work and career issues

There is growing interest in the role of psychological flexibility as a potential resilience factor in workplace settings for protecting employees against the risk of job burnout. This field study contributes to the literature by investigating the utility of delivering brief ACT-informed training to the entire regional workforce of an innovation and manufacturing organization. A total of 504 employees attended the training, 281 of whom completed study measures prior to the training and three months later. Across the 3-month timeframe, participants reported a statistically small and significant increase in work-related psychological flexibility. Increased psychological flexibility was associated with improved stress resilience, reduced exhaustion, and increased personal accomplishment. No change was observed on the depersonalization component of burnout or task performance. Moderation analyses revealed that residual change associations between work-related psychological flexibility and both exhaustion and resilience were stronger among participants with higher baseline exhaustion. By contrast, work-related psychological flexibility trended toward a stronger residual change relationship with personal accomplishment among participants with lower baseline exhaustion. We interpret these findings from the perspective of resource-based theories of workplace functioning, and highlight the potential of cultivating psychological flexibility as part of organization-wide personnel development initiatives.

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The current study tests the effects of a brief intervention program based on the contextual therapies (Acceptance and Commitment Therapy and Functional Analytic Psychotherapy) to enhance the well-being and interpersonal relationships in the workplace. This research represents a unified model (FACT) based on functional contextualism. As pilot study, we present the application with two workers with relational and emotional problems between them. We use a single-case design measuring pre, post and follow-up after six months. The assessment was made with various questionnaires and direct measurement of clinically relevant behaviors. The total intervention was carried out individually for a month and a half. The results revealed improvements in both employees about their personal and professional relationships, and also appearing generalisation with improvements in other areas (intimacy, personal relationships, family, friends). The study has implications by highlighting the importance of behavioral analysis or problems in work relationships, and by showing that the integration of contextual therapies can produce rapid results in non-clinical situations. Lastly, the in-depth insight into the change processes triggered by the interventions with FACT as a way to include this approach based on evidence philosophy applied in the workplace.

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Employees with mental health conditions often struggle to remain in employment. During the COVID-19 pandemic, these employees faced additional stressors, including worsening mental health and work productivity. In 2020, as part of a larger programme of work called the Mental Health and Productivity Pilot (MHPP), we developed a new early intervention (MENTOR) that jointly involved employees, managers, and a new professional (Mental Health Employment Liaison Worker, MHELW). The intervention involved trained MHELWs delivering ten sessions to employees with existing mental health conditions and managers (three individual sessions and four joint sessions) over twelve weeks. These sessions aimed to improve psychological flexibility, interpersonal relationships, and engagement of employees. This feasibility randomised controlled trial aimed to examine the feasibility and acceptability of the intervention from the perspective of employees and managers using a mixed methods approach. The intervention was largely considered feasible and acceptable. Initial findings suggest there may be benefits for employees productivity, mental health, and managers' mental health knowledge. Logistical challenges acted as a barrier to the participation of employees and managers in the trial and their retention throughout its duration. The major strengths of this study were the co-design and inter-disciplinary approach taken. Overall, findings suggest that this novel intervention has potential but needs some adjustments and testing in a larger sample.

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Occupational stress is a crucial risk factor for the development of somatic and mental disorders and for the reduction of overall well-being. Acceptance and Commitment Therapy (ACT) is an established treatment in clinical practice and its use as a non-clinical workplace intervention proliferated in recent years. This study provides an up-to-date meta-analysis on how face-to-face ACT interventions affect occupational stress as well as psychological distress, psychological flexibility, and well-being. Random-effects meta-analyses were conducted exploring ACT's efficacy concerning the four constructs. Sub-group analyses and meta-regressions were performed to investigate individual, workplace-related, and treatment effects. A total of 17 studies including 860 participants allocated to ACT conditions and 736 participants allocated to control conditions were extracted. ACT outperformed control conditions (passive and active control) regarding psychological distress (Hedges' g = −0.38, 95% CI [-0.57; -0.19]) psychological flexibility (g = 0.33, 95% CI [0.13; 0.54]); and well-being (g = 0.24, 95% CI [0.02; 0.47]) at post-treatment, and regarding stress (g = −0.22, 95% CI [-0.41; −0.04]), psychological flexibility (g = 0.31, 95% CI [0.16; 0.47]), and well-being (g = 0.26, 95% CI [0.03; 0.49]) at follow-up. Additional analyses revealed ACT to be most effective for office employees while showing little to no effect for health care workers. Findings demonstrate ACT to be an effective treatment to reduce psychological distress and stress, and to increase psychological flexibility and general well-being in a non-clinical, workplace setting. An application for employees working in an office setting appears to be most promising.

