Values-based Action Research Articles

The role of mindfulness in stress, productivity and wellbeing of foundation year doctors: a mixed-methods feasibility study of the mindful resilience and effectiveness training programme

BackgroundMedical Foundation Year (FY) doctors demonstrate greater psychological distress compared with the general population and other student groups. This feasibility study investigated FY doctors’ perceptions of mindfulness and the impact of a mindful resilience and effectiveness training (MRET) programme on stress, wellbeing, and performance.MethodsMixed-methods study utilising a questionnaire (study 1, N = 144) and a pre-post analysis design of MRET programme (study 2, N = 13), along with focus groups (N = 7).ResultsIn study 1 28.5% of FY’s reported using mindfulness. All five mindfulness facets were significantly, and positively, associated with mental wellbeing (p < 0.05). Acting with awareness (AA) and non-reactivity (NR) were significantly, positively associated with a challenge responses to stress (p < 0.05). Threat and loss appraisals were negatively associated with AA, NR, and non-judging (p < 0.01). Perceived productivity was positively associated with mindfulness facets: describing, AA, and NR (p < 0.001). In study 2, there were significant increases in wellbeing and mindfulness facets observing, describing, AA, and NR, and threat appraisals decreased (p < 0.05). The main themes identified across the focus group included Reframed Mindset, Values-Based Action, Embodied Leadership and Pedagogy.ConclusionsThere exists a relationship between mindfulness, psychological wellbeing, and performance in FYs. The MRET prorgamme improved psychological wellbeing and reduced threat appraisals. Future work could focus resources on enhancing the skills of AA and NR, as this may be sufficient to bring about meaningful improvements in wellbeing, percieved productivity and cognitive reappraisal of stressful life events.

Exploring the Effectiveness and Acceptability of a Self-Help Acceptance-Based Behavior Intervention for Anxiety in Black Adults: An Uncontrolled Pilot Study

An estimated one in five Black Americans meet criteria for an anxiety disorder in their lifetimes (Alvarez et al., 2019), but only about 20% of these receive mental health services. Self-help materials that have been shown to be effective in reducing anxiety and worry could be one method of increasing access to evidence-informed treatments for Black Americans. The current study explored the acceptability and effectiveness of the Worry Less, Live More: The Mindful Way Through Anxiety Workbook (WLLM), a self-help workbook based on acceptance-based behavioral therapy, for reducing anxiety in a sample of Black individuals. Sixty-five Black individuals residing in the United States received the WLLM workbook and were asked to read it over 16 weeks at their own pace without intervention from researchers: 40 of those participants completed the follow-up survey. A majority of the participants agreed that the approach was a good match for them (70%) that it aligned with their personal and cultural views (60%), and that the strategies from the workbook were helpful for them when dealing with the stress related to encountering racial stressors (71%). There were significant improvements over time on self-reported general anxiety (d = .50, anxious arousal (d = .41), cognitive fusion (d = .45), and acceptance (d = .76), but no significant changes in engagement in values-based action over time. This study provided preliminary support for the acceptability of WLLM’s acceptance-based approach for Black adults.

Investigating the acceptability of a culturally adapted acceptance and commitment therapy group for UK Vietnamese communities: A practice-based feasibility study.

Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.

Environmental identity-based therapies for climate distress: applying cognitive behavioural approaches

Abstract This paper describes an interdisciplinary integration of the concept of environmental identity into cognitive behavioural approaches to facilitate psychotherapy interventions for climate distress. Environmental identity encompasses one’s sense of self in relation to the natural world and other species, and is an important sub-identity analogous to gender, sexual and other forms of self and social identity recognized in psychotherapy. We provide a background on the construct of environmental identity as developed in social and environmental psychology and share culturally responsive methods for mental health practitioners and the public to evoke and explore their own environmental identity. We then discuss steps to create environmental identity-based therapy interventions using cognitive and behavioural approaches for climate distress. We highlight the potential for acceptance and commitment therapy to foster mindfulness and values-based action, dialectical behaviour therapy to support emotional regulation, and radically open dialectical behaviour therapy to mitigate perfectionism and over-controlled coping styles. We also describe a composite case study of environmental identity-based cognitive behavioural therapy for an LGBTQ+ client. Key learning aims (1) The paper presents new opportunities and techniques for adapting cognitive behavioural interventions in a climate conscious manner, with insights and observations from the authors based on clinical practice, which informs research into psychotherapy best practices in the context of environmental and climate issues. (2) Readers will become familiar with the empirical basis of environmental identity drawn from theory and research in social and environmental psychology; how environmental experiences and values intersect with other forms of personal and social identity addressed in mental health practice; and culturally responsive ways to elicit environmental identity on the part of practitioners and those they serve. (3) Readers are guided through examples of environmental identity-based cognitive and behavioural interventions including (1) promoting values-based action using acceptance and commitment therapy, (2) addressing emotional dysregulation using dialectical behaviour therapy, and (3) modifying over-controlled or perfectionistic coping styles using radically open dialectical behaviour therapy. (4) A composite case study provides an example of environmental identity-based cognitive behavioural therapy for a 20-year-old LGBTQ+ person experiencing climate distress.

