Group interventions for parent-child dyads impacted by parental disturbances of self organisation: A Bayesian Adaptive trial.

Participants will be randomised to either 1, Postnatal Depression and Anxiety group (control) OR 2. Parent-Child Nurture and Regulation group (treatment) The treatment group is a 10-week x 2.5-hour community-based group intervention which is provided face to face at Tresillian sites. It is based on dialectical behaviour therapy (DBT, biosocial theory), trauma theory and attachment theory. The group can accept up to 8 participants, and it is facilitated by two group facilitators. The intervention focuses on reducing parental disturbances of self organisation and improving the parent-child relationship by providing psychoeducation on the trauma response (trauma theory), and skills training in mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness (DBT skills). In addition it focusses on building mindful awareness and responsiveness to the child's cues (DBT and attachment theory). The group is provided by tertiary level educated mental health clinicians trained in psychology, social work, occupational therapy or mental health nursing. Further facilitators have undergone a two day fidelity training workshop to ensure standardisation of the intervention across sites. The facilitators will receive fortnightly supervision for one hour to support their clinical practice. Each participant receives a pre group assessment before being accepted into the group. At this assessment prospective participants are provided information on the trauma response and biosocial theory. The participant is asked to consider what skills they think they need to improve, and what behaviours they wish to reduce. Their commitment to changing behaviour is emphasised as key to the intervention. Each participant receives a manual at the first group session which outlines each week’s content as per below. Each group session begins with a mindfulness exercise, then moves to a review of prior skills learnt, and finishes with teaching new skills. The manual has been designed specifically for this study. • Week 1: Introduction to Group, Mindfulness, the trauma response and Distress Tolerance • Week 2: Distress Tolerance continued • Week 3: Mindfulness review and Introduction to Emotion Regulation • Week 4 - 6: Emotion Regulation continued • Week 7: Mindfulness review and Introduction to Interpersonal Effectiveness • Week 8 - 9: Interpersonal Effectiveness • Week 10: Mindfulness, Reflections and Final Skills The participants are encouraged to practise skills taught between sessions and to share their experience in their new learning at the beginning of the following week's session.