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Acceptance and Commitment Therapy for Posttraumatic Stress Disorder in Early Psychosis: A Case Series
Abstract
Persons with psychosis often report high levels of posttraumatic stress disorder (PTSD) symptoms, which render them more vulnerable to relapse, symptom exacerbation, and reduced well-being. However, less is known about how to adequately accommodate the needs of persons recovering from a first episode of psychosis, presenting with PTSD. Further, the existing evidence-based interventions for PTSD seem less equipped to deal with serious mental illness and comorbid conditions. This study aimed to assess the efficacy, acceptability, and safety of Acceptance and Commitment Therapy (ACT) for persons suffering from PTSD with comorbid trauma and psychosis. Three consecutively referred participants meeting ICD-10 criteria for PTSD and a first-episode nonaffective psychotic disorder were treated in an outpatient service within a case-series analysis. A manual-guided ACT intervention of 12 sessions showed clinically relevant improvement on self-report measures of PTSD symptoms and emotional distress. These initial findings are promising and appear to justify a more controlled evaluation of this brief intervention.
... Across groups, authors recommended adaptations be made to accommodate for concentration and memory difficulties commonly observed across stages of illness, including shorter exercises, reduced periods of silence, consistent verbal instructions, and more thorough psychoeducation (n=23, 36% of studies; for examples see Davis (2014); White et al. (2011)). Authors also reported individuals may require a slower pace (n=3; Brown et al. (2010); Davis (2014);Randal et al. (2016)), and emphasized the utility of concrete exercises (n=7, or 11% of studies; (Bacon et al., 2014;Davis et al., 2007;Jansen & Morris, 2017;Khoury et al., 2015;Miller, 2011;Sheets, 2009;Spidel et al., 2018)). For example, Miller (2011) suggested participants observe the sensations associated with their hand on a chair. ...
... Many authors highlighted the use of goal-setting to better motivate participants to engage with mindfulness (n=23, 36% of studies (Bach & Hayes, 2002;Bacon et al., 2014;Chadwick et al., 2016;Chadwick et al., 2005;Dannahy et al., 2011;Davis, 2014;Dennick et al., 2013;Gaudiano & Herbert, 2006;Gumley et al., 2017;Jacobsen et al., 2020;Jansen & Morris, 2017;Johns et al., 2016;Khoury et al., 2015;Lam et al., 2020;Miller, 2011;Randal et al., 2016;Shawyer et al., 2012;Sheets, 2009;Spidel et al., 2018;van der Valk et al., 2013;Veiga-Martínez et al., 2008;Wang et al., 2016;White et al., 2011)). Some authors endorsed longerinterventions to better consolidate practice (n=12, 21% of studies; (Bach et al., 2012;Braehler et al., 2013;Brown et al., 2010;Chadwick et al., 2016;Chien et al., 2017;Davis, 2014;Davis et al., 2007;Davis et al., 2015;Miller, 2011;Shawyer et al., 2017;Spidel et al., 2018)), for example, 20 weeks (Brown et al., 2010), or a twice repeated 32-week curriculum (Davis et al., 2015). ...
... Facilitators frequently cited the value of acceptance and compassion practices, alongside mindfulness. Compassion practices, in particular, were emphasized for potential utility (n=13, 20% of studies; Braehler et al., 2013;Brown et al., 2010;Davis, 2014;Davis et al., 2015;Hickey et al., 2019;Jansen & Morris, 2017;Johnson et al., 2011;Khoury et al., 2015;Martins et al., 2017;Miller, 2011;Spidel et al., 2018)). Authors suggested compassion could help drive a sense of belonging and reduce self-stigmatization in early-psychosis cohorts (n=5, 29% of completed FEP studies; (Ashcroft et al., 2012;Hickey et al., 2019;Jansen & Morris, 2017;Khoury et al., 2015;Tong et al., 2016)). ...
Objectives
How to best implement mindfulness interventions within different stages of psychosis (high risk for psychosis, first episode psychosis (FEP), established psychosis) remains relatively unexplored. Understanding where and how mindfulness research has been conducted at different stages of illness can guide future research, and improve intervention acceptability and treatment effects.Methods
An evidence mapping approach was taken to systematically search and identify where and how mindfulness research has been conducted across stages of psychosis. Papers were examined for intervention approaches and safety concerns, and content analysis examined practitioner recommendations to identify recommendations within and across stages of illness.ResultsA paucity of research relating to the application of mindfulness in the treatment of psychotic illness exists for the high risk stage, with some research in FEP. The majority of research examines mindfulness approaches for the chronic stage of illness. Intervention formats for different stages of psychosis varied widely. Across all stages of psychosis, authors recommended adaptations for cognitive impairments (e.g., shorter exercises for impacted attention), longer interventions, and more helpful ways of explaining mindfulness and encouraging practice. Few stage-specific recommendations emerged beyond the potential helpfulness of compassion-based practices within earlier stages of illness where self-stigmatization often emerges.Conclusions
Recommendations for how to best adapt mindfulness to early intervention in psychosis are needed, and future research needs to better understand risks and utility of different mindfulness practices for different stages of illness.
... The intervention approaches adopted include mindfulness-based/ oriented interventions (n = 5), acceptance commitment therapy (n = 1) and compassion-based intervention (n = 1). Further details on the intervention characteristics are provided in Table 2. Seven studies adopted a group format for intervention delivery, and only one study provided individual sessions (Jansen & Morris, 2017). ...
... • 5/11 (45.5%) preferred a longer duration of intervention exploring their perspective in the usefulness and other attitudes toward the intervention programmes. Qualitative feedback suggested that most participants found the interventions highly acceptable (Moorhead, 2012); useful and helpful (Jansen & Morris, 2017;Khoury et al., 2015;MacDougall et al., 2018;Moorhead, 2012;Tong et al., 2016), and/or enjoyable (Moorhead, 2012;Tong et al., 2016). Participants also stated that they would recommend the programme to their friends (Khoury et al., 2015;Van der Valk et al., 2013); and/or enter the programmes again (Van der Valk et al., 2013); and some stated that they preferred a longer duration/length of intervention (Tong et al., 2016). ...
... Similarly, statistically significant within-group improvements were achieved in participants' ability to observe emotions and act with awareness as measured by the Five Facet Mindfulness Questionnaire (Tong et al., 2016). A significant within-group change in levels of psychological flexibility suggested that participants were responding with greater mindfulness and acceptance toward life experience after participating in acceptance and commitment therapy (Jansen & Morris, 2017). ...
Background:
Early intervention for psychosis is recommended because the first 5 years beyond the first episode is considered the critical period within which individuals have the most potential to maximize their response to treatment and recovery. Mindfulness-based interventions (MBIs) have been studied extensively in diverse disease groups, but research in people with recent-onset psychosis is still immature.
Aim:
This review aims to explore the feasibility, acceptability and summarize any effectiveness data on of the MBIs for people with recent-onset psychosis reported by the study authors.
Methods:
A systematic search of original intervention research studies relevant to the topic published between January 2000 and August 2019 was conducted with 10 databases. Articles published in English with accessible full text were included.
Results:
A total of eight studies were included, which reported recruitment rates of between 62.5% and 100%, withdrawal rates between 0% and 37.5% and attendance rates of between 56% and 100%. Participants' qualitative feedback indicated high levels of satisfaction with the MBIs. The intervention approaches adopted in the reviewed studies include mindfulness-based interventions, acceptance and commitment therapy and compassion-based interventions. MBIs have produced promising positive effects on participants' psychiatric and psychosocial outcomes.
Conclusion:
This review confirms that MBIs are generally feasible and acceptable for people with recent-onset psychosis. The preliminary results suggested the potential effects of MBIs in this area. Fully powered randomized controlled trials are suggested to confirm the effectiveness and exploratory studies to gain greater insight into the active components and mechanism of actions of MBIs for recent-onset psychosis.
