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et al.Topics in Early Childhood Special Education


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Articles
Topics in Early Childhood Special Education

The Value of Workshops on Psychological


32(4) 196­–210
© Hammill Institute on Disabilities 2013
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DOI: 10.1177/0271121411425191
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Education Staff

Anthony Biglan, PhD1, Georgia L. Layton, MS2, Laura Backen Jones, PhD1,
Martin Hankins, PhD1, and Julie C. Rusby, PhD1

Abstract
High stress and burnout are common for early childhood special educators, contributing to high rates of attrition, diminished
educational effectiveness, and high turnover. Acceptance and Commitment Therapy (ACT) is a promising approach for
the prevention and treatment of a wide variety of problems. Using a randomized wait-list control design, this pilot study
evaluated whether ACT workshops delivered to preschool teachers who serve children with developmental disabilities
would improve stress-related problems of teachers (i.e., stress, depression, and burnout) and increase collegial support. At
pretest, measures of experiential avoidance (EA) and mindful awareness (MA) showed significant relationships to reports of
depression, stress, and burnout. The intervention reduced staff members’ EA, increased teachers’ MA and valued living (VL),
and improved teachers’ sense of efficacy. This suggests that ACT workshops can help influence factors affecting depression,
stress, and burnout in an early childhood special education setting.

Keywords
classroom environment, depression, evidence-based practices, intervention strategies, personnel, teaming

This article describes a preliminary experimental evalu- Stress Among Early Childhood
ation of workshops designed to increase psychological Special Educators
flexibility among early childhood special education (SE)
staff. Psychological flexibility involves the ability to be It is well documented that stress is a problem for educators,
fully in contact with the events of the present moment including early childhood educators (Hinds et al., in press).
and behave in ways that further one’s chosen values Frequent and prolonged stress contributes to burnout and
(Biglan, Hayes, & Pistorello, 2008). Interventions that undermines teachers’ commitment to remain in the profes-
increase psychological flexibility have been shown to sion (Wisniewski & Gargiulo, 1997). Stress also affects the
affect a surprising range of problems, including anxiety, psychological, social, and physiological health of teachers
depression, schizophrenia, epilepsy, cigarette smoking, (Hurrell, Nelson, & Simmons, 1998).
stress, job burnout, and diabetes (Biglan et al., 2008; Evidence on stress among early childhood special educa-
Gifford et al., 2004; Gregg, Callaghan, Hayes, & Glenn- tors is more limited, but evidence suggests that SE teachers
Lawson, 2007; Hayes, Bissett, et al., 1999; Hayes, Masuda, generally have higher rates of stress than teachers who are not
& De Mey, 2003; Hayes & Pankey, 2002; Hayes, Strosahl, in SE (Boe, Bobbitt, & Cook, 1997; Kokkinos & Davazoglou,
& Wilson, 2002; Masuda et al., 2007). Studies of such 2009). SE teachers are more likely than general educators to
interventions in organizational settings have been shown leave their jobs due to stress (Boe, Bobbitt, Cook, & Weber,
to increase innovativeness (Bond & Bunce, 2000) and 1995; Boe et al., 1997). Stress may be higher among special
openness to the use of evidence-based practices (Varra,
Hayes, Roget, & Fisher, 2008). Considering that stress 1
Oregon Research Institute, Eugene, OR, USA
2
and depression are common among teachers (Bauer et al., Early Education Program, Eugene, OR, USA
2006; Evans, 2003; Kyriacou, 2001) and that resistance
Corresponding Author:
to new practices is common in school settings (Carnine, Anthony Biglan, Oregon Research Institute, 1715 Franklin Boulevard,
1997, 2000), interventions of this type could be Eugene, OR 97403-1983, USA
valuable. E-mail: Tony@ori.org

