Running head: Acceptance and Commitment Therapy: A Literature Review 1

Acceptance and Commitment Therapy: A Literature Review

Samantha Black

Christelle Elvinia

Jennifer Hubner

Jessica Wilson

Indiana University-Purdue University Indianapolis

Acceptance and Commitment Therapy: A Literature Review 2

Abstract

Acceptance and Commitment Therapy strives to increase psychological flexibility in order to

better align an individual with their goals. This literature review seeks to outline the six

components of ACT, before exploring the research conducted regarding the efficacy of utilizing

this therapy with chronic pain patients and in workplace training methods. Mentioning the use of

ACT in chronic pain in this review displays its effectiveness and flexibility compared to the

workplace setting. This then sets the stage of how ACT techniques are used differently to

maximize employees' effectiveness. Specifically, this paper is to inform and present the research

for the Healthy IU-Personal Resiliency Training. However, suggestions are only made based on

the articles gathered for the review and may not take into account all research that has been

completed on this topic. The specific conclusions about the information gathered, and the future

continued use of this therapy in the workplace, are discussed.

Keywords: Acceptance and Commitment Therapy (ACT), chronic pain, workplace training
methods, Healthy IU
Acceptance and Commitment Therapy: A Literature Review 3

Acceptance and Commitment Therapy: A Literature Review

Personal Resiliency Training is a training program that is available to Indiana University,

Bloomington as well as Indiana University-Purdue University Indianapolis employees, as part of

the Healthy IU initiative. The training program at IUPUI is relatively new and has only been

offered for a little over a year. The program consists of Acceptance and Commitment Therapy

based strategies that are taught in order to improve employees’ psychological health and

performance at both home and work. Those in charge of the program are trying to determine its

influence on the lives of their employees in order to both improve and increase its use in more

programs throughout Indiana University and IUPUI. Therefore, they are in need of the

development of an interview protocol that will help guide the qualitative assessment of the

program and individuals to pilot the interviews. In order to assess the program’s fullest potential,

a deeper look into the benefits of ACT throughout its therapy use, as well as in the organization

settings, are necessary. Evidence shows that Acceptance and Commitment Therapy

implemented in counseling and the workplace has proven beneficial in offering improved

behavior for individuals and results from therapy and training have significantly transferred in

their emotional responses and social interactions, even beyond the workplace. Following is an

in-depth look at Acceptance and Commitment Therapy, a look at the research showing its effects

on chronic pain, and ACT training in the workplace.

Acceptance and Commitment Therapy

Since the Personal Resiliency Training program is based off of strategies that are from

Acceptance and Commitment Therapy (ACT), it is important to fully understand exactly what

this therapy entails. ACT has its roots in Relational Frame Theory. Relational Frame Theory

seeks to figure out the meanings behind the language that controls people’s lives. According to
Acceptance and Commitment Therapy: A Literature Review 4

Blackledge (2003), ACT is a treatment that involves methodical efforts to diffuse the meaning

behind negative thoughts (p.431).

For a more in depth understanding, Acceptance and Commitment Therapy is clearly

explained by Russell (2007): the main goal of this therapy is to increase psychological flexibility,

which is to fully immerse oneself in the current moment and thereby be able to examine the

psychological reactions that particular moment causes, as a completely aware human being, and

depending on the situation, to continue with or change the behaviour in order to reach the desired

result. In ACT, symptom reduction is not the goal, even though it does frequently happen (p.2).

The evidence of Acceptance and Commitment Therapy being effective for both adults in

the workplace and for students, appears to be conclusive. According to the research done by

Ciarrochi, J. Bilich, L., & Godsel, C. (2010), they found that ACT definitely has beneficial

outcomes and it is largely due to an increase in psychological flexibility. They found evidence to

suggest that ACT will improve both their acceptance of negative thoughts and help them to

defuse those difficult thoughts (p. 22). Pakenham (2017) stated that ACT is founded on the

premise of the theory that human suffering comes mainly from language and cognition processes

(p. 188). In essence, human beings are only miserable because they make themselves miserable

through inner dialogue, and fighting against that dialogue, rather than accepting and taking

action.