... Informed consent for participating in the program Randomization and pre-test (40) ACT (20) Wait-list Control (20) Post-test (20) Post-test (20) First follow-up (20) First follow-up (20) Second follow-up (20) Second follow-up (20) 28 patients were excluded due to: ...
... By centralizing the families on clarifying and reaffirming the values, identifying the challenging situations and urging the families, ACT plays a remarkable role in making effective changes to improve the family functions. [40] One of the therapeutic principles in ACT is focusing on the diffusion of the tension provoking situations. By this technique, TBI patients' caregivers learn observe situations without judgment instead of engaging in emotional states experienced this situations and the psychological problems related to it. ...
Background and Objectives: Traumatic brain injury (TBI) is one of the main causes of disability. Since individuals with TBI experience many problems in their daily life, they must be highly supported. Regarding the nature of their problems, their caregivers suffer from many psychological problems. The current study aimed to investigate the effect of group acceptance and commitment therapy (ACT) on the family function, experiential avoidance, and anxiety of the TBI patients' caregivers. Methods: The current study was a randomized clinical trial with waiting list and intervention groups. Forty caregivers of TBI patients who referred to Kashan's Shahid Beheshti Hospital, Iran, since 2017 until 2019 were randomly assigned to the experimental (n = 20) and the waiting list control (n = 20) groups. Both the groups completed a demographic information questionnaire, the Family Assessment Device, the Experiential Avoidance in Caregiving Questionnaire, and the anxiety subscale of the Depression, Anxiety, and Stress Scale in pretest, posttest, 3-month follow-up, and 6-month follow-up. Results: The results of repeated measures analysis of variance showed that ACT program can significantly decrease the anxiety, experiential avoidance, and most of the dimensions of the family functions (P < 0.005). Conclusion: ACT could be utilized to improve the family functions and reduce the experiential avoidance and the anxiety of the TBI patients' caregivers. This trial is registered with the Registry of Clinical Trials: “IRCT20190704044100N1.”
... En la misma línea, la ACT ha demostrado efectividad en la disminución de los síntomas de ansiedad, depresión y los propios del trastorno de estrés postraumático por abuso sexual en la infancia (Jansen & Morris, 2017). Incluso existen recientes estudios que evalúan la efectividad de terapias de tercera generación como la TDC en pacientes con TEPT relacionado con el abuso sexual en la infancia como lo demuestra el estudio de Bohus, Priebe, Dyer y Steil (2009), cuyos datos preliminares, revelaron grandes diferencias entre los tamaños de efecto de las medidas de resultado primarias. ...
... No se encontró evidencia que respalde la efectividad del uso de terapias de tercera generación en niños mientras estudios previos han determinado su efectividad en adultos víctimas de ASI. Por tanto, es una invitación a investigar sobre las terapias de tercera generación en estas edades, debido a que ya habían demostrado su efectividad en estos síntomas y en víctimas adultas de ASI; como ejemplos, la terapia de aceptación y compromiso (Jansen & Morris, 2017), la terapia dialectico comportamental (Bohus, Priebe, Dyer, & Steil, 2009), Mindfulness (Earley, y otros, 2014;Kimbrough, Magyari, Langenberg, Chesney, & Berman, 2010;Thompson & Gauntlett-Gilbert, 2008;Rempel, 2012), por lo que consideramos importante investigar su efectividad para el tratamiento de niños víctimas de ASI. ...
La literatura ha mostrado terapias para el tratamiento de los síntomas relacionados con situaciones de abuso sexual infantil en adolescentes, jóvenes y adultos. La presente revisión se enfocó en intervenciones para niños víctimas de abuso sexual con edades entre los tres y los doce años. Nos enfocamos en publicaciones en inglés, español, francés y portugués registradas en las bases de datos Science direct, Jstor, Proquest, Redalyc y Scielo. Los resultados mostraron mayor frecuencia de estudio de este tema en poblaciones norteamericanas y europeas, enfocadas en el tratamiento de síntomas o consecuencias en la salud mental tales como baja autoestima, depresión y ansiedad, actitud vital negativa, trastornos alimentarios, estrés postraumático y otras variables relacionadas como bajo rendimiento académico, conductas auto lesivas o suicidas. La terapia cognitivo comportamental individual y grupal y también su modalidad centrada en el trauma, cuenta con una frecuencia mayor de estudios que demuestran su efectividad para el tratamiento. Igualmente se identifican la terapia psicodinámica de juego, la terapia asistida por animales y la terapia de interacción padre-hijo. Se discute el papel que podría jugar las terapias de tercera generación como complementarias para el manejo de los síntomas o consecuencias del abuso sexual en niños.
... En la misma línea, la ACT ha demostrado efectividad en la disminución de los síntomas de ansiedad, depresión y los propios del trastorno de estrés postraumático por abuso sexual en la infancia (Jansen & Morris, 2017). Incluso existen recientes estudios que evalúan la efectividad de terapias de tercera generación como la TDC en pacientes con TEPT relacionado con el abuso sexual en la infancia como lo demuestra el estudio de Bohus, Priebe, Dyer y Steil (2009), cuyos datos preliminares, revelaron grandes diferencias entre los tamaños de efecto de las medidas de resultado primarias. ...
... No se encontró evidencia que respalde la efectividad del uso de terapias de tercera generación en niños mientras estudios previos han determinado su efectividad en adultos víctimas de ASI. Por tanto, es una invitación a investigar sobre las terapias de tercera generación en estas edades, debido a que ya habían demostrado su efectividad en estos síntomas y en víctimas adultas de ASI; como ejemplos, la terapia de aceptación y compromiso (Jansen & Morris, 2017), la terapia dialectico comportamental (Bohus, Priebe, Dyer, & Steil, 2009), Mindfulness (Earley, y otros, 2014;Kimbrough, Magyari, Langenberg, Chesney, & Berman, 2010;Thompson & Gauntlett-Gilbert, 2008;Rempel, 2012), por lo que consideramos importante investigar su efectividad para el tratamiento de niños víctimas de ASI. ...
La presente revisión se enfocó en estudios sobre la efectividad de las intervenciones para niños víctimas de ASI con edades entre los tres y los doce años. Se analizaron publicaciones registradas en las bases de datos Science direct, Jstor, Proquest, Redalyc y Scielo. Los resultados mostraron que la terapia cognitivo comportamental centrada en el trauma (TCC-CT) cuenta con mayor evidencia empírica para el tratamiento de las consecuencias generadas por el abuso sexual infantil. En algunos casos la TCC-CT se ha complementado con actividades de la terapia psicodinámica de juego y de la terapia asistida por animales. El efecto de la terapia de interacción padre-hijo también ha sido demostrado. Se discute el impacto de las terapias para el manejo de las consecuencias del ASI en niños y el papel que podría jugar las terapias de tercera generación como complementarias para el manejo de los síntomas o consecuencias del abuso sexual en niños
... Acceptance from this perspective is not a passive response to suffering or to incomplete recovery, but rather an active stance or 'willingness' to experience or 'have' uncomfortable thoughts, feelings and bodily sensations, while engaging in or pursuing personally meaningful behavior Jansen and Morris, 2016). Mindfulness is a core component in acceptance-based therapies and involves the cultivation of awareness, wisdom and compassion (Kabat-Zinn, 1990, 1994. ...
... Acceptance-and mindfulness-based approaches do not specifically target symptom reduction, but therapists often find that symptoms are reduced in the process of changing people's relationship to their psychotic symptoms through mindfulness, acceptance and compassion (Jansen and Morris, 2016). The process-measures showing moderate to large effect sizes for both acceptance and mindfulness as well as small to moderate effect on social functioning add to this understanding. ...
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.
