1
|
O'Brien-Venus B, Ellett L, Burgess-Barr S, Chadwick P. Systematic review of the safety of mindfulness-based interventions for psychosis. Clin Psychol Rev 2024; 112:102445. [PMID: 38851179 DOI: 10.1016/j.cpr.2024.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Harmful outcomes of psychological interventions are under-researched, including in mindfulness-based interventions (MBI) for psychosis. This systematic review summarizes reporting and prevalence of 8 harm indices (death, adverse events, hospitalisation, study drop out, noncompletion of therapy, side effects of therapy, symptom deterioration and crisis service use) in Randomised Controlled Trials (RCTs) of MBIs for psychosis. Meta-analyses of risk differences were also calculated for each harm index. The review included 39 studies, with a total n of 2684 participants across studies. The percentage of studies reporting on each index of harm, and the prevalence of harm, varied greatly across each index. 0% of studies reported on side effects of interventions compared to 92% of studies reporting on study dropout. Meta-analyses of risk differences (RD) found a higher risk of hospitalisation (RD (95% CI) = -0.136 (-0.23 to -0.05), p = 0.003) and crisis service use (RD (95% CI) = -0.160 (-0.299, -0.024), p = 0.02) in control arms compared to intervention arms, and no significant difference in adverse events, death, symptom deterioration, noncompletion of therapy, drop out and side effects of therapy. Overall, reporting of harm was inconsistent across studies and the quality of data collection and reporting varied. MBIs for psychosis appear to be safe and may reduce the risk of hospitalisation and use of crisis services. However, the absence of thorough reporting on harm precludes a balanced analysis of benefits versus harms. Future research into the effectiveness of MBIs should consistently operationalise, monitor and report data on harm.
Collapse
Affiliation(s)
- Bethany O'Brien-Venus
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
| | - Lyn Ellett
- School of Psychology, Building 44, Highfield Campus, University of Southampton, SO17 1BJ, United Kingdom.
| | - Susanna Burgess-Barr
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
| | - Paul Chadwick
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, United Kingdom.
| |
Collapse
|
2
|
Özer D, Dişsiz M. The effect of online group based acceptance and commitment therapy on psychotic symptoms and functioning levels of individuals with early psychosis. Schizophr Res 2024; 267:55-64. [PMID: 38518479 DOI: 10.1016/j.schres.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/24/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study examined the effect of online group-based Acceptance and Commitment Therapy (ACT) applied to individuals with early psychosis on psychotic symptoms and functionality levels. METHODS This randomized controlled study population consisted of 77 individuals who had been diagnosed with schizophrenia and other psychotic disorders according to DSM-5 diagnostic criteria at most three years ago. The study sample consisted of 53 individuals who met the inclusion criteria and were assigned to the intervention (n = 26) and control (n = 27) groups by simple randomization method. The intervention group received an eight-session ACT program as online group therapy, while the control group received no application made by the researchers. Data were obtained using the "Positive and Negative Syndrome Scale (PANSS)" and the "Social Functioning Assessment Scale (SFAS)" at pre-test, post-test and 3-month follow-up. RESULTS While it was found that the post-test and 3-month follow-up test PANSS mean scores of the individuals in the intervention group were lower than the mean score of the individuals in the control group; it was determined that the mean score of SFAS was higher than the mean score of the individuals in the control group (p < 0.05). In addition, while no hospitalization was observed in the intervention group during the follow-up period, 14.8 % (n = 4) of the individuals in the control group were hospitalized. DISCUSSION It was found that online group-based ACT applied to individuals with early psychosis reduced psychotic symptoms and increased their functionality levels. It was also found that hospitalizations were less in the intervention group. CLINICALTRIALS gov ID: NCT05210816.
Collapse
Affiliation(s)
- Duygu Özer
- Bartın University, Faculty of Health Sciences, Department of Nursing, Bartın, Turkey.
| | - Melike Dişsiz
- University of Health Sciences, Hamidiye Nursing Faculty, Istanbul, Turkey
| |
Collapse
|
3
|
Scholte-Stalenhoef AN, Boyette LL, Begemann M, Schirmbeck F, Hasson-Ohayon I, Cahn W, de Haan L, Pijnenborg GHM. Response to psychotic experiences: Impact of personality traits on perceived levels of distress. Schizophr Res 2024; 267:282-290. [PMID: 38583258 DOI: 10.1016/j.schres.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND This study examined the influence of personality traits on (subclinical) positive symptom distress in patients with a psychotic disorder, their unaffected siblings and healthy controls. METHODS Data were obtained from the Genetic Risk and Outcome of Psychosis study (GROUP), a Dutch longitudinal multicenter cohort study. Data from 140 patients, 216 unaffected siblings and 102 healthy controls was available for baseline levels of Five Factor Model personality traits and frequency and distress due to psychotic experiences three years later, assessed with the Community Assessment of Psychic Experience questionnaire. Main effects of all five personality traits on symptom distress were investigated as well as moderating effects of Neuroticism, Extraversion and Openness on positive symptom frequency and positive symptom distress. Age, gender, symptom frequency and IQ were controlled for. RESULTS In both patients and siblings, the observed main effects of Neuroticism and Openness on (subclinical) positive symptom distress three years later either lost significance or had a very small effect size when controlling for covariates, mainly due to the correction for the effect of positive symptoms on personality traits at baseline. In both groups, levels of Openness at baseline moderated the association between positive symptom frequency and positive symptom distress three years later, in the direction that higher levels of Openness were associated with weaker associations between positive symptom frequency and - distress, even when covariates were controlled for. DISCUSSION The level of Openness to Experiences influences the perceived distress from (subclinical) positive symptoms in both patients and siblings.
Collapse
Affiliation(s)
- Anne Neeltje Scholte-Stalenhoef
- Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands; University of Groningen, Groningen, the Netherlands.
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Marieke Begemann
- Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands; University of Groningen, Groningen, the Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands; Altrecht Science, Altrecht Mental Health Institute, Utrecht, Utrecht, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical and Neurodevelopmental Neuropsychology, the Netherlands; Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
| |
Collapse
|
4
|
Qin K, Yu Y, Cai H, Li J, Zeng J, Liang H. Effectiveness of mindfulness-based intervention in schizophrenia: A meta-analysis of randomized controlled trials. Psychiatry Res 2024; 334:115808. [PMID: 38402743 DOI: 10.1016/j.psychres.2024.115808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Schizophrenia poses significant societal challenges, including interpersonal tension, an increased risk of suicide, and soaring medical costs. Although antipsychotics can prevent relapses, they often give rise to adverse effects and do not provide lasting relief. Mindfulness-based interventions (MBI) emerge as a hopeful avenue for improving outcomes. However, existing research and meta-analyses of the efficacy of MBI in schizophrenia remain limited. This study aimed to evaluate the efficacy of MBI as an adjunctive therapy for schizophrenia. Relevant randomized controlled trials (RCTs) were searched across PubMed, Embase, Web of Science, and Cochrane Library from inception dates up to January 12, 2023. Statistical analyses were conducted using Stata software (version 15.0) and Review Manager 5.4. The quality of the included RCTs was assessed using the revised Cochrane risk of bias tool. A total of 18 RCTs were included, with 675 patients and 704 health controls. Our meta-analysis revealed that MBI significantly improved psychosocial function, insight, and mindfulness in individuals with schizophrenia. The quality of the included RCTs had a low to moderate risk of bias. These findings suggest that MBI holds promise for improving the mental health of individuals with schizophrenia.
