Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Department of Psychiatry, University of Oxford, UK.
Br J Clin Psychol. 2020 Nov;59(4):524-551. doi: 10.1111/bjc.12265. Epub 2020 Sep 17.
Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation.
Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up.
Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs.
Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion.
Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.
心理干预可减轻精神病的影响，但大范围实施存在问题。我们测试了由一线工作人员实施、并由经验丰富的服务使用者专家共同实施的团体接纳与承诺疗法治疗精神病（G-ACTp）的可行性，以服务使用者和非正式照顾者为对象（ISRCTN：68540929）。我们估计了未来评估的招募/保留率和结果变异性。
工作人员和经验丰富的服务使用者专家共同实施者参加了为期一天的研讨会，然后提供了密切监督的 G-ACTp，包括四个疗程（第 1-4 周）和两个强化疗程（第 10 和 12 周）。从成人社区精神病服务中招募的参与者被随机分配立即接受 G-ACTp 或在 12 周后接受 G-ACTp，在 0、4 和 12 周时完成结果评估。在随机分组前 1 年、0-12 周和 5 年未控制的随访期间，计算了每月的服务使用情况。
在接受培训的 41 名实施者中（29 名工作人员，12 名经验丰富的服务使用者），有 29 名（71%；17 名工作人员，12 名经验丰富的服务使用者）提供了 18 个 G-ACTp 课程。参与者拒绝率较低（服务使用者 9%[10/112]；照顾者 5%[4/79]）；邀请参加的参与者中有 60%参加了至少 1 次 G-ACTp 课程（服务使用者 64%[39/61]；照顾者 56%[35/63]）。实施者和参与者的随机化证明存在问题，参与者的随访不完整（78%[66/85]；服务使用者 82%[36/44]；照顾者 73%[30/41]）。效应大小从很小到很大，主要有利于治疗。服务使用减少需要谨慎解释，因为很少有参与者产生费用。
对于服务使用者来说，实施似乎是可行的；对于照顾者来说，保留率需要提高。结果变异性表明，每组需要 100-300 名参与者进行随访（α=0.05，90%效力）。需要复制方法学限制的结果：在有疗程结果完成的聚类随机设计中，可能会减少潜在偏倚的来源。
团体接纳与承诺疗法可以成功地适用于精神病患者及其照顾者。在常规社区心理健康护理环境中，可以成功实施（培训和提供）。临床和经济结果很有希望，但需要复制。为未来的研究提出了建议。
