A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis

Abstract

The experience of psychosis can lead to depression, anxiety and fear. Acceptance and Commitment Therapy (ACT) facilitates individuals to accept difficult mental experiences and behave in ways that are consistent with personally held values. This study was a single (rater) blind pilot randomised controlled trial of ACT for emotional dysfunction following psychosis.Twenty-seven participants with psychosis were randomised to either: ten sessions of ACT plus treatment as usual (TAU) or TAU alone. The Hospital Anxiety and Depression Scale, Positive and Negative Syndrome Scale, Acceptance and Action Questionnaire, Kentucky Inventory of Mindfulness Skills and Working Alliance Inventory were used. Individuals were assessed at baseline and 3 months post-baseline. The individuals randomised to receive ACT found the intervention acceptable. A significantly greater proportion of the ACT group changed from being depressed at time of entry into the study to not being depressed at followup. The ACT group showed a significantly greater increase in mindfulness skills and reduction in negative symptoms. Results indicated that individuals randomised to ACT had significantly fewer crisis contacts over the study. Changes in mindfulness skills correlated positively with changes in depression. ACT appears to offer promise in reducing negative symptoms, depression and crisis contacts in psychosis.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

“…Two reports were found that did not meet inclusion criteria for the systematic review, but referred to trials that targeted affective disturbance specifically in people with psychosis (White et al, 2011;Jackson et al, 2009), which most of the psychological therapy trials above had not set out explicitly to achieve. One further paper (Lecomte et al, 1999) reported on a trial of a self esteem therapy intervention that was similar to the four reviewed above (Hall & Tarrier, 2003;Knight, Wykes, & Hayward, 2006;Laithwaite et al, 2007;Laithwaite et al, 2009).…”

“…One further paper (Lecomte et al, 1999) reported on a trial of a self esteem therapy intervention that was similar to the four reviewed above (Hall & Tarrier, 2003;Knight, Wykes, & Hayward, 2006;Laithwaite et al, 2007;Laithwaite et al, 2009). White et al (2011) reported on a randomised controlled trial of Acceptance and Commitment Therapy (ACT) for emotional dysfunction following psychosis, which was published too late to be included in the above study pool. 27 people with psychosis were randomised to ACT or treatment as usual (TAU).…”

“…Only one of the psychological therapy trials included in the review set out specifically to target depression in people with psychosis (Laithwaite et al, 2009), although two more were found that targeted depression but did not meet review criteria (Jackson et al, 2009;White et al, 2011 (Birchwood, 2003), which carried the implication that by manipulating the meaning of the psychotic experience to the individual, reducing the degree of defeat and entrapment experienced, depression and its associated negative effects could be prevented. Depression showed no benefit from this intervention compared to TAU, and this was not attributable to a floor effect: baseline CDSS scores had indicated that 67% of the participants were "significantly" depressed.…”

“…Acceptance and Commitment Therapy (ACT; Hayes et al, 1999), which targets EA specifically as a means of changing the way that clients relate to distressing experiences, has been applied to psychosis in three randomised controlled trials (Gaudiano & Herbert, 2006;Bach & Hayes, 2002;White et al, 2011). Findings included lower psychotic symptom believability after ACT compared to treatment as usual (Bach & Hayes, 2002;Gaudiano & Herbert, 2006), fewer hospital admissions (Bach & Hayes, 2002) or crisis contacts (White et al, 2011), more reductions in negative affect or depression (Gaudiano & Herbert, 2006;White et al, 2011), in the distress associated with psychotic symptoms (Gaudiano & Herbert, 2006) and in negative symptoms (White et al, 2011).…”

“…Findings included lower psychotic symptom believability after ACT compared to treatment as usual (Bach & Hayes, 2002;Gaudiano & Herbert, 2006), fewer hospital admissions (Bach & Hayes, 2002) or crisis contacts (White et al, 2011), more reductions in negative affect or depression (Gaudiano & Herbert, 2006;White et al, 2011), in the distress associated with psychotic symptoms (Gaudiano & Herbert, 2006) and in negative symptoms (White et al, 2011). Mindfulness based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002) also seeks to reduce clients' avoidant struggle with symptoms, the focus here being non-judgmental awareness of experience.…”