Author: Lam, Ka Leung
Title: Group-based acceptance and commitment therapy for reducing stress and improving the psychological well-being of parents with children studying in primary schools in Hong Kong : a non-randomized, controlled trial
Advisors: Mak, Y. W. (SN)
Degree: DHSc
Year: 2022
Subject: Family psychotherapy
Group psychotherapy
Parents -- Social networks
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: v, 214 pages : color illustrations
Language: English
Abstract: Background
Parents bear the responsibility of nurturing their children, which is a major source of parental stress. Parents generally harbour high expectations for their children, which bring them stress, which contributes to their reduced psychological well-being and, in turn, negatively affects the development of their children. The COVID-19 pandemic accentuated parental stress, as parents were required to balance the demands of childcare and work while navigating the uncertainty of their children's schooling as well as concerns regarding their children contracting COVID-19. Current approaches to reducing parental stress and improving parents' psychological well-being have often been proved inadequate. Acceptance and commitment therapy (ACT), on the other hand, focuses on values that increase the sustainability of behaviour change, as it encourages confronting unpleasant feelings, as opposed to avoiding them, and taking value-based actions. Training parents with ACT has been found to be more effective in reducing their parental stress and improving their psychological well-being. However, previous studies have largely assessed the impact of ACT on training parents of children with chronic illnesses, and the parents of healthy children have not been the focus of research.
This study aimed to investigate the efficacy of a group-based ACT intervention in reducing the stress and improving the psychological well-being of parents with children studying in primary schools in Hong Kong during the COVID-19 pandemic compared to treatment as usual (TAU). Specific study objectives were to assess the effectiveness of ACT by comparing the improvement between the intervention group versus TAU group in (a) reducing parental stress, (b) promoting psychological well-being, (c) reducing psychological symptoms including depression, anxiety and stress in general, (d) reducing level of experiential avoidance, and (e) improving way of parenting. Another objective of this study was to assess any potential improvement in children's quality of life after their parents had attended the ACT sessions compared to those who attended TAU sessions.
A two-group pre-test-post-test design was conducted from October 2019 to June 2021, which included the duration of the COVID-19 pandemic. Parents with at least one child studying in primary schools in Hong Kong were recruited by convenience sampling via Christian Family Service Centre, an NGO. Parents with mild to moderate levels of stress, anxiety or depression were considered eligible for this study and, according to their residential area, were assigned to either the intervention group or the control group.
The intervention group received five group sessions of two hours each, with ACT activities aimed to enhance parental psychological flexibility and train parents to accept negative thoughts, emotions and urges about their child while continuing to act in ways that are consistent with personal chosen values. The control group received group-based educational sessions about COVID-19 and its preventive strategies with contact hours and duration identical to the intervention group.
The primary outcomes included measuring the level of parental stress using the Parental Stress Scale (PSS) and measuring the three components—level of stress, anxiety and depression, and level of psychological well-being—using the Depression Anxiety Stress Scale – 21 items (DASS-21) and World Health Organization – Five Well-being Index (WHO-5) of both the groups of participating parents. The secondary outcomes included improvement in parenting approaches as measured by the Alabama Parenting Questionnaire – 9 items (APQ-9) for both the groups of participating parents. This led to another secondary outcome—the quality of life of the children as reported by their parents, which was measured using WHO-5. The level of experiential avoidance of participants, measured using the Brief Experiential Avoidance Questionnaire (BEAQ), were also examined in this study. Data collection was conducted before the commencement of the first session and immediately after the end of the last session. Data obtained was compared within a group and across groups, and the difference in mean scores was noted using a T-test to evaluate the effectiveness of ACT for the abovementioned items.
A total of 159 parents (intervention group: 39; control group: 120) were recruited for this study. After the intervention, reduced stress level (Mdiff = -3.5, 95% CI [-5.1, -1.8]) and the depression level were observed for the 39 participants in the ACT group (Mdiff = -2.6, 95% CI [-4.1, -1.0]) compared to the 120 participants in the control group, with the p-value < 0.001, while the reduction in anxiety level was not significant. Psychological well-being had also improved in the ACT group when compared to the control group measured using The World Health Organisation – Five Well-Being Index (WHO-5) (Mdiff = 11.6, 95 % CI [2.8, 20.4], p = 0.01). For the way of parenting measured using APQ-9, participants showed no significant improvements in all subscales of Alabama Parenting Questionnaire – Short-form (APQ-9). The level of experiential avoidance was also found to have reduced in the ACT group compared to the control group (Mdiff = -4.9, 95% CI [-8.4, -1.4], p = 0.007).
This study used ACT to help parents to adapt to the psychological challenges of raising children who were studying in primary schools in Hong Kong. Students studying in primary schools are at an age at which their development would be greatly affected by the parenting approach. The results suggested that ACT could help parents to reduce stress, improve their psychological flexibility when faced with potential challenges in raising children. With these outcomes, parents would be able to select a parenting approach based on their personal chosen value, which is crucial to the development of their children.
Rights: All rights reserved
Access: restricted access

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