The role of parental cry tolerance when using behavioural sleep interventions for paediatric insomnia

Author: Hannah Whittall

  • Thesis download: available for open access on 9 Dec 2025.

Whittall, Hannah, 2022 The role of parental cry tolerance when using behavioural sleep interventions for paediatric insomnia, Flinders University, College of Education, Psychology and Social Work

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Sleep problems in infancy are highly prevalent and extremely distressing for many families. Consequences of poor sleep not only affect the wellbeing of the infant, but also the wider family system. Interventions for infant sleep face rigorous debate, with the strongest evidence of treatment gains using behavioural sleep interventions (BSI). Despite this, a number of barriers exist for families implementing BSIs. This thesis aimed to better understand specific barriers that may impede the implementation of BSIs. Accordingly, Chapter 2 – a narrative review – aimed to consider theoretical barriers that may impact treatment implementation and considered solutions for a number of these barriers. Chapter 3 extended on this framework to consider whether theoretical barriers proposed in Chapter 2, contributed to willingness to use extinction-based sleep interventions. Findings of this study found evidence for two barriers described in the original model – parental depression and parental cry tolerance. Interestingly, this study highlighted the severity of the infant’s sleep problem was not a driving factor in willingness to use an extinction-based method.

Chapter 4 focused more specifically on the role of parental cry tolerance as a barrier to BSI implementation, and whether this was amenable to change. This study compared cry tolerance using a quasi-experimental approach with three participant groups – mothers of poor sleepers, mothers of good sleepers, and women without children. Three emotion regulation strategies were used as part of this study – music distraction, game distraction, and reappraisal. Inconsistent with previous research, we did not observe differences between each of these groups on their levels of cry tolerance. However, analyses revealed a significant interaction between cry tolerance and strategy, with mothers of poor sleeping infants, demonstrating higher cry tolerance using all three emotion-regulation strategies compared to control.

The final study (Chapter 5) aimed to determine whether the emotion-regulation strategies in Chapter 4, helped to reduce drop out and increase acceptability when implementing modified extinction. Data collection for this study was completed during the COVID-19 pandemic which significantly affected final participant sample size in an already challenging area of research, thus we presented a feasibility study rather than the intended RCT. This feasibility study showed that there were no significant differences between groups or parental cry tolerance in those who did and did not complete the intervention. Importantly, mothers who completed the intervention, rated it as highly acceptable.

Overall, the findings provide support for the role of parental cry tolerance as a barrier to BSI implementation. First, we determined that parental depression and low parental cry tolerance were characteristic of those unwilling to use extinction-based methods. Second, we found parental cry tolerance is amenable to change using all three emotion-regulation strategies in an experimental setting. Finally, using these emotion regulation strategies when implementing a BSI was highly acceptable, but it is not yet clear whether these strategies assist in reducing participant drop out. In the final chapter, theoretical, methodological and clinical implications of this thesis research are discussed, alongside limitations and future directions for research.

Keywords: Infant sleep, infant sleep problems, parental cry tolerance, emotional regulation

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Education, Psychology and Social Work
Supervisor: Associate Professor Lisa Beatty