower levels of adolescents’ emotional eating through higher levels of adolescents’ self-compassion in isolation or followed by lower levels of body shame among girls but not boys
102 U.S. high-risk expectant parents due to high rates of violence exposure and psychopathology (59% Black, 27% White)
FFMQ
No
Parent depressive and trauma symptoms
Higher levels of mindfulness were associated with lower levels of depressive and trauma symptoms
Levels of dispositional mindfulness (i.e., total mindfulness score and the non-reactivity subscale score) and current trauma symptoms were significantly associated with current depressive symptoms in the expected directions
62 U.S. parent-child dyads with parents with obesity (37% White, 63% Multiracial)
MAAS
Yes
Program feasibility
Intervention
Child obesity
Participants of mindfulness-bases parent stress group intervention plus nutrition and physical activity counseling showed greater improvement in parental involvement and decreased parental emotional eating
Mindfulness-based parent stress intervention to decrease child- hood obesity risk is feasible
Jones et al. (2018)
21 UK parents of children with ASD, Down syndrome, Cerebral Palsy, ID (100% British)
FFMQ
BMPS
Yes
Intervention
General stress
Parent reported increases in mindfulness and self-compassion, and reduced general stress, anxiety and depression
No significant reductions in their child’s behavior problems or increases in the child’s prosocial behavior were found
25 U.S. mother-child dyads (72% White, 12% Latina)
FFMQ
No
mothers' dispositional mindfulness and neural responses to their own infant in different emotion-eliciting contexts.
Mothers who reported higher Nonreactivity showed reduced signal in hypothesized regions: bilateral insula and prefrontal cortex (both dorsolateral and ventrolateral regions). They further showed lower signal across a range of cortical areas—bilateral temporal (including auditory regions and temporal pole), occipital (fusiform and lingual gyri), and parietal (including precuneus, supramarginal gyrus)—and subcortical regions (thalamus, right caudate).
Mothers higher in nonjudging also showed reduced signal in parietal areas (right angular gyrus, bilateral precuneus extending to posterior cingulate cortex) and in the left dorsolateral prefrontal cortex.
Mothers higher in describing showed increased signal in several occipital (left fusiform to lingual gyrus) and parietal (bilateral precuneus, right superior parietal extending to supramarginal gyrus) areas.
young children’s self-regulation, social-emotional competence, and academic readiness parent mindfulness, self-regulation, and evidence-based parenting practices.
Parent self-reported executive function and observed scaffolding behaviors demonstrated a significant increase from pre-test to post-test, with effects sustained at follow-up, and significant decrease in rejection
Children demonstrated significant decreases in observed negative affect, while parents reported significant increases in children’s social competence and academic readiness.
Higher levels of mothers’ self-critical rumination were associated with higher levels of parenting stress through 2 dimensions of MP (nonjudgmental acceptance and emotional awareness)
Mothers with significant levels of anxiety and/or depressive symptoms
Higher levels of MP were associated with higher levels of adolescents' dispositional mindfulness, and these associations were moderated by mothers’ anxiety and/or depression symptoms
98 Netherlands parents in clinical setting (90% Dutch) and 89 parents in nonclinical setting (88% Dutch)
IM-P
Yes
Intervention
Parental stress, over reactivity, well-being, and partner relationship
Child well-being and behavior problem
MP training was as effective in a non-clinical context as it is in a clinical context.
Parents improved on parental stress, over reactivity, MP, well-being, and partner relationships, and children of these parents improved in behavior problems and well-being.
Intervention maternal sensitivity and acceptance of the child, and mother-rated child dysregulation and psychopathology, maternal over reactivity, parenting stress, parenting sense of competence, maternal psychopathology, partner relationship.
There was no significant difference were seen in outcomes between waitlist and pretest assessment, except for a deterioration in listening with full attention and an improvement in compassion for the child
Mothers were more sensitive and more accepting toward their child. Child psychopathology had decreased, and a borderline significant improvement in child dysregulation was revealed
Maternal over reactivity did not improve significantly, while parenting stress a borderline significant improvement at post-test
45 Netherlands children with ASD and their parents
IM-P
Yes
Intervention
Children’s and parents’ social communication problem, emotional and behavioral functioning, mindful awareness
There was no significant change in mindful awareness of children, but their social communication problems decreased, and their emotional and behavioral functioning improved
There was an improvement on parents’ emotional and behavioral functioning, improved parenting, and mindful awareness on all occasions of pre-, post-, 2-month follow-up, and 1-year follow up, while social communication problems reduced only directly after the intervention
109 Australia women at-risk for perinatal depression and anxiety (47% Australian, 27% non-English speaking background)
MAAS
FFMQ
Yes
Intervention
Perinatal depression and anxiety, general stress score
CBMP significantly reduced depression, anxiety, perinatal depression, perinatal anxiety and general stress scores, and significantly increased self-compassion and mindfulness with moderate to strong effect size.
Pregnant women improved significantly post MBCP-4-NHS in terms of self-reported symptoms of perceived stress, anxiety, depression, pregnancy-related distress, labor worry and positive and negative pregnancy experiences.
Fathers improved significantly post MBCP-4-NHS in self-reported symptoms of anxiety, depression and showed a trend for improvement in self-reported symptoms of perceived stress but this was not significant.
There is a different baseline score but parents showed significant improvement after the course.
155 U.S. mothers of children with Fragile X syndrome (90% White)
FFMQ-SF
BMPS
No
Acceptance
Maternal outcomes including stress, anxiety, depression, and health symptoms.
The severity of children’s disability significantly predicted each maternal outcome after controlling for total number of children in the family and where necessary, education and/or marital status.
General mindfulness, acceptance and flexibility significantly predicted all maternal outcomes, while mindfulness in parenting was a significant predictor of stress, anxiety, and depression.
196 U.S. parents with self-injuring youths and 57 parents of youths without no known mental health challenges (83% White in nonsuicidal self-injury sample and 64% White no known mental health history sample)
IM-P
No
Caregiver strain and factors that contribute to caregiver strain
Parent expectancies for positive and negative outcome for self and child
Parent-child relationship
Having a self-injuring youth adds significant strain to caregiver
Nonjudgment of self and child was positively associated to objective stress but negatively related to subjective stress.
32 UK women with difficulties in emotion regulation (100% British)
None
Yes
Intervention
Perinatal mental health
Decrease in overall psychological distress and increase in confidence in managing mental health and ability to cope with emotions were found after Dialectical Behavioral Therapy (DBT)
Strong correlations were found btw global scored of EA and MP.
MP dimensions were significantly correlated to adolescent outcomes including life satisfaction and externalizing problems.
Nonjudgmental acceptance of self and child is an MP dimension independently linked with indicators of adolescent externalizing problems, distinct from EA.
89 Netherlands parents of children assessing secondary mental health care (84% Dutch)
IM-P
FFMQ
Yes
Intervention
Parenting factors
Child and parent psychopathology
Parent-reported child and parent psychopathology improved following the intervention.
Improvements were found in the parenting factors targeted within the MP intervention.
Increased MP predicted improvements in the child attention problem, but not mindfulness. Increase in MP did not predict improvement in child internalizing and externalizing problems.
Child disordered eating behavior (emotional eating and overeating)
MP was negatively associated with children/adolescent’s emotional eating through lower levels of parenting stress followed by less frequent use of food as a reward as well as through parents’ less frequent use of food as a reward only
MP was negatively associated with children’s overeating through lower levels of parenting stress, but not adolescents.
