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The University of Arizona Global Campus

ACCEPTANCE AND COMMITMENT TRAINING TO INCREASE EMPLOYEE STRESS TOLERANCE AND WELLNESS IN ORGANIZATIONAL ENVIRONMENTS: A NOVEL

HANDBOOK FOR WORKPLACE APPLICATION --Manuscript Draft--

Manuscript Number: UoRDS-D-22-00782

Full Title: ACCEPTANCE AND COMMITMENT TRAINING TO INCREASE EMPLOYEE STRESS TOLERANCE AND WELLNESS IN ORGANIZATIONAL ENVIRONMENTS: A NOVEL

HANDBOOK FOR WORKPLACE APPLICATION

Article Type: Final Manuscript Submission

Corresponding Author: Jessica Diane Bowers, Ph.D.

The University of Arizona Global Campus Denton, TX UNITED STATES

Corresponding Author Secondary Information:

Corresponding Author's Institution: The University of Arizona Global Campus

Corresponding Author's Secondary Institution:

First Author: Jessica Diane Bowers, PsyD

First Author Secondary Information:

Order of Authors:

Order of Authors Secondary Information:

Final Manuscript Submission

ACCEPTANCE AND COMMITMENT TRAINING TO INCREASE EMPLOYEE

STRESS TOLERANCE AND WELLNESS IN ORGANIZATIONAL ENVIRONMENTS: A NOVEL HANDBOOK FOR

WORKPLACE APPLICATION

An Applied Doctoral Project submitted

JESSICA BOWERS

November 2022

THE UNIVERSITY OF ARIZONA GLOBAL CAMPUS

Upon the recommendation of the Faculty and approval of the Board of Trustees, this Applied Doctoral Project is hereby accepted in partial fulfillment of the requirements for the

degree of

DOCTOR OF PSYCHOLOGY

Approved by:

Todd Fiore, PhD Committee Chair

Committee Member:

Heather Pederson, EdD

JESSICA BOWERS 2022

iii

Acceptance and Commitment Training to Increase Employee Stress Tolerance and Wellness in Organizational Environments: A Novel Handbook for Workplace Application

Jessica Bowers

Abstract

Improving stress tolerance at work benefits individuals and organizations by creating

less turnover, more productivity, higher employee engagement, and greater satisfaction with

work and life beyond work. Acceptance and commitment therapy (ACT) has shown

promise as an effective intervention for improving stress tolerance in workplace settings.

Current ACT implementations that could be applied in the workplace are technically

complicated and use psychological jargon that creates barriers for easy implementation.

This applied doctoral project resulted in a novel handbook, Stress Management Cross

Training: How to Get More Out of Your Effort by Improving Your Stress Response, that

human resources managers with minimal previous experience in ACT or stress tolerance

training can implement in the workplace. The handbook can also be implemented without

incurring outside costs or requiring extensive training for the organization. Using the

handbook may facilitate greater stress tolerance skills for employees who engage in the

training.

Keywords: acceptance and commitment therapy, stress tolerance, organizational wellness

programs, organizational stress management interventions

ACKNOWLEDGMENTS

To Dr. Fiore and Dr. Pederson—Thank you for your guidance, your leadership, and

for embracing my learning style and allowing me to thrive in this process.

DEDICATION

There is not enough space for dedicating this project to all the people who have

served as the waypoints in my life and who have allowed me the opportunity to complete

this step in my life journey. It is a big enough step to complete that reflecting upon it made

me feel appropriately small in the fabric of life. I know that all of us are made up of the

experiences we have encountered and the people who have been a part of these experiences.

I am very lucky for the people who have been a part of my experiences.

• To my children—Thank you for continuing to work to be the best versions of

yourselves, even when it is hard. I am proud of the way you are growing up. You

inspire me.

• To my friends—Thank you for returning my texts to keep me motivated, for

celebrating my successes along the way, and for making me feel like I could do hard

things.

• To my colleagues—Thank you for inspiration and dedication to your work and your

craft. You are all artists who create beautiful, magical works of art.

• To Jordan, Ashlyn, and Caitlyn—You are shining stars in a dark world. The way

you live your lives with a pursuit of purpose is the best inspiration, and I am the

luckiest person to get to watch you shine.

• To Tim—Thank you for everything. Without you I would have had no clean

laundry, no cooked meals, and no one to dry my tears and keep me going. It took

everything to get us here. Thank you for being my perfect partner for the journey.

TABLE OF CONTENTS

CHAPTER I: PROJECT JUSTIFICATION .............................................................................1

Project Justification ...............................................................................................................2

Purpose of the Project ............................................................................................................3

Research Question .................................................................................................................4

Conceptual Framework..........................................................................................................4

Project Approach Overview ............................................................................................... 11

Definition of Terms ............................................................................................................ 12

Assumptions, Limitations, and Delimitations..................................................................... 13

Assumptions ................................................................................................................... 13

Limitations ...................................................................................................................... 14

Delimitations................................................................................................................... 15

Summary............................................................................................................................. 15

CHAPTER II: REVIEW OF THE LITERATURE ................................................................ 17

Search Strategy ................................................................................................................... 17

Introduction to Stress .......................................................................................................... 18

Early Constructs of Stress............................................................................................... 18

The Transactional Model of Stress and Coping ............................................................. 20

Coping With Distress ..................................................................................................... 21

Occupational Stress and Effects ......................................................................................... 22

Conceptualization of Occupational Stress ...................................................................... 22

Mediators of Organizational Stress ................................................................................ 24

Occupational Stress Management Interventions................................................................. 30

Organizational-Level Interventions ................................................................................ 32

vii

Individual-Level Interventions ...................................................................................... 33

Acceptance and Commitment Therapy Implementations for Stress Management ............ 36

The ACT Model of Psychotherapy ................................................................................ 37

ACT as an Effective Psychological Intervention ........................................................... 40

ACT as an Effective Workplace Intervention ................................................................ 42

Appropriateness of ACT for Workplace Implementation .................................................. 51

Features of ACT Implementations ................................................................................. 51

Barriers to ACT Implementation.................................................................................... 52

Creating a Novel Professional Development Learning Handbook .................................... 53

Workplace Handbook Development Steps .................................................................... 53

Workplace Handbook Development Guidelines............................................................ 54

Summary............................................................................................................................. 60

CHAPTER III: PROJECT APPROACH ............................................................................. 62

Project Approach ................................................................................................................ 62

Data Collection and Analysis ............................................................................................. 63

Ethical Considerations........................................................................................................ 64

Quality of the Project ......................................................................................................... 65

Summary............................................................................................................................. 66

CHAPTER IV: FINDINGS, EVALUATION OF FINDINGS, AND RECOMMENDATIONS ...................................................................................................... 67

Findings .............................................................................................................................. 68

Data Analysis ................................................................................................................. 68

Evaluation of Findings ................................................................................................... 69

Field Testing the Handbook ............................................................................................... 80

Limitations of the Project ................................................................................................... 81

viii

Recommendations for Practice ........................................................................................... 81

Future Use and Testing ....................................................................................................... 82

Conclusion .......................................................................................................................... 83

REFERENCES....................................................................................................................... 85

LIST OF TABLES

Table 1: Handbook Components ................................................................................... 70

LIST OF APPENDICES

Appendix A: Letter Sent to Field Testers........................................................................ 103

CHAPTER I: PROJECT JUSTIFICATION

Addressing workplace stress and the resulting unwanted impact to employees and

employers can help to ensure healthy and productive human resources. Work-related stress

costs society an estimated $221 million to $187 billion annually, with most of the cost

attributed to productivity loss (Hassard et al., 2018). Proactively addressing the physical,

psychological, and organizational impacts of work-related stress is increasingly necessary

due to the global impact of the COVID-19 pandemic, which included an increase in stress for

all workers as well as changes in their work environments (Du et al., 2020).

Changes in work environments resulting from the COVID-19 pandemic include

altered working conditions, lower wages, job loss/insecurity, loss of social support/contact,

and unstable working conditions (Vnoučková, 2021). These changes are likely to persist in

post-COVID-19 work environments and increase the psychological strain for workers while

simultaneously decreasing their access to resources to support their psychological well-being

(Lund et al., 2021). Workers who operate under psychological strain are at higher risk for

illness, absence, and decreased work performance.

Given the individual and organizational costs of stress, organizations must combat its

effects on employees through implementing wellness programs. Research from companies

that have implemented workplace wellness programs to reduce stress has indicated increases

in employees’ commitment to work, work engagement, positive feelings about work,

hopefulness about the future, and work–life balance and decreases in stress and anxiety about

work (Laker & Roulet, 2021). Occupational stress management interventions (SMIs) present

potential solutions and structures for wellness programs to prevent and reduce the effect of

stress on employee health and well-being. While some SMIs focus on alleviating stressful

elements of the work experience, there is a need for SMIs that can be applied when

workplace stress cannot be eliminated (Holman et al., 2018; Lazarus & Folkman, 1984).

Acceptance and commitment therapy (ACT) provides a construct for SMIs in settings where

stressors cannot be ameliorated and must be addressed by adding novel coping skills (Bond

& Bunce, 2000; Prudenzi et al., 2022).

Project Justification

Occupational SMIs present potential solutions for preventing and reducing stress’s

impact on employee health and well-being while also addressing organizational outcome

needs. Foundational theory surrounding SMIs focuses on either alleviating stressful elements

of the work experience or implementing SMIs when workplace stress cannot be eliminated

(Isa et al., 2019; Lazarus & Folkman, 1984). The COVID-19 pandemic has transformed

work settings and work stress, such as in health care organizations where staff shortages and

increased job pressure have created unmanageable workloads and stress (Mills et al., 2020).

In their foundational theory article, Bond and Bunce (2000) stated that ACT provides a

construct for SMI in settings where stressors cannot be ameliorated and must be addressed by

adding novel coping skills.

ACT is a third-wave cognitive behavioral therapy (CBT) intervention that

incorporates acceptance and mindfulness with commitment to values-based goalsetting and

behavior-change strategies to increase psychological flexibility and decrease negative

responses to experiences (Hayes et al., 2006; Wersebe et al., 2018). As an intervention, ACT

presents cognitive tools that help individuals reframe their thoughts when they encounter

stressful experiences such that the experiences do not interfere with the ability to continue to

engage in a chosen course of action, thus increasing behavioral effectiveness (Kashdan et al.,

2020; Macías et al., 2019). Acceptance and commitment training (ACTraining) has been

suggested as an effective intervention for decreasing workplace stress and job burnout, which

are costly to individuals and organizations, and increasing employee flexibility and coping

skills by bolstering stress tolerance (Pingo et al., 2019). ACTraining is particularly

applicable in the current global culture where human resources comprise large, diverse, and

virtual groups that must be managed with purposely designed learning technology

(Alexopoulos et al., 2020).

The present applied doctoral project (ADP) resulted in a comprehensive ACTraining

handbook, Stress Management Cross Training: How to Get More Out of Your Effort by

Improving Your Stress Response, that laypersons in organizational settings can use to

conduct group education sessions for stress tolerance and wellness programs. The handbook

can be used for professional development, training, or wellness programs that are cost

effective, time efficient, and applicable across individuals and settings. As an

implementation, ACT presents a flexible option for human resources managers that is widely

applicable with minimal barriers to access.

