Acceptance and Commitment Therapy for Stress Reduction in Caregivers of Children with ASD
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Acceptance and Commitment Therapy for Stress Reduction in Caregivers of Children with ASD
Empirical Literature for ACT
Studies have demonstrated the effectiveness of the Acceptance and Commitment Therapy (ACT) in managing stress among caregivers of ASD children. The ACT is concerned with the acceptance of some of the things in life that seems impossible to solve and the commitment towards changing the possible thing (Poddar, Sinha, & Urbi, 2015). Poddar and colleagues studied four indicators of stress among caregivers before and after enrolment into the ACT. The five parents were primary caregivers to children with ASD. They were monitored by assessment of five indicators of stress including depression, psychological flexibility, anxiety and their life quality. After the treatment, the levels of the different indicators were assessed pre and post the enrolment and reported a significant improvement after the ACT was administered (Poddar et al., 2015). Another study the evaluated the reduction in stress among caregivers for ASD adolescent showed that the caregivers who underwent training in mindfulness-based practices had reduced stress level. There was a statistically significant reduction in stress level among mothers who took the training to completion (Singh et al., 2014). The researchers explained the reduction in stress among mothers who took the training by the positive behaviour support model applied in training. The participants in the training learned how to engage their intuition and behavioural contingencies while taking care of their ASD children(Singh et al., 2014).
Applicability of ACT to Parents of children with ASD
Parents to children with ASD can potentially develop stress and associated disorders. Studies have shown that the application of ACT to these parents can help to reduce stress among these parents (Bluth, Roberson, Billen, & Sams, 2013). The ACT program can be applied to the parents of children with ASD in the form of a mindfulness intervention approach. The approach has been shown to help the parents to adapt to mindfulness-based stress reduction. For instance, parents can be trained on how to communicate mindfully to their children with ASD. This training enables the parents to adopt a friendly communication approach to their children. In turn, the parents get to explore and learn more about how to deal with their ASD children (Bluth et al., 2013). Gould, 2017 investigated the effects of the ACT to the parent of children with ASD. Can significantly improve the stress outcomes among these parents (Gould, Tarbox, & Coyne, 2017). The ACT is a behaviour training approach that can be applied to both the parents and caregivers of children who have ASD to enhance their adaptability to the situation of their children. A study by Robbins showed that this approach is easy to implement when applied to both the parents and the caregivers in cases where parents are not the primary caregivers (Robbins et al., 1991).
Treatment conceptualization of ACT for caregivers
The ultimate goal of ACT for caregivers is to impart a mindful change among the caregivers towards ASD children. The caregivers need to adopt a positive mindset towards the children with ASD for them to reduce mental engagements in the entire process of providing support to these children. Achieving this mindful change is the ultimate goal of the ACT (Hayes, Strosahl, & Wilson, 2009). The ACT method cannot achieve its intended purpose among the caregivers without consideration of the three critical components of psychological flexibility model. The variables of the model form the main target of the mindful change. Acceptance, willingness, and cognitive decision are essential in ensuring the success of ACT. Hayes reported that caregivers who embraced acceptance of the situations of the children with ASD showed a significant reduction in stress and were happier with their work. The willingness to accept the situation and remaining open-minded about the children with ASD have been shown to further improve stress outcomes among caregivers (S. A. Hayes & Watson, 2013). Cognitive diffusion has also been shown to support the caregivers’ acceptance willingness to help ASD children continually.
The ACT also targets to ensure continuous engagement of the present without making pre-judgement of the situation. Both the psychological and environmental occurrences are taken into consideration as they occur. The main target of engaging a continuous approach is to ensure that the caregivers can directly experience the situation of the children with ACT. This experience can effectively help the caregivers to adopt a more flexible psychological approach to the children with ASD (S. A. Hayes & Watson, 2013). On the other hand, the self as context idea is anchored on the value of “self” in the relational frame. ACT approach significantly depends on the ability of the caregivers to value their self and perceive their role as necessary to the children with ASD. This mentality has the power to affect the spiritual standing of the caregivers and improve their perception of their clients. There is evidence showing that self as context can also impact the caregivers’ language, including empathy and the theory of mind (Blackledge & Hayes, 2006).