MP was associated with more adaptive parental child-feeding practices through lower levels of parenting stress, among parents of girls from the early adolescents
Increase in parents’ dispositional mindfulness are negatively associated with children’s internalizing and externalizing problems through mindful parenting and subsequent parenting practices
MP mediated the association btw maternal state anxiety during pregnancy and child internalizing problems at age 4
The association btw maternal anxiety during pregnancy and child internalizing problems at age 4 was mediated by concurrent maternal general anxiety followed by MP
Higher levels of work-family conflict were indirectly associated with lower levels of mindful parenting dimensions through anxiety and depression symptoms and parenting stress
Adolescent externalizing and internalizing problems
Higher levels of mindful parenting were related to reduction in recurrent conflict after 3mth follow-up, and greater reduction in recurrent conflict during the 3mths were related to greater reduction in externalizing and internalizing problems over the following year
Parental stress, over-reactive parenting discipline, depression and anxiety symptoms, self-compassion
Child aggressive behavior and emotional reactivity
Online mindful parenting intervention was significantly more effective at 95% level than a waitlist period with regard to over-reactive parenting discipline, and symptoms of depression and anxiety
Self-compassion, mother-rated child aggressive behavior and child emotional reactivity were significant at 90% level
30 U.S. parents of children being treated for chronic pain (94% White)
MIPQ
No
Parental solicitousness, stress, resilience
Significant decrease was found in parental solicitous behavior and perceived stress, and increase in mindful parenting after 30-day mindfulness curriculum through mobile app
20 U.S. high-stressed mothers of adolescents (55% White, 20% Black)
IM-P
Yes
Intervention
Maternal emotion reactivity, negative emotion, salivary cortisol reactivity, and fMRI emotion task and fMRI resting task scan
Mindfulness intervention increased brain responsivity in the left posterior insula in response to negative affective stimuli, and altered resting state functional connectivity in regions involved in self-reference, behavioral regulation, and social-emotional processing
Changes in mothers’ brain function and connectivity were associated with increased mindful parenting and decreased emotional reactivity to the parent-adolescent conflict task
313 U.S. mothers who were either deployed or had partner who were deployed (91% White)
FFMQ
Yes
Intervention
Self-reported parenting skills and observed parenting skills
Trait mindfulness was a moderator the intervention effect
Mothers with lower levels of baseline mindfulness reported higher mindfulness at 1-yrs follow-up in intervention condition, while mothers with average mindfulness did not report changes at follow-up in both conditions
Mindfulness at 1 or 2 yr follow-up was associated with self-reported parenting skills at 2 yr follow-up but not with observed parenting skills
Higher levels of dispositional mindfulness were linked to greater MP, which in turn promotes secure attachment btw parent and child, thereby contributing to children’s lower emotion lability/negativity and higher adaptive emotion regulation
MP and parent-child attachment mediated the association btw parents’ dispositional mindfulness and children’s emotion regulation
Children/adolescent’s emotional eating and depressive symptoms
Higher levels of mothers’ difficulties in emotion regulation are associated with higher levels of children/adolescents’ depressive symptoms through lower levels of mindful parenting.
Lower levels of mindful parenting skills are associated with higher levels of children/adolescents’ emotional eating through higher levels of children/adolescents’ depressive symptoms.
Both mindful parenting perceived by adolescents and mindful parenting reported by primary caregivers has significant impacts on adolescent dispositional greed, and the relationship is mediated by adolescent core self-evaluations.
Parent self-reported stress, and Child challenging behavior
Medium effect for increases in behavioral strategy use and small-moderate effects for decreases in parent stress and child challenging behavior was found following intervention.
Women in the intervention group showed greater decline in depression and anxiety, and significant increase in mindfulness compared to those in the control group.
(120 families with child ADHD and 105 control families)
IM-P
No
ADHD, mindful parenting Parenting behaviors
Psychological distress
Children’s self-regulation
Parents of children with ADHD report significantly lower mindful parenting than parents in control group.
Higher mindful parenting was associated with lower levels of parent psychological distress, higher levels of parenting warmth and consistently, lower levels of parenting anger, and higher child emotion self-regulation in both groups.
Mindful parenting was indirectly associated with child emotion self-regulation through lower parenting anger.
560 Portugal mothers with a child 12 months old or younger
IM-P
No
Parent anxiety
Depression
Parenting stress
Infant temperament Mindful parenting
Mothers who perceived their infant temperament as difficult had significantly higher levels of parenting stress and lower levels of mindful parenting than those who perceived their infant temperament as easier.
Parenting stress mediated the relationship between anxious and depressive symptomatology and mothers’ perception of infant temperament and mindful parenting.
Knowledge and acceptability of mindful parenting interventions
Preference concerning the characteristics of mindful parenting intervention
Approximately 95% of mothers felt that participating in a mindful parenting intervention during the postpartum period would be useful.
Concerning mothers’ preferences, most mothers preferred a weekly frequency (85.0%) and an average of 10 sessions (48.6%) of 45–60 min in length (52.6%).
Learning how to better understand the baby’s emotions and behaviours and learning new tools to better cope with parenting stress were among the intervention contents considered most useful.
101 Croatia two-parent families with an adolescent child
MIPQ
No
Mindful parenting Cognitive parental awareness and Adolescents’ psychological well-being
Mindful parenting and cognitive parental awareness are significantly correlated to the subjective well-being of adolescents when it comes to fathers, but not to mothers.
Adolescents’ difficulties in emotion regulation Mindful parenting
The mindful parenting dimensions of compassion for the child and nonjudgmental acceptance of parental functioning were indirectly associated with difficulties in emotion regulation through self-compassion.
The mindful parenting dimension of listening with full attention was indirectly associated with difficulties in emotion regulation through psychological inflexibility.
Parents’ and children’s tendency to experience negative affect
Mindful parenting
Parents’ and children’s tendency to experience negative affect were associated with lower levels of all mindful parenting.
Parents’ neuroticism and children’s negative reactivity were both shown to be indirectly associated with lower levels of overprotection and supportive behaviors through lower levels of compassion towards the child and of emotional awareness of the child.
In contrast, parents’ neuroticism and children’s negative reactivity were indirectly associated with a greater overprotection through lower levels of nonjudgmental acceptance of parental functioning.
Higher levels of baseline caregiver dispositional mindful attention were related to higher levels of mindful parenting at 4 months.
Higher levels of mindful parenting were associated with higher levels of positive parenting and lower levels of negative parenting practices at 8 months.
Lower levels of negative parenting practices were related to lower levels of internalizing and externalizing symptoms at 12 months.
Parents’ perception of creative and socially acceptive characteristics in children
Parents’ attitudes and values toward creativity
Creative home environment
Mindful parenting
Parents’ attitudes and values toward creativity and creative home environment were significantly and positively related to support for creativity characteristics, whereas mindful parenting was significantly and negatively related to support for socially acceptable characteristics in children.
334 China parents (167 parents of children with ASD and 167 parents of typically developing parents)
IM-P
No
Positive and negative parenting practices Mindful parenting
Compared to parents of typically developing children, parents of children with ASD showed less listening with full attention, less proactive parenting, less supportiveness, more lax control, and more physical control to their children.
Listening with full attention and awareness of children’s emotions were significantly related to both positive and negative parenting practices in families of children ASD.
1007 U.S. parents with youngest child under age of 19
FFMQ
No
Parenting efficacy parenting stress
Nonreactivity of inner experience was most predictive of parenting efficacy compared to acting with awareness, whereas awareness was most predictive of lower parenting stress compared to nonreactivity.
Mothers’ greater dispositional mindfulness was associated with adolescent reports of greater maternal perspective-taking through less maternal stress.
Mothers’ greater dispositional mindfulness was associated with more adolescent disclosure to mothers and less intense conflict through less maternal stress and greater maternal perspective-taking
Compared to the active control treatment, MBCP significantly reduced perceived stress, depressive symptoms, increased positive state of mind, and mindfulness.
Change in mindfulness mediated the treatment effects of MBCP on stress, depression symptoms, and positive state of mind.
Mothers in the intervention group had a greater decrease in stress and depression, and greater increase in positive state of mind and mindfulness from baseline to post-intervention, compared to active control group.
80 U.S. children with DD and ASD and their parents
BMPS
Yes
Intervention
Parent stress
Child internalizing problem
Children of parents in the MBSR treatment group had greater reductions in internalizing problems compared to children whose parents were in the control group.
Children of parents who reported greater increase in mindfulness had greater reduction in internalizing problems.
Higher level of maternal perceived life stress weakened the positive links between maternal mindfulness and positive parenting practices and between maternal mindfulness and school-aged children’s emotion regulation.
Mothers in the MBPBS condition reported greater reductions in perceived psychological stress, followed by those in the mindfulness condition (MB), and with no significant changes reported by those in the positive behavior support condition (PBS).
Significant increases in compliance were largest in the MBPBS condition, followed by mindfulness condition (MB), and then positive behavior support condition (PBS).
