Acceptance and Commitment Training in the Workplace Dr. Paul Flaxman Dr. Joe Oliver
Acknowledgments
Workshop Overview: Part I Introductions and warm-up exercise Prevalence of mental health problems among working populations Why ACT is useful for workplace interventions ACT-oriented organising frameworks How we adapt ACT for workplace delivery (some specific technique demonstrations in Part II..)
Workshop Overview: Part II Mindfulness practices within our ACT workplace programmes Values work -How we introduce values and valuing -Card sort exercise -Translation into valued actions -Pairs sharing exercise
Workshop Overview: Part II Defusion work -Our/ your experiences with defusion exercises -Promoting defusion throughout workplace training -Defusion-oriented psychoeducation -Example defusion technique setting challenging work/ career goal and noticing one s mind in action Passengers on the bus role play for workplace settings
PART I: INTRODUCTIONS; WARM-UP; PREVALENCE; & ACT ADAPTATIONS FOR WORKPLACE
Say hello to your neighbour Find out your neighbour's name, where he/ she is from, and current job role. Then gather the following information: Two activities your neighbour tends to perform on automatic pilot that is, without much psychological awareness Two activities your neighbour performs with more awareness that is, with a stronger sense of being in the moment
Prevalence and Costs 1 in 4 of working age UK population with a common mental health problem in the past year Around 1 in 6 British workers experiencing a common mental health problem at any one time. (1 in 5 if drug and alcohol misuse included). 58% of absenteeism in public sector due to mental health problems Sources: Health & Safety Executive (2011); Seymour & Grove (2005)
Making the case for improving employees psychological well-being Happy-productive-worker studies (Wright et al., 2002; 2007...) Both psychological well-being and job satisfaction positively related to performance ratings and turnover Psychological well-being moderated the relationship between job sat and performance/ turnover...
Making the case for improving employees psychological well-being Job satisfaction associated with better performance, and lower turnover but only when psychological well-being is high No relationship between job satisfaction and performance when psychological well-being is low As long as psychological well-being was high, those dissatisfied with their work did not leave
Why we believe ACT is useful for workplace interventions Transdiagnostic Group processes ACT processes Improving mental health, resilience, and behavioural functioning Well-suited to reducing presenteeism?
Summarising the ACT approach: Simple organising frameworks
Simple organising frameworks Help participants organise intervention material Simple communication of ACT s core messages Quick reference alternative to wordy explanations Function as a reminder of what the intervention was about
Small group exercise 1. Find someone in your immediate group who has some experience of ACT 2. That person assumes the role of facilitator. His or her task is to offer the group a simple summary of the whole ACT approach! This could be a simple phrase (e.g., this intervention is designed to... ) Or maybe a quick diagram or figure that offers summary/ overview of the ACT approach 3. Other group members to provide feedback what was it like to experience that overview/ summary/ brief description?
Acceptance and Mindfulness Processes Contact with the Present Moment You can chunk them into two larger groups Acceptance Values Defusion Committed Action Self as Context
and Contact with the Present Moment Commitment and Behavior Change Processes Acceptance Values Defusion Thus the name Acceptance and Commitment Therapy Self as Context Committed Action
Two-skills Diagram MINDFULNESS Present moment awareness training Noticing and untangling from internal barriers to values-based action Strengthening your resilient self VALUES-BASED ACTION Defining your values Mindfully engaging in values-based actions Using values as a guide to goals and daily behaviour Adapted from Flaxman, Bond & Livheim (2013) The Mindful and Effective Employee.
Contact with the Present Moment Be here now Acceptance Open up Values Know what matters Open Psychological Flexibility Aware Active Defusion Watch your thinking Self as Context Pure awareness Committed Action Do what works Hayes et al. (2011)
Our straplines This training is designed to teach you skilful ways of relating to your thoughts and feelings so that they do not interfere with your behavioural effectiveness This group is about practicing different ways of being with your MINDS so you can DO MORE of what you care about
Adaptations for workplace delivery Less obvious focus on experiential avoidance Fairly quickly into values identification and translation into valued actions Relatively brief build up straight in with skills practice Skills-based language responding skilfully to unhelpful thoughts; building psychological muscle; using values as a more prominent guide to action
PART II: VALUES AND DEFUSION EXERCISES; MINDFULNESS; BRINGING ACT METAPHOR TO LIFE
In this part An example of how values and valuing has been introduced in brief workplace training programmes Relatively simple set of defusion practices that we have seen working well in workplace groups Acting out passengers on the bus
A note on mindfulness practices in our workplace programmes Some classic practices adopted (raisin; three step breathing space) Brief body and breath awareness 5 to 10 minutes only Physicalizing exercise used to demonstrate skilful relating to mood/ emotional content Encouraging mindful engagement in valued actions
Mindfulness in the workplace Enhance awareness of present moment experience Gather more/ better information Use that information to guide behaviour Engage fully for increased effectiveness and fulfillment (Harris, 2009)
Acceptance-oriented enquiry After a physicalizing exercise... Facilitator: Did anyone notice a feeling or sensation pop up? Participant: I certainly did. It was like a sense of dread or foreboding. Facilitator: Great, Jennifer. And whereabouts in your body did you experience that?
