DOI: 10.5061/dryad.9ghx3ffss
title: Breath-focused mindfulness and compassion training in parent-child dyads: a pilot intervention study

description: Background: Depression in children is a concerning societal issue, and can
 be associated with poor academic performance, school dropout and poor
 overall quality of life. Additionally, child depression is often
 associated with parallel stress and depression in parents. Objective: This
 scenario highlights the urgent need for development and implementation of
 accessible and scalable solutions that may co-benefit child and parent
 mental well-being. Methods: This pilot study introduced "Cooperative
 Compassion" (CoCo), a parent-child co-training digital application
 aimed at promoting mindfulness and compassion through brief,
 performance-adaptive sessions. A community sample of 24 parent-child dyads
 (children’s mean age: 9.5 years, 14 females/10 males, 11 Caucasian/5
 Asian/7 mixed race/1 other race; parents’ mean age: 44.5 years, 20
 females/4 males, 14 Caucasian/8 Asian/2 mixed race) of high average
 affluence socio-economic scores participated in the study. These
 parent-child dyads completed 30 sessions of CoCo training over three
 months with baseline and post-intervention assessments occurring within 2
 weeks of training initiation/completion, respectively. Results: The
 program was feasible, with 80% of families completing over 90% of sessions
 and providing positive feedback. Mental health assessments showed a
 non-significant effect in the expected direction in children’s depression
 scores (Cohen’s d=-0.19, 95% Confidence Interval (95% CI) [-8.89 to 1.74],
 P=.07) and significant reductions in parental stress (d=-0.41, 95% CI
 [-2.63 to -0.16], P=.02), anxiety (d=-0.47, 95%  CI [-2.67 to
 -0.20], P=.02), and depression (d=-0.50, 95% CI [-3.25 to -0.08], P=.03),
 with sustained benefits at the 3-month follow-up. Parental mindfulness
 improvements were correlated with stress reduction (rho=-0.45, P=.03). On
 an emotion bias task utilized as an objective assessment of cognition,
 children demonstrated improved processing speed post-intervention (d=0.54,
 95% CI [0.011 to 0.088], P=.005), and a marginal improvement was also
 observed in parents (d= 0.19, 95% CI [-0.006  to 0.031], P=.05).
 Cortical source imaging of EEG recordings acquired simultaneous to an
 attention-to-breathing assessment showed significant reduction in
 task-related default mode network (DMN) activity (d=−0.53; 95% CI −0.0010
 to −0.0003; P=.001). Conclusions: Post CoCo intervention decrease in DMN
 activity on the attention-to-breath task in parent-child dyads may be
 indicative of cortical plasticity reflecting reduced mind-wandering and
 thereby, enhanced focus after training. The current promising behavioral
 and cognitive results suggest the need for a larger sample size and a
 randomized controlled study design. Overall, these findings highlight the
 potential for brief, digital mindfulness and compassion co-training to
 improve family mental health and well-being.
description: Participants. A total of 24 parent-child dyads participated in
 the current study. Dyads were recruited from local schools and
 university-affiliated pediatric clinics in the San Diego area through
 flyer advertisements and clinic referrals, respectively. Signed informed
 consent was obtained from the parents and signed assent was obtained from
 the children for study participation following the guidelines outlined in
 the Declaration of Helsinki. The study protocol was approved by the
 institutional review board of the University of California San Diego
 (protocol #180140). The study data were de-identified by taking out
 protected health information such as names, dates, and place of birth or
 anything else that is listed by Health Insurance Portability and
 Accountability Act (HIPPA) compliance. All the parent-child dyads were
 paid $250 for completing all assessments and digital training.
 Also, all children and parents were right-handed and had normal
 or corrected-to-normal vision. Children were assessed on the Child
 Depression Index (CDI (Kovacs, 2012)) and study inclusion was based on CDI
 scores in the average and above-average range (T-score&gt;40).
 Exclusion was based on any self-reported severe illness for parent or
 child that would not allow time for study participation. All parents were
 healthy and did not report any current diagnoses or
 medications.  Sample Size and Power. This single-arm
 study was powered to detect medium effect size (Cohen d&gt;0.5)
 comparing pre- versus post-intervention differences at β power of 0.8 and
 α level of 0.05 for each assessment measure. Effect sizes were calculated
 a priori using the G*Power software (Faul et al., 2009). 
