Abstract
This study is consisted of a randomized controlled trial with two groups using a pre‐test, post‐test, and follow‐up design to detect the effect of interventions based on Acceptance and Commitment Therapy (ACT) implemented with parents of children with special needs regarding parents’ levels of psychological inflexibility, depression, anxiety, stress, and caregiver burden. A total of 60 eligible parents were recruited and randomly assigned to the intervention and control group. The intervention group participated in ACT-based interventions consisting of 6 sessions. The control group, only participated in routine training sessions organized at the school. Data were analyzed using t-tests for independent and depedent samples, ANOVAs, and the Mann–Whitney U test. It was determined that the ACT-based interventions implemented with parents were effective in decreasing parents’ levels of psychological inflexibility, depression, anxiety, stress, and caregiver burden. These observed changes continued over time. The ACT-based interventions results showed that the interventions were effective and had positive effects on the mental states of parents with special needs children. Findings of this study add important knowledge about the effect of ACT-based intervention on psychological inflexibility, depression, anxiety, stress, and caregiver burden of parents with special needs children. Considering the findings, the present study provides both important and practical contributions to the current literature. It appears that ACT is effective for supporting the mental states of parents with children with special needs. Registration number: The study is registered at ClinicalTrials.gov NCT04307706.
Similar content being viewed by others
Data availability statement
The dataset generated and analyzed during the current study is available from the corresponding author on reasonable request.
References
Akça, F., & Özyürek, A. (2019). The distress toleration status, depression, anxiety and stress levels of parents who have normally developed children and who have intellectual disability children. Journal of History Culture and Art Research, 8(1), 15. https://doi.org/10.7596/taksad.v8i1.1787
Al-Krenawi, A., Graham, J. R., & Al Gharaibeh, F. (2011). The impact of intellectual disability, caregiver burden, family functioning, marital quality, and sense of coherence. Disability & Society, 26(2), 139–150. https://doi.org/10.1080/09687599.2011.543861
Asa, G. A., Fauk, N. K., Ward, P. R., Hawke, K., Crutzen, R., & Mwanri, L. (2021). Psychological, sociocultural and economic coping strategies of mothers or female caregivers of children with a disability in Belu district, Indonesia. PLOS ONE, 16(5), e0251274. https://doi.org/10.1371/journal.pone.0251274
A-Tjak, J. G. L., Morina, N., Topper, M., & Emmelkamp, P. M. G. (2018). A randomized controlled trial in routine clinical practice comparing acceptance and commitment therapy with cognitive behavioral therapy for the treatment of major depressive disorder. Psychotherapy and psychosomatics. https://doi.org/10.1159/000486807
Azeem, M. W., Dogar, I. A., Shah, S., Cheema, M. A., Asmat, A., Akbar, M., … Haider, I. I. (2013). Anxiety and depression among parents of children with intellectual disability in Pakistan. Journal of the Canadian Academy of Child and adolescent Psychiatry, 22(4), 290.
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
Broten, L. A. (2014). A brief acceptance and commitment therapy protocol for depression in an inpatient setting: an effectiveness study. Dissertation abstracts international: section B: the sciences and engineering dissertation abstracts international, 75(3-b(e)), No-Specified. Retrieved from http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/245/CN-01039245/frame.html
Byrne, G., Ghráda, Á. N., O’Mahony, T., & Brennan, E. (2021). A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychology and Psychotherapy: Theory, Research and Practice, 94(S2), e12282. https://doi.org/10.1111/papt.12282
Carlson, J. M., & Miller, P. A. (2017). Family burden, child disability, and the adjustment of mothers caring for children with epilepsy: Role of social support and coping. Epilepsy & Behavior, 68, 168–173. https://doi.org/10.1016/j.yebeh.2017.01.013
Chong, Y.-Y., Mak, Y.-W., Leung, S.-P., Lam, S.-Y., & Loke, A. Y. (2019). Acceptance and commitment therapy for parental management of childhood asthma: An RCT. Pediatrics, 143(2), e20181723. https://doi.org/10.1542/peds.2018-1723
Davies, J. E., & Nagi, C. E. (2017). Individual psychological therapies in forensic settings (J. Davies & C. Nagi Eds. 1st edn.). Routledge.