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Biglan et al. 197

educators because their students present more challenges. & Pianta, 2004). Pianta and Stuhlman (2004) reported that
Student misbehavior is a major stressor (Abel & Sewell, ratings of first-grade students’ externalizing problems were
1999; Borg, Riding, & Falzon, 1991; Chan & Hui, 1998; higher and social competence were lower if their kindergarten
Dorman, 2003; Kelly & Berthelsen, 1995; Makinen & teacher and preschool teachers reported conflict with them.
Kinnunen, 1986; Manassero et al., 2006; Newmann, Rutter, This was true even when controlling for kindergarten and
& Smith, 1989), and teacher depression and burnout are more preschool social functioning. Moreover, Hamre and Pianta
likely in schools with high levels of student disruptive behavior (2001) found that negative relationships between teachers
(Beer & Beer, 1992; Dorman, 2003; Hastings & Bham, 2003; and students in kindergarten predicted children’s academic
Schonfeld, 1992a, 1992b). SE teachers of students with emo- and behavioral problems into eighth grade. Expulsions from
tional and behavioral difficulties report higher rates of occu- preschools are significantly higher when teachers are expe-
pational stress, job-related distress, and attrition (Kokkinos & riencing high stress (Gilliam, 2008), presumably because
Davazoglou, 2009). Lawrenson and McKinnon (1982) found teachers are less able to deal with such behavior. Stress and
that SE teachers working with children with behavioral and depression affect the quality of teachers’ interactions with
emotional disabilities are at highest risk for leaving the class- students (Hamre & Pianta, 2004; Wisniewski & Gargiulo,
room, with attrition rates approximately 6 times that of other 1997). Gilliam (2008) reported that prekindergarten teachers
special educators. Teachers report that, among children with and child care staff members who reported elevated symp-
behavioral and emotional difficulties, those with autism pres- toms of depression were more likely to engage in child care
ent the most stress, followed by those with behavioral diffi- practices rated as less sensitive to children’s needs, more
culties, Attention Deficit Hyperactivity Disorder, emotional intrusive, and more negative.
difficulties, mental retardation, visual impairment, and physi- Teachers’ relationships with other staff also affect their
cal disability (Wisniewski & Gargiulo, 1997). SE teachers wellbeing. Schools with high collegiality, where staff and
reporting frequent and intense stress indicate that they feel (a) leadership exhibit mutual support, also have high levels of
less sensitive to the social, physical, and emotional needs of staff wellbeing (Brouwers, Evers, & Tomic, 2001; Burke,
their students; (b) less likely to deliver positive reinforce- Greenglass, & Schwarzer, 1996; Talmor, Reiter, & Feigin,
ment; (c) less able to concentrate on instructional interac- 2005), teaching effectiveness (e.g., Bryk & Driscoll, 1988;
tions; (d) less effective in managing classroom discipline; and Lee, Dedrick, & Smith, 1991), and teachers remaining in
(e) more likely to use aversive methods to modify student the field (e.g., Gersten, Keating, Yovanoff, & Harniss, 2001;
behavior (Wisniewski & Gargiulo, 1997). Miller, Brownell, & Smith, 1999).
Although research on stress among early childhood spe- In sum, there is strong reason to believe that early educa-
cial educators is limited, there is ample evidence that stress tion special educators have problems with stress and related
is a problem among preschool child care providers. Curbow, psychological problems and could benefit from an interven-
Spratt, Ungaretti, McDonnell, and Breckler (2000) reported tion that helps them reduce stress and increases mutual support
that for center-based caregivers, salient stressors were late among staff members. The present study documents levels of
payments, attendance of sick children, parents who blame stress, depression, and burnout among staff in a preschool for
the child care for their children’s behavioral difficulties, children with developmental disabilities, and experimentally
parents coming late to pick up children, and events in the evaluates an Acceptance and Commitment Therapy (ACT)
children’s lives the providers cannot change. Younger pro- intervention (Hayes, Strosahl, & Wilson, 1999) to reduce
viders and those with lower social support also report greater stress and its related problems and increase supportiveness
job stress (Kontos & Riessen, 1993). As child care providers among staff members.
are among the lower paid workers in the United States
(Center for the Child Care Workforce, 2006), they are likely
to experience economic stress as well. Whitebrook, Howes, Increasing Psychological Flexibility
and Phillips (1989) estimated that 40% of early childhood Acceptance and Commitment Therapy or Training (ACT)
teachers leave the field each year. Whitebrook and Sakai promotes acceptance of unpleasant thoughts, feelings, and
(2003) found that more highly trained staff who earned the sensations; encourages mindful contact with the present
lowest wages and had coworkers with lower levels of training moment; and helps people clarify and take action in the
were most likely to leave their jobs. service of their values. Psychological flexibility allows
One of the most unfortunate effects of stress may be the people to change or persist in their behavior in the moment
impact it has on relationships with children. In an effort to to serve valued ends (Hayes, Luoma, Bond, Masuda, &
reduce distress, some teachers tend to withdraw from caring Lillis, 2006). Flexibility grows amid clarity about one’s
relationships with students (Dworkin, 2001). This is espe- values and acceptance of or defusion from one’s thoughts
cially significant for preschool teachers because a warm and feelings. Acceptance connotes a willingness to have
and caring relationship with young children affects their thoughts and feelings. Defusion refers to the process of
social, self-regulatory, and cognitive development (Hamre seeing that one’s thoughts and feelings are thoughts and

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198 Topics in Early Childhood Special Education 32(4)

