• An investigation into the development of ACT-based approaches to increase physical activity

      Lafferty, Moira; Whalley, Anthony P. (University of Chester, 2021-01)
      It is well documented that regular physical exercise supports physical and mental wellbeing. Despite the promotion of physical activity by world health experts and governments, physical inactivity within the population remains a cause for concern and disorders associated with sedentary lifestyles have continued to increase. Evidence suggests that the uncomfortable private-events people experience during physical exertion can become psychological barriers to participation in physical activity and thus result in avoidant behaviours. Acceptance and commitment therapy (ACT) has been used to promote increased physical exercise by enhancing psychological flexibility in relation to private-events that are perceived as unpleasant. However, relationships between the individual ACT processes and the theories which underpin their use in interventions designed to promote physical activity have yet to be fully explored. Understanding the relationship between ACT processes and physical exercise is key for appropriate and robust intervention development. This thesis aimed to explore the theoretical and practical application of ACT processes in relation to exercise and inform further development of effective brief interventions designed to increase activity levels. The programme of work within this thesis had two phases. The first phase included two studies: a systematic review to explore the existing evidence; and a quantitative survey study to determine if associations exist between physical activity levels and the individual core processes of ACT. Results from phase one found that the reviewed literature failed to explore the use of Relational Frame Theory (RFT) critical to ACT, and a survey suggested that ACT processes of defusion, self-as-context and personal values were likely to play a significant part in activity levels. The second phase comprised of three interrelated quantitative intervention studies designed using RFT. Each explored the ACT processes by measuring task duration and the intensity of private-events experienced during exercise. The first intervention study combined defusion and self-as-context with no significant effects on an exercise task. The second combined defusion, self-as-context and value orientated cues to behaviour change. Exercise duration was significantly increased in the ACT intervention, while there was no decrease in the intensity of private-events. The final study tested a values clarification task with cues to behaviour change and reported significantly increased exercise duration. The thesis demonstrates that relational frame theory applied to ACT processes can influence the duration of exercise although the relationship with private-events remains uncertain. The robust, theory focused approach to this work represents a small but valuable contribution to the development of intervention strategies and has implications for future research. Strategies worked best using a combination of both deictic and hierarchical relations for training cognitive defuison and self-as-context, and especially for the clarification of personal values used as cues to behaviour change. Further research is needed to establish both the external validity and longevity of observed effects.
    • Perceived stress and professional quality of life in nursing staff: how important is psychological flexibility?

      Kent, William; Hochard, Kevin D.; Hulbert-Williams, Nicholas J.; University of Chester (Elsevier, 2019-08-14)
      Objectives: Nurses are at high risk of chronic stress. Tailored, evidence-based stress-management interventions may minimise absenteeism and staff turnover, whilst at the same time promoting good quality patient care. Current literature for nurse-focused stress-management interventions is varied in quality, with little focus on data-driven intervention development. This study explores how process measures related to Acceptance and Commitment Training (ACT) are associated with perceived stress and professional quality of life in nurses, in order to guide intervention development. Design: A cross-sectional, online psychometric survey was implemented using LimeSurvey software. Methods: One-hundred and forty-two nurses were recruited from various specialties across four English National Health Service (NHS) Trusts. Questionnaires assessed demographic and work-related sample characteristics, ACT processes (mindfulness, acceptance, cognitive defusion, self-as-context, values and committed action), and four work-related wellbeing outcomes (perceived stress, burnout, compassion fatigue and compassion satisfaction). Correlation and regression models were used to analyse data. Results: All six ACT processes negatively correlated with perceived stress, burnout and compassion fatigue, and positively correlated with compassion satisfaction (all p<.05). In regression models, these same processes explained significant variance for all outcomes (R2 range=.36-.61), above and beyond that explained by socio-demographic and work-related factors. Acceptance (β range: -.25 to -.55), mindfulness (β range: -.25 to -.39), and values-based processes (β range: -.21 to -.36) were frequent independent contributors to work-related wellbeing. Conclusions: This study demonstrates that the ACT framework provides a promising platform from which to develop nurse-focused stress-management interventions. Interventions focusing on acceptance, mindfulness, and values-linked processes may be most effective.