Empirical Support for the ACT Processes

There are several published studies that provide support for the therapeutic

processes of ACT. While the numbers of studies are limited to focusing on the processes of acceptance, defusion, and values, they are evolving and are being conducted in order to establish ACT as an empirically supported psychotherapy. There is also a need for

understanding the processes of change in worksite SMIs based on the recommendation of several review articles (Bunce, 1997; Murphy, 1996, 1999; van der Klink et al., 2001).

For example, Hayes et al., (2006), conducted a meta-analysis where the relationship between psychological flexibility, as measured by the Acceptance and Action

Questionnaire (AAQ) (S. C. Hayes, Bissett et al., 2004; S. C. Hayes, Strosahl et al., 2004) and various quality of life outcomes including stress, pain, depression, anxiety and negative affectivity was explored. Correlational data revealed higher levels of psychological

flexibility (i.e., acceptance and values-based action processes) were associated with a lower likelihood of developing a psychiatric disorder, better mental health, less pain related disability, and improved job performance.

In this same review, Hayes et al., (2006) examined several dismantling, or decomposition, studies conducted using ACT processes and suggest that this research indicates good mediational effects for the processes outlined by the ACT treatment model. Dismantling studies refer to research that is conducted in order to explore the impact of core processes of an intervention that are believed to contribute to treatment efficacy, and to examine whether the processes operate in the way that is prescribed by the theoretical underpinning of the intervention (S. C. Hayes et al., 2006). Several examples will be provided for each of the ACT processes that have been examined.

The effect of a cognitive defusion technique on negative self-referential thoughts has also been examined (Masuda, Hayes, Sackett, & Twohig, 2004). The “Milk- Milk” exercise was used (see S. C. Hayes et al., 1999) and involves rapidly repeating the word “milk” aloud until it loses all meaning and just sounds like a noise. The same technique is then used with a discomforting thought. The results obtained supported the hypothesis that this technique reduced the discomfort associated with, and believability of, a particular thought, in comparison to a distraction task or a thought control task.

Another study examined the impact of an ACT acceptance, defusion and values intervention using several ACT exercises on pain tolerance (Gutierrez, Luciano, Rodriguez, & Fink, 2004). This was compared to a cognitive and emotional change intervention. In the ACT condition, participants were provided with instructions and asked to disconnect any pain-related thoughts and feelings from literal actions by noticing their private events and being willing to experience them. In the cognitive condition the goal for participants was to change or control pain-related thoughts and feelings by focusing their attention toward positive thoughts and feelings. All participants were given general instructions about the pain task that linked their performance to a valuable goal (e.g., that information gained from participants during the task would benefit other individual’s suffering from pain).

A total of 40 participants were randomly assigned to one of the interventions, and were paid to remain in the task as long as they could while pain levels were raised during the study using a electric shock stimulator. The activity involved an ‘identity matching-to- sample’ task where participants were required to look at a nonsense syllable and then choose a matching syllable from three comparison stimuli. Participants were provided with a token if they answered correctly, and they could choose to use these tokens to avoid receiving a painful electric shock. If participants chose not to receive a shock, then the activity would stop, while the opposite occurred for participants who opted to receive the electric shock. The results indicated that participants in the ACT condition demonstrated significantly higher tolerance of pain, and were more tolerating of pain and more willing to persist in the task even after they indicated that their pain levels were very high. The authors conclude that engaging in ACT processes increases individual’s tolerance of pain and reduces the ‘believability’ of pain, particularly when focusing on important values.

They further suggested that it is not necessary to remove distressing cognitions and emotions as practiced within cognitive therapy (Gutierrez et al., 2004).

Mediational analyses are another way of examining the processes of an intervention that facilitate change and enhance positive outcomes. In the majority of ACT studies mediational analyses were conducted [following Baron and Kenny’s (1986) steps for mediation, which will be explained in Chapter 4]. Several mediational studies using ACT- based interventions in an organisational setting have been conducted and will be discussed at a later stage (see section 3.2). Further information regarding ACT mediational studies can be found in the Hayes et al, (2006) review.

ACT has been used effectively to treat numerous clinical disorders and health related problems including: depression (Zettle & Hayes, 1986, 2002; Zettle & Raines, 1989); psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006); suicide (Chiles & Strosahl, 1995); social phobia (Dalrymple & Herbert, 2007); panic disorder and

agoraphobia (Carrascoso, 2000); anxiety disorders in general (Eifert & Forsyth, 2005); substance abuse (S. C. Hayes, Wilson, Gifford, & Batten, 1998; S. C. Hayes, Wilson et al., 2004); smoking cessation (Gifford et al., 2004); epilepsy (Lundgren, 2004; Lundgren, Dahl, Melin, & Kies, 2006); chronic pain (Dahl, Wilson, Luciano, & Hayes, 2005; Dahl, Wilson, & Nilsson, 2004; McCracken, Vowles, & Eccleston, 2005); and borderline personality disorder (Gratz & Gunderson, 2006).

The application of ACT has not been limited to clinical populations and has also been utilised in programs designed to target work-related stress, with several empirical studies obtaining results that support the use of ACT for worksite stress (Bond & Bunce, 2000, 2001, 2003; Bond & Hayes, 2002; Flaxman & Bond, 2006). The following section will expand on the empirical research that has been conducted using ACT in organisations.

A selection of studies will be described in detail as they are relevant to the MBEIT approach that has been used in the current project.