Dispositional mindfulness moderated the relationship between parenting-related risks and parental mental health, such that the negative impact of parenting-related risks was attenuated for parents with high dispositional mindfulness.
Maternal mentalizing and mother-reported child conduct problems negatively correlated at baseline and follow up even after controlling for baseline conduct problems.
Maternal mentalizing unrelated to child- or teacher-reported conduct problems
Both mothers’ and fathers’ RF associated with adolescent RF
Fathers’ RF was positively associated with adolescent social competence, internalizing problems and negatively associated with adolescent self-perception
Parental RF moderated links between parenting behavior (e.g., involvement, warmth) and adolescent outcomes
34 mothers in residential treatment for substance use (Finland)
PI
PDI
No
Intervention
RF increased from prenatal to postnatal phase for 63% of mothers
Smaller increases in RF for those who also used alcohol, exposed to physical abuse and secrets within family during childhood, experienced secrets or abuse/neglect
83 caregiver-child dyads (29% diverse background) (Australia)
COS Interview
No
Intervention (Circle of Security)
Lower RF among caregivers with history of family violence, divorced or separated caregivers, caregivers of older children, caregivers with less education, caregivers of boys
RF increased post-intervention for caregivers with baseline RF lower than 5 and those with less than postsecondary education
Parental distress tolerance (OBS via baby simulator task)
RF certainty negatively correlated with maternal age and education
RF pre-mentalizing negatively correlated with maternal distress tolerance (SR)
RF pre-mentalizing negatively associated with task persistence
RF interest & curiosity positively associated with lower systolic BP before, during, and after task; not significant after controlling for age & education
Statistically significant differences in infant negative affect behaviors (crying/fussing) between infants of mothers with high versus low RF.
Infants with high maternal RF demonstrated the highest level of negative affect at the still face episode versus the reunion episode for infants with low maternal RF.
No significant differences between control and treatment on reflective functioning across PDI and PRFQ
Significant changes in parenting stress/depression, parenting alliance and hostility, and child behaviors at post-assessments but no significant effects of intervention
Maternal RF, caregiving helplessness, feelings about their child (postpartum bonding), stress
Significant increase in PRF-Certainty subscale, postpartum bonding, but decreases in caregiving helplessness, mother and child frightened, and stress at post-COS-P
79 parents (85.5% European American) (United States)
PRFQ
No
Parent-child relationship quality
Child attachment security
RF was significantly associated with quality of parent-child relationship including parental involvement, communication, parent satisfaction, limit setting, and parental support
Parent-child relationship quality (support, limit setting, autonomy) was correlated with attachment anxiety
Parental support, satisfaction with parenting, involvement, and communication and attachment avoidance were associated with attachment avoidance
24 fathers with IPV and substance use problems (54.2% African American) (United States)
PDI-R
No
Parenting behaviors (e., adult criticizing, child avoidance, and dyadic tension)
Intimate partner violence (IPV)
IPV (male to partner physical aggression) was significantly correlated with parenting behaviors (dyadic constriction) and child avoidance of parents during parent-child interactions
PRF was not significantly correlated with any measured variables
17 mothers from outpatient mental health clinic (44.4% White, 33.3% Hispanic or Latina) (United States)
PDI
No
Feasibility of MIO program
Change in quality of mother-child interactions (RF and parenting stress)
MIO had good acceptability and feasibility with 83% completion.
Child-focused RF increased after intervention but self-focused RF did not.
Mothers reported decreases on certain parenting stress subscales (Personal Distress and Difficult Child) but not Parent-child Dysfunctional at post-assessments
Relational savoring group had higher positivity scores than personal savoring group, but there were no significant group differences
The indirect effects of attachment anxiety on parenting satisfaction, and positivity was present via PRF (prementalizing) in the single-group model analysis.
Attachment anxiety had a significant indirect effect on relationship satisfaction, positivity, and positive emotions for the relationship savoring group via RF. For the personal savoring group, RF only significantly mediated the association between attachment anxiety and relationship satisfaction
Fathers scored significantly higher on two RF subscales (Prementalizing and Interest in Child) than mothers. There were no differences between mothers and fathers on the Certainty of Mental States subscale.
Both mothers’ and fathers’ own RF (Certainty of Mental States) were significantly associated with their own Prementalizing
Infant-child cognitive and socio-emotional functioning
Maternal behaviors and stress
PEM was inversely associated positively associated with maternal stress and sensitivity and child outcomes including internalizing/externalizing behaviors but positive correlated with child language, academic, social skills, and competence
87 U.S. mother-child dyads; mothers enrolled in substance abuse treatment (77% White)
PDI
Yes
Maternal addiction severity
Maternal intelligence, Maternal representation of child
PRF
Maternal psychiatric symptoms
Maternal substance use
Child attachment
MIO mothers reported higher RF at post- and 3-month assessments than PE mothers
PE showed lower psychiatric symptoms at post-assessments but at the 3-month follow-up both PE and MIO showed normative levels of psychiatric distress and depression
There was no significant difference in substance use across time
MIO children were marginally more engaging with mothers than PE group at post-treatment. At 12-month MIO show significantly more engagement/involvement and dyadic reciprocity
No significant differences in child attachment post-program
There was a significant correlation between infant negative affect and toddler behavior problems, both were significantly associated with cumulative risk
Average and low levels of RF significantly moderated the association between infant negative affect and toddler behavior problems
FM group had significantly higher RF (Certainty and Curiosity) at post-test
FM group had increased in RF (FMSS-RF) at post-test than the parenting class group
Parenting stress decreased for the FM group.
There were group differences at post-test on the Defensive Responding subscale, with the parenting class group reporting higher scores on this subscale
RF was inversely associated with early childhood adversity, emotional/physical/sexual abuse, and neglect but was positively associated with early childhood and latency adaptive, competence, EF and safety
Wife RF was positively associated with marital engagement, supportive coparenting and inversely associated with marital conflict and undermining coparenting
Husband RF was positively correlated with marital engagement only
98 (40 adoptive and 58 non-adoptive parents) (Spain)
PDI
No
Quality of parent-child interaction
RF (negative/angry) was inversely correlated with parent’s encouraging behavior
RF (positive perception of child in relationship) was positively associated with parent’s encouraging behavior, sensitivity and dyad creativity, but inversely associated with child’s negative quality of demeanor
Adoptive parents had higher positive components of RF than non-adoptive parents.
Father’s RF (child-focused) was associated with socioemotional supportive behaviors and moderated the relationship between SES and fathers autonomy supportive behaviors
Maternal RF was not significantly associated with childhood maltreatment
RF did not differ between mothers with or without maltreatment history
Cumulative maternal childhood maltreatment was significantly associated with infant’s (Infant Negative) and mother’s emotional states (Mother Negative) and on a dyadic level (Infant Positive-Mother Negative)
Maternal RF was inversely correlated with parental and psychological stress but positively correlated with executive function (working memory, inhibition, and cognitive flexibility)
RF significantly mediated the association between executive function and stress (parental and psychological distress)
RF moderated association between parental rejection and 17-month dyadic cohesion with partners, and maternal unresponsiveness and controlling behavior at 5-months
RF was inversely associated with child aggressive behaviors but significantly associated with mother’s positive perception of the parent-child relationship
156 pregnant women (Majority Latina) (United States)
PI
PDI
Yes
PRF
Parents in the intervention group were 2.15 times more likely to be in a higher PRF group (intervention improved PRF)
Interaction between condition and disrupted parent-infant communication on PRF at 24 months (intervention protected against negative effects of disrupted communication on PRF)
Fathers’ lower RF associated with higher depressive symptoms, higher dysfunctional parent-child interaction and higher parenting stress; perceive child as less cuddly and more reactive
AAI Adult Attachment Interview, PDI Parent Development Interview, PDI-R Parent Development Interview-Revised, PDI-SF Parent Development Interview- Short Form, PI Pregnancy Interview, PI-R Pregnancy Interview-Revised, WMCI Working Model of Child Interview, Mini-PRFI Parental Reflective Functioning Interview, PEM Parental Embodied Mentalizing, FMSS-RF Five-Minute Speech Sample, PRFQ Parental Reflective Functioning Questionnaire, RFQ Reflective Functioning Questionnaire.
