Coping Strategies for Emotional Distress After Parental Separation/Divorce

Overseen By Sharlene A Wolchik, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Arizona State University

Disqualifiers: Active therapy, Suicidality, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

144 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will identify components for inclusion in a coping intervention package to reduce mental health problems among children exposed to high interparental conflict after parental separation/divorce. Reappraisal, distraction, and relaxation coping strategies are related to fewer mental health problems among children, making intervention components based on these strategies key candidates for inclusion in an optimized coping intervention. The primary aim is to experimentally assess the main and interactive effects of three digital intervention coping components (reappraisal, distraction, relaxation) on children's coping efficacy, emotional security, and internalizing and externalizing problems. Secondary aims are to assess indirect effects of the intervention components on children's coping efficacy, emotional security, and internalizing and externalizing problems through their cognitive, emotional, and behavioral reactions to post-separation/divorce interparental conflict events.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment 'Coping Strategies for Emotional Distress After Parental Separation/Divorce'?

Research shows that distraction techniques, such as watching television or listening to music, can help reduce anxiety and distress during medical procedures by diverting attention away from the stressor. Additionally, teaching parents to use distraction and relaxation techniques with their children during stressful situations can enhance coping skills and reduce anxiety. ^{1 2 3 4 5}

Is distraction coping safe for humans?

Distraction coping techniques, such as using music or engaging in activities, are generally safe and have been shown to reduce anxiety and distress in various settings, including medical procedures and dental treatments. ^{1 2 3 6 7}

How is the treatment for coping strategies after parental separation/divorce different from other treatments?

This treatment is unique because it combines various coping strategies like distraction, education, reappraisal, and relaxation to help children manage emotional distress after parental separation or divorce, focusing on reducing rumination and improving emotional adjustment, unlike standard treatments that may not address these specific coping mechanisms. ^{8 9 10 11 12}

Research Team

Karey L O'Hara, PhD

Principal Investigator

Arizona State University

Eligibility Criteria

This trial is for children aged 9-12 who are experiencing emotional challenges due to their parents' separation or divorce. They must have some signs of anxiety or depression, be fluent in English, and spend a significant amount of time with at least one parent willing to participate. Children already receiving therapy, those with extreme mental health issues, or expressing suicidal thoughts cannot join.

Inclusion Criteria

A parent with sufficient contact with the child who is willing to complete study assessments and has legal right to give permission for the child to participate in research

Child-report of high exposure to IPC (mean Z score ≥ 40th percentile on the two child report measures of IPC; score standardization based on data from 559 youth whose parents participated in an experimental parenting program)

I am a child aged 9-12 with separated or divorced parents.

Exclusion Criteria

I am currently receiving treatment for my condition.

Score ≥ 99th percentile on either internalizing and externalizing problems subscale

Endorse suicidality (will be ineligible for the study and referred for treatment)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants complete digital modules on reappraisal, distraction, and relaxation coping strategies

6 weeks

Daily digital module completion

Follow-up

Participants are monitored for coping efficacy, emotional security, and mental health problems

3 months

Treatment Details

Interventions

• Distraction Coping
• Education
• Reappraisal Coping
• Relaxation Coping

Trial Overview The study tests three digital coping strategies: reappraisal (changing how to think about stressful events), distraction (shifting attention away from stress), and relaxation (reducing tension). It aims to see which combination best helps kids handle emotions and behaviors after parental separation/divorce.

Participant Groups

Group I: Education + Relaxation Experimental Treatment 2 Interventions

Participants will complete an educational digital module and a skills-based digital module that teaches relaxation coping.

Group II: Education + Reappraisal + Relaxation Experimental Treatment 3 Interventions

Participants will complete an educational digital module and two skills-based digital modules, one that teaches reappraisal coping and one that teaches relaxation coping.

Group III: Education + Reappraisal + Distraction + Relaxation Experimental Treatment 4 Interventions

Participants will complete an educational digital module and three skills-based digital modules, one that teaches reappraisal coping, one that teaches distraction coping, and one that teaches relaxation coping.

Group IV: Education + Reappraisal + Distraction Experimental Treatment 3 Interventions

Participants will complete an educational digital module and two skills-based digital modules, one that teaches reappraisal coping and one that teaches distraction coping.

Group V: Education + Reappraisal Experimental Treatment 2 Interventions

Participants will complete an educational digital module and a skills-based digital module that teaches reappraisal coping.

Group VI: Education + Distraction + Relaxation Experimental Treatment 3 Interventions

Participants will complete an educational digital module and two skills-based digital modules, one that teaches distraction coping and one that teaches relaxation coping.

Group VII: Education + Distraction Experimental Treatment 2 Interventions

Participants will complete an educational digital module and a skills-based digital module that teaches distraction coping.

Group VIII: Education Experimental Treatment 1 Intervention

Participants will complete an educational digital module and no skills-based digital modules.

Who Is Running the Clinical Trial?

Arizona State University

Lead Sponsor

Trials

311

Recruited

109,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

The Distraction in Action Tool© (DAT©) is a user-friendly intervention that helps parents assess their child's risk for distress during needle stick procedures and provides tailored distraction techniques, showing high usability among parents (84.2% found it easy to use) and clinicians (100% found it helpful).

The study involved 20 parents of children aged 4-10 years undergoing venipuncture, and results indicated that DAT did not disrupt clinical workflow, suggesting it can be effectively integrated into medical settings to reduce child distress during procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Distraction in Action Tool©: Feasibility and Usability in Clinical Settings. Hanrahan, K., Kleiber, C., Miller, BJ., et al.[2021]

In a study of 42 hospitalized acute burn patients, those using music distraction during dressing changes reported significantly fewer intrusive thoughts compared to those focusing on procedural sensations.

