Brief acceptance and commitment therapy for psychotic inpatients: A randomized controlled feasibility trial in Sweden

Abstract

Psychiatric inpatient care in Sweden is often described as lacking in content other than medication and mere containment. In an attempt to increase structured psychological content in the ward context, this study aims to investigate whether a brief form of acceptance and commitment therapy (ACT) is a feasible addition to standard care for psychotic inpatients. ACT has previously been administered to psychotic inpatients in the US, and the present study was an attempt at implementing this intervention in Sweden. In this feasibility study, 22 psychotic inpatients were randomized to one of two conditions: treatment as usual (TAU) or TAU plus an average of two ACT sessions. Measures of rehospitalization and values-based living were obtained before treatment, after treatment, and at four-month follow-up. Results indicate that participants in the TAU plus ACT group were rehospitalized at a lower rate than those who only received TAU (9% vs. 40%), though the difference was not statistically significant. Controlling for age, gender, and pretreatment values-based living scores, there was a significantly higher risk for TAU participants to be rehospitalized. There was a trend toward increased values-based living scores in the ACT group. These results suggest that it is feasible to add structured psychotherapeutic interventions to the existing care package at psychiatric inpatient wards in Sweden. However, the findings need to be explored in larger samples.

The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis

“…The ACT approach used varied between studies. Four authors based their intervention on the original 2 Hayes manual, 9 , 10 , 29 , 31 while in the other four studies, 11 , 12 , 16 , 30 ACT manuals were developed or adapted especially for the trial. The Spidel 16 trial was the only study that explicitly stated metaphors were not used because of the cognitive problems associated with psychosis.…”

“…The Spidel 16 trial was the only study that explicitly stated metaphors were not used because of the cognitive problems associated with psychosis. In other studies (e.g., Gaudiano & Herbert 10 und Tyrberg et al 31 ), metaphors were applied as part of the ACT approach. In three studies, 10 , 30 , 31 participants were given homework tasks to complete between sessions.…”

“…In other studies (e.g., Gaudiano & Herbert 10 und Tyrberg et al 31 ), metaphors were applied as part of the ACT approach. In three studies, 10 , 30 , 31 participants were given homework tasks to complete between sessions. The psychology background of clinicians providing ACT was stated in two studies.…”

“… 11 , 30 That ACT was provided by a psychologist could be worked out or inferred (e.g., the affiliation of the author that provided the ACT) in other studies, but was not explicitly stated. In all but two trials, 12 , 31 the clinician providing treatment received additional training and supervision to deliver ACT.…”

“…Seven trials [9][10][11][12][29][30][31] tested individual ACT, and one tested group ACT. 16 Individual treatment comprised one 31 to 15 11 sessions, typically lasting between 45 minutes and 1 hour. Group ACT 16 comprised eight sessions lasting 90 minutes, with eight participants in each session.…”