ACT on stress: The efficacy of acceptance and commitment therapy for reducing stress and improving the quality of therapy in clinical psychology interns

Mrs Johanna (Jeanie) Stafford-Brown (). ACT on stress: The efficacy of acceptance and commitment therapy for reducing stress and improving the quality of therapy in clinical psychology interns Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Mrs Johanna (Jeanie) Stafford-Brown
Thesis Title ACT on stress: The efficacy of acceptance and commitment therapy for reducing stress and improving the quality of therapy in clinical psychology interns
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Associate Professor Kenneth Pakenham
Total pages 175
Total black and white pages 175
Abstract/Summary Research evidence suggests that post-graduate clinical psychology students are particularly vulnerable to experiencing excessive stress, which can negatively impact their personal and professional functioning and, in turn, result in less than optimal standards of care for clients. Nonetheless, there is a dearth of empirical studies on stress in this population, and there is no published intervention research on stress in Australian post-graduate clinical psychology students. The purpose of the present study was to develop a group Acceptance and Commitment Therapy (ACT) stress management intervention for post-graduate clinical psychology interns (students currently treating clients in the university psychology clinic), and evaluate the efficacy of the program in reducing stress and psychological distress, increasing life satisfaction, fostering therapist characteristics associated with better therapy outcomes, and improving the therapeutic alliance. The study also examined the mediating role of ACT processes. Five hypotheses were tested: (1) that ACT intervention participants would report greater reductions in stress and psychological distress, and greater improvements in life satisfaction than a control group, (2) that ACT intervention participants would report greater improvements in self-compassion and self-efficacy than a control group, (3) that ACT intervention participants (and their clients) would report a stronger therapeutic alliance than a control group (and their clients), (4) that ACT intervention participants would show greater improvements in the ACT process variables (acceptance and action, mindfulness, defusion, and valued living) than a control group, and (5) that changes in stress, psychological distress, life satisfaction, self-compassion, self-efficacy, and the therapeutic alliance would be mediated by changes in some or all of the ACT processes. A cohort-controlled design, where an experimental group (n = 28) was contrasted to a wait-list control group (n= 28) was utilised, with a 10 week follow-up for the treatment group. The stress management intervention was comprised of an integrated sequence of standard ACT concepts, exercises and strategies, and was delivered via one three-hour group session per week, for four consecutive weeks (12 hours in total). Data were collected via questionnaires pre-treatment, post-treatment, and at a 10 week follow-up. Pre-treatment, 73% of the total sample met criteria for caseness on the General Health Questionnaire-28. By post-treatment, caseness in the intervention group had reduced from 64% to 37%, whereas 79% of students in the control group continued to meet caseness criteria. Multivariate analyses showed that from pre- to post-treatment, ACT intervention participants demonstrated greater reductions in stress and psychological distress, and greater improvements in self-efficacy, self-compassion (Overidentification subscale), acceptance and action, mindfulness, defusion, and valued living, and a stronger therapeutic alliance (Bond subscale), than the control group. Social validation data were consistent with these findings, and all treatment gains were maintained at the 10 week follow-up. A series of bootstrapped nonparametric multiple mediator tests showed that ACT processes mediated the changes in psychological distress, self-compassion (Overidentification subscale), self-efficacy, and the therapeutic alliance (Bond subscale). There were no differences between the groups in satisfaction with their clinical training. Most reported that they would like more preparation before seeing clients for the first time, and a smaller workload. Findings provide preliminary support for the efficacy of a group ACT program for post-graduate clinical psychology interns, in terms of stress reduction, and improving qualities that have been linked to better client outcomes. The findings also contribute to our understanding of the mechanisms by which ACT brings about change.
Keyword acceptance and commitment
stress
clinical psychology interns
quality of therapy
ACT
reducing stress
psychology

 
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Created: Sun, 13 Jun 2010, 11:39:59 EST by Mrs Jeanie Stafford-brown