The effectiveness of an ACT informed intervention for managing stress and improving therapist qualities in clinical psychology trainees

"Becoming a Person Who Does Self-Care": How Health Care Trainees Naturalistically Develop Successful Self-Care Practices

OBJECTIVES

Self-care is an ethical imperative for health professionals as it can mitigate the adverse effects of stress on professional functioning and health. Yet, there tends to be a lack of self-care among healthcare trainees and an insufficient focus on self-care in medical education. The objective of this study was to develop a grounded theory of how health trainees become successful self-care users.

METHODS

Semi-structured interviews were conducted with 17 students in a variety of healthcare disciplines. Data were analyzed using grounded theory methodology.

RESULTS

Health trainees underwent 4 iterative phases to become successful at self-care: Having a Wake-Up Call, Building Skills, Gaining Confidence, and Building an Identity. Our model also explained why some trainees were unsuccessful at developing self-care practices.

CONCLUSION

We offer the first theory to explain how health trainees develop effective self-care habits. Understanding how self-care practices naturalistically develop has critical implications for developing interventions and curricula: By basing curricula about self-care on knowledge of what works, we have an opportunity to be more successful as educators. Indeed, other researchers have noted a lack of success in self-care and anti-burnout interventions for healthcare professionals. We conclude by discussing implications and recommendations for medical training and curriculum for health professions, including augmenting naturally occurring processes, linking self-care to personalized values, providing opportunities for deliberate practice, focusing on persistence with self-care, and faculty promotion and acceptance of trainee self-care.

The emotionally exhausted treating the mentally unwell? A systematic review of burnout and stress interventions for psychologists

Healthcare providers are at high risk of occupational burnout, which has negative implications on the individual, their profession, the organisation and their patients. Psychologists are particularly susceptible to the repercussions of burnout due to the emotionally draining nature and content of their work. However, research has failed to outline and evaluate effective interventions for burnout within the profession. This study aimed to investigate the treatment effectiveness of burnout through a systematic literature review. Systematic searches of four databases using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were conducted. A total of 4832 articles were identified, and 15 were included in the final analysis. The search was limited to scholarly and peer-reviewed journals published in the English language, which measured and utilised a form of intervention for the treatment of burnout or stress and included participants within the psychology profession. Interventions identified included mindfulness, training courses, self-care and other therapy-based forms of interventions. Approximately 60% of study participants reported moderate to high levels of stress. Interventions were largely variable in modality, frequency and duration of sessions and follow-up period. Of the 15 studies included within the review, only four measured burnout as an outcome variable, while the others measured stress. Findings of this systematic review indicate that mindfulness-based interventions may be a starting point for reducing stress; however, the most effective intervention for psychologists who have reached burnout is largely unclear. It is recommended that future studies focus on the identification and measurement of burnout, are more rigorously designed and reported and consider peer-based online support approaches.

Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review

BACKGROUND

People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging.

AIMS

To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care.

DESIGN

Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023.

RESULTS

1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function.

CONCLUSION

Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.

Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: a systematic review and meta-analysis

PURPOSE

To examine the effectiveness of ACT on weight (body mass index and body mass), eating behaviours (binge eating, emotional eating, external eating and restraint eating), and psychological outcomes (quality of life [QoL], depression, psychological flexibility, and weight stigma) among adults with overweight and obesity.

METHODS

Seven electronic databases (CINAHL, EMBASE, PubMed, PsycInfo Scopus, The Cochrane Library, and Web of Science) were searched from inception through 17 June 2022. 13 studies and 48 unique effect sizes were analyzed using random-effects models. Pooled effect estimates were calculated using weighted mean differences (WMD) and standardized mean differences expressed in Hedges' g (g). Heterogeneity was assessed using Q-statistics and interpreted using I².

RESULTS

ACT was found to be effective in improving weight loss in terms of BMI (k = 6, WMD = - .50, 95% CI = - .90; - .11, t = - 3.25, p = .20, I² = .0%), psychological flexibility and weight-related stigma. However, non-significant changes were found for body mass (k = 4, WMD = - 0.33 95% CI = - 1.53; 0.87, t = - .88, p = .44, I² = .0%), binge eating (k = 4, g = - .34, 95% CI = - 1.31; 0.62, t = - 1.13, p = .34, I² = 71.1%), emotional eating (k = 6, g = - .20, 95% CI = - 0.54; 0.15, t = - 1.47, p = .20, I² = 45.0%), external eating (k = 5, g = - .40, 95% CI = 0.96; 0.16, t = - 1.99, p = .12, I² = 81.8%), restraint eating (k = 3, g = .22 95% CI = - 0.57; 1.01, t = 1.19, p = .36, I² = 69.1%), QoL (k = 3, g = .01, 95% CI = - 1.51; 1.52, t = .02, p = .99, I² = 90.2%) and depression (k = 3, g = - .55, 95% CI = - 1.78; 0.67, t = - 1.94, p = .19, I² = 79.9%).

