Enhancing students' well-being with a unified approach based on contextual behavioural science: A randomised experimental school-based intervention.

A new generation of interventions has begun to move towards principles of acceptance that deal with the context and function of psychological events. The aim of this paper is to analyse the effectiveness of a brief contextual behavioural intervention to improve the psychological well-being of secondary school students. This intervention represents a unified model with key processes based on contextual behavioural science, including Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP). We conducted an intervention with 94 students (age range 17-19 years), randomly assigned to an experimental group (n = 50) or control group (n = 44). Participants took a pretest and post-test of distress, life satisfaction, psychological flexibility and mindfulness. The intervention consisted of three sessions of 1 h each. The results showed significant differences between the groups in distress and significant differences for the interaction (group × pre-post) in all the other variables. The intervention had greater benefits for girls than for boys. These results may provide a breakthrough, thus leading to a process of evidence-based therapies, which would be responsible for inducing psychological improvements in brief periods, in a population with an increasing risk of distress.

Psychological processes underlying the impact of gender-related discrimination on psychological distress in transgender and gender nonconforming people.

In this study we combined understanding from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999, 2012) to test a theoretically integrated and expansive account of the development of psychological distress in transgender and gender nonconforming (TGNC) people. Specifically, we constructed a parallel multiple mediation model in which we examined the role of psychological processes deriving from the GMSR model (i.e., internalized transphobia and identity nondisclosure) and ACT (i.e., psychological inflexibility) in the relationship between gender-related discrimination and psychological distress (i.e., depression, anxiety, and stress). We based this model upon data from a 2-wave longitudinal panel design in which 358 TGNC people living in England responded to a battery of measures on 2 occasions, 12 months apart (herein, Time 1 and Time 2). Initial tests of model fit and temporal invariance indicated that our proposed measurement model offered an excellent fit to the data and demonstrated equivalence of measurement across the two study timepoints. Autoregressive cross-lagged manifest path analysis indicated that while our hypothesized full structural model offered an excellent fit to the data, psychological inflexibility alone mediated the relationships between gender-related discrimination and depression, anxiety, and stress. Model comparison analysis confirmed the redundancy of internalized transphobia and identity nondisclosure as mediators and ruled out alternative patterns of causality. We discuss theoretical, empirical, and practical implications for the field of TGNC mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The efficacy of functional-analytic psychotherapy and acceptance and commitment therapy (fact) for public employees / La eficacia de la psicoterapia analítica-funcional y la terapia de aceptación y compromiso (FACT) para empleados públicos

Background: The literature is replete with evidence regarding the impact of psychological distress in the workplace. Traditionally, worksite interventions to enhance mental health have been carried out in groups. This study aimed to implement a brief individual program in the workplace through the combination of Functional Analytic Psychotherapy (FAP) and Acceptance and Commitment Therapy (ACT) for Public Administration employees. Method: One hundred and six public employees from a Spanish city council completed pretest measures and forty-three met the inclusion criteria. The participants' scores on distress, burnout, psychological flexibility, depression, anxiety and stress were examined in a pretest-posttest design with a waiting list control group and random assignment. Thirty-eight employees completed the intervention (FACT group= 19; Waiting list control group= 19). The intervention lasted three individual sessions using a protocol with the processes of FAP and ACT, resulting in a protocol named FACT. Results: The FACT group showed statistically significant improvements in distress, burnout, psychological flexibility and anxiety compared with the waiting list control group. Conclusion: These results provide a breakthrough and initial support for the inclusion of FAP in the workplace along with the integration with brief ACT in individual sessions to improve employees' mental health

