Acceptance and Commitment Therapy (ACT) for caregivers of children with chronic conditions: A mixed methods systematic review (MMSR) of efficacy, process, and acceptability

Abstract

Caregivers of children with chronic conditions face enormous challenges and often poor mental health, which can impact their child’s wellbeing. ACT may facilitate psychological adjustment for caregivers of children with long-term conditions. This mixed methods systematic review (MMSR) therefore aimed to examine the efficacy and acceptability of ACT-based interventions for caregivers of children with chronic conditions. PsychInfo, Ovid MEDLINE, and EMBASE were searched, returning 6877 potentially relevant citations. Following formal screening, the 19 studies which met all inclusion criteria were imported onto JBI SUMARI. The seven quantitative studies containing a control group were pooled with meta-analysis. For the 10 quantitative studies where statistical pooling was not possible, findings were presented in narrative form including tables to aid data presentation. The findings of the two qualitative studies were synthesised through the meta-aggregation approach. P-curve analysis was also conducted on five of the included studies in order to test for publication bias and p-hacking within the literature. Meta-analysis revealed significant effects of ACT on parental mood at post-intervention (SMD = -0.43, P = .001), follow-up (SMD = -0.65, P=0), and both time points combined (SMD = -0.52, P = 0). ACT 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). Finally, significant effects of the intervention on psychological flexibility (PF) were revealed at post-intervention (SMD = -2.92, P = .007), follow-up (SMD = 5.19, P=0), and both time points combined (SMD = -3.89, P = 0). Narrative synthesis suggested positive impacts of ACT on mood, general wellbeing, and all ACT processes. Qualitative findings indicated that caregiver experiences of ACT were positive and that group-based delivery of ACT, along with mindfulness techniques, were particularly helpful. P-curve analysis revealed that both the half and full p-curve tests were right-skewed with p<.1, indicating that neither publication bias or p-hacking were present within the literature. ACT was therefore shown to be an effective and potentially acceptable intervention in improving the psychological health of caregivers, with evidence supporting psychological flexibility, cognitive fusion, and mindfulness as key treatment processes.