feelings, not reality. When people accept and defuse their thoughts and feelings. They focus instead on values, such as
thoughts and feelings, they can commit to action in the making a difference in the life of a child; they become more
service of their values—even if their minds tell them they aware of their moment-to-moment interactions with chil-
cannot or should not try. dren (contact with the present moment). Because of these
Several studies have indicated the value of ACT for processes, they become better at acting in ways that are
work organizations in reducing stress, increasing psycho- likely to help them achieve their valued outcomes.
logical wellbeing, and increasing participants’ openness In summary, the study has three aims. First, given the
to using innovative practices. In a randomized controlled paucity of data on stress and psychological problems, we
trial, Bond and Bunce (2000) compared ACT workshops provide descriptive data on problems among a sample of
with an innovation promotion program aimed at helping early education special educators. Second, in light of the
workers identify and then creatively change sources of theory that the tendency to avoid unpleasant thoughts and
occupation. Participants in the ACT condition showed sig- feelings increases stress and related psychological prob-
nificantly reduced stress and reported improved psycho- lems, we also examined whether stress and other aspects of
logical health. Even though the ACT condition did not wellbeing are higher among those who are not psychologi-
target innovation explicitly, ACT recipients improved on cally flexible. Third, we evaluated the effectiveness of ACT
the propensity to innovate as much as those receiving the workshops for this population in increasing their psycho-
innovation intervention. logical flexibility and improving measures of overall psy-
Varra and colleagues (2008) found that ACT signifi- chological wellbeing, including stress and depression.
cantly increased the willingness of organization members to
implement evidence-based practices. Drug and alcohol
counselors who participated in an ACT intervention were Method
more psychologically flexible and more open to adopting Design and Participants
evidence-based treatments than those who attended an educa-
tional workshop. Hayes, Bissett, et al. (2004) hypothesized The impact of the workshops was evaluated using a wait-
that ACT training could help counselors accept their thoughts list control group design (see Figure 1). The design ensures
merely as thoughts, experience them as less believable, and that all participants ultimately receive treatment, while
recommit to their values in helping clients. They randomly enabling comparisons between those in active treatment
assigned drug-abuse counselors to receive a 1-day work- and those receiving no treatment (McKay, 2008). A change
shop on ACT, multicultural training (a common approach to in intercept and/or slope for those outcomes when the first
reducing negative attitudes toward stigmatized groups), or a set of participants receives the intervention, while no
class on biological processes of addiction. At follow-up, change appears in the control group, indicates that the inter-
ACT recipients had lower scores than those in the other vention affected outcomes. Confidence in the intervention
conditions on a measure of the believability of stigmatizing effect gains strength through replication of the effect when
attitudes toward clients and in self-reported burnout. the delayed control group receives the intervention.
Moreover, reductions in believability of stigmatizing atti- Forty-two people took part in the study: 30 preschool
tudes mediated effects on burnout. program staff (17 randomized to the immediate condition
Based on existing ACT research, we believe that ACT and 13 to the delayed condition) and 12 affiliated family
could be valuable to those providing care to young children, consultants (6 randomized to each condition). We randomly
particularly those in more challenging positions (e.g., pre- assigned classroom teams, consisting of lead teachers and
school teachers working with young children with develop- assistants, to receive the workshops immediately (immedi-
mental disabilities). It may be helpful to describe how the ate) or 3 months after the first group received them (delayed).
process of becoming more psychologically flexible might We individually randomly assigned family consultants to the
play out for an early childhood special educator. Difficult two conditions. As Figure 1 illustrates, participants com-
child behavior is ubiquitous in SE preschool classrooms. pleted assessments at four time points. Data collection for
Faced with a child who is aggressive toward other children, the second assessment began 5 weeks after the first, which
a teacher may have negative thoughts, including feelings of was 2 weeks after those in the immediate condition com-
disappointment and hopelessness. Inflexible attempts to pleted the second intervention workshop. The third assess-
control the unwanted feelings (e.g., avoiding communica- ment began 3 months after the second assessment (3 weeks
tion with the child or child’s parent, or being punitive) can after the delayed condition’s second workshop). The fourth
lead the teacher to withdraw from the child and his or her assessment began 7 weeks after that.
family and miss important opportunities to take committed The Early Education Program (EEP; http://www.earlyed-
action in the service of the teacher’s value of making a dif- ucationprogram.org/index.php) was created to serve the
ference in children’s lives. When teachers become more needs of young children with developmental disabilities.
flexible, they become better able to defuse from their About 75% of children attending EEP have a developmental

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Biglan et al. 199

Figure 1. Study design.

disability. EEP has 13 classrooms in a northwest county of (EA)—the tendency of people to avoid unpleasant thoughts
346,560 (U.S. Census Bureau, 2009). Classrooms were dis- and feelings. Hayes, Strosahl, et al. (2004) found EA related
tributed widely throughout the county, thus decreasing cross- to a wide variety of problems, including depression,
condition contamination. Although in some cases there were anxiety, and substance abuse. Higher scores on the AAQ
both morning and afternoon classes in the same building, dif- indicate lower levels of EA.
ferent staff members taught the classes, minimizing cross- The Five-Facet Mindfulness Questionnaire (FFMQ;
condition contamination. Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) includes
Two of the participating EEP staff members were admin- five subscales measuring different aspects of mindfulness.
istrative personnel who worked in the central office. The As Table 1 delineates, each facet relates to an aspect of psy-
other 28 staff members were teachers or teaching assistants chological functioning.
who worked in one of the EEP classrooms. EEP provides a The Valued Living Questionnaire (VLQ; Wilson &
half-day session that focuses on helping young children Groom, 2002) asks respondents to rate how much they live
develop the cognitive, social, behavioral, and self-regulatory in accord with 10 values: (a) family, (b) marriage/couples/
skills needed to achieve continuing success in school. The intimate relationships, (c) parenting, (d) friendship, (e)
learning environment includes small group activities and work, (f) education, (g) recreation, (h) spirituality, (i) citizen-
one-on-one interactions between children and adults. ship, and (j) physical self-care.
The participating family consultants worked with the Psychological wellbeing. We used six widely used and pre-
families of children with disabilities in the EEP classrooms. viously validated measures of psychological wellbeing. The
Their work included giving guidance and support to fami- Maslach Burnout Inventory (MBI; Maslach, Jackson, &
lies, including helping them respond more effectively to Leiter, 1997) is perhaps the most widely used measure of job
their children’s behavioral problems. burnout; Table 1 defines its three subscales. The Intrinsic Job
Motivation Scale (Warr, Cook, & Wall, 1979) assesses the
degree to which people want to do their jobs well to achieve
Measures inherent satisfaction. The Job Satisfaction Scale (Warr et al.,
Table 1 presents the number of items and alpha coefficients 1979) is a brief measure of satisfaction and stress.
for each measure we describe. We measured the processes The 43-item Teacher Characteristics subscale of the
involved in psychological flexibility, and we measured Index of Teaching Stress (ITS; Greene, Abidin, & Kmetz,
participants’ wellbeing. Participants completed the first 1997) assessed staff self-perceptions of students’ influ-
two assessments with paper and pencil and completed the ence and their own teaching process (α = .91). The sub-
third and fourth assessments online. We changed methods scale assesses areas related to a need for support, loss of
because we obtained resources to create the online assess- satisfaction from teaching, and frustration with parents
ment, which was easier to administer. and disruption of the teaching process. It is unique in its
Psychological flexibility. As noted earlier, psychological focus on the stress a teacher experiences in interactions
flexibility allows people to change or persist in their behav- with specific students. The central issues underlying the
ior in the moment to serve valued ends. Clarity about one’s ITS are the impact of student behavior on teacher self-
values and mindful acceptance of and defusion from one’s perception, teacher perception of the teaching process,
thoughts and feelings promotes psychological flexibility. and teacher perception of support from other adults
We used three previously validated measures of aspects involved. Clinically significant scores on this measure
of psychological flexibility. The Acceptance and Action indicate a generalized sense of hopelessness and ineffec-
Questionnaire (AAQ) assesses experiential avoidance tiveness in a person’s role as a teacher.