... Research has suggested that acceptance may be a central part of coming to terms with these changes. However, acceptance from the perspective of 'third wave' CBT, including ACT and mindfulnessbased approaches, is not a passive response to suffering or incomplete recovery, but rather an active stance or 'willingness' to 'be with' the experience, 'as it is, ' while engaging in or pursuing personally meaningful behavior (Hayes et al., 2012a;Jansen and Morris, 2016). For caregivers, thus, greater acceptance does not mean giving up hope for recovery. ...
... With the limitations and strengths in mind, these findings may have important clinical implications. First, these initial findings are promising and add to the body of research showing that acceptance and mindfulness-based therapies can be used for people with psychosis and their caregivers (Chadwick et al., 2005(Chadwick et al., , 2009White et al., 2011;Jansen and Morris, 2016) as well as research on caregivers in other populations (e.g., Losada et al., 2015). Second, supporting caregivers in the process of accepting, or 'making space' for distress, while simultaneously addressing personally meaningful behaviors or values related to being a caregiver, may both instill hope and improve coping skills for difficult thoughts and feelings. ...
Background: Research has shown that caregivers of persons with psychosis play an invaluable role in recovery, but unfortunately, often report high levels of distress. While cognitive models of caregiver distress have been well-supported, there is still limited knowledge of the psychological factors involved. Recent advances in cognitive behavioral therapy seem to converge on the importance of acceptance- and mindfulness based processes.
Aim: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver distress.
Method: Within a cross-sectional design, 101 caregivers of 38 persons with first-episode psychosis in a clinical epidemiological sample completed a series of self-report measures.
Results: A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress.
Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within a broad range of emotional disorders. There may be important clinical implications in terms of facilitating the process of acceptance through interventions from the ‘third-wave’ or contextual cognitive behavioral therapies.
... This finding is in line with that of another study. [43] The results of this study indicated that ACT can be a suitable treatment for those who do not respond to other interventions. Moreover, the findings of this study reveal that as a treatment for PTSD, the effect of ACT is clinically significant on decreasing the intensity of depression and anxiety among patients with PTSD. ...
Background: Posttraumatic stress disorder has a negative impact on the individual, family, and community due to disturbance in social functioning, increased stress, and life-threatening health status. Therefore, effective and useful therapeutic interventions in this area are very important. This study aimed at examining the effectiveness of acceptance and commitment therapy (ACT) on the posttraumatic cognitions of students with trauma exposure. Methods: In this quasi- experimental study, population included all students of Islamic Azad University in Roudehen, Tehran, Iran, during the academic year of 2018–2019. After administering trauma questionnaire, the second version of acceptance and action questionnaire (AAQ-II), and posttraumatic cognitions inventory (PTCI) to 500 people, 113 people who experienced trauma and had high scores in PTCI and low scores in AAQ-II were identified. Of whom 40 people were selected randomly. After the clinical interview, the subjects were randomly placed in the experimental group (who received ACT, n = 20) and placebo group (n = 20). Both groups were pre- and posttested using the PTCI and AAQ-II. Then, the obtained data were analyzed using covariance analysis. Results: The results showed that there was a significant difference in posttraumatic cognitions (negative cognitions about self, negative cognitions about the world, and self-blame) between the two groups. In addition, the results of posttest related to ACT had a significant impact on psychological inflexibility. In other words, ACT reduced posttraumatic cognitions and increased psychological flexibility of these students. Conclusion: The findings of the present study reveal that despite posttraumatic cognitions of students with trauma exposure, ACT increases value-based behaviors through increasing psychological flexibility and decreasing experiential avoidance.
... The reasons why residual symptoms persisted in several clients might be related to the duration of ACT intervention. A previous study revealed that ACT effectively decreased the symptoms of psychosis in clients with traumatic experiences such as sexual abuse and schizophrenia and increased their acceptance of the disease as well, albeit over a longer duration (12 sessions) (Jansen & Morris, 2017). Another factor that caused the higher number of residual symptoms in Client 4 might be due to the client's substance abuse history that might be worsening the symptoms of schizophrenia (Green, Noordsy, Brunette, & O'Keefe, 2008). ...
Background: Aggressive behavior frequently occurs in clients with schizophrenia and causes injuries to the clients themselves, others, and the environment. It becomes one of the most common factors causing rehospitalization in schizophrenic clients. Aggressive behavior can be managed by the intervention administered by nurses in the usual way (treatment as usual; TAU) as well as psychotherapy (acceptance and commitment therapy; ACT and family psychoeducation; FPE).
Purpose: This study aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) and family psychoeducation (FPE) on schizophrenic clients with aggressive behavior.
Methods: This study used a case series method to report four selected cases of schizophrenic clients with aggressive behavior. Acceptance and commitment therapy (ACT), family psychoeducation (FPE), and treatment as usual (TAU) were delivered to four clients with aggressive behavior for six weeks using the Stuart Stress-Adaptation Model.
Results: The finding showed decreased symptoms of aggressive behavior in cognitive, affective, physiological, behavioral, and social aspects and increased ability to control anger, to accept their problems, and to commit to the therapy after ACT, FPE, and TAU interventions.
Conclusion: This report showed that TAU, ACT, and FPE effectively decreased the symptoms of aggressive behavior and increased the clients’ ability to control anger.
... ACT is based on the psychological flexibility model and teaches skills that increases one's ability to remain engaged with the present moment while acting in accordance with chosen values (Hayes et al., 2006). ACT also has preliminary support as an effective treatment for PTSD through several case studies (Batten & Hayes, 2005;Burrows, 2013;Codd, Twohig, Crosby, & Enno, 2011;Hermann, Meyer, Schnurr, Batten, & Walser, 2016;Jansen & Morris, 2017Orsillo & Batten,2005Thompson, Luoma, & Lejeune, 2013;Twohig, 2009). ...
Preliminary evidence has demonstrated the benefits of targeting self-compassion in the treatment of posttraumatic stress disorder (PTSD). However, survivors of childhood maltreatment may present with unique challenges that compromise the effectiveness of these and other PTSD treatments. Specifically, childhood maltreatment victims often exhibit a marked fear and active resistance of self-kindness and warmth (i.e., fear of self-compassion). Victims may also attempt to control distressing internal experiences in a way that hinders engagement in value-based actions (i.e., psychological inflexibility). Research suggests that psychological inflexibility exacerbates the negative effects of fear of self-compassion. The present study expanded on previous research by examining the relations among childhood maltreatment, fear of self-compassion, psychological inflexibility, and PTSD symptom severity in 288 college women. As expected, moderate to severe levels of childhood maltreatment were associated with greater fear of self-compassion, psychological inflexibility, and PTSD symptom severity compared to minimal or no childhood maltreatment. A mediation analysis showed that childhood maltreatment had a significant indirect effect on PTSD symptom severity via fear of self-compassion, although a conditional process analysis did not support psychological inflexibility as a moderator of this indirect effect. A post hoc multiple mediator analysis showed a significant indirect effect of childhood maltreatment on PTSD symptom severity via psychological inflexibility, but not fear of self-compassion. These findings highlight the importance of addressing fear of self-compassion and psychological inflexibility as barriers to treatment for female survivors of childhood maltreatment.
This study explored the relationship between attention, negative emotions, empathy, mindfulness, and psychological trauma in catastrophic events to reduce the public’s psychological trauma. A total of 526 adults in Guangxi Province, China, were investigated using a self-rating scale for post-traumatic stress disorder, a self-rating emotion scale, a self-rating empathy scale, a five-factor self-rating mindfulness scale, and a catastrophic incident concern questionnaire. The results show that: (1) women are vulnerable to psychological trauma in catastrophic events (F [464]=0.681, p<0.05); (2) emotion has a significant mediating effect between attention and psychological trauma; (3) empathy has a significant mediating effect between attention and psychological trauma; and (4) mindfulness is conducive to buffering an individual’s negative emotions and also regulates the degree of psychological trauma in the public’s attention to catastrophic events. Therefore, people should be rational and restrained in the face of catastrophic events.
