Peer-led stress reduction may help mothers of kids with autism

NEW YORK (Reuters Health) - Programs teaching “mindfulness” and “positive psychology” both helped mothers of children with autism and other mental-development disabilities to reduce their stress, anxiety and depression, according to a new study.

Most services for such families focus on the disabled child, researchers say, but improving the mental health of parents is likely to make them better caregivers and that, in turn, could improve their child’s development.

“There are literally decades of studies that have described the high levels of stress and distress, anxiety and depressive symptoms that moms and dads of children with developmental disabilities suffer, and I didn’t want to describe anymore, I wanted to do something about it,” said Elizabeth Dykens, who led the new study.

“So this is really for parents - it was for their mental health and wellbeing, for their own adult development,” said Dykens, an associate director of the Vanderbilt Kennedy Center for Research on Human Development in Nashville, Tennessee.

“And I think that’s what really sets it apart from the traditional interventions that are much more child oriented,” she told Reuters Health.

Past research has found that cognitive behavioral therapies, such as Mindfulness Based Stress Reduction and so-called positive psychology, are effective at reducing symptoms of stress, anxiety and even depression, Dykens and her colleagues write in the journal Pediatrics.

Those two approaches have also been shown to lend themselves to group programs and to being delivered by non-professionals who have undergone the therapy themselves and been thoroughly trained to help peers, the authors add.

For their study, Dykens and her colleagues enrolled 243 mothers of children with autism or other neurodevelopmental disabilities and randomly assigned them to groups that would receive either the mindfulness training or a positive psychology program called Positive Adult Development (PAD).

“Mindfulness basically helps people focus on the present moment in a non-judgmental way, and it does that through deep belly breathing, gentle movements like yoga or qigong and meditation,” Dykens said.

She said the PAD group was more focused on thoughts, including practicing gratitude and forgiveness and defining one’s own strengths.

“Things that would counteract the anger or disappointment or feelings of guilt or sadness families often experience as they try to deal with the kids’ challenging behavior and also work with the systems that are involved in providing care,” she said.

Four peer mentors, who were themselves mothers of children with developmental disabilities, had gone through the therapies and been trained to lead the groups under the supervision of a social worker.

Both programs consisted of hour-and-a-half weekly sessions for six weeks. Psychological questionnaires were used to assess the participating mothers a total of six times before, during and up to six months after treatment.

At the start, about 85 percent of the participating mothers had significantly elevated levels of stress, 48 percent were clinically depressed and 41 percent had anxiety disorders.

By the end of six weeks, both groups showed significant reductions in stress, depression and anxiety levels, with sharp drops starting after just two weeks. In addition, both groups reported improved sleep and life satisfaction.

Mothers in the mindfulness group had greater improvements in anxiety, depression, sleep and wellbeing and stronger responses in the categories of anxiety and depression, compared to the women in the positive psychology program during that time.

The researchers speculate that may be because of the immediacy of physical relaxation promoted by the mindfulness approach. But over the longer follow-up period, mothers in the positive psychology group reported greater reductions in depression and improvements in life satisfaction compared to the mindfulness group, the researchers note.

They acknowledge the study had some limitations because it compared two active interventions without using a comparison group that got no treatment.

But, the study team writes, “untreated mothers of offspring with disabilities do not necessarily become less depressed over time.” If anything, research shows they experience more health and mental health problems with age, the authors say.

Dr. Eric Hollander told Reuters Health that despite its limitations, the study was large enough to show some interesting results.

“It’s pretty hard to show significant differences between active interventions but nevertheless the study did show some hints or suggestions of differences in terms of the type of interventions,” he said.

Hollander, who was not involved in the study, directs the Compulsive, Impulsive and Autism Spectrum Disorder Program at Montefiore Medical Center in New York.

He said this is an important area for research because “families with children with autism spectrum disorder have higher caregiver burden than any other disorder.”

“I think the idea of using parents or peers to run these interventions is a good one because I think that families will identify with people who’ve been through the process,” he said. “And it does bring down the cost.”

Dykens said that parents looking for this type of help could find books on mindfulness practice and there are some community mental health centers that offer help as well.

Mindfulness Based Stress Reduction is a program originally developed for severely ill patients coping with pain, but is now offered more widely and parents can search online for psychotherapists, meditation centers and other health and wellness centers that may offer the course.

Dykens added that joining parent groups and searching for local chapters of specific advocacy groups, such as the Autism Society and the National Down Syndrome Society, might also help parents.

SOURCE: Pediatrics, online July 21, 2014.