Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions

Abstract

PurposeAcceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well‐being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively.MethodsWe present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness‐informed interventions for psychosis.ResultsAcceptance and commitment therapy for psychosis is promising as a pragmatic, process‐driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology‐assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact.ConclusionsOver the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence‐based interventions for psychosis.

All paths do not lead to Rome or adherence: Innovative antipsychotic prescribing in partnership with people in recovery as they define.

“…In fact, due to the challenges of many with taking antipsychotics, the avenue of cognitive behavioral therapy for psychosis has burgeoning evidence as a safe and effective treatment option for those who will not take medication (Morrison, 2019). Many psychotherapeutic modalities have empirical support for those with psychosis, including but not limited to supportive psychodynamic psychotherapy, cognitive behavioral therapy for psychosis, dialectical behavioral therapy, behavioral family therapy, acceptance and commitment therapy, metacognition reflection and insight therapy, among others (Gottlieb et al, 2012; Lawlor et al, 2022; Lysaker et al, 2020; Morris et al, 2023; Rosenbaum et al, 2013; Sitko et al, 2020). In Table 1, the authors provide examples of provider options and ideas for effectively addressing the concerns that they both identify from an SDM framework…”

Value Component of Acceptance and Commitment Therapy (ACT) among Patients with Schizophrenia

“…There are several evidence-based interventions for patients with schizophrenia, including ACT [14]. ACT has been shown to be effective in reducing symptoms of anxiety and depression in patients with schizophrenia [15].…”