Is he Egoki zen pos -di o ce in e en ion p og am e ec i e in he communi y
con ex ?
Ana Ma ínez-Pampliegaa, Ma a He e oa, Mi eia Sanz b, Susana Co ala, Susana
Co menzanaa, Lau a Me inoa, Lei e I ia ea, Iñigo Ochoa de Aldac, Lei e Alcanize, I a i Al a ezb.
aDepa men o Social Psychology and De elopmen al Psychology, Facul y o Psychology and Educa ion,
Uni e si y o Deus o, A da. Uni e sidades 24, 48007 Bilbao (Bizkaia), Spain
bDepa men o Psychopedagogy, Begoñako And a Ma i Teache T aining Uni e si y College, BAM, La au i Kalea, 1A,
48160 De io, Bizkaia, Spain
cDepa men o Pe sonali y, E alua ion and T ea men , Facul y o Psychology, Uni e si y o he Basque Coun y, Tolosa
Hi ibidea, 70, 20018 Donos ia, Gipuzkoa,
Spain
dDepa men o Pe sonali y, E alua ion and T ea men , Facul y o Psychology, Uni e si y o he Basque Coun y,
Ba aincua Kalea, 2, 48009 Bilbao (Bizkaia), Spain
eDepa men o Finance. Deus o Business School, Uni e si y o Deus o, A da. Uni e sidades 24, 48007 Bilbao
(Bizkaia), Spain
⁎Co esponding au ho a : Uni e sidad de Deus o, Uni e si y o Deus o, Depa men o Social Psychology and
De elopmen al Psychology, Facul y o Psychology and Educa ion, A da. Uni e sidades, 24, 48007 Bilbao (Bizkaia),
Spain.
Abs ac
Backg ound : E idence-based pos di o ce in e en ion p og ams, aimed a p omo ing child eńs
psychological adjus men , a e sca ce in e na ionally. In Spain, he Egoki zen p og am has been
es ablished i s e ec i eness in he con ex o a uni e si y labo a o y, bu he e is no e idence
o i s e ec i eness when implemen ed om a communi y con ex .
Objec i e :
To e alua e he e ec i eness o he Egoki zen p og am in he pe cep ion o
ex e nalizing and in e nalizing child symp oma ology, when deli e ed
by communi y-based
agencies.
Me hod :
372 pa en s wi h child en unde he age o 12 pa icipa ed in a quasi-expe imen al p e-
pos in e en ion app oach wi h a wai -lis compa ison g oup
and wo ollow-up measu es a 6
and 12 mon hs. 270 we e pa o he expe imen al g oup (EG) and 112 o he con ol g oup
(CG). The pos di o ce in e en ion consis ed o he Egoki zen p og am. The ollowing
a iables we e measu ed h ough he in o ma ion p o ided by he pa en s: childhood
symp oma ology (soma iza ion, agg essi eness, anxie y/dep ession; Child Beha io
Checklis , CBCL), pa en al men al heal h symp oma ology (anxie y, dep ession, and
This is he accep ed manusc ip o he a icle ha appea ed in inal o m in Child en and You h Se ices Re iew 129 : (2021) //
A icle ID 106220, which has been published in inal o m a h ps://doi.o g/10.1016/j.childyou h.2021.106220. © 2021 Else ie unde
CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/)
in e pe sonal sensi i i y; Symp oms Checklis SCL-90), and pa en ing (induc i e, indulgen ,
and igid s yles; Scale o Rules and Demands. Pa en s's e sión, ENE-P).
Resul s :
The in e en ion p og am had an indi ec e ec on childhood symp oma ology and a
di ec e ec on pa en al symp oma ology and pa en ing. The
media ing ole o pa en al
symp oma ology on childhood symp oma ology was con i med h ough he di ec e ec o he
p og am on pa en al symp oma ology. Despi e he e ec on pa en al pa e ns, hey did no play
a media ing ole in childhood symp oma ology.
Concluions :
T
he Egoki zen p og am seems o be e ec i e in he communi y con ex and, acco ding
o he pa en s, could educe hei child en's symp oma ology indi ec ly h ough he educ ion o
pa en al symp oma ology. A he longi udinal le el, in he in e en ion g oup, ha he esul s
ob ained a e pa icipa ion in heEgoki zen p og am we e main ained and e en inc eased a 6 and
12 mon hs symp oma ology.
Keywo ds: Di o ce, P e en i e in e en ion, Child symp oma ology, Pa en al
symp oma ology, Pa en ing
1. Backg ound
App oxima ely 1 million amilies unde go di o ce each yea in Eu ope (Ins i u o de Polí ica
Familia , 2018) and mo e han 60% o hese amilies ha e child en (OECD-
27_Family_Da abase, 2015). In Spain, he di o ce a e is 58% (Ins i u o Nacional de
Es adís ica [INE-Na ional Ins i u e o S a is ics], 2019; Ins i u o de Polí ica Familia [Family
Policy Ins i u e], 2019); e e y yea , 100,000 child en expe ience he di o ce o hei pa en s,
and 75,000 o hese child en a e 18-yea -old mino s.
