ACT-Based (Acceptance and Commitment Therapy) Skills Training in Group for Adolescents and Adults with Asperger Syndrome

Background: Although high rates of depression, anxiety and stress, as well as decreased quality of life are frequently manifested in Asperger syndrome (AS), there are few adapted evidence based treatments that address these major difficulties. Acceptance and commitment therapy (ACT) is a contextual behavioural approach that has shown to be effective for complex and chronic conditions, as well as for comorbid conditions such as anxiety and depression, although not yet evaluated in AS.

Objectives: The current research project aims at evaluating feasibility, and efficacy of an adapted ACT-based skills training group program for adolescents and adults with AS.

Methods: We evaluated the feasibility and efficacy of the 12 session ACT-based skills training group program in a school setting using a randomized controlled study design (ACT/school classes as usual). Twenty-eight students with AS (aged 13–21) were assessed using self- and teacher-ratings at pre- and post-assessment, as well as 2-month follow-up. In the skills training group, the main treatment components and processes were social skills training; values work and committed action; mindfulness and acceptance practice; functional analysis; home work; and AS-related psychoeducation. In a second phase of the project, we are now performing a pilot study of the same ACT-program for adults with AS (n=10; age range 25-65 years) in an outpatient psychiatric context. Feasibility, treatment satisfaction and efficacy will be evaluated in an open trial study design.

Results: In the first study, all participants completed the skills training and treatment satisfaction was high. Levels of stress, hyperactivity, and emotional distress in the group were significantly reduced. The group also reported increased pro-social behaviour. These changes were stable or further improved at the 2-month follow-up. In the pilot study in an adult outpatient psychiatric context, the preliminary analyses showed promising feasibility and treatment satisfaction. Furthermore, participants showed significantly reduced stress and emotional distress, as well as increased quality of life.

Conclusions: The results indicate that ACT constitutes a feasible and effective approach for facilitating everyday life and alleviating symptoms of stress and psychological distress, and increase quality of life, in adolescents and adults with AS. Several larger studies are needed to fully evaluate the ACT-program in AS. We are currently conducting a randomized controlled trial to evaluate the potential benefits of ACT-based skills training in group on stress, quality of life and autistic core symptoms in adults with AS in a psychiatric outpatient context.