Group acceptance and commitment therapy for parents with anxiety: A systematic literature review and Delphi Study

Fasoulis, Alkiviadis 2025. Group acceptance and commitment therapy for parents with anxiety: A systematic literature review and Delphi Study. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

This thesis explores the under-addressed issue of parental anxiety through two interlinked research papers, a systematic review and an empirical study, centred on the potential of group-based Acceptance and Commitment Therapy (ACT) for parents with anxiety. ACT is a third-wave therapy that promotes psychological flexibility (PF), the ability to stay in the present moment and act in line with personal values despite distressing thoughts, emotions, or situations (Hayes et al., 2006). PF has been linked to improved psychological outcomes across a range of populations, including parents (Brassell et al., 2016; Swain et al., 2013). Clinical levels of anxiety in parents can significantly affect the individual and is also associated with poorer parent–child interactions, overprotective or inconsistent parenting behaviours, and elevated risk of psychological problems in children (McLeod et al., 2007; Glasheen et al., 2010; Ranøyen et al., 2020). Despite this, psychological interventions rarely focus on anxiety in parents as a standalone concern (Acri & Hoagwood, 2015), despite emerging evidence that ACT may offer benefits for this population (e.g. Byrne et al., 2021). The systematic review examined the evidence base for ACT-based group interventions for parents where anxiety was included as an outcome measure, whether or not anxiety was the primary target or focus. Following PRISMA guidelines, the literature search identified nine studies which were analysed for quality, intervention content, and outcomes. These studies included parents of children with a variety of needs, from autism to chronic illness, and delivered group ACT in varied formats, session lengths, and intervention components. The results showed that improvements in parental anxiety were noted in a small majority of studies (N=5), although overall evidence for anxiety reduction was inconclusive. However, the seven studies that included outcomes in domains of psychological flexibility, all found significant improvements following intervention. Methodological variability was a barrier in examining links between PF and anxiety in parents. Possible reasons why the evidence for anxiety was fragmented and inconclusive is that studies had methodological weaknesses, inconsistent delivery methods, and lacked long-term follow-up. Therefore, there is need for better-designed interventions, more consistent evaluation methods, and an agreed-upon framework for implementing group ACT with clinically anxious parents. The empirical study focused on the early-stage development of an ACT-based group intervention for parents with clinical levels of anxiety. The study adopted a Delphi methodology, involving two rounds of expert consultation which is a method consistent with best-practice guidelines for complex intervention development (Craig et al., 2013; O’Cathain et al., 2019). Experts in ACT and family mental health were recruited internationally to contribute insights into what such an intervention should include regarding content, delivery format, and practical elements. The first Delphi round involved semi-structured interviews with 12 experts. The interviews were informed by participants being initially presented with a theoretical background of ACT and themes generated from prior focus groups of people with lived experience as parents and frontline professionals. The interviews were transcribed and analysed through Thematic Analysis (Braun & Clark, 2022), generating key themes. This included the need to address psychological inflexibility; shame; the importance of linking intervention content to parent context; and the value of using experiential metaphors and values-based exercises. Experts also emphasised the need to account for intergenerational influences and systemic stressors (e.g., societal expectations and lack of support), which may exacerbate anxiety in parents (Nelson et al., 2014). Interview themes were transformed into the second-round consensus survey. There was an overall strong consensus between experts. Sessions should run weekly for 5–7 weeks, led by facilitators with experience and/or training in both ACT and working in parenting contexts. Key content should include they key elements of psychological flexibility, such as mindfulness, reconnecting with values, committed action according to values, and metaphors/exercises to help parents understand how past experiences and values shape behaviours and parenting. The intervention should be adaptable to different family and cultural contexts and should provide space for parents to share their own stories and support one another. Crucially, the intervention was seen not just as a way to reduce anxiety but to foster resilience, by helping parents respond more flexibly and compassionately to the everyday challenges of raising a child, which would have the additional benefit of helping the family’s functioning and child’s wellbeing. Together, the systematic review and empirical study provide a foundation for the design of an expert informed protocol for a novel ACT-based group intervention specifically for parents with anxiety difficulties. Theoretically, this work contributes to understanding how ACT can be tailored to specific populations and psychological challenges. It also reinforces the need to consider the family system, recognising that supporting parents is not only to their benefit but also a preventative step for their children and family. Following subsequent development of a protocol for an intervention, clinically and practically, this research lays the groundwork for piloting an evidence-informed, experience-shaped, expert-endorsed intervention.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	15 September 2025
Last Modified:	15 Sep 2025 13:20
URI:	https://orca.cardiff.ac.uk/id/eprint/181083

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