The link be ween di o ce and child en’s psychological, beha io al, and social p oblems
is one o he mos consis en indings conce ning di o ce (Eme y & To nello, 2014; Ja e,
2014; Mah e , O’Ha a, Sandle , & Wolchik, 2018; Ma ínez-Pampliega, A; Co menzana, S;
Co al, S; I au gi, I., & Sanz, M., 2021), including bo h ex e nalizing (dissocial diso de s,
agg essi eness, e c.) in e nalizing mani es a ions (soma ic diso de s, anxie y, dep ession,
social wi hd awal) ( an Dijk e al., 2020). These esul s a e simila in di e en coun ies and
cul u es (Ama o, 2010; Ma inón e al., 2017; Velde man e al., 2018), con i ming ha pa en al
di o ce is a undamen al s esso . The high p e alence o associa ed p oblems and he isk o
he child en u n di o ce in o a public heal h issue, and makes he de elopmen o e ec i e
pos di o ce p og ams in he communi y con ex a social u gency. These pos di o ce
in e en ion p og ams a e aimed a add essing he child en's issues associa ed wi h he di o ce
p ocess; o hem o be e ec i e, hey should ocus on he explana o y ac o s o his
ela ionship. Tha is why esea ch in ecen decades has been ocused on his goal (G ych,
2005).
F om he cogni i e-con ex ual model (G ych & Fincham, 1990) and he emo ional
secu i y heo y (Cummings & Da ies, 2010; Da ies & Cummings, 1994; Da ies, Ma in, &
Cicche i, 2012), des uc i e in e pa en al con lic (i.e., si ua ions o ange , hos ili y, non-
coope a i e pa en ing, igh s and legal con lic ) has been iden i ied as he i s explana o y
ac o (Mah e e al., 2018; Smy h & Chisholm, 2017; Yá noz-Yaben & Ga mendia, 2016).
Howe e , bo h models ha e emphasized ha he impac o con lic is no only—o e en
p ima ily—di ec , bu a he indi ec , h ough pa en ing. In o he wo ds, he con lic a ec s
child en indi ec ly when i o e whelms he pa en s and a ec s he quali y o hei ela ionships
wi h hei child en (Da ies & Cummings, 1994; Lipscomb e al., 2011). In addi ion, all he
a iables ha in luence pa en ing p ac ices will also a ec he child en's psychological
adjus men . In his sense, he pa en s’ men al heal h symp oms, linked o a highly con lic i e
di o ce p ocess, is one o he a iables ha has ecei ed he mos a en ion because o i s di ec
and indi ec impac on he child en’s inc eased isk o emo ional, cogni i e, and beha io al
p oblems (Cla k e al., 2018; Deu sch & Clyman, 2016; Zumbach, 2016).
Among he di e en in e en ion ini ia i es (media ion, psycho he apy, child
in e en ion p og ams, e c.), one o he mos p e alen op ions is psycho-educa ional p og ams
a ge ing pa en s. These a e s uc u ed in e en ions aimed a p e en ing o minimizing he
ha m o di o ce in he child en (G ych, 2005; Ped o-Ca oll & Jones, 2005) h ough he
modi ica ion o he pa en s’ ela ional pa e ns. These p og ams ha e been p oli e a ing since
he mid-1990s: Child en in he Middle (A bu hno & Go don, 1994; K ame , 1997), New
Beginning P og am (NBP, Sandle e al., 2018; Wolchik e al., 2000, 1993), Child en Fi s
(Jewell, Schmi el, Mccobin, & Hupp, 2017), Pa en s Fo e e (Beche e al., 2018; B o he son
e al., 2010), Pa en ing h ough Change (Fo gach, 1994; Fo ga ch e al., 2009), among o he s.
The cu en objec i e is o s udy he e icacy and e ec i eness o hese in e en ion
p og ams. Despi e hei widesp ead use, esea ch-based in e en ions a e sca ce (Jewell e al.,
2017; McIn osh & Tan, 2017; Philip & B ien, 2017). This, oge he wi h he absence o
published in e en ion p og ams applicable o he Hispanic popula ion and wi h e icacy
s udies, led o he de elopmen o he Egoki zen p og am. Egoki zen is a p e en i e p og am,
based on a sys emic app oach o amily unc ioning (Ma ínez-Pampliega e al., 2016). The
in e en ion akes place o e 11 weekly hou -and-a-hal sessions. Th oughou he sessions, 3
key a eas a e add essed dynamically ( ole-playing, g oup ac i i ies, p ojec ac i i ies): a)
di o ce and i s impac (2 sessions ocused on he di o ce p ocess, eac ions o di o ce, e c.);
b) in e pa en al con lic s (4 sessions ocused on dealing wi h con lic i e si ua ions); c)
pa en ing (6 sessions ocused on pa en ing guidelines, communica ion, discipline, e c.). The
ini ial esul s in he con ex o a uni e si y clinic we e highly p omising (Ap aiz, Uga e,
Aguado, & Ma ínez-Pampliega, 2015; Ma ínez-Pampliega e al., 2016) in e ms o e icacy
and e iciency. The main changes we e ound in he signi ican educ ion in he pa en s'
pe cep ion o hei own and hei child en’s symp oma ology (ex e nalizing and in e nalizing),
which was u he educed up o he 6-mon h ollow-up a e he in e en ion had been
comple ed. To da e, howe e , he e a e no s udies o Egoki zen’s e ec i eness in he
communi y con ex . Implemen ing a p og am in he communi y complex would allow many
mo e use s o di e en social se ices o bene i om i bu , o his pu pose, i s adequacy o
di e en use p o iles mus be es ablished, e en i he echnical condi ions may be simpli ied
(wi hou eco dings, one-way mi o s, in ol ing ewe p o essionals, wi hou he need o
acili a o s' clinical aining, e c.).
