Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Psychother Psychosom. 2022;91(6):411-423. doi: 10.1159/000522274. Epub 2022 Mar 18.
INTRODUCTION/OBJECTIVE: This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU.
Individuals aged 15-65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles.
Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ2(3) = 9.05; p = 0.033), and negative symptoms (χ2(3) = 19.91; p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (χ2(3) = 21.56; p < 0.001).
INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.
介绍/目的：本研究旨在探究在常规治疗（TAU）基础上，结合面对面治疗和生态瞬时干预（EMI）的日常生活中的接纳与承诺疗法（ACT-DL）对精神病性困扰的疗效，与 TAU 相比。
年龄在 15-65 岁之间，有临床确定的超高危或首发精神病的个体被随机分配到 TAU 或 ACT-DL+TAU。ACT-DL+TAU 由 8 次 ACT 治疗和 EMI 应用组成。主要结局是用风险心理状态综合评估量表（CAARMS）评估的精神病性困扰，在干预后和 6 个月和 12 个月的随访中。次要结局是功能、症状严重程度和瞬时精神病性困扰。我们根据意向治疗原则进行了多变量混合模型分析。
2015 年 6 月 1 日至 2018 年 12 月 31 日期间，共有 668 名患者被转介，其中 148 名被随机分配到 ACT-DL+TAU（n=71）或 TAU（n=77）。115 名（78%）至少在一次随访评估中提供了主要结局数据。ACT-DL+TAU 与 TAU 相比，主要结局测量 CAARMS 困扰没有减少的证据（χ2(3)=2.36；p=0.50）。然而，在测试的次要结局中，与 TAU 相比，整体功能（χ2(3)=9.05；p=0.033）和阴性症状（χ2(3)=19.91；p<0.001）以及瞬时精神病性困扰（χ2(3)=21.56；p<0.001）都有所改善。
INTERACT 不支持 ACT-DL 对 CAARMS 评估的精神病性困扰主要结局测量的效果优于 TAU。尽管发现了一些次要结局测量的显著改善，但需要进一步的复制研究来确认这些效果的强度和特异性。
