Acceptance and Commitment Therapy for Autism Spectrum Disorder: Evaluation of feasibility, effectiveness, and validity of a novel contextual behavioral treatment

Acceptance and Commitment Therapy for Autism Spectrum Disorder: Evaluation of feasibility, effectiveness, and validity of a novel contextual behavioral treatment

Autism spectrum disorder (ASD) is characterized by challenges in social interplay, adapting to new situations, and over- and under-sensitivity to sensory impressions. Autistic individuals and reducing life quality. However, mental health treatments suited for autistic individuals are few. Acceptance and commitment therapy (ACT) is a psychotherapy helpful for chronic or complex problems but is not evaluated for autism. Questionnaires assessing ACT, such as Action and Acceptance Questionnaire (AAQ) and Cognitive Fusion Questionnaire (CFQ), measuring flexibility and the ability to handle disturbing thoughts, are not assessed in autism. Therefore, this thesis evaluated ACT, AAQ, and CFQ in autistic individuals. In Study I, 28 autistic students (13-21 years) received group-based ACT adapted to autism (NeuroACT) or teaching as usual. The NeuroACT program worked well in a school environment and improved stress, anger, depression, prosocial behavior, and hyperactivity/inattention compared to teaching as usual. However, the program did not improve conduct problems, peer relationship problems, or anxiety. In Study II, ten autistic adults (25-65 years) with mental health problems received 12 NeuroACT group sessions. The program seemed logical and reasonable to the participants, and 90 % completed it. The participants experienced improved stress, life quality, depression, social ability, flexibility, and ability to handle disturbing thoughts directly after or after three months compared to before the program. However, anxiety or work and family-related disability did not improve. In Study III, 39 autistic adults (25-65 years) with mental health problems received 14 NeuroACT group sessions or standard care. NeuroACT seemed logical and reasonable to the participants, and 85 % completed the program. NeuroACT participants perceived improved
stress, life quality, sleep quality, and depression directly after or after six months compared to the standard care participants. Also, they were more flexible, could handle disturbing thoughts better, did not avoid stressful situations as much, and were more motivated to participate in social events compared to before the program. Participants in both NeuroACT and standard care were less anxious. No group difference was found in awakening difficulties, daytime tiredness, breathing problems, awareness of others, communication, or everyday functioning. In Study IV, 54 autistic adults (21-72 years) with mental health problems completed AAQ and CFQ questionnaires. The questionnaires were related to psychological distress, quality of life, and autism, and adequately measured flexibility and the ability to handle disturbing thoughts in autistic adults. In conclusion, ACT adapted to autism is appropriate and appears to improve stress and mental health in autistic adolescents and adults. Also, it may help overcome aspects of autistic core challenges. However, more research is needed to further evaluate ACT in autistic individuals.