Korean J Schizophr Res.  2022 Oct;25(2):32-42. 10.16946/kjsr.2022.25.2.32.

Effects of Structured Group Acceptance and Commitment Therapy for Psychological Acceptance and Recovery Among Inpatients With Psychotic Disorder: A Pilot Study

Affiliations
  • 1Departments of Clinical Psychology, Yong-In Mental Hospital, Yongin, Korea
  • 2Departments of Psychiatry, Yong-In Mental Hospital, Yongin, Korea
  • 3WHO Collaborating Centre for Psychosocial Rehabilitation and Community Mental Health, Yongin, Korea

Abstract


Objectives
Psychosocial intervention method is very important for clinical recovery and personal recovery for psychosis. Acceptance and Commitment Therapy (ACT) is a trans-diagnostic approach that has been proven effective in the recovery for psychosis but there are few studies in South Korea testing its effects. In this paper, the structured protocol, ‘Group Acceptance and Commitment Therapy for Psychosis Recovery (G-ACTp)’ was adopted and a systematized manual was developed to investigate the effects on psychological acceptance and recovery.
Methods
17 patients receiving treatment for psychotic symptoms were randomly assigned to the treatment group and control group, respectively. The treatment group (n=9) received G-ACTp for 5 weeks in addition to the treatment as usual, and the control group (n=8) waited with only the treatment as usual, and the scores of pre assesment, post assesment, and follow-up assessment for acceptance, recovery, mindfulness, psychotic symptoms, depression, anxiety, and quality of life were all compared.
Results
As a result, there was a significant interaction effect of time and group in acceptance and recovery variables. Also, in the mindfulness variable, there was a significant trend in the time and group interaction. There were no significant effects on psychotic symptoms, depression and anxiety symptoms, and quality of life variables.
Conclusion
As a result of this study, it was mentioned that the ACT for psychosis can be widely used as an effective method in the personal recovery of psychosis, and that results can be linked to the application of mental health services in South Korea. Finally, the significance and limitations of the studies were discussed.

Keyword

Acceptance and commitment therapy; Effects; Psychosis; Recovery; Transdiagnostic approach; 범진단적 접근; 수용전념치료; 정신증; 회복; 효과

Figure

  • Fig. 1. Research procedure.