Collapse
Affiliation(s)
- Keke Qin
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Yong Yu
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China.
| | - Huiling Cai
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jiahong Li
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jingyuan Zeng
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Huolan Liang
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| |
Collapse
|
5
|
Morris EMJ, Johns LC, Gaudiano BA. Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions. Psychol Psychother 2024; 97:41-58. [PMID: 37357973 DOI: 10.1111/papt.12479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well-being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. METHODS We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness-informed interventions for psychosis. RESULTS Acceptance and commitment therapy for psychosis is promising as a pragmatic, process-driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology-assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. CONCLUSIONS Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence-based interventions for psychosis.
Collapse
Affiliation(s)
- Eric M J Morris
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
- Northern Health, Melbourne, Victoria, Australia
| | - Louise C Johns
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Brandon A Gaudiano
- Department of Psychiatry & Human Behavior, Brown University & Butler Hospital, Providence, Rhode Island, USA
| |
Collapse
|
6
|
Paetzold I, Schick A, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Boehnke JR, Boecking B, Reininghaus U. Exploring putative therapeutic mechanisms of change in a hybrid compassion-focused, ecological momentary intervention: Findings from the EMIcompass trial. Behav Res Ther 2023; 168:104367. [PMID: 37467549 DOI: 10.1016/j.brat.2023.104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/07/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
Compassion-focused interventions represent a promising transdiagnostic approach, but the mechanisms involved in hybrid delivery combining face-to-face sessions and an ecological momentary intervention remain unexplored. The current study aimed at exploring associations of putative mechanisms with clinical outcomes at post-intervention/follow-up and mediation of outcome at follow-up by preceding pre-to post-intervention changes in putative mechanisms. The compassion-focused EMIcompass intervention was applied in an exploratory randomized controlled trial (treatment as usual (TAU) vs. TAU + EMIcompass) with youth with early mental health problems. Data was collected before randomization, at post-intervention and at four-week follow-up. We recruited N = 92 participants, N = 46 were allocated to the experimental condition. After control for baseline levels of the target outcomes, baseline-to post-intervention improvement in adaptive emotion regulation was associated with lower levels of clinical outcomes (e.g. psychological distress b = -1.15; 95%CI = -1.92 to -0.39) across time points. We could not detect indirect effects, but we observed associations of change in self-compassion and adaptive emotion regulation with outcomes at follow-up in the mediation analysis (e.g., β = -0.35, 95%CI = -0.52 to -0.16). If successfully targeted by interventions, self-compassion and emotion regulation may be promising putative therapeutic mechanisms of change.
Collapse
Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Dusan Hirjak
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan R Boehnke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; School of Health Sciences, University of Dundee, Dundee, UK
| | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| |
Collapse
|
7
|
Shi JY, Cao YM, Luo HY, Liu S, Yang FM, Wang ZH. Effect of a group-based acceptance and commitment therapy (ACT) intervention on self-esteem and psychological flexibility in patients with schizophrenia in remission. Schizophr Res 2023; 255:213-221. [PMID: 37012184 DOI: 10.1016/j.schres.2023.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/26/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023]
Abstract
The present study explored whether acceptance and commitment therapy (ACT), a cognitive behavioral therapy approach, could improve the symptoms of schizophrenia spectrum disorders among patients with schizophrenia in remission. A pre- and post-treatment design with two evaluation time points was employed. Sixty outpatients with schizophrenia in remission were randomly divided into two groups: the ACT plus treatment as usual (ACT+TAU) and treatment as usual (TAU) groups. The ACT+TAU group participated in 10 group-based ACT interventions and TAU in the hospital, and the TAU group only received TAU interventions. General psycho-pathological symptoms, self-esteem, and psychological flexibility were assessed before intervention (baseline; pre-test) and after intervention (five weeks; post-test). Results indicated that, compared to the TAU group, the ACT+TAU group exhibited a more significant improvement in general psychopathological symptoms, self-esteem, cognitive fusion, and acceptance and action at post-test. ACT intervention could effectively decrease the general psycho-pathological symptoms and increase self-esteem level and psychological flexibility in people with schizophrenia in remission.
Collapse
Affiliation(s)
- Jun-Yan Shi
- School of Psychology, Shaanxi Normal University, Shaanxi Provincial Key Research Center of Child Mental and Behavioral Health, Xi'an, People's Republic of China; Department of Medical Psychology, Mental Health Hospital affiliated to Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Yan-Mei Cao
- School of Humanalities and Social Science, Shanxi Medical University, Taiyuan, People's Republic of China
| | | | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Fa-Ming Yang
- Shanxi Acupuncture and Moxibustion Hospital, Taiyuan, People's Republic of China
| | - Zhen-Hong Wang
- School of Psychology, Shaanxi Normal University, Shaanxi Provincial Key Research Center of Child Mental and Behavioral Health, Xi'an, People's Republic of China.
| |
Collapse
|
8
|
Pahnke J, Jansson-Fröjmark M, Andersson G, Bjureberg J, Jokinen J, Bohman B, Lundgren T. Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221140749. [PMID: 36510817 DOI: 10.1177/13623613221140749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Autistic adults are often stressed and feel depressed or anxious. However, mental health programs that are suited for autistic adults are few. Acceptance and commitment therapy is a psychotherapy method that seems to help people feel better, although not thoroughly evaluated in autistic individuals. In this study, 20 autistic adults had 14 weeks of acceptance and commitment therapy group treatment suited for autism (NeuroACT), while 19 autistic adults had ordinary care. The acceptance and commitment therapy group treatment program seemed logical and reasonable to the participants. Also, when comparing the participants in the NeuroACT group with those in the ordinary care group, the NeuroACT participants reported less stress and higher quality of life. Compared to the ordinary care group, they could also manage distressing thoughts better, perceived themselves as more flexible, and did not avoid stressful situations as much as before. However, there was no significant difference between the groups in depression, anxiety, sleep problems, social aspects of autism, everyday functioning, or executive challenges. Slightly more NeuroACT participants did not finish the treatment than ordinary care participants. In conclusion, the NeuroACT program may be a treatment for autistic adults who feel stressed and have reduced quality of life. More studies are needed to see how helpful the NeuroACT program is for autistic adults.
