Acceptance and Commitment Therapy Guided Self-help for Adults With a Diagnosis of Autistic Spectrum Disorder Experiencing Psychological Distress
Phase: NA
Conditions: Autism Spectrum Disorder (ASD)
Sponsor: University of Lincoln

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
 
 
 
 
 
 
 
 
 
 
 
PROTOCOL 
Acceptance and Commitment Therapy guided self-help for adults with a diagnosis of Autistic 
Spectrum Disorder experiencing psychological distress.  
 
 Guided ACT and for adults with ASD  
 
Protocol Version 03 
Date 16.04.2020 
 
 
IRAS Project ID 
245597                        
Registration ID 
Insert ISRCTN and/or clinicaltrials.gov reference 
Sponsor  
University of Lincoln 
Sponsor ID 
190731 
Funder 
 
Trent Course Doctorate in Clinical Psychology. 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
SIGNATURE PAGE 
 
The undersigned confirm that the following protocol has been agreed and accepted and that 
the Chief Investigator agrees to conduct the study in compliance with the approved protocol 
and will adhere to the principles outlined in the Declaration of Helsinki, the Sponsor’s SOPs, 
and other regulatory requirement(s). 
I agree to ensure that the confidential information contained in this document will not be used 
for any other purpose other than the evaluation or conduct of the investigation without the prior 
written consent of the Sponsor 
I also confirm that I will make the findings of the study publically available through publication 
or other dissemination tools without any unnecessary delay and that an honest accurate and 
transparent account of the study will be given; and that any discrepancies from the study as 
planned in this protocol will be explained. 
 
Chief Investigator: 
Signature: 
....................................................... Date: 16/04/20 
Name: Dr David Dawson 
 
 
 
 
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
STUDY/TRIAL CONTACTS 
Chief Investigator 
 
Name: Dr Dave Dawson  
Address:  
Sarah Swift Building  
The University of Lincoln  
Brayford Pool  
Lincoln 
LN6 7TS 
UoL job title: Research Tutor 
Phone: 01522 83 7336  
Email: d.dawson@lincoln.ac.uk 
Sponsor  
 
Contact details: 
 
University of Lincoln 
 
Andrew Stevenson 
Director or Research and Enterprise 
University of Lincoln  
Bridge House  
Brayford Pool 
Lincoln  
LN6 7TS 
 
Sponsor contact for queries: 
Sam Lewis 
Research Governance Manager 
sponsor@lincoln.ac.uk  
Collaborators/Co-
Investigators/Protocol 
Contributors 
Dr Anna Tickle (Academic and Research Tutor) 
Yang Fujia Building  
Jubilee Campus 
Wollaton Road 
Nottingham 
NG8 1BB 
Phone: 0115 823 2203  
Email: anna.tickle@nottingham.ac.uk 
 
Dr Jenny Mogensen (Clinical Psychologist)  
Nottingham City Asperger Service 
Highbury Hospital 
Bulwell 
Nottingham  
NG6 9DR  
Phone: 0115 854 2207  
Email: jenny.mogensen@nottshc.nhs.uk 
 
Student  
{delete if not applicable} 
Megan Mellor                                        
Trainee Clinical Psychologist 
The University of Lincoln 
Sarah Swift Building  
Brayford Pool  
Lincoln 
LN6 7TS 
Mobile :07870449692  
Email: 16662521@students.lincoln.ac.uk 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
Statistician 
N/A 
Trials Pharmacist 
N/A 
 
FUNDER DETAILS 
FUNDER(S) 
 
FINANCIAL 
AND 
NON 
FINANCIALSUPPORT GIVEN 
Trent 
Course 
Doctorate 
in 
Clinical 
Psychology. 
 
 
 
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
STUDY SUMMARY 
Study Title 
Acceptance and Commitment Therapy guided self-help for 
adults with a diagnosis of Autistic Spectrum Disorder 
experiencing psychological distress.  
Study Design 
Single Case Experimental Design (SCED) 
Study Participants 
Aged 18+ adults who have received a diagnosis of Autistic 
Spectrum Disorder (ASD), and who are expiring moderate 
anxiety, depression or stress as measured by the Depression, 
Anxiety and Stress Scale (DASS).  
Eligibility Criteria 
1. 18+ years old with a formal diagnosis of Autistic 
Spectrum Disorder, without a diagnosis if an 
Intellectual Disability.  
2. To be over the age of 18 years.  
3. Experiencing elevated anxiety, and / or stress, and /or 
depression and meet the clinical threshold or moderate 
on the Depression, Anxiety and Stress Scale. 
4. Access to the internet via an electronic device (to 
complete electronic measures). 
5. Agreement and knowledge of the time commitment for 
the completion of the intervention, competition of 
measure and change questionnaire at the end of the 
study.  
 
Planned Sample Size 
6-8 participants 
Study Duration 
Participant duration: 5 months  
Total study duration: 7 months 
Objectives 
Primary: To examine whether an ACT bibliotherapy 
intervention for adults with a diagnosis of Asperger Syndrome 
who 
experience 
psychological 
distress 
increases 
psychological flexibility.   
Secondary: To examine whether psychological flexibility 
mediates changes in; personally-identified therapeutic goals, 
increasing psychological wellbeing and decreasing anxiety, 
stress and depression.  
 
