Acceptance and commitment therapy (ACT) for caregivers of children with chronic conditions: a mixed methods systematic review (MMSR) of efficacy, process, and acceptance

Caregivers of children with chronic conditions face enormous challenges and often poor mental health. ACT may facilitate psychological adjustment for this population. This MMSR therefore aimed to examine the efficacy and acceptability of ACT for caregivers of children (diagnosed aged <18) with long-term conditions. PsychInfo, Ovid MEDLINE, and EMBASE were searched. Studies were included that mentioned ACT as the intervention under study in the manuscript and referenced an existing ACT protocol or stated that the applied intervention was guided by core processes of ACT. Both individual and group ACT interventions were eligible for inclusion. Studies were excluded if they applied ACT to other populations, adopted an inappropriate research methodology (e.g., case study), or didn't publish in English in a peer reviewed journal. A total of 19 eligible studies were returned from searches based on these criteria. However, despite both individual and group ACT interventions being eligible for inclusion, none of the 19 studies delivered ACT individually. Meta-analysis revealed significant effects of group ACT interventions on parental mood at post-intervention (SMD = −0.43, P = 0.001), follow-up (SMD = −0.65, P = 0), and both time points combined (SMD = −0.52, P = 0). Group ACT interventions also had significant effects on parenting confidence at both time-points combined (SMD = 0.34, P = 0.018), and on cognitive fusion at follow-up (SMD = −6.12, P = 0.016). Further, significant effects of the intervention on psychological flexibility were revealed at post-intervention (SMD = −2.92, P = 0.007), follow-up (SMD = 5.19, P = 0), and both time points combined (SMD = −3.89, P = 0). Narrative synthesis then suggested positive impacts of group ACT interventions on mood, general wellbeing, and all ACT processes. Finally, qualitative findings indicated that group ACT interventions facilitated a sense of all being in the same boat which allowed parents to open-up. Mindfulness exercises and peer interaction were identified as particularly helpful aspects of the intervention. ACT was therefore shown to be effective and acceptable in improving the health of caregivers. Future research evaluating ACT interventions delivered in non-group-based is now required.