Collapse
Affiliation(s)
- Johan Pahnke
- Karolinska Institutet and Region Stockholm, Sweden
| | | | - Gerhard Andersson
- Karolinska Institutet and Region Stockholm, Sweden.,Linköping University, Sweden
| | - Johan Bjureberg
- Karolinska Institutet and Region Stockholm, Sweden.,Stanford University, USA
| | | | | | | |
Collapse
|
9
|
Bighelli I, Wallis S, Reitmeir C, Schwermann F, Salahuddin NH, Leucht S. Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01526-1. [PMID: 36477405 DOI: 10.1007/s00406-022-01526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD = - 0.37, 95% CI - 0.49 to - 0.25), cognitive behavioral therapy (30 RCTs, SMD = - 0.26, 95% CI - 0.39 to - 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD = - 0.60, 95% CI - 0.83 to - 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI - 0.38 to 0.39), integrated therapies (4 RCTs, SMD = - 0.21, 95% CI - 1.20 to 0.78) and other therapies (4 RCTs, SMD = - 0.74, 95% CI - 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.
Collapse
Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Felicitas Schwermann
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Nurul Husna Salahuddin
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| |
Collapse
|
10
|
Yip ALK, Karatzias T, Chien WT. Mindfulness-based interventions for non-affective psychosis: a comprehensive systematic review and meta-analysis. Ann Med 2022; 54:2340-2353. [PMID: 36004784 PMCID: PMC9423825 DOI: 10.1080/07853890.2022.2108551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AIM Although mindfulness-based interventions (MBIs) are routinely used in clinical practice, a comprehensive synthesis of the effectiveness of MBIs for non-affective psychosis has yet to be conducted. The aim of the present review and meta-analysis was to investigate the effectiveness of MBIs including those with mindfulness as an active treatment component for alleviating symptoms of psychosis to inform future clinical practice. METHODS A systematic review of studies published in journals or in dissertations in CINAHL, PubMed, EMBASE, PsycINFO, CENTRAL, ISRCTN, or CNKI from January 1990 until December 2020. A total of 31 eligible studies (n = 2146) were included. RESULTS Effect-size estimates suggested that 22 independent samples (n = 1632) produced a statistically significant small effect for psychotic symptoms (g = -0.48), and with a clinically significant reduction of 50% from baseline (pooled OR: 1.84). Separate meta-analyses demonstrated small effects for affective symptoms (g = -0.44) and small-to-large positive effects for quality of life (g = 0.38), mindfulness skills (g = 0.45), and insight into illness/treatment (g = 1.35). The heterogeneity was high across the studies. CONCLUSION Results suggest that short-term MBIs can be beneficial for non-affective psychosis. Future research is needed to test the efficacy and safety of dedicated MBIs for this population group over a longer term. KEY MESSAGESSchizophrenia spectrum and other psychotic disorders, also known as non-affective psychosis, is the most chronic and debilitating type of psychosis, seriously affecting every aspect of a person's life, including social, occupational, or general functioning.The aim of the current systematic review and meta-analysis was to investigate formerly unexamined questions regarding the clinical significance of MBIs including yoga as an increasingly utilized, conceptualized psychological intervention on overall psychotic symptoms for people with non-affective psychosis.No serious adverse events were reported in the studies, suggesting that MBIs may be safe interventions, while there is robust evidence to support the view that MBIs are beneficial to young people in particular.
Collapse
Affiliation(s)
- Annie Lai King Yip
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Wai Tong Chien
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| |
Collapse
|
11
|
Perceived ostracism and paranoia: A test of potential moderating effects of psychological flexibility and inflexibility. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
12
|
Effectiveness of Acceptance and Commitment Therapy on the Positive and Negative Symptoms and Emotion Regulation of Patients with Schizophrenia Spectrum Disorders: A Single-case Clinical Trial Study. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2022. [DOI: 10.5812/ijpbs-127419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: The literature suggests the increasing application of acceptance and commitment therapy (ACT) for people with schizophrenia spectrum disorders (SSD). Objectives: This study aimed to determine the effectiveness of ACT on the positive and negative symptoms and emotion regulation of patients with SSD. Methods: The experimental design of the current study was an AB (baseline and intervention phases) along with the follow-up phase, in addition to Treatment-As-Usual (TAU), ACT sessions were held for the participants. Among the 20 participants who had inclusion criteria to the study, five participant (three men and two women in the age range of 32 - 43 years) were randomly allocated to participate in the intervention through drawing and evaluated using the Positive and Negative Syndrome Scale (PANSS) and Difficulties in Emotion Regulation Scale (DERS) in three phases of baseline, intervention, and follow-up. For data analysis, non-overlapping indices and Cohen's d effect size were measured, and visual diagrams were plotted for interpretation. Results: The present results showed that the effect sizes of psychotic symptoms in the first to fifth participants were 1.7, 1.9, 0.6, 4, and 1.4, respectively in the intervention phase relative to the baseline; the effect size was only large for the fourth participant. Also, the effect sizes of emotion regulation in the first to fifth participants were 0.8, 1.6, 1.5, 1.2, and 2.7, respectively; the effect size was only large for the fifth participant. Conclusions: The results of data analysis showed that ACT is effective in reducing psychotic symptoms and improving emotion regulation. The effect size of ACT was the largest for the fourth participant; medium for the first, second, and fifth participants; and small for the third participant.
Collapse
|
13
|
Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Khubchandani J. The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran. Int J Soc Psychiatry 2022; 69:587-601. [PMID: 36200283 DOI: 10.1177/00207640221124438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran. AIMS To determine an ideal model for a community-based RPIs for PLS. METHODS A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions. RESULTS In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI. CONCLUSIONS Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.
Collapse
Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
| |
Collapse
|
14
|
Larsson C, Fatouros-Bergman H, Isaksson A, Johansson M, Kaldo V, Parling T, Lundgren T. Acceptance and Commitment Therapy for inpatients with psychosis –an acceptability and feasibility single case AB designed study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Ali A, Mckenzie E, Rasoul Z, Hassiotis A, Priebe S, Lloyd-Evans B, Jones R, Panca M, Omar R, Finning S, Moore S, Roe C, King M. One-to-one volunteer befriending to reduce symptoms of depression in people with intellectual disability: a feasibility RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Little is known about the effectiveness of befriending for people with intellectual disability and whether or not befriending improves depressive symptoms and social outcomes.