 
Outcome Measures 
Primary: CompACT (Francis, Dawson & Golijani-Moghaddam, 
2016).  
Secondary: Depression, anxiety and stress scale- DASS 
(Lovibond, & Lovibond, 1995).  
World Health Organization Quality of Life -WHOQOL-BREF 
(Skevington, Lotfy, & O'Connell, 2004).  
Simplified Personal Questionnaire –PQ (Elliott, Shapiro & 
Mack, 1999) 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
Data Analysis  
SCED data will be predominantly analysed using visual 
analysis. Data will be plotted onto graphs to analyse the 
direction of the data (trend), the “magnitude” (level) (Gast, 
2005) and the variability of the data (stability) (Lane & Gast, 
2014).  
To find out if change from pre and post scores is reliable, a 
Reliable Change Index (RCI) will be conducted.  
To determine if any change is clinically significant, a Clinically 
Significant Criterion (CSC) will be conducted (Jacobson, 
Follette & Revenstorf, 1984).  
 
KEY WORDS 
Autistic Spectrum Disorder (ASD) 
Acceptance and Commitment Therapy (ACT) 
Psychological Distress 
Stress 
Anxiety 
Depression 
Psychological Flexibility  
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
Table of Contents 
 
SIGNATURE PAGE .............................................................................................................. 2 
STUDY/TRIAL CONTACTS .................................................................................................. 3 
FUNDER DETAILS ............................................................................................................... 4 
STUDY SUMMARY .............................................................................................................. 5 
KEY WORDS ........................................................................................................................ 6 
LIST OF ABBREVIATIONS ................................................................................................... 9 
STUDY MANAGEMENT ..................................................................................................... 10 
ROLE OF STUDY SPONSOR AND FUNDER ............................................................. 10 
STUDY BACKGROUND and RATIONALE ......................................................................... 10 
Autistic Spectrum Disorder .............................................................................................. 10 
ASD and Cognitive Behavioral Therapy ........................................................................... 10 
What is Acceptance and Commitment Therapy? ............................................................. 11 
Acceptance and Commitment Therapy and ASD ............................................................. 11 
Why guided self-help? ..................................................................................................... 12 
Rationale for the present study ........................................................................................... 12 
STUDY OBJECTIVES AND PURPOSE .............................................................................. 12 
PURPOSE ....................................................................................................................... 12 
PRIMARY OBJECTIVE ................................................................................................... 12 
SECONDARY OBJECTIVE(S) ........................................................................................ 12 
OUTCOME MEASURES/ENDPOINTS ............................................................................... 13 
PRIMARY OUTCOME MEASURE/ENDPOINT ............................................................... 13 
SECONDARY ENDPOINTS/OUTCOMES ....................................................................... 13 
TABLE OF ENDPOINTS/OUTCOMES ............................................................................ 14 
STUDY DESIGN ................................................................................................................. 14 
DATA ANALYSIS ............................................................................................................ 14 
SELECTION OF PARTICIPANTS ....................................................................................... 15 
ELIGIBILITY CRITERIA ................................................................................................... 15 
Inclusion Criteria  ......................................................................................................... 15 
Exclusion Criteria ......................................................................................................... 15 
Sampling ...................................................................................................................... 15 
Size of sample ............................................................................................................. 16 
Sampling technique ..................................................................................................... 16 
RECRUITMENT .............................................................................................................. 16 
Participant Payment ..................................................................................................... 17 
CONSENT ....................................................................................................................... 17 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
STUDY PROCEDURES/REGIMEN .................................................................................... 17 
STUDY FLOWCHART .................................................................................................... 17 
STUDY REGIMEN........................................................................................................... 20 
SCHEDULE OF PROCEDURES ..................................................................................... 21 
WITHDRAWAL ................................................................................................................ 21 
ETHICAL AND REGULATORY CONSIDERATIONS .......................................................... 22 
ASSESSMENT AND MANAGEMENT OF RISK .............................................................. 22 
ADVERSE EVENTS ........................................................................................................ 22 
ETHICS REVIEW AND COMPLIANCE ........................................................................... 22 
PEER REVIEW ............................................................................................................... 23 
PUBLIC & PATIENT INVOLVEMENT .......................................................................... 23 
PROTOCOL COMPLIANCE ............................................................................................ 23 
DATA PROTECTION AND PATIENT CONFIDENTIALITY ................................................. 23 
INDEMNITY ........................................................................................................................ 24 
ACCESS TO THE FINAL DATASET ............................................................................... 24 
DISSEMINATION POLICY .................................................................................................. 24 
Authorship eligibility guidelines and any intended use of professional writers .............. 24 
REFERENCES ................................................................................................................... 25 
 
 
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
LIST OF ABBREVIATIONS 
AE 
Adverse Event 
ACT                Acceptance and Commitment Therapy  
ASD                Autistic Spectrum Disorder  
CF 
Consent Form 
CI 
Chief Investigator 
CRF 
Case Report Form 
GCP 
Good Clinical Practice 
HRA 
Health Research Authority 
ICF 
Informed Consent Form 
ISF 
Investigator Site File (This forms part of the TMF) 
ISRCTN 
International Standard Randomised Controlled Trials Number 
LIH 
Lincoln Institute for Health 
NHS R&D 
National Health Service Research & Development   
NCAS 
Nottingham City Autism Service  
PI 
Principal Investigator 
PIS 
Participant Information Sheet 
REC 
Research Ethics Committee 
SAE 
Serious Adverse Event 
SOP 
Standard Operating Procedure  
TMF 
Trial Master File 
UoL 
University of Lincoln 
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
STUDY MANAGEMENT  
ROLE OF STUDY SPONSOR AND FUNDER 
The sponsor of the study is the University of Lincoln. 
The Chief Investigator has overall responsibility for the study and shall oversee all study 
management. 
Megan Mellor will be the primary researcher and is funded to complete the research as part 
of her Doctorate in Clinical Psychology.  
STUDY BACKGROUND and RATIONALE 
Autistic Spectrum Disorder 
Autistic Spectrum Disorder (ASD) is a neurodevelopmental condition, characterized by 
persistent deficits in social communication and interaction across multiple contexts; alongside 
restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric 
Association [APA], 2013). ASD is also associated with executive functioning difficulties. These 
include difficulties with higher order cognitive functioning such as planning, strategy use, 
cognitive flexibility, working memory and inhibition (Happe, Booth, Charlton, & Hughes, 2006). 
Recent estimates indicate that around 2% of the population have a diagnosis of ASD (Kim 
Szatmari, Bryson, Streiner & Wilson, 2000) and the rate of diagnoses being made for this 
condition is increasing.  
There are high levels of psychiatric co-morbidity between ASD and other conditions, including 
stress (Hirvikoski & Blomgvist, 2015), anxiety, depression (Bruggink et al., 2016) and OCD 
(Ghaziuddin, 2005). Experiencing high levels of anxiety is prevalent in adults with ASD; Davis, 
et al. (2011) found that self-reported experiences of anxiety increase from young adulthood to 
older adults; which has a profound impact on their lives (Robertson et al., 2018). Hirvikoski 
and Blomqvist’s (2015) study indicated that autistic traits are associated with self-perceived 
distress and a reduced ability to cope with external stressors. This is supported by Gillott and 
Stanton (2007) who identified coping with change, anticipation, sensory stimuli and unpleasant 
events all positively correlate with high levels of anxiety and stress. Adults with ASD 
experience more stressful life events and perceived stress, which is associated with social 
difficulties related to ASD (Bishop-Fitzpatrick, Minshew, Mazefsky & Eack, 2017).  
 