Characteristics of Included Studies
Timeline (Dates) for Research
Figure 2 depicts the patterns of empirical studies on MP and PRF published from 2005-2020. Although zero MP articles were found in 2005 (the year Dumas highlighted the value of a MP approach: Dumas, 2005), MP articles were steadily published from 2007 to 2014. Starting from 2015, there was a significant increase in MP empirical studies in 2015 (n = 16), 2016 (n = 15), 2017 (n = 19), 2018 (n = 31), 2019 (n = 32), and 2020 (n = 38).
For PRF, only three articles were published in 2005 and zero PRF articles were included in our scoping review for the years 2006, 2007, and 2009. In 2008, 2012, 2013, and 2014, 16 studies were published (4 each year) and two articles were published each in 2010 and 2011. However, after 2015, there was a substantial increase in PRF empirical articles: 2015 (n = 12), 2016 (n = 17), 2017 (n = 13), 2018 (n = 12), 2019 (n = 23), and 2020 (n = 21).
Country
The majority of the studies derived from the United States (n = 65; 36.1% for MP; n = 48; 40% for PRF). The remaining MP literature was from the Netherlands (n = 20; 11.1%), Portugal (n = 16; 8.9%), Canada and China (n = 10 per country; 5.6% each), the United Kingdom (n = 16; 8.9%), Australia (n = 6; 3.3%), Hong Kong (n = 5; 2.8%), Iran, (n = 4; 2.2%), Belgium, Chile, Croatia, Egypt, Jordan, Ireland, and Sweden (n = 2 per country; 1.1% each), and India, Israel, Spain, Taiwan, Turkey, and Vietnam (n = 1 per country; 0.6% each). Six studies did not report the country (3.3% total), and two studies included 36 countries (1.1% total).
The remaining 60% of the PRF studies were from Canada (n = 12; 10%), the United Kingdom (n = 9; 7%), Australia (n = 7; 6%), Italy (n = 7; 6%), the Netherlands (n = 5; 4%), Finland, Spain, Chile, and Norway (n = 4 per country; 3% each), Denmark (n = 3; 2%) and Switzerland, (n = 2; 3%), and Germany and Turkey (n = 2; 2%). The remaining PRF studies were from the Caribbean, Poland, Sweden, and Belgium (n =1 per country/region; 1% each), except one study for which the country was not reported (e.g., Væver et al., 2020).
Intervention
Results from this scoping review indicated that 57% (n = 104) of MP studies implemented a related intervention. Of the 103 studies, the most commonly implemented interventions (n = 23; 22%) were Mindfulness-Based Stress Reduction (MBSR; e.g., Corthorn, 2018; Gannon et al., 2017; Neece, 2014), Mindfulness-Based Cognitive Therapy (MBCT; n = 12; 12%, e.g., Evans et al., 2019; Ferraioli & Harris, 2013; Gurney-Smith et al., 2017), and 17 studies (16%) employed elements of both MBSR and MBCP (Bögels et al., 2014; Mah et al., 2020; Zhang et al., 2017). In addition, Mindfulness-Based Childbirth and Parenting (MBCP; n = 9; 9%, e.g., Duncan & Bardacke, 2010; Price et al., 2019; Warriner et al., 2018), Mindfulness-Enhanced Strengthening Families Program (MSFP; n = 7; 7%, e.g., Coatsworth et al., 2018; Lippold et al., 2019), Mindfulness-Based Positive Behavior Support (MBPBS; n = 3; 3%; Singh et al., 2014) and MyMind (n = 2; 2%; Ridderinkhof et al., 2018) were studied. About 9% (n = 9) of studies adapted their interventions from more than three interventions listed above. The remaining studies either did not provide information about the source of the mindfulness-based intervention that was employed (n = 17; 16%) or used sources not identified in this review (n = 5; 5%). While most of the interventions were delivered in person, online interventions (Boekhorst et al., 2020; Shaffer et al., 2020) and app-based interventions (Hunter et al., 2019; Yang et al., 2019) were introduced in 2019 and 2020.
Over one-quarter, or 27% (n = 33), of the PRF studies implemented a mentalization-related intervention. The most implemented interventions were Minding the Baby (15%; n = 5; e.g., Slade et al., 2020) and Circle of Security—Parenting (12%, n = 4; e.g., Huber et al., 2015). The remaining studies employed the Mothers and Toddlers/Mothering from the Inside Out (18%, n = 6; e.g., Suchman et al., 2012, 2016), Family Minds (6%, n = 2; e.g., Bammens et al., 2015), and 16 studies (48%; e.g., Byrne et al., 2019; Zimmer-Gembeck et al., 2019) used different programs such the Bright Program (Paris et al., 2015), Nurturing Attachments Program (Staines et al., 2019), Reflective Fostering Program (RFP; Midgley et al., 2019), or Baby Court (Stacks et al., 2019). Within these 16 studies, one study (Enav et al., 2019) mentioned using a mentalizing-based intervention for parents of children diagnosed with autism spectrum disorder (ASD), however, the researchers did not report the name of the program.
Population Targeted
In the MP literature, 46% (n = 83) sampled mothers only, 47% (n = 85) both mothers and fathers with mothers being the majority, 2% (n = 4) with equal proportions of mothers and fathers, and 1% (n = 2) sampled parents but did not state the gender identity or gender role of the parents. Only one study sampled fathers only (MacDonald & Hastings, 2010) and 3% (n = 5) included caregivers/teachers/cohabiting partners along with parents. Of the total 180 studies, 8% (n = 14) studies sampled parents who were considered at high risk for poor outcomes. Seven studies (4%) recruited parents with mental health challenges including depression (Evans et al., 2019; Mann et al., 2016; Parent et al., 2011), anxiety (Goodman et al., 2014), stress (Turpyn et al., 2019), and difficulties with emotion regulation (Wilson & Donachie, 2018). The other seven studies (3.9%) recruited mothers with opioid and substance use disorder (Gannon et al., 2017; Short et al., 2017), methadone maintenance (Dawe & Harnett, 2007), FMR1 premutation (Hunter et al., 2019), preterm premature rupture of membranes (Korukcu & Kukulu, 2017), history of sexual trauma (Price et al., 2019), and parents who had been exposed to a high rate of violence (Hicks et al., 2018). In addition, 39% (n = 71) studies sampled parents of children who were at risk for intellectual and developmental disabilities, mental health problems, or internalizing and externalizing problems.
In the PRF literature, 26% (n = 32) sampled mothers, 2% (n = 3) fathers, 2% (n = 3) pregnant women, 2% (n = 3) couples, 2% (n = 3) parents (no specification), 11% (n = 13) parent or caregiver-child dyads, 39% (n = 47) mother-child and 1% (n = 1) father-child dyads. Of the studies that sampled mothers, four studies focused on mothers with substance-related abuse or treatment (e.g., Suchman et al., 2011), with four studies specifically on mothers with substance abuse disorder (Håkansson et al., 2018). The remaining articles sampled young mothers (Sadler et al., 2013), mothers from outpatient mental health clinics (Suchman et al., 2016), and mothers with postpartum depression (Cordes et al., 2017). Two of three studies that sampled fathers specifically targeted fathers who had committed intimate partner violence (IPV; Mohaupt & Duckert, 2016; Stover & Coates, 2016). Of the remaining articles, 4% (n = 5) sampled foster or adoptive parents (Bammens et al., 2015; Bunday et al., 2015; León et al., 2015), and one study (Zimmer-Gembeck et al., 2019) included mothers, fathers, and foster parents. Additionally, 2% (n = 3) did not report the gender identity or gender role of the parents (Ashton et al., 2016; Ensink et al., 2017b; Staines et al., 2019). Lastly, León and Olhaberry (2020) included a triad sample of mothers, fathers, and children while Mata López, Álvarez, and Gómez (2020) included parents, children, and teachers.
Conclusively, 38.2% (n = 115) of the included articles (N = 301) targeted mothers only, and only 2.3% (n = 7) focused exclusively on fathers. Across the MP and PRF studies, an overlap was identified with both areas of research sampling parents with specific, targeted characteristics including parents considered “at risk,” and those with psychopathology (e.g., depression), or substance use disorder.