Fo his pu pose, he p esen s udy was de eloped wi h he collabo a ion o mul iple
judicial e e al cen e s a he na ional le el, a ge ing di o ced pa icipan s wi h a high le el
o in e pa en al con lic . As a s a ing hypo hesis and, ollowing he cogni i e-con ex ual model
(G ych & Fincham, 1990) and he emo ional secu i y heo y (Cummings & Da ies, 2010;
Da ies & Cummings, 1994; Da ies, Ma in, & Cicche i, 2012), we expec ed ha he child en
o pa en s pa icipa ing in he p og am (In e en ion G oup) would show lowe
symp oma ology han he child en o non-pa icipa ing pa en s (Con ol G oup). In addi ion,
based on he heo e ical e iew, he educ ion in he pa en s’ men al heal h symp oma ology
and imp o emen in hei pa en ing s yles a e expec ed o ac as media ing a iables ha
explain he educ ion in he child en's symp oma ology.
2. Me hod
2.1.Pa icipan s
The s udy was ca ied ou wi h 372 pa en s p esen ing high in e pa en al con lic who a ended
amily isi a ion cen e s (FVC) in Spain. These cen e s a e a esou ce o judicial e e al in
high-con lic amily si ua ions (To e, 2018). The ollowing inclusion c i e ia we e applied: all
he pa en s we e legally di o ced om hei ex-pa ne s; hey did no li e wi h hei ex-spouse;
hey had no ac i e es angemen o de o gende -based iolence ( o sa e y easons), and hey
did no ha e any se e e nosological diso de . Conce ning g oup assigna ion, 260 o he
pa icipan s we e assigned o he in e en ion g oup (IG) and 112 o he con ol g oup (CG)
(see assignmen p ocedu e). Only one pa en pe amily pa icipa ed in he in e en ion
p og am, wi h 40% o he cases being he a he and 60% he mo he . Conce ning hei di o ce,
48% o he pa icipan s had been di o ced o mo e han 3 yea s, ollowed by 20% who
epo ed be ween 1 and 2 yea s, 13% who had been di o ced be ween 2 and 3 yea s, 10% om
6 mon hs o 1 yea , 7% om 2 o 6 mon hs, and 1% less han 2 mon hs. Conce ning cus ody,
78% o he pa icipan s epo ed ha ing join legal cus ody (JLC), ha is, bo h pa en s sha e
he igh s and du ies in ol ed in he child en's upb inging, and 22% had join physical cus ody
(JPC), which implies ha , besides sha ing pa en al esponsibili y, he ime spen wi h he child
is sha ed. The pa en s’ a e age age was 41.18 yea s (SD = 6.50) and he child en’s a e age age
was 7.59 yea s (SD = 4.14) and, conce ning he child en's gende , 48% we e boys and 52%
we e gi ls.
3. Measu es
The pa icipan s' and hei child en's desc ip ion a iables we e collec ed h ough an ad
hoc ques ionnai e. Facili a o s’ adhe ence was collec ed h ough a semi-s uc u ed ins umen
(Adhe ence Scale), whe eby he acili a o s indica ed whe he hey had ollowed (yes, pa ly,
o no) he p og am's guidelines ega ding he use o he ma e ials, he ul illmen o he
sessions’ objec i es, and hei dynamics, and a sec ion o obse a ions o desc ibe and explain
possible de ia ions. The a iable in e pa en al con lic was e alua ed aking in o accoun he
judicial e e al epo and in e iews conduc ed by he p o essionals o he FVC,
concep ualizing in e pa en al con lic as being cha ac e ized by hos ili y, escala ing dis ess,
and de achmen (Da ies e al., 2016). The exis ence o a nosological diso de o es aining
o de was checked h ough he judicial and heal h epo s con ained in he case his o y. Finally,
he a iable suppo pe cei ed in he g oup was collec ed h ough a isual analog scale, anging
om 1 (no a all suppo ed) o 10 (comple ely suppo ed), in which pa icipan s we e asked o
wha ex en hey had el suppo ed wi hin he g oup.
