Presentation by Bronwen Bonfield

1. Living Life with My Health Condition
Group
An Acceptance & Commitment Therapy
Group Programme with individuals with a
Neurological Condition
Dr Bronwen Bonfield
Principal Clinical Psychologist
Community Neurological Rehabilitation Service

2. The Development of the Group
The Community Neurological Rehabilitation Service (CNRS) identified
three clinical questions that became the basis of a 2 year inservice
training project:
Why are some clients not progressing when they
present with sufficient levels of physical and
cognitive skills?
What skills as clinicians do we need to identify and
draw out a client’s readiness to change within
neurological rehabilitation?
How can we provide the right therapy to the right
clients at the right time?

3. Ready for Rehabilitation ?
CNRS Clinicians reviewed the following areas:
•Behavioural change models
•Action to change process models
•Motivational Interviewing
•Acceptance and Commitment Therapy
The Neurological Rehabilitation Delivery Pathway
was developed incorporating Behavioural Change
Theory

4. Neurorehabilitation Delivery Pathway
• Green = Active Rehabilitation
– Traditional goal oriented self management
rehabilitation programme
• Amber = Contemplation
– Emotional and/or cognitive barriers
– Strengthening motivation and commitment to
change with motivational interviewing
• Red = Pre-contemplation
– Difficulties accepting diagnosis and implications
for life.
– Unable to work collaboratively
– High levels of emotional and psychological
distress – Act Intervention

5. Acceptance and Commitment Therapy (ACT)
ACT is a therapy approach that uses
Acceptance and Mindfulness
Processes and Commitment and
Behavioural Change processes to
produce psychological flexibility
Hayes et al 2004

6. The ACT Model of Inflexibility
The Psychological Processes ACT Seeks to Strengthen

7. Overview of the programme
• Initially a 6 week programme now increased to 8 week programme +
two follow up sessions (at one month and three months)
• 2.5 hour sessions (including two breaks)
• Content delivered via interactive group discussions, experiential
exercises, small group work and exercises between weeks to apply
the session to their lives (written tasks and guided exercises via
audio CD).
• Facilitated by Clinical Psychologists and Occupational Therapists
trained in ACT.
Aim: to help individuals adjust to living life
WITH their health condition

8. Group Content
Week 1 Introduction to the group
-Experiences of living with long term health condition
- The struggle
-Walking in the rain metaphor & choice point
learning about how to live life in the presence of the difficulties that you
have with your health, while connecting to things that are important to you
in the here and now.
-how we may not be able to change some things like rain, but if we can
change how we stand towards it, it changes our experience.

9. Group Content
Week 1 Introduction to the group
-Experiences of living with long term health condition
- The struggle
-Walking in the rain metaphor & choice point

10. Group Content
Week2 Where do we go from here?
-Passengers on the bus
-Suppressing thoughts and emotions
-Introduction to Mindfulness – Mindfulness of the breath and Leaves on a Stream

11. Group Content

12. Group Content
Week 3 Values
-Values identification
-Mindfulness Body Scan

13. Group Content
Week 5 Problem Solving
Week 6 Valued Action
– Barriers to valued living
- Communication (assertiveness)
- Mindfulness Acceptance
Week 7 Valued Action and Pacing
-Pacing
-Mindful Walking
Week 8 Keeping things going
My Tool Kit
Week 4 Living our Values
-Goals setting based on values
-Stepping back from our thoughts

14. Group Evaluation
End of programme evaluation Mean ratings of helpfulness*
(1 = not at all; 10 = extremely
helpful)
The time spent on discussing things in the group 9
The time spent practicing mindfulness 8
The time spent each week reviewing the homework tasks 7
Being part of a group 9
Overall, was it worth coming on the course? 9
4 clinical outcome measures used to evaluate quality of life, mood,
readiness for change and the degree of cognitive fusion (entanglement) with
thoughts.
Suggestive of improvements in physical and psychological health domains
(WHOQoL-BREF), cognitive fusion improved, mood and readiness for change
however some increased anxiety, but
*Statistical analysis showed that all improvements and declines were not statistically
reliable

15. Feedback from MS Clients
“It was interesting as it
made me realise things I
would like to incorporate
more into my normal week
that remind me of who I am
and can be again. Thank
you for this week - it was
wonderful and very helpful.”
“I enjoyed doing
mindfulness and
reflecting on my
experience afterwards
felt rewarding”
“Very thought
provoking
experience! :)”
“Covered all aspects
of what I am dealing
with daily +
personally with my
health condition.
Very good :) “
“Don't have to be
perfect – we’re all
human"
“I really got a
lot out of
today's
session. (…)“
“Thank you, it was
really helpful
hearing other
people’s
experiences.”
“I really enjoyed the
walking with
mindfulness, it was
very grounding.”
“The group was
really lovely
and the
facilitators were
very helpful.”
“Covered all aspects
of what I am dealing
with daily and
personally with my
health condition.
Very good. ”

16. Thank you for listening
Acknowledgement and thanks to
Dr David Gillanders, University of Edinburgh
and team for the permission to deliver their
Group Protocol within the Community
Neurological Rehabilitation Service