Objective
This pilot trial aimed to assess the feasibility and acceptability of conducting a future full-scale randomised controlled trial of one-to-one befriending for people with intellectual disability who had depressive symptoms.
Design
This was a parallel-group, two-armed randomised controlled trial incorporating an exploratory economic analysis and a mixed-methods process evaluation. Outcome assessments were conducted at baseline and at 6 months post randomisation by a research assistant who was blind to allocation. We aimed to approach 50 participants, with a view to recruiting 40.
Setting
Participants with intellectual disability were recruited from one NHS trust and from referrals to two community befriending services. The intervention was delivered by community befriending services.
Participants
Adults with mild or moderate intellectual disability with a score on the Glasgow Depression Scale for people with a Learning Disability of ≥ 5 were included. Those attending a day service/college for ≥ 3 days a week were excluded. Volunteers were aged ≥ 18 years and had no history of prior convictions.
Intervention
Participants in the intervention group were matched with a volunteer befriender and were expected to meet once per week for 1 hour, over 6 months. Volunteers recorded activities in a logbook. Volunteers received training and regular supervision. Both groups received usual care and a resource booklet of local activities.
Main outcome measures
The feasibility outcomes and progression criteria were recruitment of at least 70% of participants approached; matching of at least 70% of participants in the intervention group to a volunteer; a dropout rate of < 30% of participants and volunteers; adherence to the intervention (10 meetings between pairs); acceptability of the intervention; and feasibility of collecting data on costs and resource use for an economic evaluation. Changes in depressive symptoms (primary clinical outcome: Glasgow Depression Scale) and self-esteem, quality of life, social participation, social support, health-related quality of life and service use were recorded at 6 months. Outcomes in volunteers were also assessed.
Results
We recruited only 16 participants with intellectual disability (40% of target) and 10 volunteers. Six of the eight (75%) participants in the intervention group were matched with a befriender and there was good adherence (mean number of meetings attended 11.8; range 1–21 meetings). Going to a cafe/restaurant and having a conversation were the most frequent activities. All participants were retained at follow-up, but two volunteers dropped out. Trial procedures and the intervention might be acceptable, but modifications were suggested. Data on costs and resource use were obtained, but there were discrepancies in the health-related quality-of-life data.
Limitations
Delays to the study prevented the use of alternative recruitment strategies and the planned 12-month follow-up could not be completed.
Conclusions
Recruitment was not feasible, but other feasibility outcomes were more positive.
Future work
Evaluating befriending for people with intellectual disability could be explored through alternative study designs, such as observational studies.
Trial registration
Current Controlled Trials ISRCTN63779614.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Afia Ali
- Division of Psychiatry, University College London, London, UK
| | - Emma Mckenzie
- Research and Development Office, Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Zara Rasoul
- Division of Psychiatry, University College London, London, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | | | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Monica Panca
- Priment Clinical Trials Unit, University College London, London, UK
| | - Rumana Omar
- UK Department of Statistical Science, University College London, London, UK
| | | | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| |
Collapse
|
16
|
Rauschenberg C, Boecking B, Paetzold I, Schruers K, Schick A, van Amelsvoort T, Reininghaus U. A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study. JMIR Ment Health 2021; 8:e25650. [PMID: 34383687 PMCID: PMC8380580 DOI: 10.2196/25650] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. OBJECTIVE This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). METHODS In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). RESULTS In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). CONCLUSIONS Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy.
Collapse
Affiliation(s)
- Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Mondriaan Mental Health Center, Maastricht, Netherlands
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Mondriaan Mental Health Center, Maastricht, Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
17
|
West ML, Guest RM, Carmel A. Comorbid early psychosis and borderline personality disorder: Conceptualizing clinical overlap, etiology, and treatment. Personal Ment Health 2021; 15:208-222. [PMID: 33955194 DOI: 10.1002/pmh.1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Despite substantial efforts aimed at the detection and intervention for early symptoms of mental illness, there is relatively limited research on the clinical overlap between borderline personality disorder (BPD) and early psychosis, for example, clinical high risk (CHR) for psychosis, in young people. We present a narrative review of the clinical overlap between BPD and psychosis spectrum symptoms. Both conditions have unstable temporal course, and both are marked by functional impairment, increased suicide risk, and higher rates of psychiatric inpatient services. We then review evidence-based treatments for psychosis and BPD, emphasizing treatments for early presentations of these symptoms and initial research considering treatments for the overlap. Psychotherapies with the strongest empirical support include cognitive behavioral models, with BPD showing limited response to adjunctive pharmacotherapy. We end by discussing specific recommendations for future research, including longitudinal studies to determine the predictors of the course of illness and the development of treatments to target comorbid BPD and CHR symptoms.
Collapse
Affiliation(s)
- Michelle L West
- CEDAR Clinic and Research Program, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, University of Colorado School of Medicine (CUSOM), Aurora, Colorado, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| |
Collapse
|
18
|
Juul S, Gluud C, Simonsen S, Frandsen FW, Kirsch I, Jakobsen JC. Blinding in randomised clinical trials of psychological interventions: a retrospective study of published trial reports. BMJ Evid Based Med 2021; 26:109. [PMID: 32998993 DOI: 10.1136/bmjebm-2020-111407] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To study the extent of blinding in randomised clinical trials of psychological interventions and the interpretative considerations if randomised clinical trials are not blinded. DESIGN Retrospective study of trial reports published in six high impact factor journals within the field of psychiatry in 2017 and 2018. SETTING Trial reports published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics. MAIN OUTCOME MEASURES Blinding status of participants, treatment providers, outcome assessors, data managers, the data safety and monitoring committee, statisticians and conclusion makers, if trialists rejected the null hypothesis on the primary outcome measure, and if trialists discussed the potential bias risk from lack of blinding in the published trial report. RESULTS 63 randomised clinical trials of psychological interventions were identified. None (0%; 95% CI 0% to 5.75%) of the trials reported blinding of all possible key persons. 37 (58.7%; 95% CI 46.42% to 70.04%) trials reported blinding of outcome assessors. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of participants. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of data managers. Three (4.8%; 95% CI 1.63% to 13.09%) trials reported blinding of statisticians. None of the trials reported blinding of treatment providers, the data safety and monitoring committee, and conclusion makers. 45 (71.4%; 95% CI 59.30% to 81.10%) trials rejected the null hypothesis on the primary outcome(s). 13 (20.7%; 95% CI 12.48% to 32.17%) trials discussed the potential bias risk from lack of blinding in the published trial report. CONCLUSIONS Blinding of key persons involved in randomised clinical trials of psychological interventions is rarely sufficiently documented. The possible interpretative limitations are only rarely considered. There is a need of randomised clinical trials of psychological interventions with documented blinding attempts of all possible key persons.