Purpose of the Project

The purpose of this ADP was to create an ACTraining handbook that human

resources managers can implement in workplace settings to increase employee psychological

flexibility and stress tolerance. The handbook includes a framework for learning ACT

components with handouts for group participation and applying ACT constructs in work

settings. Human resources managers with no former training in ACT or general psychology

can use the ACTraining handbook, removing yet another barrier for effective

implementation.

The handbook is a guide for implementing stress tolerance and wellness programs

designed for employees. The resources presented in the handbook are designed to be

applicable to diverse employee populations in mental health settings. The training can be

presented virtually through webinar media, making it accessible to all organizational team

members regardless of geographic location.

Research Question

The program outlined in the handbook addressed the following research question:

How can human resources managers with minimal experience in ACT concepts use

ACTraining in group settings to address stress tolerance and wellness in employees?

Conceptual Framework

The general concept of stress was first defined physiologically by Selye (1936, 1979)

as a varied response of the organism to any demand placed on the body. Leung et al. (2011)

further refined this definition by incorporating the psychological state that is experienced

when there is stress on the human body, indicating that the concept of stress includes a

psychological state that impacts physical health. The experience of stress is therefore

subjective and based on individual evaluation of current demands and the availability of

resources to manage environmental expectations without personal harm (Pitt et al., 2017).

Job or occupational stress occurs when environmental expectations exceed the

assumed personal capacity to meet these expectations (Burman & Goswami, 2018). High

levels of occupational stress compete with the individual’s ability to engage in work-related

tasks, thus decreasing performance (Lakshmi-Narahari & Koneru, 2018). For this reason,

addressing workplace stress and promoting a productive and healthy workforce are high

priorities for human resources managers.

Stress Management Cross Training: How to Get More Out of Your Effort by

Improving Your Stress Response addresses the larger theoretical and conceptual needs for

psychological wellness and stress reduction in the work environment, which include

developing certain individual capabilities. The foundational theory of stress and coping in

the work environment was developed by Lazarus and Folkman (1984), who posited that

stress is a construct in which an individual perceives an experience as threatening due to the

lack of cognitive and social resources to cope with the stressor. Lazarus (1991) further

refined the definition of stress in the workplace context with a differentiator between

conditional stressors and individual perceptions of the stressor, such that job strain occurs

when the stressor is perceived as threatening occupationally or personally.

Theoretical models of threatening stressors in the workplace vary in construct and

nomenclature, but all generally suggest an order of events resulting in experiences perceived

as threatening, to which individuals respond by engaging in nonproductive behaviors such as

work avoidance, absenteeism, physical illness, or undesirable coping strategies (i.e.,

drinking, drugs, combative interactions; Spector & Jex, 1998; Vagg & Spielberger, 1998).

Mediating variables in all foundational research on organizational stress are the individual

perception of the stress and the self-appraisal of the available cognitive resources to cope

with the stressor. Research on physiological and psychological measures of stress has

indicated that individuals who approach stress with a balanced approach, rather than a

negative approach, have lower indicators of stress (Liu et al., 2017), suggesting that the

relationship with stress determines the impact of stress.

According to foundational research, there are three common approaches for

decreasing workplace stress: (a) redesigning the role or workplace to ameliorate potential

stressors, (b) reducing an individual’s perception of stressful events, and (c) increasing an

individual’s tolerance to stress by reframing the relationship with stress (Lazarus & Folkman,

1984). The latter two SMIs are more common than job redesign because they are more cost

effective and have less organizational impact (Ganster & Murphy, 2001; Holman et al.,

2018). Additionally, job redesign is not always effective in the long term (Murphy & Sauter,

2003), while emotion- and problem-focused SMIs are consistently associated with increased

well-being and decreased stress (Bunce, 1997; van der Klink et al., 2001).

When job redesign or stress alleviation are not possible, individuals must gain

additional capabilities for altering their interactions between themselves and their

environments. Psychological flexibility research has indicated that high psychological

flexibility levels predict higher job task performance (Bond & Bunce, 2000; Bond et al.,

2006). Additionally, high levels of psychological flexibility are a fundamental aspect of

psychological health and well-being as well as a necessary component of behavioral

effectiveness (Bond et al., 2006; Kashdan et al., 2020).

Psychological flexibility, which has been studied under other multiple names across

decades, is broadly defined as a set of dynamic internal processes that allow an individual to

(a) adapt as demands change, (b) reassign mental resources to the needed changes, (c) shift

perspective as necessary to adjust to the change, and (d) balance competing contingencies to

respond effectively (Kashdan et al., 2020). Interactions between people and their

environments produce certain psychological experiences, but flexibility suggests that

individuals can adapt and adjust based on altering their environments consistently and

without the impact of their emotions, such as those that occur at high levels in stressful

situations. Effective psychological flexibility in stress management allows the individual to

stay in the present situation, be aware of thoughts and feelings that occur because of that

situation, and without needing to change their thoughts and feelings, be able to choose a

certain set of behavioral actions consistent with their chosen values and goals (Han et al.,

2020; Hayes et al., 2006; Moran, 2011). Essentially, high psychological flexibility levels

allow individuals to continue to act even in situations where emotions that can cause stress

are present.

When implementing psychological flexibility training, it is important to understand

the evidence-based constructs that support psychological flexibility to increase performance

as well as to decrease stress. Researchers have indicated that psychological flexibility

mediates task completion in four key constructs that can be addressed through specific

training initiatives. First, psychological flexibility is supported by helping to increase

concentration, which allows for greater attention to task through mindfulness to the task

(Bond et al., 2006). This construct can be addressed through training in mindfulness to

increase awareness of the present moment and increase the ability to focus on a single task

(Sirois & Tosti, 2012).

Second, salience for the importance of task completion is aligned to goals and values,

which increases intrinsic motivation and greater task completion (Deci & Ryan, 2015; Hayes

et al., 2006). This construct can be addressed by through training in values-based

identification and alignment of tasks to these values (Moran, 2015). Third, psychological

flexibility provides a construct for recognizing ineffective task completion behaviors and

determining when to persist with the current behavior or when to change the behavior for a

more effective outcome (Hayes, 2016). This construct can be addressed through training in

behavioral flexibility (Nolan, 2010).

Fourth, psychological flexibility addresses the issue of experiential avoidance, which

is the idea that if an action feels unpleasant, the unpleasantness must be removed before the

action can be addressed (Kashdan et al., 2020). This construct can be addressed by training

in experiential acceptance, which allows for task completion even in unpleasant situations

(Block-Lerner et al., 2009). In sum, psychological flexibility training teaches people how to

identify intrinsic values and engage fully in the tasks needed to achieve these values without

being distracted by negative thoughts and feelings.

Among empirically based SMIs implemented for increasing stress tolerance

capabilities in individuals, CBT has traditionally shown the greatest efficacy in impacting

organizational outcomes (Murphy, 1996; Murphy & Sauter, 2003; Richardson & Rothstein,

2008), but is only effective with certain individuals and in certain work environments. CBT

principles suggest that people’s perceptions of stress are impacted by their cognitive thought

processes and the resulting behaviors. Traditional CBT interventions for stress management

focus on teaching people to identify thoughts that may lead to stress and replacing these

thoughts through cognitive thought interruption, relaxation, irrational thought labeling, or

implementing problem-solving skills (Freeman et al., 1990). The foundational approach of

traditional CBT is that unwanted thoughts must be removed and replaced to decrease or

eliminate stress’s problematic effects (Beck et al., 1979). Therefore, CBT is not effective for

stress management if cognitive change methods cannot be implemented (Hayes et al., 2006).

For maximum effectiveness using traditional CBT as a stress attenuating model, the

individual must stop and replace all negative thoughts associated with workplace stress.

Because the demand to consistently control thoughts is high, traditional CBT’s impact is

moderately correlated with a reduction in stress, with the results decreasing over time

(Richardson & Rothstein, 2008). In addition to the difficulty of consistently controlling

cognitive thought processes, trying to decrease stress-related thoughts can lead to higher

levels of these thoughts (Corrigan et al., 2001; Moran, 2015).

Interventions that increase tolerance to stressful thoughts and feelings are alternatives

to eliminating stressful thoughts (Lazarus & Folkman, 1984). As CBT has evolved into a

third wave of implementation, acceptance and mindfulness have been incorporated into

practice to alter interactions between individuals and their stressful thoughts and feelings

when these feelings cannot be ameliorated by other methods (Hayes et al., 2006). As a result

of adding mindfulness and acceptance as an educational tool in CBT, the ability to accept

unwanted psychological experiences when stressful situations occur has been added to

effective intervention options for workplace stress.

Training in mindfulness, psychological acceptance, and experiential engagement can

increase overall stress tolerance (Segal et al., 2002). This training can be a novel and

effective approach for helping people tolerate stress more effectively (Grossman et al., 2010).

Compared to interventions that decrease perceptions of stressful events, accepting

undesirable thoughts and feelings mediates the efficacy of interventions for increasing

tolerance to stress (Bond & Bunce, 2000). For this reason, stress acceptance interventions

are most closely suited to use in the workplace, as many organizational stressors cannot be

mitigated and must therefore be tolerated without impacting performance.

ACT is a third-wave implementation of CBT principles that increases acceptance of

stress in the environment, making it ideal as an SMI for increasing stress tolerance in the

workplace (Moran, 2015). It is a multimodal psychological intervention that combines

empirically validated interventions, including acceptance and mindfulness, traditional

behavioral therapy, value-based action and self-determination, and cognitive diffusion (Bond

et al., 2006), and has been used effectively to address depression, anxiety, chronic pain,

chronic stress, obesity, and addiction (Hayes et al., 2006). ACT is not considered a novel

treatment modality but rather a conglomeration of previously validated interventions into a

package that is easy to implement and incorporates all the constructs that contribute to

increased psychological flexibility. In ACT, mindfulness and acceptance principles are used

to alter the relationship with unwanted feelings of stress. The goal is to reduce stress’s

influence on behavior through identifying values and committing to meaningful behavior to

achieve these values (Hayes et al., 2006).

ACT contends that the roots of maladaptive behavior related to stress occur in verbal

associations that allow thoughts to become fused with reality (i.e., “My boss doesn’t like me”

becomes “I am not likable”), which lead to increases unwanted feelings like depression and

anxiety and result in avoiding experiences to control the unwanted feelings (Bond et al.,

2006). Because of the unwanted feelings associated with depression and anxiety, individuals

are willing to avoid purposeful activities, such as completing a work task, to eliminate the

negative feelings associated with these activities. The presence of unwanted feelings,

therefore, interferes with purposeful activity and can continue to impede action and

performance.

ACT is used to teach individuals to (a) disconnect their thoughts from reality through

cognitive diffusion, (b) accept rather than avoid thoughts and feelings, and (c) define a set of

values and engage in behaviors consistent with these values by persisting or changing action

even when presented with unpleasant thoughts and feelings (Hayes, 2016). Accepting

thoughts and feelings and committing to value-based behavior can result in higher

psychological flexibility levels and lead to greater performance in stressful environments.

Therefore, ACT presents an effective intervention strategy that is uniquely suited for

decreasing stress and increasing employee wellness in the workplace.

While ACT was first designed as a psychological intervention for individuals with

mental health issues, research has shown that its concepts can also be effectively

implemented in the workplace (Hayes et al., 2006). ACT is particularly suited for

organizational settings due to the unchangeable nature of many workplace stressors and the

ineffectiveness of stressor elimination in organizational design (Bond & Bunce, 2000).

