Evaluating the Preliminary Outcomes and Acceptability of a Virtual Adaptation of Acceptance and Commitment Training for Caregivers of People With Disabilities (“I Am Not Alone”): Mixed Methods Study

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Background Family caregivers of children and youth with neurodevelopmental disabilities report higher levels of stress, anxiety, and depression than other caregivers, yet few evidence-based mental health services are available to support them. Our previous research demonstrated that caregivers benefitted from our in-person group-based acceptance and commitment training (ACT) workshop, which increased their psychological flexibility and improved their mental well-being. During the COVID-19 pandemic, we adapted this intervention to be delivered virtually. Objective In this study, we evaluated the program’s impact on caregivers’ psychological flexibility and mental well-being, as well as the acceptability of the virtual program. Methods A total of 205 family caregivers of neurodivergent people or people with disabilities who registered for a virtual, group-based ACT intervention (10-12 hours across 5 or 6 weeks) from 1 of 27 teams across Canada participated in this research. ACT process (measured via the Cognitive Fusion Questionnaire, Acceptance and Action Questionnaire, Self-Compassion Scale–Short Form, and Valued Living Questionnaire) and mental well-being outcomes (measured through the Patient Health Questionnaire, Parenting Stress Index, Multi-System Model of Resilience Inventory, and Short Warwick-Edinburgh Mental Well-being Scale) were measured before and after the intervention and again at an 8-week follow-up. An acceptability survey was completed after the intervention, including items on satisfaction with virtual aspects of the intervention. Results There was high intervention acceptability related to the virtual format (at least >80% satisfaction) despite variability in individual preferences (preferred in-person format: 28/91, 31%; preferred virtual format: 37/91, 41%; no preference: 26/91, 29%). Significant improvements were found for most ACT processes (fusion: F2,279=63.96; psychological flexibility: F2,264=38.81; values: F2,244=8.32; self-compassion: F2,170=33.59; P<.001 in all cases) and mental well-being measures (parental stress: F2,236=20.27; well-being: F2,137=22.89; mood: F2,15=23.12; resilience: F2,17=32.83; P<.001 in all cases). Pairwise comparisons between preintervention and follow-up showed maintenance of ACT skills (P<.001 in all cases; ηp2 ranged from 0.09 to 0.40) and well-being improvement (P<.001 in all cases; ηp2 ranged from 0.19 to 0.37). Direct content analysis of participants’ qualitative survey responses revealed that cognitive defusion, mindfulness, and acceptance were the most helpful ACT processes. We received feedback for modifications to formatting, pacing, content, and duration of the group to support a wider range of caregiver needs. Conclusions The virtual, group-based ACT intervention was acceptable and led to positive changes in psychological flexibility and mental well-being among family caregivers of people with disabilities or neurodivergent people, similar to outcomes observed with in-person delivery of the intervention. Further comparison and contrast with in-person programming is needed to ensure accessibility and sustainability of this program.

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