Collapse
Affiliation(s)
- Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Frederik Weischer Frandsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, Boston, Massachusetts, USA
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
A Randomised Comparison of Values and Goals, Versus Goals Only and Control, for High Nonclinical Paranoia. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10226-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Paranoia is common in the general population. Focusing on values and enhancing value-based acts may attenuate it. This study compared three brief (30-min, self-directed) online conditions: focusing on values and value-based goal setting (n = 30), goal setting only (n = 32) and non-values/goals control (n = 32) in a high paranoia sample.
Methods
Participants were randomly assigned to condition. State paranoia (primary outcome) and positive and negative self-views following a difficult interpersonal experience (secondary outcome) were assessed at baseline and two-weeks.
Results
Intention-to-treat: state paranoia was significantly lower following the values condition as compared to non-values/goals control (ηp2 = .148) and goals only (ηp2 = .072). Only the former comparison was significant. Per-protocol: groups did not significantly differ (p = .077). Within-group effect sizes: values and value-based goal setting (intention-to-treat d = .82, per-protocol d = .78), goals only (intention-to-treat d = .41, per-protocol d = .42) non-values/goals control (intention-to-treat d = .25, per-protocol d = .24). Positive self-views increased in all conditions. The increase was largest for the values condition, but not significantly so.
Limitations
Reliance on self-report, brief follow-up, predominantly White female sample.
Conclusions
The values condition was most effective at reducing non-clinical paranoia. The values condition appeared to increase positive self-views more so than comparison groups, but the sample was small and the difference was non-significant.
Collapse
|
20
|
O Donnell R, Savaglio M, Vicary D, Skouteris H. Effect of community mental health care programs in Australia: a systematic review. Aust J Prim Health 2020; 26:443-451. [PMID: 33038938 DOI: 10.1071/py20147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.
Collapse
Affiliation(s)
- Renee O Donnell
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia
| | - Dave Vicary
- Baptcare, Level 1/1193 Toorak Road, Camberwell, Vic. 3124, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia; and Warwick Business School, University of Warwick, Scarman Road, Coventry CV4 7AL, UK; and Corresponding author.
| |
Collapse
|
21
|
Brown E, Shrestha M, Gray R. The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 43:324-336. [PMID: 32756808 PMCID: PMC8136399 DOI: 10.1590/1516-4446-2020-0948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology. RESULTS The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge's G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials. CONCLUSIONS Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology. SYSTEMATIC REVIEW REGISTRATION CRD42018097200.
Collapse
Affiliation(s)
- Ellie Brown
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre (IMPACT SRC), Deakin University, Geelong, VIC, Australia
| | - Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| |
Collapse
|
22
|
Millar A, Tip L, Lennon R, Macinnes M, Michalska B, Lawrie SM, Schwannauer M. The introduction of mindfulness groups to a psychiatric rehabilitation in-patient setting: a feasibility study. BMC Psychiatry 2020; 20:322. [PMID: 32563244 PMCID: PMC7305618 DOI: 10.1186/s12888-020-02725-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as 'treatment resistant'. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated. METHODS Mindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over 5 months, and weekly in a second ward over an 18 month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention. RESULTS In both wards around two thirds (65, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards. CONCLUSIONS Clinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.
Collapse
Affiliation(s)
- Audrey Millar
- Rehabilitation service, Royal Edinburgh Hospital, Edinburgh, UK. .,University of Edinburgh, Edinburgh, UK.
| | - Liesbeth Tip
- grid.4305.20000 0004 1936 7988University of Edinburgh, Edinburgh, UK
| | - Ruth Lennon
- grid.416119.a0000 0000 9845 9303Rehabilitation service, Royal Edinburgh Hospital, Edinburgh, UK
| | - Marlene Macinnes
- grid.416119.a0000 0000 9845 9303Rehabilitation service, Royal Edinburgh Hospital, Edinburgh, UK
| | - Beata Michalska
- grid.416119.a0000 0000 9845 9303Rehabilitation service, Royal Edinburgh Hospital, Edinburgh, UK
| | - Stephen M Lawrie
- grid.4305.20000 0004 1936 7988University of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
23
|
Gaudiano BA, Ellenberg S, Ostrove B, Johnson J, Mueser KT, Furman M, Miller IW. 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. [DOI: 10.1891/0889-8391.34.1.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to adapt Acceptance and Commitment Therapy for Inpatients (ACT-IN) for implementation in a typical hospital setting to prepare for a larger clinical trial. The sample consisted of 26 inpatients diagnosed with psychotic-spectrum disorders. Using an open trial design, patients received individual and group ACT-IN sessions during their stay. We assessed the feasibility/acceptability of ACT-IN and preliminary changes on patient outcomes at baseline, discharge, and 4-month follow-up. We successfully recruited and retained participants as planned. Patients reported satisfaction with treatment, and routine hospital staff showed adoption and fidelity to the intervention. Relative to baseline, patients demonstrated significant improvements in symptoms and functioning across the 4-month follow-up. The current study shows that ACT-IN may be feasible and acceptable for inpatients with psychotic disorders in a psychiatric intensive care setting and should be tested in a future effectiveness-implementation trial.
Collapse
|
24
|
Jansen JE, Gleeson J, Bendall S, Rice S, Alvarez-Jimenez M. Acceptance- and mindfulness-based interventions for persons with psychosis: A systematic review and meta-analysis. Schizophr Res 2020; 215:25-37. [PMID: 31780349 DOI: 10.1016/j.schres.2019.11.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acceptance- and mindfulness-based approaches have gained popularity in recent years. OBJECTIVE A systematic review and meta-analysis of the efficacy and safety of acceptance- and mindfulness-based therapies for persons with a psychotic or schizophrenia spectrum disorder. METHODS Following PRISMA guidelines, relevant databases were searched for published randomized controlled trials (RCTs) up to October 2018. Outcomes were severity of overall symptomatology, hospitalization, positive and negative symptoms, depression, anxiety, social functioning, quality of life, acceptance, mindfulness skills and safety of the interventions. RESULTS Sixteen studies comprising 1268 people with a schizophrenia spectrum disorder were included in the meta-analyses. Moderate to large effect sizes were found for overall symptomatology and hospitalization at endpoint (SMD .80, 95% CI -1.31, -0.29 and MD 4.38, -5.58, -3.17 respectively) and follow-up (SMD 1.10, -2.09, -0.10 and MD 7.18, -8.67, - 5.68 respectively). There were significant small effects on negative symptoms (SMD .24; -0.44, -0.03), small to moderate effects for depression (SMD .47; -0.80, -0.14), social functioning (SMD .43; -0.75, - 0.12) and mindfulness (SMD .51; -0.97, -0.05), moderate to large effects for acceptance (SMD .78; -1.44, -0.12), while no significant effects for positive symptoms (SMD .27; -0.65, 0.00), anxiety (SMD 2.11; -4.64, 0.42) or quality of life (SMD .43; -0.88, 0.02). Majority of studies (75%) had low risk of bias and sensitivity analyses supported the findings. CONCLUSION Acceptance- and mindfulness-based approaches appear to be effective and safe interventions for individuals with schizophrenia spectrum disorders and could be a useful extension of standard casemanagement and psychofarmacology.