Race/Ethnicity of Samples
Of the total 180 MP studies, 81 articles did not report the race or ethnicity of their sample. Across the remaining 99 studies, that did explicitly report their race or ethnicity of their sample, 41 studies had predominantly White (or self-identified as “Caucasian”) samples. Across all 99 studies, the average percentage of participants that identified as White or “Caucasian,” in each study was 71% (range: 0-100), 12% (range: 0-100) for Black/African American, 7.65% (range: 0-47.5) for Hispanic/ Latiné, 4.13% (range: 0-17) for Asian/Asian American, 0.50% (range: 0-6) for Native American/Hawaiian/Alaskan Native/Pacific Islander, 0.48% (range: 0-63) for Multiracial, and 3.75% (range: 0-21) for “Other.”
For PRF, 30 studies out of 121 total PRF studies did not report the race or ethnicity of their sample. Across the 91 studies that explicitly reported the race/ethnicity of their sample, 49 had predominantly White or self-identified “Caucasian” samples. More specifically, across all 93 studies the average percentage of participants who identified as White or “Caucasian,” was 60% (range: 0-100), 18.36% (range: 0-75) for Black/African American, 19.45% (range: 0-88) for Hispanic/Latiné, 1.75% (range: 0-22) for Asian/Asian American, 0.33% (range: 0-2) for Native American/Hawaiian/Alaskan Native/Pacific Islander, 2.24% (range: 0-18) for Multiracial, and 3.73% reported (range: 0-14) “Other.”
Measures Employed
In the MP articles, 40% (n = 72) MP articles used the original 10-item Interpersonal Mindfulness in Parenting (IM-P) short-form (Duncan, 2007) or the expanded 31-item IMP version (Duncan, 2023), while 26.6% (n = 48) of studies used the Five Facet Mindfulness Questionnaire (FFMQ; Benn et al., 2012) (n = 48; 26.6%). These MP measures were most commonly used to assess MP specifically, and in general, mindfulness among parents in the MP literature. Another frequently used measure was the Mindfulness Attention Awareness Scale (MAAS; n = 30; 16.6%). Since 2014, a wider array of measures was used, including the Bangor Mindful Parenting Scale (BMPS; Jones et al., 2014) (n = 8; 4.4%), the Mindfulness in Parenting Questionnaire (MIPQ; Seidman et al., 2019) (n = 4; 2.2%), the Freiburg Mindfulness Inventory (FMI; Walach et al., 2006) (n = 3; 1.7%), and the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R; Feldman et al., 2007; n = 2; 1.1%). Some measures were developed and only included in publications a handful of times. The Subjective Units of Use of Mindfulness (SUUM; Singh et al., 2006) (n = 2) and the Toronto Mindfulness Scale (TMS; Lau et al., 2006) (n = 1) were used only in 2006 and 2007 and were not used in future studies in this review. In 2019, one study (Benton et al., 2019) employed an adapted version of the Mindful Parenting Observation Scale (MPOS; Geier, 2012) which assesses the observed behavior of MP. In addition, 23 studies (12.7%) utilized more than one measure. Particularly, 17 (9.4%) studies used the IM-P in tandem with the FFMQ (n = 10), the MAAS (n = 6), and FMI (n = 1). Moreover, of the total 180 MP studies, 33 studies (18.3%) did not employ any specific MP measures.
The most frequently used measures of PRF are the Parent Developmental Interview (PDI; Aber et al., 1985) (n = 41; 33.8%), the Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017) (n = 26; 21.4%), the Adult Attachment Interview (AAI; George et al., 1985) (n = 17; 14%), Pregnancy Interview (PI-PDI; Smaling et al., 2015) (n = 10; 8.3%), PDI-Revised (PDI-R; Slade et al., 2004) (n = 7; 5.8%), Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016a, b) (n = 5; 4.1%), the PDI-Short Form (Stacks et al., 2014) (n = 4; 3.3%), Reflective Functioning Scale (RFS; Fonagy et al., 1998) (n = 2, 1.7%), or PDI-Modified (Steele et al., 2007) (n = 1; .8%). Notably, the Working Model of the Child Interview (WMCI; Zeanah et al., 1996) was used to assess PRF in 2005 (n = 1) and 2008 (n = 2), but not again until 2019 (n = 1) and 2020 (n = 2). More recently, new PRF measures were developed to assess PRF such as the Parental Embodied Mentalizing (PEM; Shai et al., 2017), the Limit Setting Interview (Möller et al., 2017), and the Mini-Parent Reflective Functioning Interview (Mini-PRFI; Ensink et al., 2019). Additionally, 13.2% (n = 16) of PRF studies employed more than one measure of PRF. For example, Hertzmann et al. (2016) used both the PDI and the PRFQ whereas 31.3% (n = 5) of those 16 studies used both the PDI and the PI-PDI in their study (Ordway et al., 2014; Pajulo et al., 2008, 2012; Sadler et al., 2013; Smaling et al., 2016). Möller et al. (2017) was the only study that employed three PRF measures (PDI, Limit Setting Interview, and RFQ). Lastly, the remaining PRF studies employed a different instrument to assess PRF such as the Rumination Reflection Questionnaire (e.g., Waldman-Levi et al., 2020), or Prenatal PRFQ (e.g., Røhder et al., 2020).
Independent Variables
More than half of the MP studies (n = 103; 57.2%) implemented mindfulness-based interventions and focused on pre- and post-assessments of the intervention. Studies with interventions mostly measured changes in parents’ levels of MP across time and groups (e.g., Chaplin et al., 2018; Potharst et al., 2019). Other common independent variables that were assessed in MP studies included dispositional mindfulness (e.g., Gouveia et al., 2016; Hicks & Dayton, 2019; Parent et al., 2016a, b; Zhang, Wang, & Ying, 2019b), anxiety (e.g., Henrichs et al., 2019), parenting stress (e.g., Chan & Neece, 2018; Laurent et al., 2017), parent-child related problems (e.g., Chan & Lam, 2017; Whitlock et al., 2018), and parent attachment (e.g., Moreira et al., 2016).
As noted earlier, 33 studies implemented a mentalization-based intervention. Not surprisingly, n = 33 (27.3%) focused on pre- and post-assessments of the program with a particular emphasis on changes in PRF scores (e.g., Sadler et al., 2013; Suchman et al., 2008). Other independent variables that were frequently examined in the remaining PRF studies (n = 90; 74.3%) varied, such as intimate partner violence (Mohaupt & Duckert, 2016), maternal and child attachment (Slade et al., 2005a, b), parenting reflectivity (Rosenblum et al., 2008), maternal accuracy (Ha et al., 2011), parenting sensitivity (Borelli et al., 2012), parenting behaviors (Ensink et al., 2017b), treatment fidelity of the mentalizing program (Suchman et al., 2012), eating disorder symptoms (Claydon et al., 2016), child sexual abuse (Ensink et al., 2016), and trauma and attachment (Cristobal et al., 2017).
Dependent Variables
Of the 180 MP studies, 47.2% (n = 85) of studies examined parent outcomes only, 18.8% (n = 34) focused on child outcomes only, and 33.3% (n = 60) included both parent and child outcomes. There was one study (Fernandes et al., 2020a) that did not examine either parent or child outcomes. This study assessed the usefulness of a MP intervention. The most commonly included parenting outcomes were: MP and mindfulness (n = 63; 74.1%; e.g., Lunsky et al., 2015; Potharst et al., 2018b; Rice et al., 2020), psychological distress including parenting stress (n = 71; 83.5%; e.g., Corthorn, 2018; Lo et al., 2017), depression (n = 27; 31.7%; e.g., Duncan et al., 2017; Pan, Gau, et al., 2019a; Pan, Chang, et al., 2019b), and anxiety (n = 18; 21.2%; e.g., Geurtzen et al., 2015; Rayan & Ahmad, 2017). For child outcome variables, child behavior challenges (n = 23; 67.6%; e.g., Beer et al., 2013; Srivastava et al., 2011) and internalizing and externalizing problems (n = 14; 41.2%; Haydicky et al., 2015; Parent et al., 2016a, b) were most commonly assessed.
