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Huish E, Donnelly O, Marks E. "I Really Felt the Feeling": A Systematic Review and Qualitative Thematic Synthesis of Healthcare Workers' Experiences of Acceptance and Commitment Therapy Training. J Cogn Psychother 2024; 38:94-118. [PMID: 38631717 DOI: 10.1891/jcp-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Purpose: Existing research suggests that Acceptance and Commitment Therapy (ACT) training is beneficial for healthcare workers' professional practice and personal well-being. This review aimed to further understanding of healthcare workers' experiences of ACT training by synthesizing existing qualitative studies.Methods: A systematic literature review identified papers published up until April 2022 using the Embase, Ovid MEDLINE, and PsycINFO databases as well as relevant studies within the gray literature. Nine studies were included in the review, which were analyzed using Thematic Synthesis (Thomas & Harden, 2008).Results: Three analytical themes were identified through the thematic synthesis: I am both the patient and the professional; a powerful and empowering experience; and it is not always comfortable.Conclusion: This review has highlighted the importance of experiential learning. The training was a powerful experience for staff, but as such, it was not always comfortable. Recommendations for the future delivery of ACT training are made.
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Affiliation(s)
- Ellen Huish
- Department of Psychology, University of Bath, Bath, UK
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Gibson Watt T, Gillanders D, Spiller JA, Finucane AM. Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. Palliat Med 2023; 37:1100-1128. [PMID: 37489074 PMCID: PMC10503261 DOI: 10.1177/02692163231183101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.
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Affiliation(s)
- Tilly Gibson Watt
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - David Gillanders
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Juliet A Spiller
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
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Finucane AM, Hulbert-Williams NJ, Swash B, Spiller JA, Wright B, Milton L, Gillanders D. Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing. Palliat Med 2023; 37:244-256. [PMID: 36576308 DOI: 10.1177/02692163221143817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing. AIM To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff. DESIGN A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up. SETTING/PARTICIPANTS Participants were recruited from Marie Curie hospice and nursing services in Scotland. RESULTS Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen's d = 0.7) and mental wellbeing (Cohen's d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction. CONCLUSION Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, University of Edinburgh, UK.,Marie Curie Hospice Edinburgh, Edinburgh, UK
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Finucane A, Hulbert-Williams NJ, Swash B, Spiller JA, Lydon B, Gillanders D. Research Evaluating Staff Training Online for Resilience (RESTORE): Protocol for a single-arm feasibility study of an online Acceptance and Commitment Therapy intervention to improve staff wellbeing in palliative care settings. AMRC OPEN RESEARCH 2022; 3:26. [PMID: 38708066 PMCID: PMC11064981 DOI: 10.12688/amrcopenres.13035.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 05/07/2024]
Abstract
Background Palliative care staff commonly experience workplace stress and distress. General stressors include unmanageable workloads and staff shortages. Stressors specific to palliative care include regular exposure to death, loss and grief. The COVID-19 pandemic exacerbated exhaustion and burnout across the healthcare system, including for those providing palliative care. Evidence based psychological support interventions, tailored to the needs and context of palliative care staff, are needed. Acceptance and Commitment Therapy (ACT) is an established form of cognitive behavioural therapy which uses behavioural psychology, values, acceptance, and mindfulness techniques to improve mental health and wellbeing. ACT is effective in improving workplace wellbeing in many occupational settings. Our study examines the acceptability and feasibility of an online ACT-based intervention to improve mental health and wellbeing in staff caring for people with an advanced progressive illness. Methods We plan a single-arm feasibility trial. We will seek to recruit 30 participants to take part in an 8- week online ACT-based intervention, consisting of three synchronous facilitated group sessions and five asynchronous self-directed learning modules. We will use convergent mixed methods to evaluate the feasibility of the intervention. Quantitative feasibility outcomes will include participant recruitment and retention rates, alongside completion rates of measures assessing stress, quality of life, wellbeing, and psychological flexibility. Focus groups and interviews will explore participant perspectives on the intervention. We will run a stakeholder workshop to further refine the intervention and identify outcomes for use in a future evaluation. Results We will describe participant perspectives on intervention acceptability, format, content, and perceived impact, alongside rates of intervention recruitment, retention, and outcome measure completion. Conclusion We will show whether a brief, online ACT intervention is acceptable to, and feasible for palliative care staff. Findings will be used to further refine the intervention and provide essential information on outcome assessment prior to a full-scale evaluation.
