1

EFFECTIVENESS OF THE BRIEF MINDFULNESS-BASED STRESS REDUCTION

PROGRAMME IN ALLEVIATING PARENTING STRESS IN MOTHERS OF CHILDREN
WITH AUTISM SPECTRUM DISORDER

BINDU, M. K1 & ARJUNAN, N. K2

[1 Research & Development Centre, Bharathiar University, Tamil Nadu, India, E-mail: bindhugayathri70@gmail.com
2
Corresponding Author: Teacher Education Centre, University of Calicut, Thrissur, Kerala, India, PIN-680618, Phone: +91
9895067619, E-mail: arjunamendall@gmail.com]

Present Address of Authors:

1. Bindu, M. K., MES Training College, Aluva, Kerala, India, PIN-683564, Phone: +919447205413, E-mail:
bindhugayathri70@gmail.com
2. Arjunan, N. K., Teacher Education Centre, University of Calicut, Thrissur, Kerala, India, PIN-680618, Phone:
+919895067619, E-mail: arjunamendall@gmail.com
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ABSTRACT

The aim of the study was to find out the effectiveness of the Brief Mindfulness-Based Stress Reduction Programme in
alleviating parenting stress in mothers of children with autism spectrum disorder. The study adopted the pre-test post-test
control group design wherein two convenient groups of mothers of children diagnoses with autism spectrum disorder were
designated as control group and experimental group. The parenting stress of the participants in both the groups were measured
before and immediately after the experimentation by administering the Stress Inventory for Mothers of Children with Autism
Spectrum Disorders. The experimental group was intervened with the Brief Mindfulness-Based Stress Reduction Programme, a
group-based mindfulness meditation, for four weeks at the rate of two 1.5 hours sessions per week and a homework of 20-25
minutes formal meditation. Analysis showed significant difference between the control group and experimental group,
revealing the effectiveness of the brief mindfulness meditation based stress reduction programme in alleviating parenting stress
in mothers of children with autism.

Key words: Parenting stress, Autism Spectrum Disorder, Mindfulness meditation, Brief Mindfulness-Based Stress Reduction
Programme

1. INTRODUCTION

Parenting children with autism spectrum disorder (ASD) can be more stressful and challenging than parenting typically
developing children or those diagnosed with other developmental disorders (Boyd, 2002; Dunn et al., 2001; Mancil et al.,
2009) due to the additional demand on their time, energy, finances, emotions and possible feelings of inadequacy about their
competence to deal with their child’s needs (Olsen et al., 1999). The major source of stress experienced by parents of child
with autism is the behaviour problems of the child. A mutually escalating reciprocal relationship between behaviour problems
of children with ASD and maternal stress has been established by earlier researchers (Pesonen et al., 2008; Baker et al., 2003;
Neece et al., 2012). Parental stress has been shown to serve as an important predictor of intervention outcomes for children
with ASD in that elevated parental stress predicts lower levels of developmental progress in behavioral interventions, including
decreased development of language, communication, and adaptive behaviors (Makrygianni & Reed, 2010). Highly stressed
parents are less able to implement interventions for their children with disabilities, and their children make less developmental
progress. Given the relationship between parental stress and child behavior problems, the need for a stress-reduction
intervention for parents of children with ASD is apparent.

Mindfulness meditation is one of the most widely known clinical programs designed to give instruction and experience
in mindfulness practice, as well as guidance and suggestion in integrating mindfulness into everyday life to facilitate increased
well-being and reductions in psychological distress. Recently, mindfulness-based interventions have been of increasing interest
as a cost-effective, low-stigma, accessible treatment option for a variety of psychological and medical symptoms, including
stress and anxiety (Hofmann et al., 2010). Mindfulness-Based Stress Reduction (MBSR) is an evidence-based stress-reduction
intervention program developed at the University of Massachusetts Medical Centre by Kabat-Zinn (1991). The MBSR is
supported by over two decades of extensive research showing its effectiveness in reducing stress, anxiety, and depression, and
promoting overall wellbeing (Chiesa & Serretti, 2010; Fjorback et al., 2011; Grossman et al., 2004). Realising the research gap
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in the literature, an experimental study was initiated to find out the effect of a Brief Mindfulness-Based Stress Reduction
Programme in alleviating the parenting stress in mothers of children with autism spectrum disorder. It was hypothesised that
the Brief Mindfulness-Based Stress Reduction Programme will be effective in alleviating the parenting stress in mothers of
children with autism spectrum disorder.