Acceptance and Commitment Therapy is comprised of two goals: acceptance that life

throws us situations which are out of our control and committed action towards living a valued

life. It is also comprised of six core process that are often seen arranged in a hexaplex. “The

hexaplex illustrates that these processes are all connected and support each other. There is not a

correct order for focusing on the processes and not all individuals need to concentrate
Acceptance and Commitment Therapy: A Literature Review 5

extensively on each of the processes” (Ciarrochi, J. Bilich, L., & Godsel, C., 2010, p.6). These

processes are: contact with the present moment, acceptance, defusion, self-as-context, values,

and committed action.

Six Core Processes

One of the first core process of ACT is contact with the present moment. Being

completely aware of your experience in the present allows you to correctly perceive what is

happening and gives you critical information about the need to continue or change that behavior.

This also allows the person to be completely engaged in their task at hand (Russell, 2007, p. 3).

Contact with the present moment is a lot like mindfulness, which will be covered in more depth

later.

The second core process of ACT is acceptance. According to Ciarrochi, J. Bilich, L., &

Godsel, C., (2010), the purpose of acceptance is to create and increase a person's ability and

readiness to accept what is happening in their life. The treatment is taking a deep look at how

pointless emotional avoidance or control actually is (p. 7). By accepting your individual reality,

a person will not continue unhealthy behaviors that are caused by fighting against something that

just IS.

The next core process of ACT is defusion. Russell (2007) said that the goal of defusion is

not to remove unwanted thoughts or make yourself feel better, but instead to lower the amount of

influence negative thoughts have on an individual’s behavior. Defusion starts the process of

being psychologically present, engaged, and aware in order to increase psychological flexibility

(p. 3). “Defusion exercises help people to notice their language processes as they unfold and to

watch the thoughts come and go, from the perspective of a neutral observer. Defusion thus

involves a radical shift in context, where thoughts are observed events, rather than literal truths
Acceptance and Commitment Therapy: A Literature Review 6

that must dictate behavior” (Ciarrochi, J. Bilich, L., & Godsel, C., 2010, p. 6). In ACT, Defusion

is a process where the patient stops and observes the negative thought, decides how the thought

is making them feel, identifies the connection between thought and feeling, and then uses a

situational metaphor to help understand that you can change the thought and thereby change the

feeling it causes.

Another core process of ACT is committed action. Committed action is basically

following your values by backing it up with your actions. According to Ciarrochi, J. Bilich, L.,

& Godsel, C. (2010), ACT teaches that choosing a valued direction is not something that will

only happen once, but something that needs to continue to happen over and over, even when you

fail (p. 8). Committed action is teaching the concept of living your truth. Every single day, in

every situation, continue to show your values in everything that you do.

The next core process of ACT is values. How a person views not only him/herself, but

the world, is the cornerstone of their value system. ACT works by first having someone identify

their core values and then helping to understand how their values drive their behavior (Berryhill

et al., 2015, pp. 25-30). These behaviors then lead to their desired goals. By knowing what is

truly important to someone as an individual, it is easier to better make sense of why they

behaviorally do the things that they do. Sticking to these sets of core beliefs helps an individual

to have a very fulfilling life. This aspect of ACT has also been shown to be beneficial to

adolescents, as well as adults. When adolescents use Acceptance and Commitment Therapy to

help evaluate their values, it allows them to reach their goals and become less frustrated with

school (Berryhill et al., 2015, pp. 25-30). This is especially beneficial for youth because it helps

to identify their core values early on in their lives for future goal oriented behaviors. If ACT can
Acceptance and Commitment Therapy: A Literature Review 7

be put in terms that adolescents can understand and benefit from, then adults should also be able

to benefit from this program.