The mediating role of gratitude and forgiveness in the sense of coherence and values-based action

Objective. The aim of the research study was to determine the mediation value of gratitude and forgiveness in the relationship between the sense of coherence and acting in accordance with the given principles. In order to answer the research interest, a predictive model of mediating effects was constructed.&#x0D; Material and method. The research study was conducted amongst 330 people aged 18 to 65, 284 women (86.1%) and 46 men (13.9%). The SOC-29 Life Orientation Questionnaire was used to measure the independent variable of sense of coherence. The mediating variables of gratitude and forgiveness were examined using the GQ Gratitude Questionnaire by McCullough, Emmons, Tsang and the Inventory of Interpersonal Motivation in Harm Situations TRIM-18 by McCullough et al. The dependent variable of Values-Consistent Actions was measured using the Values-Consistent Actions (VQ) questionnaire by Smout, Davies, Burns and Christie. The SPSS v4.2 program was used in the analysis and mediation in R environement &amp; Iavaan.&#x0D; Results. It has been demonstrated that gratitude mediates the relationship between the sense of coherence and actions consistent with values ​​- the presence of gratitude in an individual's life strengthens the relationship between the sense of coherence and values based actions. A mediating role of forgiveness in the relationship between the sense of coherence and actions consistent with values ​​was also found. The dimensions of revenge and kindness turned out to be mediators in the relationship between the sense of coherence and the dimension of obstacles to act consistently with given values, but they did not show a mediating effect in the relationship between the sense of coherence and the dimension of continuously supported actions consistent with given values. The third factor – avoidance, demonstrated none of a mediating role in any of the examined relationships; the presence of kindness strengthens the negative correlation between the sense of coherence and the obstacle dimension; however, the presence of revenge weakens this dependence.&#x0D; Conclusions. The results expressed an importance of gratitude in the functioning of mental mechanisms and demonstrated yet another aspect whereby the presence of gratitude had a positive impact on the individual’s responses to their life context.

The bidirectional associations of rumination with values-based action and depression among young adults in the school-to-work transition

BackgroundSchool-to-work transition is crucial for young adults, requiring them to maintain their values-based action, even though this task is likely to cause rumination associated with depression. In the HExAGoN model, individuals with rumination tend to engage in abstract-analytic thought (AAT) but not in concrete-experiential thought (CET). Although this inflexible style of thought is assumed to decrease values-based action and increase depression, no empirical research has examined these relationships in young adults during their transition period. Therefore, this study examined the bidirectional relationships between AAT, CET, depression, and values-based action in young adults. MethodsA one-year five-wave longitudinal survey was conducted on 756 third-year university students who engaged in job searches in Japan. Cross-lagged panel model and random-intercept cross-lagged panel model were used to estimate the bidirectional relationships at the between-person and within-person levels, respectively. ResultsAAT and CET had bidirectional associations with depression and values-based action at the between-person level. Furthermore, CET decreased depression and marginally improved values-based action at the within-person level. LimitationsThe study comprised only university students in Japan and had a high attrition rate. ConclusionsThe findings suggest that CET can reduce depression and improve values-based action in young adults undergoing the transition. It may also expand the understanding of the treatment and prevention of depression in young adults.

Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain

Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these 2 behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had 2 distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify 3 distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain. PerspectiveIndividuals with chronic pain can be classified with respect to pain acceptance and values-based action and these groups may respond differently to treatment.