The es o he a iables we e collec ed h ough he ollowing ins umen s, all o hem
adequa ely adap ed o he Spanish sample and psychome ically obus :
3.1.“Escala de No mas y Exigencias - e sión pad es” (ENE–P, Be sabé, Fuen es, & Mo ico,
2001 [Scale o Rules and Demands -Pa en s's e sion]).
This scale assesses he le el o ules and demands ha pa en s use in hei pa en ing,
based on Baum ind's (1971) pa en ing s yles. This scale consis s o 28 i ems (e.g., “I explain
he easons why hey mus ollow he ules”) s uc u ed in h ee dimensions. The i s
dimension, Induc i e Pa en ing S yle (10 i ems), co esponds o he mos posi i e educa ional
s yle, in which pa en s explain he ules and adap hem acco ding o he needs and possibili ies
o hei child en. The second dimension, Rigid Pa en ing S yle (10 i ems), co esponds o he
imposi ion and high demand o ules and hei inadequacy o he child en's needs. The hi d
dimension, Indulgen Pa en ing S yle (8 i ems), e e s ei he o he absence o ules o
bounda ies, o , i hey exis , hei compliance is no equi ed. This ques ionnai e is a ed on a
i e-poin Like scale anging om 1 (ne e ) o 5 (always). In his s udy, hese dimensions
ob ained an adequa e in e nal consis ency (α = .80 Induc i e s yle, α = .73 Rigid s yle, and α =
.75 Indulgen s yle).
3.2. Symp om Checklis (SCL-90; De oga is, 1992; Spanish e sion, González de Ri e a e al.,
2002).
This scale e alua es pa en s’ men al heal h symp oms (e.g., “Feeling suddenly a aid
o no eason”). The ollowing h ee dimensions we e analyzed in his s udy: In e pe sonal
Sensi i i y (9 i ems), Dep ession (13 i ems), and Anxie y (10 i ems). All h ee dimensions had
high eliabili y, .87, .92, and .91, espec i ely, as did O e all Symp oma ology, composed o
he p e ious h ee dimensions (α = .96). Symp oms a e sco ed on a 5-poin Like scale,
anging om 0 = no a all o 4 = e y much.
3.3. Child Beha io Checklis (CBCL; Achenbach, 1991; Spanish e sion, Sa dine o e al.,
1997).
This measu e assesses he p e alence o in e nalizing and ex e nalizing symp oms o
child en and adolescen s (“B eaks his/he own hings”), h ough he pa en 's epo . In his
s udy, we assessed h ee dimensions: Soma iza ion (12 i ems), Anxie y-Dep ession (13 i ems),
and Agg essi eness (18 i ems), as he mos equen ly s udied in he li e a u e on he impac o
di o ce. I ems a e answe ed on a 3-poin scale (0 = No ue; 1 = Some imes ue; 2 = Ve y
o en o qui e o en ue). The eliabili y coe icien s ound in his s udy we e app op ia e o
all h ee dimensions (Soma iza ion: α = .73; Anxie y-Dep ession: α = .75; Agg essi eness: α =
.91), and he h ee dimensions o Global Symp oma ology also had e y high eliabili y (α =
.92).
4. P ocedu e
The p og am was o e ed a he na ional le el, and 10 o he 19 Spanish au onomous
communi ies, a o al o 13 FVCs, ag eed o pa icipa e. All cen e s had he pe mission and
suppo o own halls and ela ed minis e ial se ices. The p o essionals o he cen e s
iden i ied he use s based on he inclusion c i e ia. Fo his pu pose, he judicial e e al epo
and/o he case his o y egis e ed a he cen e was checked o he exis ence o high
in e pa en al con lic , a nosological diagnosis, o an ac i e es aining o de . We subsequen ly
con ac ed he use s who migh be in e es ed by elephone, con i ming he inclusion c i e ia.
As shown in Fig. 1, O he 1538 use s con ac ed by elephone, 450 (29.3%) esponded
posi i ely a e he p og am's ea u es (numbe o sessions, con en , and pe iodici y) had been
explained. When bo h pa en s esponded posi i ely, we andomly selec ed he one who would
pa icipa e in he ini ial edi ion. They we e subsequen ly summoned o an in-pe son in e iew,
which was a ended by 82.6% (n = 372). This in e iew was aimed a esol ing doub s and
explaining he commi men o hei pa icipa ion (a endance, ques ionnai es, in o med
consen , e c.). Following he explana ion, he a endees i s comple ed he in o med consen
in which issues ela ed o anonymi y, con iden iali y, and he possibili y o lea ing he s udy a
any ime we e add essed. They subsequen ly comple ed he e alua ion p o ocol.
Each IG consis ed o 6-8 pa icipan s. Pa icipan s we e andomly dis ibu ed be ween
he IG and he wai ing-lis CG. Howe e , his dis ibu ion was no andom in all cases because
he CG was also made up o hose pa icipan s who, despi e ha ing ag eed o pa icipa e, we e
unable o do so o p ac ical easons (wo k schedule, g oup schedules, child en's di icul ies).