Continued... Facilitator: Right here in the pit of my gut like this burning sensation and a feeling of heaviness. There s still a bit of it left there now. Facilitator: Great work Jennifer. It sounds like you've really noticed it for what it actually is. And did it take on some kind of shape or form as if it were a physical object...?
Values and Valuing
Introducing values The personal strengths or qualities you most want to express in your day-to-day behaviour Your personally chosen guide to behaviour What you most want to be about in different areas of your life
Compass Metaphor
Introducing values Gently selling the function of personal values; they offer us something more than goals Kick-starting values reflection with simple values tools (e.g., card sort) to help people get the gist Facilitate early translation of values into action e.g., identify small value-based actions you could engage in over the next week
What are the important things in life? Tools for kick-starting values work: Survey of Life Principles (card sort) Russ Harris a quick look at your values questionnaire ACT conversations cards
Values card sort exercise How we typically do it 1. Sort cards into three piles: not very important; moderate importance; highest importance 2. Identify your top 5 values (also allowed and encouraged to create your own) 3. Share experiences with that exercise 4. Working on one of the most important values note down all the small actions you could engage in over the next week that would help to express that value 5. Select any three of these value-based actions that you would be willing to perform for your home assignment, to bring that value to life
Setting up reminders on person/ in environment
Values card sort exercise Using ACT conversations cards (www.actforadolescents.com)
Values card sort exercise: Personal reflection Lay out all the cards on the table Spend some reflecting on the cards on your table - feel free to stand up and move around so that you can get a good view of the cards. Identify your top 2 or 3 values for each of the following life areas: Work/ education Health Leisure time Relationships Also feel free to construct your own value word or phrase Note down your top 2 or 3 values for each life domain on the following handout...
Example of how I have expressed it Example of how I d like to express it Work/Education 1. 2. 3. Health 1. 2. 3. Leisure time 1. 2. 3. Relationships 1. 2. 3. www.lifecompass.se www.lifecompass.se 43
Values card sort exercise: Personal reflection Select any one of your most important values (in any area) Using the handout, noting down some specific examples of value-consistent behaviours/ actions: 1. Examples of how you have already expressed it any specific behaviours/ actions you have engaged in that that have helped to bring this value to life? 2. Examples of how you d like to express it any specific behaviours/ actions you would like to engage in that would help to bring this value to life?
Pairs exercise: Sharing values and valuesbased actions Talking 1. Select any one important value. 2. Tell your partner: a) This is important to me because b) Give a specific example of how you have expressed this in your life in the past. c) Give an example of how you would like to express this concretely in your life in the future. 3. Continue with another card if you have time. Listening 1. Maintain eye contact. 2. Be mindful, listen with your ears and eyes wide open. 3. If the speaker is too abstract, gently ask for concrete examples. 4. No further questions or comments. 5. Thank the speaker when (s)he has finished talking about a value. www.actorganisation.com
Demonstration of the LifeCompass Finding balance through personal values (see handout version of LifeCompass, developed by Fredrik Livheim)
The Life Compass Relationships Spare time Work/Education www.lifecompass.se Health 12 11
RELATIONSHIPS Close relationships * Being a loving partner * Having fun together Family relationships * Straight, honest communication * Providing reassurance Friends/Social life * Contact, support, confidence * Having fun together The Life Compass Relationships WORK/EDUCATION Work * Well paid, stimulating job * Fun colleagues, travels * Continuously learning more * Teaching Spare time Work/Education SPARE TIME Spare time activities * Sailing, travelling * Spending time in nature * Spending time with friends * Relaxing, going to parties www.lifecompass.se Health HEALTH * Healthy and varied food * Enough sleep * Regular exercise * Regular sex * Regular touch * Keeping clean and fresh 19
Your Life Compass the last week Having fun with friends Relationships Get a close relationship Create unity in the family Spending time in nature 10 Continuously learning more 5 0 Spare time Work/Education Living fully, bathing, etc. Contribute to something important A home to enjoy Having fun at work www.lifecompass.se Regular sex Health Enough sleep Regular exercise Healthy and varied food 22
What gets in the way of the important things in life?