Kelly, Garnett, Attwood and Peterson (2008), reported that depression is a secondary 
consequence of social difficulties experienced in children with ASD. A systematic review 
including 19 articles indicated there is a higher prevalence of depression in people with an 
ASD diagnosis without an intellectual disability (1%-47%) compared to general population 
prevalence rates (2.5%-10.7%), (Wigham, Barton, Parr &hg Rodgers, 2017). For adults with 
ASD 34% of families report unmet mental health needs (Nicolaidis et al., 2013). Interventions 
for mental health have been highlighted as important areas of research (van Steensel, Bogels 
& Dirksom, 2012).  
 
ASD and Cognitive Behavioral Therapy  
The National Institute for Care and Excellence (NICE) recommends the use of Cognitive 
Behavioral Therapy (CBT) in the treatment of anxiety disorders and depression (NICE, 2011); 
in combination with medication (specifically, selective serotonin reuptake inhibitors; SSRIs) for 
anxiety. However, evidence for the efficacy of SSRIs in the treatment of anxiety in adults with 
ASD is limited (Williams, Wheeler, Silove, & Hazell, 2011). The majority of evidence for 
adapted CBT in ASD populations derives from child and adolescence, little research has 
considered CBT over the lifespan for this population. A systematic review and meta-analysis 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
identifying CBT research undertaken in adult ASD populations indicates that; CBT has small-
medium effect sizes for affective disorders using self-reported measures (g=0.48) (Weston, 
Hodgekins & Langdon, 2016). Therefore, the effectiveness of CBT specifically for adults with 
ASD remains unclear and further research studying the effectiveness of CBT and ‘third wave’ 
CBT psychotherapies in an adult ASD population is required. 
What is Acceptance and Commitment Therapy? 
Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach and is referred 
to as a “third wave” CBT. It is based upon Relational Frame Theory which is a theory of human 
language, and argues that language specifies the strength and type of relationship to stimuli 
and along which dimension, which is an example of higher cognition (RFT; Hayes, Barnes-
Holmes, & Roche, 2001). RFT focus on how humans learn language through interactions with 
the environment which is underpinned by a functional contextualist epistemology (Hayes, 
Hayes, Reese & Sarbin, 1993) which seeks to predict and influence events using empirically 
based rules and concepts. ACT aims to teach strategies that enable people to live their life in 
accordance with their values (value consistent behavior). Through strategies of “acceptance” 
and “cognitive defusion” ACT aims to facilitate willingness in to experience thoughts and 
feelings as they are, without attempting to change, challenge, or avoid them (experiential 
avoidance). ACT aims to increase psychological flexibility which is defined as; “contacting the 
present moment as a conscious human being, and, based on what that situation affords, acting 
in accordance with one’s chosen values” (Hayes, Strosahl, Bunting, Twohig & Wilson, 2004). 
ACT research has shown psychological flexibility to have a mediating effect reducing 
symptomology, both later in the therapy process or at longer term follow-up. ACT comprises 
of six core processes: (1) being in the present moment (focusing attention, without judgement, 
on  present internal and external experiences); (2) values (identified qualities that are 
important to the individual); (3) committed action (changes in behavior in accordance with 
identified values); (4) self as context (the content of experience, is distinct from the  ‘self’) and 
(5) defusion (a strategy to create emotional distance from language and cognitions); (6) 
acceptance (being fully open to your experiences without defense or judgment) (Hayes, 
Luoma, Bond, Masuda & Lillis, 2006). Through the combination and interaction of these core 
processes, there is an increase in psychological flexibility and decrease experience of 
psychopathology through decreasing cognitive fusion, experiential avoidance and 
maladaptive behaviors and increasing mindfulness, acceptance and committed behavior in 
line with values.  
Acceptance and Commitment Therapy and ASD 
There have been over one hundred randomized control trials (RCTs) supporting the efficacy 
of ACT for different types of distress and severity (A-Tjak et al., 2015; Swain, Hancock, 
Hainsworth & Bowman, 2013). A literature base for third wave behavioral therapies is 
developing. Leonie, Cortie and Cavagnola (2015) reviewed and considered future research, 
for third generation behavioral therapies for neurodevelopmental disorders (NDD). This review 
highlighted ACT and mindfulness-based CBT having the most potential to be adapted for 
intervention for people with NDD, due to the behavioral elements included in the treatments. 
These results are supported by Pahnke, Lundgren, Hursti & Hirvikoski (2014), who conducted 
an ACT based group, for students with ASD. Results indicated that levels of stress, 
hyperactivity and emotional distress were reduced in the treatment group, compared to 
classes as unusual; results were maintained or improved at a 2 month follow up. ACT aims to 
increase psychological flexibility which is underdeveloped in this population (D’Cruz et al., 
2013; Geurts, Corbett and Solomon, 2009). It also gives a clear conceptual framework of the 
combined process of ACT, and how these together improve psychological flexibility. 
Therefore, this therapy compared to other third wave behavioural therapies appears to 
possess the most potential to improve psychological distress within this population. To date 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
few studies have been conducted investigating ACT interventions within an adult ASD 
population.  
Why guided self-help?  
In the UK there are significant waiting lists and access to psychological therapy is limited. As 
a consequence, to this people who would benefit from effective treatment continue to struggle 
with depression, anxiety and stress. Evidence for effective forms of alternative psychological 
interventions is required. Emerging evidence suggests that self-help and guided self-help ACT 
interventions produce significant small to medium effect sizes, in comparison to control 
conditions on measures of; acceptance/mindfulness, depression and anxiety (Cavanagh, 
Strauss, Forder & Jones, 2014). ACT self-help delivered by bibliotherapy (self-help 
workbooks), specifically targeting anxiety has shown promising effectiveness in an 
international sample (Ritzert et al., 2016). There are also small effect sizes for the 
effectiveness of ACT bibliotherapy for depression, anxiety and psychological flexibility 
(French, Golijani-Moghaddan & Schroder, 2017).  Bibliotherapies have been shown to be a 
cost effective, easily assessable option for people who experience psychological distress 
(Newman, Erickson, Przeworski & Dzus, 2003).  
Rationale for the present study 
Throughout this research the term Autistic Spectrum Disorder will be used. Although ASD is 
the correct diagnostic term, this also includes adults who have an intellectual disability. For 
this study all the adults with ASD who do not have an intellectual disability will be the sample 
population.  
STUDY OBJECTIVES AND PURPOSE 
PURPOSE 
This research will indicate if guided ACT self-help facilitates increased psychological flexibility 
for adults with ASD, which is known to be less developed in people with ASD. Psychological 
flexibility mediates the experience of psychological distress (Hayes et al., 2006), for example 
depression, anxiety and stress; which are known to be highly prevalent in this population 
(Lecavalier, 2006). Currently there are mixed results in relation to effectiveness of CBT 
(Weston et al., 2016); no study has measured the effectiveness of ACT to increase 
psychological flexibility in an adult ASD population and determine if this mediates a reduction 
in psychological distress.  
This research will add knowledge about how ACT guided self-help can be adapted for adults 
with ASD.  It will give results on how effective ACT guided self-help is in supporting adults with 
ASD, to increase psychological flexibility and reduce psychological distress. If guided ACT 
self-help intervention is effective; this will help increase access and availability of psychological 
intervention for people with ASD, specifically in relation to associated difficulties in social 
communication and interaction. 
PRIMARY OBJECTIVE 
To examine whether an ACT bibliotherapy intervention for adults with a diagnosis of ASD who 
experience psychological distress increases psychological flexibility.   
SECONDARY OBJECTIVE(S) 
To examine whether psychological flexibility mediates changes in; personally-identified 
therapeutic goals, increasing psychological wellbeing and decreasing anxiety, stress and 
depression.  