CONCLUSION

ACT could be effective in improving weight loss but more studies are needed to ascertain its effectiveness and the underlying mechanism by which the various components influence weight-related outcomes.

LEVEL OF EVIDENCE

Evidence obtained from a systematic review and meta-analysis of existing empirical studies.

The Benefits of Self-Compassion in Mental Health Professionals: A Systematic Review of Empirical Research

The importance of cultivating self-compassion is an often neglected issue among mental health professionals despite the risks to occupational well-being present in psychological care, such as burnout or compassion fatigue. In this context, this literature review has a twofold aim. Firstly, to contribute to raising awareness of the benefits of self-compassion among professionals, based on empirical research findings. Secondly, to coherently organize the available evidence on this topic, which to date appears scattered in a variety of articles. A systematic search on the APA PsycInfo database was conducted, and 24 empirical studies focused on the topic of the benefits of self-compassion in mental health professionals were finally selected. Concerning their methods, only 4 of the selected studies used experimental or quasi-experimental designs, 14 were cross-sectional studies, 3 presented qualitative research, and 3 were literature reviews. The research, regardless of methods used, points mainly to the benefits of self-compassion on the therapists’ mental health and well-being; prevention of occupational stress, burnout, compassion fatigue, and secondary traumatization as well as improvement of therapeutic competencies and professional efficacy-related aspects. In the review, self-compassion appeared as a process that could explain the benefits (eg on burnout) of cultivating other skills (eg mindfulness). To further explore this point, an additional review included 17 studies focused on the effects of mindfulness or compassion-based interventions on therapists’ self-compassion. In conclusion, our work joins those who have recommended the inclusion of self-compassion trainings in the curricula of mental health professionals.

The Role of Mindful Self-Care in the Relationship between Emotional Intelligence and Burnout in University Students

Academic burnout can have serious consequences for university students. Students are prone to higher levels of stress and depression, poorer academic performance, and attrition from university. It is therefore important to investigate factors associated with these deleterious outcomes in order to assist educators develop effective programs to proactively address student well-being. The purpose of this study was to explore the associations between emotional intelligence (EI), student well-being, mindful self-care (MSC), and academic burnout. A further aim was to investigate the mediating role of MSC in the EI-burnout relationship. A sample of 216 university students (167 females; 78%) 18 years and older (M = 35.57, SD = 11.59) completed a battery of questionnaires associated with life satisfaction, EI, MSC, and academic burnout. Results found that EI was positively associated with well-being and MSC and negatively associated with each dimension of academic burnout. A series of multiple regression mediation analyses found that MSC mediated the relationship between EI and the exhaustion and efficacy dimensions of academic burnout. However, MSC did not mediate the relationship between EI and cynicism. The findings of this study suggest that MSC may be an important factor for improving student well-being and protecting against academic burnout.

Acceptance and commitment therapy (ACT) for professional staff burnout: a systematic review and narrative synthesis of controlled trials

BACKGROUND

Staff working in people-oriented professions are vulnerable to burnout which is negatively associated with professional well-being and service-user care.

AIM

To investigate if interventions based on Acceptance and Commitment Therapy (ACT) are effective in reducing staff burnout.

METHOD

Systematic database and reference list searches were conducted resulting in the inclusion of 14 quantitative papers. A narrative synthesis, including extraction of individual effect sizes, was performed.

RESULTS

All studies were controlled trials. The settings for ACT delivery were varied across health, social care, and public services. The ACT interventions demonstrated statistically significant effects in favour of ACT on the outcome measure subscales across the majority of studies (n = 9). Thirteen studies demonstrated an effect in favour of ACT in at least one outcome measure subscale. Positive aspects of work engagement varied according to a professional role.

CONCLUSIONS

The findings suggest that ACT-based interventions using a wide range of formats may have the potential to decrease burnout across a range of professional groups. However, samples were small in the studies reviewed and the interventions were not always defined. Further research would benefit from larger studies, incorporating process measures, with explicit protocols.

Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals: A systematic review and meta-analysis

BACKGROUND

A large proportion of the healthcare workforce reports significant distress and burnout, which can lead to poor patient care. Several psychological interventions, such as Acceptance and Commitment Therapy (ACT), have been applied to improve general distress and work-related distress in healthcare professionals (HCPs). However, the overall efficacy of ACT in this context is unknown. This review and meta-analysis aimed to: 1) test the pooled efficacy of ACT trials for improving general distress and reducing work-related distress in HCPs; 2) evaluate the overall study quality and risk of bias; and 3) investigate potential moderators of intervention effectiveness.

METHOD

Four databases (Ovid MEDLINE, EMBASE, PsycINFO, CINHAL) were searched, with 22 pre-post design and randomised controlled trial (RCTs) studies meeting the inclusion criteria. 10 RCTs studies were included in the meta-analysis.

RESULTS

Two random effects meta-analyses on general distress and work-related distress found that ACT outperformed pooled control conditions with a small effect size for general distress at post-intervention (g = 0.394, CIs [.040; .748]) and for work-related distress (g = 0.301, CIs [.122; .480]) at follow-up. However, ACT was more effective than controls. The number of treatment sessions was a moderator of intervention efficacy for general distress. ACT process measures (psychological flexibility) did not show significantly greater improvements in those who received the intervention.

LIMITATIONS

The methodological quality of studies was poor and needs to be improved.

CONCLUSIONS

Overall, ACT interventions are effective in improving general distress and work-related distress in HCPs. These findings have implications for policymakers, healthcare organisations and clinicians.

Asking the Hard Questions: Psychologists' Discomfort With Inquiring About Sexual Abuse Histories

The literature on sexual abuse indicates low rates of inquiry by mental health professionals. This study explores early career psychologists' experiences of inquiry into their clients' sexual abuse histories. Twelve Australian psychologists participated in semi-structured interviews with transcripts analyzed using thematic analysis. The vast majority of participants reported that they did not routinely inquire about sexual abuse with barriers including not knowing what to do, discomfort, stigma, and fear of negative outcomes. Participants asserted that their university training in sexual abuse inquiry was inadequate. Findings emphasize the need for the development of an evidence-based framework for sexual abuse training.

A Model of the Effects of Parental Illness on Youth Adjustment and Family Functioning: The Moderating Effects of Psychological Flexibility on Youth Caregiving and Stress

Parental chronic illness may adversely impact youth and family functioning. This study examined a moderated mediation model of the effects of parental illness on youth and family functioning derived from the Family Ecology Framework. Consistent with this model, we predicted that youth caregiving and stress would serially mediate the adverse impacts of parental illness on youth adjustment and family functioning and that psychological flexibility would moderate these mediational mechanisms. A total of 387 youth, with parents affected by chronic illness, completed a questionnaire assessing parental illness severity, youth caregiving and stress, psychological flexibility, youth adjustment (i.e., internalizing and externalizing problems and psychological wellbeing), and family functioning. Path analyses indicated that the adverse effects of parental illness on youth adjustment and family functioning were serially mediated by youth caregiving and stress. Psychological flexibility buffered the adverse effects of these serial mediators on youth internalizing problems and psychological wellbeing. These findings identified three potential intervention targets: youth caregiving, related stress appraisals, and psychological flexibility. Given the large body of evidence showing that acceptance and commitment therapy fosters psychological flexibility, this intervention approach has the potential to address the psychosocial and mental health vulnerabilities of youth in the context of parental illness, which constitutes a serious public health issue.

Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion

Although self-compassion has been extensively studied in the recent decades, the representation of self-compassion as a unitary measure or the presence of self-warmth (i.e., presence of the positive components: self-kindness, common humanity, and mindfulness) and self-coldness (i.e., presence of the negative components: self-judgment, isolation, and mindfulness) remains controversial. Moreover, the differential effects of the six components of self-compassion on mental well-being and psychological distress have not been systematically investigated. To synthesize the differential effects of the six components of self-compassion and to examine how people in different cultures may associate the positive and negative components of self-compassion differentially, the present meta-analysis synthesized 183 effect sizes across 27 cultures. Results showed that the negative components of self-compassion (rs = 0.44 to 0.45) showed greater effect sizes with psychological distress than the positive counterparts (rs = -0.17 to -0.29) whereas the positive components of SCS (rs = 0.29 to.39) showed greater effect sizes with mental well-being than the negative counterparts (rs = -0.29 to -0.36), with the exception of common humanity and isolation (r = 0.29 and - 0.36). Cultural orientation of dialecticism moderated the association between the positive and the negative components of self-compassion, with dialectical cultures showing lower associations between the two opposing components. Findings have implications on the design and implementation of self-compassion interventions cross-culturally.