Workers who exhibit high levels of psychological flexibility may also exhibit high levels of

mental health and job satisfaction, irrespective of the amount of autonomy present in the

workplace, while also demonstrating high performance levels (Bond & Bunce, 2003).

The ACTraining handbook developed as part of the present project provides a

framework that human resources managers can use to implement educational sessions on

increasing stress tolerance and wellness for employees. The conceptual logic for designing

this handbook was to promote greater accessibility to ACT principles in the organizational

setting, which may underpin individual workplace effectiveness by improving skills for

addressing stress tolerance.

Project Approach Overview

The approach for this project was to create a training handbook that human resources

managers could use to increase employee stress tolerance and organizational wellness with

minimal investment in time or resources. Developing this training handbook incorporated

understanding of organizational business management with current human psychology

theories and foundations as well as fundamentals of ACTraining with limited psychological

jargon. The training handbook was completed using existing research in the areas of

effective training handbook components, organizational training needs, and employee stress

tolerance needs. The design is intended to help human resources managers disseminate

ACTraining to employees as a part of wellness education on increasing tolerance to stress

and improving workplace effectiveness. There are two handbook versions: one for leaders,

one for participants.

Definition of Terms

The following terms were used throughout this ADP and in the ACTraining

handbook. They are presented here to help align readers with the concepts and terms

presented within the scope of this project. They are also defined to ensure clarity of terms

and mutual understanding of concepts.

Acceptance and commitment therapy (ACT): ACT is a behavior modification

approach for increasing stress tolerance by decreasing cognitive fusion and experiential

avoidance (Pingo et al., 2019).

Acceptance and commitment training (ACTraining): ACTraining encompasses ACT

principles as an organizational training model, which eliminates ACT’s therapeutic element

(Moran, 2011).

Cognitive fusion: Cognitive fusion is the belief that thoughts create reality, which

allows private verbal behavior (thoughts) to be aversive to the individual (Pingo et al., 2019).

Experiential avoidance: Experiential avoidance is the tendency to avoid or control

uncomfortable thoughts and feelings that lead to avoiding engaging in activities that could

provoke these uncomfortable experiences (Pingo et al., 2019).

Psychological flexibility: Psychological flexibility is conscious awareness of the

present moment in time and the ability to act according to a set of chosen values given any

situation, regardless of any discomfort that might be present (Hayes, 2016).

Psychological stress: Psychological stress is the relationship between an individual

and their environment that is perceived as extending beyond the individual’s personal

resources and presents a threat to the individual’s well-being (Lazarus & Folkman, 1984).

Resilience: Resilience is the psychological capacity to rebound with growth and

improvement following adversity, uncertainty, conflict, or failure (Luthans, 2002).

Stress management interventions (SMIs): SMIs are programmed activities employed

in work settings to increase wellness and decrease stress, either by addressing the source of

stress or addressing stress’s impact on the individual (Holman et al., 2018).

Assumptions, Limitations, and Delimitations

There are certain assumptions, limitations, and delimitations in every research effort

that should be identified. Assumptions are the elements that are presumed as truth in the

study. Limitations are elements outside of the researcher’s control; delimitations are in the

researcher’s control. The following were assumptions, limitations, and delimitations in the

present ADP.

Assumptions

It was assumed that ACTraining is effective at increasing stress tolerance, and, as a

result, increases organizational effectiveness. Research has indicated that ACTraining is

effective at increasing stress tolerance (Hayes, 2016). For the present project, ACTraining

was also assumed to be the most effective intervention for increasing stress tolerance in

organizational settings. Research has also indicated that individuals with higher stress

tolerance levels will engage in tasks with more behavioral effectiveness (Bond & Bunce,

2000).

Given this evidence-based knowledge, it could be assumed that engaging in

ACTraining will increase workplace performance. Additional assumptions to consider

included the timeline and durability of increased stress tolerance. It is not known if greater

stress tolerance and the resulting behavioral effectiveness will occur immediately following

the implementation. Further research could be conducted in these areas to address the

assumptions presented in this ADP. Finally, that the handbook can be implemented in a

more cost-effective and timely manner than other implementations, including commercially

available ACTraining, was assumed in this ADP.

Limitations

A limitation of this ADP is that the training handbook was not implemented in an

organizational setting to determine its efficacy. As such, no formal data on the handbook’s

efficacy were gathered. Future researchers could implement the training handbook using

pre- and posttest measures to determine the efficacy of the designed intervention.

Additionally, though the handbook was designed to be used with any employee, there may be

individuals who cannot access the material as written and may need accommodations to learn

effectively. Additionally, marketing this handbook could be difficult to businesses that need

to quantify outcomes and justify the return on investment before implementation. Though

increasing stress tolerance is known to benefit employees, it is difficult to quantify the

outcomes and connect them to business drivers in a way that is easily marketable.

Delimitations

A delimitation for this ADT was the preselection of ACTraining as an appropriate

response to stress tolerance in the workplace. This selection eliminated including other

methods that might also increase stress tolerance in the workplace. Another delimitation was

that the handbook is written in English, so it is not accessible by non-English-speaking

trainers or learners. Additionally, the researcher restricted the number of interventions,

strategies, and skills presented in the handbook to ensure that the training could be

implemented simply and quickly.

Summary

The presence of stress results in loss of productivity in the workplace, which is costly

to employees and organizations (Brunner et al., 2019). While addressing job design elements

to decrease workplace stress is desirable, some stress is unavoidable and must be tolerated

without negatively impacting workplace engagement (Kašpárková et al., 2018). Increasing

stress tolerance through resilience training is one option for mitigating stress that cannot be

eliminated. ACTraining is an SMI that increases psychological resilience through cognitive

tools that help people continue to engage in their work with behavioral effectiveness in the

presence of stress (Kashdan et al., 2020; Macías et al., 2019). The purpose of the present

ADP was to create a handbook for implementing group education programs using ACT

principles to increase employee psychological flexibility and stress tolerance.

Chapter I encompassed the project justification, which included the purpose of the

project, research question, conceptual framework, project approach overview, and definition

of terms. Project assumptions, limitations, and delimitations were also identified and

discussed. Chapter II is a comprehensive discussion of the evidence-based research that

supports using ACTraining in organizational settings to increase employees’ stress tolerance

and wellness.

CHAPTER II: REVIEW OF THE LITERATURE

The purpose of this ADP was to create an ACTraining handbook that human

resources managers can implement in workplace settings to increase employee psychological

flexibility and stress tolerance. Chapter II is a review of the literature on stress tolerance,

occupational stress, the effects of stress on organizational outcomes, mindfulness, and ACT,

taking into consideration theories of adult learning and training development. The goal was

to review the foundational and current literature related to occupational stress’s effects on

organizational outcomes and literature on how mindfulness-based programs like ACT may

increase employee stress tolerance and wellness, resulting in increased organizational

outcomes. Findings from this review contributed to developing a handbook for

implementing group education programs using ACT principles to increase employee stress

tolerance and psychological flexibility.

Search Strategy

Various databases accessed through the University of Arizona Global Campus library

were used to search for articles relevant to the research. Databases used were EBSCOhost,

ProQuest, PsychINFO, and Sage. General searches were also conducted using Google

Scholar. Search terms included stress, occupational stress, stress management interventions,

workplace stress, employee stress, coping, stress coping, distress, causes of occupational

stress, mediators of occupational stress, job control and stress, relational frame theory,

psychological acceptance, experiential avoidance, self-regulation, self-regulation and stress,

individual stress management interventions, relaxation, mediation, cognitive-behavioral

therapy and stress, mindfulness and stress, acceptance and commitment therapy (ACT),

acceptance and commitment training, acceptance and commitment training in the workplace,

organizational acceptance and commitment training, professional development, instructional

design, adult learning theory, handbook development, and handbook design.

Initial searches included publication dates from 2018–2022. Additional searches

were conducted using publication dates from 2016–2022 to expand the scope of the literature

that could be included. In addition, foundational literature was explored to ensure the

project’s theoretical soundness and to help evaluate all current literature on the subjects of

interest. Relevant information was found in more than 190 sources.

Introduction to Stress

The concept of stress was developed by Hans Selye over four decades of research

related to stress. Stress was first labeled as a general adaptation syndrome and defined as a

nonspecific response of a living organism to an environmental factor (Selye, 1936), but was

further refined to reflect two different causes: unpleasant factors or stimulating factors

(Selye, 1974). The separation of positive stress from negative stress conceptualized stress’s

psychological effects on the individual (Selye, 1979). Lazarus and Folkman (1984) added an

additional variable to the concept of stress: people’s appraisals of their resources in response

to environmental demands. Following this definition, stress’s negative aspects are best

understood as subjective and based on the evaluation of the resources available and the

relative balance between resources and environmental demand.

Early Constructs of Stress

Although used colloquially and enduringly in the common lexicon, the concept of

stress is a scientific term that has been debated and defined in the fields of biology,

psychology, sociology, and ecology. Contributions to defining the construct of stress could

be described as chaotic (Flaxman & Bond, 2006), with Lazarus and Folkman (1984) noting

that stress could be defined by its effect as a stimulus, its affect as a response, or its effect as

a combination of a stimulus and response. Each of these concepts reflects the traditional

streams of research that have attempted to define stress, including the stimulus methodology,

the response methodology, and the transactional methodology (Cox & Ferguson, 1991; Fink,

2016).

Stress’s earliest definition, which relate it to a particular stimulus, is grounded in the

field of physics, where stress is conceptualized as a strain by an outside force creating a

demand (Selye, 1979). This conceptualization of stimulus-based stress was responsible for

the general adoption of stress as a negative experience that causes unwanted demand

(Matheny et al., 1986). This idea has endured as an influence when stress is defined

informally.

The contrasting view of stress as a response to a stimulus is defined from physiology

as a biological change that occurs in the organism. Cannon (1935) revealed the chemical

changes that occur in an organism’s adrenal system when under stress, suggesting a

biological response to an outside stimulus. Cannon referred to these changes as the cell’s

emergency response, which is like Selye’s definition of a general response adaptation. In

each conceptualization, the organism is preparing biologically to respond to a threat in some

form that is survival based and adaptive.

When comparing the stimulus approach and the response approach, the delineation

can be described as whether stress is a function of an external demand, as in the stimulus

approach, or a function of an internal demand, as in the response approach. While each

approach creates components of stress conceptualization, they have been criticized as

incomplete in the concept of psychological human stress (Cox & Ferguson, 1991; Lazarus &

Folkman, 1984). Regarding psychological stress, the stimulus and response approaches are

inadequate because they do not account for individual differences in stress’s effects, nor do

they account for an active participation in the interaction between stress and the individual.

The Transactional Model of Stress and Coping

The transactional model of stress and coping suggests that the human experience with

stress is an iterative system of appraisal, response, and adaptation that can be either

functional or dysfunctional (Lazarus & Folkman, 1984). This definition moves the concept

of stress from a passive environmental or internal experience to a person-centered experience

where individual differences and active participation can be considered. Lazarus and

Folkman (1984) developed the foundational theory underpinning stress research to

conceptualize stress as an individualized experience in which perceived personal resources

and perceived personal danger mitigate the response (Obbarius et al., 2021).

