Acceptance and Commitment Therapy for Parental Management of Childhood Asthma: An RCT

Abstract

To determine if Acceptance and Commitment Therapy (ACT) training with asthma education for parents reduces asthma exacerbations in children and increases parents’ ability to manage psychological difficulties encountered with asthma treatment.A parent (designated as primary caregiver) and their child diagnosed with asthma, ages 3 to 12, were recruited as pairs from pediatric outpatient respiratory clinics in Hong Kong to participate in this randomized controlled trial. Children with significant comorbidities (such as congenital disorders, respiratory disorders, and developmental disorders) were excluded.Parent-child pairs were randomly assigned to the control group receiving standard asthma management education or the experimental group receiving ACT and asthma education. ACT occurred over 4 sessions that taught mindfulness exercises to confront negative emotions associated with asthma management and self-reflection to confront conflicts in parental philosophy and asthma management. The asthma education consisted of 1 lecture discussing symptom recognition plans and management of acute exacerbations. Both groups were assessed for frequency of child emergency department visits for asthma exacerbation (primary outcome) and caregiver’s mental health status via questionnaires at baseline and 6 months postintervention.A total of 168 parent-child dyads were randomly assigned into the treatment group or the control group, and each group demonstrated similar demographic characteristics. Children of parents in the ACT group had significantly fewer visits to the emergency department for asthma exacerbation as compared with the control group (adjusted 6-month incidence rate ratio = 0.20; 95% confidence interval: 0.08–0.53; P = .001) and fewer visits to the private practitioners outpatient clinics (adjusted incidence rate ratio = 0.47; 95% confidence interval: 0.26–0.85; P = .012). Fewer symptoms were also reported in the children of the ACT group (0.5–0.6 days per week) than the control group (1.9–2.3 days per week) (P < .001). Parents who underwent ACT training demonstrated reduced symptoms of guilt and worry (P < .001) and depression and anxiety (P = .002) regarding their child’s asthma as compared with the control group. Quality of life at 6 months follow-up was also improved in parents undergoing ACT than the asthma education group (P < .001).ACT in conjunction with asthma education training reduces unscheduled visits to health care providers due to asthma exacerbation. Additionally, ACT reduces parental anxiety and depression surrounding asthma and improves their quality of life up to 6 months after sessions.This is the first study to demonstrate improvement of asthma symptoms with ACT behavioral therapy and standard asthma education. This is promising because other methods of parental therapy examined have not been associated with improving child asthma symptoms (Cochrane Database Syst Rev. 2015;[4]:CD009660). Limitations are noted in the fact that the majority of the population studied has low asthma severity (not requiring inhaled corticosteroids) and are from a single site. Thus, there is limited generalizability of these results until studies are performed in larger groups with higher-risk children.