In such cases, and as an e hical commi men (due o he p oblema ic si ua ion o he amilies),
hey we e gi en he op ion o being pa o he wai ing-lis CG, so hey comple ed he
ques ionnai e again 4 mon hs la e , a which poin hey e-assessed hei a ailabili y o
pa icipa e in a new IG. Fo he pu poses o his in es iga ion, hey cons i u ed only he CG. In
addi ion, despi e comple ing he ques ionnai es a wo imes, p e es and pos es , no all he
pa icipan s in he wai ing-lis CG would subsequen ly join he in e en ion p og am, due o
pe sonal issues simila o hose indica ed abo e. In gene al, andom alloca ion was highe han
80% in all g oups, and all he pa icipan s, IG and CG, comple ed he ques ionnai es on pape
(las ing app oxima ely 30 min).
As mos o he child en we e unde he age o 12, he pa icipa ing pa en s comple ed
he ques ionnai es. In no case was he e any inancial compensa ion.
The in e en ion was conduc ed in a o al o 39 g oups (IG), wi h an a e age numbe
o 6.5 pa icipan s pe g oup. All g oups we e mixed ega ding he pa icipan s' gende .
Be ween p e es and pos es , he e was a sample loss o 102 pa icipan s, which led o a inal
sample o he s udy o 270 pa icipan s, 197 in he IG (a i ion = 24.2%) and 73 in he CG
(a i ion = 34.8%). Despi e he signi ican numbe o d op-ou s, he e we e no di e ences
be ween he wo g oups in any o he a iables conside ed (see Appendices A and B). O he
197 people in he IG, only 105 comple ed he ollow-up ques ionnai e a he 6-mon h ollow-
up, and 69 also comple ed a ou h ques ionnai e a he 12-mon h ollow-up. The numbe o
Managemen T aining (Dega mo e al., 2004; Fo ga ch e al., 2009; Fo ga ch & DeGa mo,
2007; Sandle e al., 2019; Wolchik e al., 2013). These esul s suppo ed he imp o emen and
main enance o he child en's men al heal h, e en yea s a e he in e en ion (2, 6, 9, 15 yea s).
In any e en , he e a e ew s udies in he communi y con ex , (Sandle e al., 2019;
S allman & Sande s, 2014) o allow us o make compa isons in his con ex . On he one hand,
S allman and Sande , applying he T iple P, ound main e ec s o he p og am al eady as o i s
ini ia ion. Howe e , he measu es analyzed (in ensi y and numbe o beha io al p oblems) a e
di e en om hose used in his s udy o in o he p e iously men ioned ones (anxie y,
soma iza ion, agg essi eness, e c.), which does no allow eaching conclusi e esul s. In he
same ein wi h he da a ob ained in ou s udy, Sandle (2019) highligh ed ha he NBP showed
no signi ican di e ences a e he in e en ion, al hough i did so a 10 mon hs. As is well
known, he NBP p og am has plen y o e idence abou i s ele ance, which allows suppo ing
he exis ence o a cascade e ec , di icul o check a he beginning, bu which shows he
complex ela ionship be ween he a iables and he need o comp ehend hem sys emically
(Dega mo e al., 2004; Fo ga ch e al., 2009).
The e o e, he i s ele an esul o his s udy is he indi ec p o ec i e ole o he
in e en ion p og am in he educ ion o childhood symp oma ology, due o he impac on he
pa en s' symp oma ology. Conside ing he numbe o child en exposed o hei pa en s' di o ce,
hese esul s mean ha many child en will bene i . Reade s a e eminded ha he e is a p o en
ela ionship be ween child adjus men and he de elopmen o men al diso de s o subs ance
abuse in young adul s (Wolchik e al., 2013, 2016), e en 15 yea s la e . Despi e his, he e ec s
a e no as obus as we would ha e liked. This can be explained, i s , by he di icul y in
isola ing he p e ea men change ha he in e iews o he comple ion o he ques ionnai es
may p o oke in he g oup; he a en ion o he p o essionals pe se is a o m o in e en ion, as
al eady highligh ed (Ma ínez-Pampliega e al., 2016). In addi ion, inc eased awa eness o hei
child en's di icul ies could make some pa en s—especially pa en s o child en wi h mode a e
sco es—sco e highe a e he in e en ion han hey would ha e sco ed p e iously, because
hey may be mo e sensi i e o he de ec ion o hei child en's di icul ies. In his way, he p e-
pos in e en ion di e ence in he IG dec eased in ela ion o ha o he CG.
