Mindfulness-Based Stress Reduction for Adults with Autism Spectrum Disorder: Feasibility and Estimated Effects

Background: Adults with autism spectrum disorder (ASD) consistently report lower quality of life (QOL) and functioning compared to neurotypical peers. Despite the growing population and needs of adults with ASD, many psychosocial interventions target children and adolescents while relying on high level cognitive strategies for symptom reduction. Mindfulness-Based Stress Reduction (MBSR), which cultivates regulation skills through experiential practice instead of cognitive strategies, has been modified for autistic samples across the lifespan. However, it has not been tested if the standard MBSR curriculum for heterogenous adults is appropriate for an autistic population to improve functioning and QOL.

Objectives: This pilot feasibility trial aimed to (1) Establish the feasibility and acceptability of a traditional MBSR group intervention with adults diagnosed with ASD; (2) Evaluate teacher fidelity and integrity to the MBSR curriculum; (3) Calculate effect size estimates of change in QOL, life satisfaction, and mindfulness.

Methods: Participants included twelve adults with ASD (IQ>70; age 22-63). MBSR consisted of a one-hour orientation, 8 weekly 2.5 hour group classes, a full day (7.5 hours) silent meditation retreat after week 6, and 45 minutes of assigned daily meditation homework. The instructor was a certified rehabilitation counselor and recognized as a qualified MBSR teacher through the University of Massachusetts Oasis Institute. Fidelity was evaluated with the Mindfulness-Based Intervention Teacher Assessment Criteria (MBI-TAC) by a senior MBSR teacher trainer. Participants completed a self-report assessment battery at three time points (pre-, mid-, and post-treatment), including: Satisfaction with Life Scale (SWLS), World Health Organization Quality of Life questionnaire (WHOQOL-BREF-ID), the Child and Adolescent Mindfulness Measure (CAMM), and the Positive Outlook scale from the Healing Encounters and Attitudes Lists (HEAL). Participants also completed the client satisfaction questionnaire (CSQ-8) and a qualitative exit interview post-treatment with a research assistant not involved in the intervention.

Results: All participants completed the MBSR intervention and post-assessments (100% retention). Participants reported high satisfaction with the intervention on the CSQ-8 (M = 27.92, SD = 3.5). Sessions 4 and 5 were randomly selected for fidelity review. Both session 4 (M=5.33; SD=.5) and 5 (M=4.67; SD=.5) met fidelity with an overall rating of “proficiency +” on the MBI-TAC. While fidelity to MBSR was met without modification, ASD specific supports within the flexibility of the curriculum were identified. Participants required concrete structuring for small-group discussions and additional consultation between sessions (M=28.75, SD=22.48 minutes). Effect size estimates suggested large improvements in positive outlook (F(2,22) = 12.42, p<.001, d=2.12), satisfaction with life (F(2,22) = 3.22, p=.059, d =1.08), mindfulness (F(2,22) = 3.34, p=.054, d =1.10), and quality of life (F(2,22) = 3.09, p=.066, d=1.059). Seven of twelve participants listed emotion regulation as the primary benefit during qualitative exit interviews.

Conclusions: This project established feasibility and acceptability of traditional MBSR for adults with ASD while estimating that MBSR could be a promising QOL intervention. Utilization of a traditional heterogenous MBSR program would expand effective, affordable, and inclusive treatment options for autistic adults. Exit interviews suggest that future research should consider measuring emotion regulation as a mechanism for improved functioning.