Is it the symptom or the relation to it? Investigating potential mediators of change in Acceptance and Commitment Therapy for psychosis
Open accessAbstract
Cognitive and behavioral interventions have been shown to be efficacious when used as an adjunct to pharmacotherapy for psychotic disorders. However, little previous research has investigated potential mediators of change in psychological treatments for psychosis. Acceptance and mindfulness-based therapies do not focus on directly reducing the psychotic symptoms themselves, but instead attempt to alter the patient's relationship to symptoms to decrease their negative impact. The current study examined this issue with data from a previously published randomized trial comparing brief treatment with Acceptance and Commitment Therapy (ACT) versus treatment as usual for hospitalized patients with psychotic symptoms (Gaudiano & Herbert, 2006a). Results showed that the believability of hallucinations at posttreatment statistically mediated the effect of treatment condition on hallucination-related distress. Hallucination frequency did not mediate outcome. The current study is a first step toward understanding the potential mechanisms of action in psychological treatments for psychosis.
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Cognitive defusion has been found to mediate symptom distress in psychosis via reduced believability of thought and voice content and changes in metacognitive beliefs and coping skills.
“It has also been found to mediate symptom distress in psychosis via reduced believability of thought and voice content (131), and changes in metacognitive beliefs and coping skills (18).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [131]
The Results (Mediation Analyses; page unavailable) report that hallucination believability significantly mediated ACT’s effect on hallucination-related distress, and the Discussion interprets this as a more defused stance toward voices. The study did not establish a separate mediation effect for the believability of thoughts. The metacognitive-beliefs and coping-skills clause is attached to a different citation and is not assessed here. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOne RCT was deemed to be at high risk of bias across all six domains.
“One RCT was deemed to be at high risk of bias across all six domains (Gaudiano and Herbert, 2006, Gaudiano et al., 2010).”
From A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis (2020) · cites this paper as Gaudiano et al., 2010
Dans des études sur la dépression et les troubles psychotiques, l'amélioration après un traitement ACT dépend de l'adhésion (ou la fusion) aux pensées (dépressives ou hallucinatoires) et non de leur fréquence.
“Dans des études sur la dépression et les troubles psychotiques, l'amélioration après un traitement ACT dépend de l'adhésion (ou la fusion) aux pensées (dépressives ou hallucinatoires) et non de leur fréquence (Gaudiano, Herbert et Hayes, 2010 ; Zettle, Rains et Hayes, 2011).”
From Le modèle de la flexibilité psychologique : une approche nouvelle de la santé mentale (2014) · cites this paper as Gaudiano, Herbert et Hayes, 2010
ACT reduced distress related to hallucinations in psychotic disorder.
“while other studies showed that ACT reduced distress related to hallucinations in psychotic disorder (Gaudiano et al., 2010)”
From Acceptance and Commitment Therapy and white matter plasticity in individuals with subclinical depression and psychotic experiences: A Randomised Controlled Trial (2023) · cites this paper as Gaudiano et al., 2010
Two small randomized trials showed that ACT significantly reduces distress related to hallucinations and re-hospitalization for in-patients with psychosis, with effects extending to up to 1 year post-discharge.
“Two small randomized trials showed that ACT significantly reduces distress related to hallucinations [42], [43] as well as re-hospitalization for in-patients with psychosis [18], with effects extending to up to 1 year post-discharge [44].”
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“Primary study outcomes are presented in the original manuscript and thus will not be reported here (Gaudiano & Herbert, 2006a).2 The current analyses were limited to testing the statistical mediation of treatment effects based on patients' ratings of hallucinations.”
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“Gaudiano, Herbert, and Hayes (2010) recently found that the decreased believability of symptoms mediated reductions in hallucination distress in their original study, suggesting that cognitive defusion may be a particularly important pathway of change in ACT for psychosis.”
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“The Cognitive Fusion Questionnaire (CFQ, Gillanders et al., 2014) is a 7-item scale designed to assess the extent to which a person's behaviour is”
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Freeman, D. H. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.08.012 · Cited by 80 · see citing works
“This metacognitive aspect of the intervention overlaps with recent mindfulness and ACT approaches to psychosis (e.g. Chadwick et al., 2009; Gaudiano et al., 2010).”