If someone feels as though their values are not matching their behaviors, or that their

current behavior is not getting them to their ultimate goal, they can use Acceptance Commitment

Therapy to help them re-evaluate what is important to them and what behaviors will get them to

their goals (Gloster et al., 2017, pp. 63-70). When going about reevaluating core beliefs, it is

important to remember why the previous beliefs did not allow for goals to be achieved. This is

important so that when an individual starts to slip back into their old ways, they can become

aware of this slippage and change it to continue reaching their goals. If an individual slips back

into their previous behavior, it can lead to undesirable outcomes, causing anxiety in some

individuals. ACT has been shown to improve anxiety by helping participants become aware of

the fact that their values are not in line with their current behaviors, giving them the knowledge

of what they can do to accept and change (Gloster et al., 2017, pp. 63-70). Due to the fact that

many people live their lives with anxiety about the future, Acceptance Commitment Therapy can

help these individuals focus on their values to assist them in practicing healthy behaviors to

reduce their anxiety, while striving to reach their goals. Understanding that thoughts influence

feelings, which influence behaviors, can allow for a deeper understanding of how behaviors lead

to accomplishing goals.

The final core concept of ACT is self-as-context. Self-as-context refers to the idea of

observing self, being aware of the awareness. This observer self is free of any type of labels

(positive or negative) that may be unintentionally placed. This allows an individual to get out of

their heads and see things as they are, unbiasedly. The idea of self-as-context has proven to be

valuable to individuals who experimentally had to cope with induced pain (Carrasquillo et al.,
Acceptance and Commitment Therapy: A Literature Review 8

2014, pp. 659-669). By simply making a person aware of the fact that although they are in pain

right now, this pain will not last forever, and the pain does not define them as a person; these

people were better able to cope with this induced pain. Having someone understand that they are

more than the pain they are feeling at the current moment, it will pass, and they will continue

living their best life, is the key idea of obtaining a good self-as-context. Using self-as-context in

action allows a person to see themself as unchanged by these experiences. Being unchanged by

these experiences lets an individual examine exactly what they are thinking in that moment and

what they can do to change their thoughts.

Self-as-context not only allows people to become aware of their own thoughts, but also

to take in other’s perspectives. If a person finds him/herself making a snap judgment about

someone else, using self-as-context in the situation enables them to stop that thought and really

analyze it to see if that specific thought is beneficial to the current situation. By noticing if a

thought would not be helpful in a situation, a person is able to quickly diffuse the thought so that

it does not lead to an undesirable feeling, which would lead to a less than helpful behavior. This

type of perspective taking allows for empathising with others and trying to understand a situation

from their perspective. Being able to empathise with others is very helpful in acquiring personal

communication skills. The ability to do this allows for a more flexible sense of self. This type

of self-as-context for psychological flexibility also gives us the ability to understand why people

exhibit the behaviors they do. It is important to keep in mind that what makes sense to one, may

not make sense to others, and that is why having psychological flexibility is important.

Psychological Flexibility

Psychological flexibility is at the core of the six processes of ACT. Psychological

flexibility allows an individual to adapt better to changing situations, change their perspective of
Acceptance and Commitment Therapy: A Literature Review 9

a situation to a more beneficial mindset, and use this changed perspective to adapt to changing

situations. In a study on the influence of psychological flexibility on life satisfaction and mood

in people with muscle disorders, psychological flexibility is shown to be a strong predictor of

well-being (Ferreira et al., 2016, pp. 210-217). The ability of being flexible allows for reduced

frustration when things change in life or at work. Psychological flexibility allows individuals to

change their perspective on changing situations by focusing on the good aspects of change,

rather than ruminating on what may be considered the negative aspects of a change. This equips

people with the ability to open up and do what matters, instead of focusing on the stressful issues

that are apart of change or unexpected situations. Psychological flexibility enables people to live

a happier and more fulfilling life by teaching them to be present in the moment and roll with the

punches of life. With the theory fully explained, ACT and its different components have been

observed in different settings, a few being the workplace environment and in individuals dealing

with chronic pain.

ACT in Chronic Pain

In 2008, according to the Medical Expenditure Panel Survey (Gaskin, 2011), about 100-

million adults in the United States were affected by chronic pain. Chronic pain limits functional

and emotional status (Hughes, 2017) and impairs the quality of life of those who suffer. Chronic

pain is also very costly to manage, consisting of multiple doctor visits, physical therapy, and/or

prescriptions which are common among Americans. What is lesser known is that pain, coupled

with either anxiety or depression (or both), can further complicate the process of mitigating the

physical sensations and perception of pain. This feedback loop can become unbearable to some,

potentially leading them to coping with an opioid regimen. Between 2002 and 2012, treatment

