Acceptance and commitment therapy (ACT) for clinically distressed health care workers: Waitlist-controlled evaluation of an ACT workshop in a routine practice setting

Objectives

To examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting.

Design

A quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date.

Methods

Participants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3 months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later.

Results

At 3 months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity.

Conclusions

These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers.

Practitioner points

A 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers.

The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings.

The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills.

Study limitations include non-random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3 months post-intervention).