Introduction: The aim of present research was to develop and evaluate the effectiveness of a group treatment package based on transactional analysis and acceptance and commitment therapy on self-compassion components in girls with emotional breakdown experience.
Method: A mixed method was applied to develop the educational package and semi-experimental design were used to examine the instructional intervention. The study population consisted of all students with emotional breakdown in Islamic Azad University, Science and Research Branch in 2020. A total sample of 30 subjects selected by available sampling method and randomly divided to experimental (n=15) and control (n=15) groups and the inclusion/exclusion criteria were controled for. The experimental group received 8 session of researcher made package, wherase the control group remained in the waiting list. The Neff Self-compassion Questionnaire was administered in the pretest posttest and followup stages and extracted data were analyzed by a covariance statistical method.
Results: The findings showed significant differences between two groups after intervention and in followup(p<0.01). Decreased means of self-judgment, extreme identification and isolation, as well as , increased means of self-kindness, mindfulness and human commonalities observed in experimental group subjects than control.
Conclusion: It could be concluded that the developed package was effective and could be apply to girls with a history of traumatic emotional breakdown.
Individuals diagnosed with serious mental illness (SMI) have greater trauma exposure and are at increased risk for posttraumatic stress disorder (PTSD). However, PTSD is rarely documented in their clinical records. This study investigated the predictors of PTSD documentation among 776 clients with SMI receiving public mental health services, who had probable PTSD as indicated by a PTSD Checklist score of at least 45. Among these, only 5.3% clients had PTSD listed as a primary diagnosis, and 8.4% had PTSD as a secondary diagnosis, with a total 13.7% of documentation rate. Documentation rate was highest for those with major depression (18.8%) compared to those with schizophrenia (4.1%) or bipolar disorder (6.3%). Negative predictors of PTSD that predicted a lower likelihood of having a chart diagnosis of PTSD included being diagnosed with schizophrenia/schizoaffective disorder or bipolar disorder. Positive predictors of PTSD that predicted a higher likelihood of having a chart diagnosis of PTSD included being of non-white race, being female, and experiencing eight or more types of traumatic events. Findings highlight the need for PTSD screening and trauma informed care for clients with SMI receiving public mental health services.
Keywords: Serious mental illness, PTSD, screening, predictors, documentation, trauma
Background: Numerous studies have examined the effect of group education on reciprocal behavior analysis and acceptance
and commitment to self-criticism, but research that has developed a group educational therapy program based on interactional
behavior analysis and acceptance and commitment method and its effectiveness on girls' self-criticism components has failed.
Emotional pay has been neglected. Aims: The purpose of this study was to develop a group educational therapy program
based on the analysis of reciprocal behavior and acceptance and commitment and its effectiveness on self-critical components
of girls with emotional failure. Method: The present study was applied in terms of purpose and combined in terms of method
(qualitative and quantitative), the qualitative part was the development of a treatment program and the quantitative part was
semi-experimental. The study population consisted of all students with emotional breakdown in Islamic Azad University of
Tehran during the years 2019-2020. 30 people were available selected as a sample and randomly assigned to two
experimental and control groups (15 people). The instruments of the present study were: Thompson and Zarov Self-Critical
Questionnaire (2004) and Summary of Mutual Behavior Analysis Sessions and Acceptance and Commitment Methods (a
combination of Bern Behavioral Training Meetings, 1950 and Admission and Commitment Therapy Sessions by Hayes et al.,
2012). ). Data analysis was performed by multivariate analysis of covariance. Results: The developed group treatment
program had a significant effect on the analysis of mutual relations and acceptance and commitment to girls' self-criticism
with emotional failure (p< 0/01). Conclusions: Girls who participated in group therapy therapy sessions based on
interactional behavior and acceptance and commitment methods were less self-critical
The prevalence of Coronavirus disease (COVID-19) has been associated with many psychological problems and concerns. This study aimed to evaluate the effectiveness of virtual acceptance and commitment group therapy on mental health in women undergoing Covid-19 treatment. This study was a randomized controlled trial and a quasi-experimental with a pre-test and post-test design. The statistical population included women undergoing Covid-19 treatment living in Ardakan, Yazd, Iran. Eighteen participants were randomly and equally divided into two groups of 9 cases, including the experimental and control groups. The participants answered the Lovibond Psychological Questionnaire (1995) in the pre-test and post-test stages. The experimental group received virtual-based acceptance and commitment group therapy intervention in 8 one-hour sessions, two sessions per week. In contrast, the control group did not receive any intervention during the study. Finally, the data were analyzed by the covariance analysis method at the significance level of 0.05. The results showed that the mean score of mental health and its dimensions (depression, anxiety, and stress) in the experimental group compared to the control group decreased significantly in the post-test stage (P<0.001). According to the research results, virtual acceptance and commitment to group therapy can effectively reduce the psychological problems of people suffering from COVID-19.
Background and Objectives: Patients' psychological characteristics can affect how they deal with
cardiovascular problems, and any intervention that can improve their mental state will lead to a better
response to the disease. The aim of this study was to compare the effectiveness of acceptance and
commitment therapy and schema therapy on resilience among patients with cardiovascular diseases.
Materials and Methods: This quasi-experimental study was conducted with a pretest-posttest design,
including two experimental groups and an unbalanced control group. Participants included 45 patients with
cardiovascular diseases who were referred to the Nuclear Medicine Center for diagnostic examinations and
cardiac scans in 2017 in Tehran. Participants were selected via convenience sampling method and were
randomly assigned to three groups, each including 15 participants: the commitment training group, schema
therapy training group, and the control group. Data were collected via Connor-Davidson resilience
questionnaire. After performing the pretest for all three groups, the experimental groups underwent
therapeutic intervention in 12 sessions using the commitment and acceptance therapy protocol and the
schema therapy protocol in 10 sessions. After the intervention, a posttest was performed in all three groups.
Data were analyzed using SPSS software version 21 statistical using descriptive tests and multivariate
analysis of covariance.
Results: Among the participants in the study in the schema therapy group, 9 (60%) were female, and 6
(40%) were male, in the treatment group based on commitment and acceptance, 8 (53%) were female, and 7
(47%) were male. In the control group, 5 (33%) were female, and 10 (67%) were male. In the schema
therapy experimental group, the mean (SD) resilience score in the pretest increased from 43.8 (20.4) to 58.5
(23.9) in the posttest (P=0.003). In the experimental group based on commitment and acceptance treatment,
the mean (SD) resilience score increased from 43.7 (20.3) in the pretest to 84.5 (22.8) in the posttest
(P=0.002). No significant changes were seen in the control group.
Conclusion: The study showed that both commitment and acceptance therapy interventions and schema
therapy training effectively increased resilience of individuals with cardiovascular problems, but the
effectiveness of commitment and acceptance therapy was more significant than schema therapy education.
Keywords: Acceptance and commitment therapy; Resilience; Schema therapy.
Aims The caring of schizophrenia patients is a tiresome task for their families. This research aimed to examine the effectiveness of Acceptance and Commitment Therapy (ACT) on resilience, meaning in life, and family functioning in the caregivers of patients with schizophrenia.
Methods & Materials This was a quasi-experimental study with a pretest-posttest and follow-up design and a control group. The study sample included 30 members of schizophrenia patients’ families, referring to 2 neurological and psychological rehabilitation centers in Isfahan Province, Iran. By the convenience sampling method, the experimental group received 8 ACT sessions weekly; however, the control group received no treatment. Both groups were assessed in three phases; pretest, posttest, and one-month follow-up. The assessment tools consisted of Connor-Davidson Resilience Scale, Stagger Meaning in Life Questionnaire, and McMaster Family Functioning Scale. The obtained data were analyzed in SPSS by repeated-measures Analysis of Variance (ANOVA).
