Johns Louise C, Oliver Joseph E, Khondoker Mizanur, Byrne Majella, Jolley Suzanne, Wykes Til, Joseph Candice, Butler Lucy, Craig Thomas, Morris Eric M J
South London and Maudsley NHS Foundation Trust, London, UK; King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
J Behav Ther Exp Psychiatry. 2016 Mar;50:257-63. doi: 10.1016/j.jbtep.2015.10.001. Epub 2015 Oct 8.
Acceptance and Commitment Therapy (ACT) is a contextual cognitive-behavioural approach with a developing evidence base for clinical and cost-effectiveness as an individually-delivered intervention to promote recovery from psychosis. ACT also lends itself to brief group delivery, potentially increasing access to therapy without inflating costs. This study examined, for the first time, the feasibility and acceptability of ACT groups for people with psychosis (G-ACTp).
Participants were recruited from community psychosis teams. Ratings of user satisfaction, and pre-post change in self-rated functioning (primary outcome), mood (secondary outcome) and ACT processes were all completed with an independent assessor. Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures.
Independently assessed acceptability and satisfaction were high. Functioning (Coeff. = -2.4, z = -2.9, p = 0.004; 95% CI: -4.0 to -0.8; within subject effect size (ES) d = 0.4) and mood (Coeff. = -2.3, z = -3.5, p = 0.001; 95% CI: -3.5 to -1.0; d = 0.4) improved from baseline to follow-up. Commensurate changes in targeted ACT processes were consistent with the underlying model.
The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Participants may have improved as a result of other factors, and findings require replication in a randomized controlled trial (RCT).
This preliminary study showed that brief group ACT interventions for people with psychosis are feasible and acceptable. Uncontrolled, pre-post assessments suggest small clinical improvements, and changes in psychological processes consistent with an ACT model. Replication in an RCT is required, before implementation can be recommended.
接纳与承诺疗法（ACT）是一种情境认知行为疗法，其临床疗效和成本效益的证据基础正在不断发展，作为一种个体实施的干预措施，可促进精神病患者的康复。ACT也适用于简短的团体治疗，有可能在不增加成本的情况下增加治疗的可及性。本研究首次检验了针对精神病患者的ACT团体治疗（G-ACTp）的可行性和可接受性。
参与者从社区精神病团队招募。用户满意度评分以及自我评定功能（主要结局）、情绪（次要结局）和ACT过程的前后变化均由独立评估者完成。在招募的89人中，83人完成了基线测量，69人开始了为期四周的G-ACTp干预，65人完成了后续测量。
经独立评估，可接受性和满意度较高。从基线到随访，功能（系数=-2.4，z=-2.9，p=0.004；95%CI：-4.0至-0.8；组内效应量（ES）d=0.4）和情绪（系数=-2.3，z=-3.5，p=0.001；95%CI：-3.5至-1.0；d=0.4）有所改善。目标ACT过程的相应变化与基础模型一致。
非对照的前后设计排除了盲法评估，可能夸大了效应量。参与者可能因其他因素而有所改善，研究结果需要在随机对照试验（RCT）中重复验证。
这项初步研究表明，针对精神病患者的简短团体ACT干预是可行且可接受的。非对照的前后评估显示临床有小幅改善，心理过程的变化与ACT模型一致。在建议实施之前，需要在RCT中进行重复验证。
