Advertisement

Journal of Autism and Developmental Disorders

, Volume 48, Issue 8, pp 2740–2747 | Cite as

ACT Processes in Group Intervention for Mothers of Children with Autism Spectrum Disorder

  • Kenneth Fung
  • Johanna Lake
  • Lee Steel
  • Kelly Bryce
  • Yona Lunsky
Original Paper

Abstract

Few studies have examined interventions or therapeutic processes that may help parents of children with Autism Spectrum Disorder (ASD) manage their stress. This study examines the impact of a brief Acceptance and Commitment Therapy (ACT) group intervention, led by parents, among a cohort of 33 mothers of children with ASD. Changes in ACT process measures (psychological flexibility, cognitive fusion, values) were evaluated at pre, post, and 3 months following the intervention. Mothers reported significant improvement post-intervention in psychological flexibility, cognitive fusion, and value-consistent activities in multiple life domains, including parenting, relationships, and self-care. These improvements were maintained at follow-up. The results provide preliminary evidence that improvements observed in depression and stress may be mediated by cognitive fusion and action-values consistency.

Keywords

Autism Spectrum Disorder Acceptance and Commitment Therapy Group intervention Mothers Psychological flexibility Values 

Notes

Author Contributions

KF co-designed the study, designed and co-facilitated the intervention, co-led the data analyses, collaborated in the interpretation, and led the writing of this paper. JL collaborated with the design and assisted with the data collection, analysis, and interpretation and writing of the study. LS and KB collaborated with the design, co-facilitated the parent groups, and collaborated in the writing and editing of the final manuscript. YL co-designed and executed the study, co-led the data analyses, and collaborated in the writing and editing of the final manuscript.

Funding

This study was funded by Women’s College Hospital (Women’s Xchange 2015).