Entrepreneuring in necessity contexts: effecting change among widow entrepreneurs in Northern Ghana

ABSTRACT This article explores if and how the entrepreneuring efforts of an endogenous NGO can entrepreneurially empower widow necessity entrepreneurs living in extreme poverty in a rural area of Northern Ghana. In reconceptualizing necessity entrepreneurship as engagement in necessity contexts, three main context specific actions and processes were foregrounded: values-based action focus, upskilling by boundaried choice; and forming, organizing and maintaining symbiotic relationships. Subsequently, the extent to which these actions and processes contributed to empowerment were assessed and explained. Upon outlining how the research contributes to a more comprehensive understanding of entrepreneurship in necessity contexts and broadens our understanding of entrepreneurship, the article ends by discussing the research’s implications and limitations.

The role of psychological flexibility in palliative care

Elevated psychosocial distress, pain and existential dread are prevalent among those living with a palliative illness with consequential negative impacts on quality of life (QoL). Psychological flexibility (PF) is a protective factor related to better psychosocial outcomes in various adverse health contexts. This study tests the applicability of the PF framework in accounting for variability in four palliative patient outcomes (death attitudes, distress, pain and QoL) and the stability of these variables over one month. Fifty-four palliative patients and 21 of their carers completed a questionnaire at Time 1 and one month later (Time 2). Informal carers provided proxy ratings of the patient's QoL. Results indicated no change in PF or patient outcomes, and that higher Time 1 total PF significantly predicted better Time 2 outcomes across QoL, distress, and death attitudes. The acceptance PF dimension evidenced the strongest beneficial associations, whereas unexpectedly the values-based action PF dimension predicted higher death escape attitudes, and the mindfulness PF dimension failed to predict any outcome, although at the bivariate level it was related to better outcomes across QoL, death attitudes and distress. Unexpectedly, the values-based action PF dimension was correlated with worse pain outcomes. Overall, these findings support the role of PF in improving palliative patient outcomes, and prior calls for the evaluation of Acceptance and Commitment Therapy (ACT), which targets PF, in palliative care. The unexpected findings regarding the two PF dimensions of mindfulness and values-based action, suggest that these PF processes need further investigation and require fine tuning in ACT interventions to ensure sensitivity to the palliative care context. These findings are currently being utilised to inform the development and evaluation of a self-help ACT resource for palliative patients.

The Choice Point Model of Acceptance and Commitment Therapy With Inpatient Substance Use and Co-occurring Populations: A Pilot Study.

Objectives: Acceptance and Commitment Therapy (ACT) is an empirically supported treatment which aims to enhance self-acceptance and a commitment to core values. The present study examined the effectiveness of the Choice Point model of ACT in a residential substance use disorder (SUD) setting. Choice Point is a contemporary approach to ACT and targets transdiagnostic processes.Methods: This uncontrolled quasi-experimental design assessed 47 participants taking part in Choice Point for Substances (CHOPS) in order to investigate its influence on psychological inflexibility, values-based action, and self-compassion over time. The study additionally assessed for sleeper effects and associations between transdiagnostic processes and warning signs of relapse.Results: Findings demonstrated a decrease in psychological inflexibility and increases in values-based action and self-compassion over time. Gains were maintained at follow-up, and sleeper effects were observed for psychological inflexibility and mindfulness. Correlational analysis suggested that all transdiagnostic processes were related to warning signs of relapse at follow-up.Conclusion: These results provide preliminary evidence for the feasibility, acceptability, and effectiveness of CHOPS for SUD. Observed sleeper effects in psychological inflexibility and mindfulness indicate that CHOPS may provide longer-term benefits critical to a population where relapse is common. While encouraging, these findings should be interpreted with caution. Future research should utilize comparison groups when investigating CHOPS.

Wellbeing, burnout, and safe practice among healthcare professionals: predictive influences of mindfulness, values, and self-compassion

ABSTRACT Poor wellbeing and burnout are significant issues among health-care professionals (HCPs) and may contribute to unsafe practice. In this exploratory study, we aimed to: provide the first investigation of the combined and unique influences of these psychological factors in predicting safe practice; confirm the role played by mindfulness in relation to wellbeing, burnout and safe practice; and investigate whether values and self-compassion predict additional variability above and beyond mindfulness skills. Ninety-eight NHS staff completed measures of wellbeing, burnout, perceived safety of practice, mindfulness, values and self-compassion. Practitioners with higher perceived safety of practice reported higher levels of mindfulness, but not values or self-compassion, particularly lower experiential avoidance and nonjudgmental attitude toward difficult thoughts. Mindfulness explained significant variability in psychological distress (20%), emotional exhaustion (8%), cognitive weariness (10%), patient safety related to oneself (7%), and related to work (8%). Values (obstruction) added unique variance for psychological distress (12%) and physical fatigue (10%). Moreover, self-compassion explained a small yet significant portion of variability in emotional exhaustion. These preliminary findings suggest that mindfulness processes may be associated with perceived safety of practice. The results also indicate that mindfulness-based interventions for HCPs may benefit from the inclusion of values-based action components and self-compassion practices.

Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility.

The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one’s chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.

Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility

There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility.

An audit of emotional logic for mental health self-care improving social connection

IntroductionEmotional Logic is a practical contribution to self-care for mental health and adaptability, teaching how unpleasant loss emotions have useful purposes that enable healthy adjustments to changing circumstances. Measurable personal capacity outcomes result from SMART action plans that recover named personal values. New understanding about emotions cascades informally through families and communities at low cost. This proof of concept paper presents audits that define the theory of change for a prospective study of Emotional Logic for self-care in compassionate networked communities. MethodsComparative audits of mental health and resilience outcomes with two learning cohorts were conducted using GAD-7, PHQ-9, and ELDP questionnaires. Long-term outcome audits also asked if learners’ had shared their new understanding with others. Emotional Logic coaches categorised ELDP statements into those identifying change of individual or relational capacities. ResultsCohen’s d shows improved resilience on guided self-help learning with effect size 1.13 (p < 0.001) for anxiety and depression, and 0.91 for youth personality disorder. 31 % of improvement for mental illness measured by the ELDP is hypothesised to follow improved relational capacities measured by 13/34 (38 %) of its Likert scaled statements. ConclusionsTeaching people the useful purposes of their unpleasant loss emotions improves the quality of their social connections and their mental health. Developing this personal understanding empowers self-care in new challenging situations that might otherwise have led to professional or other dependencies. Outcomes measurement of truly values-based action plans enables a prospective study to be conducted in networked communities, achievable through social prescribing.

Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One-Year Follow-Up.

There is growing evidence to support Acceptance and Commitment Therapy (ACT) in the management of chronic pain. However, there is a need for further research evaluating ACT combined with physical exercise, and few studies have assessed the long-term impact of this type of intervention. This case series reports on the acceptability and impact of an ACT-based multidisciplinary pain management programme on a range of health outcomes in both the short and long-term. Seventy-three participants completed an 8-week group-based, pain management programme. The programme combined weekly sessions of ACT with education and exercise classes. Self-report outcome measures were completed at baseline, post-intervention and at one-year follow-up. The measures assessed pain intensity and interference, psychological distress, self-efficacy, pain acceptance, values-based action, pain catastrophizing, fear avoidance and healthcare utilization. Pedometers were worn to objectively measure physical activity. Data were analyzed using linear mixed modelling. Ethical approval for this study was granted by the Mater Misericordiae University Hospital (MMUH) Institutional Review Board (Reference 1/378/1541). Eighty-six percent of respondents reported being satisfied with the intervention. Improvements were observed in most of the self-report outcomes post-intervention and many changes were maintained at one-year. There was also a significant increase in average daily step-count. A pain management programme combining ACT with exercise appears to be an acceptable treatment option for people with chronic pain. While improvements were observed in both the short and long-term, further fully powered RCTs with long-term follow-up are required to test the effectiveness of this type of intervention.

Parent psychological flexibility in the context of pediatric pain: Brief assessment and associations with parent behaviour and child functioning.

The parent's role in the context of pediatric chronic pain is essential. There is growing evidence that parent psychological flexibility positively impacts child functioning. To assess parents' abilities to respond with psychological flexibility to their child's pain, the Parent Psychological Flexibility Questionnaire (PPFQ) was developed. Here, we aim to validate the 10-item version of the questionnaire in an English-speaking population and to evaluate associations with parent behaviour, child pain acceptance and functioning. Five hundred and seventy-eight parent-child dyads presenting at a pediatric pain clinic were included (92% mothers, average child age 15.2±1.6years). The PPFQ was completed by the parent. Parent and child also completed other standardized questionnaires. In addition to confirmatory factor analysis and assessments of reliability and validity of the PPFQ-10, a mediation analysis was performed to examine the direct and indirect effects of parent psychological flexibility on child functioning. Confirmatory factor analysis supported the three-factor model with subscales for Values-Based Action, Pain Willingness and Emotional Acceptance, and the PPFQ-10 demonstrated strong psychometric properties. After controlling for child pain, parent psychological flexibility indirectly affected child functioning through its association with both parent behaviour (i.e., protectiveness) and child pain acceptance. Our findings provide further support for use of the PPFQ-10 and the importance of assessing and addressing parent psychological flexibility in the context of child chronic pain. Our data show that parent psychological flexibility has an important adaptive role and can impact child functioning through two different routes, both of which can be actively targeted in treatment. Our findings demonstrate that the PPFQ-10 is an efficient measure of parent psychological flexibility, demonstrating strong psychometric properties. Furthermore, our analyses showed that parent psychological flexibility indirectly affects child functioning through associations with both adaptive parent behaviour and child functioning. Taken together, this study furthers the understanding of how parent psychological flexibility operates and affects children with chronic pain, and may inform and optimize treatments aimed at improving functioning by addressing child and parent coping.