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
OUTCOME MEASURES/ENDPOINTS 
PRIMARY OUTCOME MEASURE/ENDPOINT 
To examine whether an ACT bibliotherapy intervention for adults with a diagnosis of ASD who 
experience psychological distress increases psychological flexibility.   
Psychological distress will be measured by the depression, anxiety and stress scale (DASS) 
and psychological flexibility will be measured by the CompACT to measure psychological 
flexibility.  
The full versions of the DASS will be administered as a screening questionnaire, weekly during 
the baseline phase, weekly during the intervention phase, two-week post intervention phase 
and one-month post intervention phase.  
Full versions of the CompACT will be administered at the pre-intervention phase, two week 
and one-month post intervention phase.  
The short form CompACT will be administered every three days during the baseline and 
intervention phase.  
SECONDARY ENDPOINTS/OUTCOMES 
To examine whether psychological flexibility mediates changes in; personally identified 
therapeutic goals, increasing psychological wellbeing and decreasing anxiety, stress and 
depression.  
Wellbeing will be measured by the World Health Organisation Quality of Life Scale (WHOQOL-
BREF) and the Personal Questionnaire (PQ).  
The WHOQOL-BREF will be administered during the pre-intervention phase, , two-week post 
intervention and one month post intervention. 
Personally, identified therapeutic goals will be identified by the personal questionnaire, which 
will be developed during the pre-intervention meeting; administered weekly during the 
baseline and intervention phase, two week and four weeks post intervention.  
During the two-week follow-up the change questionnaire will be administered. 
 