Findings The collected results indicated the significant difference of posttest and follow-up phases in terms of meaning in life and family functioning scores between the control and experimental groups (P
Introduction: Depression in the elderly is one of the most important issues in the field of psychological science. A review of research has shown that more than thirty-two percent of the elderly suffer from clinical depression at least once. Depression affects the elderly with problems such as poor social skills, negative self-concept, mental-physical, cognitive, and severe anxiety. The aim of this study was to determine the effectiveness of acceptance and commitment therapy (ACT) to reduce cognitive conflicts and negative self-coming thoughts elderly patients with depression city Khorramabad. Methods: This quasi-experimental study in which the pretest-posttest control group was used. The sample consisted of 30 subjects from among the elderly (60 years and above) with depression Sheltered well-being of Khorramabad were selected and randomly assigned to experimental groups (based on acceptance and commitment therapy) and control group were assigned. Intervention in the experimental group received eight sessions of treatment based on acceptance and commitment. During this period, the control group received no intervention. To collect data reduce cognitive conflicts and negative self-coming thoughts Scale and Beck depression Inventory II scales the pre-test and post-test for both experimental and control groups were used. Results: Data were analyzed using multivariate analysis of covariance. Data analysis software program (SPSS.21) was performed. The results of covariance analysis showed a significant difference between the two groups. The findings showed that the level of reduce cognitive conflicts and negative self-coming thoughts in the experimental group was significantly lower than the control group. Conclusions: Covariance analysis showed significant differences between the two groups. Results showed that treatment based on acceptance and commitment is effective in reducing cognitive conflicts and negative self-coming thoughts. It is suggested that acceptance and commitment therapy in relevant organizations, such as those of welfare, faced with elderly people with depression, be optimized to reduce cognitive conflicts and negative self-coming thoughts.
Acceptance and Commitment Therapy (ACT) is a principle-based behavioral intervention that addresses human suffering using mindfulness and acceptance techniques along with behavioral commitments linked to personal values. While ACT has been applied to a wide variety of problems, it is well suited to the treatment of trauma based on its processes specifically designed to reduce experiential avoidance, and it has only just begun to be investigated for its effectiveness with this population. Furthermore, current drop-out and refusal rates for exposure-based therapies, the main empirically supported intervention for the treatment of posttraumatic stress disorder (PTSD), necessitate the development of alternatives. The current pilot studies evaluated a 12-session group ACT intervention with 10 veterans diagnosed with PTSD, and a 12-session individual ACT intervention with 9 veterans diagnosed with PTSD. Significant reductions in PTSD symptoms from pre to post or follow-up were found for both the group intervention (n = 10, g = 0.69) and the individual intervention (n = 9; g = 1.24). Decreases in thought suppression as well as increases in aspects of mindfulness and psychological flexibility were also found, but results were mixed and differed by the individual versus group intervention.
The World Health Organization is in the process of preparing the eleventh revision of the International Classification of Diseases (ICD-11), scheduled for presentation to the World Health Assembly for approval in 2017. The International Advisory Group for the Revision of the ICD-10 Mental and Behavioural Disorders made improvement in clinical utility an organizing priority for the revision. The uneven nature of the diagnostic information included in the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG), especially with respect to differential diagnosis, is a major shortcoming in terms of its usefulness to clinicians. Consequently, ICD-11 Working Groups were asked to collate diagnostic information about the disorders under their purview using a standardized template (referred to as a "Content Form"). Using the information provided in the Content Forms as source material, the ICD-11 CDDG are being developed with a uniform structure. The effectiveness of this format in producing more consistent clinical judgments in ICD-11 as compared to ICD-10 is currently being tested in a series of Internet-based field studies using standardized case material, and will also be tested in clinical settings.
© 2015 World Psychiatric Association.
Emotion regulation (ER) has been identified as a critical factor in the development and
maintenance of posttraumatic stress symptoms (PTS; Bardeen, Kumpula, & Orcutt, 2013 [Journal of
Anxiety Disorders, 27, 188–196]; Marx & Sloan, 2005 [Behaviour Research and Therapy, 43, 569–
583]; Nightingale & Williams, 2000 [British Journal of Clinical Psychology, 39, 243–254]). The current
meta-analysis aimed to provide a thorough, quantitative examination of the associations between
PTS and several aspects of ER. A search of the PsychINFO database resulted in 2557 titles, of which
57 met full inclusion criteria (the cross-sectional association between PTS symptoms and ER was
reported, participants were 18 years or older, the article was written in English, and sufficient
information was reported to calculate effect sizes). From the 57 studies that were included, 74 effect
sizes were obtained. All studies were independently coded by two of the study authors for the
following: citation, sample type, total N size (and group n’s if applicable), mean age of participants,
type of traumatic event, study design, PTS measure(s), ER measure(s), and effect size information.
Eight random effects models were conducted: seven for individual ER strategies (e.g., rumination)
and one for general emotion dysregulation. The largest effects were observed for general emotion
dysregulation (r ¼ 0.53; k ¼ 13), rumination (r ¼ 0.51; k ¼ 5), thought suppression (r ¼ 0.47;
k ¼ 13), and experiential avoidance (r ¼ 0.40; k ¼ 20). Medium effects were observed for expressive
suppression (r ¼ 0.29; k ¼ 3) and worry (r ¼ 0.28; k ¼ 6). Significant effects were not observed for
acceptance or reappraisal. Moderator analyses (sample and trauma type) were conducted for general
emotion dysregulation, experiential avoidance, and thought suppression; no significant differences
were observed. Findings from the current analysis suggest that several aspects of ER are associated
with PTS symptoms across a variety of samples. Additionally, the current study highlights a number
of limitations in the existing ER and PTS symptom literature. Key words: emotion regulation; PTSD;
trauma; meta-analysis.
Background
Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed.
Aims
To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP.
Method
Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress.
Results
Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress.
Conclusion
Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.
Objective:
The psychological flexibility model has been hypothesized as a transdiagnostic, process-oriented approach to understanding various clinical disorders and problems, including chronic pain, anxiety, and substance misuse. In this study we investigated the model's applicability to the experience of hearing distressing voices.
Methods:
Fifty people experiencing persisting auditory hallucinations were administered the Kentucky Inventory of Mindfulness Skills, Acceptance and Action Questionnaire, Beliefs about Voices Questionnaire-Revised, Thought Control Questionnaire, and the Beck Anxiety and Depression Inventories. We predicted that psychological flexibility, mindful action, and nonjudgemental acceptance would be negatively associated with distress, disability, and behavioural responses to voice hearing and would have additional explanatory power when included with appraisals of voices and thought-control strategies (as predicted by cognitive models of auditory hallucinations).
Results:
The results showed differential contributions between measures of psychological flexibility and nonjudgemental acceptance. Psychological flexibility accounted for a significant proportion of the variance in regression-based models of depression and anxiety, while nonjudgemental acceptance contributed to the prediction of emotional and behavioural resistance to voices, in addition to appraisals of voices and use of thought-control strategies. However, this was not found for distress associated with voice hearing, life disruption, and engagement with voices, which were explained solely by cognitive variables.
Conclusions:
The study results suggest that psychological flexibility and nonjudgemental acceptance are related to general emotional well being and resistance response styles to voices, but not to specific dimensions of voice hearing.
Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment, but how exposure is implemented in ACT for PTSD has not been well articulated. Although support for the use of ACT in PTSD treatment is limited to a handful of case studies and open trials, research suggests ACT is particularly useful in flexibly targeting avoidance behavior—arguably the most important process in the continued maintenance of PTSD symptoms. The purpose of this paper is to explore the use of exposure within ACT in PTSD treatment. Through an overview of PE and ACT, and with the use of case examples, we describe how ACT principles and techniques may inform exposure-based treatments for PTSD in order to create more flexible approaches. In addition, understanding exposure within an ACT framework may also contribute to clarifying processes of change.
The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N=5) or eye movement desensitization and reprocessing (EMDR; N=5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.
There is a small but increasing body of research to suggest that acceptance and commitment therapy (ACT) is useful for people experiencing psychosis. As an intervention, ACT does not specifically target symptom reduction but rather emphasizes more flexible responding in the presence of psychotic symptoms to encourage increases in value-driven behavior. A case study is presented, detailing use of ACT in working with someone experiencing long-standing distressing psychosis, specifically, paranoia, delusions, and associated emotional disturbance. Measures of general distress, severity, and intensity of delusional thoughts and depression were taken at two points prior to therapy starting and again post intervention. All measures showed improvements post therapy, although symptoms did not remit completely. However, the client reported significant increases in value-based activities. The results indicated that, although not a primary treatment target, ACT can help in reduction of symptoms. As expected, the intervention can also assist in increasing value-based behavior, in spite of the presence of ongoing psychotic symptoms.
Two studies were conducted to develop and evaluate an instrument intended to identify and measure personal values, values attainment, and persistence in the face of barriers. Study 1 describes a content validity approach to the construction and preliminary validation of the Bull's Eye Values Survey (BEVS), using a sample of institutionalized patients suffering from epilepsy. Study 2 investigated the psychometric properties of the BEVS with a sample of Swedish university students. Results suggest that the BEVS is sensitive to treatment effects and can differentiate between clients who receive values-based interventions and those who do not. The BEVS subscales and total score appear to measure an independent dimension of psychological functioning that is negatively correlated with measures of depression, anxiety, and stress, and positively correlated with a measure of psychological flexibility. The BEVS also exhibits acceptable temporal stability and internal consistency. The study provides preliminary support for the BEVS as both a research and clinical tool for measuring values, values-action discrepancies, and barriers to value-based living.
The study's objective was to assess the impact on clinical functioning of group based mindfulness training alongside standard psychiatric care for people with current, subjectively distressing psychosis. Data are presented from the first 10 people to complete one of four Mindfulness Groups, each lasting six sessions. People were taught mindfulness of the breath, and encouraged to let unpleasant experiences come into awareness, to observe and note them, and let them go without judgment, clinging or struggle. There was a significant pre-post drop in scores on the CORE (z = − 2.655, p = .008). Secondary data indicated improvement in mindfulness skills, and the subjective importance of mindfulness to the group process (N = 11). The results are encouraging and warrant further controlled outcome and process research.
Mindfulness, originally a construct used in Eastern spiritual and philosophical traditions, has found new utility in psychotherapy practice. Mindfulness practice has been recently applied to treatments of several psychological and health related problems, and research is showing successful outcomes in psychological interventions incorporating mindfulness practices. Several schools of psychotherapy have theorized why mindfulness may be an effective intervention. One population which would theoretically be benefited by mindfulness practice in treatment consists of those individuals who have experienced traumatic events and are exhibiting post-traumatic stress disorder and/or related correlates of past trauma. The present paper gives a general review of the application of mindfulness to clinical psychology interventions. Additionally, we explain how mindfulness is applicable to our integrative behavioral approach to treating trauma and its sequelae. Specifically, this paper will (a) give a general overview of the conceptions and applications of mindfulness to psychology and psychotherapy and provide a brief account of the concepts origins in eastern traditions; (b) discuss the theoretical conceptualization of clinical problems that may relate to the long-term correlates of trauma; (c) describe how mindfulness, acceptance and the therapeutic relationship can address trauma symptoms and discuss a modified treatment approach for trauma survivors that incorporates mindfulness and acceptance practices into traditional exposure treatment.
Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.
Military personnel who engaged in the conflicts in Afghanistan and Iraq frequently present for mental health care because of the stresses of service and readjustment. Although excellent treatments are available to treat the typical presenting problems, there is a need for additional empirically supported treatment approaches for this population. Because these veterans have high levels of comorbidity, transdiagnostic treatment - treatment that applies to more than one diagnosis - may be an efficient approach for this group. Acceptance and Commitment Therapy (ACT) is one such approach that is well-known and has high face validity for veterans, but it has not been rigorously evaluated as a treatment for trauma-related mental health problems. Described herein is an ongoing multi-site randomized clinical trial of ACT as compared to a psychotherapy control. Challenges in designing an RCT to evaluate transdiagnostic treatment and in executing a multi-site psychotherapy trial are discussed.
The presence of anxiety disorders (AD) in schizophrenia (SZ) is attracting increasing interest. However, published studies have yielded very broad variations in prevalence rates across studies. The current meta-analysis sought to (1) investigate the prevalence of co-occurring AD in SZ by reporting pooled prevalence rates and (2) identify potential sources of variations in reported rates that could guide our efforts to identify and treat these co-occurring disorders in patients with SZ.
We performed a systematic search of studies reporting prevalence of AD in SZ and related psychotic disorders. Mean prevalence rates and 95% confidence intervals (CIs) were first computed for each disorder. We then examined the impact of potential moderators related to patient sampling or to AD assessment methods on these rates.
Fifty-two eligible studies were identified. Pooled prevalence rates and CIs were 12.1% (7.0%-17.1%) for obsessive-compulsive disorders, 14.9% (8.1%-21.8%) for social phobia, 10.9% (2.9%-18.8%) for generalized AD, 9.8% (4.3%-15.4%) for panic disorders, and 12.4% (4.0%-20.8%) for post-traumatic stress disorders. For all disorders, we found significant heterogeneity in rates across studies. This heterogeneity could at least partially be explained by the effect of moderator variables related to patient characteristics or assessment methods.
AD are highly prevalent in SZ, but important variations in rates are observed between studies. This meta-analysis highlights several factors that affect risk for, or detection of AD in SZ, and could, thus, have an important impact on treatment and outcome of SZ patients.
Cognitive perspective-taking has attracted considerable attention in the mainstream developmental literature, and is most commonly studied under the rubric of Theory of Mind. The current article reviews the levels of understanding of informational states that are believed to underlie cognitive perspective-taking from thisconceptual framework. An alternative approach to perspective-taking from a functional behavioral framework is also presented. The concepts and methodologies behind this approach are driven by a modern behavioral account of human language and cognition known as Relational Frame Theory. As well as providing a brief summary of thecore concepts of Relational Frame Theory, the article presents the relational frame account of cognitive perspectivetaking. The empirical evidence in support of this view of perspective-taking as well as related research on false belief and deception are reviewed. The overlap between the Theory of Mind and Relational Frame Theoryapproaches to perspective-taking is discussed.
The clinical literature cautions against use of meditation by people with psychosis. There is, however, evidence for acceptance-based therapy reducing relapse, and some evidence for clinical benefits of mindfulness groups for people with distressing psychosis, though no data on whether participants became more mindful.
To assess feasibility of randomized evaluation of group mindfulness therapy for psychosis, to replicate clinical gains observed in one small uncontrolled study, and to assess for changes in mindfulness.
Twenty-two participants with current distressing psychotic experiences were allocated at random between group-based mindfulness training and a waiting list for this therapy. Mindfulness training comprised twice-weekly sessions for 5 weeks, plus home practice (meditation CDs were supplied), followed by 5 weeks of home practice.
There were no significant differences between intervention and waiting-list participants. Secondary analyses combining both groups and comparing scores before and after mindfulness training revealed significant improvement in clinical functioning (p = .013) and mindfulness of distressing thoughts and images (p = .037).
