ALSMADI MOHAMMAD LAST ONE

THE EFFECTIVENESS OF BEHAVIOURAL COGNITIVE MENTORING IN REDUCING PSYCHOLOGICAL STRESS AMONG MOTHERS OF CHILDREN WITH CEREBRAL PALSY MOHAMMAD SHABAN KHALAF ALSMADI DOCTOR OF PHILOSOPHY UNIVERSITI SULTAN ZAINAL ABIDIN 2020

THE EFFECTIVENESS OF BEHAVIOURAL COGNITIVE MENTORING IN REDUCING PSYCHOLOGICAL STRESS AMONG MOTHERS OF CHILDREN WITH CEREBRAL PALSY MOHAMMAD SHABAN KHALAF ALSMADI Thesis Submitted in Fulfilment of the Requirement for the Degree of Doctor of Philosophy in the Faculty of Applied Social Sciences University Sultan Zainal Abidin 2020

KEBERKESANAN PEMANTAUAN TINGKAH LAKU KOGNITIF DALAM MENGURANGKAN TEKANAN PSIKOLOGI DI KALANGAN IBO BAGI KANAK-KANAK CEREBRAL PALSY ABSTRAK Kebanyakan ibu bapa memberikan pelbagai reaksi dalam membesarkan seorang anak berkeperluan khas, daripada menunjukkan pemahaman dan penghargaan atas anugerah dan perkembangan, sehingga penyesalan ke atas kekurangan anak tersebut. Namun demikian, perkara sebaliknya yang akan terjadi apabila anak berkeperluan khas tersebut memberi kesan terhadap seluruh keluarga, menyebabkan tekanan psikologi kepada ibu bapa yang kadangkala memerlukan bantuan pakar dan kaunselor. Berdasarkan kenyataan tersebut, kajian ini bertujuan untuk menentukan keberkesanan program pemantauan tingkah laku kognitif dalam mengurangkan masalah kognitif dan psikologi dalam kalangan ibu kepada kanak-kanak berkeperluan khas iaitu cerebral palsy. Kajian ini dilaksanakan dengan menggunakan data kuantitatif dari kuasi-eksperimen yang diperoleh daripada 50 ibu yang mempunyai kanak-kanak berkeperluan khas cerebral palsy di bandar Irbid, Jordan. Data ini telah dianalisa menggunakan Pakej Statistik Sains Sosial (SPSS) versi 25 dan menggunakan statistik deskriptif dan kajian inferensi. Ujian statistik yang digunakan ialah Mann-Whitney U dan ujian Wilcoxon Signed-Rank. Dapatan Mann-Whitney U menunjukkan kumpulan eksperimen memberikan keputusan yang lebih baik berbanding kumpulan kawalan dalam ketiga-tiga peringkat pembahagian borang soal selidik. Selain itu, ujian Wilcoxon Signed-Rank pula menunjukkan terdapat perbezaan ketara dalam kumpulan eksperimen sebelum, selepas dan ketika pendedahan lewat kepada program tersebut. Walaubagaimanapun, kumpulan kawalan menunjukkan keputusan berbeza kerana tiada perubahan sebelum dan selepas soal selidik dilakukan. Kajian ini mengusulkan sebuah Program Pemantauan Tingkah Laku Kognitif yang terdiri daripada 12 sesi intervensi berkesan bagi menangani masalah tingkah laku di kalangan kanak-kanak bermasalah cerebral palsy. Ia juga menumpukan kepada domain psikologi, tingkah laku dan kognitif yang utama bagi mengurangkan tekanan di kalangan ibu bagi kanak-kanak bermasalah cerebral palsy. Justeru, pihak kerajaan dicadangkan untuk memperuntukkan lebih banyak sesi latihan, menggunakan aktiviti kolaboratif sebagai tugasan luar kelas, memantau dengan teliti, serta menyediakan perkhidmatan dan sokongan yang mencukupi umtuk golongan ibu bagi kanak-kanak yang mengalami cerebral palsy. ii

THE EFFECTIVENESS OF BEHAVIOURAL COGNITIVE MENTORING IN REDUCING PSYCHOLOGICAL STRESS AMONG MOTHERS OF CHILDREN WITH CEREBRAL PALSY ABSTRACT Parents respond in many diverse ways to raising a child with special needs, ranging from gaining insights and appreciation for the gifts and personal growth that the child has brought, to feelings of grief over the loss of the expected child. Furthermore, the opposite occurs when the child with special needs impacted the whole family, resulting in the distress of parents from psychological stress that needs professional assistance from specialists and counsellors. Based on this premise, the study aims to determine the effectiveness of the cognitive behavioural mentoring program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with cerebral palsy in post-evaluation. The research is based on quantitative data involving a quasi-experimental research approach which were collected from 50 mothers of children with special needs from Irbid City, Jordan. The data were analysed using the Statistical Package for the Social Science (SPSS) version 25 and treated using descriptive and inferential statistics. The statistical tests used in the study were Mann- Whitney U and Wilcoxon signed-rank test. The Mann-Whitney U results revealed that the experimental group performed significantly better than those in the control group in both three stages of the distribution of questionnaires, specifically the mothers of children with cerebral palsy. Additionally, the Wilcoxon Signed-Rank test showed that there was a significant difference in the experimental group before, after and delayed exposure to the program. Nevertheless, this is not the case for the control group as the results showed insignificant difference before, after and delayed distribution of the questionnaires. The study contributed by designing a 12-session Cognitive Behavioural Mentoring Program for effective intervention for mothers of children with cerebral palsy. It also focuses on the main psychological, behavioural and cognitive domains to reduce the stress among mothers of children with cerebral palsy. Therefore, it is suggested that the government should provide more training sessions, employ the collaborative activity as an out-of-class assignment, and carefully monitor the process as well as providing sufficient services and support for mothers of children with cerebral palsy. iii

ACKNOWLEDGEMENTS First and above all, I praise to Allah, the Almighty for providing me this opportunity and granting me the capability to proceed successfully. This thesis appears in its current form due to the assistance and guidance of several people. I would therefore like to offer my sincere thanks to all of them. Firstly, I would like to thank my family, especially Mom and Dad, for the continuous the support they have given me throughout my time in graduate school; I could not have done it without them. secondly, I would like to express my sincere gratitude to my main supervisor Associate. Professor. DR. Norsuhaily Binti Abu Bakar for accepting me as a PhD student, continuous support for my study and related research, for her patience, motivation, thoughtful guidance, critical comment and immense knowledge. Her guidance helped me throughout the research and writing of this thesis. I could not have imagined having a better advisor and mentor for my PhD study. Last but not least, my appreciation also extends to my colleagues and friends for being my friends and giving me moral support throughout this journey. iv

APPROVAL I certify that an Examination Committee has met on 14th September, 2020 to conduct the final examination of Mohammad Shaban Khalaf Alsmadi on his thesis entitled “The Effectiveness of Behavioral Cognitive Mentoring in Reducing Psychological Stress Among Mothers of Children with Cerebral Palsy” in accordance with the regulations approved by the Senate of Universiti Sultan Zainal Abidin. The Committee recommends that the candidate be awarded the relevant degree, and it has been accepted by the Senate of University Sultan Zainal Abidin as fulfilment of the requirements for the Doctor of Philosophy. The members of the Examination Committee are as follows: Ahmad Puad Bin Mat Som, PhD Professor Faculty of Social Sciences University Sultan Zainal Abidin (Chairperson) Mohd Sani Ismail, PhD Faculty of Islamic Contemporary Studies University Sultan Zainal Abidin (Internal Examiner) Azlina Abu Bakar, PhD Associate Professor Faculty human development University Pendidikan Sultan Idris (External Examiner) ________________________________ AHMAD PUAD BIN MAT SOM, PhD Professor / Dean of Graduate School University Sultan Zainal Abidin Date: v