Impact of mindfulness-based cognitive therapy on counseling self-efficacy: A randomized controlled crossover trial

OBJECTIVE

To investigate the impact of a structured eight-week mindfulness-based cognitive therapy (MBCT) program on counseling self-efficacy among counseling trainees.

METHODS

Undergraduate counseling trainees were randomized to an MBCT group (n = 25) or a waitlist control group (n = 25) with a crossover trial design. Psychological measurements regarding mindfulness, empathy, self-compassion, psychological distress, counseling self-efficacy as well as neuro-physiological measures including frontal midline theta activity, respiration rate, and skin conductance were taken at baseline (T1), after intervention (T2), and six-month follow-up (T3).

RESULTS

Mindfulness training could make significant positive changes in empathy, self-compassion, stress reduction, and counseling self-efficacy with this being backed up by both psychological and neuro-physiological evidence at T2. However, such differences between the two groups had greatly subsided after crossover in which carry-over effect and marked improvement were noted in the study and control group, respectively, at T3. In addition, mindfulness was the most significant determinant that contributed to counseling self-efficacy, followed by psychological distress reduction and self-compassion according to the regression models.

CONCLUSION

Integrating mindfulness into counseling training is beneficial for helping profession trainees.

PRACTICE IMPLICATION

Incorporating mindfulness into counseling training can enhance the necessary "being mode" qualities in counseling and address self-care issues during training.

A theory-based examination of self-care behaviours among psychologists

The present study examined psychological, spiritual, physical/leisure and social self-care behaviours among psychologists using a major model of predicting human behaviour, the theory of planned behaviour (TPB). The study used a mixed method approach with two stages of data collection. Psychologists (N = 200) completed an online questionnaire assessing TPB constructs (attitude, subjective norm, perceived behavioural control and intention) and additional constructs of action planning, coping planning, peer and supervisor norms and organizational climate. Two weeks later, participants (n = 110) completed a follow-up questionnaire assessing their self-care behaviour. Results indicated general support for the standard TPB constructs in predicting self-care intentions for psychologists and the additional construct of action planning mediated the intention-behaviour relationship across most self-care dimensions. Findings from the current research provide further understanding of the factors influencing self-care engagement among psychologists and can be used to inform development of strategies to foster greater engagement in self-care behaviour.

A preliminary comparison of the efficacy of online Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) stress management interventions for social and healthcare workers

Social and healthcare workers have been shown to experience greater levels of illness, depression and burnout as a result of chronic workplace stress. The purpose of this study was to examine whether brief online ACT and CBT interventions could reduce the experience of stress and burnout in employees, while also improving mental health and psychological flexibility. A total of 42 individuals working within the social and healthcare professions were randomly assigned to either a 2-week online ACT or CBT intervention. Recruitment was undertaken internationally, although the majority of participants were based in Ireland at the time of their participation (79%). Participants' perceived stress, burnout, mental health and work-related psychological flexibility were assessed at baseline and post-treatment. Intent-to-treat analyses were conducted on all data. Outcomes indicated that both interventions resulted in significant improvements in stress, burnout and mental health scores from baseline to post-treatment. No significant differences were observed between ACT and CBT conditions, or in psychological flexibility scores from baseline to post-treatment. Reliable Change Index (RCI) scores indicated that clinically significant improvements in stress and mental health were seen in 42% and 19% of programme-completers, respectively. These results provide preliminary evidence for the usefulness of brief internet-delivered ACT and CBT interventions for the treatment of occupational stress and its comorbid symptoms. Online programmes with a longer duration and additional therapist support should be evaluated, as these may improve the outcomes of future interventions.

Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study

Military veterans' stigmatized views on mental disorders and traditional mental health care considerably reduce veterans' access to mental health services. The present study aimed to refine a previously developed non-stigmatizing smartphone-app intervention based on the principles of acceptance and commitment therapy for college student veterans with posttraumatic stress disorder (PTSD). To this end, we tested the acceptability of the developed prototype using a mixed-method study design. A total of nine student veterans participated in the study by using the app intervention and completing pre-post study measures and a post-intervention qualitative interview. The results showed that the intervention was highly acceptable. The results of the qualitative data analysis highlighted relevant themes related to strategies for improving the content, delivery, and structure of the intervention. The results also showed that, despite a decrease in the participants' adherence as the intervention progressed, there was a consistent improvement in the participants' resilience, PTSD, and rumination. Based on the results, the intervention was revised for prospective feasibility and efficacy testing. Our results highlight the need to use a collaborative approach in the early stage of the development of self-management PTSD interventions.

Effects of Mindfulness-Based Interventions on Self-compassion in Health Care Professionals: a Meta-analysis

Objectives

Health care professionals have elevated rates of burnout and compassion fatigue which are correlated with poorer quality of life and patient care, and inversely correlated with self-compassion. Primary studies have evaluated the extent to which mindfulness-based interventions increase self-compassion with contradictory findings. A meta-analytic review of the literature was conducted to quantitatively synthesize the effects of mindfulness-based interventions on self-compassion among health care professionals.

Methods

Twenty-eight treatment outcome studies were identified eligible for inclusion. Five cumulative effect sizes were calculated using random-effects models to evaluate differences of changes in self-compassion for treatment and control groups. Within and between group comparisons were evaluated. Sub-group and moderator analyses were conducted to explore potential moderating variables.

Results

Twenty-seven articles (k = 29, N = 1020) were utilized in the pre-post-treatment meta-analysis. Fifteen samples (52%) included health care professionals and fourteen (48%) professional health care students. Results showed a moderate effect size between pre-post-treatment comparisons (g = .61, 95% CI = .47 to .76) for self-compassion and a strong effect size for pre-treatment to follow-up (g = .76, 95% CI = .41 to 1.12). The effect size comparing post-treatment versus post-control was moderate. One exploratory moderator analysis was significant, with stronger effects for interventions with a retreat component.

Conclusions

Findings suggest mindfulness-based interventions improve self-compassion in health care professionals. Additionally, a variety of mindfulness-based programs may be useful for employees and trainees. Future studies with rigorous methodology evaluating effects on self-compassion and patient care from mindfulness-based interventions are warranted to extend findings and explore moderators.

Self-compassion as a Stress Moderator: A Cross-sectional Study of 1700 Doctors, Nurses, and Medical Students

Objectives

Work stress is common in healthcare and reliably predicts negative outcomes, including burnout and lower quality of life (QOL). However, few studies have investigated factors that might attenuate the impact of stress on these negative outcomes. We investigated whether the tendency to be kind to the self during times of difficulty—self-compassion—might buffer the effect of work stress on outcomes.

Methods

Registered nurses (n = 801), physicians (n = 516), and medical students (n = 383) were recruited using convenience sampling in New Zealand. Following consent, participants (N = 1700) completed a survey including the Copenhagen Burnout Inventory, Satisfaction with Life Scale, and Self-Compassion Scale–Short Form.

Results

Across groups, greater work stress consistently predicted greater burnout and lower QOL, while greater self-compassion predicted lower burnout and better QOL. Self-compassion moderated the relationship between stress and burnout in nurses (albeit in the opposite direction to what had been predicted), but not in doctors or medical students.

Conclusions

While self-compassion predicted better outcomes (and may thus represent a target to enhance wellbeing), it strengthened the association between stress and burnout in nurses. How self-compassion impacts the experience of stress and its correlates and why it does so differently in different groups of professionals remains unclear.

Randomized controlled trial of a web-based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students

OBJECTIVE

This study evaluated a 4-week web-based Acceptance and Commitment Therapy (ACT) mental health promotion intervention for university students.

METHOD

Participants were randomized to intervention (n = 596) or waitlist control (n = 566). Assessment of primary outcomes (depression, anxiety, stress, well-being, self-compassion, life satisfaction, and academic performance) and ACT processes (acceptance, cognitive fusion, education values, valued living, and present moment awareness) occurred at pre- and post-intervention and 12-week follow-up for intervention participants, and the same pre-post interval for waitlist control participants.

RESULTS

Analyses showed significant improvements from pre- to post-intervention compared with waitlist control on all primary outcomes and ACT processes. All intervention gains were maintained at follow-up. Improvements on all primary outcomes were mediated by three or more ACT processes in both samples. Intervention effects were consistent across both sample groupings.

CONCLUSION

Findings provide support for a web-based ACT mental health promotion intervention for university students.

Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care

Stress, burnout, and professional impairment are prevalent among mental health professionals and can have a negative impact on their clinical work, whilst engagement in self-care can help promote therapist well-being. This literature review examines the role of self-care in the promotion of well-being among mental health practitioners. Specifically, empirical research is presented in relation to specific domains of self-care practice, including awareness, balance, flexibility, physical health, social support, and spirituality. Findings from this review underscore the importance of taking a proactive approach to self-care and, in particular, integrating self-care directly into clinical training programs and into the quality assurance processes of professional organizations within the field of mental health.

Can mindfulness in health care professionals improve patient care? An integrative review and proposed model

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development

The key proposition of this invited essay is that personal practice (PP), coupled with self-reflection, is central to the development of the most effective therapists. To date, the discussion about personal practice in therapist training and professional development has largely revolved around the value of personal therapy, subscribed to by some schools of psychotherapy but not by others. However, since the turn of the century a new landscape of personal practices for therapists has emerged. In particular, two forms of personal practice, meditation programs and self-practice/self-reflection (SP/SR) programs, have developed a growing evidence base. Here it is proposed that there is now a strong theoretical and empirical case to accord personal practice an explicit role in therapist training and professional development. The case rests on recent research suggesting that: (1) personal and interpersonal qualities of therapists play a key role in client outcomes; and (2) personal practice is the most effective way to achieve changes in therapists' personal and interpersonal qualities. It is suggested that the research agenda needs to move beyond asking whether or not personal practice is effective towards a more sophisticated set of questions: what personal practice, facilitated by whom, is most effective with which practitioners, in what contexts, at what point in time? To make further progress, trainers and researchers need to be supported to include personal practices in therapist training and to undertake research to evaluate their impacts.

Pilot evaluation of a web-based acceptance and commitment therapy program to promote mental health skills in university students

OBJECTIVE

This study evaluated a 4-week web-based acceptance and commitment therapy (ACT) mental health promotion program called YOLO (You Only Live Once) for university students.

METHOD

A total of 130 participants were randomized to one of three intervention groups investigating varied program delivery methods. Primary outcomes assessed: depression, anxiety, stress, well-being, self-compassion, alcohol use, and life satisfaction. ACT processes assessed: acceptance, cognitive fusion, education values, valued living, and mindfulness.

RESULTS

Improvement on the primary outcomes and ACT processes did not differ among the three intervention groups. Analyses showed significant improvements on all primary outcomes (except alcohol use), and on all ACT processes. All ACT processes mediated changes on one or more primary outcomes in the intent-to-treat sample. Intervention effects were consistent on most primary outcomes and ACT processes across three sample groupings.

CONCLUSIONS

These preliminary findings provide support for a web-based ACT mental health promotion program for university students.

Positive mental health among health professionals working at a psychiatric hospital

BACKGROUND

Positive mental health (PMH) is a combination of emotional, psychological and social well-being that is necessary for an individual to be mentally healthy. The current study aims to examine the socio-demographic differences of PMH among mental health professionals and to explore the association between job satisfaction and total PMH.

METHODS

Doctors, nurses and allied health staff (n = 462) completed the online survey which included the multidimensional 47-item PMH instrument as well as a single item job satisfaction question. Associations of PMH with job satisfaction were investigated via linear regression models.

RESULTS

Significant differences in PMH total and domain specific scores were observed across socio-demographic characteristics. Age and ethnicity were significantly correlated with PMH total scores as well as various domain scores, while gender, marital and residency status and the staff's position were only significantly correlated with domain specific scores. Job satisfaction was also found to be a significantly associated with total PMH.

CONCLUSION

The workplace is a key environment that affects the mental health and well-being of working adults. In order to promote and foster PMH, workplaces need to consider the importance of psychosocial well-being and the wellness of staff whilst providing an environment that supports and maintains overall health and work efficiency.