Findings on feasibility are encouraging and secondary analyses replicated earlier clinical benefits and showed improved mindfulness of thoughts and images, but not voices.
There are now a substantial number of controlled trials investigating the efficacy of acceptance and commitment therapy (ACT). This meta-analysis combined multiple well-controlled studies to help clarify the overall impact of ACT relative to waiting lists, psychological placebos, treatment as usual, and established therapies.
A comprehensive literature search produced 18 randomized controlled trials (n = 917) that were included in the final analyses. Effect size was computed with Hedges's g which can be interpreted with Cohen's convention of small (0.2), medium (0.5), and large (0.8) effects.
There was a clear overall advantage of ACT compared to control conditions (effect size = 0.42). The average ACT-treated participant was more improved than 66% of the participants in the control conditions. Analyzed separately ACT was superior to waiting lists and psychological placebos (effect size = 0.68) and treatment as usual (effect size = 0.42). However, ACT was not significantly more effective than established treatments (effect size = 0.18, p = 0.13). Also, ACT was not superior to control conditions for the distress problems (anxiety/depression: effect size = 0.03, p = 0.84).
The results reveal that ACT is more effective than control conditions for several problem domains, but there is no evidence yet that ACT is more effective than established treatments.
This therapist guide of prolonged exposure (PE) treatment is accompanied by the patient workbook, Reclaiming Your Life from a Traumatic Experience. The treatment and manuals are designed for use by a therapist who is familiar with cognitive behavioral therapy (CBT) and who has undergone an intensive training workshop for prolonged exposure by experts in this therapy. The therapist guide instructs therapists to implement this brief CBT program that targets individuals who are diagnosed with posttraumatic stress disorder (PTSD) or who manifest PTSD symptoms that cause distress and/or dysfunction following various types of trauma. The overall aim of the treatment is to help trauma survivors emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety. At the same time, PE has emerged from the adaption and extension of Emotional Processing Theory (EPT) to PTSD, which emphasizes the central role of successfully processing the traumatic memory in the amelioration of PTSD symptoms. Throughout this guide, the authors highlight that emotional processing is the mechanism underlying successful reduction of PTSD symptoms.
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout.
New to This Edition
*Reflects tremendous advances in ACT clinical applications, theory building, and research.
*Psychological flexibility is now the central organizing focus.
*Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation.
*Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
This book provides a practical framework for using a person based cognitive therapy approach for addressing the range of problems experienced by people with psychosis. Chapters 1-4 provide a context for the approach and chapters 5-12 cover the clinical application of the approach. Key features include; the integration of the author's work on Mindfulness (simple meditation technique that is similarly creating a lot of interest at present) for people with psychosis; inclusion of the two-chair method; plus a chapter on group therapy.
Persons with schizophrenia spectrum disorders often report high levels of childhood trauma, which often exacerbates symptoms and impede the process of recovery. However, little is known about how these traumas are experienced by service users and how they are integrated in their life stories. To examine this, we conducted in-depth interviews with 15 service users with a diagnosis of a first-episode nonaffective psychosis who had reported 1 or more childhood traumas in self-report measures. There was an unexpected discrepancy between the number of traumas reported in self-report measures and in semistructured interviews, and many of the traumas did not seem integrated in their personal narratives. The analyses further revealed that although participants often described complicated and traumatic childhood environments, they still felt supported by their families; they reported a range of ways in which they tried to cope with and gain control of their psychotic disorder, and they described a general optimistic view of the future.
In the 100 years since Eugen Bleuler unveiled his concept of schizophrenia, which had dissociation at its core, the essential connection between traumatic life events, dissociative processes and psychotic symptoms has been lost. Psychosis, Trauma and Dissociation is the first book to attempt to reforge this connection, by presenting challenging new findings linking these now disparate fields, and by comprehensively surveying, from a wide range of perspectives, the complex relationship between dissociation and psychosis. A cutting-edge sourcebook, Psychosis, Trauma and Dissociation brings together highly-respected professionals working in the psychosis field with renowned clinicians and researchers from the fields of traumatic stress, dissociation and the dissociative disorders, and will be of interest to those working with or studying psychotic or dissociative disorders, as well as trauma-related conditions such as borderline personality disorder or complex post-traumatic stress disorder. It makes an invaluable contribution to the burgeoning literature on severe mental disorders and serious life events. The book has three sections: Connecting trauma and dissociation to psychosis - an exploration of the links between trauma, dissociation and psychosis from a wide range of historical and theoretical perspectives. Comparing psychotic and dissociative disorders - a presentation of empirical and clinical perspectives on similarities and differences between the two sets of disorders. Assessing and treating hybrid and boundary conditions - consideration of existing and novel diagnostic categories, such as borderline personality disorder and dissociative psychosis, that blend or border dissociative and psychotic disorders, along with treatment perspectives emphasising humanistic and existential concerns.
Background:
Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts.
Aim:
We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment.
Methods:
In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS).
Results:
Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning.
Conclusions:
Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services.
Reviews conclude that childhood and adolescence sexual, physical, emotional abuse and emotional and physical neglect are all risk factors for psychosis. However, studies suggest only some adversities are associated with psychosis. Dose-response effects of several adversities on risk of psychosis have not been consistently found. The current study aimed to explore adversity specificity and dose-response effects of adversities on risk of psychosis.
Participants were 101 persons with first-episode psychosis (FEP) diagnosed with ICD-10 F20 - F29 (except F21) and 101 non-clinical control persons matched by gender, age and parents' socio-economic status. Assessment included the Childhood Trauma Questionnaire and parts of the Childhood Experience of Care and Abuse Questionnaire.
Eighty-nine percent of the FEP group reported one or more adversities compared to 37% of the control group. Childhood and adolescent sexual, physical, emotional abuse, and physical and emotional neglect, separation and institutionalization were about four to 17 times higher for the FEP group (all p<0.01). The risk of psychosis increased two and a half times for each additional adversity. All associations between specific adversities and psychosis decreased when they were adjusted for other adversities.
Our findings suggest that there is a large shared effect of adversities on the risk of psychosis. Contrary to the call for further research into specific adversities, we suggest a search for mechanisms in the shared effects of traumatization. Clinical implications are thorough assessment of adversities and their possible effects.
Copyright © 2015 Elsevier B.V. All rights reserved.
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
Objectives
The study examined (1) the role of experiential avoidance (EA), conceptualized as intolerance towards aversive mental states, in paranoid delusions and (2) the mechanisms underlying EA.DesignA 6-day prospective momentary assessment study.Methods
Paranoid patients (N = 41) were studied using the experience sampling method (ESM), a structured diary technique, assessing psychopathology and current context in daily life.ResultsThe results showed that both low self-esteem and EA contributed to paranoid thinking. The relationship between low self-esteem and paranoia was partially mediated by EA and the relationship between EA and paranoia was partially mediated by low self-esteem. The detrimental effect of EA on self-esteem was more pronounced under high activity-related stress. Both EA and social stress were independently associated with low self-esteem. EA was associated with self-esteem instability.Conclusions
Our results implicate mental control strategies in the development of paranoia and are compatible with the attributional model of paranoia, which suggests that persecutory delusions arise as a result of dysfunctional attempts to avoid unpleasant thoughts about the self.Practitioner pointsInterventions for paranoid individuals should target low tolerance towards negative mental states, for example using mindfulness and ACT therapeutic approaches.Interventions designed for individuals suffering from persecutory delusions should also address unfavourable views about the self.LimitationsAvoidance of unpleasant mental states may operate outside the individual's awareness and self-report measures of EA may be unable to adequately tap this process.Self-reflection abilities of psychotic patients may be impaired.
