Wakefield, S., Roebuck, S., & Boyden, P. (2018). The evidence base of Acceptance and Commitment Therapy (ACT) in psychosis: a systematic review. Journal Of Contextual Behavioral Science.
doi: 10.1016/j.jcbs.2018.07.001
This systematic review investigates the evidence of Acceptance and Commitment Therapy (ACT) based engagement for psychosis identifying the potential benefits. Wakefield, Roebuck & Boyden, 2018 reviewed 13 eligible studies including criteria, of ACT as the only treatment, persons who have experianced psychosis and quantities methodology. Results indicated the benefits of ACT in brief forms from 4 sessions for inpatients, whom have severe symptoms and complex co morbidities to longer community engagement. The improvement in symptoms even when symptoms are at the most severe and whist hospitalized identifies the benefit of such brief intervention. There is evidence of the reduction of hospital admission rates after the engagement of ACT (p.19). The limitations of the research are pinpointed as inability to identify what within ACT causes change and this impacts the outcomes of the groups to be able to replicate research, along with the inability to minimise bias with a blind group which is not possible for psychological interventions.
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Swain, J., Hancock, K., Hainsworth, C. and Bowman, J. (2013). Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review. Clinical Psychology Review, 33(8), pp.965-978.
DOI: 10.1016/j.cpr.2013.07.002
The systemic review by Swain et al. (2013) was to examine the evidence outcomes of anxiety treatment when persons are engaged in ACT. Multiple data bases were searched, focusing on inclusion and exclusion criteria. Studies which focused on ACT including two core processes, the reduction in anxiety, psychometric quality and completed in English were part of the inclusion criteria. Research focusing on stress was excluded. Independent reviewers selected thirty-eight studies that met eligibility, and methodological quality. Limitations of the study where methodological, inadequacies and low study numbers, the review identified that ACT was a new therapy, the initially publication in 1999 tends to challenge this concept. ACT was found to be effective over a spectrum of anxiety disorders, including Seasonal Affective Disorders in both the clinical and non-clinical settings, where the delivery was individually or by group settings leads to recommendations of further research with more robust methodological rigour.
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Spidel, A., Lecomte, T., Kealy, D., & Daigneault, I. (2017). Acceptance and commitment therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychology And Psychotherapy: Theory, Research And Practice, 91(2), 248-261. doi: 10.1111/papt.12159
Spidel, Lecomte, Kealy & Daigneault, (2017), explore the capability of mindful based ACT, in the reduction of symptoms and increased treatment adherence. Fifty persons who have experienced psychosis and trauma, this randomized trial compared 10 group sessions of ACT vs treatment as usual, engagement with clinician and psychiatrist. The small trial size, along with 10 ACT sessions were highlighted as limitations of research. Concrete mindfulness of eating and breathing were practiced prior to the group sessions to decrease the risk of experience of psychotic symptoms in sessions (p252). Completion of GAD, BPRS and Service Engagement Scales at baseline, completion and 3 months, concluded positive change in symptom severity, anxiety, service engagement, and help seeking for the ACT session participants. Contrary to other findings there was no reduced of trauma symptoms, hypnotizing, trauma is less amenable to change in brief treatment. Further research to replicate findings is recommended in larger target groups and comparison treatments.
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Walser, R., Garvert, D., Karlin, B., Trockel, M., Ryu, D., & Taylor, C. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behaviour Research And Therapy, 74, 25-31. doi: 10.1016/j.brat.2015.08.012
Focus on the effects experiential acceptance and mindfulness in reducing in depression and suicidal ideation (SI) in veterans was researched by Walser et al (2015). The inclusion of 981 veterans, whose depression severity and SI was rating against questionnaires that gave little bias and are repeatable. 647 (66%) of veterans completed 10 or more sessions. Those veterans who had high SI at baseline evidenced reduction in depression and SI than those at without SI at initial engagement. This also indicated that the ongoing effect of mindfulness, reducing depression may become more evident. Although results were positive there were limitations identified around the experience and length of training for the clinicians delivering ACT. The accumulation of mindfulness and experiential acceptance identifies the onset of maintenance including other psychological problems, this indication of gains, warrants further research post engagement in the study within the veteran group and in wider groups depression with SI groups.
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Pleger, M., Treppner, K., Diefenbacher, A., Schade, C., Dambacher, C., & Fydrich, T. (2018). Effectiveness of Acceptance and Commitment Therapy compared to CBT+: Preliminary results. The European Journal Of Psychiatry. doi: 10.1016/j.ejpsy.2018.03.003
The comparison of CBT to ACT was the aim for Pleger et al (2018). Sixty-Seven persons were recruited from an acute unit, with diagnosis of primary mood disorders and allocated to ACT or CBT+ groups. Referral from Emergency or self-referrals were accepted. Quassi Random means was selection basis for each group. Fifty minute sessions twice weekly had approximately 10 participants. The results were determined by self-measure reports which were completed electronically, initially and prior to discharge. Initially they believed that there would be a higher rate of reduction in symptomology and function for the participates of the ACT group it found that there was little comparison. Limitations faced focused on no reverse translation of the scoring as this was a German study, the size of the group and lack of a control group with TAU. Evidence showed that use of ACT within acute settings can be justified as an effective clinical practice.
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Bayati, A., Abbasi, P., & Ziapour, A. (2017). Effectiveness of Acceptance and Commitment Therapy on Death Anxiety and Death Obsession in the Elderly. World Family Medicine Journal/Middle East Journal Of Family Medicine, 15(10), 122-128. doi: 10.5742/mewfm.2017.93148
Bayati, Abbasi and Ziapour, (2017) examine the impact of ACTfor older persons facing anxiety around death in the later years. 26 persons rating the highest after completing death anxiety score and a death obsession rating, over the age of 60 with no previous mental illness. The test design was semi experiential with the repeat of the rating scores post engagement, persons were divided into 2 groups ACT vs Control. ACT based group participated in eight ninety-minute ACT sessions. Limitations were the small size number (26), the gender and cultural imbalance of only focusing on men in nursing homes in Iran. Results evidenced significant reduction in anxiety and obsession around death with the ability to manage emotions and distressing thoughts with improved cognitive flexibility, these results were consistent with previous studies ACT in the reduction of anxiety (p.126), the increase in sample size and a wider variant of participants are indicated for future research.
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