Antecedentes: la literatura está repleta de evidencia sobre las repercusiones del malestar psicológico en el trabajo. Tradicionalmente, las intervenciones para mejorar la salud mental en el trabajo se han llevado a cabo en grupo. El objetivo de este estudio fue implementar un programa individual breve en el entorno laboral, a través de la combinación de la Psicoterapia Analítica Funcional (FAP) y la Terapia de Aceptación y Compromiso (ACT) para empleados de la Administración pública. Método: ciento seis funcionarios de un ayuntamiento español rellenaron las medidas pretest y cuarenta y tres cumplieron los criterios de inclusión. Las puntuaciones de los participantes en malestar, burnout, flexibilidad psicológica, depresión, ansiedad y estrés fueron analizadas en un diseño experimental pre-post con un grupo de control en lista de espera y asignación aleatoria. Treinta y ocho empleados completaron la intervención (grupo FACT= 19; grupo control en lista de espera= 19). Resultados: el grupo FACT tras tres sesiones mostró mejoras estadísticamente significativas en malestar, ansiedad, burnout y flexibilidad psicológica en comparación con el grupo de control en lista de espera. Conclusión: estos resultados proporcionan una innovación y apoyo inicial para la incorporación de FAP en el entorno laboral, además de su integración con ACT breve para mejorar la salud de los empleados

The efficacy of functional-analytic psychotherapy and acceptance and commitment therapy (FACT) for public employees.

BACKGROUND: The literature is replete with evidence regarding the impact of psychological distress in the workplace. Traditionally, worksite interventions to enhance mental health have been carried out in groups. This study aimed to implement a brief individual program in the workplace through the combination of Functional Analytic Psychotherapy (FAP) and Acceptance and Commitment Therapy (ACT) for Public Administration employees. METHOD: One hundred and six public employees from a Spanish city council completed pretest measures and forty-three met the inclusion criteria. The participants´ scores on distress, burnout, psychological flexibility, depression, anxiety and stress were examined in a pretest-posttest design with a waiting list control group and random assignment. Thirty-eight employees completed the intervention (FACT group= 19; Waiting list control group= 19). The intervention lasted three individual sessions using a protocol with the processes of FAP and ACT, resulting in a protocol named FACT. RESULTS: The FACT group showed statistically significant improvements in distress, burnout, psychological flexibility and anxiety compared with the waiting list control group. CONCLUSION: These results provide a breakthrough and initial support for the inclusion of FAP in the workplace along with the integration with brief ACT in individual sessions to improve employees’ mental health.

Work-related self-efficacy as a moderator of the impact of a worksite stress management training intervention: Intrinsic work motivation as a higher order condition of effect.

Employees with low levels of work-related self-efficacy may stand to benefit more from a worksite stress management training (SMT) intervention. However, this low work-related self-efficacy/enhanced SMT benefits effect may be conditional on employees also having high levels of intrinsic work motivation. In the present study, we examined this proposition by testing three-way, or higher order, interaction effects. One hundred and fifty-three U.K. government employees were randomly assigned to a SMT intervention group (n = 68), or to a waiting list control group (n = 85). The SMT group received three half-day training sessions spread over two and a half months. Findings indicated that there were significant overall reductions in psychological strain, emotional exhaustion and depersonalization in the SMT group, in comparison to the control group. Furthermore, there were significant higher order Group (SMT vs. control) × Time 1 Work-Related Self-Efficacy × Time 1 Intrinsic Work Motivation interactions, such that reductions in emotional exhaustion and depersonalization at certain time points were experienced only by those who had low baseline levels of work-related self-efficacy and high baseline levels of intrinsic work motivation. Implications for work-related self-efficacy theory and research and SMT research and practice are discussed. (PsycINFO Database Record

The development and initial validation of the cognitive fusion questionnaire.

Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, "defusion" interventions aim to "unhook" thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories, and self-stories. A number of similar concepts have been described in the psychology literature (e.g., decentering, metacognition, mentalization, and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. While there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed-upon measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1,800 people across diverse samples show good preliminary evidence of the CFQ's factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.

Academics' experiences of a respite from work: effects of self-critical perfectionism and perseverative cognition on postrespite well-being.

