ACT Processes in Group Intervention for Mothers of Children with Autism Spectrum Disorder
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.
KeywordsAutism Spectrum Disorder Acceptance and Commitment Therapy Group intervention Mothers Psychological flexibility Values
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.
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.
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 was obtained from all individual participants included in the study.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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