2. OBJECTIVE OF THE STUDY

The major objective of the study is to find out the effect of the Brief Mindfulness-Based Stress Reduction Programme
(BMBSRP) in alleviating parenting stress in mothers of children with ASD.

3. HYPOTHESES OF THE STUDY

The following null hypotheses were tested for the study.

H01: There will be no significant difference between experimental group and control group regarding the pre-test scores
of parenting stress in mothers of children with ASD.

H02: There will be no significant difference between pre-test and post-test parenting stress scores of mothers of children
with ASD in the control group.

H03: There will be no significant difference between pre-test and post-test parenting stress scores of mothers of children
with ASD in the experimental group.

H04: There will be no significant difference in the post-test scores of parenting stress in experimental group and control
group mothers when pre-test scores of parenting stress were taken as covariate.

4. METHODOLOGY

4.1 Method

The study adopted a quasi-experimental (non-equivalent pre-test post-test control group) design.

4.2 Population

Mothers of children (in the age range 4-14) with ASD, residing within the revenue boundaries of Kerala (India)
constituted the research population.
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4.3 Participants

The participants of the study was two convenient groups of mothers of children with ASD enrolled to two district level
Centres for Research and Development of Autistic Children (CRDAC), one at Thrissur (the control group; n = 58) and the
other at Kozhikode (the experimental group; n = 63). The CRDAC is a district level education support centres for Children
with Autism, their Parents and Teachers, functioning under the Urban Resource Centres (URCs) of Sarva Shiksha Abhiyan
(SSA) Project, Govt. of Kerala (India).

4.4 Instrumentation

Parenting stress of the participants were measured by administering the Stress Inventory for Mothers of Children with
Autism Spectrum Disorders (SIM-CASD) developed by Bindu and Arjunan (2014). It is a standardised 30 item five-point
Likert-type scale covering three domains of parenting stress, viz., child characteristics, parent characteristics, and social/family
life stress. The SIM-CASD has a concurrent validity (with the Parenting Stress Index, Abidin, 1995) of 0.73 and split-half
reliability of 0.83.

4.5 Experimental Intervention

The experimental group was intervened with a mindfulness meditation bases stress reduction programme known by the
name ‘the Brief Mindfulness Based Stress Reduction Programme (BMBSRP)’. The BMBSRP is modelled on the Mindfulness-
Based Stress Reduction (MBSR) program developed at the University of Massachusetts Medical Center by Kabat-Zinn (1991).
The MBSR is an 8-week evidence-based programme that offers secular, intensive mindfulness training to support people with
pain, anxiety, stress and depression. It employs a blend of mindfulness meditation, body awareness, yoga and exploration of
patterns of behaviour, thinking, feeling and action. The BMBSRP consisted of four 1.5 hours sessions, spread over 4-weeks,
which incorporated formal techniques utilized in MBSR, such as body scan meditation, sitting meditation, hatha yoga, walking
meditation, and loving-kindness meditation. As part of the program, participants were instructed to practice 20 to 25 minutes of
formal meditation daily at the rate of 6 days per week. The intervention was made by a qualified and experienced practitioner
by strictly following the guidelines laid down by Kabat-Zinn (1993).

4.6 Procedure

The participants in both the control group and experimental group were subjected to pre-test measurement of parenting
stress before the commencement of the experimentation. Strict control condition was maintained for the participants in control
group, while the experimental group was exposed to BMBSRP intervention for four weeks at the rate of two sessions of 1.5
hours duration per week and a homework of 20-25 minutes formal meditation daily for 6 days per week. Post-test measurement
of the parenting stress was done in both control group and experimental group immediately after the experimentation. The
scores were compared statistically with the help of SPSS 17.0 for Windows.
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5. RESULTS

The pre-test scores of parenting stress in mothers of children with ASD in control group and experimental group were
compared to know whether the groups differ significantly prior to experimentation. The result of the independent sample t-test
carried out in this context is given in Table 1.