This longitudinal study examined relations between personality and cognitive vulnerabilities and the outcomes of a respite from work. A sample of 77 academic employees responded to week-level measures of affective well-being before, during, and on 2 occasions after an Easter respite. When academics were classified as being either high or low in a self-critical form of perfectionism (doubts about actions), a divergent pattern of respite to postrespite effects was revealed. Specifically, during the respite, the 2 groups of academics experienced similar levels of well-being. However, during postrespite working weeks, the more perfectionistic academics reported significantly higher levels of fatigue, emotional exhaustion, and anxiety. The greater deterioration in well-being experienced by perfectionist academics when first returning to work was mediated by their tendency for perseverative cognition (i.e., worry and rumination) about work during the respite itself. These findings support the view that the self-critical perfectionist vulnerability is activated by direct exposure to achievement-related stressors and manifested through perseverative modes of thinking.

Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance.

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.

Worksite stress management training: moderated effects and clinical significance.

Psychologically healthy participants may dilute the observed effects of worksite stress management training (SMT) programs, therefore hiding the true effectiveness of these interventions for more distressed workers. To examine this issue, 311 local government employees were randomly assigned to SMT based on acceptance and commitment therapy (SMT, n = 177) or to a waitlist control group (n = 134). The SMT program consisted of three half-day training sessions, and imparted a mixture of mindfulness and values-based action skills. Across a 6-month assessment period, SMT resulted in a significant reduction in employee distress. As predicted, the impact of SMT was significantly moderated by baseline distress, such that meaningful effects were found only among a subgroup of initially distressed workers. Furthermore, a majority (69%) of these initially distressed SMT participants improved to a clinically significant degree. The study highlights the importance of accounting for sample heterogeneity when evaluating and classifying worksite SMT programs.

A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training.

In this comparative intervention study, 107 working individuals with above average levels of distress were randomly assigned to one of three conditions: acceptance and commitment therapy (ACT; n = 37); stress inoculation training (SIT; n = 37); or a waitlist control group (n = 33). The interventions were delivered to small groups in the workplace via two half-day training sessions. ACT and SIT were found to be equally effective in reducing psychological distress across a three month assessment period. Mediation analysis indicated that the beneficial impact of ACT on mental health resulted from an increase in psychological flexibility rather than from a change in dysfunctional cognitive content. Contrary to hypothesis, a reduction in dysfunctional cognitions did not mediate change in the SIT condition. Results suggest that the worksite may offer a useful, yet underutilised, arena for testing cognitive-behavioural theories of change.

Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women.

To explore the efficacy of a mindfulness-based weight loss intervention for women. Sixty-two women (ages 19-64; BMI 22.5-52.1) who were attempting to lose weight were randomised to an intervention or control condition. The former were invited to attend four 2-h workshops, the latter were asked to continue with their normal diets. Data were collected at baseline, 4 and 6 months. BMI, physical activity, mental health. At 6 months intervention participants showed significantly greater increases in physical activity compared to controls (p<.05) but no significant differences in weight loss or mental health. However, when intervention participants who reported 'never' applying the workshop principles at 6 months (n=7) were excluded, results showed both significantly greater increases in physical activity (3.1 sessions per week relative to controls, p<.05) and significantly greater reductions in BMI (0.96 relative to controls, equivalent to 2.32 kg, p<0.5). Reductions in BMI were mediated primarily by reductions in binge eating. Despite its brevity, the intervention was successful at bringing about change. Further refinements should increase its efficacy.

The influence of psychological flexibility on work redesign: mediated moderation of a work reorganization intervention.

This quasi-experiment tested the extent to which an individual characteristic, psychological flexibility, moderated the effects of a control-enhancing work reorganization intervention in a call center. Results indicated that, compared with a control group, this intervention produced improvements in mental health and absence rates, particularly for individuals with higher levels of psychological flexibility. Findings also showed that these moderated intervention effects were mediated by job control. Specifically, the intervention enhanced perceptions of job control, and hence its outcomes, for the people who received it, especially for those who had greater psychological flexibility. Discussion highlights the benefits of understanding the processes (e.g., mediators, moderators, and mediated moderators) involved in work reorganization interventions.

