Interventions in the Workplace: Why ACT?

One of the key differences between cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) is that ACT does not seek to change the content, frequency, or intensity of people’s unwanted thoughts, feelings and sensations, but rather it aims to change the way that people fundamentally relate to their internal events in order to increase psychological flexibility and value-guided behavioral effectiveness. And yet another fundamental difference is that when evaluating the impact of ACT interventions, researchers look for improved quality of life or life satisfaction over the more traditional measures of symptom reduction. ACT interventions have shown significant improvements in life functioning that are independent of changes in the content or frequency of people’s undesirable thoughts or feelings (Hayes, Luoma, et al., 2006).

For those interested in enhancing the well-being and behavioral effectiveness of the working population, ACT represents a particularly exciting development. One of the strongest arguments for applying ACT in the workplace comes from its generic underlying model of psychological flexibility. Based on relational frame theory (RFT), which holds that most forms of psychological distress and behavioral ineffectiveness are consequences of certain features of human language and cognition, the psychological flexibility model is presumed to apply across a wide range of human experience. Namely, experiential avoidance (an important feature of psychological inflexibility referring to the tendency to try to change, avoid, or remove unwanted thoughts and feelings) is now widely acknowledged as a significant risk factor that has implications for human functioning in general (Biglan, Hayes, & Pistorello, 2008; Hayes et al., 1996; Kashdan, Barrios, Forsyth, & Steger, 2006). Research has repeatedly shown that attempts to suppress unwanted thoughts actually leads to a greater frequency of those thoughts and associated undesirable emotions (Wenzlaff & Wegner, 2000). As we humans try hard not to think about something, often our minds can think about little else. Similarly, experiential-avoidant individuals, who are simply unwilling to experience certain thoughts and feelings, will tend to avoid situations, events and interpersonal interactions that are likely to elicit those thoughts and feelings. People’s lives become restricted as they avoid pursuing valued life goals and actions in order to avoid experiencing particular internal states. Higher levels of avoidance are associated with a wide range of mental health problems, not the least of which include anxiety, depression, phobias, posttraumatic stress, eating disorders, and various forms of self-harm (Hayes et al., 1996; see Hayes, Luoma, et al., 2006 for a more recent review).

Given our understanding of such processes as experiential avoidance, and their role in psychological distress, behavioral ineffectiveness, and reduced quality of life, why should we wait for these processes to create serious dysfunction before offering intervention? Why not place equal importance on adopting preventative approaches, as well as tertiary or therapeutic interventions, by offering interventions like ACT to much greater numbers of people to prevent such processes as experiential avoidance from leading to unnecessary problems? ACT interventions have something important to offer individuals who are already functioning well enough but looking to function even better (for example, by increasing present-moment awareness, and value-and-goal-consistent behavior). Scientist Tony Biglan et al. (2008) recently proposed that our growing knowledge of experiential avoidance as a common risk factor should be harnessed in the service of prevention.

The techniques and exercises employed in ACT interventions lend themselves well to the workplace environment. To start at a general level, the six facets of psychological flexibility are:

1. Contact with the present moment
2. Acceptance
3. Cognitive defusion
4. Self-as-context
5. Values
6. Committed Action

These psychological skills can be developed through experiential practice and engagement in values-consistent action (Hayes, 2004). Akin to more traditional forms of CBT, a skills-based approach to therapeutic change and behavioral functioning is well suited to group delivery across a range of contexts. ACT has a higher purpose that goes beyond simply showing people how to “cope” with undesirable thoughts, emotions, and psychological sensations. Seeking to change the relationship that people have with their internal experiences, the emphasis in ACT is not on whether the content of particular thoughts and feelings is “negative” or “positive,” but rather on how out thoughts and feelings function. For example, mindfulness skills can be cultivated regardless of whether the participant is experiencing a high volume or intensity of negatively evaluated thoughts and emotions. The tone of thoughts experienced during the defusion process (noticing the process of thinking in the moment) is unimportant; rather the significance is in the learned ability to “watch” whatever thoughts show up. In the workplace, where ACT is often delivered to heterogeneous groups of individuals, with widely varied psychological circumstances, this feature of mindfulness is particularly useful. Similarly, the values-and-goal oriented skills central to ACT are well-suited to worksite delivery. Employees are often already reasonably familiar with the process of behavioral goal setting and the assessment of potential barriers to goal achievement. During ACT training sessions, the values work component can be identified as “goal setting with a difference,” the difference being that goals are explicitly linked to chosen values and are used to initiate and maintain behavioral movement in valued life directions. Flaxman, Bond and Livheim suggest that when ACT is used to enhance work performance, a combination of values and mindfulness interventions provides a powerful dimension to more traditional goal-setting procedures, providing a deeper sense of meaning and purpose as well as helping participants recognize and overcome their psychological barriers to performance enhancement.

 In contrast to CBT-based programs that have been used in the workplace, which typically provide a mix of different intervention approaches, the six ACT processes and related interventions are all part of a unified rationale that is always focused on the cultivation and promotion of psychological flexibility.

ACT can also be delivered effectively in groups, which is the typical format for worksite training programs, and thus a natural fit in the workplace. Walser and Pistorello (2004) highlight a number of advantages associated with delivering ACT in groups:

• The potential to normalize people’s internal experience
• The opportunity to share insights into ACT’s principles and procedures
• The creation of a context within which clients can publicly commit to chosen values
• A fair amount of humor is typically shared among group members, and can be used in the service of one or more of ACT’s processes

In recent years, occupational health research has increasingly shown an attempt to expand policies of practice beyond mere compliance and health and safety regulations and shift to place greater emphasis on prevention initiatives and particularly within psychological health in the workplace (Black 2008). There is growing recognition of the considerable costs associated with psychologically distressed employees who are present at work but experiencing performance impairments and reduced productivity. There is a noteworthy alignment between the philosophy of ACT and these trends in occupational health research, policy and practice. ACT seeks to help people function more effectively, even while experiencing undesirable thoughts, feelings and physiological sensations. ACT is uniquely suited to help people perform in their jobs and stay productive, even when they don’t particularly feel like it. If employees became less concerned or distressed about undesirable thoughts and emotions, then it is much less likely they will feel the need to drop out of the workforce (or alter their behavior in other ways) when such difficult thoughts and feelings emerge. For employees who value working life and the benefits it can bring, ACT can ensure that such values are operating as a prominent guide to work-related behavior.

Next week we’ll go further into the specifics of applying ACT in the workplace, with an overview and discussion of some of the practical considerations for the program outlined in The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance by Dr. Paul Flaxman, Dr. Frank Bond and Fredrik Livheim.

References

Biglan, A., Hayes, S. C., & Pistorello, J. (2008). Acceptance and commitment: Implications for prevention science. Prevention Science, 9, 139–152.

Black, C. (2008). Working for a healthier tomorrow. Report commissioned by the Secretaries of State for Health and Work and Pensions. Norwich, England: Stationery Office.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.

Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York: Guilford Press.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment theory: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.

Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44, 1301–1320.

Walser, R. D., & Pistorello, J. (2004). ACT in group format. In S. C. Hayes & K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy. New York: Springer.

Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. In S. T. Fiske (Ed.), Annual review of psychology (Vol. 51, pp. 59–91). Palo Alto, CA: Annual Reviews.