DECLARATION BY THE STUDENT I hereby declare that the thesis is based on my original work except for quotations and citations, which have been duly acknowledged. I also declare that it has not been previously or concurrently submitted for any other degree at University Sultan Zainal Abidin or other institutions. Mohammad Shaban AL-smadi _______________________________ Mohammad Shaban Khalaf Alsmadi Date: vi

DECLARATION BY THE SUPERVISOR This is to confirm that: The research conducted and the writing of this thesis was under my supervision. Signature: ______________________ Name of Main Supervisor: Associate.Prof. Dr. Norsuhaily Binti Abu Bakar Faculty: Faculty of Applied Social Sciences vii

TABLE OF CONTENTS ii iii ABSTRAK iv ABSTRACT v ACKNOWLEDGEMENTS vi APPROVAL vii DECLARTION BY THE STUDENT xi DECLARTION BY THE SUPERVISOR xvi LIST OF TABLES LIST OF FIGURES CHAPTER 1 INTRODUCTION 1 9 1.1 Background of the Study 13 1.2 Research Problems 14 1.3 Research Objectives 15 1.4 Research Questions 16 1.5 Research Hypothesis 18 1.6 Significance of the study 19 1.7 Limitation of the Study 19 1.8 Operational Definition of Terms 19 20 1.8.1 Cerebral Palsy 20 1.8.2 Behavioural Cognitive Mentoring 20 1.8.3 Psychological Stress 21 1.8.4 Social Support 1.8 Organization of the Study 1.9 Chapter Summary CHAPTER 2 LITERATURE REVIEW 22 22 2.1 Introduction 22 2.2 Theoretical Framework 26 29 2.2.1 Behaviourism Theory 30 2.2.2 Structural Learning Theory (SLT) 36 2.2.3 Constructivism Theory 44 2.2.4 Cognitive Behavioural Theory 44 2.2.5 Social Problem-Solving Theory 57 2.3 Conceptual Framework 66 2.3.1 Cerebral Pal, Stress 72 77 2.3.1.1 Parental Stress 82 2.3.1.2 Distress and Eustress 84 2.3.1.3 Family Stress 91 2.3.2 Prevalence of Stress in Mothers of Children with CP 96 2.3.3 Causes of Stress in Mothers of Children with CP 101 2.3.4 Stress Management in Mothers of Children with CP 109 2.4 Effects of the CP on Mothers and Children at Different Age Levels 2.5 Social Support viii 2.6 Empirical Literature 2.7 Conceptual Framework

2.8 Theoretical Model 111 2.9 Summary of the Chapter 112 CHAPTER 3 METHODOLOGY 113 114 3.1 Introduction 115 3.2 Research Design 116 3.3 Target Population of the Study 117 118 3.3.1 Sample Size of the Study 118 3.3.2 Sampling Technique 119 3.4 Data Collection Procedure 119 3.5 Data Collection Instruments 121 3.5.1 Survey Instruments 122 3.5.1.2 Survey Questionnaire 124 3.6 Data Collection Process 125 3.6.1 Quasi-Experimental Study 125 3.6.2 Design of the Quasi-Experimental Study 126 3.6.3 Pre-Test and Post-tests 126 3.7 Validation and Reliability of the Research Instrument 129 3.8 Research Procedure 129 3.8.1 Intervention Training Program 130 3.8.2 Pre-Test. 130 131 3.8.2.1 Face validity 132 3.8.2.2 Content validity 133 3.9 Pilot Study 3.10 Normality 134 3.11 Method of Data Analysis 134 3.12 Summary 137 137 CHAPTER 4 DATA ANALYSIS AND DISCUSSION 139 141 4.1 Introduction 143 4.2 Descriptive Statistics and Assessment of Normality 145 4.3 Findings of Between-group 147 149 4.3.1 Mann-Whitney Results of CBTP 151 4.3.2 Mann-Whitney Results of CBTFD 151 4.3.3 Mann-Whitney Results of CBTCF 153 4.3.4 Mann-Whitney Results of CBTIP 154 4.3.5 Mann-Whitney Results of CBTIPS 156 4.3.6 Mann-Whitney Results of CBTPS 157 4.3.7 Mann-Whitney Results of CBTFDS 159 4.4 Findings of Within- Program 160 4.4.1 Significant Impact of the Experimental Group of CBTP 4.4.2 Significant Impact Experimental Group of CBTFD ix 4.4.3 Significant Impact Experimental Group of CBTCF 4.4.4 Significant Impact Experimental Group of CBTIP 4.4.5 Significant Impact Experimental Group of CBTIPS 4.4.6 Significant Impact Experimental Group of CBTPS 4.4.7 Significant Impact Experimental Group of CBTFDS

4.4.8 Significant Impact of CBTP in the Control Group 162 4.4.9 Significant Impact of CBTFD in the Control Group 164 4.4.10 Significant Impact of CBTCF in the Control Group 165 4.4.11 Significant Impact of CBTIP in the Control Group 167 4.4.12 Significant Impact of CBTIP in the Control Group 169 4.4.13 Significant Impact of CBTPS in the Control Group 170 4.4.14 Significant Impact of CBTFDS in the Control Group 172 4.5 Socio-Economic Characteristics 175 4.6 Summary of the Chapter 178 CHAPTER 5 DISCUSSION OF THE RESULT 179 5.1 Introduction 179 5.2 Discussion of the Analysis 179 5.3 Summary of the Chapter 209 CHAPTER 6 CONCLUSION AND RECOMMENDATION 210 6.1 Introduction 210 6.2 Summary 210 6.3 Conclusion 224 6.4 Recommendations 230 6.5 Research Implication for Further Study 230 REFERENCES 232 APPENDICES 256 LIST OF PUBLICATIONS 289 CANDIDATE BIODATA 290 x

LIST OF TABLES Table No. Title Page 3.1 Research Instrument 120 3.2 Sessions of the Program 128 4.0.1 Descriptive Statistics 135 4.0.2: Between-Group among Pre-Experimental and Pre-Control CBTP 137 4.0.3: Between-Group among Post-experimental and Post-control CBTP 138 4.0.4: Between-Group among Delay-experimental and Delay-control CBTP 139 4.0.5: Between-Group among Pre-Experimental and Pre-Control CBTFD 139 4.0.6: Between-Group among Post-Experimental and Post-Control CBTFD 140 4.0.7: Between-Group among Delay-Experimental and Delay-Control CBTFD 141 4.0.8: Between-Group among Pre-Experimental and Pre-Control CBTCF 141 4.0.9: Between-Group among Post-Experimental and Post-Control CBTCF 142 4.0.10: Between-Group among Delay-Experimental and Delay-Control CBTCF 143 4.0.11: Between-Group among Pre-Experimental and Pre-Control CBTIP 143 4.0.12: Between-Group among Post-Experimental and Post-Control CBTIP 144 4.0.13: Between-Group among Delay-Experimental and Delay-Control CBTIP 145 4.0.14: Between-Group among Pre-Experimental and Pre-Control CBTIP 145 4.0.15: Between-Group among Post-Experimental and Post-Control CBTIP 146 4.0.16: Between-Group among Pre-Experimental and Pre-Control CBTIP 147 4.0.17: Between-Group among Pre-Experimental and Pre-Control CBTPS 147 4.0.18: Between-Group among Pre-Experimental and Pre-Control CBTPS 148 4.0.19: Between-Group among Pre-Experimental and Pre-Control CBTPS 149 4.0.20: Between-Group among Pre-Experimental and Pre-Control CBTFDS 149 xi

