Effectiveness of Acceptance and Commitment Therapy on cognitive flexibility of Psychiatric Nurses: A Quasi-Experimental Study

Document Type : Original Article

Authors

1 Department of Psychology and Educational science, University of Islamic Azad, Central Tehran Branch, Tehran, Iran

2 Department of Psychology and Educational science, University of Islamic Azad, Central Tehran Branch, Tehran, Iran.

Abstract

Cognitive flexibility is critical for psychiatric nurses facing high-stress environments, yet effective interventions to enhance this skill are underexplored. This quasi-experimental study aimed to evaluate the impact of Acceptance and Commitment Therapy (ACT) on cognitive flexibility among psychiatric nurses. Sixty-two nurses from Razi and Saraye Ehsan psychiatric centers in Tehran were randomly assigned to experimental and control groups (n = 31 each). The experimental group participated in eight 90-minute group-based ACT sessions, adapted from Mohagheghi et al. (2015), incorporating interactive exercises, mindfulness practices, and homework to foster psychological flexibility. The control group received no intervention. Cognitive flexibility was assessed using the Cognitive Flexibility Inventory (CFI) at pretest and post test. Paired t-tests and analysis of covariance (ANCOVA) were employed to analyze within-group and between-group differences, controlling for pretest scores. The experimental group showed a significant increase in CFI scores (M_diff = 17.14, SD = 5.27; t(30) = 18.12, p < .001). ANCOVA revealed a significant group effect (F(1, 60) = 19.63, p < .001, η² = 0.71), with 71% of post test score variance attributed to the intervention. No significant demographic differences were found between groups. The findings suggest that ACT is an effective intervention for enhancing cognitive flexibility among psychiatric nurses, potentially improving their ability to cope with workplace stress. However, the small sample size and lack of long-term follow-up limit generalizability. Future research should explore ACT’s sustained effects and applicability across diverse healthcare settings.

Keywords


Abdel Aziz, A. E., & Adam, S. S. (2020). Relationship between resilience, burnout and professional quality of life among nurses working at El Abbassiya Psychiatric Mental Health Hospital. Egyptian Journal of Health Care, 11(2), 551–577. https://doi.org/10.21608/ejhc.2020.156951
Bond, F. W., Hayes, S. C., & Barnes-Holmes, D. (2006). Psychological Flexibility, ACT, and Organizational Behavior. Journal of Organizational Behavior Management, 26(1-2), 25–54. https://doi.org/10.1300/J075v26n01_02
Cleary, M., Kornhaber, R., Sayers, J., & Gray, R. (2017). Mental health nurse prescribing: A qualitative, systematic review. International Journal of Mental Health Nursing, 26(6), 541–553. https://doi.org/10.1111/inm.12372
Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750
Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., Cipriano, P. F., Bhatt, J., Ommaya, A., et al. (2017). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. https://doi.org/10.31478/201707b
Edwards, D., Burnard, P., Coyle, D., Fothergill, A., & Hannigan, B. (2000). Stress and burnout in community mental health nursing: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 7(1), 7–14. https://doi.org/10.1046/j.1365-2850.2000.00258.x
Edward, K. L., Hercelinskyj, G., & Giandinoto, J. A. (2017). Emotional labour in mental health nursing: An integrative systematic review. International journal of mental health nursing, 26(3), 215–225. https://doi.org/10.1111/inm.12330
Fernández Jiménez, E., Vidal Bermejo, E., Torrea Araiz, I., Castellanos Villaverde, T., Navarro Oliver, G., & Hospital Moreno, A. (2021). On gender and cognitive flexibility. The REM-ACT study: Acceptance and commitment therapy versus a mindfulness-based emotional regulation intervention in anxiety disorders. A randomized controlled trial. European Psychiatry, 64(S1), S786–S787. https://doi.org/10.1192/j.eurpsy.2021.2080
Gabrys, R. L., Tabri, N., Anisman, H., & Matheson, K. (2018). Cognitive control and flexibility in the context of stress and depressive symptoms: The Cognitive Control and Flexibility Questionnaire. Frontiers in Psychology, 9, 2219. https://doi.org/10.3389/fpsyg.2018.02219
Happell, B., & Koehn, S. (2011). Seclusion as a necessary intervention: The relationship between burnout, job satisfaction and therapeutic optimism and justification for the use of seclusion. Journal of Advanced Nursing, 67(6), 1222–1231. https://doi.org/10.1111/j.1365-2648.2010.05570.x
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual review of clinical psychology, 7, 141–168. https://doi.org/10.1146/annurev-clinpsy-032210-104449
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001
Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal of Nursing Scholarship, 47(6), 522–528. https://doi.org/10.1111/jnu.12162
Killgore, W. D., Cotting, D. I., Thomas, J. L., Cox, A. L., McGurk, D., Vo, A. H., et al. (2008). Post-combat invincibility: Violent combat experiences are associated with increased risk taking propensity following deployment. Journal of Psychiatric Research, 42(13), 1112–1121. https://doi.org/10.1016/j.jpsychires.2008.01.001
Lloyd, J., Bond, F. W., & Flaxman, P. E. (2013). The value of psychological flexibility: Examining mechanisms underpinning a CBT intervention for burnout. Work & Stress, 27(2), 181–199. https://doi.org/10.1080/02678373.2013.782157
Maslach, C., & Leiter, M. P. (2016). Burnout. In Stress: Concepts, cognition, emotion, and behavior (pp. 351–357). Academic Press. https://doi.org/10.1016/B978-0-12-800951-2.00044-3
Mohagheghi, H., Dousti, P., & Jafari, D. (2016). The effectiveness of acceptance and commitment therapy on reduction of generalized anxiety disorder, social phobia and health anxiety in students. Clinical Psychology Studies, 7(23), 81–94. https://doi.org/10.22054/jcps.2016.4559
Moore, S. A., Zoellner, L. A., & Mollenholt, N. (2008). Are expressive suppression and cognitive reappraisal associated with stress related symptoms? Behaviour Research and Therapy, 46(9), 993–1000. https://doi.org/10.1016/j.brat.2008.05.001
Oraki, M., Jahani, F., & Rahmanian, M. (2018). The effectiveness of acceptance and commitment therapy (ACT) on the psychological flexibility of the elderly women. Journal of Clinical Psychology, 10(1), 47–56. https://doi.org/10.22075/jcp.2018.14182.1378
Prudenzi, A., Graham, C. D., Flaxman, P. E., Wilding, S., Day, F., & O'Connor, D. B. (2022). A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress: A randomised controlled trial. PloS one, 17(4), e0266357. https://doi.org/10.1371/journal.pone.0266357
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053