Sadra Medical Journal

The Effectiveness of Acceptance and Commitment Therapy on Marital Satisfaction and Resiliency in Mothers of Children with Autism Spectrum Disorder (ASD)

Document Type : Original Article

Authors

Yalda Biabani 1
Sara Salehi Sadagiani 2
Fatemeh Fazeli 3
Zahra Safaei 4
Leila Sadegh Marand 5

1 Department of Psychology, Urmia Branch, Islamic Azad University, Urmia, Iran

2 Department of General Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran

3 Department of Clinical Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran

4 Department of General Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran

5 Department of General Psychology, Tabriz Branch, Payam Noor University, Tabriz, Iran

https://doi.org/10.30476/smsj.2025.103141.1548
Abstract
Introduction: Parents of children with ASD face numerous psychological and familial challenges that can impair their mental health. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) on marital satisfaction and resilience of mothers with children diagnosed with ASD. 
Methods: This quasi-experimental study employed a pretest-posttest control group design. The statistical population comprised all mothers with ASD under the care of the Welfare Organization in Tabriz, Iran, during 2023. A convenience sample of 30 mothers was selected and randomly assigned to either an experimental or a control group (15 participants per group). The experimental group received ACT over eight 90-minute sessions. The measurement tools included Enrich’s Marital Satisfaction Scale (1996) and Connor-Davidson’s Resilience (2003). Data were analyzed using analysis of covariance (ANCOVA) with SPSS software, version 26. 
Results: The results showed that the mean scores of marital satisfaction and resilience in the experimental group increased significantly from pretest to posttest (P<0.005). Furthermore, a comparison of posttest scores between the experimental and control groups revealed significantly higher mean scores in the experimental group. 
Conclusion: The findings indicated that ACT was effective in improving marital satisfaction and resilience among mothers of children with ASD. Therefore, it is recommended that mental health professionals utilize ACT to enhance the psychological well-being of this population.