4.0.21: Between-Group among Post-Experimental and Post-Control CBTFDS 150 4.0.22: Between-Group among Delay-Experimental and Delay-Control CBTFDS 151 4.0.23: Within-Group of the Experimental Group of CBTP 152 4.0.24: Within-Group of the Experimental Group of CBTP 152 4.0.25: Within-Group of the Experimental Group of CBTP 153 4.0.26: Within-Group of the Experimental Group of CBTFD 153 4.0.27: Within-Group of the Experimental Group of CBTFD 154 4.0.28: Within-Group of the Experimental Group of CBTFD 154 4.0.29: Within-Group of the Experimental Group of CBTCF 155 4.0.30: Within-Group of the Experimental Group of CBTCF 155 4.0.31: Within-Group of the Experimental Group of CBTCF 156 4.0.32: Within-Group of the Experimental Group of CBTIP 156 4.0.33: Within-Group of the Experimental Group of CBTIP 157 4.0.34: Within-Group of the Experimental Group of CBTIP 157 4.0.35: Within-Group of the Experimental Group of CBTIPS 158 4.0.36: Within-Group of the Experimental Group of CBTIP 158 4.0.37: Within-Group of the Experimental Group of CBTIP 159 4.0.38: Within-Group of the Experimental Group of CBTPS 159 4.0.39: Within-Group of the Experimental Group of CBTPS 160 4.0.40: Within-Group of the Experimental Group of CBTPS 160 4.0.41: Within-Group of the Experimental Group of CBTFDS 161 4.0.42: Within-Group of the Experimental Group of CBTFDST 161 4.0.43: Within-Group of the Experimental Group of CBTFDS 162 4.0.44: Within-Group of the Control Group of CBTP 162 xii

4.0.45: Within-Group of the control Group of CBTP 163 4.0.46: Within-Group of the Control Group of CBTPS 163 4.0.47: Within-Group of the Control Group of CBTFD 164 4.0.48: Within-Group of the Control Group of CBTFD 165 4.0.49: Within-Group of the Control Group of CBTFD 165 4.0.50: Within-Group of the Control Group of CBTCF 166 4.0.51: Within-Group of the Control Group of CBTCF 166 4.0.52: Within-Group of the Control Group of CBTCF 167 4.0.53: Within-Group of the Control Group of CBTIP 167 4.0.54: Within-Group of the Control Group of CBTIP 168 4.0.55: Within-Group of the Control Group of CBTIP 169 4.0.56: Within-Group of the Control Group of CBTIP 169 4.0.57: Within-Group of the Control Group of CBTIP 170 4.0.58: Within-Group of the Experimental Group of CBTIP 170 4.0.59: Within-Group of the Control Group of CBTPS 171 4.0.60: Within-Group of the Control Group of CBTPS 171 4.0.61: Within-Group of the Control Group of CBTPS 172 4.0.62: Within-Group of the Control Group of CBTFDS 173 4.0.63: Within-Group of the Control Group of CBTFDS 173 4.0.64: Within-Group of the Control Group of CBTFDS 174 4.0.65 Socio-Economic Characteristics of the Respondents 177 A.1 The mean and standard deviation for items measuring CBTP 256 A.2 The KMO and Bartlett’s Test Score for CBTP 257 A.3 : The Total Variance Explained for CBTP 258 xiii

A.4 The Components and Their Respective Items 258 A.5: The Internal Reliability for the CBTP Construct 258 A.6: The mean and standard deviation for the items measuring CBTFD 259 A.7: The KMO and Bartlett’s Test Score for CBTFD 259 A.8: Total Variance Explained of RE 260 A.9: The Components and Their Respective Items 261 A10: The Internal Reliability for the CBTFD Construct 261 A.11: The mean and standard deviation for items measuring CBTIP 262 A.12: The KMO and Bartlett’s Test Score for CBTIP Construct 262 A.13: Total Variance Explained 263 A.14: The components and their respective items 263 A.15: The Internal Reliability for the Construct 264 A.16: The mean and standard deviation for items measuring FI 264 A.17: The KMO and Bartlett’s Test Score for FI 265 A.18: Total Variance Explained for FI Construct 266 A.19: The components and their respective items 266 A.20: The Internal Reliability for the FI Construct 266 A.21: The mean and standard deviation for items measuring FCI 267 A.22: The KMO and Bartlett’s Test Score for FCI 267 A.23: Total Variance Explained 268 A.24: The components and their respective items 268 A.25: The Internal Reliability for the Construct 269 A.26: The mean and standard deviation for items measuring PV 269 A.27: The KMO and Bartlett’s Test Score for PV 269 xiv

A.28: Total Variance Explained 270 A.29: The components and their respective items 271 A.30: The Internal Reliability for the FI Construct 271 A.31: The mean and standard deviation for items measuring PVI 272 A.32: The KMO and Bartlett’s Test Score for PVI 272 A.33: Total Variance Explained 273 A.34: The Components and Their Respective Items 274 A.35: The Internal Reliability for the Construct 274 xv

LIST OF FIGURES Figure No Title Page 1.1 CBT 5 1.2 Stress and its Categories 7 2.1 Coping Summary 95 2.2 ABCX Model 110 2.3 CBT-Stress Conceptual Model 111 3.1 Quasi-Experimental Design Diagram 124 4.1 Analysis Chart 174 A.1 The Scree Plot shows three Components Emerged from the EFA Procedure 257 A.2 The Scree Plot shows three Components Emerged from the EFA Procedure 260 A.3 The Scree Plot shows one Component Emerged from the EFA Procedure 263 A.4 The Scree Plot shows one Component Emerged from the EFA Procedure 265 A.5 The Scree Plot shows one Component Emerged from the EFA Procedure 268 A.6 The Scree Plot shows one Component Emerged from the EFA Procedure 270 A.7 The Scree Plot shows one Component Emerged from the EFA Procedure 273 xvi

CHAPTER 1 INTRODUCTION 1.1 Background of the Study Stress is a boundless marvel rotating all people all through their life expectancy. Each individual has encountered it since their commencement and humanity's history. Stress is one of the exceptional attributes of life and its quality has been quite featured, so much that it has been tended to in expressive arts and writing everything being equal. The purpose behind the augmenting nearness and comprehensiveness of worry in human networks is the intricacy of human social, individual, and natural conditions, numerous and synchronous cooperation’s of people with encompassing issues, and assorted variety in stress articulation (Patten, and Hoekstra, 2018). In psychological science, stress is an inclination of mental weight and strain. Low degrees of stress may be wanted, helpful, and even reliable. Stress, in its positive structure, can improve bio- psychosocial wellbeing and encourage execution. Besides, positive pressure is viewed as a significant factor in inspiration, adjustment, and response to the encompassing condition (Marwick, 2018). Nevertheless, elevated levels of stress could bring about psychological, biological, social issues, and even substantial damage to individuals. Stress might be either caused remotely with an ecological source or brought about by the inside view of the person. The last structure, thus, can create uneasiness, as well as other negative feelings and sentiments, for example, stress, torment, misery, and so on. These may bring about genuine mental issues, for example, post-traumatic stress disorder (PTSD). Studies in the field of official working and cognitive performance have explored the job of various factors in the change of amount and nature of such procedures. One of the significant 1

related factors in these studies is the role of weight on perception and higher cortical capacities. Stress is a Millennium-age issue and life is a summit of stress. However, the outer elements are not in its embodiment distressing and additionally compromising; yet the people's recognition frameworks translate them in that capacity. Stress activating variables, for example, unexpected and shocking occasions, or watching explicit kinds of items that look like serious incidents for people, might be translated as mental strains. People experience stress or see issues as compromising or risky at whatever point they have lacking assets to adapt to such hindrances (stimuli, individuals, circumstances, and so on.) (Tremellen, 2019). Regardless, high parenting stress is a pivotal ecological hazard variable. It has been related with many bothersome results, including guardian misery, conjugal clash, and less fortunate physical health, less fascinating parenting, and of most significance to the present study, expanded child conduct issues. Children with delays being developed are bound to live in family situations with elevated levels of parenting stress. Parents of children with delays commonly report more parenting stress than parents of regularly creating children. Even though there is some proof that the stress experienced by parents of children with formative deferrals can be constant, there is a stamped individual variety in its direction through a fantastic span (Galloway, Newman, Miller, and Yuill, 2019). Nonetheless, high parenting stress is a crucial environmental risk variable. It has been associated with numerous undesirable outcomes, including parent depression, marital conflict, and poorer physical health, less effective parenting and of most importance to the present study, increased child behaviour problems. Children with delays in 2

