Evidence Base for ACTp
There are six randomized controlled trials (RCTs) evaluating the efficacy of ACT with people with psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006; Shawyer, Farhall, Mackinnon, Trauer, Sims, Ratcliff, Larner, Thomas, Castle, Mullen & Copolov, 2012; Shawyer, Farhall, Thomas, Hayes, Gallop, Copolov & Castle, 2017; Tyrberg, Carlbring and Lundgren, 2016; ), plus recent systematic reviews of these approaches for psychosis (Khoury et al., 2013; Cramer, Lauche, Haller, Langhorst, & Dobos, 2016; Louise, Fitzpatrick, Strauss, Rossell and Thomas, 2017). The initial RCTs focused on inpatient readmission rates, and RCTs involving outpatients have focused on either depression following psychosis or ongoing positive symptoms. The findings of these trials indicate that ACT approaches can help to reduce the impact of psychotic symptoms, particularly in terms of believability, emotional impact and disruption to functioning. These interventions are acceptable to this patient group, and participants are able to respond in a psychologically flexible way to their unusual experiences. Mediation analyses have found that the positive effects of ACTp result from changing the targeted processes of psychological flexibility, and this finding is supported by qualitative data from client interviews about the active ingredients of ACTp for them (Bacon, Farhall & Fossey, 2014).
ACT Groups for People with Psychosis (G-ACTp)
In addition to individual ACTp, ACT has been successfully developed as a group-based intervention for people who experience psychosis (McArthur, Mitchell and Johns, 2013 [DOI: 10.1002/9781118499184.ch15]; Butler et al, 2016).
The ACT for Life Study (Johns et al., 2015) examined the feasibility and acceptability of delivering a G-ACTp intervention, according to a manualised protocol, in routine community psychosis services in the UK. We were successful in our manualization of the intervention, and it was possible to deliver G-ACTp to a standardised protocol in a routine service setting. Our four-week G-ACTp intervention was acceptable to people with psychosis (first episode and established psychosis). Pre-post assessments showed small improvements in mood and functioning, plus changes in psychological flexibility processes consistent with the ACT model.
ACT for Recovery Study (Jolley, Johns et al LINK) developed the G-ACTp intervention further. This study recruited clients with established psychosis, and added G-ACT for carers as part of the intervention. Separate groups were run for carers, based on the same protocol. The effectiveness of this intervention in improving wellbeing was evaluated in a pilot RCT, in which clients and caregivers received G-ACTp immediately or after a 12-week wait. The findings suggest that G-ACTp improves self-reported overall wellbeing, with no difference in outcomes immediately after the group, and at 12 weeks, or between clients and caregivers.