Parents and caregivers of a child with an autism spectrum disorder (ASD) are presented with extreme challenges and demands. Oftentimes, this begins immediately when the parent notices that their child is displaying developmental delays. Parents commonly experience a great deal of uncertainty, apprehension, and concern throughout the process of seeking evaluations, learning that their child has been diagnosed with ASD, exploring treatment options, and navigating educational and mental health interventions.
These difficulties are combined with challenges such as overseeing home programming, ensuring adequate and appropriate schooling, planning for the future, and attending to the direct needs of their child. This places the parent in direct contact with circumstances that commonly result in high levels of chronic stress (Holroyd, Brown, Wikler, Simmons, 1975). Many of the challenges become obstacles to living a life of harmony between caring for their child, providing and managing ASD recovery treatments, being available for other important relationships (e.g., spouse, other children, friends), sustaining success in the workplace, and attending to their own well-being. Similar to others on the “front line” positions, these parents experience a lower quality of life and elevated depressive and anxious symptoms (Poddar & Urbi, 2015). Parents can become caught in the symptoms (i.e., excessively ruminating about the future, struggling with sadness) and attempting to reduce these avoidable and difficult thoughts and emotions at the expense of doing what is important to them. Given their responsibilities and worries, how can we help parents live a more meaningful, balanced life style?
Using Acceptance and Commitment Therapy (ACT) to Increase Psychological Flexibility
ACT is an empirically supported supplement to behavior therapy. ACT capitalizes on empirically supported treatments (behavioral activation, exposure and ritual prevention, mindfulness, etc.) to foster meaningful behavior change that helps someone continually move toward their chosen values (Hayes & Strosahl, 2004; Hayes, et al., 2012). Values associated with raising a child with ASD may include being a caring and supportive parent, being well-educated in effective treatments for ASD, maintaining one’s own positive mental health, etc. By engendering behavioral change using this approach, we can help parents become more psychologically flexible.
What is Psychological Flexibility?
Psychological Flexibility (PF) is the ability to be present (direct our attention, with curiosity and openness, to whatever matters in the moment), open up (fully contact our experience and make room for all our thoughts and feelings) and do what matters (act in accordance with our values) (Harris, 2013). The concept of PF stems from behavior analysis and ACT’s notion of workability. This idea answers the questions: 1. Does the behavior function effectively given the environmental conditions? and 2. Is the behavior aligned with what the parent finds meaningful? Workability links long-term behavior patterns in the service of a more meaningful (i.e., value-driven) life.
Increasing PF is critical when helping parents remain fully connected (present) throughout challenging situations they encounter themselves and when caring for their child with ASD without trying to change one’s thoughts, feelings, or core beliefs (Hayes, et al., 2006). For instance, when working through a functional communication training protocol and their child is becoming frustrated and starts to tantrum, the parent commits to the action of withholding the requested item until the child approximates communicating appropriately rather than giving the item to end the tantrum.
How to Increase Psychological Flexibility?
There are various ways to foster greater PF, specifically among parents of a child with ASD. Within the ACT model, we can use the ACT matrix based on Dr. Kevin Polk’s protocol (2014). The ACT matrix helps clients identify thoughts, feelings, sensations, values, and behavior through noticing and sorting. When using the matrix, we notice what shows up by acknowledging it and then sorting if the experience is within our outer experience (i.e., in the world of the five senses, something that we can see, hear, touch, taste or smell) or within our inner experience (i.e., in the world of the mind or language which includes our thoughts, feelings, beliefs). For example, inner experiences may include the thought, “It is my fault that my child has no friends” or “It is so unfair that my child has ASD.” This contrasts the outer experience such as noticing the behaviors you are displaying when you are with your child, your spouse, your child’s teacher or therapist, your own behaviors when experiencing stress, etc.
Additionally, the ACT matrix can help the parent sort whether their behaviors are associated with the experience of moving in the direction toward what they value (i.e., that which they have identified as important and meaningful to them) versus behaviors associated with moving away from the discomfort and stress associated with unwanted internal experiences. Examples of the former may include sitting and reading with your child, modeling and reinforcing desired social skills, scheduling and attending therapy appointments, scheduling a play date for your child, working out at the gym, getting a restful night sleep, remaining calm, etc. Conversely, behaviors that may move one away from what is important and away from discomfort may include yelling at your child, arguing with your spouse, overeating, staying in bed all day, etc.
Getting “hooked” by unhelpful and unproductive thoughts and feelings may lead parents astray from whom they want to be as a parent. Likewise, this will likely become unhelpful and unproductive for their child with ASD. Thus, it is easy for parents to slip into becoming the parent they swore they never were going to be when experiencing the stress associated with raising a child with ASD. For example, parents may think, “This intervention is too hard,” or, “Life is so unfair, why do I have to do this,” leading them to temporarily try the intervention or implement it with inconsistent integrity. Alternatively, it is important to slow down, be mindful by noticing how their thoughts try to push them around and prevent them from doing what is valued by them (i.e., helping their child), and be present in the moment.
There are various ways to be more psychologically flexible and therefore become “unhooked,” including using relaxation techniques (taking a deep breath from the belly and pressing your feet firmly into the floor; slowly “smelling the pizza” and slowly “blowing out the candles”); talking about their thoughts and feelings with a confidant (spouse, friend, therapist); looking at the situation with humor; acknowledging and accepting that while there is currently no cure for ASD, there is a lot they can do to demonstrate care, support, and steps to help their child improve their skills; assist their child who may be showing an interest in artistic expression; noticing which of their child’s characteristics are extremely difficult or impossible to change and focusing on what they can do to help their child improve; etc.
In this manner, those working with caregivers to increase PF may help parents gain greater perspective to avoid reacting to a stressful situation, respond more creatively, increase their own mental health, and enrich the relationship they have with their child.
Glenn M. Sloman, PhD, BCBA-D, NCSP and Michael C. Selbst, PhD, BCBA-D are from Behavior Therapy Associates in Somerset, New Jersey and can be reached at gsloman@BehaviorTherapyAssociates.com or mselbst@BehaviorTherapyAssociates.com and via their website at www.BehaviorTherapyAssociates.com
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.
Coyne, L. W., & Murrell, A. R. (2009). The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years. Oakland, CA: New Harbinger.
Harris, R. (2013). Getting Unstuck in ACT: A Clinician’s Guide to Overcoming Common Obstacles in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications.
Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, A. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
Hayes, S. C., & Strosahl, K. D. (Eds.). (2004). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer-Verlag.
Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd edition). New York, NY: The Guilford Press.
Holroyd, J., Brown, N., Wikler, L., & Simmons, J. Q. (1975). Stress in families of institutionalized and noninstitutionalized autistic children. Journal of Community Psychology, 3(1), 26-31.
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.
Polk, K. L., & Schoendorff, B. (Eds.). (2014). The ACT Matrix: A New Approach to Building Psychological Flexibility Across Settings and Populations. Oakland, CA: New Harbinger Publications.
Polk, K.L., Schoendorff, B., Webster, M., & Olaz, F.O. (2016). The Essential Guide to the ACT Matrix: A Step-by-Step Approach to Using the ACT Matrix Model in Clinical Practice. Oakland, CA: New Harbinger Publications.