The use of Acceptance and Commitment Therapy to address psychological distress experienced by caregivers: a randomised controlled feasibility trial

Background: An extensive research literature has documented the impact of caring for an individual with acquired brain injury (ABI) on caregivers and family members, including role adjustment, psychological distress, social isolation, family tension and coping with the cognitive and behavioural difficulties of the injured person. Given these findings it is important this population have access to services and supports. Acceptance and Commitment Therapy (ACT) is an intervention that helps individuals to accept difficult experiences and commit to behaviour that is consistent with their values. Research into the effectiveness of ACT to support caregivers is at a preliminary stage. Aim: To investigate the feasibility of using ACT to reduce psychological distress and increase psychological flexibility in ABI caregivers. A secondary aim was to gain an understanding of the experience of caregivers in this context and how this can inform the development and delivery of interventions for this population. Method: Phase one was a randomised controlled feasibility trial of an ACT intervention for use with ABI caregivers. The parameters of this study were formulated around the PICO (population, intervention, control, and outcome) framework. Eighteen carers were recruited and randomised to ACT or an enhanced treatment as usual (ETAU) group. ACT was implemented over 3 sessions; and ETAU was implemented over 2 sessions. The General Health Questionnaire, Valuing Questionnaire, Acceptance and Action Questionnaire, Experiential Avoidance of Caregiving Questionnaire and the Flexibility of Responses to Self-Critical Thoughts Scale were administered to both groups at baseline and following the final session. Phase two used a retrospective qualitative design that involved conducting semi-structured interviews with four participants from phase one. Results: ACT and control participants were successfully recruited. Positive feedback was obtained from ACT participants suggesting that the intervention was acceptable. There were no significant differences between the ACT and ETAU groups on outcome measures. However, there were challenges retaining participants and the overall attrition rate was high (44.44%). Therefore a number of participants did not complete the full complement of sessions, which may have impacted on this result. Qualitative results illustrated the challenges this population face including significant adjustments in their life, the emotional impact of having a loved one with a brain injury and trying to adapt to the changes in the injured person. In addition, findings elucidated the types of support that this population would find helpful and the barriers to accessing same. Conclusions: Findings from this study highlight factors that will help the development of this intervention further for a caring population. Recommendations for future implementation include completing some preparatory work with carers before beginning the intervention, consideration of a larger sample and wider recruitment strategy from local services, barriers to attending interventions and the possibility of holding groups in local venues.

Hybridity in contemporary commercial organizations: implications for employee trust

This study advances the concept of organizational hybridity (OH). By doing so, it takes into account the individual level of analysis often neglected in organizational theory. More specifically, it aims to understand the implications of organizational hybridity for employees’ trust in contemporary commercial organizations. Informed and guided by current literature, this study argues that the current literature on organizational hybridity fails to adequately address the consequences of hybridity for employees' behaviour. The empirical study was conducted in 2014 using data collected via semi-structured interviews and document analysis. The study was based on a comparison of two case studies in Nigeria: Alter Securities Limited and Barak Petroleum Limited. A total of forty (40) interviews were conducted; twenty (20) from each organization. The data were analysed using thematic analysis. The main findings are that organizational hybridity in this study produced tensions that resulted in negative behavioural responses and employees’ distrust in the commercial hybrid organizations. However, employees’ identification with non-market orientated institutional logics such as family, philanthropic and religious logics is seen to facilitate their commitment, honesty, and trust in the organizations. Nevertheless, caution is required here as religious logics may also lead to an acceptance of unethical behaviour by employees. Overall, this study contributes to the literature on organizational hybridity by extending on Battilana and Lee’s (2014) framework, which highlights governance, leadership, organizational culture and intra-organizational relationships as core organizational attributes in the context of which issues may arise in commercial hybrid organizations. Furthermore, it addresses a gap in Besharov and Smith’s (2014) hybrid typology framework by providing an alternative line of argument focused on understanding how tensions manifest within commercial hybrid organizations. The key recommendations of this research underscore the need for commercial hybrid organizations to invest in mechanisms for improving employees’ trust so as to reap the benefits associated with trust. This could be achieved by involving employees in the decision-making process and clearly communicating the organizations’ values, so as to minimise the misinterpretation of the embodied institutional logics by employees.