 Feasibility. We assessed intervention feasibility by monitoring
 the total number of assigned intervention sessions completed.
 Additionally, parents completed a feasibility survey at end of study that
 we have standardized in previous digital training studies (Mishra et al.,
 2016). The survey queried 16 questions about the training as elaborated in
 the Results (Table 2) and each question required a response on a
 seven-point Likert scale. The Cronbach α measure of reliability for the
 training survey was high (α = 0.92). Assessments. Each
 parent-child dyad made two visits (baseline [pre-intervention] and
 three-months later [post-intervention]) to the Neural Engineering and
 Translational Labs (NEATLabs) and participated in behavioral and
 neurocognitive assessments. Behavioral assessments were also completed
 online at a 3-month follow-up after intervention completion. 
description: # Breath-focused mindfulness and compassion training in parent-child
 dyads: a pilot intervention study ## Description of the Data and file
 structure The xlsx file contains the study data corresponding to (1)
 Demographics 24 Dyads (2) Training Feasibility (TF) survey (3) Spreadsheet
 (1) - Demographics 24 Dyads Dyad_ID: ID starting with the prefix PJ
 assigned to each parent-child dyad Child Age Bins: Children's age in
 years; 1 = 5-10 Years Old; 2 = 11-15 Years Old Child Gender:
 Children's Gender, 1: male, 2: female Child Race: Children's
 race, 1: Caucasian; 2: Black/African American; 3: Native Hawaiian or Other
 Pacific Islander; 4: Asian; 5: Native American; 6: More than one
 ethnicity; 7: Other Child_Ethnicity:Children's Ethnicity, 1. Hispanic
 2. Non Hispanic 3. Other Parent Age Bins: Parents' age in years; 3 =
 25-35 Years Old; 4 = 35-45 Years Old; 5 = 45-55 Years Old Parent Gender:
 Parents' Gender, 1: male, 2: female Parent Race: Parents' race,
 1: Caucasian; 2: Black/African American; 3: Native Hawaiian or Other
 Pacific Islander; 4: Asian; 5: Native American; 6: More than one
 ethnicity; 7: Other Parent_Ethnicity:Parents' Ethnicity, 1. Hispanic
 2. Non Hispanic 3. Other SES_Score: Parents' Socioeconomic status
 (SES) scores, 0-2 (low affluence), 3-5 (middle affluence), &gt;5 (high
 affluence) Spreadsheet (2) -Training Feasibility (TF) survey TF1: We
 enjoyed the training. TF2: We felt frustrated after the training. TF3: We
 felt satisfied with the training. TF4: We felt tired after the training.
 TF5: The training was easy to understand. TF6: The training was difficult
 to use. TF7: The training was easy to navigate. TF8: We were worried about
 our data security. TF9: The training was easy to initiate each day. TF10
 The training fit in our daily schedule. TF11: The training time passed by
 quickly. TF12: The training felt therapeutic. TF13: The training felt
 useless. TF14: We would recommend this training outside of this study.
