Development and Evaluation of Acceptance and Commitment Therapy delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: A Preliminary Analysis.

Background: Previous studies have demonstrated Acceptance and Commitment Therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients. Aims: To conduct a preliminary evaluation whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults. Method: Staff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy post-therapy and at three month follow-up. Results: Standardised measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists, Conclusions: ACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed

Resilience and surgeons: train the individual or change the system?

We investigate both sides of the coin

Hypervigilance for faces, but typical gaze following in social anxiety. Abstract

A hypervigilance-avoidance theory has been proposed to explain early attentional biases towards faces followed by their subsequent avoidance, in social anxiety (SA) (Mogg et al., 1997). This theory has arisen from data obtained from dot probe-type tasks presenting static images which lack in ecological validity. Moreover, whilst the gaze of others is considered a threatening cue in SA and is typically avoided, the gaze following mechanism has not been examined in SA. We analysed eye movements, including gaze following in 39 participants, who were either high or low in SA (HSA and LSA respectively) as they watched an emotionally-neutral dynamic social scene. Contrary to the hypervigilance-avoidance hypothesis, whilst HSA participants directed significantly more early fixations towards the face than the LSA group, both groups fixated the face equally after this time. There were no group differences in gaze following. Results suggest that when viewing a neutral social scene, HSA individuals are initially biased towards the face but when threat is not perceived a typical viewing strategy is adopted. Furthermore, although direct gaze may be avoided in SA, the gaze following mechanism may be so automated that it is impervious to higher level socio-cognitive factors such as fear of social evaluation

Adults with higher social anxiety show avoidant gaze behaviour in a real-world social setting: A mobile eye tracking study.

Attentional biases are a core characteristic of social anxiety (SA). However, research has yielded conflicting findings and failed to investigate these biases in real, face-to-face social situations. Therefore, this study examined attentional biases in SA by measuring participants' eye gaze within a novel eye-tracking paradigm during a real-life social situation. Student participants (N = 30) took part in what they thought was a visual search study, when a confederate posing as another participant entered the room. Whilst all participants avoided looking at the confederate, those with higher SA fixated for a shorter duration during their first fixation on him, and executed fewer fixations and saccades overall as well as exhibiting a shorter scanpath. These findings are indicative of additional avoidance in the higher SA participants. In contrast to previous experimental work, we found no evidence of social hypervigilance or hyperscanning in high SA individuals. The results indicate that in unstructured social settings, avoidance rather than vigilance predominates, especially in those with higher SA

Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training.

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups

Attention to faces and gaze-following in social anxiety: preliminary evidence from a naturalistic eye-tracking investigation

Social attentional biases are a core component of social anxiety disorder, but research has not yet determined their direction due to methodological limitations. Here we present preliminary findings from a novel, dynamic eye-tracking paradigm allowing spatial–temporal measurement of attention and gaze-following, a mechanism previously unexplored in social anxiety. 105 participants took part, with those high (N = 27) and low (N = 25) in social anxiety traits (HSA and LSA respectively) entered into the analyses. Participants watched a video of an emotionally-neutral social scene, where two actors periodically shifted their gaze towards the periphery. HSA participants looked more at the actors’ faces during the initial 2s than the LSA group but there were no group differences in proportion of first fixations to the face or latency to first fixate the face, although HSA individuals’ first fixations to the face were shorter. No further differences in eye movements were found, nor in gaze-following behaviour, although these null effects could potentially result from the relatively small sample. Findings suggest attention is biased towards faces in HSA individuals during initial scene inspection, but that overt gaze-following may be impervious to individual differences in social anxiety. Future research should seek to replicate these effect

Stress among UK consultant urologists and factors influencing when they leave full-time NHS practice

Objective: The UK medical workforce is in crisis. The number of surgeons in National Health Service (NHS) practice has decreased, partly because newly qualified doctors withdraw from the workforce, and partly because of the early retirement of experienced surgeons. The reasons for urological trainee loss are largely known, but stress factors influencing the retirement of consultants before state pension age (SPA) are not. Methods: An online survey of the consultant membership of the British Association of Urological Surgeons was carried out over a 12-week period starting in September 2020. Information was sought regarding stresses at work and home, together with factors affecting retirement decisions. Data analysis was performed if > 90% of questions were complete. Results: Overall, 36.5% of 1374 invitees completed the survey. Workplace-based issues were the main causes of stress: on-call, an unsupportive working environment, complaint handling and poor relations with hospital managers were predominant factors which were exacerbated by punitive taxation. Experienced urologists ameliorated these factors by reducing their contracted activity, increasing part-time working and, ultimately, retiring before SPA. Conclusions: Workplace-based factors are associated with stress reported by consultant urologists. Alleviation of stressor factors, especially those related to on-call activity, should be explored to reduce the erosion of the senior workforce. Level of evidence: Not applicable

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. Whilst 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 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 1800 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

Acceptance and commitment therapy: cognitive fusion and personality functioning

Personality disorders (PDs) are common, chronic, mental health problems. The majority of treatment outcome research, which has focused specifically on Borderline PD, has provided substantial empirical support for Dialectical Behaviour Therapy (DBT; Linehan, 1993), particularly in terms of self-harm reduction. Nevertheless, DBT graduates can continue to experience poor personality functioning across PD diagnostic categories, Axis I disorders, and restricted lives. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), might be suitable as a follow-up intervention for DBT graduates, to address their continued difficulties: to date, however, there has been little empirical investigation of its utility in relation to PD. This thesis was therefore designed to examine theoretical underpinnings of ACT relevant to the development of an ACT intervention for DBT graduates.Study 1 tested the performance of a new self-report measure of cognitive fusion (CF), the Cognitive Fusion Questionnaire (CFQ), with a mental health sample, including individuals with PD. CF is a key ACT concept, and the CFQ proved to be a psychometrically sound measure of CF with people with mental health problems. Study 2 used cross-sectional modelling to show that CF fully mediated the relationships between two PD risk factors, negative affectivity and childhood trauma, and personality functioning in adulthood. Study 3 used the CFQ to investigate the behavioural correlates of CF. These findings strengthened the possibility that an ACT-based intervention might prove effective in improving outcomes for DBT graduates. To explore this further, Studies 4 and 5 were designed as very small-scale uncontrolled treatment development trials for this population. Study 4 suggested that ACT had a positive impact on engagement in life, but produced little improvement in psychiatric symptomology. Study 5 tested a revised protocol, which yielded more consistently positive findings, with improvements in both engagement in life and psychiatric symptoms. These findings tentatively suggest that ACT may have a role to play as a DBT follow-up intervention