, Volume 8, Issue 3, pp 677–690 | Cite as

Effectiveness of Mindfulness-Based Intervention on Perceived Stress, Anxiety, and Depression Among Parents of Children with Autism Spectrum Disorder

  • Ahmad Rayan
  • Muayyad Ahmad


Parents of children with autism spectrum disorder (ASD) frequently report poor psychological well-being. Previous research has supported mindfulness-based interventions to enhance psychological well-being in parents of children with ASD, but studies about this topic are still rare. The purpose of this study was to examine the effectiveness of brief mindfulness-based intervention (MBI) on perceived stress, anxiety, and depression among parents of children with ASD in Jordan. A quasi-experimental pretest–posttest design with a comparison group was used. A sample of 104 parents of children with ASD has completed the study. Parents were matched on measures of age, gender, and level of severity of ASD in their children based on DSM-V criteria and randomized to one of the two groups. The intervention group participated in 5-week mindfulness-based intervention program, while participants in the comparison group had not attended the program between pretest and posttest measures. Participants in both groups had poor psychological well-being before the intervention program. After the intervention program, the one-way analyses of covariance (ANCOVA) indicated that parents in the intervention group had better outcomes on the measures of psychological well-being and mindfulness than those in the comparison group (P < 0.01). Furthermore, results of paired samples t test indicated that parents in the intervention group demonstrated significant improvements in measures of stress, anxiety, depression, and mindfulness scores with medium to large effect size (Cohen d between 0.42 and 0.85, P < 0.01). Although the comparison group demonstrated small improvement in measures of the dependent variables, these improvements were much less than improvements in the intervention group. The MBIs are culturally adaptable, feasible, and effective interventions to improve psychological well-being in parents of children with ASD.


Parent Mindfulness Anxiety Stress Depression Autism Child 


Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


The authors acknowledge the partial funding from the University of Jordan.


  1. Abu-Hamour, B., & Muhaidat, M. (2014). Parents' attitudes towards inclusion of students with autism in Jordan. International Journal of Inclusive Education, 18(6), 567–579.CrossRefGoogle Scholar
  2. Ahmad, M., & Dardas, L. (2016). Jordan: aspiration for a culturally sensitive nursing model. In J. J. Fitzpatrick & A. L. Whall (Eds.), Conceptual models of nursing: global perspectives. Upper Saddle: Pearson.Google Scholar
  3. Al-Khalaf, A., Dempsey, & Dally, K. (2014). The effect of an education program for mothers of children with autism spectrum disorder in Jordan. International Journal for the Advancement of Counselling, 36(2), 175–187.CrossRefGoogle Scholar
  4. Al-Krenawi, A. (2005). Mental health practice in Arab countries. Current Opinion in Psychiatry, 18(5), 560–564.PubMedCrossRefGoogle Scholar
  5. American Psychiatric Association (APA). (2013a). Diagnostic and statistical manual of mental disorders, (DSM-5®). American Psychiatric Pub.Google Scholar
  6. American Psychiatric Association. (2013b). The clinician-rated severity of autism spectrum and social communication disorders scale. Retrieved from
  7. Athari, P., Ghaedi, L., & Kosnin, M. (2013). Mothers' depression and stress, severity of autism among children and family income. International Journal of Psychological Research, 6(2), 98–106.CrossRefGoogle Scholar
  8. Baker, J. K., Seltzer, M. M., & Greenberg, J. S. (2011). Longitudinal effects of adaptability on behavior problems and maternal depression in families of adolescents with autism. Journal of Family Psychology, 25(4), 601–609.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Bazzano, A., Wolfe, C., Zylowska, L., Wang, S., Schuster, E., Barrett, C., & Lehrer, D. (2015). Mindfulness-based stress reduction (MBSR) for parents and caregivers of individuals with developmental disabilities: a community-based approach. Journal of Child and Family Studies, 24, 298–308.Google Scholar
  10. Beer, M., Ward, L., & Moar, K. (2013). The relationship between mindful parenting and distress in parents of children with an autism spectrum disorder. Mindfulness, 4(2), 102–112.CrossRefGoogle Scholar
  11. Benn, R., Akiva, T., Arel, S., & Roeser, R. W. (2012). Mindfulness training effects for parents and educators of children with special needs. Developmental Psychology, 48(5), 1476.PubMedCrossRefGoogle Scholar
  12. Bitsika, V., & Sharpley, C. F. (2004). Stress, anxiety and depression among parents of children with autism spectrum disorder. Australian Journal of Guidance and Counselling, 14(2), 151–161.CrossRefGoogle Scholar
  13. Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child & Family Behavior Therapy, 28(1), 1–18.CrossRefGoogle Scholar
  14. Bögels, S., & Restifo, K. (2013). Mindful parenting: a guide for mental health practitioners. Springer.Google Scholar
  15. Brislin, R. W. (1970). Back translation for the cross-cultural research. Journal of Cross Cultural Research, 1(13), doi: 10.1177/135910457000100301.
  16. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psycholog, 84(4), 822–848.CrossRefGoogle Scholar
  17. Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: a systematic review. Journal of Child and Family Studies, 25, 1–14. doi: 10.1007/s10826-015-0193-8.
  18. Carmody, J., & Baer, R. A. (2009). How long does a mindfulness‐based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638.PubMedCrossRefGoogle Scholar
  19. Carmody, J., Reed, G., Kristeller, J., & Merriam, P. (2008). Mindfulness, spirituality, and health-related symptoms. Journal of Psychosomatic Research, 64(4), 393–403.PubMedCrossRefGoogle Scholar
  20. Chapman, D. W., & Carter, J. F. (1979). Translation procedures for the cross cultural use of measurement instrument. Education Evaluation and Public Analysis, 1(3). doi: 10.3102/01623737001003071.
  21. Conner, C. M., & White, S. W. (2014). Stress in mothers of children with autism: trait mindfulness as a protective factor. Research in Autism Spectrum Disorders, 8(6), 617–624.CrossRefGoogle Scholar
  22. de Bruin, E. I., Blom, R., Smit, F. M., Steensel, V., & Bögels, S. M. (2014). MYmind: mindfulness training for youngsters with autism spectrum disorders and their parents. Autism, 19, 906–911.Google Scholar
  23. Deng, Y. Q., Li, S., Tang, Y. Y., Zhu, L. H., Ryan, R., & Brown, K. (2012). Psychometric properties of the Chinese translation of the mindful attention awareness scale (MAAS). Mindfulness, 3(1), 10–14.CrossRefGoogle Scholar
  24. Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014). Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics, 134(2), e454–e463.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Ellis-Jones, I. (2013). Mindfulness and Islam. Retrieved 11 1, 2014, from Scholar
  26. Epstein, B. J. (2010). Effects of a mindfulness based stress reduction program on fathers of children with developmental disability. Hofstra University.Google Scholar
  27. Fakhr El-Islam, M. (2008). Arab culture and mental health care. Transcultural Psychiatry, 45, 671–682.PubMedCrossRefGoogle Scholar
  28. Faul, F., Erdfelder, E., Lang, A., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.PubMedCrossRefGoogle Scholar
  29. Ferraioli, S. J., & Harris, S. L. (2013). Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: feasibility and preliminary outcome data. Mindfulness, 4(2), 89–101.CrossRefGoogle Scholar
  30. Firth, I., & Dryer, R. (2013). The predictors of distress in parents of children with autism spectrum disorder. Journal of Intellectual and Developmental Disability, 38(2), 163–171.PubMedCrossRefGoogle Scholar
