Evaluating ACT Workshops: Changes in Knowledge and Clinical Practice

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Evaluating ACT Workshops Changes in Knowledge
and Clinical Practice

• Eric Morris, Joe Oliver, Rachel Richards,
• Alessandra Iervolino Janet Wingrove

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ACT Workshops

• Following the 2006 ACT World Con in London we
  thought it would be a good idea to introduce more
  of our colleagues to the approach
• So we led 3 one-day Introductory ACT workshops,
  and attempted to evaluate them!
• Aim of training was to increase interest and
  knowledge in ACT, situating it as part of the
  broader family of behavioural and cognitive
  psychotherapies.

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Context (where we work)

• a mental health Trust that employs over 300
  psychologists
• Largest mental health Trust in the UK, and
  supports research and innovation, linked with the
  Institute of Psychiatry and Kings College
• a number of specialties adult, child, older
  adult, learning disability, forensic services
• the majority of psychologists are CBT trained,
  using a formulation-based approach (rather than
  manualised treatments)

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Context 2

• We arranged for ACT workshops to psychologists
  working with adults in 3 directorates
• Interest was high, with the workshops having
  attendance from the majority of psychologists in
  these directorates.
• Workshops were designed to be a mixture of
  theory, experiential exercises and discussion of
  the state of the evidence for ACT.

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Context 3

• We were interested to see how ACT would be
  received by our colleagues, and hopefully turn
  some more people on to it as an approach.
• As psychologists in the UK tend to be trained in
  a broader form of CBT, it was going to be
  interesting to see whether people could integrate
  ACT into their idea of what CBT is, and use some
  of the techniques and functional analytic
  thinking in their practice.
• We sent participants a copy of Russ Harris' paper
  Embracing your Demons an introduction to
  Acceptance and Commitment Therapy prior to the
  workshop.

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Content of training

• Based on our aims, training sought to
• Engage audience
• Offer some theoretical background
• Balance theory with experiential exercises (give
  examples of exercises used)
• Review outcome data
• Suggest the ACT model as an interesting
  alternative. Avoid direct challenges
• Consider how audience could pragmatically use ACT
  in their current practice

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Some experiential exercises used

• Leaves on a Stream
• Lifetime Achievement Award (Attend your own
  funeral)
• Milk, Milk, Milk
• Wearing a label
• Taking Your Mind for a Walk
• Eyes On

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Evaluation and Feedback

• Knowledge - AKQ (ACT Knowledge Questionnaire
  Luoma, 2007), Discriminating CBT/ACT
• Interest/Intentions to learn more ACT (visual
  analogue)
• Evaluation of Experiential Exercises
• Qualitative Feedback

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Results
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Participants

• Feedback collected from 38 participants pre and
  post, and 24 followed up after 12 months
• A minority of participants were pre-qualification
  psychologists (trainees or assistants N 3
  pre/post, N 0 f/u)
• Therapeutic orientation
• CBT or CBT other 92
• 8 participants had previously attended ACT
  workshops

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Effect on ACT Knowledge

• Paired t-test (N32) demonstrated a main effect
  of time on the number of correct responses to the
  AKQ.
• There were more correct answers post-workshop
  (mean 8.9, SD 2.7, range 3-14) compared with
  pre-workshop (mean 7.1, SD 2.8, range 2-14).
• E.g., Q10 Which of the following is not an
  ACT-consistent explanation of psychopathology?
• emotional avoidance.
• ineffective thinking and behavior patterns.
• cognitive fusion.
• lack of committed action.

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Discriminating ACT from CBT

• Discriminating important components of each
  approach (criterion-related)
• Participants scored significantly better at
  identifying important ACT components
  post-workshop
• Specific effect, with no changes in identifying
  CBT components
• Use of Metaphor in ACT- Important? Pre 66
  Post 84
• Identifying cognitive errors in ACT Important?
  Pre 66 Post 34

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Discriminating ACT from CBT

• Inspection of data showed greatest improvement in
  following items on ACT questionnaire
• Realising not important
• Identifying cognitive errors
• Using written thought records
• Challenging negative thoughts and beliefs
• Working with dysfunctional assumptions
• Realising important
• Use of metaphors
• Reflect bias in assuming everything important to
  start with but then being able to be selective
  and understand what not important after the
  workshop.

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Satisfaction with Experiential Exercises

• Relationship between expectations regarding
  disclosure and coercion
• People who anticipated difficulty sharing
  reported post-workshop that it was difficult to
  share (r .55, p lt.01)
• Found the exercises coercive?
• In general most people didnt (mean 1.6, SD
  1.9, range 0 7.4)
• However, People who reported difficulty sharing
  tended to feel more pressured/coerced to disclose
  experiences (r .49, p lt.01)

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Intention to learn more ACT

• Likely to Read more 94
• Likely to Use ACT 89
• Likely to do Further Training 89

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12 month feedback

• Influence on clinical work
• 83 said yes, with 90 saying with 3 or more
  clients
• 63 said it influenced their supervision practice
• Planning to use ACT in the future 92
• How?
• Integrated with another treatment approach 46
• Recommend workshop to colleagues? 96

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Conclusions

• How to assess effectiveness in ACT training
  knowledge, behaviour change?
• Most clinicians may integrate ACT into their
  practice rather than have a Damascene
  conversion
• Acceptability of experiential exercises
• use informed consent, however even with this a
  minority of therapists will anticipate and
  experience exercises as aversive, and perceive
  the use of them as coercive

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Discussion

• Assessing the impact of ACT training is best done
  across several domains
• Improvements in knowledge
• Satisfaction with content and perceived
  usefulness
• Changes in behaviour
• Doing training in an ACT-consistent fashion
• Not dogmatic but pragmatic
• Building on clinicians repertoires, expanding
  practice
• Being willing for some people to not get it,
  and not like it
• An introduction to ACT doesnt have to be a 2 day
  highly experiential workshop, to get people
  enthused about the model

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Discussion Points

• Future training alteration to content?
• Issue of coercion re experiential exercises
• Future of evaluation of ACT training

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Contact Eric.Morris_at_kcl.ac.ukJoseph.Oliver_at_sl
am.nhs.uk