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

Trial Summary

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 data supports the effectiveness of the treatment Acceptance and Commitment Therapy for Nurses and Nursing Aids (ACT NNA) and Eastern Principles Acceptance and Commitment Therapy for Nurses and Nursing Aids (EPACT NNA)?

Research shows that Acceptance and Commitment Therapy (ACT) can help reduce stress and improve mental health for nurses, leading to fewer work-related injuries and missed days. In a study, nurses who participated in ACT reported fewer mental health symptoms and rated the treatment positively. ^{1 2 3 4 5}

How is the treatment Acceptance and Commitment Therapy for Nurses and Nursing Aids (ACT NNA) unique compared to other treatments for work injury prevention?

ACT NNA is unique because it focuses on improving psychological flexibility and reducing stress through mindfulness and values-based actions, which can help nurses and nursing aides manage work-related stress and reduce injuries. This approach is different from traditional treatments that might focus solely on physical safety measures. ^{2 3 5 6 7}

What is the purpose of this trial?

This clinical trial will evaluate the effectivness of an Eastern Principles Acceptance and Commitment Therapy intervention (EPACT) relative to an estabished traditional Western-based Acceptance and Commitment Therapy intervention (ACT) and a no treatment control group. The participants for the study will be nurses and nursing aides (NNAs) who work in long-term care settings in the USA and Thailand. The primary dependent variables are work-related injuries, work stress and burnout, wellbeing, musculoskeletal symptoms, time off from work due to injury. High frequency heart rate variability will also be investigated as a predictor of responsiveness to the interventions. The study has three primary aims: 1. To compare the EPACT NNA intervention to an established traditional Western ACT NNA intervention and a no-treatment control group. 2. To identify predictors of ACT NNA and EPACT NNA responsiveness to the interventions and injury likelihood across time. 3. To assess EPACT NNA's feasibility and effectiveness across cultures. USA participants working in Ohio will be randomly assigned to one of three groups: EPACT NNA (n = 80), ACT NNA (n = 80), or a no treatment control group (n = 80). All participants will participate in an assessment session where study questnnaires are completed and a baseline high frequency HRV measurement is collected. Subsequent to the assessment, the EPACT NNA and ACT NNA participants will attend two 2.5 hour sessions spaced one week apart. The control group will have no further in-person meetings with the researchers. One-month after completing the intervention (4 weeks after the baseline assessment) a follow-up survey will be sent to participants for the first follow-up. Three months after baseline, the second follow-up survey will be sent to participants. The surveys assess demographic characteristics, organizational variables, work-related injuries, work stress, and well-being. A second RCT study will be conducted in Thailand comparing EPACT NNA (n = 40) to a no-treatment control group (n = 40) among nurses and nursing aides working in healthcare settings. The same outcome measures and procedures will be used. This research aims to develop a culturally-informed, evidence-based intervention that integrates both Western and Eastern mindfulness principles to address the high rates of work-related injuries among NNAs.

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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 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 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 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]

References

1. England 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. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy on perceived stress and psychological flexibility of psychiatric nurses: a randomized control trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

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

4. England pubmed.ncbi.nlm.nih.gov

Applicability of acceptance and commitment therapy-based mobile app in depression nursing. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Group-Based Acceptance and Commitment Therapy for Nurses and Nurse Aides Working in Long-Term Care Residential Settings. [2019]

6. Canada 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. [2020]

7. Netherlands pubmed.ncbi.nlm.nih.gov

[New generation behaviour therapy; new generation assessment measures; a review of currently available assessment measures]. [2018]