Journal of health research in community

Introduction
One of the most stressful experiences in any family is having a child with disability or chronic illness such as Autism Spectrum Disorder (ASD). ASD is usually diagnosed at the age of 2-5 years. Over the past few decades, the prevalence of ASD has increased, affecting 1 in 68 school-age children. Parents of these children report social interaction problems and stereotypical behaviors in their children. The parents’ feeling of inability to control their child’s inappropriate behaviors can increase the intensity of their stress. Given the high prevalence of stress, anxiety, and self-criticism in mothers of children with ASD, it seems that interventions that focus on increasing self-compassion and reducing self-judgment, such as compassion-focused therapy (CFT), can be helpful. Studies have shown that self-compassion is a powerful predictor of mental health. Also, self-compassion is negatively related to self-criticism, depression, anxiety, rumination, and thought suppression. Therefore, the present study aimed to investigate the effectiveness of CFT in improving the level of self-compassion in mothers of children with ASD in Iran. The main hypothesis of the research is: CFT is effective in improving self-compassion in mothers of children with ASD.

Materials & Methods
This is a quasi-experimental study with a pre-test-posttest design. The study population consisted of all mothers of children with ASD living in Arak, Iran, in 2024. Using a non-random, convenience, and purposive sampling methods, 40 eligible mothers were selected and randomly assigned to two groups of CFT and control (each with 20 people). The instrument used in this study was the self-compassion scale (SCS) developed by Neff et al. (2003). In this study, the long form of this scale was used (having 26 items). The questionnaire’s overall reliability, as measured by Cronbach’s alpha in the present study, was 0.88. The participants who scored 30-70 on this questionnaire were included. The cut-off point of this questionnaire is 65. The intervention group received an educational intervention based on Germer’s protocol. This intervention was implemented in 7 weekly two-hour group sessions. During the training sessions, the control group did not receive any type of intervention. To test the research hypotheses, one-way analysis of covariance was used. It should be noted that all assumptions for using analysis of covariance were met. 

Results
The results show that the mean total score of the SCS in the pre-test phase was 82.50±6.57 in the CFT group and 80.70±7.72 in the control group. In the post-test phase, the scores changed to 92.30±6.32 and 80.40±8.07, respectively. 
The results in Table 1 showed that CFT had a significant effect on the self-compassion of mothers (F1,17=56.98, η2=0.77, P<0.001).


The value of the eta coefficient shows that the training explained 77% of the variance in the self-compassion of mothers. To determine the effectiveness of CFT on the six components of self-compassion, the results showed that CFT had a significant effect on all components including self-kindness (F1.12=9.67, P=0.001, η2=0.44), self-judgment (F1.12=18.96, P=0.001, η2=0.61), common humanity (F1.12=4.46, P=0.05, η2=0.27), isolation (F1.12=22.62, P=0.001, η2=0.65), mindfulness (F1.12=7.83, P=0.01, η2=0.39), and over-identification (F1.12=5.37, P=0.03, η2=0.31). The greatest effectiveness of CFT was on the isolation subscale and had the least effect on human commonalities.

Conclusion 
 The results showed that CFT was effective in improving the self-compassion of mothers of children with ASD. Among the components of self-compassion, CFT had the greatest impact on the “isolation” and “self-judgment” of mothers. Increasing self-compassion can be the key to effective knowledge and action mechanisms for parents of children with autism and reduce their stress, because self-compassion reveals limitations and identifies unhealthy behaviors and improves them through follow-up. The limitations of the present study included the use of convenience sampling, reliance solely on self-report data, and the lack of a follow-up phase. Given the importance of self-compassion and the results of the current study, it is recommended that this intervention be used as a complementary program in treatment clinics, rehabilitation centers, and support groups for families with autistic children.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Khomein Branch (Code: IR.IAU.ARAK.REC.1403.247).

Funding
This article was extracted from the thesis of Sahar Shams Kolahi at Islamic Azad University, Khomein Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
All authors contributed to conceptualization, literature review, methodology, data analysis and interpretation of data. The second author performed pre-test and post-test assessments and wrote the initial draft.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the officials and staff of the Arak Autism Association, as well as all participants in this study, for their assistance and cooperation.

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