development are more likely to live in family environments with high levels of parenting stress. Parents of children with delays typically report more parenting stress than parents of typically developing children. Although there is some evidence that the stress experienced by parents of children with developmental delays can be chronic, there is a marked individual variation in its trajectory over the course of their life (Galloway, Newman, Miller, & Yuill, 2019) Though there is some proof to help a value-based connection between parenting stress and child behavioural issues, not very many studies have inspected this relationship even in groups of children with regular subjective improvement. A few investigations of children with formative deferrals have discovered that the conduct issues intervened the connection between child improvement and parenting stress. In these investigations, when the child behavioural issues were presented, there was never again a critical connection between child psychological deferral and parenting stress. Furthermore, controlled longitudinal studies have recommended that the connection between conducting issues and parenting stress is bidirectional and that numerous heights in behavioural issues can prompt an expansion in parenting stress after some time. High parenting stress prompts increment in behavioural issues in children and grown-ups (Knight, Albright, Huth-Bocks, Morris, Mills, Klok, and Drayton, 2019). Conversely, there is little information about the directions of conduct issues and parenting stress crosswise over time, and as far as anyone is concerned, no investigation had analyzed the relationship among these directions over various time focuses. Besides, past studies have tried every direction of impact (early behavioural issues to later parenting stress and early parenting stress to conduct issues independently rather than examining models where both directions of effect tested simultaneously. 3

Therefore, cognitive behaviours have been very helpful in introspecting different forms of depression, anxiety, and stresses. It refers to the Cognitive Behavioural Therapy (CBT), which includes the culmination of several forms of behavioural and pre-listed approaches that are borrowed from some principles (Dorter, 2016). It yields positivity in terms of results through multiplying conditions, reflecting internal and external environmental influences among other principles. Stress and other forms of depression have been managed through different forms of therapies (McCubbin et al., 1980; McCubbin & Patterson, 1983; Thoits, 1995). The other forms of depression include the Post-Partum depression, emotional and mood swings, genetic and biological affiliated issues, actions and behavioural disorders. Hence, CBT is mostly driven by feelings, thoughts, and behaviours as presented in Figure 1.1 (Dorter, 2016). From the categorisation, each theme reflects some features which include thoughts, beliefs, and self-talk as cognition. Actions determining behavioural disposition are also guided by emotions and psychological attributes of genetics among others. The acceptance of this approach has been successfully used in contending with large psychological stresses such as mothers' stress reflected through Post-Partum depression and depression due to a child's non-motility or disabilities. 4

Figure 1.1 CBT (Dorter, 2016) Child upbringing is one of the most sacred gifts and a tasking endeavour that every parent face (Ayón, 2016, Ireland, 2016). Attributing the relationships and emotions of raising a child can be stress-driven most times, but dissociating the cons from the blessings, it is most rewarding (Hazel, 2019). If these children are the poorest of the poor, so too are their mothers. A few decades ago, developmental scholars and practitioners had become increasingly aware of the fact that women play a crucial role in a country’s development. Although they are often poorer than men and more deprived in terms of education and health care, women hold the keys to the future, as they are primarily responsible for bringing up the next generation. Indeed, studies have shown that mothers invest more of their energy and resources (including more of their disposable income) than fathers to ensure their children’s wellbeing. They are also primarily responsible for transmitting positive values and behaviours to their children (Collado, Staats, & Sancho, 2019). If developmental funds and initiatives can be increased towards advancing the education 5

and health-care for women. Income-generating schemes, integration into the economic mainstream, and women’s freedoms and rights will strongly benefit their children. Indeed, studies have shown that the healthier and more educated a mother is, the more she will be able to make informed and healthy decisions for her children (and she will pass what she had learned to the next generation). Therefore, mothers help to pull their children out of poverty, reducing the country’s poverty in the long run (Hakovirta, Skinner, Hiilamo, & Jokela, 2020). However, the task of raising children with disabilities brings great stress and uncommon changes. According to the submission by Hill (1949), raising children with such disabilities affects parenting in regards to their psychological, emotional, physical, and financial stress due to medications and medical consultations (Kayama, Haight, Lee, & Ku, 2019). Having a child with significant disabilities often lead mothers to experience multiple dimensions of poverty, causing them to go deeper into poverty, and increase the likeliness that they will never escape impoverished lives (Park et al, 2002). Besides, mothers are not only expected to be the primary caregiver for the child with a disability, they also have to fulfil their other roles such as being a wife and a mother (i.e., bringing up other children, taking care of extended relatives, finding additional income, etc.). In addition, many women have to face the stigma, myths, and stereotypes that accompany disabilities in many developing countries and one can see that such women lead challenging lives (Edwardraj et al., 2010). It is important to make sure that their voices are being heard and their needs are being catered. Hence, this research will focus on 6

their unique experiences, needs and opinions, and what can be done to help reduce their poverty. Figure 1.2. Stress and its Categories (Edwardraj et al., 2010) Stress has been termed and studied as one of the delicate domains for family stability and the aspects of emotional state and personal state that drives the well-being of an individual's psychology (see Figure 2). Stress can be referred to as a state of the body that responds uncontrollably towards stimulation, pain or emotions related to fear and anxiety. Therefore, stress is seen as a challenge that is mapped to other forms of issues within families, workplaces and schools alike. According to the WHO statistics in 2011 and (WHO, 2016), a large portion of the global population suffers at least one form of disability. For example, interns causing stress to their managers. It has been estimated that out of the approximate 7 billion population of the entire world, nearly a billion individuals are living with disabilities (WHO, 2016). These factors range from physical, 7

emotional, accidental and natural-born disabilities. With such magnitude, children and adolescents make up about 200 million of the said population. The large percentage makes up around 10% of the entire youths in the world today. In another study by UNICEF (2007), about 80% of the reported disabilities are from developing countries and attributed towards a particular age range between 0-14. However, with these large reports and summing the high number of children with disabilities, mothers have been identified to be the ones on the receiving end. The effect of this disability creates stress, nagging, temperaments and other forms of stress (McQuillan, & Bates, 2017). Mothers' bond through birth and nurturing of their children makes stress their embodiment. Recently, cerebral palsy (CP) is a form of disability that affects the motor and cognitive functioning of the children by the non-progressive development of the motor neurons and other brain functions (Brossard-Racine et al., 2015). It is defined as \"a non-progressive motor impairment syndrome caused by a problem in the developing brain\" This is one of the most common disabilities found in newly born children, according to (Stanley, Blair, & Alberman, 2000). Families' perception of children with disabilities is stressfully characterised as a form of bearing both external and internal resource expenditures (Koa Whittingham et al., 2014). Therefore, mothers need to adapt to a regime of behavioural endeavours to curtail the excessive outbursts of stress in the whole family (Koa Whittingham et al., 2014). Therefore, coping with this stress is to deal with a large build-up of tension that affects the overall psychology, emotional trauma, and physical residuum. 8