Collapse
Affiliation(s)
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| |
Collapse
|
25
|
Yıldız E. The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials. Perspect Psychiatr Care 2020; 56:149-167. [PMID: 31074039 DOI: 10.1111/ppc.12396] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/31/2019] [Accepted: 04/24/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To identify, evaluate, and synthesize existing randomized controlled trials (RCTs) that examine the effect of acceptance and commitment therapy (ACT) in the treatment of psychotic disorders and to integrate this knowledge and experience into the nursing literature. DESIGN AND METHODS This systematic review is based on the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS This study was completed with 11 RCTs meeting the research criteria. It has been determined that the vast majority (82%) of the assessed studies were published after 2010. There is evidence that ACT is effective on depression, anxiety, and hallucinations seen in psychotic disorders. PRACTICE IMPLICATIONS ACT is seen as a reasonable approach to be used and tested by nurses and other clinicians because it provides an explanatory and pragmatic approach to psychotic disorders.
Collapse
Affiliation(s)
- Erman Yıldız
- Department of Psychiatric Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| |
Collapse
|
26
|
Reininghaus U, Klippel A, Steinhart H, Vaessen T, van Nierop M, Viechtbauer W, Batink T, Kasanova Z, van Aubel E, van Winkel R, Marcelis M, van Amelsvoort T, van der Gaag M, de Haan L, Myin-Germeys I. Efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL) in early psychosis: study protocol for a multi-centre randomized controlled trial. Trials 2019; 20:769. [PMID: 31878966 PMCID: PMC6933690 DOI: 10.1186/s13063-019-3912-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background Psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP. Methods/design In a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed. Discussion The current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services. Trial registration Netherlands Trial Register, ID: NTR4252. Registered on 26 September 2013.
Collapse
Affiliation(s)
- Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. .,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Annelie Klippel
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Henrietta Steinhart
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, University of Amstderdam, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| |
Collapse
|
27
|
Evans N, Ellett L, Carpenter R, Kingston J. Immediate and short term effects of values-based interventions on paranoia. J Behav Ther Exp Psychiatry 2019; 65:101500. [PMID: 31394412 DOI: 10.1016/j.jbtep.2019.101500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/06/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Paranoia is a common, distressing, and persistent experience that can negatively impact on health, wellbeing, and functioning. This study examined the immediate and short term (2-weeks) effects of two values-based interventions, versus a non-values control, on paranoia, as well as the moderating effect of self-esteem. METHODS 171 non-clinical adults were randomised to a value-affirmation and goals task (VAG: clarifying and reflecting on core values and setting value-based goals) (n = 57), a value-affirmation task (VA: clarifying and reflecting on core values without setting value-based goals) (n = 57), or a non-affirmation control task (NAC) (n = 57). Paranoia was assessed at baseline (T1), post-intervention (T2), and two weeks post-intervention (T3). Self-esteem was measured at baseline. RESULTS VAG participants had significantly lower state paranoia scores at T3 than VA (d = .34) and NAC (d = .31) participants. This effect was moderated by trait self-esteem: At follow-up, the differential effect of condition on state paranoia was greatest amongst those with low self-esteem, with the VAG condition being most beneficial for participants with low self-esteem and the VA condition being least beneficial. LIMITATIONS Without a goals only control group it is possible that the benefits of VAG over VA were attributable to setting and achieving goals. Use of a nonclinical sample limits generalisability to clinical groups. CONCLUSIONS The findings suggest that focusing on a deeply held value and setting goals in line with that value reduced paranoia. This intervention may be most beneficial for individuals with low self-esteem.
Collapse
Affiliation(s)
- Nicole Evans
- Royal Holloway, University of London, Egham Hill, Egham, TW10 0EX, Surrey, UK
| | - Lyn Ellett
- Royal Holloway, University of London, Egham Hill, Egham, TW10 0EX, Surrey, UK
| | - Rebecca Carpenter
- Royal Holloway, University of London, Egham Hill, Egham, TW10 0EX, Surrey, UK
| | - Jessica Kingston
- Royal Holloway, University of London, Egham Hill, Egham, TW10 0EX, Surrey, UK.
| |
Collapse
|
28
|
The Phenomenon of Treatment Dropout, Reasons and Moderators in Acceptance and Commitment Therapy and Other Active Treatments: A Meta-Analytic Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i3.33058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes. This meta-analysis reviewed and systematically examined dropout effects of Acceptance and Commitment Therapy (ACT) as compared to other active treatments. The goals of this study were to compare treatment dropout rates and dropout reasons, examine the influence of demographic variables and identify possible therapy moderators associated with dropout.
The current meta-analysis reviewed 76 studies of ACT reporting dropout rates for various psychological and health-related conditions.
Across reviewed studies (N = 76), the overall weighted mean dropout rate was 17.95% (ACT = 17.35% vs. comparison conditions = 18.62%). Type of disorder, recruitment setting and therapists’ experience level were significant moderators of dropout. The most frequently reported reasons for dropout from ACT were lost contact, personal and transportation difficulties, whereas for comparative treatments they were lost contact, therapy factors and time demands.
Given that most moderators of influence are not amenable to direct changes by clinicians, mediation variables should also be explored. Overall, results suggest that ACT appears to present some benefits in dropout rates for specific disorders, settings and therapists.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
Collapse
|
29
|
Pahnke J, Hirvikoski T, Bjureberg J, Bölte S, Jokinen J, Bohman B, Lundgren T. Acceptance and commitment therapy for autistic adults: An open pilot study in a psychiatric outpatient context. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
30
|
Villanueva J, Meyer AH, Rinner MTB, Firsching VJ, Benoy C, Brogli S, Walter M, Bader K, Gloster AT. "Choose change": design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients. BMC Psychiatry 2019; 19:173. [PMID: 31182051 PMCID: PMC6558686 DOI: 10.1186/s12888-019-2109-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome. METHODS This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context. DISCUSSION We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting. TRIAL REGISTRATION This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.
