Comparing the Effectiveness of Cognitive-Behavioral Therapy and Treatment Based on Acceptance and Commitment on Psychological Problems, Mental Wellbeing of Mothers with Children Affected with Autism Spectrum Disorder

Nervous stress caused by children's developmental and behavioral defects, such as autism spectrum disorder (ASD), negatively impacts individual and family life and damages parental efficiency. Numerous studies have been performed on psychological problems and the mental wellbeing of mothers with children with ASD. However, no study compared the effectiveness of cognitive–behavioral therapy with acceptance and commitment therapy based on psychological and mental health problems of mothers with ASD children. This study aimed to compare the effectiveness of cognitive–behavioral therapy and treatment based on acceptance and commitment on psychological problems and mental wellbeing of mothers with ASD children.

The present quasi–experimental study has a pretest–posttest and follow–up design with a control group. The study's statistical population included all mothers with children with ASD (boys and girls), referred to the Autism Association of Guilan Province, Iran, in 2019 (N=156 mothers). Among the study population, 51 mothers whose children received a definitive diagnosis of ASD and scored higher than the cut–off point (31.5) in psychological problems and a low score (90) in mental wellbeing were selected. They were randomly assigned to three groups of 17 mothers in each group: the cognitive–behavioral therapy group, the acceptance and commitment–based treatment group, and the control group. For the intervention groups, 12 sessions of 60 minutes of cognitive–behavioral therapy (one session every 5 days for a total of 2 months) and treatment based on acceptance and commitment, 8 sessions of 60 minutes (one session per week for a total of 2 months) were held. In this study, the following tools and protocols were used to collect the required data as well as therapeutic interventions: Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995), Mental Wellbeing Questionnaire (Keyes & Magyar–Moe, 2003), Cognitive–Behavioral Therapy Protocol (Hawton et al., 1990), and acceptance and commitment Therapy Protocol (Hayes et al., 1999). Regarding the descriptive statistics, mean and standard deviation, and regarding the inferential statistics, repeated measures analysis of variance and Bonferroni post hoc test were performed using SPSS24 software. The significance level was considered 0.05 for all tests

The results showed that cognitive–behavioral therapy and acceptance and commitment therapy decreased psychological problems (p<0.001) and improved mental wellbeing (p=0.049). Also, the group × time interaction caused a decrease in psychological problems (p<0.001) and an increase in mental wellbeing (p<0.001) over time compared to the control group. According to the Bonferroni post hoc test, there was a significant difference between cognitive–behavioral therapy and acceptance and commitment therapy with the control group for both variables of psychological problems and mental wellbeing (p<0.001). However, there was no significant difference between the effectiveness of the mentioned therapies in reducing psychological problems (p=0.628) and improving mental wellbeing (p=0.920). Also, the average scores of the pretest with posttest and pretest with follow–up showed the effect of cognitive–behavioral therapy and acceptance and commitment therapy on reducing psychological problems and improving mental wellbeing (p<0.001). There was no statistically significant difference between the average scores of the posttest and follow–up stages for the variables of psychological problems (p=0.124) and mental wellbeing (p=0.176), which showed the persistence of the effects of the mentioned treatments in the follow–up stage.

According to the research findings, using interventions based on cognitive–behavioral therapy and acceptance and commitment reduces psychological problems and improves mental wellbeing in mothers with children with ASD. Also, there is no significant difference between the effectiveness of cognitive–behavioral therapies and the acceptance and commitment on psychological problems and mental wellbeing of mothers with ASD children.