admissions linked to prescription opiates more than quadrupled (NIDA, 2018). Current research
Acceptance and Commitment Therapy: A Literature Review 10

on ACT and its effect on pain, and subsequent depression and anxiety, could possibly show

people how to become more in tune with their perception of pain thereby reducing the amount of

opiates they consume. This would then help people learn to handle their experiences of chronic

pain instead of masking it. Following are a few studies that discuss pain management and ACT,

including findings from a meta-analysis, as well as suggestions of how to use this information for

better pain management. Lastly, looking at how American culture increasingly uses smartphones

for healthcare needs, it would be wise to investigate how using a smartphone application for

ACT impacts participants. As a society without a lot of free-time, perhaps an application like

this can serve those times between active sessions to stay on track with various treatments.

In the article written by Yu, et al. (2017), researchers discuss the impact of self-as-

context (SAC), otherwise known as perspective taking, in terms of ACT and chronic pain, and

the correlations with chronic pain and depression. This longitudinal study is consistent with

other longitudinal and mediation studies that show how ACT improves patient functioning

specifically through its proposed mechanisms that enhance psychological flexibility—the core of

ACT. Yu et al. says that the improvement in treatment processes underlying ACT should

correlate with improvement in functioning. Their primary focus was how psychological

flexibility allowed people to be fully in contact with the present moment without needless

defense, and to persist or change behaviors in the service of one’s goals (p. 664).

There are significant associations between rumination, decentering, and depression

reported in previous studies that show how being entangled and consistently focused within

one’s thoughts contributes to depression. In this study, a strong association between SAC and

depression suggests an effect with ACT on emotional functioning which has been stable in

previous research. One of the key components to SAC is “distancing one’s self from thoughts”
Acceptance and Commitment Therapy: A Literature Review 11

or “disentangling” from thoughts which infers its effect on emotional functioning (p.670). A few

takeaways from this study include: while pain acceptance showed a relatively large effect size at

post-treatment, the effect size for SAC was particularly small and declined at the follow-up (p.

670). This was noted as a possible challenge for group delivery of ACT and proposed a more

individualized focus on shaping SAC before a group setting, however, this was also suggested as

speculation on the behalf of those researchers. Also, a very peculiar outcome happened during

this particular study: some participants (Ps) actually worsened in their functioning after treatment

and differed from those who improved on changes in SAC from the baseline to post-treatment.

Ps who worsened showed a decline in SAC whereas most Ps improved which supports the

proposed association between SAC and functioning (pp. 670).

Some further research should include why some Ps actually worsened as well as ensuring

post-treatment follow-ups, and limitations include the need for a more randomized sample of Ps

with chronic pain (these Ps were referrals from a pain management center), how chronic pain is

mitigated in other cultures and geographical locations, and finally, since this particular study is

not random or experimental, causal relationships cannot be drawn between SAC and functioning,

despite differences between baseline measures and post-treatment follow-ups.

The study by McCracken & Vowles (2014), focuses on how mindfulness and ACT

interact with chronic pain by centering, again, on psychological flexibility. This paper discusses

the differences between CBT and ACT, especially the context of the thoughts a person has. ACT

is a treatment approach within CBT, is rooted in learning theory and behavioral processes,

processes of language and cognition guided by relational frame theory (RFT) and shows a

bidirectional relationship between language and situational context (p. 181). ACT emphasizes

noticing events and their context rather than CBT’s approach at changing these thoughts. In
Acceptance and Commitment Therapy: A Literature Review 12

terms of pain management, learning how to cope with pain seems more useful than trying to

change our thoughts about the pain. When a person learns that they have control over their

response to pain, quality of life can be improved, even if slightly. The processes behind

psychological inflexibility shows a model for how beliefs, thoughts, rules, and even pain or other

psychological experiences can narrow the range of a person’s available responses and obstructs

healthy behavior (p. 181).

To determine what professionals thought about using acceptance-based versus cognitive-

behavioral therapies, a survey was administered to 176 licensed and practicing cognitive

behavioral therapist (88 self-identified as traditional CBT or acceptance-based therapists) were

asked about attitude toward evidence-based practices and thinking styles (p.182). Those who

self-reported favoring CBT reported greater use of cognitive restructuring and relaxation while

those who favored ACT reported greater use of exposure, mindfulness, and family systems

theory. The results from this survey showed that ACT is neither inferior nor superior in efficacy

compared to established approaches, the only difference really being the techniques used

(McCracken, 2014, p. 181).

