ACTing On Mental Health: The Evidence

This week someone asked me for a meeting, so I looked at my diary….kept looking…and eventually came up with a date in early December.

It’s not just me – though of course I am terribly important.

I don’t know anyone who isn’t busy (and terribly important) and perhaps no surprise – many of us feel stressed as a result.

Some of the stress statistics would be shocking if they weren’t so familiar:

• In the UK, work-related stress accounts for 37% of ill health and 45% of days lost (Health and Safety Executive, 2016).
• 1 in 6 people in paid employment will suffer a common mental health issue this year (Mental Health Foundation, 2016).
• The estimated cost of poor mental health is £74 – £99 billion p.a. (Stevenson & Farmer, 2017).

So what can be done?

Tackling Stress at Work

In a recent interview for the New Scientist (on behalf of one of my Fintech clients), I argued that interventions at both organisation and individual level were required.

But given that 75% of people suffering from a mental health issue will never receive any form of psychological support (Seymour & Grove, 2005), this places extra emphasis on other forms of support, such as workplace training, to help people deal with the demands of the modern workplace.  The trouble is, of course, that workplace training often gets a bad name.

And a lot of it lacks even that most basic criterion; evidence that it works.  Ideally there should also be evidence of how the training works too.

The Case for Using ACT to Improve Mental Health in the Workplace

As part of the preparation for the New Scientist interview (and prior to publishing a Systematic Review on the subject) I looked at some of the main evidence for ACT training.  Below I’ve listed five workplace studies which caught my eye.

1. Dahl, Wilson and Nilsson (Behavior Therapy, 2004)

This study gave an ACT intervention to a group of Swedish care workers selected as being at high risk of long term work disability due to stress and musculoskeletal pain.  An ACT group was compared to a group who received their respective medical treatment as usual (MTAU).

At post and 6-month followup, ACT participants showed fewer sick days and used fewer medical treatment resources than those in the MTAU condition, with a mean of 1 sick day versus a mean of 11.5 sick days for the MTAU condition.

2. Flaxman and Bond (Journal of Occupational Health Psychology, 2010)

This study randomly assigned 311 local government employees them to either stress management training based on Acceptance and Commitment Therapy (n =177) or to a waitlist
control group (n =134). The ACT program consisted of three half-day training sessions.

Across a 6-month assessment period, the ACT training resulted in a significant reduction in employee distress for those who had been at high risk initially, as well as a significant reduction  compared to the waitlist group.  In fact, of these initially distressed SMT participants, 69% improved to a clinically significant degree, compared to 31% in the waitlist group.

3. Waters, Frude, Flaxman, Boyd, (British Journal of Clinical Psychology, 2017)

This study demonstrated that even a short, one-off training intervention can have positive effects.  A 1-day ACT workshop was offered to 17 care home workers in Wales, UK with a further 18 assigned to a waitlist control group.

At 3 months post-intervention, those in the ACT group reported a significantly lower level of psychological distress compared to the control group, with clinically significant change 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.

In keeping with ACT theory, the ACT intervention also resulted in significant improvements in psychological flexibility, but did not significantly reduce the frequency of negative cognitions.

4. Vilardaga et al., (Journal of Substance Abuse Treatment, 2011)

This was a cross-sectional survey with nearly 700 addiction counsellors working in substance abuse treatment centres in the USA.

Results indicated that burnout was more strongly associated with psychological flexibility than other well-known predictors of burnout e.g.  job control, supervisor support, salary etc.  The study concluded that a future approach to reduction of burnout among addiction counsellors should target psychological flexibility.

5. Lloyd, Bond and Flaxman (Journal of Work and Stress, 2013)

This study took 43 employees of a UK government department receiving an ACT workshop (3 half days over 2 months) aimed at increasing participants’ levels of psychological flexibility (PF), and 57 participants allocated to a waitlist control group. The study found significant reduction in burnout and strain in the ACT group.

Crucially the study was also able to show that it was higher levels of PF that mediated (or caused) the reduction of emotional exhaustion at follow up.  In other words, this study showed not only that ACT training works, but why it works.

Conclusion

Of course, training psychological flexibility is only a part of the solution to a complex problem.  We shouldn’t overstate the evidence, or see it as a standalone solution.  But increasingly it looks to be a critical part of our response to an increasingly demanding world of work.

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