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200 Topics in Early Childhood Special Education 32(4)

Table 1. Reliability for Measures of Psychological Processes and


Teacher Wellbeing The Intervention
No. of items α The intervention involved two 3.5-hr workshops held 2
weeks apart for the immediate group and 3 weeks apart for
Psychological processes
AAQ (Hayes, Strosahl, et al., 16 .84
the delayed group. In the immediate group, 97% of partici-
2004) pants attended the first session and 91% the second. In the
FFMQ (Baer et al., 2006) 39 .98 delayed group, 89% attended the first session and 67% the
   Acting With Awareness 8 .96 second. Overall attendance was 93% for the first workshop
subscale and 80% for the second.
  Describing Inner 8 .98 Workshop content was based on descriptions of ACT
Experience subscale workshops previously given to work organizations (Bond
  Observing/Noticing/ 8 .94 & Bunce, 2000; Hayes, Bissett, et al., 2004) and on the
Attending to Inner first author’s (A.B.) training and experience in providing
Experience subscale
ACT clinically. ACT uses metaphors and experiential
   Nonjudging of Experience 8 .98
exercises to assist people in increasing six psychological
subscale
   Nonreactivity to Inner 7 .96
processes leading to the reduction of EA and promotion
Experience subscale of psychological flexibility. Table 2 describes each pro-
VLQ (Wilson & Groom, 2002) 10 .82 cess. Detailed descriptions of ACT are available (e.g.,
Wellbeing Bond & Bunce, 2000, 2003; Hayes, Follette, & Linehan,
MBI (Maslach et al., 1997) 22 2004; Hayes, Jacobson, Follette, & Dougher, 1994;
Educators’ Survey Hayes, Strosahl, et al., 1999).
  EE 9 .90 The first and second (G.L) authors of this article (who
  DP 5 .72 are married to each other) led the workshops. The first
   EE and DP 14 .82 author is a clinical psychologist with more than 30 years of
  PA 8 .84 experience. He participated in numerous intervention train-
IJM (Warr et al., 1979) 6 .61 ings for the development of ACT in the 1980s and has pub-
JSS (Warr et al., 1979) 10 .78 lished a case study description of its value for parents of
ITS (Greene et al., 1997) 43 .91 children with developmental disabilities (Biglan, 1989).
TES (Gibson & Dembo, 1984) 30 .72 The second author is the director of EEP. She received
CES-D (Radloff, 1977) 20 .93 training in a 2.5-day workshop conducted by the originator
Abbreviations: AAQ, Acceptance and Action Questionnaire; FFMQ, Five- of ACT, Steven Hayes.
Facet Mindfulness Questionnaire;VLQ,Valued Living Questionnaire; MBI, The ultimate goal of this project was to create a psycho-
Maslach Burnout Inventory; EE, emotional exhaustion; DP, depersonaliza-
tion; PA, personal accomplishment; IJM, Intrinsic Job Motivation Scale; JSS,
logically flexible culture within the preschool. To this end,
Job Satisfaction Scale; ITS, Index of Teaching Stress; TES, Teacher Efficacy following the workshops, the EEP director and the three
Scale; CES-D, Center for Epidemiological Studies–Depression Scale. supervisors continued to promote the use of ACT princi-
ples in staff meetings and supervisory contacts. One month
after completing both sets of workshops, participants
The Teacher Efficacy Scale (TES; Gibson & Dembo, received a booster session, at which the presenters
1984) assessed teachers’ perception of their effectiveness reviewed ACT principles. In addition, preschool supervi-
(α = .72). Finally, we included the Center for Epidemiological sors modeled and applied ACT principles when training
Studies–Depression Scale (CES-D; Radloff, 1977), a their preschool teams. For example, discussions of chal-
widely used measure for determining depression during the lenging students or implementation of new procedures
previous week. included discussions of staff thoughts and feelings about
Open-ended questions about organizational change. To the situation, acceptance of those thoughts and feelings,
gauge the intervention’s impact on the preschool pro- and promotion of their values in working with children,
gram, approximately 2 years after the workshops, we colleagues, and parents.
asked supervisors and seven randomly chosen staff to
anonymously answer six questions about the preschool.
We asked if they had noticed any changes in (a) how peo- Results
ple get along, (b) people’s willingness to try new things, Descriptive Data
(c) people’s willingness to give feedback, (d) people’s
willingness to take feedback from others, and (e) people’s As there are normative data for the CES-D and the MBI, we
dedication to kids. In addition, we asked staff why they can estimate the level of burnout and depression among
felt the changes had occurred. No question mentioned participants before the intervention. On the CES-D, 50%
ACT or any of the component skills. were at or above the cutting score of 16. On the MBI,

