psychosis

Objective

Acceptance and Commitment Therapy for Inpatients (ACT-IN) with psychosis has been found to be efficacious in previous trials, but its effectiveness has not been studied when implemented by frontline clinicians in routine settings.

Method

Introduction
The psychological inflexibility model proposes several transdiagnostic processes maintaining psychological distress and is one of the models forming the basis of Acceptance and Commitment Therapy (ACT). ACT has been used as an intervention for psychosis but prior to the present review and meta-analysis (PROSPERO ID: CRD42022369048) the relationship between psychological inflexibility and other ACT processes in the context of psychosis or psychosis-like symptoms has not been investigated.

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness.

Background
There is a lack of research on psychological treatments for psychosis in the inpatient setting. Acceptance and Commitment Therapy for psychosis (ACTp) is a diagnose specific adaptation of the transdiagnostic ACT treatment model which has shown promising results in patients with psychosis.

Aim
The aim was to explore treatment effects of ACTp on inpatients with psychosis on symptoms, level of functioning, level of activity, psychological flexibility, –health-related quality of life, valued living, and to explore the acceptability and feasibility of ACTp.

Acceptance and Commitment Therapy (ACT) has demonstrated promising outcomes to date with clinical populations affected by psychosis, however there is a dearth of such investigations involving non-clinical samples despite evidence that symptoms of psychosis exist on a continuum in the general population. The present study aimed to investigate how key ACT processes relate to psychosis-like symptoms in the general population. A convenience sample of 77 adults completed self-report measures of cognitive fusion, mindfulness, experiential avoidance, and psychosis-like symptoms, and relative distress, intrusiveness and frequency.

A new model of medication adherence, rooted in an understanding of psychological flexibility, is presented here to illustrate how Acceptance and Commitment Therapy processes might guide the development of more effective adherence interventions for patients with psychotic-spectrum disorders. Medication adherence is a product of a negotiated, collaborative agreement between patient and provider, and it is predicted by a number of internal and external contextual factors.

This review explores the evidence base for Acceptance and Commitment Therapy (ACT) for people experiencing psychosis, the quality of the evidence, and potential benefits of this intervention. A systematic search of the literature was conducted on the electronic academic databases MEDLINE, Google Scholar, PsycArticles and PsycINFO up to October 2016. A systematic search identified 427 articles and thirteen studies were selected as eligible for review. The current research base indicates that ACT has the potential to be considered an effective treatment in psychosis even in briefer forms, such as 4 sessions for inpatients, and in individuals experiencing severe symptoms or complex co-morbidities.

Described as a contextual behavioural approach, Compassion-focused Therapy (CFT) aims at helping people develop compassionate relationships both with others and with the self. CFT has been used to promote recovery in psychosis with promising results. The development process of the Compassionate Approach to Schizophrenia and Schizoaffective Disorder (COMPASS) builds upon the available research on contextual behavioural approaches for psychosis. Its main framework is the affect regulation system's model and the compassion-focused therapy rationale as it was adapted for psychosis. Other theoretical and empirical influences are presented and innovations regarding CFT protocols for psychosis are highlighted.

Alleviating the suffering of patients treated in psychiatric inpatient wards is a great challenge. Preliminary or multiple diagnoses, inherent complexities of the inpatient milieu and the lack of potentially effective psychological treatment form part of this challenge. The present study explored the usefulness of a transdiagnostic psychological treatment model (Acceptance & Commitment Therapy, ACT) as a means of improving inpatient care from the perspective of psychiatric nurses. Nurses (n =10) participated in three ACT workshops, a total of 21 h, and were interviewed about the experienced usefulness and difficulties of the ACT model, as a tool for improving everyday ward work.