Acceptance-based Behavior Therapy for Depression With Psychosis

Abstract

Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N = 13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring (EAM) versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT post-treatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared to medications alone and requires testing in a fully powered randomized trial.

Understanding the effect of attachment styles in paranoid ideation: The mediator role of experiential avoidance

“…Results have shown ACT interventions to decrease symptom believability (Bach & Hayes, 2002;Bach, Hayes, & Gallop, 2012), social interference, distress related to hallucinations as well as to improve aff ect (Gaudiano & Herbert, 2006;Gaudiano, Herbert, & Hayes, 2010). These studies found reduced rates of rehospitalization after the intervention, reduced depressive and negative symptoms, illness severity, (Gaudiano et al, 2015;Shawyer et al, 2012;White et al, 2011), and improvement of psychosocial functioning (Gaudiano et al, 2015), acceptance towards symptoms, and quality of life (Shawyer et al, 2012).…”

How Counseling Based on Acceptance and Commitment Therapy and Supported with Motivational Interviewing Affects Levels of Functional Recovery in Patients Diagnosed with Schizophrenia: A Quasi-Experimental Study

“…Emphasis on the use of ACT as a promising therapy in treatment of depression in psychotic disorders appears to be a common outcome of two studies (Gumley et al, 2017;White et al, 2011). It was found that ACT provided a subjective benefit in psychotic disorders (Shawyer et al, 2017), and it had positive effects on treatment satisfaction and recovery expectations (Gaudiano et al, 2015). In the context of psychotic disorders, the fact that ACT is easier and less costly than other therapies appears as an interesting finding (Thomas et al, 2014).…”

“…In recent years, early studies in treatment of psychotic disorders through a third generation Cognitive Behavioral Therapy (CBT), namely the ACT, have provided promising results (Alicia, Tania, David, & Isabelle, 2018;Gaudiano et al, 2015;Ghouchani et al, 2018;Thomas et al, 2014). According to the ACT model, the source of the problem is the individual's association with unwanted emotions, thoughts and personal experiences, as well as their efforts to change, suppress, eliminate or control them.…”

Schizophrenia: An Exploration of an Acceptance, Mindfulness, and Compassion‐based Group Intervention

“…Finally, Gaudiano et al (2015) found that ACT (16 individual sessions) was associated with improved depression in people with psychosis as well as psychosocial functioning (measured by the World Health Organization Disability Assessment Schedule) and experiential avoidance. Small effect sizes were also found for psychotic symptoms.…”

“…To date, five RCTs have been published on ACT or acceptance-based interventions for psychosis (Bach & Hayes, 2002;Gaudiano & Herbert, 2006;Gaudiano et al, 2015;Shawyer et al, 2012;White et al, 2011). In a study with 80 participants with positive psychotic symptoms, randomised to "Treatment As Usual" (TAU) and TAU plus four individual sessions of ACT, Bach and Hayes (2002) found that ACT was linked to significantly higher symptom reporting (consistent with reduced avoidance), lower symptom believability, and reduced re-hospitalisation over a 4-month follow-up period.…”