Objective. Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and cofacilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. Methods. Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year prerandomization, weeks 0-12, and 5-year uncontrolled follow-up. Results. Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect

In this paper, we discuss the practice implications of our group Acceptance and Commitment Therapy for psychosis (ACTp) evaluations, in terms of the adaptations required to ACT interventions for group implementation in routine services for people with psychosis. ACTp shows promise as a brief individual intervention for people with psychosis to improve recovery, reduce future relapse, and reduce healthcare costs. Outcomes for group ACT interventions for nonpsychotic severe mental illnesses support the potential for further cost-savings, through group delivery, and two recent trials suggest that adapting group ACT interventions to suit people with psychosis is both feasible and clinically effective.Trials were run from 2010-2014, and included people with psychosis and caregivers. Qualitative feedback was collected from group participants and service user co-facilitators. Based on this experience, we recommend psychosisspecific content for group interventions, and highlight process considerations to accommodate the particular needs of people with psychosis and their caregivers.With these adaptations, group ACTp can be feasible, acceptable, and effective as a routine frontline intervention in services for people with psychosis, however; this work is in the preliminary stages and further research is needed to consolidate the evidence base.

Implementing specialist psychological support for caregivers in psychosis services: A preliminary report.