Using the Repertory Grid Technique to Examine Trainee Clinical Psychologists' Construal of Their Personal and Professional Development

The repertory grid technique was used to explore how 26 third-year trainee clinical psychologists construed their personal and professional selves over the course of training and into the future. Each trainee completed a demographic questionnaire and a repertory grid with 10 elements: four 'personal self' elements, four 'professional self' elements and two 'qualified clinical psychologist' elements. They then rated the 10 elements on 10 bipolar constructs of their choosing. Trainees' personal and professional selves were construed to be similar to each other. Trainees had low self-esteem and reported currently feeling anxious, stressed, unsettled and lacking an appropriate work-life balance. These difficulties were attributed to the demands of training and were expected to resolve once training was completed with future selves being construed as similar to ideal selves. Suggestions for future research with improved methodology are made, and the implications of the findings for trainees, training providers and employers of newly qualified clinical psychologists are given. The overall implication being that stress in training is normative and the profession has a duty to normalize this and ensure that self-care and personal development are recognized as core competencies of the clinical psychologist for the benefit of its members and their clients. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Clinical psychology trainees experience training as demanding and stressful, which negatively impacts on their personal and professional self-image and self-esteem. However, they are optimistic that they will become more like their ideal self in the future. Stress in clinical training (and beyond) is normative, and thus, personal development and self-care should be recognized as clinical psychologist's core competencies.

Self-Compassion Online: A Pilot Study of an Internet-Based Self-Compassion Cultivation Program for Psychology Trainees

OBJECTIVE

The current study sought to conduct a preliminary investigation of the effectiveness and feasibility of a novel, self-guided online self-compassion training for reducing psychological distress and increasing self-compassion and happiness among psychology trainees.

METHOD

A 6-week online self-compassion cultivation program was developed and delivered to Australian psychology trainees (n = 37), and a pre-experimental repeated-measures design was used to collect change data on self-compassion, happiness, perceived stress, emotion regulation difficulties as well as symptoms of depression, anxiety, and stress.

RESULTS

Participants reported significant increases in self-compassion and happiness and significant decreases in depression, stress, and emotion regulation difficulties between pretest and posttest, with the majority of changes maintained at 3-month follow up.

CONCLUSION

 This study provides preliminary evidence supporting the effectiveness and acceptability of online self-compassion training as a positive, integrated, and meaningful way of reducing distress and promoting self-compassion and happiness among trainee psychologists.

Self-Compassion, Emotion Regulation and Stress among Australian Psychologists: Testing an Emotion Regulation Model of Self-Compassion Using Structural Equation Modeling

Psychologists tend to report high levels of occupational stress, with serious implications for themselves, their clients, and the discipline as a whole. Recent research suggests that self-compassion is a promising construct for psychologists in terms of its ability to promote psychological wellbeing and resilience to stress; however, the potential benefits of self-compassion are yet to be thoroughly explored amongst this occupational group. Additionally, while a growing body of research supports self-compassion as a key predictor of psychopathology, understanding of the processes by which self-compassion exerts effects on mental health outcomes is limited. Structural equation modelling (SEM) was used to test an emotion regulation model of self-compassion and stress among psychologists, including postgraduate trainees undertaking clinical work (n = 198). Self-compassion significantly negatively predicted emotion regulation difficulties and stress symptoms. Support was also found for our preliminary explanatory model of self-compassion, which demonstrates the mediating role of emotion regulation difficulties in the self-compassion-stress relationship. The final self-compassion model accounted for 26.2% of variance in stress symptoms. Implications of the findings and limitations of the study are discussed.

Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial

BACKGROUND

Multiple health behavior change can ameliorate adverse effects of cancer.

PURPOSE

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

METHODS

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

RESULTS

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037).

CONCLUSIONS

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (

TRIAL REGISTRATION NUMBER

ACTRN12608000399392).

Stress and burnout among healthcare professionals working in a mental health setting in Singapore

International literature suggests that the experience of high levels of stress by healthcare professionals has been associated with decreased work efficiency and high rates of staff turnover. The aims of this study are to identify the extent of stress and burnout experienced by healthcare professionals working in a mental health setting in Singapore and to identify demographic characteristics and work situations associated with this stress and burnout. A total of 220 Singaporean mental health professionals completed a cross-sectional survey, which included measures of stress, burnout (exhaustion and disengagement), participants' demographic details, and working situation. Independent t-tests and one-way ANOVAs were used to examine between-group differences in the dependent variables (stress and burnout). Analyses revealed that healthcare professionals below the age of 25, those with less than five years experience, and those with the lowest annual income, reported the highest levels of stress and burnout. No significant differences were found with other demographic or work situation variables. Findings suggest that healthcare professionals working in a mental health setting in Singapore are experiencing relatively high levels of stress and burnout. It is important that clinicians, administrators and policy makers take proactive steps to develop programs aimed at reducing stress and burnout for healthcare professionals. These programs are likely to also increase the well-being and resilience of healthcare professionals and improve the quality of mental health services in Singapore.