According to the transactional model of stress and coping, people first conduct

primary appraisals to determine if the environmental elements are relevant and if they are

likely to present gain or harm. If harm is determined as present in the environment, a

secondary appraisal occurs to assess the balance between the perceived demands and the

perceived resources to meet these demands (Lazarus, 2020). If resources are determined

sufficient for meeting environmental demands, eustress occurs, allowing people to feel as

though they can meet the challenge, succeed, and grow. Conversely, if this appraisal shows

that demands are greater than resources, people will experience distress and begin to engage

in coping skills to manage distress’s negative effects (Lazarus, 2020). Essential to this model

of stress is the presence of positive outcomes when the resources are perceived to be robust

enough to meet the challenge and also an inherent engagement in coping when resources are

not perceived as adequate.

Coping With Distress

The transactional model of stress encompasses a structure for various coping types

that can be either functional or dysfunctional. Coping is defined as efforts to manage distress

by reducing, minimizing, or tolerating it (Folkman et al., 1986). Broadly, coping approaches

fall into two groups. Problem-focused coping reflects attempts to directly interact with the

environment and its presenting stressors to decrease or change these stressors, while

emotion-focused coping attempts to change the relationship between the individual and the

environmental stressor to lessen the stressor’s emotional impact (Lazarus & Folkman, 1984).

If stressors can be eliminated, problem-focused coping strategies are very effective, but in

instances where stressors cannot be eliminated, emotion-focused coping strategies are

necessary.

Such coping strategies, according to the transactional model of appraisal and coping,

will be highly individualized and determined by how the individual evaluates the stress

(Lazarus & Folkman, 1984). For example, when an individual receives a new task at work,

the individual will evaluate the demand through the lens of their perceived personal

resources. If the individual feels their resources are robust enough to meet the demands of

the new task, the task will be perceived as a challenge that could be beneficial, thus creating

eustress (Lazarus & Folkman, 1984). A different individual, or the same individual at a

different time, could interact with the same new task, use their appraisal system, and

determine that the task will overwhelm their resources and create personal harm. This results

in distress, propelling the individual to feel as though they have harmful stress in their

working environment.

Occupational Stress and Effects

A result of conceptualizing psychological stress is understanding how environmental

elements impact personal resources in positive and negative ways. Applying this concept can

reduce and prevent stress. Stress-reduction knowledge, informed by the transactional model

of stress and coping, can be applied in areas where stress’s presence is costly, such as

occupational stress management (Flaxman & Bond, 2006). Studies have indicated that

occupational stress is the leading source of stress for U.S. adults, with the World Health

Organization estimating a cost of $300 billion per year for U.S. businesses (Fink, 2016).

To conceptualize the impact of COVID-19 pandemic on the American workforce, the

American Psychological Association’s 2021 Work and Well-being Survey report indicated

that 71% of employed adults felt stressed during their workday (American Psychological

Organization [APA], 2021). In comparison, the same report in 2014 indicated only 31% of

employed adults felt stressed during their workday (APA, 2014). Although COVID-19 was a

considering factor, the 2021 report indicated that occupational stress continues to increase

and impact the workforce.

Conceptualization of Occupational Stress

Following Lazarus and Folkman’s transactional model of stress and coping,

occupational stress is similarly conceptualized in the literature as a disparity between

perceived personal resources and perceived occupational demands (Bunce, 1997; Murphy,

1996; Spector & Jex, 1998). The Centers for Disease Control (CDC) and the National

Institute of Occupational Health and Safety agreed with Lazarus and Folkman’s definition of

stress for occupational application by stating that damaging physical and emotional responses

occur when the individual’s resources and job expectations are unbalanced (CDC, 2019;

National Institute of Occupational Health and Safety, 1999).

Prominent theoretical foundations of occupational stress mirror the transactional

model of appraisal coping to suggest that workers will evaluate work environments and

determine how to cope with environmental demands, with individual differences determining

stress responses (Jex, 1998). This early model was used to conceptualize a contemporary

occupational stress model as the interaction between job demands and resource, known as the

JD-R model of occupational stress (Bakker et al., 2022). This model suggests that the

relationship between job demand and resources will cause motivation or strain depending on

the balance between the two constructs, resulting in engagement or disengagement in work

tasks (Tetrick & Winslow, 2015).

When conceptualizing occupational stress as a relationship between job demand and

personal resources, it cannot be assumed that decreasing job demands will solve this stress.

Nor should it be assumed that any presence of stress is inherently dysfunctional in the

occupational environment. To reiterate the separation between positive stress or eustress

from negative stress or distress, the presence of eustress is considered a positive and integral

occupational construct to drive performance (Choudhary & Ranjan, 2021; Hargrove et al.,

2015). Furthermore, the separation of eustress and distress does not depend on occupational

constructs or designs but is instead individualized based on the worker’s response to the

environment (Bienertova‐ Vasku et al., 2020).

Unless considered excessive in relation to personal resources, employees prefer high

occupational demands and the perceived presence of high personal resources (Kwon & Kim,

2020). The result of perceived high personal resources interacting with high occupational

demands is engagement in occupational demands and active engagement in coping strategies

(Kwon & Kim, 2020). That is, when demands are high and perceived resources are high,

workers will stay engaged in work tasks and will continuously reappraise and employ

adaptive coping skills to allow sustained engagement in their tasks. Thus, when

encountering high work demands, high perceived personal resources are positively reinforced

by the ability to cope and continue engagement in the task, which drives continuous

accessing of coping skills.

Mediators of Organizational Stress

With individual interaction between work ability and stress well established, it is

necessary to understand the variables that mediate stress in the organizational stress model so

that these variables can be monitored and selected as intervention areas. Understanding the

antecedents and correlates of occupational stress from a psychological perspective is

necessary to select and implement appropriate human resources interventions. As

demonstrated with stress theory, when workers increase their personal resources, well-being

and job performance increase (Chen & Fellenz, 2020). Likewise, believing that one has

many personal resources to access indicates a lower likelihood of experiencing stress-related

burnout (Bakker & de Vries, 2020). These mediators are considered lists of personal

resources for workers that can be increased, thus increasing workers’ stress tolerance by

balancing their job demands and resources and protecting their engagement in their

occupational expectations.

Job Control as a Mediator for Occupational Stress

In addition to individual perceptions of stress, organizational stress is also mediated

by the level of workplace control available in the environment. Job control is the ability to

alter the work environment to access more reinforcing elements and avoid aversive elements

(Perrewe & Ganster, 1989), thus decreasing the possibility of encountering psychologically

threatening events that increase stress. Low job control levels predict increased health

concerns, such heart disease (Marmot et al., 1997), while high job control levels predict

decreased burnout, anxiety, and health complaints at work (Terry & Jimmieson, 2003).

Increasing job control by adding discretion and choice as a job role reorganization method

can improve mental health measures and decrease absenteeism. Employees may also self-

rate their performance higher than before the intervention (Bond & Bunce, 2003). In Bond

and Bunce (2003), results of job control increase were sustained at least 1 year after the

intervention, according to postintervention assessment of participants.

Multiple foundational theories in both cognitive and behavioral sciences explain the

relationship between job control and job performance as mediated by stress. Seminal

research by Karasek (1979) suggested that job control creates a psychological buffer between

job demands, thus reducing job stress and increasing performance. Working environments

that shift control to the individual foster internal locus of control growth, which empowers

individuals to internalize autonomy and develop self-determination, two foundational

psychological factors that increase motivation and performance (Deci & Ryan, 2015).

High internal locus of control levels correlate with low occupational stress and high

job satisfaction (Bhattacharya et al., 2013). Thus, increasing locus of control levels can

decrease stress and increase satisfaction, motivation, and performance. Job control can allow

individuals to engage in workplace activities that are rewarding to them, avoid workplace

activities that may be aversive, or schedule averse activities when their cognitive and social

resources provide enough of a psychological buffer to consider them nonthreatening (Bond et

al., 2006; Flaxman & Bond, 2006).

Relational Frame Theory and Stress

Relational frame theory (RFT) is a language and thinking concept that accounts for

how language, including internal language, creates environmental contingencies that may not

actually be present in the environment but are still strong enough to impact individual

behavior (Tagliabue et al., 2021). Simply put, how people think about their environments

and their role in these environments will impact how they behave, whether their thoughts are

grounded or not. Thus, individual thoughts control behavior through decision-making and

behavioral choice and can be altered to increase behavioral effectiveness to complete tasks.

The psychological challenges associated with maladaptive responses to stress can be

explained behaviorally with RFT, which describes human behavior as sensitive to

environmental contingencies (i.e., rewards and punishments) as well as relational

contingencies, which are created by the human ability to use language (Hayes et al., 2006).

As individuals use private or internal language, they assign contingencies to their thoughts,

which effects behavioral choices. Through language, humans assign relationships mutually

and in combination that are not limited to form. For example, if children hear the word

“yummy” when they eat a favorite snack, they will come to associate the word yummy with

something good. When presented with a new food and told it is yummy, they will associate

the past experiences with “yumminess” and apply them to the new food even though the new

food is different from the original yummy food.

RFT also applies to negative experiences (Hayes, 2004). In the workplace, an

employee may have an unpleasant experience with a boss and think “My boss doesn’t like

me,” which can lead to feeling stressed at work. Through the internal language process,

unpleasant feelings can also be associated with being in a certain conference room, sending

emails, or being at work in any capacity. Such associations can even be carried over to a new

workplace where the boss is not even the same person, suggesting that relational associations

are enduring and can consistently impact behavior even if the original experience has been

eliminated (Hayes, 2004). Therefore, work stress cannot be eliminated by avoiding certain

elements.

RFT theorists have opined that SMIs that avoid or reduce the feelings of stress are not

effective, and, paradoxically, can actually increase stress by strengthening the verbal

relationships formed with these words and feelings (Barnes-Holmes et al., 2020; Wenzlaff et

al., 1988). Further, verbal associations cannot be cognitively eliminated or controlled;

therefore, they must be addressed as constant elements in the environment. RFT posits that

verbal processes are a stimulus that occur in the internal environment and that new responses

to these stimuli can be learned such that the stimuli (unwanted thoughts or feelings) create a

different and more adaptive behavioral response other than withdrawal from action due to

stress.

Psychological Flexibility and Stress

Applying a relationally related behavioral response to unwanted thoughts and feelings

requires developing psychologically flexible thinking. High psychological flexibility levels

are a fundamental aspect of psychological health and well-being as well as a necessary

component of behavioral effectiveness (Bond et al., 2006; Kashdan & Rottenberg, 2010).

Psychological flexibility is broadly defined as a set of dynamic internal processes that allow

individuals to adapt as demands change, reassign mental resources to the needed changes,

shift perspective as necessary to adjust to the changes, and balance competing contingencies

to respond effectively (Kashdan & Rottenberg, 2010).

Interactions between individuals and their environments produce certain

psychological experiences, some perceived as good and some perceived as bad. High

psychological flexibility indicates that individuals can consistently adapt and adjust to

changing environments without negative behavioral impact (Kashdan & Rottenberg, 2010).

Effective psychological flexibility in stress management allows people to stay in the present

situation and be aware of thoughts and feelings that occur because of that situation. Further,

these individuals can choose certain sets of behavioral actions consistent with their chosen

values and goals without needing to change their thoughts and feelings (Hayes et al., 2006;

Moran, 2011). Essentially, high levels of psychological flexibility allow people to continue

acting, which can result in continued performance, especially when stress is present.

Experiential Avoidance and Occupational Stress

Experiential avoidance is best described as the unwillingness to experience negative

thoughts and feelings that interferes with the ability to complete an action in the presence of

the negative emotion (Hayes & Wilson, 1994). Experiential avoidance is typically

considered high in individuals with excessive levels of anxiety, depression, and acute

emotional distress, but this characteristic can also simply reflect psychological vulnerability

for anxiety and depression rather than being a symptom of these psychopathologies. This

vulnerability is thought to be related to negative thoughts and feelings such that the more an

individual avoids feeling anxious or depressed, the more these feelings increase.

Kashdan et al. (2006) conducted two separate studies to create an understanding of

the construct of experiential avoidance. The first study focused on a correlation between

experiential avoidance and anxiety and showed that experiential avoidance mediated all

anxiety symptoms. With a correlation established, the second study compared two types of

interventions used to decrease anxiety: emotional suppression and cognitive reappraisal. The

two interventions were chosen in coordination with Lazarus and Folkman (1984) to compare

the effects of each on anxiety. Neither intervention type was effective if experiential

avoidance is high, further indicating that experiential avoidance impedes psychological

interventions.

Self-Regulation and Occupational Stress

Employees often encounter environments that present stressors they must react to

while balancing work demands and internal resources. Appraisal of resources and demand

occurs in a continuous loop (Lazarus, 2020), such that appraisal is constantly occurring and

can require a monitoring and review process for the individual that influences the work

environment and subsequent maladaptive or adaptive coping skills. Furthermore, as people

engage in constant reappraisal, the risk for distress increases if they appraise their personal

resources and do not feel their resources are adequate for the demand (Bakker & de Vries,

2020; Leone et al., 2008). To affect the reappraisal loop in a way that will decrease distress,

people must have contact with reappraisal that results in resources that can meet or exceed

the demand.

Consistent interaction with demands that cannot be met can result in a decrease in

behavioral engagement. Workers who experience distress that cannot be regulated are more

likely to have difficulties concentrating (Bakker & de Vries, 2020; van der Linden et al.,

2005) and are likely to narrow their behavior repertoire and engage less in tasks. In other

words, if workers have high levels of distress, they will decrease their engagement in work

tasks and be less effective at them.

Lazarus and Folkman (1984) originally defined coping. The term was later refined

into two categories: approach-based coping and avoidance-based coping (Tobin et al., 1989).

These broad coping strategies are like emotion-focused and problem-focused coping

strategies in that approach-based coping attempts to reduce the stressor and avoidance-based

coping attempts to avoid the stressor.

Given the dynamics of occupational stressors and personal demands, the ability to

move between coping skills positively correlates with decreased stress. Not being able to

switch between various coping skills positively correlates with increased stress (Bakker & de

Vries, 2020). People with maladaptive internal coping skills are more likely to use one type

of coping skill to meet changing environmental needs (Bonanno & Burton, 2014; Cheng et

al., 2014), which impairs the ability to adjust to the stressors over time (Bakker & de Vries,

2020).

In the workplace, maladaptive internal coping skills will present as workers who

avoid coming into work or try to decrease the tasks they complete. Both types of coping

strategies, when used inflexibly and without variability, will result in decreased success at

work and increased depression (Stange et al., 2017). Coping inflexibility is, therefore, a

predictor of increased distress levels over time.

Occupational Stress Management Interventions

Occupational SMIs are interventions for increasing employee well-being and

decreasing stress, either by addressing the cause of the stress or reducing the negative effects

of stress on employees. SMIs are categorized according to how they are applied and when

they are introduced in the environment (Tetrick & Winslow, 2015). Broadly, SMIs can be

used with individuals or groups in an organization (Holman et al., 2018). Additionally, SMIs

are organized as primary, secondary, or tertiary to distinguish when they are applied .

Interventions for preventing stress are primary interventions. Interventions for reducing the

intensity or duration of stress are secondary interventions. When stress negatively impacts

mental health and rehabilitation is necessary, SMIs are considered tertiary (Holman et al.,

2018).

Primary interventions are proactive and preventative in nature, while secondary

interventions can be either proactive or reactive but are used with employees designated at

high risk for stress intolerance. Tertiary interventions are always considered reactive and are

used with employees or groups who present with stress-related symptoms (Tetrick &

Winslow, 2015). As a preventative measure, primary interventions are much more likely to

be used with large groups or across entire sections of the organization, while tertiary

interventions, due to their reactive nature, are typically applied on an individual basis.

Results from multiple metareviews have suggested that primary interventions are

more effective than secondary interventions and that secondary interventions are more

effective than tertiary interventions (Richardson & Rothstein, 2008; Tetrick & Winslow,

2015). The most efficacious SMIs combine individual and organizational interventions

(LaMontagne et al., 2007; Tetrick & Winslow, 2015). These findings suggest that the most

effective SMIs are primary interventions applied both organizationally and individually.

Organizational-Level Interventions

Organizational-level interventions (OLIs) are generally used strategically and broadly

across organizations to proactively decrease the potential for stress or address stress’s

presence in the workplace. OLIs tend to cost more and require more time to implement (Cox

et al., 2000), so they are less likely to be used, but their results are more impactful and more

enduring than individual interventions (Molek-Winiarska & Molek-Kozakowska, 2020).

OLIs can be implemented at primary, secondary, or tertiary levels, though primary and

secondary are most common.

Primary OLIs focus on designing jobs to decrease the potential for stress. Such

interventions can address organizational practices, including the role of leadership, work

expectations, or increased safety measures (Anger et al., 2019), but typically include some

form of job redesign and work environment modification to produce less stressful job

expectations (Giga et al., 2018). Job characteristics most often determine stress and well-

being in the workplace (Demerouti et al., 2001) and are well suited to change to remove the

potential for developing occupational stress. Job design interventions for stress reduction can

address one element of job design, such as task choice (Bond & Bunce, 2000), or can address

multiple job design elements to increase well-being faster and more efficiently (Holman &

Axtell, 2016; Knight & Parker, 2019).

Secondary organizational-level SMIs provide group-based applications that can

improve employee skills for coping with stressful situations. Common interventions for

increasing stress tolerance and the resources employees can apply to stressful situations at

work include peer support groups for occupational stress (Agarwal et al., 2019) and skills

training courses ranging from communication skills and emotional intelligence training to

mindfulness (Ghannam et al., 2020; Kriakous et al., 2020; Meng & Qi, 2018). There is not

always a clear distinction between primary and secondary organizational SMIs, particularly if

there are social components to the interventions (Holman et al., 2018). As employees gain

social contact, they increase their general resources for preventing stress, thus group-oriented

secondary interventions will inherently contain a primary intervention component.

Individual-Level Interventions

Individual-level interventions (ILIs) consider individual differences and needs for

stress management. Most often, ILIs are prohealth education at the individual level. These

interventions are beneficial because they can be implemented faster, their results can be

measured faster, and they are more easily adapted to individual needs (Cox et al., 2000). ILIs

can also cost organizations less to implement and monitor (Molek-Winiarska & Molek-

Kozakowska, 2020). There are primary-, secondary-, or tertiary-level ILIs, though secondary

and tertiary are most common.

Primary ILIs can be applied in organizational settings through human resources

assessment and selection prior to hiring (Holman et al., 2018). Informed assessment and

selection of employees prior to job assignment can predict employees who already have the

capability to tolerate stress inherent in the job design (Johnsen et al., 2013).

Secondary ILIs can increase employees’ skills and capabilities for coping with stress

when it is present in the work environment. Such interventions can include relaxation

techniques, meditation, mindfulness training, CBT, exercise and diet programs, and

educational programs on stress (Holman et al., 2018). Secondary ILIs are considered

antecedent-based interventions as they increase the capabilities to respond to stressors before

they present.

Relaxation and Meditation

Relaxation, which includes mental relaxation or meditation, provides restoration and

increases in mental health and well-being. Relaxation principles are considered incompatible

with distress; that is, as relaxation increases, distress decreases. Physical relaxation can

include progressive muscle tensing and releasing through massage (Ruotsalainen et al., 2021)

or meditation, which includes repeating a single word or thought while maintaining a passive

thought state (Greenberg, 2021, Chapter 10). Physical and mental relaxation can result in

greater decreases in stress than no intervention alone (Hathaisaard et al., 2022; Vidic, 2021;

Woolfolk et al., 1982). Relaxation and meditation modalities can be delivered in adaptable

settings, including in groups to influence individual stress levels and virtually without the

need for physical contact (Bostock et al., 2019; Riches et al., 2021).

Cognitive Behavioral Therapy

CBT supports the theory that thoughts about stress contribute to the physical and

psychological symptoms of stress, which affect the behavioral repertoire of the individual

when experiencing stress. CBT focuses on teaching a range of techniques that allow

individuals to identify and reappraise their thoughts that contribute to stress. The goal is to

eliminate stress responses that impact behavior by changing these maladaptive thoughts

(Hong et al., 2016).

CBT can be used to teach people how to reappraise their thoughts about stress and

replace them with thoughts that do not cause stress (Beck, 2016; Beck & Haigh, 2014). CBT

approaches to stress reduction are predicated on the practice of changing or eliminating

maladaptive thoughts. In their meta-analysis of occupational SMIs, Richardson and

Rothstein noted that CBT was more effective for reducing stress than relaxation or

combination SMIs.

CBT is widely recognized as the psychological implementation with the most

empirical support. It is a long-standing practice that has evolved over time (Kroenke &

Swindle, 2000; Nakao et al., 2021). The first iteration of CBT was classic behavioral therapy

as conceptualized theoretically by Freud, which used the principles of relaxation and

desensitization to reduce stress and change outward behaviors (Newmann & Beehr, 1984).

CBT’s second wave is characterized by the identification of maladaptive thinking patterns

and the use of various techniques, such as those developed by Beck and Ellis (Beck, 1976;

Ellis, 1962), to reduce stress by replacing maladaptive thinking patterns with more adaptive

thinking patterns. The techniques and concepts in second-wave CBT are consistent with

problem-focused coping strategies suggested by Lazarus and Folkman (1984) but rely on

constant removal of stress-inducing thoughts to produce the desired effect, which can be

difficult to maintain on a daily basis (Beck et al., 1979; Hayes et al., 2006). Summarizing the

application of second-wave CBT to stress management indicates that the content of thoughts

must be changed for stress to be attenuated.

Mindfulness-Based Training

As an intervention for stress, CBT has developed into a third wave that incorporates

mindfulness. Hayes (2004) conceptualized CBT’s third wave as a byproduct of functional

contextualism, which addresses altering the function of psychological stress rather than

changing the event, thoughts about the event, or the response to the event (Kennedy &

Pearson, 2020, Chapter 6). Third-wave CBT techniques focus on issues such as mindfulness,

emotions, acceptance, values, and metacognition (Hayes & Hofmann, 2017), with an

emphasis on interacting with environmental stressors in an adaptive way when they cannot

be removed. This method of adapting to stress aligns with Lazarus and Folkman’s (1984)

process-focused response to stress and is most applicable in settings when individuals must

encounter stress without negative effects that will overwhelm their resources.

Adding mindfulness to CBT promotes being aware of the present moment and the

resulting thoughts, feelings, and experiences that occur in that moment. Unlike relaxation-

based and CBT-based SMIs that focus on removing stressful thoughts and physical

symptoms, mindfulness-based SMIs do not avoid or suppress negative thoughts or

experiences. This approach is valuable as avoiding negative thoughts and experiences

negatively impacts well-being (Gross & John, 2003). Rather than avoiding negative thoughts

and experiences, mindfulness principles allow the individual to engage in the potentially

stressful experience while also developing adaptive coping skills.