In current and ongoing studies of ACT and pain management, there is additional support

in favor of ACT by observing effect sizes. Research shows an average small-to-medium effect

size for CBT but not maintained at follow-up (Huges, 2017, p. 552) while ACT has been shown

to be consistent at follow-up (Huges, 2017, p. 560) and sometimes beyond. There are

increasingly consistent positive effects of ACT including: increases in physical and social

activity, decreased pain-related medical visits, and consistent outcomes during follow-ups (even

at the 3 year mark, [McCracken, 2014, p. 182]).

Acceptance and Commitment Therapy: A Literature Review 13

While ACT is listed by the American Psychological Association as an empirically based

treatment for chronic pain (Division 12), meta-analysis show that ACT approaches are at least as

effective as traditional CBT methods (McCracken, p. 182). An increase in acceptance of pain

correlates with improvements during the treatment in the form of reduced anxiety, depression,

and disability. An increase in values-based action correlates with improvements observed at the

3 month follow up in the same outcomes (McCracken, p. 182). Also noteworthy, increases in

pain acceptance, general psychological acceptance, mindfulness, and values-based action during

the active phase of treatment significantly correlated with improvements in anxiety, depression,

and disability at the 3 month follow-up independent of changes in pain! To summarize,

psychological flexibility mediated pain management outcomes as predicted, and ACT produces

significant improvements in outcomes for people with chronic pain, however, the improvements

are specific to the therapeutic process and not the underlying processes specified by other

theories (McCracken, p. 182). For further development, we need larger sample sizes, as usual.

More information is needed to determine how mindfulness-based approaches may or may not

change behavior related to improved physical and social functioning. Finally, a recent

consideration in ACT training is the rise of technology in the helping professions.

The next study we look at discusses implications for therapist-guided and unguided ACT

or CBT in comparison to those offered via the Internet (IACT, ICBT), smartphone applications,

or through computers, both guided and unguided. In general, therapist-guided CBT showed

higher symptom reduction than unguided programs and had better results with client adherence

and compliance to the program. This upholds the hypothesis that guided treatment is superior to

unguided treatment, regardless of mode (in real life or smartphone application).

Acceptance and Commitment Therapy: A Literature Review 14

There is much to consider regarding internet-delivered treatment versus face-to-face

treatments. As far as internet-based treatment goes, smartphone applications (apps) have been

popping up as supplemental therapies for the between session exercises. The primary advantage

of the apps is that they offer an opportunity for the client to participate in active behavioral

modification in their everyday life. These apps offer self-monitoring, increased privacy and

comfort, and possibly influence the idea of stigma associated with mental illness and may also

mimic the therapeutic setting where the client performs a task and gets immediate feedback and

support (Ivanova, et al., 2016, p. 2).

This particular study (Ivanova, et al., 2016) was based on the core principles of ACT and

the program was marginally organized to complete one “module” per week. Ps could choose to

use just an application (online or smartphone), just a book offered as supplemental, or both the

book and the application. The results from the study show that the guided group accessed the app

more often and completed more modules on the application. There was shown to be a moderate

between-group effect size showing that guided was indeed favored for completion.

In terms of results, 10 individuals met the criteria for a clinically significant improvement

in the unguided group at post-treatment compared to 14 in the guided group. In all, the

difference was not statistically significant and remained that way at the 12-month follow-up. The

main purpose of this study (Ivanova, et al., 2016) was to determine if the internet-based delivery

of ACT was better than face-to-face delivery of ACT, and whether ICBT is more proficient than

IACT using symptoms of panic disorder and generalized anxiety, with results reading

inconclusive (Ivanova, p. 33). More needs to be researched using a larger sample for each

variable, more information taken about pharmacological use, and lastly, a more organized way to

define mental health conditions that will help decipher if IACT/ICBT is helpful in ameliorating
Acceptance and Commitment Therapy: A Literature Review 15

symptoms alongside guided or unguided sessions. What this means in terms of organization is,

are there some disorders or conditions that ought not be seen and tended to via the Internet?