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Biglan et al. 201

Table 2. Workshop Components, With Descriptions and Length of Each

Component Description Workshop Length (min)


Session 1
Introduction Overview, introductions, review of rules and expectations; 1 15
confidentiality and Institutional Review Board (Human
Subjects)
What happens as we try Discuss how people react to the children, other teachers, 1 45
to make a difference? parents, and work supervisors. Discuss ways that people
attempt to cope with stress
Hexaflex Introduce ACT 6-component diagram and explain each 1 10
component
Values exercise Break into pairs to review values in work with children 1 35
Acceptance Present the concept of accepting unpleasant thoughts and 1 40
feelings
Committed action Discuss committed action in the service of one’s values, even 1 15
when unpleasant
Defusion Presentation of the Monsters on the Bus metaphor 1 25
Taking action Participants specify committed actions they might take 1 10
between the two sessions
Session 2
Mindfulness exercise Participants close their eyes and notice thoughts and feelings 2 15
Using the Hexaflex Review each component of psychological flexibility 2 15
Your feedback People describe experiences between the two workshops 2 30
Observer self Use the Chessboard metaphor and Observer Self exercise 2 40
(Hayes, Bissett, et al., 1999) to help people get a sense of
the part of them that just observes
Evaluation, relating, and Discuss and illustrate one’s tendency to evaluate and 2 45
avoidance emphasize negatives. Include how evaluations prevent
honest feedback (e.g., typical situations in the preschools).
Complete a defusion exercise
Relationships with Write words on a flip chart to characterize the shared values 2 25
others of the preschool
Eye contact exercise Pair up for eye contact exercise to make contact, despite 2 15
thoughts and feelings
Closing People have an opportunity to share their reactions to the 2 5
workshop
Abbreviation: ACT, acceptance and commitment therapy.

73.81% reported emotional exhaustion (EE) at a level significantly higher levels of teacher stress (r = −.49,
above the top third of the normative distribution. However, p = .002) and depression (r = −.59, p < .001) and lower
on the Personal Accomplishment Scale, only 2.38% of the self-reported personal work-related accomplishment (r =
teachers involved were below the cut point for the bottom .33, p = .033). Mindfulness as measured by the FFMQ was
third of normative distribution, which indicated a high level associated with lower levels of depression (r = −.59, p <
of perceived achievement. Thus, although many teachers .001) and higher levels of personal accomplishment (r =
reported feeling depressed and emotionally exhausted, .41, p = .009). The Acting With Awareness subscale per-
most also reported having a sense of accomplishment in formed similar to the overall FFMQ scale, relating to lower
their work. levels of depression (r = −.54, p < .001) and higher levels
of accomplishment (r = .38, p = .020). The Nonreactivity to
Inner Experience subscale was also associated with less
Correlations Between Psychological Flexibility depression (r = −.57, p < .001) and more accomplishment
and Wellbeing (r = .39, p = .016); in addition, it showed an association
As Table 3 shows, measures of psychological flexibility with lower levels of EE (r = −.44, p = .006) and stress (r =
were related to wellbeing in expected directions. EA, −.34, p = .037). The Observing, Noticing, and Attending
as indicated by low scores on the AAQ, accompanied to Inner Experience subscale was associated with higher

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202 Topics in Early Childhood Special Education 32(4)

Table 3. Correlations for ACT-Relevant and Teacher Outcome Measures

ACT-related measures

FFMQ FFMQ FFMQ FFMQ FFMQ


Teacher outcome measures AAQ FFMQ Aware Describe Observe Nonjudge Nonreact VLQ
MBI (emotional Correlation −.284 −.264 −.285 −.153 .189 −.075 −.436** −.234
exhaustion)
Significance .068 .100 .083 .347 .243 .647 .006 .136
n 42 40 38 40 40 40 38 42
MBI Correlation −.168 −.107 −.224 .023 −.195 −.035 −.039 −.042
(depersonalization)
Significance .288 .511 .176 .889 .228 .829 .817 .790
n 42 40 38 40 40 40 38 42
MBI Correlation .329* .407 .376 .352 .166 .082 .389* .370*
(accomplishment)
Significance .033 .009 .020 .026 .307 .615 .016 .016
n 42 40 38 40 40 40 38 42
IJM Correlation −.148 −.033 .011 .277 .436** −.403* −.252 −.109
Significance .356 .843 .947 .088 .006 .011 .132 .499
n 41 39 37 39 39 39 37 41
JS Correlation .080 .047 −.138 .165 .127 −.100 .073 .108
Significance .615 .773 .410 .308 .435 .539 .663 .497
n 42 40 38 40 40 40 38 42
ITS Correlation −.485** −.293 −.189 −.108 −.230 −.190 −.344* −.310
Significance .002 .071 .263 .513 .159 .247 .037 .055
n 39 39 37 39 39 39 37 39
TES Correlation .014 .130 .310 .024 −.109 −.074 .039 .219
Significance .935 .432 .062 .884 .509 .656 .820 .180
n 39 39 37 39 39 39 37 39
CES-D Correlation −.585** −.592 −.544 −.107 .034 −.522** −.571** −.679**
Significance .000 .000 .000 .512 .834 .001 .000 .000
n 42 40 38 40 40 40 38 42

Abbreviations: ACT, acceptance and commitment therapy; AAQ, Acceptance and Action Questionnaire; FFMQ, Five-Facet Mindfulness Questionnaire;
VLQ,Valued Living Questionnaire; MBI, Maslach Burnout Inventory; IJM, Intrinsic Job Motivation; JS, Job Satisfaction; ITS, Index of Teaching Stress; TES,
Teaching Efficacy Scale; CES-D, Center for Epidemiologic Studies–Depression Scale.
*p < .05. **p < .01.