Mindfulness-based SMIs include ACT and mindfulness-based cognitive therapy

(MBCT). ACT and MBCT have both shown positive results when implemented for stress

tolerance, but few studies have been conducted in organizational settings (Holman et al.,

2018). Of those that have been conducted, MBCT was shown to decrease stress in

employees (Hülsheger et al., 2013). ACT was shown to have a moderate effect across

sample populations with applications in all settings (Dindo et al., 2017).

Acceptance and Commitment Therapy Implementations for Stress Management

As psychological intervention has matured through research, waves of psychological

constructs have built upon previous foundational frameworks such that a third wave of

psychological intervention has emerged (Hayes, 2004). The third wave was identified in the

early 2000s and is characterized by identifying people’s relationships to their thoughts

through mindfulness, emotional acceptance, value-driven behavior management, and

metacognition (Hayes & Hofmann, 2017). The evolution toward third-wave psychology is

rooted in process-based therapy, which connects evidence-based processes and procedures,

including SMIs, to alleviating societal problems (Hayes & Hofmann, 2017). Intervention

models identified in the third wave include functional-analytic psychotherapy, dialectical

behavioral therapy, MBCT, and ACT.

The ACT Model of Psychotherapy

ACT is a third-wave CBT implementation that is founded in RFT and functional

contextualism. ACT is unique in that it is transdiagnostic, multimodal, and can be delivered

in brief and varied sessions, making it applicable for diverse populations (Dindo et al., 2017).

Although ACT is connected to a cognitive-behavioral tradition, there are notable

philosophical differences. Both modalities address cognitions as a variable in developing

psychological distress. However, second-wave CBT attempts to change the content of the

thoughts to avoid or alleviate stress. ACT contends that the content of thoughts is not

harmful but that the relationship between the individual and the thoughts can be harmful

(Bond & Bunce, 2000; Hayes et al., 2006).

According to ACT principles, cognitive fusion creates a harmful relationship between

the individual and the thought (Cookson et al., 2019; Pingo et al., 2019). Cognitive fusion,

which results in behavior becoming tightly controlled by cognitions, occurs when people

respond to their thoughts as if they are literal (Zare, 2017). For example, thinking they are

not good enough to complete a report for work can create negative feelings in people. To

avoid these feelings, they will avoid completing the report until they no longer have negative

feelings. However, relational verbal networks, based on RFT, prevent the thought and

feelings from being eliminated. Believing they can only engage in the activity of writing the

report if it does not create negative thoughts and feelings will restrict behaviors in these

people, creating behavioral ineffectiveness.

The fundamental understanding of ACT is that pain and suffering, including painful

emotions, are an inherent part of the human existence. As such, ACT’s philosophical focus

is not to remove pain and suffering but instead to accept these experiences as essential to

humanity and that people should continue to act based on identified values even as these

actions and values produce pain and suffering (Hayes et al., 2006). Practicing ACT

techniques aims to increase engagement in chosen meaningful activities, even while

experiencing unpleasantness, by increasing psychological flexibility.

Broadly, ACT proposes that experiential avoidance created by cognitive fusion

results in behavioral ineffectiveness. Experiential avoidance, which is a mediator for stress

levels, is the unwillingness to experience uncomfortable internal experiences. This

unwillingness results in escaping or avoiding the experience, resulting in long-term

dysfunction (Hayes et al., 1999).

Avoiding or escaping the unpleasant situation can take any form, including calling in

sick to work, surfing the internet instead of working, or other escape methods, like drinking

alcohol. Escaping or avoiding the unpleasant situation can prevent contact with

psychological pain in the short term. However, it removes the individual from engaging in

meaningful actions, like going to work, and creates long-term problems, including high

levels of distress. Engaging in experiential avoidance because of cognitive fusion is strongly

predictive of high distress levels (Cookson et al., 2019).

Given that cognitive fusion and experiential avoidance are the key predictors of

distress, decreasing cognitive fusion and experiential avoidance is an effective target for

SMIs. The willingness to engage in pain and suffering to pursue value-based actions, or

experiential acceptance, is the countermeasure for experiential avoidance (Block-Lerner et

al., 2009). Experiential acceptance can increase through therapeutic application of

psychological flexibility, defined as the ability to persist or change behavior in order to

remain engaged in the present moment based on chosen values, even as the present moment

presents psychological discomfort or distress (Hayes, 2004).

Psychological flexibility is conceptualized in the ACT intervention by six core skill

sets, which can be taught as a part of an SMI. The six core processes, as defined by Hayes et

al. (2013), are as follows:

1. Contact with the present moment; that is, purposefully recognizing and

experiencing what is presently occurring, including all thoughts, feelings, and

physical sensations.

2. Cognitive defusion, defined as creating a perspective on thoughts and feelings that

is not literal by noticing thoughts but not connecting actions to thoughts.

3. Self as context, which is developing a flexible perspective on the self such that the

individual is observing and aware of experiences without classifying or

quantifying them.

4. Values, defined as identifying what is most important to the individual and the

behaviors that align with pursuing these values.

5. Committed action, which is cultivating a commitment to engage in the actions to

pursue the chosen values.

6. Acceptance, defined as accepting unpleasant thoughts and feelings that occur

when engaged in committed action.

ACT aims to teach the skills necessary to accept that uncomfortable thoughts and

feelings occur as a part of the human experience and commit to engage in the areas that can

be controlled (e.g., the behavior that the individual chooses) by employing psychological

flexibility in noticing the unpleasant thoughts/feelings, disregarding their impact on action,

and pursuing chosen values.

ACT as an Effective Psychological Intervention

ACT interventions have been studied in a wide variety of clinical applications since

the early 2000s, but unlike other psychotherapy approaches that assign a specific type of

intervention to a specific diagnosis, the base research for ACT is applicable across diagnoses,

settings, and applications (Dindo et al., 2017). This research base indicates that ACT is

suitable and effective in a wide variety of settings. Randomized control trials of ACT across

diagnoses and populations are increasing. Nine hundred and twenty-four trials have been

catalogued since 1986, and 127 were 127 completed in 2021 alone (Hayes, 2022).

Hayes (2004) conducted the earliest metareview of ACT as an intervention to address

concerns that third-wave psychological interventions, like ACT, did not reflect data-driven

research. After evaluating 34 published articles on ACT and other third-wave treatments,

Hayes determined that while the research was still developing, this therapeutic model was

effective and showed a clinically significant mean effect size.

Following up on the early meta-analysis by Hayes (2004), a meta-analysis in 2014

incorporated 10 more years of ACT research (A-Tjak et al., 2014). A-Tjak et al. (2014)

surveyed 39 studies and determined that ACT was more efficacious than waitlist,

psychological placebo, and treatment as usual. They also determined that ACT was

applicable across diagnoses, settings, and existing psychological or medical comorbidities,

suggesting that ACT would be applicable across a generalized cross-section of individuals.

In a meta-analysis of 60 randomized control trials related to ACT intervention, Öst

(2014) found that ACT had a small but nonsignificant advantage over other cognitive and

behavioral treatments. Findings also showed that ACT was applicable across diagnoses and,

without knowing or assessing the diagnoses, was efficacious when applied in groups and to

address a spectrum of individual needs. These findings indicated that ACT was not the only

applicable treatment for stress intervention but was ideal for heterogenous group settings

such as those found in organizations (Öst, 2014).

Similar findings were reported in Gloster et al.’s 2020 meta-analysis of 20 studies

representing 12,477 participants. Results from all 20 studies reflected positive gains when

participating in ACT for all diagnostic impressions, including anxiety, depression, substance

abuse, and chronic pain (Gloster et al., 2020). Results from these studies demonstrated

ACT’s efficacy across groups and with various diagnoses.

In a 2021 meta-analysis, ACT was found moderately effective over time when

implemented virtually. Thompson et al. (2021) analyzed 25 implementations of internet

ACT (iACT) and found pooled clinical effects after implementation that were maintained

with follow-up measures. Thompson et al.’s analysis also indicated a greater effect when

iACT was implemented with guided access by a therapist, rather than self-guided. Greater

effects were also seen in groups with identified diagnoses than in diverse groups with no

diagnoses. Thompson et al. concluded that iACT was effective for reducing stress in diverse

populations and had lasting effects but may not have efficacy in all settings or with all

individuals.

ACT as an Effective Workplace Intervention

There is an inherent presence of stress in the workplace that cannot be avoided and

must be confronted. Strategies that allow stress to exist when it cannot be ameliorated by

preventative measures are a necessary component of effective workplace stress management

programs. As such, ACT, which is designed for stress tolerance rather than stress

elimination, has been identified as particularly applicable in workplace settings due to its

implementation flexibility.

Foundational Research for ACT in the Workplace

Existing research on using ACT in work environments has indicated its efficacy as an

intervention for organizational needs, including the effects of stress in human resources. In a

study of the first application of ACT training components in the workplace, Bond and Bunce

(2000) explored stress moderation in the workplace by comparing SMIs. Methods proposed

to decrease workplace stress included targeting negative feelings associated with the stressors

or identifying the stressors and attempting to ameliorate their presence based on Lazarus and

Folkman’s (1984) foundational theories of stress.

To test the application of this theory, Bond and Bunce (2000) contrasted ACT, which

focuses on addressing emotions involved in stress, with an innovation promotion program

(IPP) that focused on removing stressors from the environment. There were 90 volunteers in

the study. Thirty participated in ACT, 30 participated in IPP, and 30 were assigned to a

waitlisted control group (Bond & Bunce, 2000).

Participants in the ACT group addressed emotions related to stress (Bond & Bunce,

2000). Components taught in this intervention included acceptance of the unpleasant

emotions most often associated so that the participants could continue engaging in actions in

pursuit of their values. The expected outcome was that after practicing ACT skills, group

members could engage in the prescribed workplace actions that resulted in workplace stress

but remain empowered, maintain performance, feel competent, and reduce stress over time

(Bond & Bunce, 2000). ACT skills were taught in three 3-hr sessions over the course of 2

months, reflecting a brief implementation of an SMI that was not time intensive.

In contrast, study participants assigned to the IPP group were taught how to identify

and eliminate stressors from their environments. Both interventions showed positive

correlations with task completion and mental health measures, but the impact was mediated

by the dependent variable, which was either acceptance of the stressor or modification of the

stressor (Bond & Bunce, 2000). Participants trained in the ACT intervention decreased stress

without removing stressors, while those in the IPP group decreased stress when stressors

were removed. Individuals who engaged in the ACT training indicated higher levels of

creative and innovative thinking when presented with stressful situations in the workplace,

indicating that ACT principles decreased stress and increased other skills not directly taught

in the training components (Bond & Bunce, 2000).

Results from Bond and Bunce (2000) indicated that SMIs are effective at increasing

task completion during stress but suggested the importance of knowing which variables are

present. Bond and Bunce further stated that IPP would not be considered an appropriate

intervention when working in settings where stressors cannot be removed. ACT, however,

would be appropriate in such settings (Bond & Bunce, 2000).