Keywords

Acceptance and commitment therapy
Marriage
Marital Therapy
Resilience
Psychological
Autism Spectrum Disorder
  1. Hirota T, King BH. Autism spectrum disorder: a review. JAMA. 2023;329(2):157-68.
  2. Talantseva OI, Romanova RS, Shurdova EM, Dolgorukova TA, Sologub PS, Titova OS, et al. The global prevalence of autism spectrum disorder: a three-level meta-analysis. Front Psychiatry. 2023;14:1071181.
  3. Micai M, Fatta LM, Gila L, Caruso A, Salvitti T, Fulceri F, et al. Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2023;155:105436.
  4. Yavari A, Zamanian M, Panahian M, Valizadeh A. Prevalence of autism spectrum disorder with high-functioning among children aged 7–12 years. Dep Health. 2022;13(2):165-74. Persian.
  5. Desquenne Godfrey G, Downes N, Cappe E. A systematic review of family functioning in families of children on the autism spectrum. J Autism Dev Disord. 2024;54(3):1036-57.
  6. Sutherland D, Flynn S, Kurzeja O, Griffin J, Hastings R. Family-systems interventions for families of people with an intellectual disability or who are autistic: a systematic review. J Intellect Disabil Res. 2023;67(10):1003-28.
  7. Hartley SL, Barker ET, Seltzer MM, Floyd F, Greenberg J, Orsmond G, et al. The relative risk and timing of divorce in families of children with an autism spectrum disorder. J Fam Psychol. 2010;24(4):449-57.
  8. Cyr Brisini KS, Tian X, Solomon D. Marital experiences and parental “highs” and “lows” when a child with autism starts school. J Autism Dev Disord. 2023;53(10):3932-42.
  9. Wolstencroft J, Srinivasan R, Hall J, van den Bree MBM, Owen MJ, Consortium I, et al. Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin. JCPP Adv. 2023;3(1):e12128.
  10. Abdi R, Narimani A. Comparison of personality traits and resiliency in mothers of children with autism disorder and attention deficit/hyperactivity disorder with normal children’s mothers. Middle East J Disabil Stud. 2018;8(70):1-6. Persian.
  11. Halstead E, Ekas N, Hastings RP, Griffith GM. Associations between resilience and the well-being of mothers of children with autism spectrum disorder and other developmental disabilities. J Autism Dev Disord. 2018;48(4):1108-21.
  12. Lee GK, Lopata C, Volker MA, Thomeer ML, Toomey JA, Rodgers JD, et al. Stress, resiliency factors, quality of life among caregivers of children with high functioning autism spectrum disorders (HFASDs). Aust J Rehabil Couns. 2012;18(1):25-36.
  13. Tyszkiewicz-Gromisz B, Burdzicka-Wolowik J, Tymosiewicz P, Gromisz W. Parental competences and stress levels in mothers of children with autism spectrum disorders and children developing neurotypically. J Clin Med. 2024;13(4):1119.
  14. Clark M, Adams D. Resilience in autism and intellectual disability: a systematic review. Rev J Autism Dev Disord. 2022;9(1):39-53.
  15. Ghanouni P, Quirke S. Resilience and coping strategies in adults with autism spectrum disorder. J Autism Dev Disord. 2023;53(1):456-67.
  16. Botha M, Dibb B, Frost DM. “Autism is me”: an investigation of how autistic individuals make sense of autism and stigma. Disabil Soc. 2022;37(3):427-53.
  17. Marcinechova D, Zahorcova L, Lohazerova K. Self-forgiveness, guilt, shame, and parental stress among parents of children with autism spectrum disorder. Curr Psychol. 2024;43(3):2277-92.
  18. Ebrahim MT, Alothman AA. Resilience and social support as predictors of post-traumatic growth in mothers of children with autism spectrum disorder in Saudi Arabia. Res Dev Disabil. 2021;113:103943.
  19. Jamshidian E, Abed EH, Sourtiji H, Azar EF, Hashemzadeh M, Mirzaie H. Lived experiences of Iranian parents of children with autism spectrum disorder: a systematic review. Iran J Public Health. 2023;52(8):1626-41. Persian.
  20. Öz B, Yüksel T, Nasiroğlu S. Depression-anxiety symptoms and stigma perception in mothers of children with autism spectrum disorder. Arch Neuropsychiatry. 2019;57(1):50-8.
  21. Ashrafun L, Uddin MJ, Debnath D. Caregiver narratives of children with autism spectrum disorder: exploring symptom recognition, diagnosis, and interventions. J Autism Dev Disord. 2025;55(9):3314-27.
  22. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. The empirical status of acceptance and commitment therapy: a review of meta-analyses. J Contextual Behav Sci. 2020;18:181-92.
  23. Coto-Lesmes R, Fernandez-Rodriguez C, Gonzalez-Fernandez S. Acceptance and commitment therapy in group format for anxiety and depression: a systematic review. J Affect Disord. 2020;263:107-20.
  24. Bagheri Sheykhangafshe F, Savabi Niri V, Baryaji S, Saeedi Z, Kiani A, Fathi-Ashtiani A. The effectiveness of acceptance and commitment therapy on sexual function, coping strategies and distress tolerance of employees with rheumatoid arthritis. Sadra Med J. 2023;11(4):360-73. Persian.
  25. Geda YE, Krell-Roesch J, Fisseha Y, Tefera A, Beyero T, Rosenbaum D, et al. Acceptance and commitment therapy in a low-income country in Sub-Saharan Africa: a call for further research. Front Public Health. 2021;9:732800.
  26. Byrne G, Ghrada AN, O’Mahony T, Brennan E. A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychol Psychother. 2021;94 Suppl 2:378-407.
  27. Sander AM, Clark AN, Arciniegas DB, Tran K, Leon-Novelo L, Ngan E, et al. A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychol Rehabil. 2021;31(7):1105-29.
  28. Asadpour E, Veisi S. The effectiveness of acceptance and commitment therapy on marital satisfaction, sexual self-esteem and burnout martial among women with type 2 diabetes. J Arak Univ Med Sci. 2019;21(7):8-17. Persian.
  29. Marino F, Failla C, Chila P, Minutoli R, Puglisi A, Arnao AA, et al. The effect of acceptance and commitment therapy for improving psychological well-being in parents of individuals with autism spectrum disorders: a randomized controlled trial. Brain Sci. 2021;11(7):880-95.
  30. Sanieemanesh M, Asadpour I, Zahrakar K. The effectiveness of group counseling based on acceptance and commitment therapy on marital stress and psychological hardiness in mothers of children with profound and multiple disabilities. J Appl Psychol Res. 2022;13(2):141-55.
  31. Schwartzman JM, Millan ME, Uljarevic M, Gengoux GW. Resilience intervention for parents of children with autism: findings from a randomized controlled trial of the AMOR method. J Autism Dev Disord. 2022;52(2):738-57.
  32. Sarmad Z, Bazergan A, Hejazi E. Research methods in behavioral science. Tehran: Agah Publications; 1997. p. 1-408. Persian.
  33. Fowers BJ, Olson DH. Enrich marital inventory: a discriminant validity and cross-validation assessment. J Marital Fam Ther. 1989;15(1):65-79.
  34. Tahmasby H, Khorramabadi Y. Predicting marital satisfaction based on extraversion, marital empathy, and marital forgiveness in married women. Soc Psychol Res. 2023;13(51):61-74. Persian.
  35. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
  36. Bigdeli I, Najafy M, Rostami M. The relation of attachment styles, emotion regulation, and resilience to well-being among students of medical sciences. Iran J Med Educ. 2013;13(9):721-9. Persian.
  37. Hayes SC, Masuda A, Bissett R, Luoma J, Guerrero LF. DBT, FAP, and ACT: how empirically oriented are the new behavior therapy technologies? Behav Ther. 2004;35(1):35-54.
  38. Mardani F, Yousefi SA, Ghorbani E, Mirzaei Z. The effectiveness of realistic acceptance and commitment therapy (RACT) on marital burnout and alexithymia in couples. J Assess Res Appl Couns. 2023;5(1):9-18. Persian.
  39. Kaviani Z, BakhtiarPoor S, Heidari A, Askary P, Eftekhar Z. The effect of treatment based on acceptance and commitment (ACT), on resiliency and dysfunctional attitudes of MS female patients in Tehran. Knowl Res Appl Psychol. 2020;21(1):84-92. Persian.
  40. Salehi S, Zahrakar K, Asadpour E, Tehranian A. The effectiveness of acceptance and commitment therapy on occupational burnout, couple burnout, and family resilience among nurses. Sadra Med J. 2024;12(2):175-92. Persian.
Sadra Medical Journal
Volume 13, Issue 4
Autumn 2025
Pages 810-821

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