 
 
 
 
 
 
 
 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
TABLE OF ENDPOINTS/OUTCOMES  
Stage  
Frequency  
Measures 
Screening  
 
• 
DASS (21) 
 
 
 
Pre-Intervention  
Data collected within one 
week of consenting to take 
part.  
• 
CompACT  
• 
WHOQOL-BREF  
• 
Personal Questionnaire  
 
 
 
Baseline 
(two 
weeks with option 
to extend to three 
weeks if required) 
Data collected every three 
days 
• 
CompACT (short form) 
 
Data collected weekly 
• 
DASS (21) 
• 
WHOQOL-BREF  
Intervention 
(eight-ten weeks) 
Data collected every three  
days 
• 
CompACT (short form)  
• 
 
Data Collected weekly 
• 
DASS 
• 
WHOQOL-BREF  
 
 
 
Two week post 
intervention  
Data collected which one 
week of sending. 
• 
DASS 
• 
CompACT  
• 
WHOQOL-BREF  
• 
Personal Questionnaire 
• 
Change Questionaire 
One month follow 
up 
Data collected within one 
week of sending.  
• 
DASS 
• 
CompACT  
• 
WHOQOL-BREF  
• 
Personal Questionnaire 
STUDY DESIGN  
This is a repeated measures design, using a single case experimental design. Each participant 
with be asked to complete weekly measures and shortened measure every three days, please 
see above table for the measures and timeframes. Weekly data collection will last for 
approximately 9 weeks, with a two- and four-week follow-up.  
DATA ANALYSIS  
SCED data will be predominantly analysed using visual analysis. Data will be plotted onto 
graphs to analyse the direction of the data (trend), the “magnitude” (level) (Gast, 2005) and 
the variability of the data (stability) (Lane & Gast, 2014). To find out if change from pre and 
post scores is reliable, a Reliable Change Index (RCI) will be conducted. To determine if any 
change is clinically significant, a Clinically Significant Criterion (CSC) will be conducted 
(Jacobson, Follette & Revenstorf, 1984). The data will be analysed at the University of Lincoln 
and Students home (via secured sites). The data will be analysed using Excel software. No 
interim analysis if planned for safety, efficacy, or management purposes.  
STUDY SETTING  
Participants will be recruited from Nottingham City Autism Service (NCAS). The initial 
appointment to collect consent to participate in the research will be competed remotely via 
Microsoft Teams or over the telephone  All the data will be collected via Qualtrics online, the 
participants will complete the bibliotherapy at their home and weekly telephone calls will be 
made to the participants at a designated time convenient to them. 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
SELECTION OF PARTICIPANTS 
ELIGIBILITY CRITERIA 
Inclusion Criteria  
 
1. 18+ years old with a formal diagnosis of Autistic Spectrum Disorder, without a 
diagnosis if an Intellectual Disability.  
2. To be over the age of 18 years.  
3. Accessing Nottingham City Autism Service  
4. Experiencing elevated anxiety, and / or stress, and /or depression and meet the clinical 
threshold or moderate on the Depression, Anxiety and Stress Scale. 
5. Access to the internet via an electronic device (to complete electronic measures). 
6. Agreement and knowledge of the time commitment for the completion of the 
intervention, competition of measure and change questionnaire at the end of the study.  
 
Exclusion Criteria 
 
1. Unable to communicate fluently in English (justification: the cost of hiring an 
interpreter).  
2. Unable to read English (justification: participant will be unable to read and engage in 
the bibliotherapy) 
3. Adults who are currently accessing psychological therapy. If participants start 
psychological therapy during the study, they will be removed from the study 
(justification: unable to separate out effects of research intervention from psychological 
therapy intervention).  
4. If they have a co-morbid diagnosis of intellectual disability (justification: may have 
different needs regarding therapy adaptations.  
5. No access to mobile or internet (justification: unable to complete measures).  
 
Sampling 
Participants will be recruited from the Nottingham City Autism Service (NCAS) within 
Nottingham Healthcare NHS Foundation Trust. This is an appropriate service for recruitment 
as it is an ASD diagnostic service for adults, without an intellectual disability. The study will be 
advertised through clinical staff within the diagnostic team talking to appropriate clients. Clients 
experiencing stress, or anxiety, or depression will be initially identified through clinical 
interviews and observations as part of the diagnostic process. The client will be asked to 
complete the depression, anxiety and stress scale (DASS). If the clinical cut off for moderate, 
severe or very severe anxiety (10+), or depression (14+) or stress (19+) is met then the client 
will meet the inclusion criteria.  
It will be explained verbally and in writing that entry into the study is entirely voluntary and that 
their treatment as usual (TAU) will not be affected by their decision. It will also be explained in 
writing (information sheet) and verbally that each participant can withdraw at any time. 
Participants have the right to withdraw their data up to two weeks after their final data is 
collected. Consent will be obtained on entry to the study to ensure all data collected is retained 
for seven years, to allow for replicability and final analysis. 
 

 
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Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
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published, or used by others persons without prior written authorisation from the University of Lincoln 
Size of sample 
To ensure robust internal validity there must be replicability in results at least three times 
(Kratochwill et al., 2010). Therefore, a minimum of three participants are required; sampling 
will continue until six participants have consented to the research; this is in line with publishing 
standards (Smith, 2012). Taking attrition into account 6-8 participants will be recruited. Based 
upon the service evaluation statistics for 2016-2017, Nottingham City Autism Service (NCAS) 
received 85 referrals per year for support (clients who have an existing diagnosis) and 268 
referrals per year for ASD diagnostic assessment; from this figure 75 people received a 
diagnosis of ASD. This gives an estimated sample pool of 160 people diagnosed with ASD, 
within NCAS per year. The service has experienced a year on year referral increase, indicating 
that the 2018/19 sample pool will be larger than 160 people.  
Sampling technique 
Opportunity sampling will be implemented, clients who meet the inclusion criteria and are 
accessing Nottingham City Autism Service will be asked to take part.  
RECRUITMENT 
There are three points with the service pathway at which clients could be identified by the 
patient’s usual care team to take part in this research; 1) Initial appointment for clients with 
existing ASD diagnosis; 2) following diagnostic assessment and receipt of ASD diagnosis; 3) 
post diagnostic group 4) identified via support telephone calls provided by NCAS. 
 
