The Impact of ACT Training on Stress and Burnout in Human Services Workers

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The Impact of ACT Training on Stress and Burnout
in Human Services Workers

• Jo Lloyd BSc MSc (j.lloyd_at_gold.ac.uk)
• Professor Frank Bond BA MSc PhD CPsychol

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CBT and Individual Focussed Stress-Management

• Historic relationship between the cognitive
  behaviour therapies (CBTs) and stress management
  training (SMT) programmes.
• Dates back to relaxation techniques that stemmed
  from Wolpes (1958) systematic desensitization
  during the 1st wave of behaviour therapy.
• SMT movement has wholeheartedly embedded 2nd wave
  CBT technologies, however research into the
  relevance of newer psychopathology theories to
  models of occupational health is in its infancy.
• During the past 20 years, these newer theories
  of psychopathology have posited individual
  characteristics that may be applicable to
  occupational health.

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ACT for Stress-Management

• Bond Hayes (2002) adapted the traditional ACT
  therapeutic approach to fit into a more
  training-oriented stress management protocol.
• It is predicted that by increasing psychological
  flexibility people will be better able to
• Be mindful of unwanted thoughts (e.g. negative
  perceptions of clients or themselves), feelings
  (e.g. anger, frustration), and impulses (e.g.
  suppression, avoidance).
• Identify, prioritise and pursue their values and
  goals.

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Stress-Management Format

• Brief group-based training intervention (8-12
  people)
• Run from standardised training protocols
• 21 method of delivery (9 hours contact time in
  total)
• Format allows participants to carry out homework
  assignments in order to encourage application of
  learned coping strategies.
• Participants receive feedback on their efforts
  during following session.
• Effective behaviours learnt in less therapeutic
  time

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Stress-Management Protocols

• Training protocols map directly onto clinical
  goals of ACT
• Creative hopelessness ? questioning workability
  of stress coping strategies.
• Control is the problem ? paradox of trying to
  get rid of stress, polygraph metaphor.
• Defusion/acceptance ? e.g. costs of low
  willingness (clean vs. dirty discomfort), leaves
  on the stream exercise, right vs. wrong, observer
  exercise.
• Values based action ? e.g. tombstone eulogy,
  values clarification (work and personal domains),
  willingness question (promoting goal-directed
  action).
• Willingness as a values-based action ? bubble in
  the road metaphor, goals, actions and barrier
  clarification, public commitment to values.

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ACT/Psychological Flexibility and Employee
Wellbeing

• Within occupational contexts ACT training has
  significantly improved
• General mental health and propensity to innovate
  in a media organisation (Bond Bunce, 2000)
• General mental health largely in high strain
  individuals working in UK local government
  (Flaxman Bond in press)
• Psychological flexibility predicts peoples
  ability to learn new software as well as their
  mental health and job performance (Bond and
  Flaxman, 2006)
• People with greater psychological flexibility are
  better able to take advantage of job control
  opportunities (Bond Bunce, 2003 Bond Flaxman
  2006 Bond, Flaxman, Bunce, 2008)

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ACT for Professional Burnout and Stigma

• Psychological effects of working with difficult
  clients (entanglement with stigmatizing
  attitudes) is a key feature of professional
  burnout.
• Hayes, Bissett et al, (2004) compared the impact
  of ACT, multicultural, and educational training
  on professional burnout and stigmatizing
  attitudes amongst drug abuse counselors.
• ACT significantly reduced stigma at follow-up and
  burnout at post-intervention and follow-up. In
  addition, reductions in burnout at follow-up
  significantly exceeded those attained through
  multicultural training.
• Changes in the ACT condition were mediated by
  changes in the believability of stigmatizing
  attitudes.

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The Human Service Profession

• Extending the work of Hayes, Bissett et al (2004)
  to the human service profession.
• Human service workers are often required to spend
  a considerable proportion of their time in direct
  involvement with vulnerable people.
• Such frequent and emotionally charged
  interactions can lead to chronic stress and
  eventually emotional burnout (Maslach, Jackson
  Leiter, 1996).
• There are a plethora of individual and
  organisational consequences of stress and
  emotional burnout.

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Present Study

• Aim Investigate the impact of ACT training in
  improving mental health and performance outcomes
  among human service workers who deal directly
  with the elderly.
• Design Randomised controlled outcome experiment
  comparing two training conditions (1) ACT stress
  management training (n 43) and (2) a waitlist
  control group (n 67).
• Participants 110 customer-facing staff (sampled
  nationally)
• Outcomes measured at four time points
• T1 pre-training
• T2 1 week (3 hours contact time)
• T3 2 months (6 hours contact time)
• T4 6 months (9 hours contact time)

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Present Study Contd.

• Training marketed as Work-Life Effectiveness
  Training
• Outcome measures
• Emotional burnout (MBI-HSS)
• Psychological distress (GHQ)
• Attitude towards the elderly (Kogans OP scale)
• Job measures (motivation, satisfaction and
  turnover)
• Absenteeism (no. of absences 6 months prior to
  training, during training and 6 months
  follow-up).
• Mediator variable
• Psychological flexibility (AAQ-II)

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Hypotheses

1. In comparison to a control group, workers who
   receive ACT training will show significant
   improvements in mental health and performance
   outcome measures.
2. An increase in psychological flexibility will
   serve as the mechanism by which these changes
   will occur.

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Results Emotional Exhaustion
Non significant T1 ? T4 (overall) group X time
interaction effect.
Significant T2 ? T3 group X time interaction
effect. ACT ?² .12 Control Non sig
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Results Depersonalisation
Significant T1 ? T4 (overall) group X time
interaction effect ACT ?² .32 Control Non
sig
Significant T3 ? T4 group X time interaction
effect. ACT ?² .19 Control Non sig
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Results Psychological Distress
Significant T1 ? T4 (overall) group x time
interaction effect ACT ?² .32 Control ?²
.21
Significant T2 ? T3 group X time interaction
effect. ACT ?² .19 Control ?² .18
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Results Mediation Analysis

• A series of linear multiple regressions were
  carried out according to a procedure detailed by
  Baron and Kenny (1986) to determine mediation.

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Conclusions/Implications

• ACT training useful in alleviating two emotional
  burnout components and psychological distress in
  human service workers.
• Mechanism of change for psychological distress
  was consistent with the core underlying theory of
  ACT.
• No significant change in performance and attitude
  outcomes.
• Critical reductions in negative psychological
  outcomes can be isolated as occurring at
  different time points.
• Limitations of longitudinal research
• Implications for continued support
• Burnout patterns (Hatinen, Kinnunen, Pekkonen
  Aro, 2004).
• Limitation of the long-term utility of
  interventions focussing only on modifying the
  individuals coping strategies, without also
  targeting the toxins inherent in their work
  environment.

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