The t-value estimated is not significant (t = 0.282; p>.05), showing that there is no significant difference between
control group and experimental group prior to experimentation. The H 01, (there will be no significant difference between
experimental group and control group regarding the pre-test scores of parenting stress in mothers of children with ASD), is,
hence, accepted.

The pre-test and post-test scores of control group were compared to find out whether the control condition has
contributed to any significant change in the parenting stress of mothers of children with autism. The result of the paired t-test
performed in this connection is given in Table 2.

The t-value estimated is not large enough to be significant at least at 95% confidence interval (t = 1.499; p>.05),
revealing that the control condition has not contributed to any significant change in the parenting stress of mothers in the
control group. The second hypothesis, viz., H02 (there will be no significant difference between pre-test and post-test parenting
stress scores of mothers of children with ASD in the control group), is, therefore, accepted.

In order to find out the effect of experimental condition on the parenting stress of mothers of children with ASD, the
pre-test and post-test scores of the experimental group was compared by applying paired t-test. The data and result of the
analysis is given in Table 3.

The t-value obtained on comparing the pre-test and post-test parenting stress score of experimental group is significant
at .01 level revealing the true difference between pre-test and post-test conditions of the group which received experimental
treatment. The H03 (there will be no significant difference between pre-test and post-test parenting stress scores of mothers of
children with ASD in the experimental group), formulated in this context, is hence rejected.

In order to find out the real effect of the BMBSRP on the parenting stress of mothers of children with autism, one way
ANCOVA was carried out by taking pre-test scores of parenting stress as covariate. The result of the analysis is given in Table
4.

he F-value obtained is significant (F = 257.782; p<.001), showing that there is a significant difference between control
group and experimental group with regard to their post-test scores of parenting stress when adjusted for pre-test scores of
parenting stress. The estimated marginal means of the post-test scores for the control group and experimental group is given in
Table 5.

The estimated marginal mean for the experimental group (M = 94.389) is lower than for the control group (M =
102.932). It reveals that the BMBSRP intervention was effective in reducing the parenting stress of mothers of children with
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autism. The H04 (there will be no significant difference in the post-test scores of parenting stress in experimental group and
control group mothers when pre-test scores of parenting stress were taken as covariate) is, therefore, rejected.

6. CONCLUSIONS

The result of the comparison of the mean parenting stress scores of mothers of children with ASD in the control group
and experimental group shows that the groups are almost alike with respect to parenting stress prior to the experimentation.
Though a slight variation in the mean parenting stress scores of mothers in the control group was observed between pre-test
and post-test conditions, the difference was not significant. This lead to the conclusion that the control condition was efficient
in not causing any considerable change in the parenting stress of mothers of children with autism. The significant difference
observed between the mean pre-test and post-test parenting stress scores in the experimental group reveals that the BMBSRP
intervention has resulted in a considerable decline in the parenting stress of mothers of children with autism. The result of
ANCOVA shows that the experimental intervention has resulted in a true difference between the control group and
experimental group with regard to the parenting stress. The mean parenting stress score of the experimental group is
significantly lower than that of the control group after experimentation, revealing the effectiveness of BMBSRP in alleviating
the parenting stress of mothers of children with autism.

7. ACKNOWLEDGEMENTS

This paper is a part of the Ph.D research by the first author under the supervision of the second author. The authors
place on record their profound and sincere gratitude to the Director, Research and Development Centre, Bharathiar University,
Coimbatore, for the opportunity given to carry out the research activity. Heartfelt thanks are also due to the Directors of the
Urban Resource Centres (SSA) at Thrissur and Kozhikode, and also to the participant mothers of the study for their whole
hearted cooperation and support during the data collection phase of the study.

8. REFERENCES

Baker, B. L., McIntyre, L. L., Blacher, J., Crnic, K., Edelbrock, C., & Low, C. (2003). Preschool children with and without developmental
delay: Behaviour problems and parenting stress over time. Journal of Intellectual Disability Research, 47 (4-5), 217-230.
doi:10.1046/j.1365-2788.2003.00484.x

Bindu, M. K., & Arjunan, N. K. (2014). Stress inventory for mothers of children with autism spectrum disorders. Coimbatore: Research &
Development Centre, Bharathiar University.

Boyd, B. (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on Autism
and Other Developmental Disabilities, 17, 208-215. doi:10.1177/10883576020170040 301.

Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological
Medicine, 40 (8), 1239-1252. Retrieved from http://dx.doi.org/10.1017/S0033291709991747
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Dunn, M. E., Burbine, T., Bowers, C. A., & Tantleff-Dunn, S. (2001). Moderators of stress in parents of children with autism. Community
Mental Health Journal, 37, 39-52. doi:10.1023/A:1026592305436.

Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive
therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124 (2), 102-119. Retrieved from
http://dx. doi.org/10.1111/j.1600-0447.2011.01704.x.

Grossman, P., Niemannb, L., Schmidtc, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis.
Journal of Psychosomatic Research, 57, 35-43. doi: 10.1016/S0022-3999(03)00573-7

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. Retrieved from http://dx.doi.
org/10.1037/a0018555.

Kabat-Zinn, J. (1991). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness.  New York: Dell
Publishing.

Kabat-Zinn, J. (1993) Mindfulness meditation: Health benefits of an ancient Buddhist practice. In D. Goleman & J. Gurin (Eds.), Mind/Body
Medicine (pp. 259–275). Yonkers, NY: Consumer Reports Books.

Makrygianni, M. K., & Reed, P. (2010). Factors impacting on the outcomes of Greek intervention programmes for children with autistic
spectrum disorders. Research in Autism Spectrum Disorders, 4 (4), 697-708. doi:10.1016/j.rasd. 2010.01.008

Mancil, G., Boyd, B., & Bedesem, P. (2009). Parental stress and autism: Are there useful coping strategies? Education and Training in
Developmental Disabilities, 44 (4), 523-537. Retrieved from http://www.dddcec.org/ etmrddv/TOC/ etddv44n4. htm#seven.

Neece, C. L., Green, S. A., & Baker, B. L. (2012). Parenting stress and child behavior problems: A transactional relationship across time.
American Journal on Intellectual and Developmental Disabilities, 117 (1), 48-66. doi: 10.1352/1944- 7558-117.1.48

Olsen, S.F., Marshall, E.S., Mandeleco, B.L., & Allred, K.W. (1999). Support, communication and hardiness in families with children with
disabilities. Journal of Family Nursing, 5, (4), 275–291.

Pesonen, A. K., Raikkonen, K., Heinonen, K., Komsi, N., Jarvenpaa, A. L., & Strandberg, T. (2008). A Transactional model of
temperamental development: Evidence of a relationship between child temperament and maternal stress over five years. Social
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Table 1. Comparison of the pre-test scores of parenting stress of control group and experimental group

Groups Statistical Indices t-value Sig.

N M SD SEM

Contl. Group 58 102.40 12.827 1.684

0.282 NS
Exptl. Group 63 103.02 11.366 1.432
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Table 2. Comparison of the pre-test and post-test scores of parenting stress of control group

Groups Statistical Indices t-value Sig.

N M SD SEM

Pre-test 102.40 58 12.827 1.684

1.499 NS
Post-test 101.79 58 12.172 1.598
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Table 3. Comparison of the pre-test and post-test scores of parenting stress of experimental group

Groups Statistical Indices t-value Sig.

N M SD SEM

Pre-test 63 103.02 11.37 1.43

17.895 .01
Post-test 63 94.67 10.64 1.34
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Table 4. ANCOVA result of parenting stress of experimental group and control group with pre-test scores of parenting stress as covariate.

Dependent Variable: Post-test

Source Type III Sum of df Mean Square F Sig. Partial Eta Squared

Squares
Corrected Model 17124.256a 2 8562.128 1.008E3 .000 .945
Intercept 10.453 1 10.453 1.231 .269 .010
Pre-test 15221.986 1 15221.986 1.793E3 .000 .938
Group 2188.731 1 2188.731 257.782 .000 .686
Error 1001.893 118 8.491
Total 1191409.000 121
Corrected Total 18126.149 120
a. R Squared = .945 (Adjusted R Squared = .944)
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Table 5. Descriptive statistics of post-test scores after adjusting for pre-test scores

Dependent Variable: Post-test

95% Confidence Interval
Groups Mean Std. Error
Lower Bound Upper Bound

Control 102.932a .383 102.147 103.663

Experimental 94.389a .367 93.662 95.116

a. Covariates appearing in the model are evaluated at the following values: Pre-test = 102.72.
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