Evaluation of an Acceptance and Commitment Therapy Group for Adjustment Difficulties in Neurological Conditions
Condition: Brain Injuries; Multiple Sclerosis; Parkinson Disease; Stroke
MeSH terms: Parkinson Disease; Multiple Sclerosis; Brain Injuries
Study type: Interventional

Summary: 
      With an increase of over 38% in neurological related hospital admissions between 2008-13,
      there are now over 12.5 million cases of individuals with neurological conditions in the UK.
      Following diagnosis of a neurological condition, there is often a period of adjustment to new
      life circumstances, with changes to relationships, ability to work and leisure activities.
      With a future often fraught with uncertainty, psychological difficulties such as Anxiety and
      Depression are common. It is estimated that following diagnosis of a neurological condition,
      up to 60% of individual's will experience mental health difficulties.

      Acceptance and Commitment Therapy (ACT) has been gaining popularity in supporting those with
      neurological conditions. ACT is based on emotional acceptance and supporting individuals to
      live a valued life, despite ongoing symptoms. Research into the use of ACT with this
      population has found it to be effective in reducing levels of psychological distress and
      increasing psychological flexibility.

      With limited resources and an ever increasing desire to improve interventions offered to
      patients, services are now looking at new and innovative ways of offering increasingly
      effective and satisfactory treatments. Therefore, in early 2014, the author devised a six
      week ACT group intervention for adjustment following diagnosis of a neurological condition.
      The intervention provides a combination of ACT techniques, in addition to a space for group
      members to build relationships and share their difficulties, to help individuals increase
      acceptance of their difficulties and reduce psychological distress.

      Following an initial pilot, findings illustrated that participants' psychological distress
      reduced and psychological flexibility increased. Therefore, this research project aims to
      further evaluate the intervention under controlled conditions.
    

Detailed description: 
      A variety of psychological approaches have been developed in order to support this
      population. One of the most popular approaches to working psychologically with this
      population is through the use of Cognitive Behavioural Therapy (CBT). However, research
      suggests that the use of CBT in this population has varying levels of effectiveness with some
      evidence of negative outcomes (Lincoln and Flannagan, 2003). Therefore, it would be
      worthwhile investigating other models of working with this population, such as Acceptance and
      Commitment Therapy (ACT). ACT which has been gaining popularity and is a growing area in
      supporting those with neurological conditions.

      Contrary to widespread symptom reduction approaches such as CBT, the use of ACT is based on
      emotional acceptance and supporting individuals to live a valued life, despite ongoing
      symptoms. It appears under the umbrella of "third-wave" approaches and focuses on altering an
      individual's relationship with their thoughts and feelings, rather than focusing on altering
      the content of such experiences. In addition to this, ACT aims to support people to
      experience their internal processes in a non-judgemental and mindful manner, which enables
      them to participate in meaningful action. In order to do this, the ACT model focuses on six
      core concepts which each contribute to helping an individual to develop their Psychological
      Flexibility. Psychological Flexibility is defined by the ability to connect with the present
      moment and act according to one's set of values. In a move away from experiential avoidance
      (ie. avoiding ones thoughts and feelings), the ability to be flexible offers individuals the
      choice to commit to their values and change their actions or persist with those which are
      working for them.

      It has been suggested that ACT may be particularly helpful for those adjusting to
      neurological conditions as it works to enable emotional acceptance and an integration of an
      individual's impairments into their new self-concept. This has been supported by research
      investigating the effectiveness of ACT in working with those with adjustment difficulties
      following traumatic and acquired brain injury. One such study investigated the use of ACT in
      the promotion of psychological adjustment following Traumatic Brain Injury. Findings
      indicated reduced psychological distress and increased Psychological Flexibility following
      the ACT intervention. One reason ACT is more desirable for this population is through the use
      of more experiential methods and less reliance on verbal expression, as verbal abilities can
      sometimes be compromised by a neurological condition. Rather than attempt to reduce
      symptomatology, techniques such as mindfulness encourage the individual to notice their
      difficulties and experience these with curiosity and openness. In addition to this, there is
      evidence that the use of acceptance based techniques support individuals to adapt their
      behaviour and reintegrate socially in a way that is meaningful to them. As a result, this may
      enable the individual to adjust to their new circumstances and enable them to reconnect with
      their values and commit to moving their life in a direction they value.

      Overall, the use of ACT is a promising intervention for individuals adjusting following a
      diagnosis of a neurological disorder. However, with a limited number of studies investigating
      the topic, further research is required into the effectiveness of ACT within
      neuro-rehabilitation.
    

Intervention name(s): Acceptance and Commitment Therapy group
Intervention type(s): Other
Intervention description(s): Six week, Acceptance and Commitment Therapy group for those with adjustment difficulties following an acquired/traumatic brain injury or other neurological condition.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment