“I am not alone”: Evaluating the Effectiveness and Acceptability of a Virtual Adaptation of Acceptance and Commitment Training for Caregivers of People with Disabilities (Preprint)

UNSTRUCTURED 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 them. Our prior research demonstrated that caregivers benefitted from an in-person group-based Acceptance and Commitment Training (ACT) workshop, which increased their psychological flexibility and improved their mental wellbeing. During the pandemic, we adapted this intervention to be delivered virtually and evaluated its impact on caregivers’ psychological flexibility and mental wellbeing. Methods Two hundred and five 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 one of 27 teams across Canada participated in this research. ACT process (measured via Cognitive Fusion Questionnaire [CFQ], Acceptance and Action Questionnaire [AAQ], Self Compassion Scale - Short Form [SCS-SF] and Valued Living Questionnaire [VLQ]) and mental well-being outcomes (measured through Patient Health Questionnaire [PHQ-4], Parenting Stress Index (PSI-4), Multi-System Model of Resilience Inventory [MSMR-I] and Short Warwick–Edinburgh Mental Wellbeing Scale [SWEMWBS]) were measured before and after the intervention, and again at 8 week follow-up. An acceptability survey was completed post-intervention including items on satisfaction with virtual aspects of the intervention Findings Significant improvements were found for most ACT processes and mental wellbeing measures from pre- to post - intervention and these improvements were maintained (psychological flexibility, values, self-compassion) or continued to improve (cognitive defusion) at follow-up. There was high intervention acceptability related to the virtual format (>80% satisfaction) despite variability in individual preferences. Direct content analysis of participants qualitative survey responses revealed that cognitive defusion, mindfulness and acceptance were the most helpful ACT processes. Conclusions A virtual, group-based ACT intervention was acceptable and led to positive changes in psychological flexibility and mental wellbeing among family caregivers of people with disabilities or neurodivergent individuals, similar to in-person delivery of the intervention. Further exploration of accessible and sustainable ways to deliver this type of intervention to a diversity caregivers is important. This is an important first step to facilitate the dissemination of such services to the community.