Defusion Fusion means getting caught up in our thoughts and allowing them to dominate our behaviour. Defusion means separating or distancing from our thoughts, letting them come and go instead of being caught up in them (Harris, 2009).
Building defusion skills Loosening attachment to the literal content of thoughts, to increase behavioural flexibility in the presence of such thoughts Cultivating psychological distance between the person and his or her psychological content Taking unhelpful or self-critical thoughts a bit less seriously Focus on workability : Does buying into this thought improve your life in some way? If you did what this thought says, would you move closer or further away from doing things you would choose to do?
Our experiences of defusion in workplace groups Can be a confusing process Plenty of different techniques out there you name it, we ve probably tried it! Now settled on a relatively simple set of defusion practices: Noticing the mind in action Experiencing unhelpful thoughts in an unusual / playful context Taking unhelpful thought content a bit less seriously Offered as a skilful way of relating to thoughts
Small group discussion Share some of your own experiences of facilitating defusion with clients/ groups Reflect on defusion practices that might be best suited to brief group interventions/ workplace delivery 25/06/13
Our experiences of defusion in workplace groups Cultivating defusion from the outset: Therapist: Does anyone else have any hopes or expectations about what you might get from these three sessions? Participant: I d love to learn something that would help me to stop worrying and going over and over things in my head. Therapist: Right. Thanks Sam. So your mind loves a good worry?
Cont... Participant: It sure does. You name it, I ll worry about it! Therapist : Neat. We ll have a good look at that in these sessions; worrying is one thing minds are very good at! My mind is the same it loves a good old worry... Anyone else s mind do something similar? [most members of the group raise their hands]
Defusion demonstration Defusion-oriented psychoeducation Setting a challenging goal and noticing mind s output Experiencing an unhelpful thought in a playful context **see defusion exercise handout**
Setting yourself a challenging and values-based goal Where the magic happens Your comfort zone www.lifecompass.se www.lifecompass.se
Pairs/ small group discussion Any potential challenges of delivering ACT in workplace settings?
Common challenges in workplace applications of ACT Marketing of the intervention Intact work group or relative strangers in the room? Cynicism about purpose of the training/ who's paying you to do this? Group discussion veering off into organisational issues Personal values clashing with organisation's values
ACTING OUT PASSENGERS ON THE BUS
Passengers on the Bus Thoughts Feelings Voices Mindfulness Bell Memories Sensations
POTB role play indicates four ways of responding to thoughts: 1. Compromising with them 2. Arguing/ battling with them 3. Passive acceptance 4. Acceptance AND action
Important questions/ observations with POTB role play: For each of the four responses: Where is the focus of the person s energy? Do the thoughts become more or less important? Does the person move any closer to engaging in his/ her value-guided action?
Post-exercise reflections 1. From members of the group who actually participated 2. From wider group members 25/06/13
EXAMPLES OF ACT GROUP PROGRAMMES; Q&A
Personal Resilience Training 3 half-day sessions of skills training Mindfulness and values-based action Session 1: Basic mindfulness work; introduction to valuing; values card sort; translate one value into 3 specific actions for the next week; engage in valued actions and notice what happens when you do so Session 2 (one week later): Basic mindfulness work; home practice review; noticing and untangling from unhelpful thoughts, feelings, sensations, urges; construct a value in one or two life domains; translate one or two values into 4 values-based goals for next month; 3 valued actions for next week; public commitment Session 3 (one month later): Basic mindfulness work; assessment of valuesconsistency over past two weeks; contact values; acceptance and defusion exercises practiced; contacting resilient sense of self; final values-based goal and action planning; personal reflections and public commitment Flaxman, Bond, & Livheim (2013)
Main Results
8 7 6 5 4 3 ACT (non-cases) Control (non-cases) ACT (cases) Control (cases) 2 1 0 Time 1 Time 2 Time 3 Score of 4 and above = probable minor psychiatric disorder Flaxman & Bond (2010). Journal of Occupational Health Psychology
Final Exercise Based on what you have learned today, think about one thing you will do differently in your practice Then, in your small groups, make a public commitment to do this action (and notice your mind at work as you do this!)
Thank you for your attention today!