levels of job motivation (r = .44, p = .006), whereas the For the outcome analysis, we used Latent Growth
Nonjudging of Inner Experience subscale was associated Modeling (LGM) to assess workshop effects. LGM allows
with lower levels of depression (r = −.52, p = .001). We also analysis of change over time for individuals and takes
found significant associations for VL (VLQ) with higher advantage of the statistical power involved in analyzing
levels of personal accomplishment (r = .37, p = .016) and multiple time points (Curran & Muthén, 1999; Muthén &
lower levels of depression (r = −.68, p < .001). Curran, 1997). We followed similar procedures for analyz-
ing a wait-list control design as reported by Irvine, Biglan,
Smolkowski, Metzler, and Ary (1999). We created a model
Effects of the Intervention of change over time for each condition that specified the
Participants’ workshop ratings. Participants generally felt quite expected change in dependent variables as a function of
satisfied with the workshops. In the immediate condition, 76% exposure to the intervention. Thus for the immediate group,
said the content was the “best ever” (19%) or outstanding we expected change to occur between the first and second
(57%). For delayed, 82% said it was the “best ever” (19%) or assessments; for the delayed group, we expected change
outstanding (63%). between the second and third assessments. The measure of
Data analysis. We analyzed data for all 42 participants this effect was the slope for change over time. As several
using an intent-to-treat model, even though 4 teachers studies of ACT interventions have shown continued
attended no workshops. improvement in follow-up, we set the weights on this factor

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Biglan et al. 203

to represent continued growth postintervention (Muthén & for each model) and was better for the multisample model
Curran, 1997). For the immediate group, the weights were 0 (CFI = 0.98). For each model, the change in slope was
preintervention and 1, 2, and 3 at three postintervention significant (p = .001, .007, and .045, respectively). Thus,
assessments. For the delayed group, the weights were 0 at the workshops were instrumental in reducing experienced
Times 1 and 2, and were 1 and 2 at the two postintervention stress.
times (Times 3 and 4). Thus, the models assumed that peo- As Table 5 shows, both the separate models for the
ple continued to show improvement at each postinterven- TES and the multisample model fit the data (CFIs of 0.96,
tion time point. 1.00, and 1.00, respectively). The slope was not signifi-
We evaluated model fit separately for each condition cant for the immediate condition but was for the delayed
using traditional structural equation modeling and then we (p = .05) and the multisample (p = .018) conditions, pro-
tested the fit of a multisample model combining both condi- viding evidence that the workshops led to increased
tions. The comparative fit index (CFI) assessed model fit, teaching efficacy.
using values of 0.90 to 0.94 as acceptable, 0.95 to 0.99 as Qualitative reports on changes in the culture of the pre-
close, and 1.00 as exact (Hu & Bentler, 1998, 1999). school. Table 6 presents the responses of the seven staff to
Confidence that an intervention had an effect comes from open-ended questions about changes at the preschool. As
model fit and a significant effect factor. Our confidence is shown, most noticed positive changes in the preschool and
greatest when the immediate, delayed, and combined mod- attributed them to the ACT-related processes.
els all fit. However, given the study’s small N, the models Respondents indicated that people were getting along
that combine immediate and delayed data may fit at times better. One supervisor said, “There has been a real shift in
when the individual models do not, due to greater statistical the sensitivity, willingness to work with people, and overall
power provided by the full sample. effort to support people, come as they may.” Supervisors
Effects on psychological flexibility. Table 4 presents the noted that teachers were more open to feedback during
results of these analyses. We found effects on three sub- employee evaluations and that coworkers offered a greater
scales of the FFMQ. For the Nonreactivity to Inner Experi- number of positive and constructive comments. Leaders
ence subscale, the model fit very well for the immediate also noted that, with encouragement, staff was more open
group (CFI = 1.00), but there was no significant change in to try new procedures and curricula to promote positive
slope. For the delayed condition, the model fit adequately behavior and social skills. Respondents credited many
(CFI = 0.984), and there was a significant change in slope changes to an increased willingness to accept thoughts and
(p = .029). Thus, nonreactivity did not increase significantly feelings and to people “asking the question—does this
following the workshops for the immediate condition but behavior/act of mine lead in the direction of my values?”
did so for the delayed condition. However, change in slope One supervisor noted that staff practiced mindfulness in
was significant for the combined model (CFI = 0.984). classrooms and meetings, and that reminding others of the
For the Nonjudging of Experience subscale, we noted a ACT principles before communication and feedback facili-
significant change in slope for the immediate condition (p tated better results.
= .007) where model fit was excellent (CFI = 1.00). Slope
approached significance for the delayed condition (p = .12)
where model fit was also good (CFI = 0.981). The multi- Discussion
sample model fit the data well (CFI = 1.00) and change in The results of this pilot study suggest that brief ACT work-
slope was significant (p = .001), indicating that the work- shops can increase acceptance of inner experience, reduce
shops increased people’s ability not to judge their thoughts stress, and increase feelings of efficacy among early child-
and feelings. hood special educators. Moreover, not only did these ben-
There was also evidence that the workshops increased efits continue at the first follow-up but also the best fitting
participants’ ability to attend to inner experiences. For the models showed that participants experienced further
Observing/Noticing/Attending to Inner Experience sub- improvement over time. The workshops also may have
scale, the model for the immediate condition fit very well helped to foster an open and respectful culture within par-
(CFI = 1.00), with a significant change in slope (p = .004). ticipating preschools that facilitated being supportive,
The model fit for the delayed condition was marginal (CFI working cooperatively, giving and receiving feedback, and
= 0.91), and change in slope only approached significance embracing innovation.
(p =.11). Yet the multisample model fit well (CFI = 1.00), It is interesting that the ACT intervention affected rat-
and change in slope was significant (p = .002). There were ings of teaching self-efficacy. Items on the TES have to do
no effects on the AAQ or the VLQ. with whether the person believes that his or her actions can
Effects on wellbeing. LGM analyses indicated that the have desired effects on students. For example, “The influ-
workshops affected the ITS and the TES. The ITS model ences of a student’s home experiences can be overcome by
fit was adequate for immediate and delayed (CFIs = 0.94 good teaching.” ACT encourages people to “hold their