Mental health and cognitive function in adults aged 18 to 92 years.

We investigated mental health and cognitive function in 195 community-dwelling adults aged 18 to 92 years (M = 46.64). We assessed several cognitive domains, including psychomotor, executive function, and episodic memory. We found a significant Age x Mental Health interaction in relation to within-person (WP) variability (trial-to-trial variability in reaction time performance) in a four-choice psychomotor task and a Stroop task, but not in relation to mean reaction time measures from those tasks. Poorer mental health was associated with greater WP variability in older adults. We did not find this effect in relation to memory. The findings suggest that measures of WP variability may be sensitive to relatively subtle effects associated with age and poor mental health, and that they provide valuable insights into cognitive function in old age.

Avoidance and cognitive fusion--central components in pain related disability? Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS).

Acceptance of pain and other associated negative private experiences has received increasing attention in recent years. This approach is in stark contrast to the traditional approach of reducing or controlling symptoms of pain. The empirical support for treatments emphasizing exposure and acceptance, such as Acceptance and Commitment Therapy, is growing. However, to date, few instruments exist to assess the core processes in these types of treatments. This study describes the development and preliminary validation of the Psychological Inflexibility in Pain Scale. Principal components analysis (PCA) suggests a 2-factor solution with a total of 16 items measuring avoidance of pain and cognitive fusion with pain. Results also indicate adequate reliability and validity for the scale. Implications of these findings for clinical assessment, as well as for research on pain related disability, are discussed along with suggestions for further research in this area.

Assessing the relationship between cold pressor pain responses and dimensions of the anxiety sensitivity profile in healthy men and women.

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance-based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self-report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.

Acceptance and commitment therapy: model, processes and outcomes.

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.

Improving academic performance and mental health through a stress management intervention: outcomes and mediators of change.

Two hundred and nine pupils were randomly allocated to either a cognitive behaviourally based stress management intervention (SMI) group, or a non-intervention control group. Mood and motivation measures were administered pre and post intervention. Standardized examinations were taken 8-10 weeks later. As hypothesized, results indicated that an increase in the functionality of pupils' cognitions served as the mechanism by which mental health improved in the SMI group. In contrast, the control group demonstrated no such improvements. Also, as predicted, an increase in motivation accounted for the SMI group's significantly better performance on the standardized, academic assessments that comprise the United Kingdom's General Certificate of Secondary Education. Indeed, the magnitude of this enhanced performance was, on average, one-letter grade. Discussion focuses on the theoretical and practical implications of these findings.

Comparing acceptance- and control-based coping instructions on the cold-pressor pain experiences of healthy men and women.

The current study reflects recent developments in psychotherapy by examining the effect of acceptance-based coping instructions, when compared to the opposite, more control/distraction-based instructions, on cold-pressor pain. Since previous research indicates gender differences in how people cope with pain, we also sought to determine whether differences would be found between healthy men and women. As predicted, results indicated that women reported lower pain threshold and tolerance level than did men. Furthermore, the acceptance-based instruction resulted in lower sensory pain reports when compared to the opposite instructions. Finally, for affective pain, acceptance instructions only benefited women. These results suggest that acceptance-based coping may be particular useful in moderating the way in which individuals, especially women, cope with pain.

The role of acceptance and job control in mental health, job satisfaction, and work performance.

Acceptance, the willingness to experience thoughts, feelings, and physiological sensations without having to control them or let them determine one's actions, is a major individual determinant of mental health and behavioral effectiveness in a more recent theory of psychopathology. This 2-wave panel study examined the ability of acceptance also to explain mental health, job satisfaction, and performance in the work domain. The authors hypothesized that acceptance would predict these 3 outcomes 1 year later in a sample of customer service center workers in the United Kingdom (N = 412). Results indicated that acceptance predicted mental health and an objective measure of performance over and above job control, negative affectivity, and locus of control. These beneficial effects of having more job control were enhanced when people had higher levels of acceptance. The authors discuss the theoretical and practical relevance of this individual characteristic to occupational health and performance.