A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses

BACKGROUND

Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care.

DESIGN

In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from acceptance and commitment training (ACT) to prevent the development of stress and burnout was evaluated.

METHOD

The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a three-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model.

RESULTS

The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data.

CONCLUSION

This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.

What Factors Promote Resilience and Protect Against Burnout in First-Year Pediatric and Medicine-Pediatric Residents?

Burnout has high costs for pediatricians and their patients. There is increasing interest in educational interventions to promote resilience and minimize burnout among pediatric trainees. This study tested a conceptual model of factors that might promote resilience and protect against burnout, and which could serve as targets for addressing burnout in pediatric residents. Questionnaires were administered in a cross-sectional survey of (n = 45) first-year pediatric and medicine-pediatric residents. A minority (40%) of residents met one or more criteria for burnout. Physician empathy and emotional intelligence were not significantly correlated with burnout or resilience. Self-compassion and mindfulness were positively associated with resilience and inversely associated with burnout. Thus many residents in this sample endorsed burnout; mindfulness and self-compassion were associated with resilience and may promote resilience and protect against burnout in these trainees. Future studies should explore the impact of training in mindfulness and self-compassion in pediatric trainees.

Mindfulness, Psychological Flexibility, and Counseling Self-Efficacy

The purpose of this study was to explore the mechanism by which counselor trainees’ mindfulness and psychological flexibility are positively associated with counseling self-efficacy. First, it was hypothesized that having fewer experiences of hindering self-focused attention (i.e., counselor trainees’ awareness of their own anxiety and distracting thoughts in sessions) would mediate the association between mindfulness and counseling self-efficacy. Second, it was hypothesized that having fewer experiences of hindering self-focused attention would mediate the association between psychological flexibility and counseling self-efficacy. Participants included 154 graduate counselor trainees. Results supported our hypotheses that counselor trainees with greater mindfulness reported having fewer experiences of hindering self-focused attention, which in turn was positively associated with counseling self-efficacy. Similarly, those with greater psychological flexibility also reported having fewer experiences of hindering self-focused attention, which in turn was positively associated with counseling self-efficacy. These findings were significant after controlling for age and number of practicum courses.

'Feel the Feeling': Psychological practitioners' experience of acceptance and commitment therapy well-being training in the workplace

This empirical study investigates psychological practitioners' experience of worksite training in acceptance and commitment therapy using an interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with eight participants, and three themes emerged from the interpretative phenomenological analysis data analysis: influence of previous experiences, self and others and impact and application The significance of the experiential nature of the acceptance and commitment therapy training is explored as well as the dual aspects of developing participants' self-care while also considering their own clinical practice. Consistencies and inconsistencies across acceptance and commitment therapy processes are considered as well as clinical implications, study limitations and future research suggestions.

Effects of Acceptance and Commitment Therapy (ACT) Training on Clinical Psychology Trainee Stress, Therapist Skills and Attributes, and ACT Processes

Despite the increasing uptake of Acceptance and Commitment Therapy (ACT) by mental health practitioners, few studies have investigated the effects of ACT training on trainees. Clinical psychology trainees (CPTs) are susceptible to high stress such that their training represents a teachable moment for personal application of the therapy skills they learn for clinical practice. This study investigates the effects of ACT training on stress, therapist skills and attributes, and the personal acquisition of ACT strategies in CPTs. Thirty-two CPTs completed questionnaires before and after university-based ACT training that consisted of 12 2-h weekly workshops. Pairwise t-tests showed that CPTs reported improvements from before to after training on measures of counselling self-efficacy, client-therapist alliance, self-kindness, acceptance, defusion, mindfulness and values, and a marginally significant improvement on somatic symptoms, despite a trend towards increased work-related stress. As predicted, each of the ACT process variables was related to one or more of the therapist stress, skill and attribute variables, such that greater levels of mindfulness, values and acceptance, and less thought suppression were related to better trainee outcomes. This study provides preliminary data on therapist skill development and personal benefits for CPTs related to receiving ACT training that interweaves instruction in competencies acquisition with self-care.

KEY PRACTITIONER MESSAGE

This study provides preliminary data on therapist skill development and personal benefits for clinical psychology trainees related to receiving ACT training that integrates training in competencies acquisition with self-care. The ACT training offers a framework for integrating the acquisition of clinical competencies and self-care skills and positive therapist attributes in trainees. Findings support a strong positive union between the ACT processes and better trainee personal and professional outcomes.