Acceptance and Commitment Therapy for Work Injury Prevention

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Bowling Green State University

Disqualifiers: Psychological distress, Mental health condition

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 2 weeks

255 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two types of therapy to reduce work-related injuries and stress among nurses and nursing aides. One therapy, Eastern Principles Acceptance and Commitment Therapy for Nurses and Nursing Aides (EPACT NNA), combines Eastern and Western mindfulness principles. The other, Acceptance and Commitment Therapy for Nurses and Nursing Aides (ACT NNA), uses only Western methods. The researchers aim to determine which therapy more effectively improves well-being and reduces injuries. Nurses and nursing aides in Ohio and Thailand who work in long-term care and healthcare settings are eligible to join. Participants will be assigned to either a therapy group or a no-treatment group for comparison. As an unphased trial, this study provides a unique opportunity to explore innovative therapies that could enhance well-being and work experience.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on therapy sessions rather than medication changes.

What prior data suggests that these interventions are safe for nurses and nursing aides?

Research has shown that Acceptance and Commitment Therapy (ACT) is generally easy for people to handle. In past studies, participants reported missing fewer workdays due to injury and experienced improved mental well-being. This suggests that ACT might be effective and safe for nurses and nursing aides.

For Eastern Principles Acceptance and Commitment Therapy (EPACT), specific safety information is limited. However, since it builds on the well-known ACT approach by incorporating Eastern mindfulness ideas, similar safety results are reasonable to expect. This expectation arises from the combination of familiar ACT methods and common mindfulness practices, both typically safe for most people.

In summary, both ACT and EPACT appear to be safe, with ACT having more documented evidence of being well-tolerated. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these therapies because they offer a fresh approach to preventing work injuries among nurses and nursing aides. Unlike typical physical or ergonomic interventions, these therapies focus on psychological flexibility, which helps individuals adapt to challenging situations. Acceptance and Commitment Therapy (ACT) is already recognized for its six core processes, but the Eastern Principles Acceptance and Commitment Therapy (EPACT) adds elements like compassion and awareness of impermanence. This unique blend aims to foster resilience and emotional well-being, which could potentially reduce work-related stress and injuries in a novel way.

What evidence suggests that this trial's treatments could be effective for work injury prevention?

Research has shown that Acceptance and Commitment Therapy (ACT) helps nurses reduce stress and improve mental health, leading to fewer work-related injuries. Participants in previous studies reported fewer days off due to injury and fewer mental health issues. In this trial, some participants will receive Acceptance and Commitment Therapy for Nurses and Nursing Aids (ACT NNA), which focuses on improving psychological flexibility to better manage stress. Another group will receive Eastern Principles Acceptance and Commitment Therapy for Nurses and Nursing Aids (EPACT NNA), which includes additional elements like compassion and mindfulness to enhance these benefits. Although EPACT is newer, its design suggests it could be just as effective, if not more so, by incorporating these extra components. ^{1 2 3 4 5}

Are You a Good Fit for This Trial?

This trial is for nurses and nursing aides in the USA (Ohio) and Thailand working in long-term care who have not started any treatment. They should be experiencing work-related stress, burnout, or musculoskeletal pain. The study excludes those outside of these regions or occupations, and anyone already undergoing similar therapies.

Inclusion Criteria

USA: Employed as a nurse or nursing aide in a long-term care facility within a 120 mile radius of Bowling Green, Ohio

Thailand: Employed as a nurse or nursing aide in Chiang Mai, Thailand or Krung Thep Bangkok, Thailand

I can attend all my medical appointments.

Exclusion Criteria

I will be referred to another treatment if I have significant mental health issues.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Assessment

Participants complete study questionnaires and baseline high frequency HRV measurement is collected

1 week

1 visit (in-person)

Treatment

EPACT NNA and ACT NNA participants attend two 2.5-hour sessions spaced one week apart

2 weeks

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment with follow-up surveys at 1 month and 3 months

3 months

2 surveys (remote)

What Are the Treatments Tested in This Trial?

Interventions

• Acceptance and Commitment Therapy for Nurses and Nursing Aids (ACT NNA)
• Eastern Principles Acceptance and Commitment Therapy for Nurses and Nursing Aids (EPACT NNA)

Trial Overview The trial tests Eastern Principles Acceptance and Commitment Therapy (EPACT) against traditional Western ACT therapy and no treatment to see which reduces work injuries, stress, burnout, musculoskeletal symptoms, time off from work due to injury among nurses and aids.

How Is the Trial Designed?

Group I: Eastern Principles Acceptance and Commitment Therapy for Nurss and Nursing Aids (EPACT NNA) Active Control 1 Intervention

The EPACT intervention is designed to promote psychological flexibility (Hayes, et al., 2006), compassion, a recognition of impermanence, common humanity, and non-self-attachment. Psychological flexibility has six core processes: acceptance, cognitive defusion, present moment awareness, self-as-context, values, committed action. The EPACT NNA intervention will be group-based with 5-10 participants per group. The group-based format has been shown to be an effective delivery method for NNAs (O'Brien, et al., 2019b). The EPACT NNA protocol is comprised of two 2.5-hour sessions spaced one week apart.

Group II: Control Group Active Control 1 Intervention

Control group participants will complete measures at the same time points as the EPACT NNA and ACT NNA groups. We opted to use a no-treatment control group to allow for measurement of the durability of treatment gains across a 3-month follow-up period without an expectation for treatment.

