Acceptance and Commitment Therapy in Group Format for College Students

This thesis presents a programme of research designed to examine the impact of Acceptance and Commitment Therapy (ACT) informed performance and development coaching. A preliminary repeated measures study tested the impact of a brief ACT-informed coaching intervention on coachee general mental health, generalised self-efficacy, life satisfaction, intrinsic motivation, goal-directed thinking, goal attainment, and psychological flexibility with 53 UK adults. Data were collected at four time points over 5 weeks. Analyses revealed significant increases in general mental health, life satisfaction, goal-directed thinking, and goal attainment. A randomised controlled trial (RCT) study tested the impact of a more substantial ACT-informed coaching intervention on coachee work performance, general mental health, generalised self-efficacy, job satisfaction, job motivation, goal-directed thinking, goal attainment, and psychological flexibility with 126 senior managers in the UK Civil Service. Participants were randomly allocated to either an ACT-informed coaching intervention (n = 65) or a waitlist control condition (n = 61). Data were collected at four time points over 13 weeks. Analyses showed significant increases in general mental health, generalised self-efficacy, goal-directed thinking, goal attainment, and psychological flexibility in the ACT group compared to the control condition. Consistent with ACT theory, analyses indicated that increases in psychological flexibility mediated improvements in general mental health, generalised self-efficacy, goal-directed thinking, and goal attainment. A final parallel mediation study compared the effects of psychological flexibility and working alliance (a plausible alternative mediator) using data from the coaching arm of the RCT study. These analyses revealed that significant increases in psychological flexibility mediated increases in generalised self-efficacy, goal-directed thinking, and goal attainment. Despite significant increases in working alliance over time, no mediation effects for increases in study variables were found. Overall, findings suggest that ACT-informed coaching is an effective approach to performance and development coaching, and psychological flexibility mediates the beneficial impact of the ACT coaching intervention.

This thesis describes three intervention studies that were designed to investigate the mediators and moderators of change in worksite stress management training (SMT) programmes. In the first study (Study I), 154 local government employees were randomly assigned to one of three conditions: 1) a training programme based on acceptance and commitment therapy (ACT); 2) stress inoculation training (SIT); or 3) a waist-list control group. The ACT and SIT interventions were delivered to small groups of employees via three training sessions spread over three months. Outcome and process of change measures were administered at baseline (Time 1), three months after two sessions of training (Time 2), and again in three months after a final session of training (Time 3). Both ACT and Sit resulted in large improvements in general mental health across the six month assessment period. Further analyses indicated that the beneficial impact of ACT on mental health was mediated by an increase in psychological flexibility, while the impact of SIT was mediated (at least in part) by a decrease in dysfunctional cognitions. Study II used a similar methodology to investigate the impact of ACT on the frequency of dysfunctional thinking, and on learning at work. In this second study, 81 local government employees were randomly assigned to an ACT group or to a wait-list control group. The ACT intervention resulted in a significant improvement in employee well-being across a seven month period. As predicted, these improvements mental health were mediated by an increase in psychological flexibility but not by a reduction in the frequency of dysfunctional thinking. Psychological flexibility also served as the mechanism by which ACT increased work-related learning. In the final study (Study III), participants’ initial level strain was examined as a potential moderator of change in the ACT and SIT interventions. The data from the two previous studies were merged for this final analysis. Results indicated that initial level of strain moderated the effects of these two interventions on employees’ mental health. Moreover, approximately 70% of the initially high strain ACT and SIT participants improved to a clinically significant degree by the final assessment point. The general discussion focuses on the theoretical and practical implications of this research, and highlights the utility of using worksite SMT programmes to test underlying cognitive-behavioural theories of change.

To examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting. A quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date. Participants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3months later. At 3months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d=1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity. These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers. A 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers. The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings. The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills. Study limitations include non-random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3months post-intervention).

سالمندی فرایند زیستی است که تمام موجودات زنده از جمله انسان‌ها آن را تجربه می‌کنند، از این رو توجه خاص و پیشگیری از اختلالاتی نظیر باورهای غیرمنطقی و نگرش منفی به مرگ در سالمندی بسیار مهم است. بنابراین مطالعه حاضر با هدف تعیین اثربخشی درمان مبتنی بر تعهد و پذیرش بر باورهای غیرمنطقی و نگرش به مرگ سالمندان انجام شد. روش پژوهش نیمه آزمایشی با طرح پیش‌آزمون-پس‌آزمون با گروه کنترل بود.جامعه آماری پژوهش کلیه سالمندان شهر خرم آباد در سال 1399 بودند. حجم نمونه پژوهش شامل 30 نفر سالمند (60 تا 70 سال) بود که با روش نمونه‌گیری در دسترس و با توجه به ملاک‌های ورود و خروج مطالعه انتخاب شدند. گروه آزمایش مداخله آموزشی را در قالب هشت جلسه 90 دقیقه‌ای هفتگی دریافت نمودند. پرسش‌نامه‌های مورد استفاده در این پژوهش شامل پرسش‌نامه باورهای غیرمنطقی اهواز و نیمرخ نگرش به مرگ وونگ بود. داده‌ها با تحلیل کوواریانس تک متغیره، با استفاده از نرم‌افزارSPSS نسخه 22 مورد تجزیه و تحلیل قرار گرفتند. یافته‌ها نشان داد که بین گروه‌های آزمایش و کنترل در پس­آزمون از نظر باورهای غیرمنطقی و نگرش به مرگ تفاوت معنی‌داری وجود داشت (001/0>P). به عبارت دیگر درمان مبتنی بر تعهد و پذیرش باعث کاهش باورهای غیرمنطقی و نگرش منفی به مرگ شد. منطبق با یافته‌های پژوهش حاضر می‌توان درمان مبتنی بر تعهد و پذیرش را به عنوان یک روش کارا جهت کاهش باورهای غیرمنطقی و نگرش منفی به مرگ سالمندان پیشنهاد داد.

The aim of the current study was to assess the feasibility, safety, and effectiveness of a newly developed Acceptance and Commitment Therapy (ACT) intervention developed specifically to address the unique context of pregnancy and parenthood. The intervention was delivered to women accessing a specialist Perinatal Community Mental Health Service (PCMHS). An open-label pilot study was conducted of an 8-week, group-delivered ACT intervention targeting women with moderate-to-severe mood and/or anxiety disorders during pregnancy and/or postpartum. Outcomes included session attendance rates, dropout rates, crisis/inpatient service use, and standardized symptom scales. Participant's responses to open-ended questions contained in an end of therapy questionnaire were analysed using thematic analysis. Seventy-four women were referred to the intervention with 65 (88%) completing treatment. The median number of sessions attended was 7. No women required input from crisis/inpatient services. All reported finding the intervention helpful. The implementation of ACT in daily life, therapist support, and group processes were cited as helpful aspects of the intervention. At post-treatment, there was a significant reduction in global distress (d=0.99) and depressive symptoms (d=1.05), and an increase in psychological flexibility (d=0.93). On the secondary outcome of global distress, 38% of women were classified as recovered, 31% had reliably improved, 27% remained the same, and 4% had reliably deteriorated. The delivery of ACT in a routine practice setting is feasible, safe, and effective. A randomized control trial (RCT) is needed to establish the efficacy and cost-effectiveness of this group-delivered ACT intervention. Group-delivered Acceptance and Commitment Therapy (ACT) is acceptable for women with moderate-to-severe perinatal mood and/or anxiety disorders and can be feasibly delivered in a routine practice setting. The trans-diagnostic nature of ACT enables the concurrent treatment of depressive and anxiety symptoms within the same intervention which is particularly helpful in the perinatal context given the comorbidity of mood and anxiety disorders. With training and supervision, mental health practitioners without extensive education in the delivery of psychological therapies can facilitate the ACT group programme. As this was a feasibility study, there was no control group, adherence to the manual was not assessed, and the absence of a follow-up period limits our knowledge of the longer-term benefits of the ACT group programme.