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
Ercan, F. Z., Kırlıoğlu, M., & Kalaycı Kırlıoğlu, H. İ. (2019). Engelli Çocuğa Sahip Ailelerin Bu Durumu Kabulleniş Süreçleri Ve Bu Duruma Dair Görüşleri. Sosyal Politika Çalışmaları Dergisi, 19(44), 597–628. https://doi.org/10.21560/spcd.v19i49119.459666
Eren, G., & Doğan, U. (2020). Zihinsel Engelli Çocuğa Sahip Babaların Stres Düzeyleri Ve Stresle Başa Çıkma Yöntemlerinin İncelenmesi: Karma Desenli Bir Çalışma. Yıldız Sosyal Bilimler Enstitüsü Dergisi, 4(1), 1–21.
Eyüboğlu, S. (2019). The role of psychological resilience and collectivist coping styles in predicting the depressive symptoms of parents having children with special needs. (Master), Trabzon University, Trabzon. Retrieved from http://acikerisim.trabzon.edu.tr/xmlui/handle/20.500.12598/378
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
Fung, K., Lake, J., Steel, L., Bryce, K., & Lunsky, Y. (2018). ACT processes in group intervention for mothers of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(8), 2740–2747. https://doi.org/10.1007/s10803-018-3525-x
Gould, E. R., Tarbox, J., & Coyne, L. (2018). Evaluating the effects of Acceptance and Commitment Training on the overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7, 81–88. https://doi.org/10.1016/j.jcbs.2017.06.003
Hahs, A. D., Dixon, M. R., & Paliliunas, D. (2018). Randomized controlled trial of a brief Acceptance and Commitment Training for parents of individuals diagnosed with autism spectrum disorders. Journal of Contextual Behavioral Science. https://doi.org/10.1016/j.jcbs.2018.03.002
Hamarta, E., & Özteke-Kozan, İ. (2019). Engelli Ergenlik: Engelli Çocuğa Sahip Annelerin Ergenliğe Bakışı ve Yaşadıkları Problemler. Elementary Education Online, 18(3), 977–989. https://doi.org/10.17051/ilkonline.2019.609600
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (R. Bernstein Ed. 2. ed.): New Harbinger Publications.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. https://doi.org/10.1016/S0005-7894(04)80013-3
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research & Therapy, 44(1), 1–25.
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. British Journal of Clinical Psychology, 44(2), 227–239.
Hodge, D., Hoffman, C. D., & Sweeney, D. P. (2011). Increased psychopathology in parents of children with autism: Genetic liability or burden of caregiving? Journal of Developmental and Physical Disabilities, 23(3), 227–239. https://doi.org/10.1007/s10882-010-9218-9
Holmberg Bergman, T., Renhorn, E., Berg, B., Lappalainen, P., Ghaderi, A., & Hirvikoski, T. (2022). Acceptance and Commitment Therapy Group intervention for parents of children with disabilities (navigator ACT): An open feasibility trial. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-022-05490-6
İnci, F. H., & Erdem, M. (2008). Bakım Verme Yükü Ölçeği’nin Türkçe’ye uyarlanması geçerlilik ve güvenilirliği. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, 11(4), 85–95.
Joekar, S., Farid, 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 Social Sciences, 2(4), 2763–2772.
Kaçan Softa, H. (2012). Engelli çocuğa sahip ebeveynlerin depresyon düzeylerinin incelenmesi. Kastamonu Eğitim Dergisi, 21(2), 589–600.
Kanbir, A. E. (2018). Engelli çocuğa sahip ailelerde evlilik doyumu: niteliksel bir çalışma. (Master dissertation), Maltepe Üniversitesi.
Karadağ, G. (2009). Engelli Çocuğa Sahip Annelerin Yaşadıkları Güçlükler ile Aileden Algıladıkları Sosyal Destek ve Umutsuzluk Düzeyleri. TAF Preventive Medicine Bulletin, 8(4), 315–322.
Karahan, A. Y., & İslam, S. (2013). Fiziksel engelli çocuk ve yaşlı hastalara bakım verme yükü üzerine bir karşılaştırma çalışması. Marmara Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 3(5), 1–7.