The patient’s usual care team will identify patients who meet the inclusion criteria and verbally 
discuss with them about the study. If the patient is interested in the study,  will be sent an 
information sheet via e-mail and be asked to complete an online consent  to be contacted 
form. This form is not to consent to participant in the research but to consent to be contact by 
the researcher (Megan Mellor) for more information.  
 
The researcher (Megan Mellor) will then contact the client via their chosen communication 
preference (e-mail or phone) within two weeks and send the Depress, Anxiety and Stress 
Scale (DASS) screening measure to be completed. If the client’s scores meet inclusion criteria 
then they will be contacted and asked if they would like to take part in the study, a date will be 
arranged to speak with the researcher (Megan Mellor) over the phone or via Microsoft Teams, 
to find more about the study.. If the clients scores do not meet inclusion criteria, then they will 
be contacted and informed that they are unable to take part in the study and referred to NCAS 
for further support (if required). During the initial researcher contact if the client continues to 
be interested in participation, they will be invited to arrange a time and date to speak with  the 
researcher (Megan Mellor) via the phone or Microsoft Teams.  
 
During the initial telephone/ online meeting information will be given about the research and 
an opportunity for the client to ask questions. The intervention will not delay any other identified 
treatment and is an addition to what the service currently delivers. 
 
It will be explained to the potential participant that entry into the trial is entirely voluntary and 
that their treatment and care will not be affected by their decision. It will also be explained that 
they can withdraw at any time, but attempts will be made to avoid this occurrence. In the event 
of their withdrawal it will be explained that their data collected so far may not be erased in 
accordance with the University’s Research Privacy Notice and information given in the 
Participant Information Sheet and we will seek consent to use the data in the final analyses 
where appropriate. 
 

 
Page 17 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
If the client consents to take part in the research, then they will sent a consent form to 
complete via Qualtrics). If the client consents during this meeting, the personal questionnaire 
can be developed between the participant and researcher. Following the meeting the 
participant will be sent the pre-intervention measures (CompACT WHOQOL-BREF, Personal 
Questionnaire electronically to complete. 
 
Participant Payment  
Participants will be given £20.00 Amazon electronic voucher to participate in the study. 
Participants who wish to withdraw from the study can do so after the first session without losing 
any monetary rewards.   
CONSENT  
All participants will be contacted initially by their usual care team. Capacity to consent will be 
accessed at this point. However, the clients accessing the service are over eighteen years, do 
not have an Intellectual Disability (Learning Disability) and are not accessing the service for 
support related to specific mental health problems; as this is an autism assessment service, 
not a mental health service.  
All participants shall provide informed consent, via completion of the informed consent form 
via Qualtrics. The completion of the Informed Consent Form (ICF) will provide consent and 
the date the form is completed will be logged electronically.   
The recruiting Investigator will explain the details of the study and provide a Participant 
Information Sheet (and any other study related literature), ensuring that the participant has 
enough time to consider participating or not. Opportunity will be given to the participant to ask 
any questions they may have has concerning study participation.  
The process for obtaining participant informed consent will be in accordance with the REC 
guidance, and Good Clinical Practice (GCP) and any other regulatory requirements that might 
be introduced. 
Informed consent will be collected from each participant before they undergo any study 
interventions related to the study.  
One copy of the ICF will be sent to the participant electronically, one will be kept by the 
Investigator, and a third will be sent electronical to NCAS and retained in the participant’s 
medical records. 
Should there be any subsequent amendment to the final protocol, which might affect a 
participant’s participation in the trial, continuing consent will be obtained using an amended 
Consent form which will be signed by the participant. 
STUDY PROCEDURES/REGIMEN 
STUDY FLOWCHART  

 
Page 18 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, published, or used by others persons without prior written authorisation from 
the University of Lincoln 
Flow chart of the four stages before starting the intervention phase  
 
 
Stage one 
• The usual care team at NCAS to ask patients if they are interested in taking part in research. 
•An informtion sheet will be  electronicaly sent to prospective particiapants.
•If participants are interested in finding out more, they will be electronicaly sent a consent to be contacted form. 
Stage three
•If scores on the DASS do NOT meet the research 
inclusion criteria. Megan will contact the 
prospective participant via e-mail or phone and let 
them know. This means they will not be asked to 
particiapt in the study and referred back to 
Nottingham City Autism Service  (NCAS).                                                                               
Stage two 
• Prospective participants will then be contacted by the researcher (Megan Mellor) via e-mail or phone within two weeks.
•Attached to this e-mail will be Depression, Anxiety and Stress Scale (DASS) for the potial participant to compete and return.
•If  support completing this questionaire  is required or if there are any questions  participants you can e-mail Megan Mellor. 
Stage three 
•If scores on the DASS meet the research 
inclusion criteria. Megan will contact the 
participants via e-mail or phone to arrange a 
meeting via the telephone or Microsoft Teams 
and electronicaly send the consent form. 
Stage four
•Megan will meet with the participant via telephone or microsoft teams;
•go through information sheet 
•to give you participants information and answer any questions they have about the research and what to expect.
•to identify your behavioural goals for the intervention phase (Personal Questionaire). 
•Complete demographic information 
•to complete pre-intervention questionaires; Personal Questionaire, WHOQOL-BRIEF, CompACT

 
Page 19 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, published, or used by others persons without prior written authorisation from 
the University of Lincoln 
Flow chart of the four stages from baseline phase, intervention phase, one week and two months post intervention 
 
 
Baseline (2 
weeks) 
•Particiapnts will rate 8 questions evey three days from thier mobile phone or computer (CompACT Short Form).  
•Particants will be asked to complete three questionaires once a week (DASS, WHO-BRIEF and PQ). 
Intervention 
phase (8-10 
weeks)
•Particapnts will be asked;
• to read a chapeter of a self help book in the week. 
•to rate 8 questions every three days (Short Form CompACT, PQ and DASS (3 item).
•to complete 3 questionaires once a week (DASS, WHO-BRIEF and PQ)
•Participants will be called once a week by Megan Mellor , the aim of this conversation if for you to ask questions regarding the information  they 
are reading.
2 week
follow-up 
•Participants will be asked to complte 5 questionaires, one week after they have completed the intervention phase (DASS, PQ, WHOQOL-BRIEF, 
Change Questionaire and CompACT).  
4 weeks follow 
up 
•Participants will be asked to complete 4 questionaires., four weeks after they have finished the intervention phase (DASS, PQ, WHOQOL-BRIEF, 
and CompACT). 