Collapse
Affiliation(s)
- Jeanette Villanueva
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marcia T. B. Rinner
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Victoria J. Firsching
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Charles Benoy
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Sandra Brogli
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Marc Walter
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Klaus Bader
- Center for Psychosomatics and Psychotherapy, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Andrew T. Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| |
Collapse
|
31
|
A review of AAQ variants and other context-specific measures of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
32
|
Thomas N, Bless JJ, Alderson-Day B, Bell IH, Cella M, Craig T, Delespaul P, Hugdahl K, Laloyaux J, Larøi F, Lincoln TM, Schlier B, Urwyler P, van den Berg D, Jardri R. Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations. Schizophr Bull 2019; 45:S32-S42. [PMID: 30715539 PMCID: PMC6357981 DOI: 10.1093/schbul/sby103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.
Collapse
Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Josef J Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | | | - Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychosis Early Intervention, South London and Maudsley NHS Trust, London, UK
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
- Institute of Neuroscience, Newcastle University, Newcastle-Upon-Tyne, UK
| | - David van den Berg
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Renaud Jardri
- PsyCHIC Team, SCALab CNRS UMR-9193, Lille University, Lille, France
- CURE Platform, CHU Lille, Fontan Hospital, Lille, France
| |
Collapse
|
33
|
Matthijssen SJMA, Heitland I, Verhoeven LCM, van den Hout MA. Reducing the Emotionality of Auditory Hallucination Memories in Patients Suffering From Auditory Hallucinations. Front Psychiatry 2019; 10:637. [PMID: 31620028 PMCID: PMC6759685 DOI: 10.3389/fpsyt.2019.00637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Eye movement desensitization and reprocessing (EMDR) therapy targets emotionally disturbing visual memories of traumatic life events, and may be deployed as an efficacious treatment for posttraumatic stress disorder. A key element of EMDR therapy is recalling an emotionally disturbing visual memory while simultaneously performing a dual task. Previous studies have shown that auditory emotional memories may also become less emotional as a consequence of dual tasking. This is potentially beneficial for psychotic patients suffering from disturbing emotional auditory memories of auditory hallucinations. The present study examined whether and to what extent emotionality of auditory hallucination memories could be reduced by dual tasking. The study also assessed whether a modality matching dual task (recall + auditory taxation) could be more effective than a cross modal dual task (recall + visual taxation). Thirty-six patients suffering from auditory hallucinations were asked to recall an emotionally disturbing auditory memory related to an auditory hallucination, to rate emotionality of the memory, and to recall it under three conditions: two active conditions, i.e., visual taxation (making eye-movements) or auditory taxation (counting aloud), and one control condition (staring at a non-moving dot) counterbalanced in order. Patients re-rated emotionality of the memory after each condition. Results show the memory emotionality of auditory hallucinations was reduced and the active conditions showed stronger effects than the control condition. No modality-specific effect was found: the active conditions had an equal effect.
Collapse
Affiliation(s)
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Liselotte C M Verhoeven
- Personality Disorders, GGZ Centraal, Amersfoort, Netherlands.,Hospital psychiatry, mood disorders and anxiety, Meander Medical Centre, Amersfoort, Netherlands
| | - Marcel A van den Hout
- Altrecht Academic Anxiety Centre, Altrecht GGZ, Utrecht, Netherlands.,Clinical Psychology, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
34
|
Cognitive therapy of psychosis: Research and implementation. Schizophr Res 2019; 203:62-65. [PMID: 29129504 DOI: 10.1016/j.schres.2017.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
|
35
|
Bighelli I, Salanti G, Huhn M, Schneider‐Thoma J, Krause M, Reitmeir C, Wallis S, Schwermann F, Pitschel‐Walz G, Barbui C, Furukawa TA, Leucht S. Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta-analysis. World Psychiatry 2018; 17:316-329. [PMID: 30192101 PMCID: PMC6127754 DOI: 10.1002/wps.20577] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychological treatments are increasingly regarded as useful interventions for schizophrenia. However, a comprehensive evaluation of the available evidence is lacking and the benefit of psychological interventions for patients with current positive symptoms is still debated. The present study aimed to evaluate the efficacy, acceptability and tolerability of psychological treatments for positive symptoms of schizophrenia by applying a network meta-analysis approach, that can integrate direct and indirect comparisons. We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov for randomized controlled trials of psychological treatments for positive symptoms of schizophrenia, published up to January 10, 2018. We included studies on adults with a diagnosis of schizophrenia or a related disorder presenting positive symptoms. The primary outcome was change in positive symptoms measured with validated rating scales. We included 53 randomized controlled trials of seven psychological interventions, for a total of 4,068 participants receiving the psychological treatment as add-on to antipsychotics. On average, patients were moderately ill at baseline. The network meta-analysis showed that cognitive behavioural therapy (40 studies) reduced positive symptoms more than inactive control (standardized mean difference, SMD=-0.29; 95% CI: -0.55 to -0.03), treatment as usual (SMD=-0.30; 95% CI: -0.45 to -0.14) and supportive therapy (SMD=-0.47; 95% CI: -0.91 to -0.03). Cognitive behavioural therapy was associated with a higher dropout rate compared with treatment as usual (risk ratio, RR=0.74; 95% CI: 0.58 to 0.95). Confidence in the estimates ranged from moderate to very low. The other treatments contributed to the network with a lower number of studies. Results were overall consistent in sensitivity analyses controlling for several factors, including the role of researchers' allegiance and blinding of outcome assessor. Cognitive behavior therapy seems to be effective on positive symptoms in moderately ill patients with schizophrenia, with effect sizes in the lower to medium range, depending on the control condition.
Collapse
Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of BernBernSwitzerland
| | - Maximilian Huhn
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Johannes Schneider‐Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Marc Krause
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Felicitas Schwermann
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Gabi Pitschel‐Walz
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Corrado Barbui
- Department of NeuroscienceBiomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVeronaItaly
| | - Toshi A. Furukawa
- Department of Health Promotion and Human BehaviorKyoto University Graduate School of Medicine, Kyoto, Japan and School of Public HealthJapan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| |
Collapse
|
36
|
Ong CW, Lee EB, Twohig MP. A meta-analysis of dropout rates in acceptance and commitment therapy. Behav Res Ther 2018; 104:14-33. [PMID: 29477890 DOI: 10.1016/j.brat.2018.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/02/2018] [Accepted: 02/13/2018] [Indexed: 12/19/2022]
Abstract
Many psychotherapies, including cognitive behavioral therapy and acceptance and commitment therapy (ACT), have been found to be effective interventions for a range of psychological and behavioral health concerns. Another aspect of treatment utility to consider is dropout, as interventions only work if clients are engaged in them. To date, no research has used meta-analytic methods to examine dropout in ACT. Thus, the objectives of the present meta-analysis were to (1) determine the aggregate dropout rate for ACT in randomized controlled trials, (2) compare dropout rates in ACT to those in other psychotherapies, and (3) identify potential moderators of dropout in ACT. Our literature search yielded 68 studies, representing 4,729 participants. The weighted mean dropout rates in ACT exclusive conditions and ACT inclusive conditions (i.e., those that included an ACT intervention) were 15.8% (95% CI: 11.9%, 20.1%) and 16.0% (95% CI: 12.5%, 19.8%), respectively. ACT dropout rates were not significantly different from those of established psychological treatments. In addition, dropout rates did not vary by client characteristics or study methodological quality. However, master's-level clinicians/therapists (weighted mean = 29.9%, CI: 17.6%, 43.8%) were associated with higher dropout than psychologists (weighted mean = 12.4%, 95% CI: 6.7%, 19.4%). More research on manipulable, process variables that influence dropout is needed.
Collapse
Affiliation(s)
- Clarissa W Ong
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA.
| | - Eric B Lee
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA
| | - Michael P Twohig
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA
| |
Collapse
|
37
|
Turkington D, Spencer H, Lebert L, Dudley R. Befriending: active placebo or effective psychotherapy? Br J Psychiatry 2017; 211:5-6. [PMID: 28673943 DOI: 10.1192/bjp.bp.116.197467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
Befriending allows for control of the non-specific factors of the therapist-patient interaction in psychosocial research. Manualised befriending is at the very least an active placebo and potentially an effective intervention. Befriending now merits increased research attention to determine indications for use and to elucidate mechanisms of action.
Collapse
Affiliation(s)
- Douglas Turkington
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Helen Spencer
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Latoyah Lebert
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Robert Dudley
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| |
Collapse
|
38
|
The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice. BMC Psychiatry 2017; 17:172. [PMID: 28482829 PMCID: PMC5423029 DOI: 10.1186/s12888-017-1321-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes. METHODS The mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18-75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview-based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data. DISCUSSION Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614000957695 . Date registered: 8 September 2014.
Collapse
|
39
|
Thomas N, Farhall J, Foley F, Rossell SL, Castle D, Ladd E, Meyer D, Mihalopoulos C, Leitan N, Nunan C, Frankish R, Smark T, Farnan S, McLeod B, Sterling L, Murray G, Fossey E, Brophy L, Kyrios M. Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol. BMC Psychiatry 2016; 16:312. [PMID: 27604363 PMCID: PMC5015321 DOI: 10.1186/s12888-016-1024-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery. METHODS/DESIGN This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined. DISCUSSION This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce. TRIAL REGISTRATION NCT02474524 , 24 May 2015, retrospectively registered during the recruitment phase.
Collapse
Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC, 3122, Australia. .,Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC, 3004, Australia.
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC 3086 Australia ,NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, VIC 3050 Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia ,Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC 3004 Australia ,Department of Psychiatry, St Vincent’s Hospital, Fitzroy, VIC 3065 Australia
| | - David Castle
- Department of Psychiatry, St Vincent’s Hospital, Fitzroy, VIC 3065 Australia ,Department of Psychiatry, University of Melbourne, Parkville, VIC 3052 Australia
| | - Emma Ladd
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Cathrine Mihalopoulos
- Centre for Population Health Research, Deakin University, Burwood, VIC 3125 Australia
| | - Nuwan Leitan
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Cassy Nunan
- Wellways Australia, Fairfield, VIC 3068 Australia
| | | | - Tara Smark
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Sue Farnan
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Bronte McLeod
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Leon Sterling
- Centre for Design Innovation, Swinburne University of Technology, Hawthorn, VIC 3122 Australia ,Department of Computing and Information Systems, University of Melbourne, Parkville, VIC 3052 Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University - Peninsula Campus, Frankston, VIC 3199 Australia ,Living with Disability Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Lisa Brophy
- Mind Australia, Heidelberg, VIC 3084 Australia ,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052 Australia
| | - Michael Kyrios
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia ,Australian National University, Canberra, ACT 2601 Australia
| |
Collapse
|
40
|
Thomas N, Farhall J, Foley F, Leitan ND, Villagonzalo KA, Ladd E, Nunan C, Farnan S, Frankish R, Smark T, Rossell SL, Sterling L, Murray G, Castle DJ, Kyrios M. Promoting Personal Recovery in People with Persisting Psychotic Disorders: Development and Pilot Study of a Novel Digital Intervention. Front Psychiatry 2016; 7:196. [PMID: 28066271 PMCID: PMC5179552 DOI: 10.3389/fpsyt.2016.00196] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For people with persisting psychotic disorders, personal recovery has become an important target of mental health services worldwide. Strongly influenced by mental health service consumer perspectives, personal recovery refers to being able to live a satisfying and contributing life irrespective of ongoing symptoms and disability. Contact with peers with shared lived experience is often cited as facilitative of recovery. We aimed to develop and pilot a novel recovery-based digitally supported intervention for people with a psychotic illness. METHODS We developed a website to be used on a tablet computer by mental health workers to structure therapeutic discussions about personal recovery. Central to the site was a series of video interviews of people with lived experience of psychosis discussing how they had navigated issues within their own recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment model of recovery. We examined the feasibility and acceptability of an 8-session low intensity intervention using this site in 10 participants with persisting psychotic disorders and conducted a proof-of-concept analysis of outcomes. RESULTS All 10 participants completed the full course of sessions, and it was possible to integrate use of the website into nearly all sessions. Participant feedback confirmed that use of the website was a feasible and acceptable way of working. All participants stated that they would recommend the intervention to others. Post-intervention, personal recovery measured by the Questionnaire for the Process of Recovery had improved by an average standardized effect of d = 0.46, 95% CI [0.07, 0.84], and 8 of the 10 participants reported that their mental health had improved since taking part in the intervention. CONCLUSION In-session use of digital resources featuring peer accounts of recovery is feasible and acceptable and shows promising outcomes. A randomized controlled trial is the next step in evaluating the efficacy of this low intensity intervention when delivered in conjunction with routine mental health care.
Collapse
Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia; NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology , Hawthorn, VIC , Australia
| | - Nuwan Dominic Leitan
- Centre for Mental Health, Swinburne University of Technology , Hawthorn, VIC , Australia
| | | | - Emma Ladd
- Wellways Australia , Melbourne, VIC , Australia
| | - Cassy Nunan
- Wellways Australia , Melbourne, VIC , Australia
| | - Sue Farnan
- Wellways Australia , Melbourne, VIC , Australia
| | | | - Tara Smark
- Wellways Australia , Melbourne, VIC , Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC, Australia; Department of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Leon Sterling
- Centre for Design Innovation, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology , Hawthorn, VIC , Australia
| | - David Jonathon Castle
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Michael Kyrios
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Research School of Psychology, Australian National University, Canberra, ACT, Australia
| |
Collapse
|