In a similar study, Flaxman and Bond (2010) conducted a randomized control trial

with participants rated as having high levels of distress. The participants were assigned to an

ACT intervention, a stress inoculation intervention, or a waitlisted control group. Both the

ACT and stress inoculation intervention groups showed improvement in their mental health

and decreases in levels of distress based on the mediating variables. Flaxman and Bond

concluded that the efficacy of either intervention in the workplace setting supported

implementing cognitive behavioral principles to address workplace problems.

Based on findings in Bond and Bunce (2000), Bond and Hayes (2002) created the

first guided ACT intervention designed for workplace implementation by trained

professionals. The intervention consisted of three sessions designed for brief ACT

implementation in the workplace, including two didactic 3-hr training sessions and a follow-

up session 1 month later, which has become a standard model for ACT workplace

interventions. Bond and Hayes based their intervention model on a brief psychotherapy

implementation for workplace settings that showed improvement in more than 50% of

participants with only two intervention sessions (Barkham & Shapiro, 1990).

To continue demonstrating ACT’s efficacy and to expand the knowledge of ACT

application in the workplace, Bond and Bunce (2003) investigated if high levels of

psychological acceptance would impact task completion at work. They tested this hypothesis

on a sample of data entry clerks to determine their measures of psychological acceptance and

job satisfaction and their ability to complete tasks. High levels of psychological acceptance

were associated with high levels of mental health and job performance, suggesting that study

participants with high acceptance levels were less likely to engage in task avoidance and

could focus their mental resources on task completion (Bond & Bunce, 2003).

The study results also showed a correlation between psychological flexibility, job

satisfaction, and task completion (Bond & Bunce, 2003). Even if employees reported low

job satisfaction levels, they still exhibited high task completion if they also had high

psychological flexibility levels. Bond and Bunce (2003) concluded that employees with high

psychological flexibility will have greater task completion, even if they are unsatisfied with

their job.

To further expand the understanding of ACT as an evidence-based workplace

intervention, Hayes et al. (2006) discussed the role of RFT and ACT in workplace behavior

analytics. The authors began by contending that behavior analytics in the workplace,

practiced as part of organizational behavior management, did not adequately address or

present solutions applicable to the workplace environment because of the inability to address

motivational operations and private events in ways that are consistent with behavior analytic

research. In other words, organizational behavior management did not yet have the

theoretical basis needed to address the effects of thoughts and feelings in the workplace and

would not have this basis until RFT was more fully developed in the research (Hayes et al.,

2006).

Hayes et al. (2006) continued by stating that RFT provides an explanation for how

language develops thoughts and feelings that are barriers to workplace success. They then

presented ACT and explained the elements of ACT practice through the RFT framework.

RFT suggests that the evaluation of the stressor, which is driven by language, is often the

source of increased stress and can be mediated based on changes in behavior even when the

stressor cannot be removed. Given the theoretical foundations of ACT and RFT,

implementing these interventions is appropriately applied to organizational SMIs.

ACT’s Effects on Psychological Flexibility in the Workplace

ACT is effective as an SMI because it mediates psychological flexibility levels in

individuals in any given setting. The correlation between psychological flexibility and high

mental well-being is empirically established (Hayes et al., 1996; Kashdan & Rottenberg,

2010), and ACT is known to increase psychological flexibility. Ciarrochi et al. (2010)

measured determinants of ACT’s mediating effects on psychological flexibility to ensure that

psychological flexibility produced by ACT correlated with other measures of health and

well-being. The researchers compared the Acceptance and Action Questionnaire (AAQ-II)

with other validated mental health measures to determine the efficacy of increasing

psychological flexibility using ACT. The AAQ-II is used to measure individuals’ flexibility

levels compared to other measures of well-being: work-specific well-being and quality of

life.

Ciarrochi et al. (2010) determined that the AAQ-II aligned with the other validated

measures. Additionally, high AAQ-II scores negatively correlated with measures of

depression, anxiety, and psychological stress. The correlation between AAQ-II scores and

other valid health and wellness measures suggested that psychological inflexibility will

predict stress and that implementing ACT will increase psychological flexibility, further

validating ACT’s efficacy in increasing psychological flexibility.

To further explore psychological flexibility’s mediating effects in the workplace,

Deval et al. (2017) implemented a workplace ACT training for a group of managers and

leaders. As managers and leaders, the participants were considered high functioning due to

the behavioral skills they developed to reach their high-ranking positions. Additionally, the

participants did not present with psychopathology consistent with high stress levels and were

rated as high in well-being.

Prior to this study, workplace ACT implementations had focused on employees who

did manual or technical work or who already presented with high levels of distress (Deval et

al., 2017). Results indicated that ACT increased psychological flexibility levels in high-

functioning participants but did not change their overall measures of well-being. Deval et al.

(2017) concluded that ACT was beneficial for individuals whose behavioral skills were

already rated as high and distress was not present.

As a mediator of organizational outcomes, increases in psychological flexibility are

predictive of increases in other prowork skills and capabilities. For example, when

implementing a workplace intervention to decrease burnout and increase well-being at work,

psychological flexibility was the key mediator for all other gains measured (Puolakanaho et

al., 2020). Given these findings, increasing psychological flexibility, which is the core

outcome of ACT, is foundational in addressing multiple organizational goals.

ACT’s Effects on Work Performance and Attendance Measures

When work performance is considered as a measured variable, implementing ACT

principles has shown positive correlations with increasing job performance. In Bond and

Flaxman (2013), measures of psychological flexibility among call center workers predicted

higher levels of mental health and the ability to learn a new task faster. The authors

theorized that when learning new skills, employees with high psychological flexibility levels

would remain more engaged in the task rather than avoid task engagement to escape distress.

Similarly, Varra et al. (2008) found that employees who engaged in ACT principles

were more likely to follow through with workplace initiatives requiring learning and skills

acquisition than employees without ACT training. Likewise, in Luoma et al. (2007),

counselors who engaged in ACT training sessions for 8 weeks were more likely to apply

their newly gained skills than those who did not attend the sessions. Findings from these

studies suggest that ACT training helps employees gain new work-related skills and that

these skills endured beyond the initial training.

ACT can also enhance work task performance. Among direct care professionals

working with individuals with developmental disabilities, active treatment and technical

competence increased after ACT training (Pingo et al., 2019). In this study, the participants

who received ACT in addition to corrective feedback were higher performers than those who

just received corrective feedback.

In Gaupp et al. (2020), a 2-day ACT training for health care professionals showed

similar results to Pingo et al. (2019); specifically, increased productivity and attendance at

work. Employees who engaged in the training demonstrated significantly higher

performance efficacy than those who did not (Gaupp et al., 2020). Additionally, there were

measurable gains in work attendance in the employees who attended the ACT training

compared to their attendance before the intervention. Analysis showed a 10-fold savings for

the employer as a result of higher work attendance among these employees (Gaupp et al.,

2020). When applied to employees diagnosed with or experiencing symptoms of depression,

anxiety, or burnout, ACT is effective for decreasing illness-related absences, thus increasing

attendance overall (Finnes et al., 2019).

ACT’s Effects on Workplace Burnout

Increased psychological flexibility through ACT implementation are also predictive

of decreases in burnout among employees. Burnout occurs because of chronic contact with

workplace stressors (Maslach & Jackson, 1981) and can be predicted by low levels of

psychological flexibility (Lloyd et al., 2013; Ortiz-Fune et al., 2020). A systematic review of

13 studies on ACT implementation for burnout reflected various implementation formats and

populations, but all showed positive effects on at least one measured variable (Towey-Swift

et al., 2022).

In Biron and van Veldhoven (2012), service workers with higher psychological

flexibility levels, as indicated by questionnaire, had lower daily exhaustion levels when

measured at bedtime. These workers, who were subjected to high levels of emotional labor

during their daily tasks, were able to lessen the effects of stress when they encountered them.

Based on the participants’ journal entries, Biron and van Veldhoven concluded that the

employees with high psychological flexibility used less emotional energy when attempting to

control their emotions and were better able to engage in relevant workplace tasks, thus

increasing their optimal performance.

Reeve et al. (2021) explored ACT and burnout using a nonconcurrent multiple-

baseline across-participants single-case experimental design. Findings showed that ACT

reduced burnout symptoms and increased psychological flexibility in all four study

participants. The findings supported ACT’s efficacy in decreasing burnout and highlighted

the mediating variable of psychological flexibility (Reeve et al., 2021).

ACT’s Effects on Psychological Distress in the Workplace

Psychological distress in the workplace can significantly impact employees’ physical

and mental well-being, resulting in physical and mental dysfunction and productivity loss

(Mopkins, 2022). In a meta-analysis and systematic review, ACT consistently showed

greater efficacy in decreasing workplace distress when compared to control groups (Prudenzi

et al., 2021). Prudenzi et al. (2021) identified the putative mechanism that aids ACT’s

effectiveness as needing further clarity. In implementations with health care workers, ACT

interventions resulted in significant decreases in psychological distress symptoms (Prudenzi

et al., 2022), indicating the effectiveness of work-based ACT interventions for decreasing

psychological distress.

In a systematic review of four studies, Reeve et al. (2018) found that ACT

implementation had a greater effect on psychological distress than on burnout. Findings

showed the effects being highest for individuals who reported high levels of psychological

distress. The greatest impact on psychological distress was shown in postintervention

checks, rather than directly after the ACT intervention, indicating that the results of ACT

implementation accumulated over time and with continued practice. Reeve et al.

hypothesized that as ACT principles are consistently applied, individuals can engage in more

meaningful and value-based action, thus increasing their well-being.

Similarly, Brinkborg et al. (2011) found that presenting stress levels in study

participants determined the efficacy of the ACT intervention. When participants were

divided into stratified groups such that the stress levels could be used as a moderator, those

with higher distress levels clearly had the greatest positive effects when engaging with ACT

interventions. These findings indicate that decreasing psychological distress is a factor to

consider when implementing ACT interventions and could indicate that individuals who do

not have high distress levels may already have the coping skills necessary to prevent distress

from impacting them at work.

Appropriateness of ACT for Workplace Implementation

Workplace research has supporting ACT as a human resources intervention. The

efficacy of ACT’s theories and principles in the workplace are well founded (Bond & Hayes,

2002) and provide confidence for human resources managers who want to implement

evidence-based interventions. Additionally, ACT in the workplace aligns with SMI’s

theories and principles as well-identified mediators for stress in the workplace (Bond &

Bunce, 2003; Bond & Flaxman, 2006). With such close alignment to theories of stress

management in the workplace, ACT is well founded as an intervention that addresses

identified organizational needs.

Beyond the theories, ACT has features that make it conducive to implementation by

human resources managers. Best practices indicate that effective wellness program

implementation includes the ability to modify the implementation to meet varied needs and

the ability to ensure that participation is easy and does not require so much time or effort that

there is attrition (Goetzel et al., 2007). Features of ACT that increase its usability in work

environments include that ACT is transdiagnostic, it can be flexibly delivered, and it can be

implemented with very few learning sessions (Dindo et al., 2017).

Features of ACT Implementations

ACT focuses on accepting the presence of unpleasant thoughts and feelings. As such,

it is not designed to address symptom reduction or psychopathology. Accepting unpleasant

thoughts and feelings creates an ACT feature that is described as transdiagnostic and is

generally understood to be applicable to all individuals (Dindo et al., 2017) as all individuals

experience unpleasant feelings as a function of being human. This feature makes ACT easily

applicable in work settings and generalizable to all employees, regardless of the presence or

absence of diagnoses.