  31. Flückiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59(1), 10.PubMedCrossRefGoogle Scholar
  32. Gunaratana, H. (2011). Mindfulness in plain English. USA: Wisdom Publications. Retrieved 10 15, 2014, from Scholar
  33. Hayes, S., & Watson, S. (2013). The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642.PubMedCrossRefGoogle Scholar
  34. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Hwang, Y. S., Kearney, P., Klieve, H., Lang, W., & Roberts, J. (2015). Cultivating mind: mindfulness interventions for children with autism spectrum disorder and problem behaviours, and their mothers. Journal of Child and Family Studies, 24(10), 3093–3106.CrossRefGoogle Scholar
  36. Iacoviello, B. M., McCarthy, K. S., Barrett, M. S., Rynn, M., Gallop, R., & Barber, J. P. (2007). Treatment preferences affect the therapeutic alliance: implications for randomized controlled trials. Journal of Consulting and Clinical Psychology, 75(1), 194.PubMedCrossRefGoogle Scholar
  37. Jabery, M. A., Arabiat, D. H., Khamra, H. A., Betawi, I. A., & Jabbar, S. K. (2014). Parental perceptions of services provided for children with autism in Jordan. Journal of Child and Family Studies, 23(3), 475–486.CrossRefGoogle Scholar
  38. Jones, L., Hastings, R. P., Totsika, V., Keane, L., & Rhule, N. (2014). Child behavior problems and parental well-being in families of children with autism: the mediating role of mindfulness and acceptance. American Journal on Intellectual and Developmental Disabilities, 119(2), 171–185.PubMedCrossRefGoogle Scholar
  39. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.Google Scholar
  40. Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
  41. Kabat-Zinn, J. (2011). Mindfulness for beginners: reclaiming the present moment—and your life. Sounds True.Google Scholar
  42. Kwan, B. M., Dimidjian, S., & Rizvi, S. L. (2010). Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression. Behaviour Research and Therapy, 48(8), 799–804.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Lai, W. W., & Oei, T. P. S. (2014). Coping in parents and caregivers of children with autism spectrum disorders (ASD): a review. Review Journal of Autism and Developmental Disorders, 1(3), 207–224.Google Scholar
  44. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behavior problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183. doi: 10.1111/j.1365-2788.2005.00732.x.PubMedCrossRefGoogle Scholar
  45. Lengua, L., & Kerns, S. (2014). Whole U 'Mindful parenting' seminar. USA: Center for Child and Family Well-Being. Retrieved 10 16, 2014, from Scholar
  46. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.Google Scholar
  47. Mak, W. W., & Ho, G. S. (2007). Caregiving perceptions of Chinese mothers of children with intellectual disability in Hong Kong. Journal of Applied Research in Intellectual Disabilities, 20(2), 145–156.CrossRefGoogle Scholar
  48. Manikam, R. (2014). Psychology of meditation. Mindfulness, 5(5), 613–616.CrossRefGoogle Scholar
  49. Masri, A. T., Al Suluh, N., & Nasir, R. (2013). Diagnostic delay of autism in Jordan: review of 84 cases. The Libyan Journal of Medicine, 8. doi: 10.3402/ljm.v8i0.21725.
  50. Morgan, J. R., Masuda, A., & Anderson, P. L. (2013). A preliminary analysis of the psychometric properties of the mindful attention awareness scale among African American college students. Mindfulness, 5(6), 639–645.CrossRefGoogle Scholar
  51. Nyklíček, I., Dijksman, S. C., Lenders, P. J., Fonteijn, W. A., & Koolen, J. J. (2014). A brief mindfulness based intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (PCI) patients: the MindfulHeart randomized controlled trial. Journal of Behavioral Medicine, 37(1), 135–144.PubMedCrossRefGoogle Scholar
  52. Pepping, C. A., O’Donovan, A., & Davis, P. J. (2013). The positive effects of mindfulness on self-esteem. The Journal of Positive Psychology, 8(5), 376–386.CrossRefGoogle Scholar
  53. Phang, C., & Oei, T. (2012). From mindfulness to meta-mindfulness: further integration of meta-mindfulness concept and strategies into cognitive-behavioral therapy. Mindfulness, 3, 104–116.Google Scholar
  54. Pourhoseingholi, M. A., Baghestani, A. R., & Vahedi, M. (2012). How to control confounding effects by statistical analysis. Gastroenterology and Hepatology from Bed to Bench, 5(2), 79.PubMedPubMedCentralGoogle Scholar
  55. Rayan, A., & Jaradat, A. (2016). Stigma of mental illness and attitudes toward psychological help-seeking in Jordanian university students. Research in Psychology and Behavioral Sciences, 4(1), 7–14.Google Scholar
  56. Retso, J. (2002). Arabs in antiquity: their history from the Assyrians to the Umayyads. Florence: Routledge. 9780700716791. ISBN 0-7007-1679-3.Google Scholar
  57. Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: The Guilford Press.Google Scholar
  58. Singh, N. N., Lancioni, G. E., Winton, A. S., Singh, J., Curtis, W., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31(6), 749–771.PubMedCrossRefGoogle Scholar
  59. Taouk, M., Lovibond, P., & Laube, R. (2001). Psychometric properties of an Arabic version of the Depression Anxiety Stress Scales (DASS21). Report for New South Wales Transcultural Mental Health Centre, Cumberland Hospital, SydneyGoogle Scholar
  60. Uchino, B. N. (2006). Social support and health: a review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29(4), 377–387.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.The Faculty of Nursing, Psychiatric and Mental Health NursingZarqa UniversityZarqaJordan
  2. 2.Clinical Nursing Department, The Faculty of NursingThe University of JordanAmmanJordan

Personalised recommendations