Group III: Acceptance and Commitment Therapy for Nurses and Nursing Aids (ACT NNA) Active Control 1 Intervention

The ACT NNA intervention has been previously tested for NNAs. It contains the six core processes identified above and omits the added EPACT components of acceptance of suffering, common humanity, impermanence, self- and other-compassion, and non-self- attachment. It will be delivered in a similar group-based format of 5-10 participants in three 2.5 - hour sessions.

Who Is Running the Clinical Trial?

Bowling Green State University

Lead Sponsor

Trials

2

Recruited

310+

Ohio Bureau of Workers Compensation

Collaborator

Trials

1

Recruited

260+

Published Research Related to This Trial

A group-based Acceptance and Commitment Therapy (ACT) intervention significantly reduced the number of days nurses and nurse aides missed due to injury and decreased mental health symptoms, indicating its efficacy in improving well-being in this high-risk occupation.

The study involved 71 participants from nursing homes and assisted living facilities in Northern Ohio, highlighting the potential of ACT to address the unique stressors and injuries faced by healthcare workers in long-term care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group-Based Acceptance and Commitment Therapy for Nurses and Nurse Aides Working in Long-Term Care Residential Settings. O'Brien, WH., Singh, RS., Horan, K., et al.[2019]

The study involved 82 patients who underwent orthopedic surgery, and those receiving an automated mobile messaging intervention based on Acceptance and Commitment Therapy (ACT) used 36.5% fewer opioid tablets compared to the control group, indicating a significant reduction in opioid consumption (P=0.004).

Patients in the ACT intervention group reported lower pain intensity scores after two weeks post-surgery (mean score of 45.9) compared to the control group (mean score of 49.7), suggesting that ACT may help in managing pain, although the difference may not be clinically significant (P=0.04).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Anthony, CA., Rojas, EO., Keffala, V., et al.[2020]

A virtual group-based acceptance and commitment therapy (ACT) intervention significantly improved psychological flexibility among 70 intern nurses, with effects lasting one month after the six-session program, indicating its efficacy in enhancing mental health.

The ACT intervention also led to significant improvements in social adjustment and a reduction in work-family conflict, suggesting it can positively impact intern nurses' job performance and overall quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of virtual group-based acceptance and commitment therapy on social adjustment and work-family conflict among intern nurses: a randomized control trial. El-Ashry, AM., Elhay, ESA., Taha, SM., et al.[2023]

A study involving 70 nurses from Razi Psychiatric Center showed that Acceptance and Commitment Therapy (ACT) significantly reduced perceived stress and increased psychological flexibility among nurses after eight 2-hour training sessions.

The experimental group that received ACT training reported lower levels of stress and higher psychological flexibility compared to the control group, indicating that ACT can be an effective intervention to support nurses in high-stress psychiatric environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy on perceived stress and psychological flexibility of psychiatric nurses: a randomized control trial. Zarvijani, SAH., Moghaddam, LF., Parchebafieh, S.[2021]

A study involving 16 Finnish nurses using an acceptance and commitment therapy-based mobile app for 5 weeks found that they perceived it as a suitable self-management tool for preventing and treating depression.

The nurses identified three practical models for using the app in clinical settings, but expressed concerns about the need for proper training and the importance of assessing the app's benefits versus risks for specific client groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applicability of acceptance and commitment therapy-based mobile app in depression nursing. Kaipainen, K., Välkkynen, P., Kilkku, N.[2018]

A systematic review of 11 randomized controlled trials found that Acceptance and Commitment Therapy (ACT) is effective in reducing symptoms of depression, anxiety, and hallucinations in individuals with psychotic disorders.

The majority of studies (82%) were published after 2010, indicating a growing interest in ACT as a practical treatment option for psychotic disorders that can be utilized by nurses and clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials. Yıldız, E.[2020]

A systematic review identified over 50 questionnaires related to Acceptance and Commitment Therapy (ACT), highlighting specific measures for different components of ACT, such as the AAQ-II for acceptance and the CFQ for defusion.

Clinicians and researchers have access to a variety of ACT measures, most of which are free to use, facilitating the assessment of therapy effectiveness in Dutch-speaking populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[New generation behaviour therapy; new generation assessment measures; a review of currently available assessment measures]. Batink, T., Jansen, G., Peeters, FP.[2018]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06813495

Eastern Principles Acceptance and Commitment Therapy For ... This clinical trial will evaluate the effectivness of an Eastern Principles Acceptance and Commitment Therapy intervention (EPACT) relative to an estabished ...

2. trialx.com trialx.com/clinical-trials/listings/302147/eastern-principles-acceptance-and-commitment-therapy-for-injury-prevention-among-nurses-and-nursing-aides/

Eastern Principles Acceptance and Commitment Therapy For ... Specific Aim 1: Conduct a randomized clinical trial to evaluate EPACT NNA's effectiveness against traditional ACT for NNAs and a no-treatment control group.

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31314564/

Group-Based Acceptance and Commitment Therapy for ... Results: Participants in the ACT group reported significantly fewer days missed due to injury and a significant reduction in mental health symptoms compared to ...

4. withpower.com withpower.com/trial/phase-well-being-psychological-4-2023-95a42

Acceptance and Commitment Therapy for Work Injury ... Research shows that Acceptance and Commitment Therapy (ACT) can help reduce stress and improve mental health for nurses, leading to fewer work-related injuries ...

5. researchgate.net researchgate.net/publication/334532473_Group-Based_Acceptance_and_Commitment_Therapy_for_Nurses_and_Nurse_Aides_Working_in_Long-Term_Care_Residential_Settings

Group-Based Acceptance and Commitment Therapy for ... Results: Participants in the ACT group reported significantly fewer days missed due to injury and a significant reduction in mental health ...