Caregivers values are tested by the quality of their actions towards the children with ASD. In ACT, the caregivers are educated on how to apply their values to help their clients to define their life directions. The use of verbal communications that may result in the clients making life decisions based on avoidance or social compliance is encouraged. This approach of this approach is considered successful when the clients finally make a decision based on their intuition and not social influence (Bond et al., 2011). Committed action, on the other hand, links the patterns of effective action to the values of the caregivers. The incorporation of the committed step in the ACT to enforce behaviour change as a way of enhancing care for children with ASD (Barnes-Holmes, Hayes, Barnes-Holmes, & Roche, 2002).
Evidence
A hospital-based study investigated the indicators of stress among parents before ACT and after administration of the therapy. The state depression, anxiety, psychological and flexibility were evaluated. The researchers reported a 51.6 reduction in the state of anxiety following the treatment. Psychological flexibility reduced from 84.4AAQ to 78.4 AAQ at p = 0.04, while depression was the most improved stress indicator having reduced by half from 20.6 to 10.2 BDI at P-value 0.04 (Poddar et al., 2015). This study demonstrated the critical role of ACT in reducing stress indicators and in particular depression was significantly reduced. Another study that assessed the state of anxiety, depression, aggression and psychological flexibility among parents and caregivers of children with ASD reported improvement following an ACT session (Singh et al., 2006). These findings provide evidence to support the application of ACT among parents and caregivers to manage stress.
Integration of ACT and caregivers of children with ASD
Autism Spectrum Disorder (ASD) is a neurodegradative disorder that results in poor coordination in language, social behaviour and communication function among the victims of ASD (Asih & Saraswati, 2019). The majority of the people living with ASD are children who require care from both their parents and other caregivers. The family dynamics are significantly affected by the presence of a child with ASD. The parents who are sometimes the primary caregivers are faced with the daunting task so learning how to take care of the child newly diagnosed with this disorder (Taylor & Warren, 2012). The most affected members of the family with a child diagnosed with ASD are the parents who are required to cope with the disorder. These parents struggle with challenges such as trying to understand the communication of their ASD child, unpredictable expression of emotions and the language impairment expressed by the ASD affected child. The ASD affected children may occasionally show repetitive movements and may become too aggressive. The parents and caregivers have to always check for these symptoms in the child and respond to them appropriately (Singh et al., 2014). Besides, the parents and caregivers are expected nurture and provide all the basic need for these children. In light of all the additional responsibilities that the caregivers have to undertake, they must be at a high risk of developing stress and depression symptoms. According to Thorton, 2003, caregivers are strained by their responsibilities, especially when required to provide care to a particular group of children like those with ASD (Thornton & Travis, 2003).
Another study by Catalano showed that a group of parents, who take care of ASD children experience high levels of stress compared to a control group who did not have the responsibility of ASD child (Catalano, Holloway, & Mpofu, 2018). Most of the factors associated with ASD cause a high level of stress among parents and caregivers, as discussed above. However, some elements are associated with either high levels of anxiety or no stress. This has been witnessed mostly among the parents who learn and adjust to the unique needs of their children. Analysis of parents who have undergone mindful training shows that they have lower levels of stress and can adequately tend to the children with a positive mindset (Singh et al., 2006). It is, therefore, essential for parents with ASD children to attend ACT sessions.