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204
Table 4. Latent Growth Modeling Results for ACT-Related Measures (T1-T4): Immediate, Delayed, Combined (Fixed Effects)

Immediate (n = 23) Delayed (n = 19) Combined (n = 42)

Measure Est. SE C.R. Significance Est. SE C.R. Significance Est. SE C.R. Significance
Nonreactivity to Inner Experience subscale
Comparative fit index 1.000 0.984 0.984
Coefficient: Intercept value 22.190 0.998 21.997 <.001 21.588 0.903 24.159 <.001 21.675 0.695 31.166 <.001
Coefficient: Slope value 0.279 0.252 1.108 .268 1.104 0.505 2.186 .029 0.543 0.211 2.570 .010
Nonjudging of Experience subscale
Comparative fit index 1.000 0.981 1.000
Coefficient: Intercept value 28.435 1.305 21.840 <0.001 28.412 1.366 20.920 <.001 28.425 0.952 29.692 <.001
Coefficient: Slope value 1.021 0.378 2.702 .007 1.051 0.671 1.567 .117 0.985 0.296 3.328 <.001
Observing/Noticing/Attending to Inner Experience subscale
Comparative fit index 1.000 0.910 1.000
Coefficient: Intercept value 27.870 1.212 22.759 <.001 29.06 0.949 30.514 <.001 28.110 0.795 35.377 <.001
Coefficient: Slope value 1.030 0.358 2.878 .004 0.699 0.435 1.609 .108 0.784 0.248 3.164 .002

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Abbreviations: ACT, acceptance and commitment therapy; Est., parameter estimate; C.R., Est./SE.
Biglan et al. 205

Table 5. Latent Growth Modeling Results for Teacher Outcome Measures (T1-T4): Immediate, Delayed, Combined (Fixed Effects)
Immediate (n = 23) Delayed (n = 19) Combined (n = 42)

Measure Est. SE C.R. Significance Est. SE C.R. Significance Est. SE C.R. Significance

Index of Teaching Stress


Comparative 0.938 0.942   0.980
fit index
Coefficient: 128.73 5.444 24.28 <.001 115.27 4.221 19.22 <.001 123.10 6.103 30.70 <.001
Intercept
value
Coefficient : −5.36 1.556 −3.44 <.001 −4.54 1.123 −4.03 .007 −4.57 2.282 −2.00 .045
Slope value
Teacher Efficacy Scale
Comparative 0.960 1.000   1.000
fit index
Coefficient: 43.318 0.910 47.446 <.001 41.824 1.314 32.282 <.001 42.704 0.794 53.801 <.001
Intercept
value
Coefficient : 0.512 0.356 1.441 .150 1.149 0.634 1.814 .050   0.649 0.275 2.360 .018
Slope value

Abbreviations: Est., parameter estimate; C.R., Est./SE.

Table 6. Responses from a Random Sample Regarding Changes in the Preschool

Question and open-ended responses Number of responses


Have you noticed any changes in the preschool regarding how people get along? Yes = 6 No = 1
People are more caring and sensitive 4
More respectful of one another 2
People show more support to each other 1
Greater acceptance of one another 1
More mindful of one another 1
Better leadership 1
Greater focus on team values 1
People are stressed and unhappy 1
Have you noticed any changes in willingness for people at the preschool to try new things? Yes = 6 No = 0
Better attitudes/more energy/greater willingness for a new curriculum 4
More support from leadership provided for trying new things 1
More positive feedback and compliments given 1
People do not easily change 1
More openness and respect when changes take place 1
More following through on trying new things 1
More talking among coworkers to enhance children’s performance 1
Greater professionalism 1
Have you noticed any changes in willingness to give feedback? Yes = 6 No = 0
More complements and positive feedback 2
Expressing concerns in a more positive/kind manner 2
More people are giving feedback, but there is little follow through on it 1
More are giving feedback, but it is still hard for a lot of us to do 1
Leadership is acknowledging and using people’s talents 1
Leadership has offered a model on how to provide feedback 1
Realized that giving feedback is positive and constructive, not hurtful 1
Giving positive feedback is a team goal 1
Have you noticed any changes in willingness to take feedback? Yes = 7 No = 0
Feedback given in a more positive way is easier to accept/receive 4
Now daily feedback and discussions about feelings are happening 1
Willingness has increased as we are working together on common values 1
(continued)

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206 Topics in Early Childhood Special Education 32(4)

Table 6. (continued)

