Effectiveness of Mindfulness-Based Stress Reduction Groups for Autistic Adults: A Randomized Clinical Trial

Abstract

Background:

Autistic adults often experience high levels of stress and difficulties in coping with stressors in everyday life. The aim of this study was to evaluate the effectiveness of mindfulness-based stress reduction (MBSR) groups, adjusted for autistic adults in an outpatient context.

Methods:

We conducted a two-arm, parallel-group, randomized controlled effectiveness trial during the years 2018–2020. Autistic adults (N = 77) were recruited from outpatient services and randomized to either MBSR (n = 39) or treatment as usual, TAU (i.e., continued regular services, n = 38). We used linear mixed models with random intercept to analyze the effects of intervention on self-rated perceived stress (primary outcome), as well as mental health, mindfulness skills, quality of life, and autism acceptance (secondary outcomes). In addition, we collected qualitative data at exit discussions in the MBSR groups and examined the transcription using thematic content analysis.

Results:

Participants (52% female) had a mean age of 40 years, with a majority being unemployed at the time of inclusion (64.9%) and having at least one co-occurring psychiatric diagnosis (87%). The completion rate in the MBSR group was 81%. A comparison of the slopes of the two groups showed a greater reduction of perceived stress from pre- to postintervention in the MBSR group than in the TAU group (Perceived Stress Scale total score: between-group effect size d = 0.55 [0.20–0.90] at postintervention and d = 0.61 [0.13–1.10] at the 3-month follow-up). Likewise, symptoms of mental health problems decreased more in the MBSR group (Hospital Anxiety and Depression Scale total score: between group d = 0.64 [0.23–1.05] at postintervention and d = 0.70 [0.14–1.26] at the 3-month follow-up). No changes in autism acceptance or general quality of life were observed in this study. Qualitative analysis indicated that participants perceived the MBSR group as inclusive and safe. Moreover, they appreciated both the conveyance of mindfulness techniques and the change in their approach (a “new mindset”) regarding stress. The participants also reflected on the challenges of continued practice after completed intervention.

Conclusions:

The MBSR groups for autistic adults may be an effective intervention in a clinical context. Future studies should examine the facilitators and barriers for the long-term maintenance of the acquired benefits.

Community Brief

Why is this an important issue?

Autistic adults often experience high levels of stress and difficulties in coping with everyday stressors, such as sensory overload or social stressors. Mindfulness-based stress reduction (MBSR) is a group program that promotes the ability to be in the present moment (mindfulness) and related techniques for coping with stress. The program is based on mindfulness exercises and experiences rather than lectures.

What was the purpose of this study?

The purpose of this study was to evaluate the effectiveness of the MBSR groups for autistic adults in an outpatient health care context.

What did the researchers do?

The 77 participants in the study were randomly assigned into one of the two study conditions: 39 participants took part of the MBSR group while 38 participants continued their treatment as usual (including, for example, medical treatment, physiotherapy, occupation therapy, or counseling). Those participants who were randomized to continued treatment as usual could take part in the MBSR program during the following term. In this study, MBSR was adjusted for autistic adults’ needs following previous participants’ feedback.

We used self-report questionnaires to collect data before and 3 months after the program. In addition, we recorded group discussions at the end of each MBSR group, to collect the participants’ views and lived experiences.

What were the results and conclusions of the study?

Participants had a mean age of 40 years and 52% of them were female. Most participants (64.9%) were not studying or working at inclusion, and 87% had at least one co-occurring psychiatric diagnosis. In the MBSR group, 81% of the participants completed the program.

When we compared self-reported stress in the two groups (MBSR and treatment as usual), we found that participants in the MBSR group received greater benefit from the program than those who received continued treatment as usual. The MBSR group participants experienced improved stress coping and mindfulness skills. Moreover, well-being increased more in the MBSR group. However, there were no changes in autism acceptance or general quality of life, in either of the two groups.

What is new about the findings?

This is the first effectiveness study of MBSR for autistic adults conducted in an outpatient setting and showing positive effects on stress reduction and well-being. In the group discussions, the participants in the MBSR group described that MBSR provided important hands-on tools for coping with stress. They also experienced a positive change in their “mindset” or approach to stress, and their own thoughts and reactions in stressful situations. The participants also discussed the challenges of continuing with mindfulness training and maintaining the skills learned after finishing the program at the clinic.

How will these findings help autistic adults now or in the future?

The MBSR groups for autistic adults may be a helpful support for autistic adults with high levels of stress in everyday life and co-occurring mental health problems. Aside from a clinical setting, as in this study, the program might also be suitable for other contexts.

What are potential weaknesses in the study?

Since the follow-up time in this study was only 3 months after the program, future research should examine if the acquired mindfulness skills and a new approach to stress hold over longer time.