Preliminary Examination of Associations Between Psychological Flexibility Processes of Change and Quality of Life in Digital Acceptance and Commitment Therapy for Autistic Adults.

An understanding of the relations between psychological flexibility processes and quality of life among autistic adults could help inform treatment development to improve the acceptability of mental healthcare among autistic adults. This pre-registered (https://osf.io/t3pws) secondary analysis of a mixed-methods pilot open trial provides a preliminary test of which subprocesses of psychological flexibility are associated with improvements in quality of life among a sample of 56 autistic adults who received a 6-week digital self-help acceptance and commitment therapy (ACT) intervention. Online self-report assessments were collected at pre-treatment, 6 weeks (post-treatment), and 10 weeks (1-month follow-up). Pre- to post-treatment improvements in values progress and valued action, but not openness to experience, behavioral awareness, or values obstruction, were associated with pre- to follow-up improvements in quality of life. Qualitative themes suggested that psychological flexibility with thoughts, emotions, and behaviors may be experienced as impacting quality of life. An exploratory analysis found that greater adherence to the digital ACT program was associated with greater pre- to post-treatment improvements in awareness and values obstruction, but not other psychological flexibility subprocesses. Although these are preliminary associative findings limited by a single-arm design, they suggest psychological flexibility, especially values, is a promising candidate for future research on mechanisms for improving quality of life among autistic adults.