Köksal, G., & Kabasakal, Z. (2012). Zihinsel engelli çocuklari olan ebeveynlerin yaşamlarinda algiladiklari stresi yordayan faktörlerin incelenmesi. Dokuz Eylül Üniversitesi Buca Eğitim Fakültesi Dergisi (32), 71–91.
Kowalkowski, J. D. (2012). The impact of a group-based acceptance and commitment therapy intervention on parents of children diagnosed with an autism spectrum disorder. (Master's Theses and Doctoral Dissertations), Eastern Michigan University, Retrieved from https://books.google.com.tr/books?id=A6ERnQAACAAJ
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
Lunsky, Y., Fung, K., Lake, J., Steel, L., & Bryce, K. (2018). Evaluation of Acceptance and Commitment Therapy (ACT) for mothers of children and youth with autism spectrum disorder. Mindfulness, 9(4), 1110–1116. https://doi.org/10.1007/s12671-017-0846-3
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2017). Learning ACT: An acceptance and commitment therapy skills training manual for therapists (J. Star Ed. 2 ed.): New Harbinger Publications.
Maurer, F. A., & Smith, C. M. (2014). Community/public health nursing practice - e-book: Health for families and populations (F. A. Ed. 5 ed.): Elsevier Health Sciences.
McConachie, D. A. J., McKenzie, K., Morris, P. G., & Walley, R. M. (2014). Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities. Research in Developmental Disabilities, 35(6), 1216–1227. https://doi.org/10.1016/j.ridd.2014.03.005
Molander, P., Hesser, H., Weineland, S., Bergwall, K., Buck, S., Hansson-Malmlöf, J., … Andersson, G. (2015). Internet-based Acceptance and Commitment Therapy for psychological distress experienced by people with hearing problems: Study protocol for a randomized controlled trial. American Journal of Audiology, 24(3), 307–310. https://doi.org/10.1044/2015_AJA-15-0013
Montgomery, D. (2015). The Effects of Acceptance and Commitment Therapy on Parents of Children Diagnosed with Autism. (Doctoral Dissertation), Walden University.
Odabaş, Y. (2020). Evaluation of the effect of spiritual care given to mothers of children with disabilities on increasing spiritual well-being and hope levels. (Master), Zonguldak Bulent Ecevit University, Zonguldak. Retrieved from https://hdl.handle.net/20.500.12628/9339
Olzmann, A. E. (2017). Acceptance and commitment therapy components and their relationship with caregiver burden in primary caregivers of individuals with dementia. Xavier University, Retrieved from http://rave.ohiolink.edu/etdc/view?acc_num=xavier1493678269237335
Opoku, M. P., Nketsia, W., Banye, M. A., Mprah, W. K., Dogbe, J. A., & Badu, E. (2020). Caregiving experiences and expectations of parents with in-school children with intellectual disability in Ghana. Research in Developmental Disabilities, 96, 103524. https://doi.org/10.1016/j.ridd.2019.103524
Orak, O., & Sezgin, S. (2015). Kanser Hastasına Bakım Veren Aile Bireylerinin Bakım Verme Yüklerinin Belirlenmesi. Psikiyatri Hemşireliği Dergisi, 6(1), 33–39.
Özmen, D., & Çetinkaya, A. (2012). The problems experienced by families with disabled children. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, 28(3), 35–49.
Parmar, A., Esser, K., Barreira, L., Miller, D., Morinis, L., Chong, Y.-Y., … Orkin, J. (2021). Acceptance and commitment therapy for children with special health care needs and their parents: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(15), 8205.
Poddar, S., Sinha, V., & 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
Putra, I. P. G. Y. S., Hamdani, N., & Supriati, L. (2017). Influence of Acceptance and Commitment Therapy on the family’s burden in treating people with mental disorders. NurseLine Journal (2), 126–133%V 122. https://doi.org/10.19184/nlj.v2i2.5932
Sarpdağı, Y. (2018). Epilepsili Çocuğa Sahip Ebeveynlerin Bakim Yükü ve Umutsuzluk Düzeyinin İncelenmesi. (Yüksek Lisans), Atatürk, Sağlık Bilimleri Enstitüsü, Erzurum.
Sawyer Cohen, J. A., & Semple, R. J. (2010). Mindful parenting: A call for research. Journal of Child and Family Studies, 19(2), 145–151. https://doi.org/10.1007/s10826-009-9285-7
Schoon, P. M., Porta, C. M., & Schaffer, M. A. (2018). Population-based public health clinical manual: The Henry Street model for nurses, 3rd ed. Indianapolis: Sigma Theta Tau International Society of Nursing.