However, stress has been studied and analysed as one of the major forms of depression. As was mentioned earlier, stress could come in the form of family instigation, personal or collective, age-dependent, gender-driven, beliefs, and emotions. This study attempts to devise a cognitive-behavioural mentoring therapy for mothers of children suffering from cerebral palsy and other related forms of disabilities. In this study, the stress model by Hill is extended through new variables such as religiosity, support from the father, family population and upbringing to derive an acceptable rate of stress mitigation suffered by mothers. It has been studied that a greater percentage of maintaining family unity lies in mothers. Therefore, the study is significantly helpful in actualising the entire family's psychological and emotional balance. 1.2 Research Problems Behavioural mentoring exercises have been progressively used to deal with the mental psychology of individuals. However, mothers have been negatively perceived in the community and society as an influence to some of the attitudes displayed by their children. Families with member disabilities are stressed and tend to be financially adverse than the non-affected families according to (Dyson, 1993). Recent studies have examined the effects on mothers and family members on children with mental retardation, lowered syndromes or down syndromes, cerebral palsy (CP) as a cause of depression. Coping with the children has been connoted as having declining effects as the ages of the disabled grows. Thus, this is a problem that could affect the entire family environment, especially the financial state and emotional balance of the mothers. 9

Therefore, investigating the methods of cognitive-behavioural mentoring of these affected children in a wider perspective such as religiosity, family member tolerance, and male to female emotional concern to cater to the needs of the children with CP is important. Studies by (Lin et al., 2011) explained a home-based therapy against dose- matched intervention for children living with CP. A number of researchers had examined the relationships and methods of managing stress among mothers of disabled children with a wide distinction (Barrett, & Fleming, 2011; Da Paz, & Wallander, 2017; Benson, 2018). Also, the religious contribution to mitigate stress on mothers of children with disabilities has been less studied. Coping forms such as social, positive coping and parental coping with the inculcation of religious factors can benefit and lessen the stress on mothers (DePasquale, et al., 2017). In this developing world, instead of adding an abundance of field studies on the topic considering that no one has made a comparison on the existing studies, the main objective of the research is more crucial to be focused on. The overall objective is to increase the knowledge and understanding of these mothers’ situations to realise the implication of raising a child with moderate to severe disabilities by looking across cultures at the commonalities and trends in their lives and experiences. This is a means towards a more focused developmental efforts to cater to the mothers’ greatest need. Hopefully, the efforts can help alleviate the poverty of these mothers who often hold the least social power in the developing world. Children and adolescents under the age of 18 who provide care, assistance or support for one or more chronically ill family members are called young carers (Feldstein, et al., 2020). According to a former comprehensive review, these children provide help 10

and care at any age, and the amount of their tasks increases with age. There is a wide range of young carers’ duties described in the literature. They become involved in all areas of housekeeping and care; in summary it can be stated that they do the same as adult informal carers (Duanet al., 2020). However, a common categorical system could not be identified, which makes comparison between study findings difficult. The extent of their help varies and depends on many factors, i.e. the severity of the chronic illness, family constellation, the family’s economic and emotional deprivation, lack of outside support and the process of being socialized into care. More than half of young carers live with single mothers who predominately suffer from chronic somatic diseases. Positive as well as negative effects are described in the literature: young carers show an increased sense of self-esteem, early maturity, a close relationship towards their parents and some feel well prepared for life. Negative impact relates to the children’s physical, psychosocial and educational situation and further development (Stiglic, & Viner, 2019). Cerebral palsy (CP) is a non-progressive impairment in the developing brain that encompasses a group of movement, sensation, cognition, communication, and perception disorders, as well as emotional and behavioral problems (). The primary impairments in CP increase the vulnerability to secondary impairments and functional losses, which may result in decreased functional independence and social participation (Whitney, et al., 2019). In Jordan, the incidence of CP is higher than the incidence reported in North America and Europe (Celdir, et al., 2020). However, to date, there is no information on the characteristics of children with CP or on services for this population. These information 11

are essential to understand the needs for this population and thus for planning and delivery of high-quality care. Parents of children with disabilities are more likely to experience depression and distress (Fritz, & Sewell-Roberts, 2020; Osborn, Roberts, & Kneebone, 2020) emotional distress and cognitive problems and significantly poorer physical and mental health than the general population, women more so than men. One study has shown that mothers of children with cerebral palsy exhibited more neuroticism, perceived less family cohesion and expressed poorer quality of married life and greater need for social support than others. Perceived stress and social support significantly predict well-being in mothers of school-aged children with cerebral palsy (Lim, et al., 2020). It has also been confirmed that mothers of children with cerebral palsy experienced poorer quality of life than those with unaffected children (Ku, & Rhodes, 2020). The common determinants of need for such families have been identified, including access to services, care processes and family relationships. Additional factors relating to specific needs included the adaptive behaviour of the child, gross motor function, communication ability and family income. Clearly, the picture of need can be complex, requiring sophisticated responses from supporting agencies, including nursing, psychology, physiotherapy and occupational therapy. Disability problems such as CP usually escalate and it induces a stress to the family which requires interventions. Consequently, the stress on the mother translates to other forms of issues such as the lack of family stability and poor life quality. The awareness through religious outlets about children born with CP will go a long way in curtailing the aforementioned challenges. Devising cognitive behavioural influences for mothers 12

of children who is suffering from CP generate awareness pertaining stress and will unanimously improve the general wellness of the society, and ultimately policy setters in any country. Many previous studies conducted in other part in the world and Jordan in particular (Naeem, Arif, Asghar, and Mahmood, 2018; Hashem, and El Aziz, 2018; Dim, Edwards, and Gibbons, 2018; Ellery et al. 2018; Mohamed Mandy and Aranda, 2019; Kuschmann and Lowit, 2019; Dieleman, Van Vlaenderen, Prinzie, and De Pauw, 2019; Silva, and de Araujo, 2019; Kriti, Pradhan, and Tufel 2019). However, none of the above mentioned studied examined the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy post- evaluation Hence, this current study filled the gap created by the previous studies by investing the moderating effect of social support on the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy post- evaluation. This study applied quasi experiment (pre-distribution of questionnaires, post-distribution of questionnaires, as well as the immediate distribution of questionnaires) in Jordan 1.3 Research Objectives The main objectives of this study are to determine the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy post- evaluation. The following are the specific research objectives: 13

i. To examine the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child among mothers of children with Cerebral Palsy ii. To investigate the relationship between the Behavioural Cognitive Mentoring Program in reducing concern for the future of the child and the feelings of despair and frustration among mothers of children with Cerebral Palsy iii. To determine the significant relationship between the Behavioural Cognitive Mentoring Program and the child's independent performance among mothers iv. To examine the influence/the contributions of behavioural cognitive mentoring Program and the social support in reducing the feelings among mothers in post evaluation through (social support) v. To investigate the ways/strategy concern in reducing the psychological stress among mothers of children with Cerebral Palsy for the future 1.4 Research Questions The research questions in line with the research objectives are: i. What is the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child among mothers of children with Cerebral Palsy in pre and post evaluation? ii. What is the relationship between the Behavioural Cognitive Mentoring Program in reducing concern for the future of the child and the feelings of despair and frustration among mothers of children with Cerebral Palsy in pre and post evaluation? 14

iii. Is there any significant relationship between the Behavioural Cognitive Mentoring Program AND the child's independent performance among mothers in pre and post evaluation? iv. Is there any influence of behavioural cognitive mentoring Program and the social support in reducing the feelings of stress among mothers in pre and post evaluation through the social support? v. What is the strategy concern in reducing the psychological stress among mothers of children with Cerebral Palsy for the future? 1.5 Research Hypothesis The null hypotheses were presented as follow: H01: There is no significant effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child among mothers of children with Cerebral Palsy in post evaluation H02: There is a no significant relationship between the Behavioural Cognitive Mentoring Program in reducing concern for the future of the child and the feelings of despair and frustration among mothers of children with Cerebral Palsy in post evaluation H03: There is no significance relationship between the Behavioural Cognitive Mentoring Program and the child's independent performance among mothers in post evaluation H04: There is no significant influence/contribution of Behavioural Cognitive Mentoring Program and the social support in reducing the feelings among mothers in post evaluation through moderators (social support) H05: There is no way/strategy concerned in reducing the psychological stress among mothers of children with Cerebral Palsy for the future 15

