Investigating Acceptance and Commitment Therapy (ACT), and the role of mindfulness, in the context of stress management

Hope-Bell, Joshua

Abstract

This PhD initially set out with a view to examine the feasibility and effectiveness of an acceptance and commitment therapy (ACT) intervention for healthcare staff, a highly stressed population. The results of this initial study found that mindfulness levels of staff improved, whilst they reported not engaging with formal mindfulness home practice. This then led to a novel research question, specifically whether formal mindfulness practice is needed in ACT interventions. This question is tested in multiple studies, before culminating in a comparison of ACT with and without mindfulness practice. The results and their implications for practice and theory are discussed throughout.

Study 1 of the thesis evaluated the effectiveness of an ACT intervention for hospital staff. The results suggested that participants had improved their general psychological wellbeing, as well as improving engagement in valued living, psychological flexibility and mindfulness skills. In Study 2, the participants of this intervention were interviewed about their experiences, to provide a richer evaluation of the course. One of the findings from this qualitative inquiry was that participants did not seem to engage with formal mindfulness practice. It was therefore questioned how they had improved their mindfulness skills if they had not been formally practicing mindfulness. It was hypothesised that ACT metaphors alone may have improved mindfulness skills.

This hypothesis paved the way for Studies 3 and 4, which tested whether ACT metaphors could improve mindfulness skills, relative to formal mindfulness practice. The results suggested that those in the ACT metaphor conditions did indeed improve mindfulness skills. Study 5 aimed to investigate this idea further, by comparing ACT interventions both with (ACT-M) and without (ACT-WM) formal mindfulness practice, with care home staff. This study could not take place due to COVID-19, but a similar study was instead conducted with undergraduate students in Study 6. The results suggested that those in both the ACT-M and ACT-WM interventions recorded improvements in psychological wellbeing, which were mediated by improvements in mindfulness skills. Interestingly, both components of mindfulness, mindful attitude and mindful awareness, mediated outcomes, suggesting that both are important in mindfulness interventions.

This thesis details the first attempt to determine whether ACT metaphors can improve mindfulness skills. It also contributes to the mindfulness literature by finding that formal mindfulness practice is not needed to improve mindfulness skills and by researching the importance of mindful attitude versus awareness. Finally, it adds more support to the ACT model as a useful intervention for workplace stress.

• Thesis Type: Thesis
• Deposit Date: Apr 7, 2022
• Publicly Available Date: Nov 9, 2022
• Public URL: https://uwe-repository.worktribe.com/output/9303712
• Award Date: Nov 9, 2022