Le développement du Capital Emotionnel pour un Mindful Management et une Qualité de Vie au Travail : une approche de la prévention des risques psycho-sociaux, du stress en particulier, par la psychologie positive et la thérapie de l’acceptation et de l’engagement (ACT) chez les apprentis aides-soignants et futurs personnels éducatifs / The development of Emotional Capital for Mindful Management and Quality of Life at Work: an approach to prevention of psychosocial risks, stress in particular, positive psychology via the acceptance and commitment therapy approach for apprentices carers and futur educators

This study aims to explore the extent to which participating in a Mindfulness-Based Stress Reduction (MBSR) programme may result in shifts in people’s relationship with time, notably whether they become more present-focussed. The eight week MBSR programme advocates mindfulness, which is defined as paying attention on purpose in the present moment without judgement, as a way of reducing stress. The programme has been available in East London since 2009. A case study of eight MBSR programme participants’ experiences using narrative analysis was conducted. Narrative psychology and social constructionism provided the theoretical basis in which our storied lives are located in culturally inscribed narratives, with specific discourses around time and stress. Time discourses tend to pressurise people to believe that it is better to go about daily life at a fast pace, which requires significant hurrying and rushing with pervasive senses of time urgency. Stress discourse locates stress management within individuals. One-on-one semi structured interviews were held so that participants could reflect on their experience of time and the present moment orientation of the programme. Participants’ perceived a shift in how they experienced time with greater awareness of being present-focussed and they identified stress reduction benefits, which included feeling calmer, less panicked and more self-accepting. However, some of the participants maintaining the formal mindfulness practices like the body scan, meditation and mindful movement after the programme often proved difficult, as they were drawn back into their dominant narratives around time which were characterised by busyness, productivity and time scarcity.

Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-ofprinciple data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.

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多くの肥満者は，生活習慣のセルフマネジメントが困難であると指摘される。これに対し本稿は，肥満者の行動的QOLの低さ，すなわち行動レパートリーの不足に着目し，それを拡大する援助方略を行動変動性の観点から検討した。その結果，行動変動性が回避場面で減少することが示され，行動変動性に対する強化手続きや，その応用であるアクセプタンス＆コミットメント・セラピーが行動的QOLの拡大に有効であることが示された。 / It has been argued that many individuals with obesity have difficulty managing their lifestyle. This study focused on lack of behavioral repertory as a cause of the difficulty and attempted to expand behavioral repertory and behavioral quality of life (QOL) from the viewpoint of behavioral variability. The result showed that the decrease in behavioral variability was related to avoidant behavior. Furthermore, the result showed that reinforcement of behavioral variability and Acceptance and Commitment Therapy (ACT) promoted behavioral QOL expansion and lifestyle improvement. / 博士(心理学) / Doctor of Philosophy in Psychology / 同志社大学 / Doshisha University

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<p>Examen i vårdadministration, YH-utbildning: 20 Yh-poäng</p>

Abstract Rule-governed behavior is a unique form of human behavior that comes with many advantages. Rule-following can however become problematic when it makes us insensitive to the consequences of our behavior and undermines our ability to adapt to changes in contingencies. This phenomenon has been hypothesized to play a central role in different psychological problems. In this thesis project, we investigated whether a mindfulness exercise from Acceptance and Commitment Therapy (ACT) could improve people's ability to adapt to changes in contingencies, as measured with the Wisconsin Card Sorting Test (WCST). We also explored whether recently developed self-report questionnaires of rule-governed behavior, the Generalized Pliance Questionnaire (GPQ-9) and the Generalized Tracking Questionnaire (GTQ) could predict the participants' performance on the WCST. In addition, we looked at the association between intolerance of uncertainty (IUS-12) and generalized pliance (GPQ-9). The sample consisted of 45 university students at Örebro university in Sweden. The results revealed that the brief mindfulness exercise did not improve the participants ability to adapt to contingency changes. The questionnaires of rule-governed behavior also did not predict this performance on the WCST. However, we found a novel association between generalized pliance and intolerance of uncertainty, which could be a future research path. Further, generalized pliance and generalized tracking displayed a moderate negative correlation, in line with previous research. Despite limited significant findings in this study, it was an effort to investigate central claims from the ACTand behavioral literature, centered around psychological flexibility and rule-governed behavior.

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.