The alternative hypotheses are as follow: H1: There is a significant effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child among mothers of children with Cerebral Palsy in post evaluation H2: There is a significant relationship between the Behavioural Cognitive Mentoring Program in reducing concern for the future of the child and the feelings of despair and frustration among mothers of children with Cerebral Palsy in post evaluation? H3: There is a significance relationship between the Behavioural Cognitive Mentoring Program and the child's independent performance among mothers in post evaluation H4: There is a significant influence/contribution of Behavioural Cognitive Mentoring Program and the social support in reducing the feelings among mothers in post evaluation through moderators (social support) H5: There is a way/strategy concerned in reducing the psychological stress among mothers of children with Cerebral Palsy for the future 1.6 Significance of the study This study contributes towards the theory, practice, empirical and policy. Theoretically, the study considers the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. This study had contributed distinctively to the knowledge on the theory, especially since the study focuses on Jordan. Conversely, this theoretical contribution is also significant due to the lack of insights on the concepts. Therefore, this study had contributed to the theoretical understanding on the effectiveness of the Behavioural Cognitive Mentoring Program in reducing 16

cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. Similarly, the results of the study can motivate researchers for future studies on in-depth involvement in the process. Furthermore, the theoretical implications of this study were based on the conceptualization and operationalization of the main research constructs. The Man- Whitney U Analysis offered support for the statistical effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. Finally, the major findings of this study suggested that it would be imperative for Jordanian mothers of children with Cerebral Palsy in post-evaluation to make a good effort in the implementation of CBT to continue addressing the cognitive and psychological problems of the child's independent performance. Therefore, the study has a substantial capacity for the government to provide more precise applications related to mothers. Moreover, this study provided empirical evidence on the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. The findings of this study reflected the existing empirical evidence in this field and filled the research gap specifically in the cognitive and psychological literature by focusing on areas that are not covered such as the effectiveness of the Behavioural Cognitive Mentoring Program in reducing cognitive and psychological problems of the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. 17

Furthermore, the practical contribution of this study and the significance of its policy lies in the context of defining the strategy in relation to the child's independent performance among mothers of children with Cerebral Palsy in post-evaluation. This study seeks to validate the following constructs of the study. Also, this study offered insights for the Jordan government at the State and Federal levels considering the scarcity of research in Jordan, as shown in the existing literature. Significantly, the results from this study imposed far-reaching implications for all mothers, government, and psychologist in other parts of the world. 1.7 Limitation of the Study However, the present study is not without some limitations. The first limitation was that, even though there are so many variables with respect to the cognitive behavioural management problems that can be addressed, this study is limited to only mothers of children who are suffering from Cerebral Palsy, stress , positive problem orientation, rational problem skill, negative problem orientation, impulsive-careless skill and coping. Another limitation would be the data collection which is obtained in only one state in Jordan particularly in Irbid, which made generalisation of data difficult. Similarly, this study shall explore the correlational questionnaire approach in the nature of the analysis. The approach involves data collection that will last in a span of almost four months which can be considered as a short period due to limited resources and time. The study employed convenience sampling, disregarding random sampling. Additionally, this study is limited by the small sample size due to the fact that there are limited number of mothers with children in (Irbid-Jordan). The accessibility to this kind of sample could prove to be difficult as previously indicated by (Dennis & Callahan, 2012; Fonte et al., 2005). Also, it can be mentioned that sometimes the cases are not as 18

paramount as the intended research would want. This may affect the generalisation of the study findings. Another foreseen major limitation is the fact that the Jordan populace have almost the same cultural heritage and religious practice as Islam. Therefore, the Muslim women should conceal some of the information pertaining their family background, principles and norms. Other religious faith may have little to contribute, thus the findings may not be generalised easily to reflect all mothers of children suffering from CP. Despite all these shortcomings, this study aims to examine the relationship between mothers and children with CP as it relates to stress, coping and managing using the CBT. 1.8 Operational Definition of Terms 1.8.1 Cerebral Palsy Cerebral Palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles (Cappellini, et al., 2020). 1.8.2 Behavioural Cognitive Mentoring Cognitive Behaviour approach fundamentally rooted in motivating self-analysis believes one prerequisite for personal effectiveness is enhanced self-awareness. Johari Window, developed by Luft and Ingham (Luft, 1973) is a popular model for self- awareness, which is widely used. It focuses on two key dimensions for understanding the self: first is features of a person’s behaviour and mode that are known to him (self) and second feature is of his behaviour that are known to those with whom he interacts (Others) (Junker, Pömmer, & Traut-Mattausch, 2020). 19

1.8.3 Psychological Stress Psychological stress is a popular term denoting processes believed to contribute to a variety of mental and physical conditions. Psychological Stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be desired, beneficial, and even healthy. Positive stress helps improve athletic performance (Xu, Lee, Zhang, & Frenette, 2020). 1.8.4 Social Support Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. Government-provided social support may be referred to as public aid in some nations (Molinillo, Anaya-Sánchez, & Liebana-Cabanillas, 2020). 1.8 Organization of the Study This study is organized based on a quasi-experiment method, categorized into five chapters. Chapter one contained the introduction, background of the study, motivation of the study which addresses the problem statement of the study, objectives and questions of the study as well as the hypotheses for this study. This is followed by the significance of the study, limitation of the study, operational definition of terms organization of the study and finally the chapter summary. Chapter two provides the discussion on the basic concepts of the Behavioural Cognitive Mentoring Program, Cerebral Palsy and stress. This is followed by the empirical research related to the Behavioural Cognitive Mentoring Program, the psychological stress among mothers of children with Cerebral Palsy, cognitive and psychological problems of the child, feelings of despair and frustration, concern for the future of the 20

child, the problem of the child's independent performance as well as social support. In addition, the chapter has presented the model and theories used in the study. Finally, the chapter presented the summary of the whole chapter. Chapter three focused on the research methodology of this study which includes the research design, sample and data collection, unit of analysis, method of data collection, operational definition and measurement of variables. Chapter four focused on the research findings and discussion. Chapter five elucidated on the overview of the study and a conclusion is drawn. Lastly, the chapter explains the contribution of the study towards future research and recommendations. 1.9 Chapter Summary The chapter generally introduced and laid the foundation for the thesis. Hence, the research tackles the issues of stress suffered by mothers of the children born with disabilities and issues of Cerebral Palsy (CP). The objectives of the study were meticulously explained linked with the related research scope. Lastly, the issues surrounding the topic were discussed and fully introduced. 21

CHAPTER 2 LITERATURE REVIEW 2.1 Introduction This chapter presents the reviews of related literature in the study. It discusses several theoretical approaches adopted as a guiding framework to the present study; these theoretical approaches are Behaviourism Theory, Constructivism, Cognitive Behavioural Theory and Social Problem-Solving Theory. In addition, the study presents related theories, concepts, and paradigms to the study including Cerebral Pal, Stress, Parental Stress, Distress and Eustress, Family Stress, Prevalence of Stress in mothers of children with CP, Causes of Stress in mothers of children with CP, and Stress Management in mothers of children with CP. Finally, the study explains on other empirical studies relevant to the present research. 2.2 Theoretical Framework The present study was based on five theories which are Behaviourism theory, Structural Learning theory, Constructivism theory, Cognitive Behavioural theory and Social Problem-Solving theory. These theories are presented below: 2.2.1 Behaviourism Theory The Behaviourism theories of learning famously emerged in the 1930s and are most popularly linked with its proponent Ivan Pavlov, James Watson, B.F. Skinner and Thorndike. In the 1960s and 70s, discussion on Behaviourism stayed a dominant theoretical view and can still be seen in several behavioural modification programs as well as everyday exercise (Nagowah, & Nagowah, 2009). By definition, Behaviourism is a theory of learning focusing on observable behaviours and discounting any mental 22