 
Page 20 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
STUDY REGIMEN 
Recruitment and screening: Participants will be identified by their usual care team and 
verbally informed about the research, sent an information sheet and asked if they consent to 
be contacted by the researcher for more information. They will be sent an electronic consent 
to be contacted by the researcher form. They will be contacted within two weeks either over 
phone or via e-mail (which ever they specified on the consent to be contacted form). A 
screening measure (DASS) will be sent via e-mail to be completed. If the participant meets 
the inclusion criteria, then they will be contacted and invited to arrange a telephone call or 
Microsoft Teams meeting with the researcher for an initial meeting at NCAS. During the 
meeting the prospective participant will go through the information sheet, send out the consent 
form, clients will have the opportunity to ask any questions about the study, identify 
behavioural goals for the personal questionnaire and complete the pre intervention 
questionnaires (Depression, Anxiety and Stress Scale (DASS); Personal Questionnaire, 
WHOQOL-BRIEF, CompACT.  
All measures and forms administered via Qualtrics and all contact with the researcher will be 
over the phone or via Microsoft Teams.  
Baseline phase: This will last two weeks, with an option to extend to three weeks if required 
(If three or more stable baseline points have not been met within two weeks) participants will 
complete rate eight questions every three days from their mobile phone or computer (Short 
Form ComptACT. Participants will be asked to complete two questionnaires once a week 
(DASS, WHO-BRIEF).  
Intervention Phase: This phase will last from 8-10 weeks, dependent on if the participant 
requires an additional two weeks due to personal circumstances. They are required to read a 
section of a self-help book ‘Get out of your mind and into your life’ (Hayes 2005) in the week. 
Each chapter will be either e-mailed and/or posted to the participant on a weekly basis. The 
participant will receive a full copy of the book following the completion of the intervention 
phase. To rate 9 questions every three day (Short Form CompACT,); complete two 
questionnaires once a week (DASS and WHO-BRIEF). Participants will be called once a week 
by Megan Mellor, the aim of this conversation if for them to ask questions regarding the 
information they are reading and exercises they are completing. All telephone calls will follow 
a set structure and be recorded for fidelity checking.  
Two-weeks follow-up: OTwo weeks following the completion of the intervention phase. 
Participants will be asked to complete five questionnaires (DASS, PQ, WHOQOL-BRIEF, 
Change Questionnaire and CompACT) via Qualtrics.   
Four week follow-up: Participants will be asked to complete four questionnaires, four weeks 
after they have finished the intervention phase (DASS, PQ, WHOQOL-BRIEF, CompACT).  
 
 
 
 
 

 
Page 21 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
SCHEDULE OF PROCEDURES 
Procedures 
Visits (insert visit numbers as appropriate) 
Screen
ing 
Initial 
meeting 
at NCAS 
Baseline 
(2 weeks) 
Intervention 
(8-10 weeks) 
2-week 
follow-
up 
4week 
follow-
up 
Consent to be contact by 
the researcher 
x 
 
 
 
 
 
Informed consent 
 
x 
 
 
 
 
Demographics 
 
x 
 
 
 
 
Pre-Intervention 
questionnaire 
 
x 
 
 
 
 
Developing 
Personal 
Questionnaire  
 
x 
 
 
 
 
Completion 
of 
baseline 
questionnaires 
 
 
x 
 
 
 
Reading a chapter of the 
bibliotherapy each week  
 
 
 
x 
 
 
Every 
other 
day 
completion of measures  
 
 
 
x 
 
 
Completion 
of 
weekly 
measures 
 
 
 
x 
 
 
Engaging 
in 
weekly 
telephone calls  
 
 
 
x 
 
 
Completion of follow-up 
questionnaires 
and 
change questionaire 
 
 
 
 
x 
 
Completion of follow-up 
questionnaires 
 
 
 
 
 
x 
 
WITHDRAWAL  
Participants may be withdrawn from the trial either at their own request or at the discretion of 
the Investigator. The participants will be made aware that this will not affect their future care. 
Participants will be made aware (via the information sheet and consent form) that should they 
withdraw the data collected to date may not be erased in accordance with the University’s 
Research Privacy Notice and information given in the Participant Information Sheet and may 
still be used in the final analysis. 
Participants may withdraw from the study or be withdrawn from the study at any time. It will 
also be explained that data cannot be withdrawn following two weeks of the last data 