 TF15: We would recommend this training to others. TF16: This training
 positively affected our family's life. Spreadsheet (3) - Behaviors
 Dyad_ID: ID starting with prefix PJ assigned to each parent-child dyad
 Pre_Tscore_cdi_Child: Pre Child Depression Index (CDI ) T-Score by
 children Pre_Tscore_cdi_Parents: Pre Child Depression Index (CDI ) T-Score
 by parents Pre_GAD7_Anxiety_Parent: Pre General Anxiety Disorder-7 score
 parent Pre_Depression_phq9_Parent: Pre Patient Health Questionnaire
 (PHQ-9) depression score parent Pre_Stress_DASS_Parent: Pre Stress score
 on Depression Anxiety Stress Scale-21 parent Pre_Mindfulness_Parent: Pre
 Mindful Attention Awareness Scale score parent Final Breathe Level: Final
 level of breath focused training reached by parent-child dyad Total
 Sessions: Total training session completed by parent-child dyad
 Post_Tscore_cdi_Child: Post Child Depression Index (CDI ) T-Score by
 children Post_Tscore_cdi_Parents: Post Child DePostssion Index (CDI )
 T-Score by parents Post_GAD7_Anxiety_Parent: Post General Anxiety
 Disorder-7 score parent Post_Depression_phq9_Parent: Post Patient Health
 Questionnaire (PHQ-9) depression score parent Post_Stress_DASS_Parent:
 Post Stress score on DePostssion Anxiety Stress Scale-21 parent
 Post_Mindfulness_Parent: Post Mindful Attention Awareness Scale score
 parent FollowUp_T_cdi_Child_score: Follow-up Child Depression Index (CDI )
 T-Score by children FollowUp_T_cdi_Parent_score: Follow-up Child
 DeFollow-upssion Index (CDI ) T-Score by parents
 FollowUp_anxietyscore_parent: Follow-up General Anxiety Disorder-7 score
 parent FollowUp_depressionscore_phq9_Parent: Follow-up Patient Health
 Questionnaire (PHQ-9) depression score parent FollowUp_DASS_Stress_Parent:
 Follow-up Stress score on DeFollow-upssion Anxiety Stress Scale-21 parent
 FollowUp_mindfulnesscore_parent: Follow-up Mindful Attention Awareness
 Scale score parent Spreadsheet (4) - Cognitive Dyad_ID: ID starting with
 prefix PJ assigned to each parent-child dyad Pre_Child_speed_neutral: Pre
 speed for neutral faces in children Pre_Child_speed_happy: Pre speed for
 happy faces in children Pre_Child_speed_angry: Pre speed for angry faces
 in children Pre_Child_speed_sad: Pre speed for sad faces in children
 Pre_Child_speed_all: Pre speed for all faces in children
 Post_Child_speed_neutral: Post speed for neutral faces in children
 Post_Child_speed_happy: Post speed for happy faces in children
 Post_Child_speed_angry: Post speed for angry faces in children
 Post_Child_speed_sad: Post speed for sad faces in children
 Post_Child_speed_all: Post speed for all faces in children
 Diff_Child_Speed_PostPre: Difference between Post and Pre speed for all
 faces in children Pre_Parent_speed_neutral: Pre speed for neutral faces in
 Parents Pre_Parent_speed_happy: Pre speed for happy faces in Parents
 Pre_Parent_speed_angry: Pre speed for angry faces in Parents
 Pre_Parent_speed_sad: Pre speed for sad faces in Parents
 Pre_Parent_speed_all: Pre speed for all faces in Parents
 Post_Parent_speed_neutral: Post speed for neutral faces in Parents
 Post_Parent_speed_happy: Post speed for happy faces in Parents
 Post_Parent_speed_angry: Post speed for angry faces in Parents
 Post_Parent_speed_sad: Post speed for sad faces in Parents
 Post_Parent_speed_all: Post speed for all faces in Parents
 Diff_Parent_Speed_PostPre: Difference between Post and Pre speed for all
 faces in Parents Spreadsheet (5) - Neural Dyad_ID: ID starting with prefix
 PJ assigned to each parent-child dyad Group: Rows for Child and Parents
 Group FPN_pre: Fronto-parietal network source activity at Pre CON_pre:
 Cingulo-opercular network source activity at Pre DMN_pre: Default mode
 network source activity at Pre FPN_post: Fronto-parietal network source
 activity at Post CON_post: Cingulo-opercular network source activity at
 Post DMN_post: Default mode network source activity at Post FPN_postpre:
 Fronto-parietal network source activity at Post-Pre Difference
 CON_postpre: Cingulo-opercular network source activity at Post-Pre
 Difference DMN_postpre: Default mode network source activity at Post-Pre
 Difference ## Sharing/access Information Links to other publicly
 accessible locations of the data: N/A Was data derived from another
 source? No ## Human subjects data Signed informed consent was obtained
 from the parents and signed assent was obtained from the children for
 study participation following the guidelines outlined in the Declaration
 of Helsinki. The study protocol was approved by the institutional review
 board of the University of California San Diego (protocol #180140). The
 study data were de-identified by taking out protected health information
 such as names, dates, and place of birth or anything else that is listed
 by Health Insurance Portability and Accountability Act (HIPPA) compliance.