DOES ACT INCREASE COMMITMENT TO VALUED ACTIVITY IN RELATION TO WORK RELATED STRESS? Maria Stavrinaki, M.Sc. Elena Charalambous, M.Sc. Eleni Karayianni,

DOES ACT INCREASE COMMITMENT TO VALUED ACTIVITY IN RELATION TO WORK RELATED STRESS?

Maria Stavrinaki, M.Sc.

Elena Charalambous, M.Sc.

Eleni Karayianni, Psy.D.

Maria Karekla, Ph.D.

University of Cyprus

INTRODUCTION Work stress is a growing issue that influences

people worldwide (WHO, 2007) Given the economic crisis, lack of legislation

implementation, and limited related research in Cyprus, there is urgent need to address some of these problem areas.

CBT is the most effective and well researched evidence-based intervention for work stress (e.g., Richardson & Rothstein, 2008).

ACT has a growing evidence base and there is growing support for its effectiveness in the area of work stress (e.g., Bond & Bunce, 2000).

University staff seem to be more influenced by work stress in recent years (Hogan et al. 2002).

RESEARCH SIGNIFICANCE & INNOVATION

Most research involves academic staff as opposed to administrative staff (Fako, 2010).

Not much is known about what constitutes effective intervention for this section of the population (Tytherleigh et al. 2007; Winefield et al. 2003).

First study examining the effectiveness of ACT on work-related stress using a university administrative staff sample in Cyprus.

Previous research: 3 session ACT intervention programme for work stress (2+1; Bond & Bunce, 2000). Current study: 6 sessions plus follow up.

NEEDS ASSESSMENT

When compared to epidemiological data (Panayiotou and Karekla, 2010), this sample reported above average endorsement of: perceived stress (PSS-10). physical health problems (PHQ). perceived support from friends and partner, not family

(SSQ). specific coping styles (e.g., positive reframing, humour)

(Brief-COPE). Issues raised:

tight work schedules, large work load, problems with colleagues and superiors – especially communication issues.

Staff also provided responses to questions pertaining to ways of increasing productivity, ways of dealing with work stress within and outside of the workplace, etc (Report - Karayianni & Panayiotou, 2010).

GENERAL RESEARCH GOALS

• Address needs identified by needs assessment.

• Establish ACT effectiveness for work-related stress using a 6 week psycho-educational intervention programme.

• Compare ACT and CBT effectiveness for work stress in administrative staff at a public university.

• Compare the effectiveness of values-based action as compared to defusion and acceptance.

• Compare the long term effectiveness of these interventions and impact on QOL.

HYPOTHESES

Current pilot study:The ACT intervention aimed at:

helping people build psychological flexibility. move toward increased value-based action. increased external control. increased job satisfaction. improved mental health.

The CBT intervention aimed at: increased internal control. identifying and addressing cognitive distortions. increased coping and use of skills. improved mental health. increased job satisfaction.

METHODOLOGY

o Sample o Baseline assessment using the ADISo Random allocation of participants to either

ACT or CBTo 4 participants (ACT group)o 2 participants (CBT group)

o Procedureo 6 psychoeducational sessionso Once a weeko 90 minuteso Two co-leaders – clinical psychology

trainees

DEMOGRAPHICS

SEX AGE EDU JOB MAR KID

Subject1

F 44 High school

FT Yes Yes

Subject 2

F 39 College FT Yes Yes

Subject 3

M 28 MBA FT Yes Yes

Subject 4

F 46 MBA FT No No

Subject 1 CBT

F 31 MSc FT Engaged No

Subject 2 CBT

M 34 MSc FT No No

INTERVENTION DESIGN

Session Outline: 1st –What is stress, internal

and external triggers. 2nd -“Control” and

alternative coping for internal triggers.

3rd – Diffusion from internal triggers, self as a context, defining values and goals.

4th – Choice, Acceptance and Value based action.

5th –Willingness and Value based Action.

6th – Problem solving obstacles and committed action.

Session Outline: 1st- Introduction to CBT and

work-stress. 2nd -Problem Solving. 3rd –Automatic Thoughts

and Cognitive Distortions. 4th –Cognitive Restructuring

and Relaxation. 5th -Assertiveness Training. 6th - Review and Summary

of 5 Modules – bringing everything together.

ACT Group CBT Group

PROCEDURE

o Qualitative and Quantitative Analysis

o Time frame and data collection points: 1. Baseline assessment pre-treatment2. Following each session 3. Post treatment 4. 3 month follow up5. 6 month follow up

MEASURES

o Quantitative Measures:o Distribution: 1st and 6th session, at 3 and 6 month

follow ups. 1. Psychological flexibility - AAQ 2. Health - PHQ3. Anxiety Sensitivity – ASI4. Perceived Stress - PSS5. Job description - JDI6. Quality of life– WHOQOL-BREF7. Valued Living Questionnaire – VLQ8. Willingness Scale - WS9. Internal Control- ACQ, TCQ10.Mindfulness – PHLMS

MEASURES

ACT INTERVENTION:

Sessions1-6o Defusion Stamp (Karekla, 2010). o Values Compasso Group motivation questionnaire

Session 6o Group Satisfaction Questionnaire (Karekla,

2010).

