Joseph E. Oliver

The feasibility and acceptability of a brief Acceptance and Commitment Therapy (ACT) group intervention for people with psychosis: The ‘ACT for life’ study

BACKGROUND AND OBJECTIVES Acceptance and Commitment Therapy (ACT) is a contextual cognitive-behavioural approach with a developing evidence base for clinical and cost-effectiveness as an individually-delivered intervention to promote recovery from psychosis. ACT also lends itself to brief group delivery, potentially increasing access to therapy without inflating costs. This study examined, for the first time, the feasibility and acceptability of ACT groups for people with psychosis (G-ACTp). METHODS Participants were recruited from community psychosis teams. Ratings of user satisfaction, and pre-post change in self-rated functioning (primary outcome), mood (secondary outcome) and ACT processes were all completed with an independent assessor. Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures. RESULTS Independently assessed acceptability and satisfaction were high. Functioning (Coeff. = -2.4, z = -2.9, p = 0.004; 95% CI: -4.0 to -0.8; within subject effect size (ES) d = 0.4) and mood (Coeff. = -2.3, z = -3.5, p = 0.001; 95% CI: -3.5 to -1.0; d = 0.4) improved from baseline to follow-up. Commensurate changes in targeted ACT processes were consistent with the underlying model. LIMITATIONS The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Participants may have improved as a result of other factors, and findings require replication in a randomized controlled trial (RCT). CONCLUSIONS This preliminary study showed that brief group ACT interventions for people with psychosis are feasible and acceptable. Uncontrolled, pre-post assessments suggest small clinical improvements, and changes in psychological processes consistent with an ACT model. Replication in an RCT is required, before implementation can be recommended.

Acceptance and Commitment Therapy and Mindfulness for Psychosis: Morris/Acceptance and Commitment Therapy and Mindfulness for Psychosis

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Using Acceptance and Commitment Therapy With People With Psychosis: A Case Study

There is a small but increasing body of research to suggest that acceptance and commitment therapy (ACT) is useful for people experiencing psychosis. As an intervention, ACT does not specifically target symptom reduction but rather emphasizes more flexible responding in the presence of psychotic symptoms to encourage increases in value-driven behavior. A case study is presented, detailing use of ACT in working with someone experiencing long-standing distressing psychosis, specifically, paranoia, delusions, and associated emotional disturbance. Measures of general distress, severity, and intensity of delusional thoughts and depression were taken at two points prior to therapy starting and again post intervention. All measures showed improvements post therapy, although symptoms did not remit completely. However, the client reported significant increases in value-based activities. The results indicated that, although not a primary treatment target, ACT can help in reduction of symptoms. As expected, the intervention can also assist in increasing value-based behavior, in spite of the presence of ongoing psychotic symptoms.