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Affiliation(s)
- Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Marie Curie, Edinburgh, UK
| | - Nicholas J Hulbert-Williams
- School of Psychology, University of Chester, Chester, UK
- Department of Psychology, Edge Hill University, Ormskirk, Lancashire, UK
| | - Brooke Swash
- School of Psychology, University of Chester, Chester, UK
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Aciksari K, Karatepe HT. Comparison of Work-Related Stress between Emergency Medicine and Internal Medicine Doctors: A Single Center Cross-Sectional Study. Medeni Med J 2020; 35:15-22. [PMID: 32733745 PMCID: PMC7384488 DOI: 10.5222/mmj.2020.06432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/22/2019] [Indexed: 11/10/2022] Open
Abstract
Objective: In this study we aimed to examine and compare the stress levels and the factors affecting stress levels of physicians working in Emergency Medicine (EM) and Internal Medicine (IM) Departments. Method: This is a cross-sectional study performed in a research and training hospital. The study population consisted of 39 physicians. Professional Life Stress Scale (PLSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Acceptance and Action Questionnaire-II (AAQ-II) were used. Results: Thirty-nine physicians (female 56.4%; mean age 32.6±6.8 years) included in analysis. They were from EM (n=19; 48.7%), and IM (n=20; 51.3%). Twenty-six (66.7%) participants had a score of 16-30 points indicating a moderate degree of stress in their professional life. The BAI and BDI scores of the participants ranged from 0 to 36 (mean, 8.4±8.9) and 0 to 29 (mean, 7.6±5.9), respectively, which indicated that the participants were below the psychopathological limits in terms of anxiety and depressive symptoms. AAQ-II scores were found to be significantly lower in emergency physicians (p=0.049) indicating that they had a lower level of experiential avoidance than others. Also, AAQ-II scores were found significantly lower in those who had children (p=0.028). Conclusion: Working in EM departments for longer periods is associated with higher stress levels while increases the ability to cope with stress. Our study shows that having children is related with decrease in experiential avoidance, hence higher levels of psychological flexibility. Any significant differences were not found between the groups in terms of PLSS, BAI and BDI scores.
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Affiliation(s)
- Kurtulus Aciksari
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Hasan Turan Karatepe
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
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Ledingham M, Standen P, Skinner C, Busch R. “I should have known”. The perceptual barriers faced by mental health practitioners in recognising and responding to their own burnout symptoms. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2019. [DOI: 10.1080/21507686.2019.1634600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M.D. Ledingham
- School of Arts and Sciences, University of Notre Dame, Fremantle, Australia
| | - P. Standen
- School of Business and Law, Edith Cowan University, Perth, Australia
| | - C. Skinner
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - R. Busch
- School of Arts and Sciences, University of Notre Dame, Fremantle, Australia
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Gismervik SØ, Fimland MS, Fors EA, Johnsen R, Rise MB. The acceptance and commitment therapy model in occupational rehabilitation of musculoskeletal and common mental disorders: a qualitative focus group study. Disabil Rehabil 2018; 41:3181-3191. [PMID: 30114980 DOI: 10.1080/09638288.2018.1490824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aims: The aim of this study was to examine whether and how intended processes of behavioural change were reflected in participants' experiences after an inpatient occupational rehabilitation programme. The programme was transdiagnostic, lasted 3½ weeks and was based on the acceptance and commitment therapy model.Methods: Twenty-two participants (17 women and 5 men) took part in five qualitative focus group interviews after the programme. Analysis was data-driven, categorising participants' experiences using an initial explorative phenomenological approach. The emerging data-driven categories were re-contextualised within the theoretical framework of the therapy model.Results: The participants referred to experiences within all three intended domains of the model (openness, awareness, and engagement). Our results indicate that the transdiagnostic approach may have facilitated openness, while the attainment of flexible self-awareness was less evident. Participants expressed engagement and behavioural changes linked to personal values, but did not mention actions leading to imminent return to work.Conclusions: The results imply that for implementation in occupational rehabilitation, further development of this model is needed specifically regarding processes related to self-awareness and committed action towards work. These findings are relevant for the interpretation of results from randomised clinical trials on acceptance and commitment therapy in occupational rehabilitation.Implications for rehabilitationAcceptance and commitment therapy seems to be a feasible component in an occupational rehabilitation programme for persons with different diagnoses.A transdiagnostic approach mixing musculoskeletal pain disorders and common mental disorders in the same rehabilitation programme seems to facilitate the process of openness and acceptance.There is a need to further develop and operationalise some of the processes in Acceptance and commitment therapy to accommodate the approach to the occupational rehabilitation context.
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Affiliation(s)
- Sigmund Ø Gismervik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
| | - Marius S Fimland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Hysnes Rehabilitation Centre, St. Olavs University Hospital, Trondheim, Norway
| | - Egil A Fors
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit B Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Showing up for class: Training graduate students in acceptance and commitment therapy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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