How do we determine which issues are able to be handled from a distance? What can be said

about the application is that it is useful, it’s only a matter of how well the application is written

and designed, how it aligns with Ps current therapy sessions (how ACT translates into app-form),

and what kind of feedback Ps do or do not get from using the application.

ACT in the Workplace

While there is certainly more to investigate and improve on ACT-based therapy in

chronic pain, it is simply in its early phases and can easily be rectified with further application.

Chronic pain isn’t the only setting ACT can be used in. The workplace setting is one area where

ACT can be used to improve an employee’s psychological health, as well as their effectiveness.

It is to be noted that ACT is only being used in specific sectors, as of currently, and the

overarching goal is to prevent future health issues. Therefore, ACT does not try to change

people’s cognitive processes or reduce pathology like CBT interventions do (Brinkborg et al.,

2011, p. 390). Thus, when implemented throughout the organization, many, if not all, will

change their behaviors in line with their chosen values.

Before we can focus on the work environment, we first must look at the branch of

psychology that deals with humans at work. Industrial-Organizational (I/O) is the field of

psychology that looks at the quality of the work setting for the employees, as well as their

effectiveness and efficiency, to ameliorate any harmful conditions. Traditionally, the three

domains of job satisfaction, attitudes, and work behavior and their relationship with one another

have been the main focal point of I/O psychology research (Stewart et al., 2006, p. 57).

Organizational behavior management or OBM was the primary method to address the three
Acceptance and Commitment Therapy: A Literature Review 16

domains listed above. However, OBM “...has not had a large impact on traditional I/O

psychology” (Stewart et al., 2006, p. 56). It is rather limited because I/O’s issues are wide

ranging and OBM principles are to reduce injuries and promote and maintain safe behaviors

(Stewart et. al., 2006, pp. 60-62).

With the emergence of RFT or Relational Frame Theory, Stewart et al. (2006) claims that

I/O issues can now be solved with the correct conceptual framework as well the evidence needed

to tackle such problems (p. 75). Both ACT and RFT maintain that psychological health is largely

determined by how one thinks, and the relationship it has, on their long-term values and goals

(Bond et al., 2010, p. 297). RFT is an important theory to discuss regarding why ACT is

transformative in the work setting because it is based upon said theory. Veritably, ACT has

proven itself to create better mental health and performance at work, even after one year (Bond

& Bunce, 2003, p. 1064). If employees are not avoiding stressful situations and using that time to

learn how to effectively immerse themselves, they will act in a way that is driven by their values

and goals (Bond & Bunce, 2003, p. 1058). This translates to increased work performance, if their

goal is to perform well at work.

According to Moran (2011), Acceptance and Commitment training has the evidence-

based foundation that will enhance leaders’ behavioral flexibility (p. 66). This statement may

seem that only leaders can benefit from this, but Moran’s study was only implemented to

managers/leaders. Indeed, Moran (2011) found that leaders (with ACTraining) had the option to

notice their thoughts, accept them as what they are, and behave effectively (p. 68). This has led

Moran to confidently state that the leadership coaching method based off of ACT has developed

crisis resilience in leaders in order to better manage their behaviors. If they did not use

ACTraining intervention in their work environment, the individual might stop performing
Acceptance and Commitment Therapy: A Literature Review 17

anxiety-provoking responses (e.g. attending social events, work meetings), which then lead to a

cycle of more avoidance (Moran, 2011, p. 68). Secondly, when leaders restrict themselves by

describing their strengths and weaknesses, they “... lead to an inflexible behavioral repertoire”

(Moran, 2011, p. 72) which ACT can amend. Lastly, his study also found that by practicing

mindfulness exercises, leaders can be open to new solutions because they are fully in the moment

rather than bogged down by distracting thoughts (Moran, 2011, p. 71). In comparison, the study

done by Bond and Bunce was compromised only with non-managerial customer service center

personnel and therefore can give proof that ACTraining is for the whole organization, not just a

part. Their study further demonstrated that enhancing acceptance in the workplace does improve

mental health and productivity at work (Bond & Bunce, 2003, p. 1064).

