The Efficacy of Solution-Focused Brief Therapy for Distress of Chinese Parents of Children with Congenital Heart Conditions: A Pilot Randomized Controlled Trial

Background/Purpose: High levels of distress experienced by parents of children with congenital heart disease impair these parents’ psychological well-being and the quality of care of their children. Solution-focused brief therapy (SFBT) has been found highly effective in reducing psychological distress among several Chinese population groups (Kim et al., 2015). Although SFBT’s short-term, structured approach fits well within fast-paced medical settings (Franklin, 2011), little research has been done to evaluate SFBT’s effectiveness for parental distress in hospitals. The purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of SFBT, compared to treatment as usual (TAU), for reducing parental distress in a large pediatric heart center in Shanghai, China.

Methods: Thirty-nine individuals who scored 10 (for male) or 13 (for female) on the validated Chinese-version of Brief Symptom Inventory (BSI-18) were randomly assigned to receive either three, one-hour sessions of SFBT (n=18) by 3 master’s-level social workers or treatment as usual (TAU; n=21). TAU consisted of unstructured, brief social work counseling and psycho-education and one ICU visitation with the child’s attending cardiologist. Intervention outcomes in terms of parental distress and levels of hope were measured by the BSI-18 and the Herth Hope Index two weeks after the baseline. Analysis of Covariance (ANCOVA) was used to examine the intervention outcome, with post-test score as the dependent variable, pre-test score as the covariate, and treatment condition as the fixed factor. Power analysis revealed a total sample size of 84 was required to achieve 80% power to detect a large effect size (f=0.4) using fixed-effect ANCOVA for 2 groups with an alpha level of 0.05. Because this is a pilot study, we followed Browne’s (1995) recommendation of a minimum of 30 participants.

Results: ANCOVA revealed SFBT significantly decreased parental distress at post-test (Mean=21.25, SD=15.91) versus control (Mean=31.04, SD=16.20), (F=11.89, p<0.01,η2=0.24). Specifically, SFBT decreased parental anxiety for the treatment group (Mean=9.75, SD=5.73) versus control (Mean=12.75, SD=5.80), (F=15.13, p<0.001, η2=0.29), and decreased depression for the treatment group (Mean=6.88, SD=5.52) versus control (Mean=10.42, SD=6.18), (F=13.39, p<0.001, η2=0.27). Parents in the SFBT group also reported significantly higher level of hope (Mean=36.62, SD=5.26) than the control group (Mean=35.42, SD=4.84), (F=5.35, p<0.05, η2=0.13).

Conclusions/Implications: Despite the fact that this pilot RCT was under-powered due to its small sample size, it still supported SFBT’s efficacy in reducing parental distress, anxiety and depressive mood in particular, in a pediatric cardiology setting.  The findings are consistent with the empirical literature that SFBT is most effective for depressive and/or anxiety disorders (Franklin, 2011). In conclusion, SFBT is a promising intervention for Chinese parents of children with congenital heart disease. Future RCTs with larger sample sizes will be beneficial in evaluating SFBT’s long-term effectiveness in hospital settings.