Development and Evaluation of Acceptance and Commitment Therapy Delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: a Preliminary Analysis

Abstract

Background: Previous studies have demonstrated Acceptance and Commitment Therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients. Aims:To conduct a preliminary evaluation whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults.Method: Staff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy post-therapy and at three month follow-up. Results:Standardised measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists, Conclusions: ACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed. ACT IN AN NHS SERVICE 3 Development and Evaluation of Acceptance and Commitment Therapy delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental HealthService: A Preliminary Analysis. IntroductionAcceptance and Commitment Therapy (ACT) is a 'third wave therapy' which tries to change how individuals relate to their thoughts and emotions rather than change the thoughts and emotions themselves. It is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behaviour change processes, to produce greater psychological flexibility (Hayes, Strosahl, and Wilson, 1999). Psychological flexibility can be Meta-analyses have also suggested that ACT may be effective for a range of problems including anxiety disorders, psychosis, OCD, anxiety, drug abuse, trichotillomania and skin picking and tinnitus (Montgomery, Kim, and Franklin, 2011;Öst, 2008)

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

“…The quality of treatment and adherence to the treatment model could have been improved through visual-or audio recordings and the possibility of random audit of sessions by an outside expert. Overall, the present studies indicate that good outcomes can be attained with adequately supervised staff, students or novice therapists (Ekers et al, 2011;, even when they lack a mental health background (Richardson et al, 2017), and that in some cases outcomes can be comparable with those of professionals (Goldstein, 2015).…”

“…Either a psychologist-or non-psychologist -delivered ACT intervention for depression was examined in a community mental health services program (Richardson et al, 2017). The results tentatively indicated that overall ACT may be effective in clients with complex co-morbidities including depressive symptoms.…”

“…The results tentatively indicated that overall ACT may be effective in clients with complex co-morbidities including depressive symptoms. Reductions in symptomatology were found both at the post-and 3month follow-up measurements with no differences between non-psychologists and psychologists, the latter being assigned to more complex cases (Richardson et al, 2017). Comorbid depression and alcohol abuse were examined using an acceptance-and value-based intervention compared to treatment-as-usual.…”

“…ACT outperforms waiting-list, treatment-as-usual and psychological placebos (effect sizes ranging from 0.42 to 0.82), but no significant differences to established treatments has been found (see reviews and meta-analyses by Ruiz, , 2012Öst, 2008, 2014. There is also a growing body of literature on the application of ACT in the context of depressive symptoms (e.g., Gumley et al, 2017;Richardson, Bell, Bolderston, & Clarke, 2017;. Sub-class analyses of depression in reviews and meta-analyses indicated a within-group effect of d = 0.92 (Hacker, Stone, & MacBeth, 2016) and comparison effects ranging from 0.37 to 0.76 Hacker et al, 2016), favoring ACT over control conditions.…”

Conceptualisation of patient- and family-centred care for young adults with hearing loss and their family members

“…In particular, Sairanen et al (2018) found that increased mindfulness skills and decreased cognitive fusion were associated with lower distress, suggesting that therapies targeted at increasing mindfulness and cognitive defusion, such as Acceptance and Commitment Therapy (ACT), are likely to be effective at reducing parental distress. ACT can be effectively delivered in the clinic by non-psychologists (T. Richardson, Bell, Bolderston, & Clarke, 2018), which suggests that it could be trialled in the clinic by appropriately trained and skilled audiologists as a tool for managing parental distress.…”