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.

This is a preview of subscription content, log in to check access.


  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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  Google 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.

    Article  PubMed Central  Google 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.

    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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

  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.

  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.

  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    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.

    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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  Google Scholar 

Download references


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

Author information




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.

Corresponding author

Correspondence to Kenneth Fung.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fung, K., Lake, J., Steel, L. et al. ACT Processes in Group Intervention for Mothers of Children with Autism Spectrum Disorder. J Autism Dev Disord 48, 2740–2747 (2018).

Download citation


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