Acceptance-Based and Traditional Cognitive-Behavioural Stress Management in the Workplace: Investigating the Mediators and Moderators of Change

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

Acceptance and Commitment Therapy: Applications for Educational Psychologists within Schools

© 2018, © 2018 Association of Educational Psychologists. Guidance for schools regarding the promotion and enhancement of psychological wellbeing represents an invitation to intervene to promote effective, evidence-informed, whole-school approaches for school staff, students and parents. With its transdiagnostic approach and evidence from empirical literature, Acceptance and Commitment Therapy (ACT) is asserted as a coherent psychological model that has potential to support schools in developing effective and sustainable practices to promote psychological wellbeing. Three ways of applying ACT within educational contexts are discussed, demonstrating potential utility of the model: supporting school staff wellbeing; targeted interventions for children and young people; and a potential universal application, through the development of an ACT-based emotional health and wellbeing curriculum

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 to a control group, this intervention produced improvements in mental heath and absence rates, but 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, but particularly 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

Mindfulness and meditation in the workplace: An acceptance and commitment therapy approach

There is a wide-ranging and growing body of evidence that mental health and behavioral effectiveness are influenced more by how people interact with their thoughts and feelings than by their form (e.g., how negative they are) or frequency. Research has demonstrated this key finding in a wide range of areas. For example, in chronic pain, psychosocial disability is predicted more by the experiential avoidance of pain than by the degree of pain (McCracken 1998). A number of therapeutic approaches have been developed that share this key insight: Distress tolerance (e.g., Brown et al. 2002; Schmidt et al. 2007), thought suppression (e.g., Wenzlaff and Wegner 2000), and mindfulness (Baer 2003). It is also central to a number of the newer contextual cognitive behavior therapy (CBT) approaches to treatment, such as mindfulness-based cognitive therapy (MBCT; Segal et al. 2002), dialectical behavior therapy (DBT; Linehan 1993), metacognitive therapy (Wells 2011), and acceptance and commitment therapy (ACT; Hayes et al. 1999). The purpose of this chapter is to describe how ACT conceptualizes mindfulness and tries to enhance it in the pursuit of promoting mental health and behavioral effectiveness (e.g., productivity at work). To this end, we discuss ACT’s key construct of psychological flexibility, which involves mindfulness, and how it has led to a somewhat different approach not only to conceptualizing mindfulness, but also to how we try to enhance it in the workplace. In so doing, we hope to show that whilst formal meditation practice is valued in ACT, it is only one strategy that is used to promote mindfulness, as well as psychological flexibility more generally

Identifying Psychological Mechanisms Underpinning a Cognitive Behavioural Therapy Intervention for Emotional Burnout. (Forthcoming)

One hundred employees of a UK government department were randomly assigned to one of two conditions: (1) a worksite, group-based, CBT intervention called Acceptance and Commitment Therapy (ACT; n = 43), which aimed to increase participants’ psychological flexibility; and, (2) a waitlist control group (control; n = 57). The ACT group received three half-day sessions of training spread over two and a half months. Data were collected at baseline (T1), at the beginning of the second (T2) and third (T3) workshops, and at six months follow-up (T4). Consistent with ACT theory, analyses revealed that, in comparison to the control group, a significant increase in psychological flexibility from T2 to T3 in the ACT group mediated the subsequent T2 to T4 decrease in emotional exhaustion in the ACT group. Consistent with a theory of emotional burnout development, this significant decrease in emotional exhaustion from T2 to T4 in the ACT group prevented the significant T3 to T4 increase in depersonalization seen in the control group. Strain also decreased from T2 to T3 in the ACT group, only, but no mediator of that improvement was identified. Discussion focuses on implications for theory and practice in the fields of ACT and emotional burnout

Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools

Anxiety in autism is an important treatment target because of its consequences for quality of life and wellbeing. Growing evidence suggests that Cognitive Behaviour Therapies (CBT) and Mindfulness-Based Therapies (MBT) can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomized controlled trial examined whether online CBT and MBT self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online CBT (n=16) or MBT (n=19) programme or a waitlist control group (WL; n=19). Primary outcome measures of anxiety, secondary outcome measures of broader wellbeing, and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 MBT, 9 CBT) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help CBT and MBT tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools

A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress : a randomised controlled trial

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

Global estimates on the number of people blind or visually impaired by cataract:a meta-analysis from 2000 to 2020

BACKGROUND: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals.METHODS: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity &lt;6/18, ≥3/60) and blindness (presenting visual acuity &lt;3/60). Estimates are age-standardized using the GBD standard population.RESULTS: In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by -27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%).CONCLUSIONS: The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.</p

Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

Background To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050. Methods We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050. Findings In 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%; 20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to −27·7) and prevalence of mild vision impairment decreased slightly (–0·3%, −0·8 to −0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia. Interpretation Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages.publishedVersio

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians