Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12611000270910
Ethics application status
Approved
Date submitted
11/03/2011
Date registered
14/03/2011
Date last updated
4/06/2011
Type of registration
Prospectively registered

Titles & IDs
Public title
Acceptance and Commitment Therapy (ACT) to enhance stress resilience in police recruits: A randomized control trial
Scientific title
Enhancing stress resilience in new police recruits using Acceptance and Commitment Therapy, measuring symptom prevention, coping flexibility, acceptance-based attitudes and engagement in valued living: A randomized control trial
Secondary ID [1] 259768 0
Nil
Universal Trial Number (UTN)
Nil
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Depression 261345 0
Anxiety Disorders 261346 0
Substance Use Disorders 261347 0
Condition category
Condition code
Mental Health 259501 259501 0 0
Anxiety
Mental Health 259502 259502 0 0
Depression
Mental Health 259503 259503 0 0
Studies of normal psychology, cognitive function and behaviour

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Acceptance and commitment therapy (ACT) is intended to provide a framework in which coping flexibility, defined as the ability to flexibly choose and implement different coping strategies that fit the needs of the situation (Folkman & Moskowitz, 2004), can be enhanced.

Acceptance and Commitment Therapy targets six interrelated processes in order to enhance the ability to contact the present moment more fully, and to change or persist in behavior when doing so serves valued ends (Hayes, et al., 2006, p. 7).

The six core processes include acceptance (a willingness to experience negative thoughts, feelings and sensations), cognitive defusion (techniques that aim to reduce the literal quality of thoughts), being present (experiencing the world directly as events occur rather than being dominated by mental experiences of the past or future), self-as-context (a standpoint from which one can observe experiences), values (behavioural patterns in domains such as family, career and physical fitness that are intrinsically rewarding (Wilson, Sandoz, Kitchens, & Roberts, 2010)), and committed action (taking effective action linked to values).

The ACT intervention for this study will be delivered by group format, following protocols from previous ACT workplace interventions (Bilich & Ciarrochi, 2009; Bond & Hayes, 2002; Flaxman & Bond, 2006) with additional content from basic coping skills programs (Frydenberg & Brandon, 2007).

It will consist of 3 X 3-hour group sessions, delivered over a 3 month period. The training will be delivered by registered and provisional clinical psychologists.
Intervention code [1] 264196 0
Prevention
Intervention code [2] 264197 0
Behaviour
Intervention code [3] 264198 0
Lifestyle
Comparator / control treatment
The training group will be compared to a wait-list control group, who will receive the training after the final data collection time point.
Control group
Active

Outcomes
Primary outcome [1] 262307 0
Depression and Anxiety Subscales (from the DASS-21)
Timepoint [1] 262307 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Primary outcome [2] 262308 0
General Health Questionnaire (GHQ-12)
Timepoint [2] 262308 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Primary outcome [3] 262309 0
PTSD Checklist (PCL-C)
Timepoint [3] 262309 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [1] 273500 0
Brief COPE
Timepoint [1] 273500 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [2] 273501 0
Need for Closure Scale (NFCS)
Timepoint [2] 273501 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [3] 273502 0
Valued Living Questionnaire (VLQ)
Timepoint [3] 273502 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [4] 273503 0
Positive Affectivity (subscale of the PANAS)
Timepoint [4] 273503 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [5] 273504 0
Mindfulness Attention Awareness Scale (MAAS)
Timepoint [5] 273504 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [6] 273505 0
The Acceptance and Action Questionnaire (AAQ-2)
Timepoint [6] 273505 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up
Secondary outcome [7] 273506 0
Sick Leave (participant self report of number of sick leave days taken over the past month)
Timepoint [7] 273506 0
1. Baseline
2. Post-treatment
3. At 6 months follow-up
4. At 12 months follow-up

Eligibility
Key inclusion criteria
Police recruits from the same graduate cohort, who volunteer to participate
Minimum age
No limit
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
Yes
Key exclusion criteria
None

Study design
Purpose of the study
Prevention
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants will be recruited from a cohort of police recruits before they complete their training. Allocation to groups will be undertaken by a researcher not involved with the study.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Phase 1
Type of endpoint/s
Efficacy
Statistical methods / analysis