From the 121 PRF studies, PRF was the dependent variable for half (47.9%; n = 58) of the articles, with 0.8% (n = 1) study focused on prenatal reflective functioning (Smaling et al., 2015) and 0.8% (n = 1) on postpartum reflective functioning (Rutherford et al., 2018). The remaining studies (n = 64) focused on a range of outcome variables—either in addition to PRF or separately—such as mothers’ representation of the children (Schechter et al., 2005), atypical maternal behavior (Schechter et al., 2008), child conduct problems (Ha et al., 2011), adolescent reflective functioning and behaviors (Benbassat & Priel, 2012), child anxiety (Esbjørn et al., 2013), maternal distress tolerance (Rutherford et al., 2013), infant attachment disorganization (Berthelot et al., 2015), parenting stress (Adkins et al., 2018), and child temperament (Vismara et al., 2020).
Overlaps in Correlates and Outcomes
Review of studies for both MP and PRF revealed overlap in four general constructs: (a) parent well-being; (b) child well-being; (c) parenting behaviors; and (d) attachment. Specifically, 58.3% of MP studies (n = 105) and 28.9% of the PRF studies (n = 35) included a variable related to parents’ well-being (e.g., parenting stress, anxiety, depression; e.g., Hertzman et al., 2016; Kohlhoff et al., 2016; Lo et al., 2017; Short et al., 2017; Wheeler et al., 2018). Further, 41.6% of MP (n = 75) and 23.1% PRF studies (n = 28) examined child well-being (e.g., internalizing and externalizing behaviors; e.g., Parent et al., 2016a, b; Mann et al., 2016; León et a., 2015) and 38.3% of MP (n = 69) and 38.8% PRF studies (n = 47) evaluated parenting behaviors (e.g., responsivity, sensitivity; e.g., Weitlauf et al., 2020, Rutherford et al., 2013; Borelli et al., 2012). Lastly, 1.6% of MP (n = 3) and 21.5% PRF studies (n = 26) focused on some attachment-related variables, such as parent attachment (e.g., Cristobal et al., 2017; Korukcu & Kukulu, 2017), child attachment (e.g., Ensink et al., 2019; Moreira et al., 2018), or attachment anxiety (e.g., Moreira et al., 2016; Nijssens et al., 2018).
Discussion
This scoping review covers empirical evidence from 2005 to mid-January 2020 linking MP and PRF with other positive parenting outcomes. We present conclusions regarding the research questions that guided this scoping review, discuss the conceptual and theoretical overlaps of MP and PRF based on the results of our study, and suggest future directions for these lines of research.
The results of the scoping review demonstrated a significant association between MP and other elements of positive parenting and parent and child well-being, including parental warmth and responsiveness (Campbell et al., 2017; Duncan et al., 2015), less parenting stress (Zeegers et al., 2019), and fewer child externalizing and internalizing problems (Han et al., 2019). About two-thirds of the studies included a mindfulness-based intervention aimed at increasing levels of mindfulness in parenting. Most of the interventions were based on MBSR and/or MBCT, which aimed to improve parents’ ability to cope more effectively and reduce psychological reactivity to stressful parenting situations by bringing mindful awareness to moment-to-moment parent-child interactions while being nonjudgmental of self and child. Participation in mindfulness-based interventions was found to significantly reduce various types of stress including stress related to parenting (Potharst et al., 2019; Zeegers et al., 2019), perceived stress (Seidman et al., 2019), and general stress (Townshend et al., 2018). Other notable advantages of MP were reported in parents’ psychological functioning, such as a reduction in overreactive parenting (Potharst et al., 2019) and reduced emotion dysregulation (Gershy et al., 2017; Lengua et al., 2018). Applying mindfulness in parenting can alter not only parents’ intrapersonal experiences as a parent but also interpersonal experiences between parent and child. Researchers reported an association between parental mindfulness with a more optimal parenting style (e.g., authoritative parenting, parental warmth; Williams & Wahler, 2010; Duncan et al., 2015), positivity (Jones et al., 2014), and less negative emotion expression toward the child (Turpyn & Chaplin, 2016).
Additionally, the effects of MP on parents’ psychological well-being and positive parenting outcomes were found promising for parents considered to be “at risk.” For example, scholars have targeted interventions for parents with depression (e.g., Mann et al., 2016), substance use disorder (e.g., Short et al., 2017), and mood, anxiety, and stress disorder (e.g., Zeegers et al., 2019). After participation in mindfulness-based interventions that focused on cultivating mindfulness in the parenting context, these parents reported improvements in both their clinical symptoms (e.g., reduction in depression and anxiety symptoms) and parenting-related outcomes (e.g., reduction in parenting stress and increase in acceptance toward child). Notably, these studies did not examine mechanistic changes in levels of mindfulness or MP in parents after the intervention. However, several cross-sectional studies found evidence that levels of dispositional mindfulness are significantly related to parents’ psychological well-being considered to be at “high risk” (Hicks et al., 2018; Parent et al., 2011). Through MP interventions, parents may improve their ability to manage negative emotions and stress that arise in their parenting role.
A stream of research that has examined the efficacy of mindfulness-based interventions for pregnant women at risk of perinatal depression or anxiety also found similar results (Goodman et al., 2014; Korukcu & Kukulu, 2017; Townshend et al., 2018). These studies demonstrated that developing mindfulness skills and applying them to parenting helped expectant mothers cope with anxiety and depression related to pregnancy, birth, and early parenthood, and significantly increased mindfulness and self-compassion. Perinatal mindfulness intervention studies with lower risk samples also indicate they may prevent postpartum depression symptoms (Duncan et al., 2017). Researchers have often focused on targeted samples of parents suffering from or at risk for depression, anxiety, and other psychological disorders. However, a new stream of research has developed in examining more diverse groups such as parents with obesity (Jastreboff et al., 2018) and military-deployed parents (Zhang et al., 2018; Zhang, Zhang, & Gewirtz, 2019a).
Evidence from the studies in this review demonstrates that PRF has significant implications for parenting and child development. For example, PRF is associated with parenting sensitivity (Ensink et al., 2016), parenting stress (Nijssens et al., 2018), child attachment (Slade et al., 2005a, b), and child behavior problems (Suardi et al., 2020). One-quarter of the studies implemented mentalization-based interventions that sought to enhance parents’ capacities for reflective functioning. These programs help caregivers, via PRF, fully understand their view of their child, themselves, and their parenting. Specifically, reflective functioning enables parents to consider how their past (their own childhood memories) and present (perceptions of the child, current mental states) influence their caregiving behaviors, their child’s behavior, and the parent-child relationship. Parents’ failure to engage in high levels of PRF can result in less sensitive parenting and child attachment insecurity (Ensink et al., 2019). The intervention studies included in this review provided evidence that mentalization-based interventions improve parents’ capacity for reflective functioning, parenting sensitivity, and child attachment (e.g., Slade et al., 2020; Suchman et al., 2018).
Articles from our review of PRF also focused on parent psychopathology. For instance, scholars have targeted interventions toward mothers with substance abuse disorders (e.g., Suchman et al., 2008) and mothers from outpatient mental health clinics (e.g., Suchman et al., 2016). These studies have important clinical implications. Specifically, psychopathology can inhibit parents’ capacity to reflect on both their own and the child’s mental states, potentially resulting in negative child outcomes such as insecure attachment or psychopathology. Taken together, an increase in PRF through participation in mentalization-based programs (e.g., Mothering Inside Out) improves parents’ abilities to provide sensitive care to their children. In specific, parents can help their children identify and organize their mental states about external experiences when parents can recognize how their own feelings impact their behavior. These empirical results have significant clinical implications as it may be critical to target parents who are more vulnerable or susceptible to psychopathology and impaired mentalization.
Moving beyond interventions focused on enhancing PRF, there is also evidence that PRF may mitigate the association between parental stress and psychopathology and risks to healthy child development. In the past, PRF had been primarily tested as a mechanism explaining parenting sensitivity and behavior (e.g., Alvarez-Monjarás et al., 2019; Suchman et al., 2008). Theoretically, however, it should have buffering effects, especially on the association between parenting stress and indicators of parenting behavior or child well-being (e.g., attachment). First, several studies document an inverse association between PRF and parenting stress (León et al., 2015) and a significant reduction in parenting stress after participation in mentalization programs (Huber et al., 2016). Further, even when parents with higher RF are under stress, they may be able to respond with greater sensitivity to their child’s cues, which in turn, promotes child well-being and secure attachment. This theory is supported by several studies in our review, which demonstrated that PRF moderated associations between various risk factors (e.g., SES, stress) and parenting behavior or child outcomes (e.g., Benbassat & Priel, 2012; Borelli et al., 2020a; Buttitta et al., 2019). In sum, the expansive literature on PRF over the last 15 years suggests that it is an important factor in promoting healthy child development and parent-child relationships.
Our review identified several areas of overlap in studies on MP and PRF. Both MP and PRF consist of intrapersonal processes that impact interpersonal relationships between parent and child. Fostering greater MP and PRF in parenting can result in improved parent-child interactions. Studies of MP and PRF demonstrate a range of similar effects, including improvements in parent well-being (e.g., parenting stress, depression), child well-being (e.g., internalizing or externalizing behaviors), parenting behaviors (e.g., responsiveness), and other qualities of the parent-child relationship. Conceptually, both MP and PRF are reflective processes in parenting that may be important targets for understanding how a parent’s intra- and interpersonal relationship with childrearing may contribute to their parenting behaviors and impact on child well-being. Specifically, a commonality between MP and PRF is that both involve cognitive and affective processes in which the parent needs to engage in awareness of their feelings and thoughts to support their child’s emotional needs and thoughts behind their behaviors. To an extent, both MP and PRF entail some level of emotion coregulation and intentional awareness to establish a deeper understanding of the parent’s and child’s internal world (thoughts, feelings, mental states) within the parent-child relationship.
There are some characteristics that differentiate MP and PRF from one another. For example, PRF involves the parents’ capacity to reflect and establish insightful conclusions when discussing the caregiving they received in childhood and its impact on them and their caregiving. Thus, PRF involves deep reflections of the past, which assessment tools such as AAI and PDI aim to facilitate. In contrast, the construct of MP—rooted in mindfulness tenets—focuses on caregivers’ capacity to intentionally bring their attention and awareness to the present moment, allowing thoughts and difficult emotions to arise without judgment, providing compassion to self and the child, especially when the parent or the child are having a difficult interaction. One possible explanation for this difference is that MP is typically captured via self-report assessments while the majority of PRF studies use coded interviews. Evidenced in the attachment literature (Roisman et al., 2007), these different modalities may capture different facets of an overlapping construct. For instance, assessing PRF via coded interviews may capture underlying or more implicit concepts that parents lack enough awareness of to identify in a self-report measure, whereas MP assessed through self-report may capture parents’ more intentional efforts to bring awareness to a given moment in parenting. Future research may benefit from comparing these constructs using the same modality to reveal more about how measurement has impacted their conceptualization. Collectively, given the apparent benefits of MP and PRF interventions, they seem both worthy intervention targets, as they can change and improve through support and training, potentially with synergistic effects.
Findings from this scoping review clarify the need for future research incorporating MP and PRF to advance our current knowledge of reflective processes in parenting and the parent-child relationship. For example, much is unknown regarding the extent to which MP and PRF are correlated with each other and the direction of those associations. Notably, it is unclear whether PRF enhances MP, or vice versa, as rigorous, longitudinal, joint assessments of these constructs and their mechanisms of change do not exist. While there are inconsistencies in how MP has been assessed across the reviewed studies, the Interpersonal Mindfulness in Parenting scale (IM-P; Duncan, 2007; Duncan, 2023) is the frequently used measure that explicitly assesses mindfulness in parenting, followed by the Mindfulness in Parenting Questionnaire (MIPQ; McCaffrey et al., 2017), which assesses MP of parents with children two-years-old or older. Because there are multiple robust instruments to measure PRF, an unanswered research question that warrants further investigation is how the IM-P relates to various PRF measures (e.g., AAI, PDI, and PRFQ).
Studies assessing attachment, MP, and PRF in a single research design are needed, given that both MP and parenting reflective functioning are correlated with parent and child attachment. Because PRF is grounded in attachment theory, there is a substantial body of research supporting the link between reflective functioning and attachment-related constructs. Although correlational studies have examined the association between MP and both parent attachment (Moreira et al., 2016) and adolescent attachment (Moreira et al., 2018), this research is limited. For example, existing studies utilize a variety of self-report attachment measures, but no studies have compared MP and attachment using “gold-standard” assessments of attachment security (e.g., Strange Situation, AAI).
Collectively examining attachment, PRF, and MP can further our understanding of how these constructs simultaneously influence child development. Specifically, new evidence can advance our understanding of parents’ mental representations of attachment influence MP, and the impact of MP on observed parenting sensitivity and child-attachment security, particularly in infancy and young childhood. There is ample evidence that increases in PRF, through interventions, can facilitate child attachment security (Huber et al., 2015) and parental sensitivity to a child’s cues (Suchman et al., 2008). Still, this evidence is limited to smaller and/or qualitative studies for MP. Moreover, it is still unclear what role MP plays in the association between attachment and PRF. For example, Cristobal et al. (2017) found that maternal insecure attachment was associated with lower PRF. It would be particularly interesting to examine whether MP significantly moderates or mediates the association between parental attachment and PRF as the specific effects of MP on this association are unknown. Given the associations between MP and stress, and that parental reflective capacities tend to be compromised under extreme stress or trauma (Fonagy & Target, 1997), one possibility is that MP buffers the effects of stress on PRF and parenting sensitivity.
One advantage of integrating these two lines of work is identifying unique strengths in each area that may benefit the other. For instance, while emotion regulation has been shown to improve MP interventions (Gershy et al., 2017; May et al., 2016; Wilson & Donachie, 2018), it has not been examined as an outcome of mentalization-based interventions, even though PRF should theoretically improve parents’ ability to regulate their emotions. A few studies have found positive associations between PRF and both parents’ distress tolerance (Rutherford et al., 2013; Rutherford et al., 2015), and emotion regulation skills (Schultheis et al., 2019), but this work is limited to self-report assessments of PRF. Campora et al. (2019) use the AAI to assess maternal reflective functioning but found no significant association with emotion regulation, thus this is an area for additional inquiry.
Parent well-being is important to consider in these studies, given the links between parental well-being and parenting behavior (Dix, 1991). Moreover, parent psychopathology and extreme stress can hinder both parent well-being and the capacity to engage in MP and PRF. There is some evidence that MP buffers the negative effects of life events on mother and infant cortisol levels (Laurent et al., 2017). However, research needs to be expanded to other developmental stages. Researchers have documented a significant improvement in parent well-being via reduction of stress (e.g., Fonagy et al., 2016a, b; Kohlhoff et al., 2016) after participation in a mentalization-based program. In contrast, others found a decrease in parenting stress at post-assessments but no significant effects of the intervention (Hertzman et al., 2016). However, including variables that assess parental well-being is limited and could benefit from additional investigation. Existing studies typically include measures of parenting stress or mental health (e.g., anxiety, depression). However, much is still unknown about how PRF and MP are associated with or impact other facets of parental well-being such as emotional experiences.
Another benefit of looking at these two lines of research together is that it illuminates gaps in targeted developmental stages. For example, there has been an examination of PRF during the prenatal period, with the development of the Pregnancy Interview (Slade et al., 2007), which was administered in 8.2% of the studies reviewed. On balance, MP has been more extensively studied in parents of adolescents (29.1%), whereas only a few studies have explored PRF in parents of adolescents. Additionally, it is necessary to note there are limitations to when MP can be evaluated. For instance, MP is specifically about the parent-child interaction, precluding examining MP before birth. It may only be possible to examine dispositional mindfulness prenatally for first-time parents, and then MP at postpartum. It is important for researchers to consider this limitation when examining changes in MP, especially after participating in an intervention with a sample of first-time parents.
There are more existing interventions focused on promoting MP than PRF. As such, more research is needed to examine how combining the strengths of MP and PRF informs parenting experiences and impacts the quality of parent-child relationships. There is empirical value in this integration, especially if changes or improvements in parenting behaviors via parenting reflective processes or capacities (MP and PRF) can positively enhance parent-child relationship quality. Interventions that aim to enhance both MP and PRF to promote positive parent-child relationships may yield impactful results as PRF can be promoted as early as the prenatal period. For example, Pajulo et al. (2008) found prenatal PRF was positively associated with maternal sensitivity at four months. Given the extensive evidence base of MP interventions and complementary processes, combining the two together in one intervention may yield effects greater than either one can alone.