Training in distraction techniques, like music, can effectively reduce procedure-related distress, while focusing on sensations may increase feelings of intrusion and tension during medical procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping with the stress of a painful medical procedure. Fauerbach, JA., Lawrence, JW., Haythornthwaite, JA., et al.[2022]

In a study involving 69 children undergoing dental treatment, watching television significantly reduced anxiety levels and improved cooperation compared to the traditional Tell-Show-Do method.

Television distraction led to a notable decrease in pulse rate and increased cooperation, especially during the administration of anesthetic injections, highlighting its effectiveness in pediatric dental care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments. Kharouba, J., Peretz, B., Blumer, S.[2021]

The development of a parent education booklet encourages the use of distraction and relaxation techniques during painful procedures in children with cancer, aiming to reduce anxiety and pain.

Implementing these nonpharmacologic strategies can enhance coping skills for both parents and children, potentially decreasing the need for general anesthesia and improving overall patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting parental use of distraction and relaxation in pediatric oncology patients during invasive procedures. Christensen, J., Fatchett, D.[2022]

Coping is a circular process involving perception of change, cognitive processing, and active coping strategies, with active behaviors being more beneficial for patient well-being than passive ones.

Structured coping-based interventions, which include establishing a therapeutic relationship and problem analysis, have been shown to significantly enhance the healing process across various medical fields.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping-based intervention strategies. Heim, E.[2019]

Positive distraction, which involves engaging in activities that induce positive emotions, can be an adaptive coping strategy for managing chronic stress, as shown in a study with 1,152 participants across multiple samples.

Unlike traditional avoidance strategies, positive distraction is associated with better well-being, increased positive emotions, and fewer depressive symptoms, suggesting it should be included in future coping interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Not all disengagement coping strategies are created equal: positive distraction, but not avoidance, can be an adaptive coping strategy for chronic life stressors. Waugh, CE., Shing, EZ., Furr, RM.[2021]

In a study of 100 children aged 3 to 10 years undergoing ambulatory surgery, higher levels of engagement (or 'flow') in distracting activities were linked to lower preoperative anxiety during critical waiting periods.

The findings suggest that the effectiveness of distraction as an anxiety management strategy in children is influenced by how absorbed they are in the task, which could inform better clinical practices for reducing anxiety before surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The benefits of experiencing flow through distracting activities: flow reduces preoperative anxiety in children before surgery, but not postoperative difficulties. Tordet, C., Erhel, S., Dodeler, V., et al.[2023]

Support from family adults and nonfamily adults significantly helps children of divorce adjust better, especially under high stress, as seen in a study of 104 children.

Interestingly, at low stress levels, children with high support from nonfamily adults showed worse adjustment, suggesting that the type of support matters depending on the stress context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social support of children of divorce: direct and stress buffering effects. Wolchik, SA., Ruehlman, LS., Braver, SL., et al.[2023]

In a study of 351 children whose parents recently divorced, stress from divorce-related events and how children perceive these threats were found to increase their ruminations about the divorce.

Effective coping strategies were linked to lower levels of ruminations over time, suggesting that helping children develop better coping mechanisms could reduce their negative thoughts related to their parents' divorce.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stress and coping as predictors of children's divorce-related ruminations. Weyer, M., Sandler, IN.[2007]

Divorce creates significant stress that can negatively affect parent-child relationships, which are crucial for helping children adjust during this challenging time.

Implementing early intervention strategies can lead to better outcomes for both parents and children, highlighting the importance of timely support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in parent-child relationships following divorce. Melnyk, BM.[2004]

Divorce and parental separations in the U.S. affect over 1 million children annually, leading to potential emotional trauma for both children and parents.

Pediatricians can play a crucial role in identifying family dysfunction and providing age-appropriate counseling and resources to help mitigate the negative effects of divorce on children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping Children and Families Deal With Divorce and Separation. Cohen, GJ., Weitzman, CC.[2018]

In a study of 60 children and adolescents from a residential treatment facility, most of whom had experienced severe abuse and neglect, children reported low levels of depressive symptoms despite caregivers noting significant psychological issues.

The children predominantly used avoidant coping strategies, which were more common than emotion-focused and problem-focused strategies, highlighting a need for targeted interventions to help them cope with parental loss effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping with parental loss because of termination of parental rights. Schneider, KM., Phares, V.[2014]

References

1. United States pubmed.ncbi.nlm.nih.gov

The Distraction in Action Tool©: Feasibility and Usability in Clinical Settings. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Coping with the stress of a painful medical procedure. [2022]

3. Germany pubmed.ncbi.nlm.nih.gov

The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Promoting parental use of distraction and relaxation in pediatric oncology patients during invasive procedures. [2022]

5. Ireland pubmed.ncbi.nlm.nih.gov

Coping-based intervention strategies. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Not all disengagement coping strategies are created equal: positive distraction, but not avoidance, can be an adaptive coping strategy for chronic life stressors. [2021]

7. England pubmed.ncbi.nlm.nih.gov

The benefits of experiencing flow through distracting activities: flow reduces preoperative anxiety in children before surgery, but not postoperative difficulties. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Social support of children of divorce: direct and stress buffering effects. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Stress and coping as predictors of children's divorce-related ruminations. [2007]

10. United States pubmed.ncbi.nlm.nih.gov

Changes in parent-child relationships following divorce. [2004]

11. United States pubmed.ncbi.nlm.nih.gov

Helping Children and Families Deal With Divorce and Separation. [2018]

12. United States pubmed.ncbi.nlm.nih.gov

Coping with parental loss because of termination of parental rights. [2014]