Reference

1. Corrigan PW, Reinke RR, Landsberger SA, Charate A, Toombs GA. The effects of atypical antipsychotic medications on psychosocial outcomes. Schizophr Res. 2002; 63:97–101.
2. Gorman JM. The new psychiatry. New York: St. Martin’s Press;1996.
3. Mørup MF, Kymes SM, Oudin Åström D. A modelling approach to estimate the prevalence of treatment-resistant schizophrenia in the United States. PLoS One. 2020; 15:e0234121.
4. Miner CR, Rosenthal RN, Hellerstein DJ, Muenz LR. Prediction of compliance with outpatient referral in patients with schizophrenia and psychoactive substance use disorders. Arch Gen Psychiatr. 1997; 54:706–712.
5. Bach P, Hayes SC. The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. J Consult Clin Psychol. 2002; 70:1129–1139.
6. The National Mental Health and Welfacre Commission. A social cost of the mental disorder. Ment Health Trends. 2019; 14:1–3.
7. Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993; 16:11–23.
8. Davidson L, Strauss JS. Sense of self in recovery from severe mental illness. Br J Med Psychol. 1992; 65:131–145.
9. Deegan P. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil J. 1998; 11:11–19.
10. Jacobson N. Experiencing recovery: a dimensional analysis of recovery narratives. Psychiatr Rehabil J. 2001; 24:248–256.
11. Mental health recovery: what helps and what hinders? a national research project for the development of recovery facilitating system performance indicators. a national research project for the development of recovery facilitating system performance indicators. Onken SJ, Dumont JM, Ridgway P, Doman DH, Ralph RO. National Association of State Mental Health Program Directors. Alexandria: National Technical Assistance Center;2002.
12. Ridgway P. Restorying psychiatric disability: learning from first person recovery narratives. Psychiatr Rehabil J. 2001; 24:335–343.
13. Farkas M. The vision of recovery today: what is and what it means for services. World Psychiatry. 2007; 6:68.
14. Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H. Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a meditation analysis. Lancet Psychiatry. 2015; 2:305–313.
15. Waller H, Freeman D, Jolley S, Dunn G, Garety P. Targeting reasoning biases in delusions: a pilot study of the Maudsley review training programme for individuals with persistent, high conviction delusions. J Behav Ther Exp Psychiatry. 2011; 42:414–421.
16. Gilbert P, Birchwood M, Gilbert J, Trower P, Hay J, Murray B, et al. An exploration of evolved mental mechanisms for dominant and subordinate behaviour in relation to auditory hallucinations in schizophrenia and critical thoughts in depression. Psychol Med. 2001; 31:1117–1127.
17. Chadwick P, Birchwood M. The omnipotence of voices: a cognitive approach to auditory hallucinations. Br J Psychiatr. 1994; 164:190–201.
18. O’Donogue EK, Morris EM, Oliver JE, Johns LC. ACT for psychosis recovery: a practical manual for group-based interventions using acceptance and commitment therapy. Oakland: Contextpress;2018.
19. Thomas N, Morris EM, Shawyer F, Farhall J. Acceptance and commitment therapy for voices. In : Morris EM, Johns JC, Oliver JE, editors. Acceptance and commitment therapy and mindfulness for psychosis. Chichester: Wiley-Blackwell;2013.
20. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford Press;1999.
21. Kashdan TB, Rottenberg J. Psychological flexibilit as a fundamental aspect of health. Clin Psychol Rev. 2010; 30:865–878.
22. Hayes SC, Strosahl KD. A practical guide to acceptance and commitment therapy. New York: Springer Science & Business Media;2004.
23. Taylor R, Bremner G. Adapting ACT workshop for Acute Inpatient Settings. In : O’Donoghue EK, Morris EM, Oliver JE, Johns LC, editors. ACT for psychosis recovery: a practical manual for group-based interventions using acceptance and comitment therapy. Seoul: Hakjisa;2021. p. 83–100.
24. Gaudiano BA, Herbert JD. Acute tretment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behav Res Ther. 2006; 44:415–437.
25. Tyrberg MJ, Carlbring P, Lundgren T. Brief acceptance and commitment therapy for psychotic inpatients: a randomized controlled feasibility trail in Sweden. Nord Psychol. 2017; 69:110–125.
26. Gumley A, White R, Briggs A, Ford I, Barry S, Stewart C, et al. A parallel group randomised open blinded evaluation of acceptance and commitment therapy for depression after psychosis: a pilot trial ouctomes (ADAPT). Schizophr Res. 2017; 183:143–150.
27. Gaudiano BA. Ellenberg S, Ostrove B, Johnson J, Mueser KT, Furman M, et al. Feasibility and preliminary effects of implementing acceptance and commitment therapy for inpatients with psychotic-spectrum disorders in a clinical psychiatric intensive care setting. J Cogn Psychother. 2020; 34:80–96.
28. Kim EJ, Jeong NR, Park HY, Kim JY, Jeon MJ. ACT for psychosis recovery. Seoul: Hakjisa;2021.
29. Johns LC, Oliver JE, Khondoker M, Byrne M, Jolley S, Wykes T, et al. The feasibility and acceptability of a brief acceptance and commitment therapy (ACT) group intervention for people with psychosis: the ‘Act for life’study. J Behav Ther Exp Psychiatry. 2016; 50:257–263.
