24 Acceptance and Commitment Therapy (ACT) for Parents of Children with a Chronic Medical Condition: A Systematic Review

Abstract

Caring for a child with a chronic medical condition can adversely affect parental health and well-being. Family-centered care requires clinical teams to consider novel ways of providing holistic care to the entire family by understanding the unique challenges of caring for a child with a chronic medical condition. Addressing parental well-being not only improves parental capacity to care for their child, but may also optimize long-term health outcomes for the child themselves. Acceptance and Commitment Therapy (ACT) is an established behavioural therapy that has been used with caregivers in the paediatric setting. Through ACT, individuals learn skills to increase psychological flexibility, cognitive diffusion, and mindfulness. ACT aims to help with coping and adjustment, but its impact has not been systematically appraised in parents of children with chronic medical conditions. To synthesize available research evidence on the efficacy of ACT for parents of children with medical conditions. A comprehensive literature search (December 2008 to October 2018) in PubMed, Cochrane Library, EMBASE, Web of Science, and Google Scholar was conducted. Abstracts were included if: 1) they were original articles and 2) they assessed the efficacy and outcomes of ACT on parents caring for children with chronic medical conditions. In total, 66 abstracts were identified. Nine publications describing ACT as an intervention aimed at improving parent-oriented outcomes met the final inclusion criteria. Five studies were randomized control trials. Medical conditions included children with: chronic pain (n=4), acquired brain injuries (n=2), autism spectrum disorder (n=1), cerebral palsy (n=1), and life-threatening illness (cancer or life-saving cardiac surgery) (n=1). All nine studies found improvements in caregiver related outcomes following ACT treatment. Improvements were seen in psychological flexibility (n=5), family functioning (n=3), parenting (n=1), and depression (n=2). Significant, medium to large effect sizes were found for measures of psychological flexibility, dysfunctional parenting styles (laxness and over reactivity). A medium effect size was found for family functioning. ACT improved outcomes for parents caring for children with chronic medical conditions. The majority of studies concentrated in paediatric patients with chronic pain or neurologic conditions. Less is known about the efficacy of ACT in improving parent-related outcomes in other paediatric disease groups however, further research in this area is warranted.