Ano he objec i e o he s udy was o analyze he ole o pa en ing s yles in he
educ ion o child ens’ symp oma ology. The hypo hesis p oposed he exis ence o a media ing
ole, bu he da a ha e no suppo ed his, which is con a y o he pa e ns in e ed om he
heo e ical e e ence models (Da ies & Cummings, 1994; G ych & Fincham, 1990) and o he
empi ical s udies ( an Dijk e al., 2020). Howe e , we no e ha he IG pa icipan s showed
pos -in e en ion imp o emen o hei inadequa e pa en al s yles, ha is, educing igid and
indulgen pa e ns. On he one hand, his esul , in i sel , is e y ele an , as many o he
componen s o he in e en ion p og am a e linked o wo king wi h pa en al pa e ns
(discipline, ules, communica ion, e c.), an e ec ha was main ained o e ime. Howe e , no
changes we e obse ed in he induc i e pa en ing s yle. This esul is consis en wi h he ci ed
me a-analysis ( an Dijk e al., 2020), which ound ha hos ile pa en ing was he mos s ongly
ela ed o con lic i e di o ce. A he in e en ion le el, his aspec could lead us o hypo hesize,
ollowing he esul s o Fo ga ch e al., (2009), ha in amilies wi h a high le el o in e pa en al
con lic , he p ocess o socializa ion could be en angled by he aps o nega i e ein o cemen .
In ac , hose au ho s ound ha he educ ion pe yea in coe ci e pa en hood p edic ed he
g ow h o posi i e pa en ing h ee yea s la e . Howe e , his could only be e i ied a e a
ollow-up o he pa icipan s o e he nex ew yea s. In any case, we emphasize he di icul y
o making compa isons be ween he s udies ha ha e add essed pa en ing, as his a iable has
been unde s ood in e y di e en ways by he di e en esea che s (Beche e al., 2018;
Dawson-McClu e e al., 2004; Fo ga ch e al., 2009; S allman & Sande s, 2014).
In sho , he esul s abou pa en ing s yles should lead us o assume ha we a e a om
knowing i s ole in child en’s symp oma ology. Pe haps in he sho e m, he g ea es impac
on child en’s symp oma ology comes om pa en al adjus men , mainly a ec ing in e nalizing
symp oma ology and, in compa ison, pa en ing s yle (especially he nega i e s yles) could play
a mo e media ing and indi ec ole in he child en’s ex e nalizing symp oma ology in he
medium o long e m. This possibili y is consis en wi h he analysis ca ied ou by Dawson-
McClu e e al. (2004) in a 6-yea ollow-up o he in e en ion p og am. The sys emic analysis
o Fo ga ch e al. (2009) in child en aged 9 is also e y app op ia e, highligh ing how changes
in one membe can ini ia e a complex p ocess ha can a ec he en i e amily sys em in he
long un. Bu o da e, we do no know hese p ocesses clea ly.
In sho , i seems ha he Egoki zen p og am has been e ec i e in he communi y con ex
o educe child en’s symp oma ology, h ough he impac o he in e en ion on pa en s’
symp oma ology. The p og am also seems o imp o e he mo e inadequa e educa ional s yles,
especially igid s yles, bu his imp o emen does no appea o be esponsible o he impac
o he p og am on child en’s symp oma ology, which equi es u he esea ch in he u u e.
On he o he hand, in his s udy, mode a o s such as pa en s' gende o age o he suppo o
hei pa icipa ion g oup do no appea o be linked o he esul s, implying ha he p og am
was equally e ec i e o all pa icipan s, no ma e whe he he pa en s we e mo he s o a he s,
younge o olde , and ega dless o he suppo o he g oup. This esul is e y ele an , gi en
he need o con inue o inco po a e bo h pa en s in o he s udies, ega dless o hei age. I is
also ele an o emphasize ha he objec i es we e achie ed in he communi y con ex . The
acili a o s did no p esen di icul ies wi h he implemen a ion, which was ca ied ou wi h
g ea adhe ence o he guidelines and was highly sa is ac o y o he pa icipan s. This has
con ibu ed o he ans e o he p og am, and he e o e, he in e en ion p og am will con inue
o be used as an in e en ion ool in he espec i e se ices. This p e en i e line will
undoub edly con ibu e o he ampli ica ion o he esul s ob ained in he labo a o y con ex
and in oduce he e alua ion and implemen a ion o e idence-based in e en ions in he
communi y con ex .
Finally, many u u e lines o wo k open up wi hou ha ing comple ed he p esen wo k;
some a e he esul o he limi a ions ha we ha e been able o iden i y. On he one hand, in
his s udy, only pa en al measu es we e used, as all child en we e unde he age o 12. This is
he usual p ac ice, especially in child en unde 9 yea s o age (B a e e al., 2005; Dega mo e
al., 2004; Sandle e al., 2018; Velde man e al., 2018). Howe e , we emphasize ha he
pa en s' pe cep ion could be a ec ed by hei pa icipa ion in he in e en ion p og am, a e
which hey may be mo e sensi i e o iden i ying dis ess in hei child en. Hence, we
ecommend supplemen ing pa en al epo s wi h measu es by o he men al heal h p o essionals
because he changes could be in luenced, e en nega i ely, by he in e en ion i sel . I would
also be ele an o inco po a e emo ional adjus men a iables (coping, insecu i y,
insensi i i y) ha would help us unde s and he di e en ial e ec o he p og am on some
a iables e sus o he s (anxie y/dep ession s. agg ession, soma iza ion). Ano he impo an
limi a ion o he s udy is i s quasi-expe imen al design. Al hough he ini ial in en ion was
andom alloca ion, his was no possible in all cases. In addi ion, we mus highligh he small
numbe o pa icipan s, s a ing om hose in i ed ini ially, which gene a es a sel -selec ing
e ec ha can lead o o e es ima ion o unde es ima ion o he da a, bo h o he CG and he
IG. Bo h issues equi e ca e ul conside a ion o he esul s. Wi hou denying he abo e, as o he
au ho s also poin ou (Philip & O´B ien, 2017), his e lec s a eal si ua ion in a e y di icul
communi y con ex . Finally, we should also highligh he limi a ion linked o he numbe o
pa icipan s. Despi e he e o equi ed, 39 g oups (IG), 372 pa icipan s, is s ill a small numbe
when sophis ica ed s a is ical analyses and obus esul s a e desi ed. Finally, we no e he
signi ican numbe o d op-ou s h oughou he ollow-up, which should lead o a e lec ion on
he need o use sho e e alua ion p o ocols and he desi abili y o using an ac i e CG, ha is,
pa icipa ing in ano he in e en ion, a he han a wai ing-lis CG. On ano he hand,
de eloping in en - o- ea analysis could be a key s a egy o alle ia e he impac o he high
le el o d op-ou s.