Takuri, B. S. (2014). Stress and coping mechanism among the parents of intellectual disable children. Journal of Advanced Academic Research, 1(2), 56–63.
Totsika, V., Hastings, R. P., Emerson, E., Lancaster, G. A., & Berridge, D. M. (2011). A population-based investigation of behavioural and emotional problems and maternal mental health: Associations with autism spectrum disorder and intellectual disability. Journal of Child Psychology and Psychiatry, 52(1), 91–99. https://doi.org/10.1111/j.1469-7610.2010.02295.x
Truglio-Londrigan, M., & Lewenson, S. B. (2017). Public health nursing: Practicing population-based care, 3rd ed. Jones and Bartlett Publishers.
Tura, G. (2017). Engelli çocuğu olan ve çocuğu engelli olmayan annelerin anksiyete, depresyon ve psikolojik sağlamlık düzeylerinin incelenmesi. Dicle Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 9(18), 30–36.
Vernhet, C., Dellapiazza, F., Blanc, N., Cousson-Gélie, F., Miot, S., Roeyers, H., & Baghdadli, A. (2019). Coping strategies of parents of children with autism spectrum disorder: A systematic review. European Child & Adolescent Psychiatry, 28(6), 747–758. https://doi.org/10.1007/s00787-018-1183-3
Weiss, J. A., Robinson, S., Fung, S., Tint, A., Chalmers, P., & Lunsky, Y. (2013). Family hardiness, social support, and self-efficacy in mothers of individuals with Autism Spectrum Disorders. Research in Autism Spectrum Disorders, 7(11), 1310–1317. https://doi.org/10.1016/j.rasd.2013.07.016
Whittingham, K., Sanders, M. R., McKinlay, L., & Boyd, R. N. (2013). Stepping stones triple p and acceptance and commitment therapy for parents of children with cerebral palsy: Trial protocol. Brain Impairment, 14(2), 270–280. https://doi.org/10.1017/BrImp.2013.19
Whittingham, K., Sanders, M. R., McKinlay, L., & Boyd, R. N. (2016). Parenting intervention combined with acceptance and commitment therapy: A trial with families of children with cerebral palsy. Journal of Pediatric Psychology, 41(5), 531–542. https://doi.org/10.1093/jpepsy/jsv118
Whittingham, K., Sanders, M. R., McKinlay, L., & Boyd, R. N. (2019). Parenting intervention combined with Acceptance and Commitment Therapy: Processes of change. Journal of Child and Family Studies, 28(6), 1673–1680. https://doi.org/10.1007/s10826-019-01386-9
World Health Organization. (2020). Depression. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/depression
Yavuz, F., Ulusoy, S., Iskin, M., Esen, F. B., Burhan, H. S., Karadere, M. E., & Yavuz, N. (2016). Turkish version of Acceptance and Action Questionnaire-II (AAQ-II): A reliability and validity analysis in clinical and non-clinical samples. Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 26(4), 397–408. https://doi.org/10.5455/bcp.20160223124107
Yılmaz, Ö., Boz, H., & Arslan, A. (2017). Depresyon anksiyete stres ölçeğinin(DASS-21) Türkçe kısa formunun geçerlilik güvenilirlik çalışması. Finans Ekonomi Ve Sosyal Araştırmalar Dergisi, 2(2), 78–91.
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
Funding
The research was supported by the Akdeniz University Scientific Research Projects Coordination Unit (Project ID number: TDK-2019–4588).
Author information
Authors and Affiliations
Contributions
EÇG: Project administration- project apply, Conceptualization, Methodology, Investigation, Implementation and interventions, Writing—original draft, Writing—review & editing. SÖ: Project administration, Conceptualization, Methodology, Review & editing, Supervision, Funding acquisition. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest has been declared by the authors.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Çiçek Gümüş, E., Öncel, S. Effects of Acceptance and Commitment Therapy-based interventions on the mental states of parents with special needs children: Randomized controlled trial. Curr Psychol 42, 19429–19442 (2023). https://doi.org/10.1007/s12144-022-03760-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-022-03760-1