Bach 2001

Auditory hallucinations and delusions are common symptoms of serious mental illness. Delusions and hallucinations are also notoriously resistant to both somatic and psychotherapeutic interventions. Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral therapy that attempts to help the client use psychological acceptance as a coping strategy in situations where internal or external sources of distress cannot be easily changed. The client is encouraged to accept unavoidable private events, identify and focus on actions directed toward valued goals, and deliteralize cognition so that private events are seen as distinct from external events. The present study examined whether an acceptance focused intervention based on ACT can lead to improvements in the functioning of mental health patients experiencing delusions or hallucinations. Subjects were recruited from an inpatient unit of a state hospital. Following a four session intervention, subjects exposed to ACT were half as likely to be hospitalized as treatment as usual (TAU) control subjects at four month follow-up. ACT subjects were much more likely to report symptoms at follow-up than were TAU subjects. The outcome differed between subjects primarily reporting delusions and those primarily reporting hallucinations. Among all subjects reporting symptoms at follow-up, ACT subjects showed greater reductions in believability of symptom content. The intervention was found to have little impact on the hospitalization of subjects reporting delusions, and a large treatment effect for auditory hallucinations.