activity. Learning is simply defined as the acquisition of new behaviour. Behaviourists claimed that this method of learning is known as ‘conditioning’. Two different types of conditioning are described and demonstrated as viable explanations of the way in which animals and humans alike can be ‘taught’ to do certain things. First there was the classic conditioning which involved the reinforcement of a natural reflex or the occurrence of some other behaviour which acts as a response to a particular stimulus, a well-known example of this type of conditioning (Saari, 2019). The second type of conditioning is ‘operant conditioning’. Operant conditioning is the most important type of behaviourist learning. It is more flexible in its nature than the classic conditioning and therefore seen as potentially more powerful. It involves reinforcing a behaviour by rewarding it. It can also work in a negative way when an undesirable behaviour can be discouraged by treating it with punishment of some form (Saari, 2019). B.F Skinner, a renowned and influential scholar has defined the concept of radical behaviourism. A philosophy that codifies the basis of this school of research is known as (the Experimental Analysis of Behaviour). While the Experimental Analysis of Behaviour varies from other ways towards behavioural research on various theoretical and methodological points, radical behaviourism stemmed from the methodological behaviourism except several aspects such as the treatment of feelings, scientific treatment, existing introspection, and states of mind. It can be described as a result of the identification placed on them as something that is non-dualistic. However, Skinner continued with a divide-and-conquer method through some case with psychological conditions or behaviour and other researchers can delve deeper into an extended 'analysis' regarding behaviour. Sometime later, radical behaviourism does not identify feelings as the cause of the behaviour. 23

Some of the points that Skinner raised include defending of a scientific behaviour not as a complementary aspect but independent of physiology and a rejection of reflex and response as a model of all behaviours. Behaviourism is a form of materialism, denying any independent significance for the mind. Its importance for psychological treatment has been very fruitful, making it one of the pillars of pharmacological therapy. Generally, behaviourism could be seen as a psychological approach based on the premise that behaviour can be researched scientifically without the need to delve and recourse towards inner mental states. Some of the assumptions of behaviourist’s thoughts include; free-will is illusionary, and also all behaviours could be determined by the environment either through association or reinforcement. According to these theories, the environment for learning is the determining factor. Learning is viewed as the conditioned response towards external stimuli. Rewards and punishments, or at least the withholding of rewards, are powerful ways of forming or extinguishing habits. Praising may be an instance of the reward system. These theories also viewed that complex wholes are disassembled out of specific parts so learning can be best accomplished when complex performances are deconstructed and when each element is practised, reinforced, and subsequently built upon. These theories have no concept of mind, intelligence, and ego; there is ‘no ghost in the machine’. This is not necessarily to say that theorists deny the existence of human consciousness but the idea of explaining learning through that discussion is not necessary since only observable behaviour are a common, sufficient interest. From this perspective, the achievement in learning is often equated with the accumulation of skills and the memorisation of 24

information (facts) in a given domain, demonstrated in the formation of habits that allow speedy performance (Fletcher, 2016). In line with the behaviourism theory, the present study emphasises the mothers’ experiences in learning, which was the main phenomenon that the research is concerned with and could be constructed as knowledge through interpretation and reflection upon them. The process of understanding the children’s experiences rely upon several factors such as their motivation, their feelings like anxiety or apprehension in using e-resources like Edmodo, Penzu, blogs and other similar tools used to facilitate teaching and learning in an online context. My beliefs about the world and how knowledge is constructed are reflected in a research paradigm which is referred to as constructivism. This paradigm is also called a naturalistic or interpretive paradigm (Nagowah, & Nagowah, 2009). The behaviourist school of thought ran concurrently with the psychoanalysis movement in psychology in the 20th century. The most impactful proponent includes; Pawesty, (2012) who rejected Ivan Pavlov’s introspective methods that investigated classical conditioning and sought to restrict psychology to experimental laboratory methods. Meanwhile, B. F. Skinner tried to give ethical grounding to behaviourism, relating it to pragmatism. Furthermore, the present study is concerned with the behaviourism theory in investigating the change of behaviour among the mother’s experience prior and after implementing the intervention Program. Behaviourism focuses more on behaviour than thinking, knowing, or feeling. It centered on the observable and objective factors of behaviour. The behaviourist theories all share some version of stimulus-response mechanisms for learning. John B. Watson (an American psychologist), originator of 25

behaviourism was not concerned with the human consciousness and the mind but rather held the view that psychology should only concern itself with the study of behaviour. Eminently, he also considered that human beings could be studied objectively, like apes and rats. This is based on Ivan Pavlov’s experiments of classical conditioning. However, behaviourism is nowadays prominently associated with B.F. Skinner, who made his fame by testing Watson's theories in the laboratory. Skinner ultimately rejected Watson's almost exclusive emphasis on reflexes and conditioning. Skinner believed that people respond to their environment but they also operate within the environment to produce certain consequences. Thus, they participate in a feedback loop as an important part of a larger system. Hence, Skinner further developed the theory of \"operant conditioning”, the idea that we behave the way we do because this specific behaviour has had certain consequences in the past. 2.2.2 Structural Learning Theory (SLT) Structural Learning Theory (SLT) is a deterministic theory conceived by Scandura in 1973 that deals with the intellectual competency of individuals and proposes that the competence underlying any particular problem in domain can be represented in terms of finite sets of rules (Scandura, 2001). The motivation for SLT stemmed from instructional considerations in both the classroom and non-school settings. The primary focus of the theory is for problem-solving instruction (Scandura, 2001). Scandura has applied the theoretical framework to the development of authoring tools and software engineering. Structural Learning Theory is a cognitively oriented model that combines the learning theories, instructional theories, and instructional-development procedures in algorithmic formats for an individual. 26

Sherwood, and Covin, (2008) claimed that Structural Learning Theory (SLT) is a cognitive oriented model combining learning theories, instructional theories, and instructional development procedures. SLT proposes that content should be taught in the form of rules, on the highest possible macro level. SLT further proposes the use of equivalence with the idea that mastery of any rule in a group should be taken as mastery of all rules within that group in designing instruction. It also requires the use of educational goals as initial inputs, determining prototypic cognitive processes to measure learning, and structural analysis to determine content. SLT has been applied in artificial intelligence with computer-assisted instruction and related areas. Nelson added that SLT help learners to develop their own background knowledge and encourages learner processing with a wide range of applicability and provides a process for the selection of lessons or topics from a body of knowledge as well as a method for optimal presentation of the instruction. In addition, Hale, Sharpe, and Haworth, (1996) asserted that Structural Learning Theory was based on the assumption that “behaviour is caused by rules, an underlying construct-in effect, that subjects actually do use rules” and that stimuli only provides the opportunity for responding. The two major postulation of this theory can be summarised as follows: first it is assumed that all behaviour is generated by rules and second, rules can be devised to account for all kinds of human behaviour. He further posited that Structural Learning Theory have particular implications for cognitive processing for the analysis and assessment of individual learner’s competence and for instructional design in terms of problem-solving capacity. Structural Learning Theory also assumes that \"working memory\" holds both rules and data (i.e., rules which do not act on other rules); the memory load associated with a task depends upon the rule(s) 27

