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Randomized Controlled Trial
. 2023 Nov:261:72-79.
doi: 10.1016/j.schres.2023.09.017. Epub 2023 Sep 14.

Effectiveness of acceptance and commitment therapy for inpatients with psychosis: Implementation feasibility and acceptability from a pilot randomized controlled trial

Brandon A Gaudiano  1 , Stacy Ellenberg  2 , Jennifer E Johnson  3 , Kim T Mueser  4 , Ivan W Miller  5
Affiliations
Randomized Controlled Trial

Effectiveness of acceptance and commitment therapy for inpatients with psychosis: Implementation feasibility and acceptability from a pilot randomized controlled trial

Brandon A Gaudiano et al. Schizophr Res. 2023 Nov.

Abstract

Objective: Acceptance and Commitment Therapy for Inpatients (ACT-IN) with psychosis has been found to be efficacious in previous trials, but its effectiveness has not been studied when implemented by frontline clinicians in routine settings.

Method: In this pilot randomized controlled effectiveness trial, inpatients with schizophrenia-spectrum disorders were randomized to ACT-IN plus treatment as usual (TAU) (n = 23) or a time/attention matched (TAM) supportive condition plus TAU (n = 23) delivered by routine hospital staff. Both conditions received individual and group therapy during inpatient care and completed follow-up phone sessions during the first month post-discharge. Patients were assessed through 4 months post-discharge (blinded to condition) to determine feasibility, acceptability, and preliminary effectiveness of ACT-IN.

Results: ACT-IN was feasible to deliver with fidelity by frontline staff when integrated into an acute care setting. At post-treatment, patients reported significantly greater treatment satisfaction in ACT-IN relative to TAM. Overall, results showed significant but similar improvements for both conditions through 4-month follow-up in psychiatric symptoms, functioning, and mindfulness. Only ACT-IN improved over time in distress. Furthermore, patients receiving TAM had a 3.76 times greater risk of rehospitalization over 4 months compared with ACT-IN.

Conclusions: ACT-IN is feasible and acceptable for patients with psychosis, can be implemented by hospital staff when integrated into acute treatment, and may result in decreased rehospitalization compared to alternative therapies. A future full-scale randomized-controlled implementation trial is warranted.

Clinicaltrials: gov Identifer: NCT02336581.

Keywords: Acceptance and commitment therapy; Psychiatric inpatient hospitalization; Psychosis; Schizophrenia.

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Conflict of interest statement

Declaration of competing interest Dr. Gaudiano has received honoraria from presentations and book royalties related to Acceptance and Commitment Therapy for psychosis. There are no other conflicts of interest to report related to this work.

Figures

Figure 1.
Figure 1.
Participant Flow Diagram.
Figure 2.
Figure 2.
Cox Regression Analysis of Time to Rehospitalization by Group
See this image and copyright information in PMC

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