Research has shown that ACT can be implemented in wide varieties of settings and

formats, including online, in person, individually, in groups, through telephone coaching, or

by app. Multiple studies on using ACT for smoking cessation showed success with each

delivery modality (Bricker et al., 2013; Bricker, Bush et al., 2014; Bricker, Mull et al., 2014).

Delivery flexibility is useful when designing workplace wellness programs because it allows

customizing program delivery to meet employee needs.

ACT offers additional flexibility in that it can be delivered relatively quickly. From

the outset, ACT in the workplace was designed to be delivered in two didactic 3-hour

training sessions and a follow-up session 1 month later (Bond & Hayes, 2002). ACT training

has also been delivered in 2-day implementations (Gaupp et al., 2020; Waters et al., 2017)

and 1-day implementations (Dindo, 2021). Brief ACT implementation is appealing for

human resources managers concerned about training initiatives interfering with work goals.

The intervention’s short nature is also beneficial because it reduces program attrition and

allows employees to fully benefit from the implementation.

Barriers to ACT Implementation

While ACT is well-suited to workplace use, there are some barriers to implementing

it in this setting. In their handbook on ACT training in the workplace, Flaxman et al. (2013)

suggested that trainers should have a background in psychology or behavioral science with a

minimum of 8 weeks of mindfulness practice and training before teaching ACT in a group

setting. This represents a barrier for human resources managers who want to implement

ACT in the workplace but do not have the background or training Flaxman et al. suggested.

Because ACT is based on broad principles that underpin human behavior and have

been applied transdiagnostically and with nonclinical populations, it has expanded from a

clinically based therapeutic intervention for diagnosed populations to a workshop-based

application for providing training rather than therapy (Cihon et al., 2021; Dindo et al., 2017;

Humphreys, 2016). ACT applied without therapeutic expectations is called ACTraining,

which moves ACT from being implemented by trained psychologists only and into

application by laypersons (Moran, 2011, 2015). By adding an implementation that does not

require therapeutic training and background, other professionals can teach ACT using guided

materials, such as the handbook developed as part of the present ADP.

Creating a Novel Professional Development Learning Handbook

Creators of professional development learning handbooks for use in work settings

should consider best practices for implementation during the design process so that the end

result is an effective product. Professional development is skill building and training

purposefully designed for a target group and a specific learning objective (CDC, 2019).

Professional development can be delivered through trainings, workshops, handbooks, or

online learning and can be self-guided or led by a facilitator (Martin et al., 2013).

Workplace Handbook Development Steps

Creating a novel professional development handbook starts with determining the need

for the handbook and how it will be implemented. Harris et al. (2015) identified four broad

steps in program development: (a) identifying the need for the handbook, (b) developing the

program for proposal to stakeholders, (c) implementation, and (d) evaluation. Projected

outcomes of program implementation should be considered from the outset of instructional

design (Harris et al., 2015). Effective handbooks will have a foundation in empirical

research from credible sources, be testable and adaptable, clearly demonstrate return on

investment, and have a simplistic presentation free from barriers related to complexity. They

should also be consistent with the organization’s culture and have accessible and attractive

delivery modalities (Harris et al., 2015).

Established formats for evaluating existing professional development handbooks

should also be considered during the design process so that the final product can be evaluated

based on categories previously identified as valuable to stakeholders. Established areas of

evaluation to consider include (a) implementation, including the curriculum guides/learning

materials and format for implementation; (b) stakeholder reaction, including the perception

of the program and outcomes; (c) learning, including the presence of increased knowledge,

skills, and capabilities; (d) behaviors; including the program’s impact on changing individual

and organizational behaviors in measurable ways; and (e) impact, including the enduring

effects of program implementation (CDC, 2019; Guskey, 2000; Kirkpatrick & Kirkpatrick,

2006).

Workplace Handbook Development Guidelines

How a learning handbook is designed can determine the outcomes of its

implementation. Designing a learning handbook for applying ACT in workplace settings to

increase employee stress tolerance and wellness was a complex undertaking that

encompassed elements of instructional design theory and adult learning theory to ensure

effective implementation of the ACT intervention. A balance between declarative and

procedural learning is a primary consideration when developing these handbooks (Anderson,

1982; Hong et al., 2016; Schunk, 1996). Declarative learning occurs in any printed or

visually represented materials that are presented to students. Procedural learning to guide

knowledge application through practice is embedded in declarative learning materials (Hong

et al., 2016). For the handbook developed as part of the current ADP, each type of learning

was informed by empirically supported instructional design that facilitates complex skill

acquisition.

Adult Learning Theories

Adult learning theories are pivotal in designing and implementing effective

professional development programs (Mukhalalati & Taylor, 2019). As such, the defining

features of adult learning theories should be reflected in professional development materials.

Knowles (1970) formalized adult learning theories by identifying certain underlying

assumptions and principles. Andragogy, the most fundamental understanding of adult

learning, posits that adult learning needs and motivations differ from children’s and that these

needs should be considered when developing learning materials for adults.

Knowles (1970) proposed five assumptions and four principles of adult learning to

incorporate into adult learning materials. The first assumption is that adult learners have a

concept of self that is autonomous and independent, creating a strong need to choose self-

directed learning goals. The second assumption is that adults have unique life and learning

experiences that must be considered and incorporated into their novel learning experiences

(Knowles, 1970; Kolb, 1984). The third assumption is that adults identify their readiness to

learn, often in response to changes in social roles (Merriam, 2001). Readiness to learn is

closely related to goal orientation, thus adults assess their readiness to learn as it relates to

personal and social goals (Knowles, 1970).

The fourth assumption is that adults assess the immediacy of learning need rather

than the future possibility of learning needs. Adults present with a practical need to engage

in activities that are immediately valuable to them (Lieb, 1991), thus learning must be

applied to the current needs. The fifth and final assumption is that adult learners are

intrinsically rather than extrinsically motivated (Henschke, 2016). This indicates that adults

are motivated to engage in learning to gain self-esteem, secure social capital, or achieve

new capabilities at work but may not be motivated to learn for money or a new position at

work.

Based on these assumptions, Knowles (1970) created four guiding principles for adult

learning. Effective adult learning includes each of these guiding principles and should be

designed with each principle in mind. First, adult learning involves the learner in the

planning and evaluation of the learning experience. Second, adult learning activities should

be experiential. Third, learning objectives should be immediately applicable to a current

problem. Fourth, adult learning is most effective when it is focused on solving a problem,

rather than sharing content (Knowles, 1970).

To highlight using the guiding principles in real-world learning solutions, Knowles

(1984) created examples of how to apply the principles to learning tasks He suggested the

following: (a) explaining why certain elements are included in the learning experience, (b)

focusing instructional activities on completing a common task rather than rote memorization,

directed activities, which allow learners to explore autonomously and discover without

guidance while providing guidance when understanding needs support.

While Knowles’s assumptions and principles of adult learning have endured,

continued research in adult learning identified an area of adult learning not highlighted in

Knowles’s theory that should also be considered when developing learning opportunities for

adults. Mezirow (2000) proposed the theory of transformative learning, which suggests that

as adults learn, they encounter learning experiences that challenge their current frames of

reference and cause shifts in beliefs, assumptions, or values. Through experience and

reinforcement, these assumptions, beliefs, and values become engrained in adult learning

patterns.

A new type of learning occurs––transformative learning––in which adults challenge

their assumptions, beliefs, and values and change them based on new information (Cranton,

2006; Merriam & Bierema, 2014). Transformative learning occurs most often in social

learning environments due to the likelihood that different participants will share different

ideas (Frerejean et al., 2021). Because of the value of transformative learning, particularly

when learning objectives are likely to reflect new ideas, social learning is a valuable learning

environment.

Instructional Design Theories

Teaching how to implement ACT principles is an inherently complex task. Complex

learning is defined as learning designed to facilitate complex skills and professional

competencies acquisition by integrating knowledge, skills, and attitudes (Gagné & Merrill,

1990; van Merriënboer, 2019) and is best used when learning must be transferred from

theoretical to practical application. The practical application of complex theoretical

knowledge to demonstratable application is a dynamic and somewhat unpredictable process

but can be managed with complex learning methodologies (Ragan & Smith, 2004). To

succeed in complex learning, learners must understand how the different parts relate to the

whole (Kirschner & van Merriënboer, 2008). Learning should not be fragmented but instead

should reflect fluid and practical application of the whole learning package (van

Merriënboer, 2019).

The instructional design theory that best supports complex learning with an informed

view of adult learning theory is four component instructional design (4C/ID; van

Merriënboer, 2019). C/ID is compatible with other theories of whole-task learning, including

cognitive apprenticeship learning (Brown et al., 1989) and Merrill’s first principles of

instruction (Merrill, 2012). A meta-analysis reflecting 20 years of application and research

showed that educational programs developed using 4C/ID increased performance regardless

of the topic or skills taught (Costa et al., 2021).

As a learning design suite, 4C/ID can be used to develop a framework for

constructing complex learning courses that apply whole task learning and nontrivial learning

activities to real-world problems with increasing complexity (van Merriënboer, 2019). The

underpinning of 4C/ID is inductive learning, the process of learning by encountering

concrete experiences (van Merriënboer, 2013).

4C/ID has four main components and 10 prescribed steps. All focus on effective

instructional design. The four main components of 4C/ID are described next.

Learning Tasks. Learning tasks are the foundational units of any learning design

and consist of whole tasks that will teach the knowledge, skills, and attitudes needed to

complete the tasks in the real world (Pelligrini, 2021). Learning tasks should be designed to

incorporate nonroutine skills like problem-solving and decision-making as well as routine

skills that will be completed the same way every time (van Merriënboer, 2013). To

maximize the utility of learning tasks, the tasks should be designed with variability,

increasing levels of complexity, and graduated guidance and support (van Merriënboer,

2019; van Merriënboer et al., 2003).

Graduated guidance and support can be presented in several ways, including starting

with completed tasks to study, progressing to incomplete tasks where only part of the

solution is available, and, finally, performing the tasks independently (Renkl & Atkinson,

2003). Graduated guidance can also be provided with leading questions to guide learners

through task completion (Nadolski et al., 2006). Designing learning tasks in this way is

consistent with the principles of adult learning theory.

After learning tasks are designed, performance rubrics should be constructed. The

tasks should sequence from simple to more complex. To facilitate self-directed learning,

learners should be allowed to select learning tasks based on their own skill levels (van

Merriënboer, 2019).

Supportive Information. Supportive information is used to enforce the knowledge

acquired in learning tasks, particularly around nonroutine tasks. Supportive information

allows learners to acquire the foundational constructs for problem-solving or making critical

decisions related to learning tasks (Pelligrini, 2021). Supportive information is typically

presented in lectures and printed materials since it does not represent skills that can be

practiced in application (van Merriënboer, 2019).

Procedural Information. Procedural information is the step-by-step instructions

addressing routine aspects of learning tasks (van Merriënboer, 2019). Procedural

information is usually best applied during hands-on learning tasks as the information is

needed to perform these tasks. Through practicing these rote activities, procedural

information can become automatic and free up cognitive space so that learners can work

through tasks more efficiently (Anderson, 1987). When considering instructional design, the

designer should identify elements that can be automatized. This will speed up some parts of

the learning process and ease the strain on learners so they can apply the new knowledge