Self-help Acceptance and Commitment Therapy for Carers of People with Multiple Sclerosis: A Feasibility Randomised Controlled Trial

Abstract

Acceptance and Commitment Therapy (ACT) is an established psychological therapy, but its effectiveness for carers of people with multiple sclerosis (MS) experiencing carer-related strain has not been established. This study assessed the acceptability and feasibility of conducting a randomised controlled trial comparing ACT self-help, telephone-supported ACT self-help, and usual care. We describe a mixed-method, parallel three-armed feasibility randomised controlled trial. Participants were carers (i.e. caregivers) of people with MS. The self-help group received an ACT self-help text (covered over 8 weeks), the enhanced self-help group additionally received weekly telephone support. All participants completed questionnaires at baseline, 3-month, and 6-month post-randomisation, assessing carer strain, health-related quality of life, and ACT-related processes. A sample of participants was also interviewed. Twenty-four carers were randomised. Participants found the study procedures to be acceptable, but highlighted difficulties with the self-help text and timing of the intervention. An exploratory, group-level analysis indicated effectiveness for the enhanced self-help group on carer strain (consistent across both follow-ups), with convergent qualitative reports to support this. A full trial of ACT-based, telephone-supported self-help is warranted, including both the self-help and enhanced self-help design, following significant adaptions to the self-help itself. An internal pilot would, therefore, be recommended to further assess the feasibility after changes are incorporated. Trial registration: The trial was registered on ClinicalTrials.gov (NCT03077971).

Acceptance and commitment therapy for family caregivers: A systematic review and meta-analysis

“…Participants were parents of children with asthma in Chong et al. and family caregivers of people with multiple sclerosis in Potter et al. (2020).…”

“…The included 2 RCTs tested the effects of ACT interventions on quality of life of family caregivers, compared to either a treatment as usual control group (Potter et al, 2020) or an attention control group providing education (Chong et al, 2019). Participants were parents of children with asthma in Chong et al and family caregivers of people with multiple sclerosis in Potter et al (2020). While the intervention in Chong et al involved 4 weekly face-to-face ACT sessions delivered in a group format, the intervention in Potter et al was ACT self-help workbook with 8 weekly chapters with weekly telephone support.…”

Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge

“…The earliest of these papers was published in 2007. The purpose of the interventions varied: improving health literacy (Jafari et al., 2020); developing caregiver knowledge and skills on a range of topics such as coping strategies, emotional support, providing practical assistance, MS knowledge (Alimohammadi et al., 2015; Coles et al., 2007; Finlayson et al., 2009; Jafari et al., 2020); acceptance and commitment therapy (Potter et al., 2021); a resilience‐based telehealth program (Halstead et al., 2020) and a collaborative care model (Rakhshan et al., 2018). Most of the interventions were delivered in a group format over five to eight sessions completed over 1–12 weeks.…”

“…Some interventions were delivered in blocks of 1–2 hr at a time, while other interventions occurred in a single day. Two interventions were delivered in an individualised format (Halstead et al., 2020; Potter et al., 2021). Only one intervention targeted child caregivers (Coles et al., 2007); others targeted adult caregivers.…”

A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy for Managing Grief Experienced by Bereaved Spouses or Partners of Adults Who Had Received Palliative Care

“…With regards to carers, Losada et al (2015) found that 8-weekly, individual, face-to-face sessions improved depressive symptoms among carers of people with dementia. A self-help form was an effective intervention for carers of people with MS (Potter et al, 2020), whereas web-based ACT was effective for carers of people with cancer (Köhle et al, 2015). In addition, a blended support program of face-to-face contact, telephone support and online modules based on ACT increased feelings of control in people caring for partners with Amyotropic Lateral Sclerosis and Progressive Muscular Atrophy (De Wit et al, 2020).…”