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This study aimed to examine the relationships between occupational stressors, mental health problems, and sleep difficulty, and the mediating roles of cognitive fusion and cognitive reappraisal on the relationships in Chinese nurses. A total of 323 nurses (mean age = 32.11 ± 6.75 years) from 25 hospitals in China participated a cross-sectional online survey. Participants were asked to refer to the period during the severest time of the COVID-19 pandemic in China (January to March 2020) when assessing the psychological variables. The direct links from occupational stressors to cognitive fusion, cognitive reappraisal, mental health and sleep difficulty were significant. Cognitive fusion and cognitive reappraisal mediated the links from occupational stressors to mental health problems, while cognitive fusion and mental health problems mediated the links from occupational stressors to sleep difficulty. The sequential mediation via cognitive fusion and mental health problems as well as via cognitive reappraisal and mental health problems on the links from occupational stressors to sleep difficulty were also significant. Findings from the current study indicate that intervention strategies focusing on the reduction of cognitive fusion and improvement of cognitive reappraisal could help better prepare nurses to alleviate mental health problems and sleep difficulties that are related to COVID-19 and potentially similar pandemics in the future.

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Approximately ten million individuals in the United States self-identify as lesbian, gay, bisexual, and/or queer, and comprise 4% of the work force. There are currently no global protections against discrimination based on sexual identify in the workplace. Therefore, several people who identify as sexual minorities may experience discrimination, incivility, and hostility in the work place leading to burnout, as well as poor mental and physical health. Although global policies and protections against discrimination based on gender and sexual identity are needed, Acceptance and Commitment Therapy (ACT) could provide useful tools at the individual level for sexual minorities experiencing work stress. The current study is a pilot study designed to measure feasibility and acceptability of treatment. Participants were adults (n = 8) who self-identified as sexual minorities, were employed at least half time, and reported experiencing work stress. Participants attended a 4-h ACT session for sexual minorities experiencing work stress. Participants completed process-based measures and symptom-based measures. All measures of feasibility and acceptability indicated that participants found the intervention to be helpful, effective, and insightful. Further, one-tailed paired-samples t-tests indicated significant change for burnout. These results suggest that initial outcomes of the study are promising and encourage further examination of the efficacy of ACT as an intervention for sexual minority employees struggling with work stress. Although it is important to continue to create policy changes against discrimination, ACT may provide skills for sexual minorities to build resilience and increase well-being in an unjust world.

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Objective
To report the theoretical basis and design of a novel digital Acceptance and Commitment Therapy (ACT) intervention for people with chronic pain, the Pain Tracker Self Manager (PTSM), which had promising efficacy in a recent pilot trial.

Methods
Content development by a multidisciplinary panel of experts in psychiatry, clinical psychology, nursing and social work, with feedback from a group of patients with chronic pain and their providers. Materials included paper-based sketching of a story character, visual metaphors, and a series of stories designed to deliver the theory-based components of our behavioral intervention.

Results
This development and design process resulted in 4 digitally delivered clinical modules that combine visual and verbal cues. In addition, it generated a series of novel ACT metaphors specifically tailored to patients with chronic pain: Pain: Injury vs. Threat, Life Navigation System, The Fog of Pain, and Get Rhythm. Consistent with ACT theory and the contextual behavioral science framework, PTSM utilized: perspective-taking, values clarification, acceptance strategies, and nursing and psychological care recommendations.

Discussion
Reports of the design and theoretical basis of digital health interventions are highly needed to increase the rigor of their development process and more progressively advance our body of knowledge. This pilot study developed and tested a series of ACT metaphors that can be readily used by ACT clinicians working with this population.

Conclusion
PTSM is a novel digital ACT intervention for patients with chronic pain with features directly linked to ACT processes and theory.

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A novel eight-week program based on Acceptance and Commitment Therapy (ACT) principles was created to alleviate burnout-related ill-being and to enhance well-being. This randomized controlled trial investigated the effectiveness of the program and explored whether changes in psychological flexibility mediated the results of the intervention. The program consisted of structured weekly face-to-face group meetings and daily practices provided via a website. Employees from varying professional backgrounds with burnout (mean age = 47 years, 79% female), who all received usual treatment, 1 were randomized into control (TAU, n = 80, receiving no other support) and ACT + TAU intervention (n = 88, receiving additional ACT support) groups. The ACT + TAU group outperformed the TAU group in all 14 scales used, indicating that burnout-related ill-being at work (between-group Cohen's d = 0.36–0.76) and psychological symptoms (d = 0.27–0.61) decreased and general well-being (d = 0.14–0.38) and psychological flexibility skills (d = 0.29–0.64) increased during the intervention. These gains were maintained during the one-year follow-up period. The changes in the psychological flexibility -factor mediated almost completely the changes in the outcome factors of burnout, well-being, and psychological symptoms. The study suggests that psychological flexibility skills can be crucial elements in job-related burnout interventions and that combined group and web-based interventions may offer an efficient treatment method.

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The Work-related Acceptance and Action Questionnaire (WAAQ) has been developed to assess psychological flexibility in occupational settings. The aim of this study was to evaluate reliability and validity of the Swedish translation of WAAQ in a sample of 184 healthcare professionals. A principal component analysis supported a one-factor-solution, explaining 53.8% of the overall multivariate variability. WAAQ showed good internal consistency (Cronbach's alpha 0.85) and good test-retest reliability (ICC = 0.85). Validity was assessed by analysing the relationship between WAAQ and other work-related constructs. Spearman's rank correlations illustrated a significant negative relationship between WAAQ and perceived stress and a significant positive correlation with work engagement. Results from the study are consistent with previous studies on WAAQ, supporting the use of the Swedish translation of the instrument among healthcare professionals.

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