30. Jeong NR, Woo JH. Systematic literature review and meta-analysis on acceptance-commitment therapy for psychotic disorder based on the perspective of recovery. J Rehabil Psychol. 2021; 28:14–62.
31. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inf lexibility and experiential avoidance. Behav Ther. 2011; 42:676–688.
32. Hur JH, Choi MS, Jin HJ. Study on the Reliability and Validity of Korean Translated Acceptance-Action Questionnaire. Korean J Counseling Psychother. 2009; 21:861–878.
33. Young SL, Bullock WA. The mental health recovery measure. Measuring the promise of recovery: a compendium of recovery measures. Cambridge: Evaluation Center;2005.
34. Song KO. Validation of the korean version of the mental health recovery measure. Ment Health Soc Work. 2010; 34:154–188.
35. Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003; 84:822–848.
36. Kwon SJ, Kim KH. Validation of the korean version of mindful attention awareness scale. Kor J Psychol: Health. 2007; 12:269–287.
37. Derogatis LR. SCL-90-R (Revised) manual I. Baltimore: Johns Hopkins University School of Medicine;1977.
38. Kim KL, Kim JH, Won HT. Korean manual of symptom checklist-90-revision. Seoul:ChungAng Aptitude Pubulishing Co;1984: p.7-11.
39. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 1983; 67:361–370.
40. Oh SE, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for koreans - a comparison of normal, depressed and anxious groups. J Kor Neuropsychiatr Assoc. 1999; 38:289–296.
41. Kook SH, Son CN. The development of happy-QOL scale for asessing the quality of life in patients with schizophrenic disorder. Kor J Clin Psychol. 2002; 21:665–691.
42. Lehman AF, Kernan E, Postrado L. Toolkit for evaluating quality of life for persons with severe mental illness: to be used in conjunction with the Lehman quality of life interview. Cambridge: Evaluation Human Services Research Institute Evaluation Center:1995.
43. Heinrichs DW, Hanlon TE, Carpenter Jr WT. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull. 1984; 10:388–398.
44. Yoon JS, Kim HJ, Lee KY, Koo SH, Jeong HY. The development of a korean modification of the scale to measure subjective well- being under neuroleptic treatment (KmSWN). J Kor Neuropsychiatr Assoc. 2000; 36:987–998.
45. Kook SH, Son CN. The validation of GHQ/QL-12 scale for assessing the quality of life in patients with schizophrenic disorder. Kor J Clin Psychol. 2000; 19:587–602.
46. Jolly S, Johns LC, O’Donogue EM, Oliver JE, Khondoker M, Byrne M, et al. Group acceptance and commitment therapy for patients and caregivers in psychosis services: feasibility of training and a prelimeinary randomized controlled evaluation. British Psychol Soc. 2020; 59:523–551.
47. Argentzell E, Backstrom M, Lund K, Eklund M. Feasibility and challenges of inpatient psychotherapy for psychosis: lessons learned from a veterans health administration pilot randomized controlled trial. BMC Research Notes. 2020; 9:376.
48. Chadwick P. Person-based cognitive therapy for distressing psychosis. Chichester: J. Wiley and Sons;2006.
49. Khoury B, Lecomte T, Gaudiano BA, Paquin K. Mindfulness interventions for psychosis: a meta-analysis. Schizophr Res. 2013; 150:176–184.
50. Strauss C, Thomas N, Hayward M. Can we respond mindfully to distressing voices? A systematic review of evidence for engagement, acceptability, effectiveness and mechanisms of change for mindfulness-based interventions for people distressed by hearing voices. Front Psychol Front Psychol. 2015; 1154:1–12.
51. Pérez-Álvarez M, García-Montes JM, VallinaFernández O. Changing relationship with voices: new therapeutic perspectives for treating hallucinations. Clin Psychol Psychother. 2008; 15:75–85.
52. White R, Gumley A, McTaggart J, Rattrie L, McConville D, Cleare S, et al. A feasibility study of acceptance and commitment therapy for emotional dysfuntion following psychosis. Behav Res Ther. 2011; 49:901–907.
53. Shawyer F, Farhall J, Mackinnon A, Trauer T, Sims E, Ratcliff K, et al. A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behav Res Ther. 2012; 50:110–121.
54. Lee JW, Ha JH. The effects of an acceptance-commitment therapy based stress management program on hospitalization stress, self-efficacy and psychological well-being of inpatients with schizo-phrenia. J Kor Acad Nurs. 2018; 48:443–453.
55. WHO. Recovery practice for mental health and well-being. WHO QualityRights Specialized Training. Course guide. Geneva: WHO;2019.
56. Kim NE, Je CU, Choi KH. Current status and future directions for community mental health services after the amended mental health welfare act in South Korea. Kor J Psychol Gen. 2020; 39:1–26.
57. Yi JS, Ahn YM, Shin HK, An SK, Joo YH, Kim SH, et al. Reliability and validity of the Korean version of the Positive and Negative Syndome Scale. J Kor Neuropsychiatr Assoc. 2001; 40:1090–1105.
58. Kim MK, Lee BK, Jeon YW. Reliability of Korean Brief Psychiatric Rating Scale (BPRS)-comparison of interrater reliability between the two rating methods and correlation of BPRS and SCL-90 self-report test-. Kor J Clin Psychol. 2003; 22:685–698.
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