Acceptance and Commitment Therapy for depression following psychosis: An examination of clinically significant change

Abstract

Depression following psychosis is common and can impact negatively on individuals' quality of life. This study conducted post-hoc analyses on 14 participants with psychosis from a larger randomised controlled trial who presented with clinically important levels of depression at baseline. Eight of the participants received Acceptance and Commitment Therapy (ACT), whilst the remaining six individuals received treatment as usual (TAU). The focus was on investigating clinically significant change in outcome measures between baseline and 3-months post-baseline in the participants. Participants completed measures assessing depression and anxiety (HADS), psychosis symptoms (PANSS) and psychological inflexibility (AAQ-II) between baseline and at 3-month post-baseline assessments. Odds ratio analysis indicated that participants receiving ACT, compared to TAU, were 15 times more likely to achieve clinically significant decreases in depression scores (Fisher's Exact Test p = 0.05). Differences between the ACT and TAU groups in clinically significant changes in anxiety, psychological inflexibility, positive symptoms, negative symptoms and general level of psychopathology were not statistically significant. The study provides tentative support for the use of ACT to treat depression emerging in the context of psychosis.

Shame, social deprivation, and the quality of the voice‐hearing relationship

“…The findings suggest that interventions that target shame such as compassion‐focused therapy (Gilbert, ) or that address negative voice‐hearing beliefs such as cognitive behavioural therapy for psychosis (CBTp) may be helpful. Interventions such as acceptance and commitment therapy that help individuals to non‐judgementally acknowledge distressing experiences whilst pursuing valued goals, and mindfulness, which focuses upon changing the nature of the relationship that individuals have with their voices, may also play a role in relation to reducing the emotional dysfunctional associated with psychosis (Aust & Bradshaw, ; Gumley et al ., ; White et al ., , ). Results suggest the use of therapies that address the interpersonal relationship between the voice‐hearer and the voice such as relating therapy (Hayward, Overton, Dorey, & Denney, ) or cognitive analytic therapy (CAT; Ryle, ), which has several features that suggest its suitability for working with experiences of psychosis (Taylor, Perry, Hutton, Seddon, & Tan, ).…”

What happens after five years?: The long-term effects of a four-session Acceptance and Commitment Therapy delivered by student therapists for depressive symptoms

“…Depression treated with acceptance-and value-based interventions for psychosis has been examined using a few ACT-based models (Gaudiano et al, 2015;Gaudiano, Nowlan, Brown, Epstein-Lubow, & Miller, 2013;Gumley et al, 2017;White et al, 2011;White et al, 2015). A model combining elements of ACT with behavioral activation termed Acceptance-Based Depression and Psychosis Therapy (ADAPT) was investigated in two studies with patients suffering from depression and psychotic features.…”

A parallel group randomised open blinded evaluation of A cceptance and Commitment Therapy for d epression a fter p sychosis: Pilot t rial outcomes (ADAPT)

“…Finally, our approach to recruitment was informed by an earlier feasibility trial of ACT for emotional distress in psychosis (White et al, 2011). A clear signal emerging from the trial was a change in depression amongst those participants receiving ACT (White et al, 2013;White et al, 2015).…”

“…In a later analysis, White et al (2015) found that ACT was associated with significantly greater likelihood of achieving a clinically significant improvement in depression.…”