Not only do these studies produce evidence of what has already been studied in therapy,

this can also give organizations two ways to approach their problems. They can either tackle the

matter of job stress and productivity by providing individuals in leadership roles this training, or

spread it across the organization for all employees. These two studies prove that whichever path

management goes on, the situation can be handled properly.

Overall improved mental health and increased productivity are two outcomes most

employers want to see in their workers. Yet, ACT interventions can go beyond just these two

primary outcomes. Employees who experience chronic stress are much more prone to burnout

and “take a hit” regarding their overall job control/demand, as well as self-esteem (Brinkborg et

al., 2011, p. 390). After randomizing participants, Brinkborg et al. (2011) found that the

intervention had significant positive results to individuals who had high stress levels (p. 396). It

is interesting to note that while conducting their study, they screened participants regarding their

stress levels and separated them accordingly. Thus, an intervention targeting individuals in
Acceptance and Commitment Therapy: A Literature Review 18

organizations that have high stress levels can effectively combat burnout and reduce absences

and sick days (Brinkborg et al., 2011, p. 395). With this information in mind, it seems imperative

for an organization to completely understand its employees’ psychological health requirements

and conduct necessary work interventions accordingly. People who have low stress levels seems

to already have adequate coping skills already in place and, therefore, will not benefit as much

with interventions (Brinkborg et al., 2011, p. 395). This could be about the difference of their

work load or overall personality, but this means less resources and funding would need to be

expended if only certain individuals have these pressing matters. Another secondary outcome

ACT can assist in is when inexperienced employees start training or work. Some of the

individuals were not quite as experienced as the others in their work domain and therefore

suggests that regardless of skills, they can also be affected (Brinkborg et al., 2011, p. 396).

Many of the studies concerning ACT interventions in the workplace have had relatively

similar results. This is to be expected. ACT, again, has six components that all target

psychological flexibility to improve quality of life. There are very few studies comparing ACT

interventions with other work interventions targeting job stress and mental health. However,

when ACT and SIT (stress inoculation training) are compared in working individuals, both “...

interventions were equally effective reducing psychological distress across a three-month

assessment period” (Flaxman & Bond, 2010, p. 819). SIT is a traditional SMT (stress

management training) that adopts CBT technologies, and have been effective in enhancing

mental health (Flaxman & Bond, 2010, p. 816). However, this should not be taken as both

interventions impacting participants through the same mediator. SIT still changes a person’s

negative thoughts, whereas ACT changes behavior in align with the person’s chosen values.

Nevertheless, the impact of both trainings targeted the same problem in this particular study.
Acceptance and Commitment Therapy: A Literature Review 19

Conclusion and The Future

Taking an in-depth look into the six components of ACT, before exploring the research

conducted regarding the efficacy of utilizing this therapy with chronic pain patients and in

workplace training methods, provides clear proof of its effectiveness in both settings. A

relatively new therapy needs to be properly assessed in its theory before implementation. In both

environments, all the components work together to change an individual’s behavior in service of

their values. This shows that it is flexible enough to help manage a person’s pain or stress, as

well as produce its desired results.

In general, further research needs to be done in different workplace settings. ACT work

interventions have proven comparable and successful in its endeavor to better the psychological

health, efficiency, and effectiveness of employees. More research is still needed in the I/O realm

to truly understand and employ ACT training more effectively. Like previously mentioned, it has

only been applied to specific sectors in the workplace and so not every area will yield the same

results. Also, since there has been far less research done to compare it to traditional SMT than

utilizing it on its own, it would be interesting to see if it works better or the same as ACT.

Another sector ACT training needs further research is the impact it may have on genders. Most

of the research done did not separate male versus female, and therefore it would be interesting to

note which gender is more receptive to it. Lastly, cultural background is a definite area where it

needs further research. None of the articles mentioned above touched on cultural differences so

one cannot assume it works on every individual. Nevertheless, this new training approach seems

to reap positive results in the few settings it has been applied to.
Acceptance and Commitment Therapy: A Literature Review 20

References

Berryhill, M. B., & Lechtenberg, M. M. (2015). Acceptance and Commitment Therapy with

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