Several gaps in the MP and PRF literature were identified through this scoping review. First, across both bodies of research, the sampling of fathers was lacking. Understanding how mothers, fathers, and gender-expansive parents may engage in MP and PRF differently is important. Compared to mothers, fathers tend to report lower levels of MP (Medeiros et al., 2016; Moreira & Canavarro, 2018b). However, studies found fathers also benefit from practicing MP. For example, Gershy et al. (2017) revealed that fathers of school-age children who developed interpersonal mindfulness skills were more likely to report improvement in the capacity for emotion regulation, reduced negative feelings, and reduced parental submission. For example, studies have also demonstrated that fathers’ MP is associated with greater emotional awareness of the child (Coatsworth et al., 2018) and less dismissive responses to the child’s emotions (McKee et al., 2018). No research among parents identifying with a gender-expansive parenting role was found in our review, highlighting a major gap in both bodies of literature.
From the PRF literature, Benbassat and Priel’s (2014) review revealed that fathers tend to score lower than mothers on reflective functioning, although other recent studies have found no differences (Borelli et al., 2016). Benbassat and Priel (2014) also reported that fathers’ reflective functioning is particularly important during adolescence as it is inversely correlated with adolescent behavior problems. However, more research that includes additional child outcomes and at different developmental stages is needed. It would be useful to identify whether reflective functioning in mothers and fathers is linked to the same parent and child outcomes. For example, Buttitta et al. (2019) found that fathers’ reflective functioning was linked to specific types of sensitivity, such as autonomy-supporting behaviors, which may be qualitatively different from mothers’ sensitive behaviors. Moreover, an unexplored research question is “How does mindful parenting differ based on parent gender identity/gendered parenting role (e.g., mother, father)? Rigorous assessment of MP and PRF in diverse samples of parents is necessary to answer this research question.
Diversifying the sample of caregivers continues to be a limitation as only 1.5% of the MP articles studied adoptive or stepparents, and an additional 2.7% of studies included a combination of parents with caregivers or teachers. In the PRF articles, only 4% studied adoptive or foster parents, and only one study included a combination of mothers, fathers, and foster parents. This limitation is concerning as family structure continues to change and family members such as grandparents, which some studies sampled, can take on the primary caregiver role in the family.
Another major sample limitation is the lack of racial and ethnic diversity. Surprisingly, over one-third of the studies (n = 111) did not even report the racial/ethnic makeup of their sample. Best standards in clinical trial reporting (e.g., CONSORT guidelines; Moher et al., 2012) require this level of detail. Particularly with the entrenched existence of racial/ethnic disparities due to systemic oppression and racism, research highlighting the potential benefit of MP and PRF for minoritized communities would be highly beneficial. Further, determining the cultural fit of mindfulness interventions for racial/ethnic minoritized communities is essential to creating effective interventions and understanding their impact (Black & Switzer, 2018). Among the studies that reported on the racial/ethnic makeup of their participants, the MP literature was more diverse than the PRF literature. However, there was little attention to the potential for iatrogenic effects or cultural mismatch of intervention approach with participants’ parenting values. A serious area of caution in parenting research led primarily by white researchers with predominantly white samples is an overgeneralization of parenting values based on white cultural ideology. Much could be learned by engaging scholars with expertise and life experience as members of Black, Indigenous, Latinx, and other communities of color in this area of inquiry. Questions in this line of research could include consideration of other longstanding cultural traditions that emphasize reflective capacities that go beyond MP and PRF.
Both lines of work could also benefit from more rigorous assessments of their instruments. For example, despite sixteen studies from our review that employed two PRF measures simultaneously in their research, as of 2020, no studies had empirically compared these various PRF instruments. This is a critical next step in the reflective functioning literature, as these instruments may assess overlapping but distinct constructs, similar to the differences between self-reported and interview-based measures of attachment (Roisman et al., 2007). For MP, there are currently two primary self-report assessments (IM-P; MIPQ), but no interview measures exist, and the only observational coding system for MP (Geier, 2012) has not been adopted in the field. Perhaps one benefit of looking at these two constructs together is that researchers can identify the extent to which MP could be assessed in interview-based assessments, such as the Parent Development Interview-Revised (Slade et al., 2004), or another interview created specifically for MP. The IM-P has been linked with both mother-infant stress physiology (Laurent et al., 2017) and parent-adolescent communication assessed through observational methods (Duncan et al., 2015).
Limitations and Future Directions
Taken together, the studies reviewed here provide support for the critical influences of MP and PRF on the quality of parenting. Several strengths of this scoping review should be noted. To date, researchers have primarily investigated and viewed these two strands of parental reflective capacities separately. Hence, this is the first scoping review that comprehensively summarizes the MP and PRF literatures together to provide an initial conceptual link between these processes within a parenting framework. Ideally, the results from this review may bring potentially “siloed” MP and PRF functioning researchers’ attention to the existence of the other area of research. Second, our scoping review identified and summarized the distinct and overlapping empirical outcomes from MP and PRF studies published from 2005 to early 2020. Therefore, the results of this review can be used to identify future directions that address the existing gaps in the literature and present opportunities for further investigations (see the previous section). Lastly, this review highlights areas of growth for both MP and PRF research that may inspire new and important lines of work within these individual areas, such as the critical need to study more racially and ethnically diverse populations and to expand the research beyond mothers.
This scoping review is not without limitations. First, PRF is the only mentalization component focused on in this review. There are two additional components of mentalization—parental insightfulness and mind-mindedness—that were intentionally excluded from this scoping review. Future reviews may include these components to fully distinguish all the mentalization components from one another and their specific effects on parenting. Likewise, expanding the content search terms to include terms such as “parental insightfulness” and “parental mind-mindedness” is important to capture the full range of the existing mentalization literature. Second, this scoping review examined articles on PRF, not child reflective functioning. Thus, future reviews may include child reflective functioning as well as greater emphasis on child reports of parents’ MP (Coatsworth et al., 2015), given the bidirectional nature of the parent-child relationship. Lastly, we endorse the critical importance and value of qualitative research despite qualitative studies were beyond the scope of this review. Qualitative research is critically needed to understand more complex research questions and variables related to parenting.
Nonetheless, findings from this scoping review provide empirical evidence that MP and PRF play important roles in parenting. Specifically, our results support our suggestion of investigating these constructs concurrently as the evidence reported in our study establishes links between MP and PRF, overlapping outcomes, and independent contributions to parenting. The parent-child relationship is dynamic, and the quality of these interactions impact children’s emotional development and well-being over the short- and long-term. Thus, MP and PRF may be a critical faculty that promotes responsive caregiving as greater MP and PRF is associated with more positive parenting behaviors (Gershy et al., 2017; Krink et al., 2018) and higher quality parent-child interactions (Coatsworth et al., 2010; León et al., 2018). Our ability to understand and enhance parenting through intervention may be advanced when these two distinct streams of parenting research come together.
MP and PRF have different areas of focus and approaches, despite a similar goals of improving parenting and enhancing the parent-child relationship. MP emphasizes mindfulness practices to promote awareness, emotional regulation, and compassionate parenting in the present moment. PRF, on the other hand, is a psychological concept that specifically relates to a parent's capacity to understand and reflect on their child's inner world, with a focus on the child's mental and emotional experiences. Both can be valuable tools for effective and nurturing parenting, and they likely complement each other in helping parents better connect with and support their children through reflective processes.
Acknowledgements
Special thanks to Ron Rabin, Executive Director of the Maritz Family Foundation and Nancy Ashley of Heliotrope for sparking the idea for this work, to Yaffa Maritz for being a champion for deepening our understanding of mindful parenting, and to Arietta Slade for providing valuable feedback on an earlier version of this paper.
Use of Artificial Intelligence statement
AI was not used for editing the manuscript to improve English language.
Declarations
Ethical Approval
The study did not engage human subjects and thereby did not require ethical approval.
Informed Consent
No informed consent was obtained because the study did not engage human subjects.
Conflict of Interest
The authors declare no competing interests.
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