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

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

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)

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 A Range of Consequences Linked to Poor Sleep

ACT Vs Mindfulness-Based Training

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)

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.

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

ACT worksite protocol

MBSR worksite protocol

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

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

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?

= , df = 127, p <.0001, CFI =.92, TLI =.92, RMSEA =.066 (.053,.079) FFMQ Intercept FFMQ Slope t2t3t1 Goals & activities Intercept Goals & activities Slope t2t3t1 ACT t4t5 t4t5 Sleep Intercept Sleep Slope t2t3t1t4t5 Mindfulness training

Main Results

Main Effects Mindfulness Goals & Activities ACT Mindfulness training Sleep Problems

Indirect Effects Mindfulness Goals & Activities ACT Mindfulness training Sleep Problems

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

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

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

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

Thank you! Any questions?