In conclusion, Egoki zen is he i s pos di o ce in e en ion p og am de eloped o i s
Spanish applica ion ha has s udies o e icacy and e ec i eness. Howe e , i is clea ha he
s udy mus con inue unde mo e s ingen esea ch condi ions and wi h measu es sus ained
o e ime, bo h in he pa icipan s and in he wai ing-lis CG. Childhood is a key pe iod o
psychological adjus men , wi h undamen al epe cussions in adolescence and adul hood,
making his p og am and simila ones a majo p e en i e ini ia i e. Gi en he scope o his
ask, i would be desi able o achie e g ea e coo dina ion among esea che s a ound a join
s a egy ha akes in o accoun a iables, s udy popula ions, child en's age, and o he a iables
al eady no ed abo e.
Decla a ion o Compe ing In e es
The au ho s decla e ha hey ha e no known compe ing inancial in e es s o pe sonal
ela ionships ha could ha e appea ed o in luence he wo k epo ed in his pape .
Acknowledgmen s
This wo k was suppo ed by he Minis e io de Economía y Compe i i idad [g an RETOS
2015: PSI2015-67983-R] and by Minis e io de Sanidad, Se icios Sociales e Igualdad
[FEDEPE_g an n° exp 492, p og ama 002; 9/12/2016].
The au ho s hank he p o essionals and use s o he Family Visi a ion Cen e s o hei
pa icipa ion in his s udy.
Appendix A Supplemen a y da a
Supplemen a y da a o his a icle can be ound online a
h ps://doi.o g/10.1016/j.childyou h.2021.106220.
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Table 2.
ANOVA Resul s on P e-Pos In e g oup Di e ences
Con as s o In e g oup Di e ences
S udy a iable
β
SE
P
95% CI
η2p
d
Pa en al pa e ns
Induc i e s yle
-0.01
0.64
0.01
.990
[-1.24, 1.26]
< .01
< .01
Rigid s yle
1.59
0.68
2.35
.020
[0.26, 2.93]
.021
.29
Indulgen s yle
0.91
0.53
1.70
.091
[-0.15, 1.96]
.011
.21
Pa en al
symp oma ology
Global
4.14
1.98
2.09
.037
[0.25, 8.03]
.017
.26
Anxie y
0.99
0.67
1.47
.144
[-0.34, 2.31]
.008
.18
Dep ession
1.95
1.02
1.92
.056
[-0.05, 3.95]
.014
.24
In e pe sonal
Sensi i i y
1.20
0.63
1.91
.058
[-0.39, 2.44]
.014
.24
Child en's
symp oma ology
Global
0.03
0.03
0.90
.369
[-0.03, 0.08]
.003
.11
Soma iza ion
0.01
0.03
0.43
.671
[-0.05, 0.07]
< .01
.06
Anxie y/Dep ession
< 0.01
0.04
0.05
.960
[-0.08, 0.08]
< .01
< .01
Agg essi eness
0.02
0.04
0.38
.700
[-0.06, 0.09]
< .01
.06
Table 3.
Clinical Signi icance o P e es o Pos es on S udy Va iables
CG
(n = 73)
IG
(n = 197)
%
Imp o e-
men
%
No
change
%
Ge s
wo se
%
Imp o e-
men
%
No
change
%
Ge s
wo se
Pa en al pa e ns
Induc i e s yle
4
88
8
5
88
7
Rigid s yle
4
93
3
6
93
1
Indulgen s yle
7
86
7
4
93
3
Pa en al
symp oma ology
Global
15
75
10
30
62
8
Anxie y
10
86
4
15
81
4
Dep ession
9
88
3
21
74
5
In e pe sonal
Sensi i i y
4
92
4
11
86
3
Child en's
symp oma ology
Global
1
96
3
4
95
1
Soma iza ion
17
71
12
17
70
17
Anxie y/Dep ession
12
85
3
10
84
7
Agg essi eness
12
84
4
18
76
6
Table 4.