used for the task at hand. Scandura markets his theory as the first to approach the understanding of human learning from a deterministic point of view as opposed to a probabilistic one. In other words, Scandura believes it is possible to identify the conditions under which human behaviour could be predicted and controlled with near certainty. SLT is also concerned with the content of human knowledge and the cognitive processes associated with learning in an attempt to account for individual differences and competence. It dealt with how people discover and utilise structure in the activities that they perform. In this sense, structure is not intended to represent something objectively existing in the real world, but rather is viewed as a simplifying code an individual becomes aware of when evaluating something that initially appeared to be unstructured (Scandura, 2001). According to Structural Learning Theory, what is learned are rules which consist of a domain, range, and procedure, there are probably alternative set of rules for any given tasks. Problem-solving may be facilitated when higher order rules are used, i.e., rules that generate new rules. Higher order rules account for creative unanticipated outcomes as well as the ability to solve complex problems by making it possible to learn new rules (Scandura, 2001). Despite the diversity which presently exists in behavioural theorising, higher order rules accounting for creative behaviour as well as the ability to solve complex problems by making it possible to generate new rules with reference to probabilistic notions are all- pervasive. Even the support at the .05 significance level is often enough to elicit glee from most cognitive theorists. Considering Scandura Structural Learning Theory, the present study is underpinned by the fact which suggests that human behaviour could be 28

predicted and controlled as Scandura believes that theory building should occur under idealised conditions. 2.2.3 Constructivism Theory The constructivist belief systems that are discussed in this section involve the ontological question (what is there that can be known?), the epistemological question (What is the relationship of the knower to the known?), and the methodological question (What are the ways of finding out knowledge?) (Mills, Bonner, & Francis, 2006). Ghezeljeh, and Emami, (2009) distinguishes ‘Constructivism’ from ‘Constructionism’, he defines Constructionism as “the view that all knowledge, and therefore all meaningful reality as such, is contingent upon human practices, being constructed in and out of interaction between human beings and their world, and developed and transmitted within an essentially social context’. According to the constructivist belief, the knowledge is constructed by individuals through their effort to make sense of their experiences, and thus it requires them to recall their experiences through an interactive process. In the same vein, Taber, (2012) argued that a social reality “can be understood only from the standpoint of the individuals who are part of the ongoing action being investigated” (p.19). As a consequence, the construction is influenced by the researcher’s cultural and historical background, and inquiry is value-bound (Onuf, 2012). In Crotty’s interpretation of ‘Constructionism’, we are introduced to meaning as a whole, externally, in ‘Constructivism’ meaning is gradually built up, internally, as we are engaged more and more with the world of meaning. 29

2.2.4 Cognitive Behavioural Theory The Cognitive Behavioural Theory is researched and posited as one of the most critically and agreed model of depression and stress management. It is believed that negative and maladaptive thoughts accumulated by irrational or dysfunctional beliefs are the central phenomenon to stress. The decision to be discussed in this research is due to its wide reach ability and added holistic approach to depression. This has the vital incorporation of learning and behavioural ingredients towards cognitive theories (Whitfield, & Davidson, 2018; Robertson, 2019). It has recorded successes in the management of stress and depression evident from the past two centuries. The crises on stress management through depression were prominently described from the learning or cognitive behavioural models (Salkovskis, Forrester, & Richards, 1998). These models unanimously approached the problem of the over-generalised response of depressed persons towards aversive conditions. A study by (Rehm, 1977) viewed depression as a loss or lack of response and contingent positive reinforcement. He reemphasized that a person who has inadequate or lack reinforcement in his major part of life will result to dysphoria, decreased in behaviour, low self-esteem, and hopelessness which are the major depressive symptoms. Depressed persons as argued by Lewinsohn, experienced lower activity levels and have less pleasure from supposed pleasurable life events. They are unable to experience reinforcement and obtain less pleasure than the people without depression. Researchers in line with reinforcement contingencies indicated that daily mood is positively correlated with pleasant events and negatively correlated with unpleasant events (Glaser, 1978; Selye, 1975, 1976). Deficiency in social ability and skill 30

reinforcement also improved depression (Rehm, 1977). These relationships are congruent with the basic theoretical idea that loss or lack of reinforcement produces depression and this provides a rationale for increasing reinforcements as a major therapeutic effort to increase mood. Additionally, (Seligman, 1974), discussed on helplessness and explained the dimensions of overgeneralization in terms of a depressive attributional style leading to an inner, steady, and overall perception of helplessness as a result of unpleasant or adverse events. Depression according to Seligman, is due to learned helplessness and the perception of non-contingency between the individual’s behaviour and consequences. A great submission was made in (Beck, 1988) which proposed and defined depression with stress from the cognitive point of view. Beck believed that negative automatic thoughts due to irrational beliefs are the causes of depression. These thoughts include beliefs about the self, the world, and the future which leads to automatic negative thought patterns. Beck (1998) went on to assert that depression is linked with self-defeating beliefs. This is further described in Beck's cognitive triad, where she explained the reason of negative thoughts about the self, the world, and the future. However, the Cognitive Behavioural Theory is one of the highest influential models of depression which believed that negative and maladaptive thoughts generated by irrational or dysfunctional beliefs are the central phenomenon to depression. It is chosen in this research because of its holistic approach to understand depression that incorporated both learning, behaviour and cognitive theories (Beck, 1988). It has been documented that, for the past two centuries the phenomena of depression were prominently described from the learning or cognitive behavioural models (Rehm, 1985). Both the models unanimously approached the problem of the overgeneralized response 31

of the depressed person towards aversive conditions. Moreover, Rehm, (1977) proposed and defined depression from the cognitive point of view. Rehm believed that negative automatic thoughts due to irrational belief are the causes of depression. These thoughts include beliefs about the self, the world, and the future, and can lead towards automatic negative thought patterns (Whitfield, G., & Davidson, 2018). The study went on to assert that depression is linked with self- defeating beliefs. This is further described in the Beck's cognitive triad, where she explained the reason of negative thoughts about the self, the world and the future. A depressed person perceived life irrationally and negatively. The negative view of themselves, their life situation and their future lead them to overestimate the severity of the negative or fear events and underestimate the positive events or their ability to cope. Thus, these irrational thoughts may not correspond with the external situation or the actual reality. The individual in this condition misinterpreted and exaggerated physical symptoms and situation. The theory further argued that the disturbances in depression may be viewed in terms of interpreting experience in a negative way, viewing life as being filled with relentless defeat, burdens, obstacle or traumatic situation. The depressed person also perceives himself and ascribes his unpleasant experience to his fault and sees the future as in an irrational manner, while he viewed his current problems, defeat or trauma as persistent and consistently indefinite (Walters, 2017). Walters, (2017) after synthesizing a literature on depression asserted that the items associated with a depressed individual are pessimism, indecision, suicidal wishes, and week inhibition. Then, it is followed by physiological factors (such as anorexia, insomnia, and loss of libido), sense of worthlessness and self-derogation (example, 32

reproach, self-blame), hopelessness and suicidal thoughts (sadness, loneliness and desire to escape, hide or die, withdrawal, agitation, poor concentration, and nervousness). Stress has been the cornerstone of topic for the cognitive-behavioural models of depression (Stallard, 2019). These studies proposed the psychological cognitive vulnerabilities are responsible for the person susceptible to depression. In support of this assertion, Stallard, (2019) debated that if depression is considered in terms of range and the severity of the symptoms rather than the present signs and symptoms, then stress can be predicted as a result of delivery and child care which are the stressful life events predicted by the cognitive behavioural model. In a study was conducted among 170 mothers and pregnant women during the second trimester, three months after childbirth to determine the cognitive- behavioural factors in depression. Beck Depression Inventory measured the level of depression during pregnancy and postpartum period. Antepartum depression, attributional style, delivery stress, and stressful life events were found as cognitive vulnerability predictors towards stress which accounted for about 40% of the variance in the level of stress. On the other hand, the result indicated that the predictor variables like menstrual problems, parity, education and income did not account for the significant variance to the level of maternal stress. Another study was also carried out to examine the role of cognitive vulnerability factors and determining their effects on stress. Two cognitive constructs were tested in relation to stress which includes dysfunctional attitudes of Beck's cognitive model of depression and attributional style (the reformulated model of learned helplessness, Abramson, and 33