Recruitment
Recruitment status
Active, not recruiting
Date of first participant enrolment
Anticipated
16/05/2011
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
160
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 264642 0
Commercial sector/Industry
Name [1] 264642 0
NSW Police Association and NSW Police Joint Grant
Country [1] 264642 0
Australia
Primary sponsor type
University
Name
Australian National University
Address
Canberra ACT 0200
Country
Australia
Secondary sponsor category [1] 263783 0
None
Name [1] 263783 0
Address [1] 263783 0
Country [1] 263783 0

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 266643 0
ANU Human Research Ethics Committee
Ethics committee address [1] 266643 0
Research Office
Australian National University
Canberra, ACT, 0200
Phone: (61-2) 6125 7945
Ethics committee country [1] 266643 0
Australia
Date submitted for ethics approval [1] 266643 0
11/03/2011
Approval date [1] 266643 0
03/05/2011
Ethics approval number [1] 266643 0
Protocol: 2011/122

Summary
Brief summary
Stress is a major issue for police. Officers face a range of stressors related to operational duties, such as exposure to violence and trauma, in addition to a range of organisational stressors. These stressors have been associated with a range of physical and psychological problems, in addition to low morale, absenteeism and increased turnover. They have also been found to impact negatively on an officer’s relationships with family members, friends and colleagues.

The nature of police work means it is not possible to remove all stressors. However, it is possible for police organisations to help develop skills in officers that foster resilience, such that officers are better able to adapt, or bounce back from stress, without experiencing the negative consequences outlined above. Coping refers to thoughts and behaviours that individuals use to deal with stressors. While no single coping strategy has been found to be good or bad in all situations, coping flexibility, the ability to flexibly choose different strategies that fit the needs of the situation has been associated with positive adaptation (Folkman & Moskowitz, 2004).

Studies have found that police have a tendency to use unhelpful, avoidant coping strategies to deal with difficult emotional experiences (Evans, Coman, Stanley, & Burrows, 1993), strategies such as emotional detachment and excessive use of alcohol (Richmond, Wodak, Kehoe, & Heather, 1998). Emotional detachment has been found to undermine the ability of officers to emotional engage and maintain healthy relationships and social networks (Madamba, 1986). Avoidant coping is socialised among new recruits when they are encouraged to take control of situations and not to let their emotions affect their work (Paton, et al., 2009). The primary objectives of the current study is to enhance resilience of police officers by providing training in coping flexibility skills and reducing the use of maladaptive coping skills.

Experiential avoidance, the extent to which individuals: 1) are unwilling to stay in contact with aspects of their private experience; and 2) take steps to alter these experiences (Hayes, Strosahl, & Wilson, 1999) has been found to mediate the effects of maladaptive coping on psychological distress and wellbeing (Fledderus, Bohlmeijer, & Pieterse, 2010) and make people more vulnerable to a range of stressors (Biglan, Hayes, & Pistorello, 2008). As Acceptance and Commitment Therapy (ACT) aims to reduce experiential avoidance, it is thought to be particularly beneficial for preventing severe psychological distress. Furthermore, by enabling officers to persist with valued actions in the face of adversity, ACT is also likely to lift performance and wellbeing.

A range of workplace stress management studies have been conducted using ACT. The current study aims to extend the research of Bilich and Ciarrochi (2009) who conducted a trial of group based acceptance and commitment therapy for senior police officers. The transition from training to active policing environment is a particularly stressful period for new recruits. The current intervention is designed to provide coping skills training to police recruits just before they make the transition to operational duties, and before maladaptive coping strategies have been socialised. Measures of mental health, sick leave and coping strategy use will be used to assess the effectiveness of the training, the sustainability of that effect and measures such as the AAQ, the VLQ and the MAAS will be used to assess mechanisms of change.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 32327 0
Address 32327 0
Country 32327 0
Phone 32327 0
Fax 32327 0
Email 32327 0
Contact person for public queries
Name 15574 0
Chris Horan
Address 15574 0
Department of Psychology (Building 39)
The Australian National University
Canberra ACT 0200
Country 15574 0
Australia
Phone 15574 0
+61 413 457 998
Fax 15574 0
Email 15574 0
christopher.horan@anu.edu.au
Contact person for scientific queries
Name 6502 0
Prof Don Byrne
Address 6502 0
Department of Psychology (Building 39)
The Australian National University
Canberra ACT 0200
Country 6502 0
Australia
Phone 6502 0
+61 (2) 6125 3094
Fax 6502 0
Email 6502 0
don.byrne@anu.edu.au

No information has been provided regarding IPD availability


What supporting documents are/will be available?

No Supporting Document Provided


Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
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