Question and open-ended responses Number of responses


People are noticing others’ strengths more 1
Talking about feelings has changed how people deal with problems 1
Have you noticed any changes in people’s dedication to children? Yes = 6 No = 0
The staff is very dedicated/devoted to and cares about the children 4
Changes in the preschool environment to enhance children’s skills 2
Shared value of making a difference in children’s lives 1
Increased willingness to try new curriculum to promote friendship skills 1
Staff is more thoughtful about children’s emotions 1
Why do you think changes have occurred in the preschool?
More caring/acceptance/respect/support for one another 2
Accepting thoughts and feelings 2
Practicing mindfulness 2
Greater compassion 1
It is very positive 1
Focusing on values 1
People are more aware of other’s values and beliefs 1
Feedback given and received in a calmer manner 1
More acceptance about other people’s situations 1
Staff is more rushed and stressed this year 1
Reminders of ACT principles and noticing changes that have occurred 1
It has made a huge difference in my life 1
Abbreviation: ACT, acceptance and commitment therapy.

beliefs lightly” and to act in the service of their values, even (Early Childhood PBIS, 2011) and the PATHS Preschool
when their thoughts tell them they can’t succeed. In con- Program (Promoting Alternative Thinking Strategies;
trast, traditional self-efficacy theory suggests that increas- Domitrovich, Cortes, & Greenberg, 2007). Implementation
ing one’s beliefs about self-efficacy leads to increased of each program met with less staff resistance than had pre-
action (Bandura, 1985). Apparently, encouraging people to viously been experienced. ACT training also appeared to
defuse from their thoughts and focus on their actions make it easier for staff to implement emotion coaching
increases the degree to which they endorse statements about (Greenberg, 2002). When children become distressed, their
their ability to make a difference. distress often produces emotional reactions in their care-
We note that the time between the workshops and the givers. Such reactions can get in the way of providing the
first postassessment may have been too brief. Other ACT skilled and caring interactions that can help the child learn
research suggests that the benefits of ACT often take time to about their emotions and the circumstances that have
appear (Bach & Hayes, 2002; Gifford et al., 2004; Hayes, brought on the emotion (e.g., “Oh you are angry because
Bissett, et al., 2004; Lillis & Hayes, 2007; Masuda et al., he took your toy.”). The increased psychological flexibility
2007; Twohig, Hayes, & Masuda, 2006). People may of staff appears to have helped them to control their own
become more psychologically flexible initially, but the full emotional reactions and to help the children learn about
benefit may emerge only when they deal with important life their emotions, self-regulate, and learn ways to deal with
issues. For example, two coworkers who have been in con- difficult situations.
flict may continue to feel hurt and angry toward each other, Findings presented here generally confirm expectations
even after they have chosen to pursue values of respect and regarding ACT-relevant measures of EA, mindful awareness,
cooperation and have begun to act on those values in their and VL. All three show an interrelationship to higher levels of
interactions. Changes in feelings may come later. mindfulness; we found VL associated with less EA.
Although the current study does not provide experimen- Results also support several hypothesized relationships
tal evidence of the impact of ACT on teaching practices, between ACT-associated measures and teacher psycho-
the preschool’s experience is consistent with reports in the logical outcomes. EA and VL were associated with lower
literature of the benefits of ACT in increasing the use of levels of stress and depression and higher levels of per-
innovative or evidence-based practices (Hayes, Bissett, sonal accomplishment; mindfulness was associated with
et al., 2004; Varra et al., 2008). In the year following the lower levels of depression and higher levels of personal
workshops, EEP implemented Positive Behavior Support accomplishment.

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Biglan et al. 207

This study provides further documentation of the psy- Thus, we provide only preliminary evidence on the value
chological needs of those who work with young children, of ACT workshops. It may justify further research on their
especially children with special needs. The interrelation- impact but does not support dissemination to nonresearch
ships among teachers’ psychological problems were appar- settings at this time.
ent: Depression showed a strong connection to higher
levels of stress and EE and with lower levels of personal Acknowledgments
accomplishment and teaching efficacy. Half of the pre- The authors thank Richard Farmer for his very substantial help in
school participants reported depression levels above the developing the measures for this study; Yvonne Kuo for her mas-
cutting score for a diagnosis of depression. This concurs tering of the various measures and file structures necessary for
with other studies indicating high levels of depression producing analytic data sets; Jason Luoma, director of the
among teachers (Jurado, Gurpegui, Moreno, & de Dios, Portland Psychotherapy Clinic, Research, and Training Center, for
1998), especially those working with difficult students his helpful comments on earlier versions of the article; Christine
(Abel & Sewell, 1999; Byrne, 1998). Not all participants Cody for her editorial input, assistance with locating literature,
work directly with children but other factors could contrib- and help preparing the article; and Susan Long for additional help
ute to these high rates of depression, including the stress of preparing the article.
working with special needs children, low pay, large time
demands, and the fact that most participants are women, Declaration of Conflicting Interests
who have higher rates of depression than men (Kornstein, The author(s) declared no potential conflicts of interest with
1997; Weissman & Olfson, 1995). respect to the research, authorship, and/or publication of this
Although depression was associated with significantly article.
higher levels of EE and lower levels of personal accom-
plishment, it did not preclude a sense of instructional Funding
achievement. Based on commonly accepted cut points for The author(s) disclosed receipt of the following financial support
categorizing respondents on the CES-D and MBI-EE scales, for the research, authorship, and/or publication of this article: The
the majority of the teachers surveyed were both depressed National Institute on Drug Abuse (DA018760 and DA-019037)
and emotionally exhausted but most still reported feeling a and the National Institute of Child Health and Human Development
sense of personal accomplishment in their work. This is (HD060922) provided financial support for the completion of the
especially encouraging given the ACT emphasis on still work on this manuscript.
moving forward on valued courses of action while accept-
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