The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain

The symptoms of posttraumatic stress disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of Psychological Flexibility mediate the relationship between these 2 conditions. Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least 1 traumatic experience. People seeking treatment for chronic pain and reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below the diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion, and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the Psychological Flexibility model. Processes from the Psychological Flexibility model were identified as mediators of the relationship between PTSD and chronic pain in people seeking treatment for chronic pain. The Psychological Flexibility model may be useful as an overarching model to help understand the relationship between PTSD and chronic pain. It is possible that targeting pain-related acceptance, committed action, and cognitive fusion (among other processes) in the treatment of chronic pain may produce corresponding improvements in comorbid symptoms of PTSD when these are present and may reduce impacts of PTSD on outcomes of chronic pain. Conversely, targeting of these processes in the treatment of PTSD may produce similar improvements for symptoms of chronic pain. Further research to evaluate these possibilities is needed.

Attaining elite leadership: career development and childhood socioeconomic status

PurposeThe existence of disadvantaged sub-populations whose talents are under-leveraged is a problem faced by developing and developed countries alike. Life history data revealed that a large proportion of elite business leaders in the Caribbean emerged from childhood poverty (families subsisting on US$1-2 a day, 40 percent). The purpose of this paper is to examine the key factors supporting the career development of elite leaders from a broad socioeconomic spectrum and both genders in order to build a model of career development for elite leadership.Design/methodology/approachData were collected via in-depth interviews from a deliberately gender-balanced sample of 39 male and 39 female elite business leaders. Thematic analysis identified consistencies across independent interviews and resulted in a model identifying factors supporting pre-career development as key to eventual attainment of elite leadership.FindingsFindings indicated that in childhood and youth, proactivity plus talent recognition and mentoring by adults enhanced access to early developmental opportunities. Early career mentoring guided talented youth to build personal drive, self-esteem, altruism, and integrity, which created a foundation for developing career capital through values-based action. Altogether, these findings indicate the importance of pre-career relational capital to attainment of elite career success.Originality/valueDifficult-to-access elite leaders provided rich information emphasizing the importance of pre-career development in childhood and youth to eventual elite leadership attainment. Virtually all of the elites in the sample remember being identified as talented early in life and consider early messages about drive to achieve as well as support received from parents, teachers, and other interested adults to be critical to their success. Hence, a process of talent recognition and encouragement to excel appear to be crucial for connecting young people to important relational capital allowing them to eventually achieve elite status, particularly those individuals hailing from disadvantaged backgrounds.

Improvements in Depression and Mental Health After Acceptance and Commitment Therapy are Related to Changes in Defusion and Values-Based Action

Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.

Inclusive Pathways to Elite Leadership: Lessons from Caribbean Women and Men

This qualitative study of 39 women and 39 men in three Caribbean countries (Barbados, Trinidad and Tobago, and Jamaica) examines the pathways to elite leadership. In this developing country context, elites emerged primarily from poor and working-class families (74 of 78 interview participants), and all had attended top-tier “prestige” secondary schools. In-depth interviews revealed three important themes rooted in childhood and early youth and sustained throughout the career lifetime: 1) proactivity, 2) mentorship and sponsorship support, and 3) values-based action. All of the elites reported taking on leadership roles during childhood, an indicator of early emergence of proactivity and leadership talent. All of the elites ascribed critical importance to role models, mentors and sponsors in childhood and youth. These important adults provided support for academic success and emphasized the importance of values as the foundation for a positive life trajectory. All of these elite leaders evidenced sustained proactivity and values-based action throughout their careers, attaining their high-level positions through unwavering focus on goal attainment, values-driven advancement, and the resulting store of career capital. The findings form the basis for a conceptual model with 10 propositions regarding inclusive pathways to elite leadership.