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Workplace ACT Intervention vs MBSR Training for Sleep: Outcomes and Mechanisms

This study compares the effectiveness of a workplace ACT intervention to MBSR training for sleep outcomes and explores the underlying mechanisms of change. The research involves a randomized controlled trial with participants from an NHS mental health trust. The results suggest that both interventions are effective for improving sleep, with ACT training focusing more on behavioral changes and MBSR training emphasizing mindfulness. The study also highlights the importance of goal-directed behavior in improving sleep outcomes.

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Workplace ACT Intervention vs MBSR Training for Sleep: Outcomes and Mechanisms

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  1. The effectiveness of a workplace ACT intervention compared to MBSR training for sleep – outcomes and mechanisms Joe Oliver Vasiliki Christodoulou Paul Flaxman & Eric Morris

  2. Reading RFT Purple Book The morning after the Follies In bed actually trying to sleep

  3. Problems with workplace sleepiness • 2008 'sleep in America' poll - 65% of people experienced sleep problems a few nights per week. • Amount of sleep workers get has been declining steadily over past 30 years as working hours have increased (declined around 7% between 1999 and 2009 alone) • Estimated economic burden of sleepiness (figures from US): $16 billon in medical expense; $53 to $69 in vehicle accidents, $18 - to $24 billion in work-related accidents • (Source: Mullins et al. 2014; Welsh et al. 2014)

  4. A Range of Consequences Linked to Poor Sleep • Common mental health problems; unethical work behaviour (due to reduction in self-regulatory resources); poor mood; incivility in workplace; various physical health problems (obesity, hypertension, CVD), increased absence rates, reduced work performance

  5. ACT Vs Mindfulness-Based Training

  6. Research Questions • Comparing ACT training to Mindfulness-based training (low-dose) on sleep outcomes for working individuals. • Do the interventions operate via the expected mechanisms of change? -ACT (values-based action) -MBSR (mindfulness)

  7. Participants • Staff from an NHS mental health trust. • 26% nursing, 15% psychology, 11% administrative, 8% allied health & other professions. • N=200; ACT(n)=66; Mindfulness(n)=58; Waiting list(n)=75 • Dropout by T5: T5 waitlist: 22.6% T5 Act: 25.7% T5 Mindfulness training:29.3% • 77% female • Mean age=42 (sd=10.4) • 58.6%:Above clinical level of distress at T1.

  8. Protocol • 4 sessions (3, 2-hour sessions in consequent weeks; one session after 6 weeks). • Randomised controlled trial (ACT, Mindfulness-based training, Waiting list). • Completion of measures at pre (T1), post 4 weeks (T2), post 10 weeks (T3), post 16 weeks (T4), follow-up 22 weeks (T5). • Groups: 5-12 participants

  9. ACT worksite protocol

  10. MBSR worksite protocol

  11. Questionnaires • General Health Questionnaire-12 • Perceived Stress Scale • Work Limitations Questionnaire • Sleep Scale (from physical health questionnaire) • Activity and Circumstances Change Questionnaire • Acceptance & Action Questionnaire-7 • Five Factor Mindfulness Questionnaire • Behavioural Activation Scale • Valuing Questionnaire

  12. Questionnaires • Sleep Scale (from physical health questionnaire) • “How often have you had difficulty getting to sleep?” • “How often have you woken up during the night?” • Activity and Circumstances Change Questionnaire (4 item) • “Please rate the extent to which you have adopted some significant positive new goal or activity over the last 4 weeks” • Five Factor Mindfulness Questionnaire • Act with Awareness • Non-judgement • Non-reactivity

  13. Analysis and Results • Latent growth curve modelling • Rate of change across 5 time points in outcome • Rate of change of mediators • Does rate of change of goal directed behaviour and mindfulness mediate the effect of the interventions on sleep?

  14. t1 t2 t3 t4 t5 t3 t4 t5 t1 t2 FFMQ Intercept FFMQ Slope Sleep Intercept Sleep Slope ACT Mindfulness training Goals & activities Intercept Goals & activities Slope t1 t2 t3 t4 t5 = 237.78, df = 127, p < .0001, CFI = .92, TLI = .92, RMSEA = .066 (.053, .079)

  15. Main Results

  16. Main Effects Mindfulness .27 -.60 ACT .43 -.49 Sleep Problems -.54 Mindfulness training .47 .40 -.70 Goals & Activities

  17. Indirect Effects Mindfulness ACT Sleep Problems Mindfulness training Goals & Activities

  18. Indirect Effects - ACT Mindfulness ACT Sleep Problems Mindfulness training -.33 Goals & Activities

  19. Indirect Effects - Mindfulness Mindfulness ACT Sleep Problems Mindfulness training -.28 Goals & Activities

  20. Summary • Both ACT training & Mindfulness-based training appear to be suitable and effective for poor sleep • Programs can be brief. • ACT impacts more on behavioural changes • MBSR impacts more on mindfulness • Change in both interventions appears to be mediated through increases in goal directed behaviour

  21. Summary (2) • Behavioural change important in sleep outcomes • Change to routines • Increased self care • More values guided behaviour • Evidence that impact is not via “relaxation” processes • Next steps to look more closely at rates of change of variables

  22. Thank you! Any questions?

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