Applying ACT in Sierra Leone
ACT, as a behaviorally based and trans-diagnostic approach to psychotherapy, can be applied within various cultural contexts and to a range of different issues. This circumvents potential problems with attempting to apply manu- alized treatment programs that were developed in the West for specific issues and diagnoses that may not be relevant or valid in the context of Sierra Leone. commit and act focuses more broadly on difficulties that are comparatively widespread in Sierra Leone (e.g., trauma, gender-based violence etc.) rather than on particular psychiatric diagnoses. Following functional analyses of these issues and related effects on individuals or groups, ACT techniques can be adapted and applied to promote more adaptive behaviors that serve valued ends and to alleviate suffering and distress.
In keeping with WHO (2010) recommendations and the Sierra Leone Ministry of Health and Sanitation’s (2012) mental health plan, commit and act is dedicated to ensuring that its services are evidence-based. The evidence-base summarized above makes ACT an appropriate initial choice for providing health care workers with effective psychotherapeutic skills that can be applied to various issues and groups within Sierra Leone. Evidence also suggests that individuals can be trained to deliver ACT as an intervention in a relatively short period of time (Strosahl et al. 1998) and that therapists with limited ACT training can achieve positive therapeutic changes with clients using this approach (Lappalainen et al. 2007). Given the limited resources available to scale up mental health services in Sierra Leone at present, the ACT model can be introduced reasonably quickly via field-based training.
In addition, by working with a variety of professionals (e.g., teachers, religious leaders, social workers), non-specialized workforces, NGO staff and existing groups (e.g., women’s groups), commit and act aims to increase the amount and range of access points to psychosocial support. For instance, by training teachers and local groups in validated psychotherapeutic methods, children can receive support for various problems by speaking to a teacher who is trained in these methods and adults can access psychosocial support from trained individuals within their local community, commit and act aspires to create sources of continuous psychosocial support within communities by working with and empowering individuals and groups to develop structures that provide mental health care by local people for local people. It also aims to promote psychoeducation and reduce stigma so that individuals seek help as and when various difficulties arise, thereby helping to prevent such problems from escalating to a point where the individual becomes severely impaired. commit and act also provides ongoing supervision following ACT training so that individuals can further develop and refine their skills and discuss cases with ACT trainers and local ACT experts.
Another important reason why ACT was adopted by commit and act as its main psychotherapeutic approach is due to evidence which suggests that ACT training can have a positive impact both professionally (Hayes et al. 2004a) and personally (Luoma and Vilardaga 2013) on individuals who undergo this type of training. Typically, ACT training consists of a combination of didactic presentations and experiential exercises where therapists engage in ACT processes in an effort to increase their own psychological flexibility (see Luoma et al. 2007). Hayes et al. (2004a) found that ACT training had a positive impact on stigma and burnout for substance abuse counselors and that followup improvement with regard to burnout exceeded those of cultural competency training alone (i.e., training designed to help counselors become aware of their own biases in areas such as culture and race). Luoma and Vilardaga (2013) observed improved conceptual knowledge, increased psychological flexibility and reduced burnout in therapists on validated self-report questionnaires post-ACT training and at follow-up. Given the increased burden on health care workers in Sierra Leone due to the lack of training, limited resources and low pay (Song et al. 2013), there is an increased risk of burnout for health care professionals. Thus an important component of improving the health care services and their sustainability should involve the promotion of self-care for health care staff.