Conceptualization of the Parent of a child with ASD using ACT perspective
The parents of children with ASD have additional responsibilities to take care of their ASD children. ASD causes significant retardation in the development of the affected children, including mental communication and physical development. The children are unable to take care of themselves, requiring the parents to remain alert of their aggressive behaviour. This added responsibility exerts pressure on their parents. Studies have reported high levels of stress among the parents of children with ASD (Lambrechts et al., 2015). These parents may suffer rejection and the belief that the situation of their child cannot be changed may affect their efforts to seek help. Despite the principle of ACT focusing on the process of behaviour and psychological change, it is not concerned with the thought process of a person. The main idea of ACT is to improve mental flexibility regardless of the individual’s thoughts. This principle of ACT has been cited as an inadequacy of the therapy (Zhang et al., 2018). According to Hayes (2009), psychological flexibility can be improved by influencing an individual’s thoughts, yet the ACT method does not consider this vital strategy. Besides (Hayes and colleagues, 2013, demonstrated the inability of ACT to challenge ideas and logical reasoning. Instead, Haye proposes that the ACT adopts a behaviour change model not linked to the thought processes. According to Haye, ACT is a psychological process anchored on philosophical principles.
The belief that stress associated with parenting children with ASD is not different from the stress as a result of the reaction to circumstances has been disputed in the literature. Researchers have presented evidence to support the high intensity of stress associated with parenting children with ASD (Miranda et al., 2019). Some of the sources of stress that have been proposed include the difficulties in dealing with the behaviour of the child, straining coping strategies for the parents, the children are sometime aggressive and violent (Miranda et al., 2019). The severity of the symptoms of ASD has also been shown to increase the level of stress among the parents. Such factors delineate the level of stress experienced by parents of ASD children from the level of stress caused by a normal reaction to circumstances (Bluth et al., 2013). Despite the increasing evidence in the literature, supporting the notion that stress encountered by parents of children with ASD is unique, their nature of the stress remains the same, and the outcome is the same. The interpretation of evidence in literature presents the challenge of distinguishing the between normal stress reaction and the stress caused by ASD children.
The ethical perspective of ACT has been raised with disagreement on whether the method is a violation of social principles. For instance, the argument that the ACT method does not consider that feeling bad about the situation of their parents is the problem that the parents of the children with ASD face. The parents feel sorry for their children whose situation cannot be reversed. Eventually, the parents get into depression and stress. Psychotherapists suggest that a necessary treatment to stress reduction is through optimized metal assessment model as opposed to the behaviour change perspective indicated by the ACT. Therefore, the ACT method can be viewed as a violation of universal social principles (Dindo et al., 2017).
The approach adopted in the ACT majorly focusses on the effectiveness of behaviour and the application of psychological flexibility to reduce stress among caregivers and parents of children with ASD. The effectiveness of this integrated approach is evident in its ability to improve the thought of caregivers. For instance, caregivers who experience troubling thought may develop functional behaviour after ACT session. Kanter showed the effectiveness of ACT in the alleviation of stress-related symptoms among caregivers who were troubled by thoughts of attending to children with ASD (Kanter, Baruch, & Gaynor, 2006). Most notably, there was a significant reduction in depression among the participants.
Cognitive fusion and the influence experiential avoidance
The effect of cognitive fusion stems from the tenant that the suffering endured by a human is due to psychological inflexibility. The concept of cognitive fusion and experiential avoidance are strongly interrelated and together affect the process of distress and psychopathy. Consequently, distress and psychopathy are responsible for the manifestation of stress and related disorders (Bardeen & Fergus, 2016). The influence of both cognitive fusion and experimental avoidance have been studied with respect to the indicators of stress such as anxiety, depression, and posttraumatic stress (Bardeen & Fergus, 2016).
The practice of ACT
ACT practice depends on the availability of training resources to incorporate it as a necessary skills training to parents and aspiring parents. The use of skills-based instruction to impart basic ACT knowledge to parents can help to enhance the process of care provided to children with ASD while reducing the psychological effects on parents and caregivers. According to the necessary behavioural change principles, parents can be trained on how to perceive the situation of their children positively and take the measures needed to improve the situation. Maintaining psychological flexibility is a critical skill that the parents should be trained on (Batink et al., 2016).
References
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