Clients who present to psychotherapy reporting diffuse and/or sub-clinical concerns may provide a puzzling treatment decision for providers of evidence-based practice. The current case study illustrates the implementation of an evidence-based treatment, Acceptance and Commitment Therapy (ACT), for a client diagnosed with adjustment disorder with mixed anxiety and depressive symptoms. ACT targets a dimensional, transdiagnostic construct known as psychological flexibility, currently conceptualized as involving six inter-related behavioral repertoires. The client was a Caucasian woman in her 30s who self-referred to therapy. She reported feeling anxious and depressed, especially in regard to interpersonal difficulties with her mother and her ex-husband. Fourteen sessions of an ACT protocol emphasizing a modular approach to the repertoires emphasized by the psychological flexibility model were provided. Each modular session consisted of psychoeducation, metaphors, experiential exercises, and daily practice assignments for one of the repertoires. The client completed pre-treatment, post-treatment, and 6-month follow-up outcome measures and weekly process measures to track change throughout treatment. One process measure assessed each of the six repertoires. The client’s data revealed substantial increases in psychological flexibility and decreases in psychological distress from pre- to post-treatment, which remained stable at follow-up. This case report suggests that ACT may be a desirable treatment option for clients bearing ambiguous or sub-clinical presentations, including interpersonal conflicts. The report also provides a model for monitoring change with individual psychological flexibility repertoires with respect to a modular approach to teaching those repertoires.

Objective To observe the near-and long-term effects of acceptance and commitment therapy (ACT) on psychological flexibility, self-efficacy, and glycemic control in patients with type 2 diabetes. Methods A total of 96 patients with type 2 diabetes admitted to Zhuzhou Central Hospital during the period from January to December 2017 were selected as subjects. According to the random number table method, they were divided into the control group and the ACT group, 48 cases in each group. The control group was given regular health education, and the ACT group was given ACT-oriented health education. The psychological flexibility, self-efficacy and glycemic control of the two groups were compared before intervention, 7 weeks after intervention and 1 year after intervention. Results After 7 weeks of intervention, the psychological flexibility and self-efficacy scores of the ACT group was (21.47±4.89) and (8.96±1.70) respectively, the control group was (25.28±6.33) and (7.80±1.42) respectively. After 1 year of intervention, the psychological flexibility and self-efficacy scores of the ACT group was (23.87±5.03) and (8.09±1.38) respectively, and the control group was (27.19±5.48) and (6.97±1.24) respectively. The ACT group was significantly better than the control group, and the difference was statistically significant (t=-3.300-4.044, P<0.01). After 7 weeks of intervention, the effective rate of blood glucose control in the ACT group was 93.75% (45/48), and the control group was 75.00% (36/48). After 1 year of intervention, the effective rate of blood glucose control in the ACT group was 86.96% (40/46), and the control group was 65.91% (29/44). The ACT group was significantly higher than the control group, and the difference was statistically significant (χ2=6.400, 5.569, P<0.05). Conclusions The application of health education activities based on ACT is significant in patients with type 2 diabetes, can significantly improve the patient's near-term psychological flexibility and self-efficacy, conducive to better long-term blood sugar management. Key words: Acceptance and commitment therapy; Diabetes mellitus, type 2; Health education

Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder

The levels of psychological distress and burnout among healthcare staff are high, with negative implications for patient care. A growing body of evidence indicates that workplace programmes based on Acceptance and Commitment Therapy (ACT) are effective for improving employees’ general psychological health. However, there is a paucity of research examining the specific psychological and/or behavioural processes through which workplace ACT programmes transmit their beneficial effects. The aim of this randomised controlled trial was to investigate the outcomes and putative processes of change in a 4-session ACT training programme designed to reduce psychological distress among healthcare staff (n = 98). Ninety-eight employees of a healthcare organisation were randomly allocated to the ACT intervention or to a waiting list control group. Study measures were administered on four occasions (baseline, mid-intervention, post-intervention, and follow-up) over a three-month evaluation period. Results showed that the ACT intervention led to a significant decrease in symptoms of psychological distress and a less pronounced reduction in burnout. These effects were mediated primarily via an improvement in mindfulness skills and values-based behaviour and moderated by participants’ initial levels of distress. At four-week post-intervention, 48% of participants who received the ACT intervention showed reliable improvements in psychological distress, with just under half of the aforementioned improvements (46.15%) meeting criteria for clinically significant change. The results advance ACT as an effective stress management intervention for healthcare staff. The findings should be confirmed in a large scale randomised controlled trial with longer follow-up and cost-effectiveness analyses.

Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review

A significant portion of individuals with overweight or obesity seek behavioral weight loss, which aims to modify behaviors and habits related to diet, physical activity, and lifestyle and has been shown to result in clinically meaningful weight loss and improved cardiometabolic health. While the physical outcomes of behavioral weight loss are well documented, relevant psychological processes and mental health outcomes are less studied. This secondary analysis examined psychological flexibility in relation to depression change and weight change in adults (N = 508) with a body mass index greater than 25 enrolled in a 3-month automated behavioral weight loss intervention. Psychological flexibility was assessed using the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT), a tool based on Acceptance and Commitment Therapy (ACT) principles. The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative Depression-Short Form, which collects information directly reported by patients, was used to measure levels of depression. Change in psychological flexibility was found to significantly moderate the positive relationship between weight change and change in depression over the course of a 3-month behavioral weight loss intervention, such that individuals with greater increases in psychological flexibility experienced greater reductions in depression levels when also losing weight. These results suggest that psychological flexibility may enhance the psychological benefits of behavioral weight loss and could be a useful target in a modified version of behavioral weight loss intervention.

Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer

One of the proposed psychological treatments in hemodialysis patients is acceptance and commitment therapy. The acceptance and commitment therapy focuses on psychological flexibility and this occurs when a person consciously accepts his or her thoughts and feelings and shows a behavior consistent with his or her personal values. As chronic kidney failure causes many psychological problems for patients, which can affect their various aspects of life and significantly reduce their quality of life and as acceptance and commitment therapy has provided promising results in helping patients with severe and chronic conditions to cope with their psychological, physical, social, family and economic problems and given the important role of the variable of illness perception in this regard, the present study was conducted to evaluate the effect of acceptance and commitment therapy on illness perception of patients. The statistical population of this study included hemodialysis patients in the dialysis ward of Bouali Marivan Hospital from 22-11-2018 to 22/11/2012. The number of subjects in each of the experimental and control groups was 15. The experimental group received acceptance and commitment therapy at 8 sessions and the control group received no therapy. The data were collected using Illness Perception Questionnaire-Revised (IPQ-R). Data were analyzed by SPSS software using descriptive statistics and covariance analysis. The results of the study showed that acceptance and commitment therapy (ACT) was effective on illness perception, consequences of the illness perception, illness personal control perception, illness treatment control perception, concern and emotional responses perception in dialysis patients. However, acceptance and commitment therapy (ACT) did not affect the illness timeline perception, identity of the illness perception and the illness recognition in dialysis patients.

The effect of acceptance and commitment therapy on the psychological flexibility and inflexibility of undergraduate students: A systematic review and three-level meta-analysis

Acceptance and Commitment Therapy (ACT) is an approach that aims to promote psychological flexibility (PF). Although it has shown to be effective in adult populations, there is relatively little research on ACT with children. The purpose of this systematic review was to identify and characterize the peer-reviewed literature on ACT in elementary-aged populations with a focus on intervention and assessment characteristics, implementation, and study quality. The total sample included 22 articles using ACT with participants between five and 12 years of age. Articles were coded for characteristics pertaining to treatment, participants, implementation, setting, assessment, and design. Results found that although ACT is understudied in elementary-age populations compared to adolescents and adults, it has been used to promote positive outcomes across a large number of dependent variables, settings, and youth demographic groups. Specifically, 19 of the 22 included students reported statistically significantly improvements in at least one outcome, five of which were conducted in school settings. These promising findings indicate a need for more ACT work, particularly in school settings where mental health service delivery is becoming increasingly more common. Implications for both researchers and school-based mental health professionals are discussed. Impact Statement Acceptance and Commitment Therapy (ACT) is a promising treatment to reduce symptoms of psychological distress and increase mental well-being, including psychological flexibility. Although it is under-researched in elementary-aged youth, this systematic review synthesized the nascent literature and examined how ACT is being implemented with young children. These results open doors for future ACT research and practice with elementary-aged youth and highlight the need for more school-based ACT research.