 
Page 22 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
collection. Participants who wish to withdraw will be asked to consent for primary outcome 
data to be collected at the end of follow up. This will support with the planned analysis and 
replicability of the study. Participants will not be accepted as lost to follow up unless enough 
attempted contact has been made via phone calls and letters. This will include two attempted 
telephone calls across four days, with messages left asking them to call back, and one letter 
if they have not responded within a week. 
Participants can be withdrawn from the study by the primary researcher if they stop adhering 
to the protocol, not completing the bibliotherapy, or are unable to complete the reading within 
the three-week extension period. The remainder of the bibliotherapy will be provided following 
withdrawal, if the participant desires.  
Following the withdrawal of a participant, a new participant will be recruited, time permitting. 
There are not anticipated safety reasons for terminating participants from the study.   
ETHICAL AND REGULATORY CONSIDERATIONS 
ASSESSMENT AND MANAGEMENT OF RISK 
Individual participant medical information obtained as a result of this study are considered 
confidential and disclosure to third parties is prohibited with the exceptions noted. Medical 
information may be given to the participant’s medical team and all appropriate medical 
personnel responsible for the participant’s welfare.  
If information is disclosed during the study that could pose a risk of harm to the participant or 
others, the researcher will discuss this with the CI and where appropriate reported accordingly. 
If any risk to self or others is reported during the research, alongside discussing this with the 
CI this will be reported to the client’s clinical team at Nottingham City Autism Service and the 
Nottinghamshire Health Care NHS safeguarding procedures and risk management 
procedures will be adhered to.  
To date no research has been found highlighting a detrimental or negative impact of ACT 
therapy. However, participants who identify values by which they are not living to may 
experience some distress. Any participants experiencing distress directly associated with the 
ACT chapters and exercises will be provided with support via weekly telephone calls from the 
researcher.  
ADVERSE EVENTS 
Due to the nature of this study, no adverse events are anticipated, and no adverse event data 
will be collected.  
ETHICS REVIEW AND COMPLIANCE  
The study shall not commence until the study protocol, information sheets and consent forms 
have been reviewed and approved from a Research Ethics Committee and relevant 
NHS/Social Care permission is obtained.  
The sponsor will be responsible for deciding whether amendments are substantial and non-
substantial in collaboration with the Chief Investigator.  
Where an amendment is required to study documentation that required REC approval, 
changes will not be implemented until REC approval and HRA categorisation is received. 
Where an amendment requires local approval, this shall be sought prior to the amendment be 

 
Page 23 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
implemented at each site in accordance with the categorisation given on the HRA approval 
letter.  
Should an amendment be required to eliminate an apparent immediate hazard to participants 
this may be implemented immediately and the REC/HRA and R&D will be notified as soon as 
possible.  
Minor amendments for logistical or administrative purposes may be implemented immediately 
Amendments will be logged on the Sponsor’s Study Amendment Log and stored in the Trial 
Master/Site File(s).  
Annual Progress Reports shall be submitted to the REC within 30 days of the anniversary date 
on which the favourable opinion was given – until the end of the study.  
A final report shall (where possible) be submitted to the REC within one year after the end of 
the study.  
If the study is terminated prematurely the CI will notify the REC, including the reasons for 
premature termination.  
PEER REVIEW 
This study design and protocol has been reviewed by Research tutors on the Trent Doctorate 
in Clinical Psychology.  
PUBLIC & PATIENT INVOLVEMENT 
Design of the research: Service users (not taking part in the research) will have the opportunity 
to input into adaptations of the bibliotherapy.   
Undertaking the research: Service users will be actively involved in participant of the research.  
PROTOCOL COMPLIANCE 
Accidental protocol deviations may occur at any time. Accidental protocol deviations will be 
adequately documented on the relevant forms and reported to the Chief Investigator and 
Sponsor immediately.  
Deviations from the protocol which are found to frequently recur are not acceptable, these will 
require immediate action and could potentially be classified as a serious breach. 
DATA PROTECTION AND PATIENT CONFIDENTIALITY  
All study staff and investigators will comply with the principles of the General Data Protection 
Regulation (GDPR) 2016/079 in protecting the rights of study participants with regards to the 
collection, storage, processing and disclosure of personal information and will uphold the 
Act’s/Regulations core principles.  
Each participant will be assigned a study identity number, for use on study records, other study 
related documents and the electronic database. 
Personal data, research data and the linking code will be stored in separate locations. When 
stored electronically, this will include using encrypted digital files within password protected 
folders and storage media. Personal information shall be stored separately to research data 
and will be kept secure and maintained.  

 
Page 24 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
Personal data will be stored for five years following the end of the study, so that the Chief 
Investigator may provide participants with a summary of the research (should they wish to 
receive a copy). 
Data generated as a result of this study will be available for inspection on request by the 
participating physicians, the University of Lincoln representatives, the REC, local R&D 
Departments and the regulatory authorities. 
INDEMNITY 
Insurance and indemnity for trial participants and trial staff is covered within the NHS Indemnity 
Arrangements for clinical negligence claims in the NHS, issued under cover of HSG (96)48. 
There are no special compensation arrangements, but trial participants may have recourse 
through the NHS complaints procedures. 
The University of Lincoln as research Sponsor indemnifies its staff, research participants and 
research protocols with both public liability insurance and clinical trials insurance. 
ACCESS TO THE FINAL DATASET 
The Chief Investigator and the co-investigator Dr Anna Tickle and student Megan Mellor will 
have access to the final data set.  
DISSEMINATION POLICY 
The data custodian will be the Chief Investigator on behalf of the University of Lincoln. 
The research will be disseminated via Megan Mellor’s research thesis. All participants will be 
e-mailed an electronic of the research report and any published work resulting for the research 
data.  
 
Authorship eligibility guidelines and any intended use of professional writers 
The final study report will be written in accordance with the Trent Doctorate and Clinical 
Psychology guidelines. Any journal papers resulting from this study will be written in 
accordance with the selected journal. All researchers named on this protocol will be named 
authors of ant publications resulting from the data collected in this study. 
 
 

 
Page 25 of 26 
 
Guided ACT and for adults with ASD - Protocol Draft Version 03 date 16.04.2020 
This protocol is confidential and the property of the University of Lincoln. No part of it may be transmitted, reproduced, 
published, or used by others persons without prior written authorisation from the University of Lincoln 
REFERENCES 
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published, or used by others persons without prior written authorisation from the University of Lincoln 
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