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Title: Exploring acceptance and commitment processes as predictors of subjective wellbeing in student practitioners
Author: Stenhoff, Alexandra
ISNI:       0000 0004 7970 4712
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2019
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Subjective wellbeing (SWB) has been defined broadly as "a person's cognitive and affective evaluations of his or her life" (Diener, Lucas, & Oishi, 2002, pp.63). Conceptualizations of 'wellbeing' can be broadly distinguished into 'hedonic' and 'eudaemonic' approaches. The former, encompasses satisfaction with life, and an emotional equilibrium between positive affect (e.g. happiness) and negative affect (Larsen & Prizmic, 2008), whereas the latter relates to optimal, psychological functioning and the fulfilment of one's own potential (i.e. "self-acceptance", "environmental mastery", "positive social relationships", and "purpose in life") (Ryff & Keyes, 1995, pp.720). Acceptance and commitment therapy (ACT) is a trans-diagnostic psychological therapy, which focuses on the cultivation of wellbeing through enhanced valued living and the promotion of psychological flexibility). A range of measures have been utilised within the ACT literature to measure SWB, including the Mental Health Continuum- short form (MHC-SF) that measures both the hedonic and eudemonic aspects of wellbeing. Elevated levels of subjective wellbeing (SWB) may be referred to as 'flourishing', and low levels of SWB may be referred to as 'languishing'. The main focus of the current thesis was to explore SWB in relation to ACT's theorised mechanisms of change. Psychological flexibility (purported to be the central mechanism of change in ACT) has previously been linked to SWB in clinical and non-clinical populations (e.g. Wersebe, Lieb, Meyer, Hofer, & Gloster, 2018). Additionally, ACT has shown promise for enhancing SWB in an increasing number of research trials (e.g. Grégoire, Lachance, Bouffard, & Dionne, 2018; Räsänen, Lappalainen, Muotka, Tolvanen, & Lappalainen, 2016). In particular, the current thesis aimed to explore ACT processes in relation to medical, other healthcare and veterinary students collectively referred to here as student practitioners (SPs); a group that frequently report high levels of psychological distress, and decreased wellbeing during professional training (e.g. Dyrbye, Liselotte, Thomas, Matthew , Shanafelt & Tait, 2006). Amongst a number of commonly cited stressors and contributing factors related to training (i.e. demanding workloads, frequent exposure to the suffering of others), 'maladaptive perfectionism' has been associated with poor adjustment, psychological distress, depression, hopelessness and reduced wellbeing in this group (Henning, Ey, & Shaw, 1998; Enns, Cox, Sareen, & Freeman, 2001; Stoeber & Corr, 2016). Further research is needed in this area in order to understand and support improved health and SWB in SPs. Two papers are presented within this thesis. Chapter 1 presents a systematic literature review which aims to synthesise and critically appraise published, randomised controlled trials (RCTs) of face-to-face and guided ACT interventions that have assessed SWB. Overall, 1108 participants were recruited on to the 11 included studies. The results of the risk of bias assessment highlighted the variable quality of the included studies across assessed domains. Methodological issues highlighted in the systematic review related to allocation concealment, handling of incomplete data, and small sample sizes. Five measures of SWB were utilised in the included studies, of which the most common measure used was the Mental Health Continuum-Short Form (MHC-SF). The findings indicated that guided, ACT interventions may be of benefit in enhancing SWB in clinical and non-clinical populations. The heterogeneity of included studies precluded metaanalysis. It was concluded that further RCTs that include standardised measures of SWB, are needed to facilitate a future meta-analysis of the research. Chapter 2 presents an empirical study "Exploring Acceptance and Commitment Processes as Predictors of Subjective Wellbeing in Student Practitioners". The study aimed to explore factors, and mediating processes (i.e. ACT related mechanisms of change, maladaptive perfectionism, and self-critical thoughts) as predictors of SWB in SPs. Furthermore, the study aimed to explore relationship between maladaptive perfectionism and SWB, and the potential mediating roles of psychological flexibility (the purported central mechanism of change targeted by ACT) in this relationship. Two hundred and seventy four SPs took part in the online study. Four out of every ten SPs who participated in the study met clinical caseness for psychological distress, and less than half the sample reported experiencing the highest level of SWB ('flourishing'). Psychological flexibility was found to be the strongest predictor of SWB, followed by values-based action. Psychological flexibility (AAQ-II) was found to mediate the relationship between maladaptive perfectionism and SWB. Based on these findings, further research (pilot studies, RCTs) is merited in order to evaluate the efficacy of contextual behavioural science approaches (e.g. ACT) in this group, and to explore how interventions aimed at improving SWB in SPs might be best integrated into university curricula. As both the systematic review and empirical paper will be submitted to The Journal of Contextual Science, both chapters are formatted in line with recommendations from this journal (See appendix A).
Supervisor: White, Ross ; Steadman, Linda ; Reilly, James Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral