work and career issues

This thesis presents a programme of research designed to examine the impact of Acceptance and Commitment Therapy (ACT) informed performance and development coaching. A preliminary repeated measures study tested the impact of a brief ACT-informed coaching intervention on coachee general mental health, generalised self-efficacy, life satisfaction, intrinsic motivation, goal-directed thinking, goal attainment, and psychological flexibility with 53 UK adults. Data were collected at four time points over 5 weeks. Analyses revealed significant increases in general mental health, life satisfaction, goal-directed thinking, and goal attainment. A randomised controlled trial (RCT) study tested the impact of a more substantial ACT-informed coaching intervention on coachee work performance, general mental health, generalised self-efficacy, job satisfaction, job motivation, goaldirected thinking, goal attainment, and psychological flexibility with 126 senior managers in the UK Civil Service. Participants were randomly allocated to either an ACT-informed coaching intervention (n = 65) or a waitlist control condition (n = 61). Data were collected at four time points over 13 weeks. Analyses showed significant increases in general mental health, generalised self-efficacy, goal-directed thinking, goal attainment, and psychological flexibility in the ACT group compared to the control condition. Consistent with ACT theory, analyses indicated that increases in psychological flexibility mediated improvements in general mental health, generalised self-efficacy, goal-directed thinking, and goal attainment. A final parallel mediation study compared the effects of psychological flexibility and working alliance (a plausible alternative mediator) using data from the coaching arm of the RCT study. These analyses revealed that significant increases in psychological flexibility mediated increases in generalised self-efficacy, goal-directed thinking, and goal attainment. Despite significant increases in working alliance over time, no mediation effects for increases in study variables were found. Overall, findings suggest that ACT-informed coaching is an effective approach to performance and development coaching, and psychological flexibility mediates the beneficial impact of the ACT coaching intervention. 

Acceptance and commitment theory (ACT) and positive psychology are deeply aligned despite their development in different traditions, as both focus on human flourishing and wellbeing. This chapter provides an overview of ACT, highlighting how the theory is applied to coaching in the workplace as acceptance and commitment coaching (ACC). A summary of research demonstrating the impact of ACT-based interventions in the workplace is provided, so practitioners can see the workplace outcomes ACC has an effect on. The chapter outlines the six behavioural processes for building psychological flexibility: Values; committed action; present moment awareness; self-as-context; defusion; and acceptance. The reader is given examples of how to apply the behavioural processes within the framework of ACC. The distinct features of the practitioner stance within ACC are presented, such as disrupting existing behaviours which allows the coachee to develop new, more effective behaviours aligned with their values. The chapter closes with an illustrative case study and discussion points to help the reader reflect on how they can apply ACC in their coaching practice.

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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