接受和承诺疗法治疗精神病：随机对照试验。
Acceptance and commitment therapy for psychosis: randomised controlled trial.
机构信息
Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia.
Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
出版信息
Br J Psychiatry. 2017 Feb;210(2):140-148. doi: 10.1192/bjp.bp.116.182865. Epub 2016 Dec 15.
BACKGROUND
The efficacy of acceptance and commitment therapy (ACT) in psychosis has been reported but not for medication-resistant psychosis.
AIMS
To test the efficacy of ACT in a sample of community-residing patients with persisting psychotic symptoms. (Australian New Zealand Clinical Trials Registry: ACTRN12608000210370.) METHOD: The primary outcome was overall mental state at post-therapy (Positive and Negative Syndrome Scale - total); secondary outcomes were psychotic symptom dimensions and functioning. In total, 96 patients were randomised to ACT (n = 49) or befriending (n = 47). Symptom, functioning and process measures were administered at baseline, post-therapy and 6 months later.
RESULTS
There was no group difference on overall mental state. In secondary analyses the ACT group showed greater improvement in positive symptoms and hallucination distress at follow-up: Cohen's d = 0.52 (95% CI 0.07-0.98) and 0.65 (95% CI 0.24-1.06), respectively.
CONCLUSIONS
Improvements reflected the treatment focus on positive symptoms; however, absence of process-measure changes suggests that the ACT intervention used did not manipulate targeted processes beyond befriending. Symptom-specific therapy refinements, improved investigation of process and attention to cognitive functioning and dose are warranted in future research.
背景
接受与承诺疗法（ACT）在精神病学中的疗效已得到报道，但针对药物抵抗性精神病尚未有报道。
目的
在持续存在精神病症状的社区居住患者中测试 ACT 的疗效。（澳大利亚新西兰临床试验注册处：ACTRN12608000210370。）
方法
主要结局是治疗后总体心理状态（阳性和阴性综合征量表-总分）；次要结局是精神病症状维度和功能。共有 96 名患者被随机分配至 ACT 组（n = 49）或交友组（n = 47）。在基线、治疗后和 6 个月后，分别进行症状、功能和过程测量。
结果
在总体心理状态上，两组之间没有差异。在次要分析中，ACT 组在随访时阳性症状和幻觉困扰方面有更大的改善：Cohen's d = 0.52（95%CI 0.07-0.98）和 0.65（95%CI 0.24-1.06）。
结论
这些改善反映了治疗对阳性症状的关注；然而，过程测量变化的缺失表明，所使用的 ACT 干预除了交友之外，并没有操纵目标过程。在未来的研究中，需要对症状特异性治疗进行改进，更深入地研究过程，并关注认知功能和剂量。
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