Compliance with Ethical Standards

Conflict of interest

All of the authors declare no conflict of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36.  https://doi.org/10.1159/000365764.CrossRefPubMedGoogle Scholar
  2. Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child & Family Behavior Therapy, 28(1), 1–18.  https://doi.org/10.1300/J019v28n01_01.CrossRefGoogle Scholar
  3. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K.,… Zettle, R. D. (2011). Preliminary psychometric properties of the acceptance and action questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688.  https://doi.org/10.1016/j.beth.2011.03.007.CrossRefPubMedGoogle Scholar
  4. Brassell, A. A., Rosenberg, E., Parent, J., Rough, J. N., Fondacaro, K., & Seehuus, M. (2016). Parent’s psychological flexibility: Associations with parenting and child psychosocial well-being. Journal of Contextual Behavioral Science, 5(2), 111–120.  https://doi.org/10.1016/j.jcbs.2016.03.001.CrossRefGoogle Scholar
  5. Cachia, R. L., Anderson, A., & Moore, D. W. (2015). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: A systematic review. Journal of Child and Family Studies, 25(1), 1–14.  https://doi.org/10.1007/s10826-015-0193-8.CrossRefGoogle Scholar
  6. Cederberg, J. T., Cernvall, M., Dahl, J., Essen, von, L., & Ljungman, G. (2015). Acceptance as a mediator for change in acceptance and commitment therapy for persons with chronic pain? International Journal of Behavioral Medicine, 23(1), 21–29.  https://doi.org/10.1016/S0005-7916(97)00005-0.CrossRefPubMedCentralGoogle Scholar
  7. Christensen, D. L., Baio, J., Van Naarden Braun, K., Bilder, D., Charles, J., Constantino, J. N.,… Yeargin-Allsopp, M. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years–autism and developmental disabilities monitoring network, 11 sites, United States, 2012. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 65(3), 1–23.  https://doi.org/10.15585/mmwr.ss6503a1.Google Scholar
  8. Creedon, P. S., & Hayes, A. (2015). Small sample mediation analysis: How far can we push the bootstrap? New York: Association for Psychological Science.Google Scholar
  9. Dabrowska, A., & Pisula, E. (2010). Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome. Journal of Intellectual Disability Research, 54(3), 266–280.  https://doi.org/10.1111/j.1365-2788.2010.01258.x.CrossRefPubMedGoogle Scholar
  10. Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014). Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics, 134(2), e454–e463.  https://doi.org/10.1542/peds.2013-3164.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism, 13(4), 375–387.  https://doi.org/10.1177/1362361309105658.CrossRefPubMedGoogle Scholar
  12. Frögéli, E., Djordjevic, A., Rudman, A., Livheim, F., & Gustavsson, P. (2016). A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses. Anxiety, Stress, and Coping, 29(2), 202–218.  https://doi.org/10.1080/10615806.2015.1025765.CrossRefPubMedGoogle Scholar
  13. Fung, K. P., Li, A., Wong, J., Kapac, J., Murray, J., Luyombya, H.,… Zurowski, M. (2011, November). Addressing HIV-related stigma: The possibilities in using acceptance commitment therapy (ACT). Paper presented at the OHTN Research Conference. Toronto, ON.Google Scholar
  14. Fung, K. P., & Wong, J. (2014). ACT to reduce stigma of mental illness: A group intervention training manual on acceptance and commitment therapy. Unpublished Manuscript, Strength in Unity. Toronto, ON.Google Scholar
  15. Fung, K. P., & Zurowski, M. (2008, May). ACT vs CBT groups for treatment of chronic pain in Toronto. Paper presented at the Acceptance and Commitment Therapy Summer Institute IV. Chicago, IL.Google Scholar
  16. Fung, K. P., & Zurowski, M. (2016). Chair sculpture of suffering exercise. In A. Peterkin & P. Brett-McLean (Eds.), Keeping reflection fresh: Top educators share their innovations in health professional education. Kent, OH: Kent State Press.Google Scholar
  17. Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L.,… Remington, B. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45(1), 83–101.  https://doi.org/10.1016/j.beth.2013.09.001.CrossRefPubMedGoogle Scholar
  18. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.  https://doi.org/10.1016/j.brat.2005.06.006.CrossRefPubMedGoogle Scholar
  19. Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press.Google Scholar
  20. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. The British Journal of Clinical Psychology, 44(Pt 2), 227–239.  https://doi.org/10.1348/014466505X29657.CrossRefPubMedGoogle Scholar
  21. Joekar, S., Farid, A. A. A., Birashk, B., Gharraee, B., & Mohammadian, M. (2016). Effectiveness of Acceptance and Commitment Therapy in the support of parents of children with high-functioning Autism. International Journal of Humanities and Cultural Studies 2(4), 2763–2772.Google Scholar
  22. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.  https://doi.org/10.1093/clipsy/bpg016.Google Scholar
  23. Lunsky, Y., Fung, K., Lake, J., Steel, L., & Bryce, K. (2017). Evaluation of acceptance and commitment therapy (ACT) for mothers of children and youth with autism spectrum disorder. Mindfulness.  https://doi.org/10.1007/s12671-017-0846-3.Google Scholar
  24. Lunsky, Y., Fung, K., & Zurowski, M. (2012). Acceptance and commitment therapy (ACT) for parents of youth with autism spectrum disorders: Preliminary findings. Journal of Intellectual Disability Research, 56(7–8), 743–748.Google Scholar
  25. MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614.  https://doi.org/10.1146/annurev.psych.58.110405.085542.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Montoya, A. K., & Hayes, A. F. (2017). Two-condition within-participant statistical mediation analysis: A path-analytic framework. Psychological Methods, 22(1), 6–27.  https://doi.org/10.1037/met0000086.CrossRefPubMedGoogle Scholar
  27. Poddar, S., Sinha, V. K., & Urbi, M. (2015). Acceptance and commitment therapy on parents of children and adolescents with autism spectrum disorders. International Journal of Educational and Psychological Researches, 1(3), 221–225.  https://doi.org/10.4103/2395-2296.158331.CrossRefGoogle Scholar
  28. Polk, K. L., & Schoendorff, B. (2014). The ACT matrix: A new approach to building psychological flexibility across settings & populations. Oakland: New Harbinger Publications.Google Scholar
  29. Ruiz, F. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125–162.Google Scholar
  30. Wilson, K., Sandoz, E., Kitchens, J., & Roberts, M. (2010). The valued living questionnaire: Defining and measuring valued action within a behavioral framework. Psychological Record, 60(2), 249–272.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Department of PsychiatryUHN - Toronto Western HospitalTorontoCanada
  3. 3.Adult Neurodevelopmental ServicesCentre for Addiction and Mental HealthTorontoCanada
  4. 4.Extend-A-Family TorontoTorontoCanada
  5. 5.Surrey Place CentreTorontoCanada

Personalised recommendations