12 research outputs found
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
Linking Recent Discrimination-Related Experiences and Wellbeing via Social Cohesion and Resilience
The current study examined the relationship between recent experiences of discrimination and wellbeing and the mediating effects that social cohesion and resilience had on this relationship. Using online sampling, participants (N =255) from a South London community rated the levels of discrimination related experiences in the past 6 months, alongside measures of social cohesion, resilience, and wellbeing (happiness and depressive symptoms). Results revealed a negative relationship between recent experiences of discrimination and wellbeing which was explained by a serial mediation relationship between social cohesion and resilience, and singly by resilience alone. The study highlights how recent experiences of discrimination can lead to a depletion of personal resources and social resources (which in turn also lead to reduced personal resources) and in turn, to lower levels of wellbeing
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
Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial
Background
Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear.
Methods
RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047.
Findings
Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths.
Interpretation
Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population
Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial
Background
Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain.
Methods
RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and
ClinicalTrials.gov
,
NCT00541047
.
Findings
Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths.
Interpretation
Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy.
Funding
Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society
Examining the relationship between acceptance and commitment therapy (ACT) processes and stigma
EThOS - Electronic Theses Online ServiceGBUnited Kingdo
Flexible Organisations: Creating a Healthy and Productive Context for Gender and Sexual Minority Employees
It is fairly straightforward to imagine how mindfulness and acceptance skills can help gender and sexual minority (GSM) individuals to live vital and effective lives, even when experiencing difficult circumstances. In an organisational setting, one can even imagine how individual or group training sessions can help to promote mindfulness and acceptance. But what about at the team and organisational levels of the workplace: Can we design teams and organisations that are ‘mindful’ and that can promote mindfulness and acceptance in their employees?
We believe that this is possible through the concepts and techniques that are associated with Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999). ACT maintains that a process called psychological flexibility is at the core of helping people to maintain good mental health and behavioural effectiveness. It refers to people’s ability to focus on their current situation, and based upon the opportunities afforded by that situation, take appropriate action towards pursuing their values-based goals, even in the presence of challenging or difficult psychological events (e.g., thoughts, feelings, physiological sensations, images, and memories; Hayes, Luoma, Bond, Masuda & Lillis, 2006). Later in this chapter, we will note how we can use ACT to increase psychological flexibility in GSM employees. First, how can we use the concept of psychological flexibility to create an organisational environment in which these individuals can thrive, both emotionally and in terms of their productivity
Acceptance and Commitment Therapy
Acceptance and commitment therapy (ACT) is best described as a contextual cogni¬tive behaviour therapy (CBT). Contextual CBTs are a recent addition to the cognitive behavioural tradition and are distinct from earlier approaches (e.g. Beck’s cognitive therapy) in both their proposed mechanisms of change and core therapeutic techniques. Whilst earlier forms of CBT focus on changing the content, form or the frequency of people’s difficult or challenging internal experiences (e.g. thoughts, feelings, physiological sensa¬tions, images and memories), contextual CBTs seek to alter the psychological context, or perspective, in which people approach these experiences. Thus, rather than focusing on challenging and disputing problematic thoughts and feelings, contextual CBTs encourage people to approach those internal events from a mindful and open perspective. In so doing, these unwanted events are less likely to overwhelm them and determine their actions