It has been asserted that psychotherapy might help persons with schizophrenia to improve their capacity for metacognition, that is, their ability to think about their own thinking and the thinking of others. To explore this issue, metacognitive capacity, delusions, and insight were assessed using the psychotherapy transcripts of an adult with schizophrenia and severe delusions for a period of time spanning 32 months. Correlations revealed that metacognitive capacity increased as symptoms and lack of insight decreased. Results suggest that metacognitive capacities increased before symptoms changed and that awareness of one's own thoughts emerged before awareness of others’ thoughts. Progress appeared to be initially volatile, with early gains sustained only after approximately 1½ years.
Although post-traumatic stress disorder (PTSD) and substance abuse are commonly co-occuring conditions, it is generally recommended that an individual must first receive successful substance abuse treatment before posttraumatic symptoms can be addressed. Given the high comorbidity of these conditions, however, it would be helpful if more broadly focused therapies were available that simultaneously targeted common functional processes underlying the multiple problems of the dually diagnosed. Both PTSD and substance abuse can be conceptualized as disorders with significant experiential avoidance components. One treatment that has been specifically developed for the treatment of experiential avoidance is Acceptance and Commitment Therapy (ACT). In this case study, application of ACT for an individual with comorbid PTSD and substance abuse is described, and its effects are examined.
Contrary to long-standing pessimistic views regarding the prognosis for people with schizophrenia, emerging literature suggests that many with this condition can meaningfully recover over time. Using increasingly complex models of recovery with clearly defined operationalized criteria, numerous longitudinal studies have provided data pointing out that progressive deterioration is more of an exception than a rule for people with this condition. To address the issues of the definition and likelihood of recovery from schizophrenia, this article reviews evolving definitions which stress that recovery must involve the development of a sense of hope, self-reliance, and a personalized awareness of current strengths and challenges. Empirical research indicates that while many with schizophrenia experience significant bouts of disability, more people experience long periods of relatively good functioning, including symptom remission, healthy levels of self-esteem, and meaningful community participation. Implications for how clinical practice can reinforce and promote recovery are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews the treatment guidelines of eight different cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD): exposure therapy (EX), systematic desensitization, stress inoculation training, cognitive processing therapy, cognitive therapy, assertiveness training, biofeedback and relaxation training, as well as combination approaches. EX was found to be the most efficacious in treating PTSD patients. CBT techniques are generally very short-term, averaging approximately 8–12 sessions, meeting once or twice weekly. Recommendations and limitations for each of the treatments are examined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Subscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the UK to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors.
An adult woman with chronic posttraumatic stress disorder (PTSD) and major depressive disorder who was nonresponsive to 20 sessions of cognitive behavior therapy (CBT) is presented in this case study. Two months after her CBT trial, she was treated with 21 sessions of Acceptance and Commitment Therapy (ACT) for PTSD. Measurements of PTSD severity, depression, anxiety, psychological flexibility and trauma-related thoughts and beliefs were taken at pretreatment, after Sessions 8 and 16, and at posttreatment. Results showed significant reduction on all measures throughout treatment, except for trauma-related thoughts and beliefs, which did not decrease until near the end of treatment. Strengths, limitations, and future directions are discussed.
There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.
Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiety disorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to down-regulate and control unwanted private events (thoughts, images, bodily sensations). The goal is to foster more flexible and mindful ways of relating to anxiety so individuals can pursue life goals important to them. This article describes in some detail a unified ACT protocol that can be adapted for use with persons presenting with any of the major anxiety disorders. To exemplify this approach, we present pre- and posttreatment data from three individuals with different anxiety disorders who underwent treatment over a 12-week period. The results showed positive pre- to posttreatment changes in ACT-relevant process measures (e.g., reductions in experiential avoidance, increases in acceptance and mindfulness skills), increases in quality of life, as well as significant reductions in traditional anxiety and distress measures. All three clients reported maintaining or improving on their posttreatment level of functioning.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.
The experience of psychosis can lead to depression, anxiety and fear. Acceptance and Commitment Therapy (ACT) facilitates individuals to accept difficult mental experiences and behave in ways that are consistent with personally held values. This study was a single (rater) blind pilot randomised controlled trial of ACT for emotional dysfunction following psychosis. Twenty-seven participants with psychosis were randomised to either: ten sessions of ACT plus treatment as usual (TAU) or TAU alone. The Hospital Anxiety and Depression Scale, Positive and Negative Syndrome Scale, Acceptance and Action Questionnaire, Kentucky Inventory of Mindfulness Skills and Working Alliance Inventory were used. Individuals were assessed at baseline and 3 months post-baseline. The individuals randomised to receive ACT found the intervention acceptable. A significantly greater proportion of the ACT group changed from being depressed at time of entry into the study to not being depressed at follow-up. The ACT group showed a significantly greater increase in mindfulness skills and reduction in negative symptoms. Results indicated that individuals randomised to ACT had significantly fewer crisis contacts over the study. Changes in mindfulness skills correlated positively with changes in depression. ACT appears to offer promise in reducing negative symptoms, depression and crisis contacts in psychosis.
There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.
Clinical investigators have argued that the experience of a recent onset of psychosis is an event of such severity that it can lead to posttraumatic stress disorder (PTSD), or at least to PTSD symptoms. The traumagenic elements of the psychotic experience may relate to the distressing nature of psychotic symptoms, components of treatment, or both. However, this hypotheses has not been fully empirically evaluated. In particular, the importance of the DSM-IV A1 (perception of threat) and A2 (negative emotion at time of event) criteria for a traumatic event due to a psychotic episode has not been assessed. To address this question, 38 clients in treatment for recent onset of psychosis were interviewed to identify distressing experiences related to the episode, with PTSD assessed (including A1/A2 criteria) related to those events. More than one-half of the participants reported intense distress related to psychotic symptoms or treatment experiences, with 66% meeting symptom criteria for the PTSD syndrome (regardless of A1/A2), and 39% meeting full diagnostic criteria for PTSD (including A1/A2). Both participants with the PTSD syndrome and full PTSD reported more problems in daily functioning and more severe symptoms than those without PTSD. Participants with the PTSD syndrome were also more likely to have an integrative rather than sealing over coping style compared to those without the PTSD syndrome. The results suggest that individuals with PTSD symptoms related to a recent onset of psychosis may benefit from intervention designed to help them integrate their experience into their lives and address potentially stigmatizing beliefs that could contribute to distress and impaired functioning.
Acceptance and Commitment Therapy (ACT, Hayes, Strosahl, & Wilson, 1999) is a behaviorally based intervention designed to target and reduce experiential avoidance and cognitive fusion (holding the thoughts in one’s mind to be literally true) while at the same time helping clients to make powerful life enhancing behavioral changesthat are in line with their personal values. As a therapeutic approach, ACT is specifically used to help clients come into contact with an experiential sense of knowing, rather than relying too heavily on verbal knowledge. That is, clients are taught to see themselves as a context for ongoing experiential events that include all things occurring inside the skin, emotion, thinking, memories, and bodily sensations, without excessive verbal involvement andcontrol. The goal is to reduce experiential avoidance and move toward meaningful life paths, or more generally, to help the client who has fallen into rigid way of thinking and behaving to become more psychologically and behaviorally flexible.
In an open trial design, adults (n=20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n=13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts.
Psychiatric comorbidities are common among patients with schizophrenia. Substance abuse comorbidity predominates. Anxiety and depressive symptoms are also very common throughout the course of illness, with an estimated prevalence of 15% for panic disorder, 29% for posttraumatic stress disorder, and 23% for obsessive-compulsive disorder. It is estimated that comorbid depression occurs in 50% of patients, and perhaps (conservatively) 47% of patients also have a lifetime diagnosis of comorbid substance abuse. This article chronicles these associations, examining whether these comorbidities are "more than chance" and might represent (distinct) phenotypes of schizophrenia. Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. Additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives and searches for genetic and environmental risk factors are needed to replicate preliminary findings and further investigate these associations.