Table 4 Qualitative themes and subthemes from interviews with therapists who attended the ACT+ workshops

1. Therapist background and stance towards ACT

1.1 Therapists’ stance towards ACT (in the context of current practice)

I think ACT as a model, […] it’s very much about us coming alongside a patient rather than us being experts. […] it’s not that something’s broken in the patient that needs to be fixed. It’s really that they’re making understandable changes that, in the circumstances they’ve been in, but now we need to look at well, what’s working and could you do something different? So I really like that it’s not blaming, it’s not punitive and it’s very much about what are we going to do about how you’re managing in the here and now. (W1–2)

I think it’s pertinent to clients, I think it could be useful. It moves away from some of the traditional CBT that seems less helpful to people with physical health conditions, particularly in this instance, cancer. Because it does tap into who that person is, and not who they used to be, but still who they are. And allows you to then move forward with that, rather than keep on going back to the past. (W2–4)

1.2 Delivering a manualised intervention

[…] having the amount of experience that I have […], I think the risk is engaging in this trial might not make enough use of that level of experience and flexibility and adaptability. […] as an intervention it may be an intervention that’s better suited to be provided by people with a lower level of experience. Because it provides a scaffolding for their work, which would be helpful, rather than constraining. (W1–6)

So doing a trial where you just have to do something in particular really quite appeals to me, and I just see how that is. But […] if I feel like something else might be helpful, then I’m not allowed to do that, I’ve just got to do what I’m doing within the model, then I guess that will be a bit of a dilemma. Well, not a dilemma, but that will be maybe, yeah, challenging. But I guess, yeah, we’ve got to try these things and see if they work and see if they have value in that sense. (W2–3)

1.3 Supporting work- and exercise-related goals

We have like a local exercise on prescription scheme, and we’ve got a member of the team whose, that’s kind of their thing. And so it’s quite prominent, and equally the employment obviously, is IAPT, the employment support workers that we have here. […]So it feels in line with what we’re already doing. I suppose the difference for me is the sense of me doing all of those things. (W2–3)

[…]But yeah, how much are we expected to do? To get into that part of it. And how much does a client want you to do that? Because they’re coming to you for therapy. So probably the expectation might not be I’m coming to you so you can sort out my issues with my employer, and talk to me about the Disability Discrimination Act and what that means for me and how I can fight my corner. But again, we’d bring that back to problem-solving. (W2–4)

2. Content and structure of the training workshop

2.1 Training content

Maybe at least one other day covering ACT in itself would’ve been really helpful. Because everybody came with different levels of knowledge about ACT. […]So a separate component teaching that, before moving on to how it would work in practice in six sessions for this particular patient group would’ve been really useful. (W1–1)

But the SURECAN training was good for me because it was pitched at that level of people who didn’t know so much about ACT already sort of thing. […] I didn’t come out of it feeling like oh, there were things that we didn’t cover. (W2–3)

It was a nice, flexible approach. Everything … the pace was great. We knew what we were doing at the end of each session. So I think the length of time devoted to each subject and the mix of role-play and theory. Yeah, I couldn’t say do anything different […] we all thought it was great, we really enjoyed it. Yeah, I don’t think there was anything, you could do anything different there. (W3–1)

2.2 ACT+ materials and resources

[…] there were lots of worksheets, both for clinicians but also for patients to go through. And I think that’ll be great for them to have that information. I know in the service I work in we don’t have access to anything like that. So it’s always oh, I’ll print you this off, or there’s a bit of paper here. Whereas when they go to see IAPT they get a really nice glossy brochure. And I do think, I think it gives a really strong message to people that people have really invested in trying to deliver something helpful to them. (W1–2)

I think holding onto that manual is useful with the ACT+, with the SURECAN, but also generally speaking I think I can probably use that in other areas of my practice. A nice little manual to have. (W2–4)

2.3 Training format

I seem to remember that there was a reasonable mix in that there was a fair amount of presentation. But there was some role-play and there was also some discussion time. (W1–5)

I think the training was very, very well designed. I was very impressed with it. […] This training did give me a lot of confidence. I loved the way that it was delivered. The venue was amazing. The trainers were very accommodating, they were very open and understanding and inviting. The people were really nice, but I think that’s just coincidental. […] Everyone felt very comfortable speaking about things. There wasn’t really a person who didn’t speak […] (W2–2)

3. Workshop outcomes

3.1 Knowledge and confidence

I think it was useful in breaking down a few prejudice and preconceptions. Maybe my expectations were too low in terms of people getting back to the work that they were doing and … (W2–1)

[…] Whereas I thought with this, actually I’m learning a skill, like the ACT+ that’s quite specific to the cancer survivors. And actually then it doesn’t stop there because I’m going on in a way to be assessed. So I might be able to hone those skills better, and actually be able to deliver, hopefully, quite a good therapy programme. (W2–4)

3.2 Engagement and commitment

Because I remember every one of us, when we went for a lunch break, was saying oh gosh, I hope I end up seeing a client. […] And I thought to myself oh gosh, I hope I will be given a client because this sounds really exciting, it sounds like a good training. I want to train and get on with it. (W2–2)

So with a trial you’re looking to find out what works, what works best, what doesn’t work. So I’m very open to it, and actually quite excited by it. And looking forward to learning from it. (W3–1)