P e-Pos In ag oup Di e ences
Con ol
Egoki zen in e en ion
S udy a iable
∆Mean
95% CI
d
∆Mean
95% CI
d
Pa en al pa e ns
Induc i e s yle
0.73
0.47
[-0.81, 1.74]
.09
1.54
0.47
[-0.13, 1.08]
.08
Rigid s yle
-0.54
-0.32
[-1.49, 0.86]
-.05
3.61***
1.28
[0.58, 1.98]
.21
Indulgen s yle
-0.55
-0.27
[-1.27, 0.72]
-.06
2.34*
0.63
[0.10, 1.16]
.15
Pa en al
symp oma ology
Global
2.32*
2.78
[0.39, 5.17]
.12
6.05***
6.92
[4.66, 9.18]
.30
Anxie y
1.98
1.01
[-0.01, 2.03]
.14
5.21***
2.00
[1.27, 2.73]
.26
Dep ession
2.54*
1.48
[0.32, 2.64]
.15
5.72***
3.43
[2.26, 4.60]
.31
In e pe sonal
Sensi i i y
0.70
0.29
[-0.53, 1.11]
.05
4.02***
1.49
[0.78, 2.20]
.23
Child en's
symp oma ology
Global
0.56
0.02
[-0.04, 0.07]
.06
2.80**
0.04
[0.01, 0.07]
.16
Soma iza ion
-0.23
-0.01
[-0.07, 0.05]
-.03
0.41
0.01
[-0.02, 0.04]
.02
Anxie y/
Dep ession
1.20
0.04
[-0.03, 0.11]
.14
2.13*
0.05
[<0.01, 0.09]
.13
Agg essi eness
1.10
0.04
[-0.02, 0.10]
.10
2.57*
0.05
[0.01, 0.09]
.14
* p < .05. ** p < .01 *** p < .001.
Table 5.
Pos o 6-mon h Follow-Up and 6-mon h o 12-mon h Follow-Up. In ag oup Di e ences in
he IG.
Pos - o 6-mon h Follow-up
6-mon h o 12-mon h Follow-up
S udy a iable
∆Mean
95% CI
d
∆Mean
95% CI
d
Pa en al pa e ns
Induc i e s yle
1.27
0.69
[-0.39, 1.77]
.13
-1.87
-1.50
[-3.10, 0.10]
-.20
Rigid s yle
1.48
0.88
[-0.31, 2.07]
.15
-0.07
-0.05
[-1.51, 1.41]
-.01
Indulgen s yle
0.99
0.38
[-0.38, 1.14]
.10
-1.03
-0.47
[-1.38, 0.44]
.12
Pa en al
symp oma ology
Global
4.58***
9.09
[5.15, 13.03]
.46
0.48
0.63
[-2.00, 3.26]
.03
Anxie y
3.44**
2.09
[0.88, 3.30]
.34
0.69
0.29
[-0.55, 1.13]
.05
Dep ession
4.99***
5.01
[3.02, 7.00]
.50
0.02
0.02
[-1.39, 1.42]
< .01
In e pe sonal
Sensi i i y
3.46**
1.99
[0.86, 3.12]
.35
0.98
0.40
[-0.42, 1.23]
.08
Child en's
symp oma ology
Global
3.47**
0.07
[0.03, 0.11]
.34
0.75
0.01
[-0.02, 0.05]
.06
Soma iza ion
1.83
0.04
[<-0.01, 0.10]
.20
-0.43
-0.01
[-0.06, 0.04]
-.04
Anxie y/
Dep ession
3.32**
0.11
[0.04, 0.17]
.31
-0.69
-0.02
[-0.09, 0.04]
-.07
Agg essi eness
3.19**
0.10
[0.04, 0.16]
.32
1.41
0.05
[-0.02, 0.11]
.13
p < .10. * p < .05. ** p < .01. *** p < .001.
Table 6.
Indi ec E ec s o Egoki zen In e en ion on he Child en's Symp oma ology
Media o
Rigid Pa en al S yle
Pa en s' symp oma ology
Dependen a iables
IE
B SE
LLCI
UPCI
2
d
IE
B SE
LLCI
UPCI
2
d
Global
Symp oma ology
-0.02
0.03
-0.08
0.04
.01
-.14
-0.04
0.03
-0.11
>-0.01
.03
-.34
Soma iza ion
< 0.01
0.03
-0.05
0.05
.01
.23
-0.02
0.03
-0.08
0.03
.02
-.26
Anxie y
-0.01
0.03
-0.07
0.05
< .01
-.08
-0.06
0.03
-0.13
>-0.01
.04
-.39
Agg essi eness
-0.02
0.03
-0.08
0.05
< .01
-.12
-0.01
0.02
-0.06
0.04
< .01
-.09
No e. IE = Indi ec e ec ; B SE = Boo s ap S anda d E o ; LLCI = Boo s ap 95% Lowe Limi Con idence In e al; ULCI =
Boo s ap 95% Uppe Limi Con idence In e al.
