Currently submitted to: JMIR Pediatrics and Parenting
Date Submitted: Feb 24, 2026
Open Peer Review Period: Feb 26, 2026 - Apr 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Feasibility and Preliminary Efficacy of a Brief Videoconferencing Acceptance and Commitment Therapy Workshop for Chinese Parents of Children with Autism Spectrum Disorder: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Parents of children with autism spectrum disorder (ASD) often experience elevated levels of stress and psychological distress. In Hong Kong, cultural norms regarding emotional suppression may exacerbate these challenges. Acceptance and commitment therapy (ACT) offers a promising approach by targeting psychological inflexibility. However, its efficacy and specific mechanisms of change within Chinese cultural contexts, particularly when delivered via online formats, remain under researched compared with traditional cognitive therapy (CT).
Objective:
To evaluate the efficacy of a brief, 3-session online ACT workshop in reducing parental stress and improving general well-being among Chinese parents of children with ASD compared with an active online CT control and a passive waitlist control, and to determine if reductions in psychological inflexibility mediated these therapeutic outcomes.
Methods:
A 3-arm randomized clinical trial was conducted with 60 parents of children with ASD (mean age, 7.5 years) in Hong Kong. Participants were assigned to online ACT (n = 24), online CT (n = 23), or a waitlist control group (n = 13). The interventions consisted of 3 weekly 1.5-hour synchronous group sessions delivered via Zoom. Primary outcomes were general well-being (General Health Questionnaire-12) and parental stress (Parenting Stress Index–Short Form). Process variables included psychological flexibility and cognitive distortions. Data were analyzed using analysis of covariance and mediation analysis with bootstrapping (5000 resamples).
Results:
The online ACT group demonstrated significantly better general well-being at post-test compared with the waitlist control (P = .02) and the CT group (P = .03). Similarly, parental stress was significantly lower in the ACT group compared with the waitlist (P = .04) and CT (P = .01) groups. No significant differences were found between the active CT control and the waitlist control. Mediation analysis revealed that the reduction in psychological inflexibility significantly mediated the relationship between the ACT intervention and improvements in both parental stress (95% CI, -0.56 to -0.06) and general well-being (95% CI, -0.36 to -0.03). Cognitive distortions did not serve as a significant mediator for either outcome.
Conclusions:
A brief, online ACT intervention is effective in reducing stress and improving well-being among Chinese parents of children with ASD. The findings confirm that the intervention works through the theoretical mechanism of reducing psychological inflexibility, even when delivered remotely. This suggests that low-intensity, online ACT is a scalable, cost-effective, and culturally adaptable solution for supporting caregivers who may face barriers to traditional face-to-face therapy. Clinical Trial: N/A
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