DEFUSION STAMP

Existing Stamp

Where the person is now

High levels of fusion

Low levels of fusion

ACT GROUP RESULTSParticipant 1Pre Post

Participant 2Pre Post



ADIS GADOCD

None PhobiaGAD

Phobia PhobiaGAD

PhobiaGAD

None None

AAQ 30 ? 34 30 28 37 36 36

ACQ Ext- 69Int-48

? Ext-49Int-49

Ext-51Int-43

Ext-58Int-47

Ext-47Int-46

Ext-68Int-50

Ext-61Int-48

WS-WS 68 ? 68 60 48 45 69 72

TCQ D-19SC- 17W-9P-13Reap- 15

? D-22SC-16W-17P-11Reap-15

D-18SC-17W-15P-11Reap-15

D-20SC-9W-9P-8Reap-12

D-16SC-7W-9P-7Reap-10

D-20SC-13W-9P-14 Reap-18

D-17SC-15W-15P-15Reap-18

PHLMS Aw-31Ac-25

? Aw-22Ac-33

Aw-29Ac-33

Aw-27Ac-23

Aw-21Ac-37

Aw-32Ac-31

Aw-35Ac-25

PSS 24 ? 20 21 21 25 10 16

PHQ 7 ? 5 4 8 7 7 6

ASI 20 ? 19 13 14 24 10 11

JDI 44/99 ? 67 53 39 30 56 56

WHOQOL-BREF PhH-16.8Ps-14.6SR-16E-16

? PhH-15Ps-14SR-12E-15.4

PH-13.7Ps-14.6SR-14.6E-15

PhH-14.6Ps-11.3SR-12.8E-10.5

PH-14.2Ps-10.6SR-11.2E-8.5

PhH-16Ps-14.6SR-15.2E-13

PhH-15.1Ps-14.6SR-12.8E-12

VLQ ? ? D-27I-105C-78

D-10I-87C-80

D-3I-76C-74

D-6I-63C-57

D-4I-73C-93

D-23I-77C-71

CBT GROUP RESULTS



ADIS Panic NoneGAD

IBS IBS SAD SADOCD OCDManic D Manic DSomatoform Somatoform

PHQ 4 3 12 4

PSS 22 15 24 18

ASI 18 12 18 14

JDI 177 215 134 130

WHOQOL-BREF 140 15284 8885 72108 104

144 132 84 76 80 68148 140

BRIEF COPE Improvement of 1 in active coping and venting

Improvement of 1 in active coping and venting

WEEKLY STAMP MEASURES - THOUGHTS

0

1

2

3

4

5

6

7

8

9

Week 1 Week 3 Week 5 Week 6

Participant 1

Participant 1

Dis

tan

ce in

cm

0

1

2

3

4

5

6

Week 1 Week 2 Week 3 Week 5 Week 6

Participant 2

Participant 2

9

10

11

12

13

14


Participant 3

Participant 3

1

1.5

2

2.5

3

3.5


Participant 4

Participant 4

WEEKLY STAMP MEASURES - BEHAVIOURS

6

7

8

9

10

11

12

13

14


Dis

tance

in c

m

Participant 1

Participant 1

0

0.5

1

1.5

2

2.5

3

3.5

4


Dist

ance

in cm

Participant 4

Participant 4

8

9

10

11

12

13

14


Dis

tanc

e in

cm

Participant 3

Participant 3

2

4

6

8

10

12

14

16


Dis

tanc

e in

cm

Participant 2

Participant 2

PARTICIPANT 1 VALUES

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10


Marriage

Health

Family

Work

Community

Friends

Valu

es C

om

pass D

ista

nce

2

3

4

5

6

7

8

9

10


Valu

es

Com

pass

Dis

tance

Marriage

Health

Family

Work

Religion

Friends



3

4

5

6

7

8

9

10


Valu

es

Com

pass

Dis

tance

Marriage

Health

Family

Work

Country

Friends


DISCUSSION Improvements in pre and post scores are seen both in

CBT and ACT groups. ACT participants seem to improve in flexibility,

awareness, have less of a gap between what they consider important and their action (value-based action).

CBT seems to be improving in terms of decreasing sensitivity to anxiety and perceived stress at 6 weeks.

ACT has better results in QOL, external control and less internal control strategies.

ACT better HW completion: ACT 90%, CBT 50% of time. Job satisfaction decreases for both groups in 6 weeks

but follow up scores needed. Better satisfaction with ACT compared to CBT.

LIMITATIONS & FUTURE WORK

1. Self report questionnaires.2. No double-blind procedures (assessment and intervention).3. Small N- Lack of participation.4. Missed sessions (no drop out)5. Incomplete assessment pack (1 person). 6. Pilot study, will repeat intervention in order to get more data. 7. More participants in ACT compared to CBT.8. Anecdotal data/results, no statistical analyses.

Documents

DOES ACT INCREASE COMMITMENT TO VALUED ACTIVITY IN RELATION TO WORK RELATED STRESS? Maria Stavrinaki, M.Sc. Elena Charalambous, M.Sc. Eleni Karayianni,