MethodBach, P., Gaudiano, B. A., Hayes, S. C., & Herbert, J. D. (2013) · Psychosis · doi:10.1080/17522439.2012.671349 · Cited by 73 · see citing works
“The present study confirms and extends previous findings that ACT reduced hospitalization and extends the finding (Gaudiano et al., 2010) that reduced symptom believability-mediated changes in the symptom distress to rehospitalization itself.”
BackgroundResultSelf-citationLópez-Navarro, E., Del Canto, C., Belber, M., Mayol, A., Fernández-Alonso, O., Lluis, J., Munar, E., & Chadwick, P. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.08.016 · Cited by 66 · see citing works
Wood, L., Williams, C., Billings, J., & Johnson, S. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.03.041 · Cited by 63 · see citing works
“…6.4(1.8) Boden (2016) ACT NR 4 1-hr (standalone) NR NR NR Individual 12 NR USA 53.4 (17.5) 18/18 100 2.8 (1.6) session attendance TAU 6 Gaudiano2006 (Gaudiano, 2010)* ACT Positive symptom & rehospitalisation 4 1-hr (standalone) NR NR NR Individual 19 4, 12 40 (10) 64% male 100 NR ETAU 15m daily…”
InfluentialMindfulness-Based Treatment for People With Severe Mental Illness: A Literature Review
Davis, L., & Kurzban, S. (2012) · American Journal of Psychiatric Rehabilitation · doi:10.1080/15487768.2012.679578 · Cited by 61 · see citing works
Vilardaga, R., Estévez, A., Levin, M. E., & Hayes, S. C. (2012) · The Psychological Record · doi:10.1007/bf03395811 · Cited by 53 · see citing works
Self-citationGaudiano, B. A., Nowlan, K., Brown, L. A., Epstein-Lubow, G., & Miller, I. W. (2013) · Behavior Modification · doi:10.1177/0145445512465173 · Cited by 49 · see citing works
“Research on ACT for psychosis suggests that working with psychotic symptoms in this more indirect fashion can paradoxically lead to changes in the believability of symptoms, perhaps through the reduction of avoidancebased coping and the adoption of a mindful outlook that allows these problems to resolve on their own a…”
BackgroundSelf-citationThe evidence base of Acceptance and Commitment Therapy (ACT) in psychosis: A systematic review
Wakefield, S., Roebuck, S., & Boyden, P. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.07.001 · Cited by 49 · see citing works
Pahnke, J., Hirvikoski, T., Bjureberg, J., Bölte, S., Jokinen, J., Bohman, B., & Lundgren, T. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.04.002 · Cited by 48 · see citing works
Vilardaga, R., Hayes, S. C., Atkins, D. C., Bresee, C., & Kambiz, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.04.003 · Cited by 49 · see citing works
“A formal measure of experiential acceptance was not taken because none had yet been developed, however the re-hospitalization outcome was mediated by the increased ability to notice positive psychotic symptoms without believing them (Bach, Gaudiano, Hayes, & Herbert, 2013; Gaudiano, 2010; Gaudiano & Herbert, 2006b).”
Self-citationMorris, E. M. J., Johns, L., & Gaudiano, B. A. (2023) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12479 · Cited by 42 · see citing works
Self-citationRobust Mediation Analysis: The R Package robmed
Alfons, A., s, N. Y. A., & Groenen, P. J. F. (2022) · Journal of Statistical Software · doi:10.18637/jss.v103.i13 · Cited by 40 · see citing works
“…Erreygers, Vandebosch, Vranjes, Baillien, and De Witte (2018) find that poor sleep quality in adolescents explains cyberbullying through anger, and Gaudiano, Herbert, and Hayes (2010) report that the be-lievability of hallucinations after treatment for psychotic disorders mediates the relationship…”
Network analysis: A new psychometric approach to examine the underlying ACT model components
Christodoulou, A., Michaelides, M. P., & Karekla, M. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.10.002 · Cited by 41 · see citing works
Landstra, J. M. B., Ciarrochi, J., Deane, F. P., & Hillman, R. J. (2013) · British Journal of Health Psychology · doi:10.1111/bjhp.12026 · Cited by 40 · see citing works
Acceptance-based Behavior Therapy for Depression With Psychosis
GAUDIANO, B. A., BUSCH, A. M., WENZE, S. J., NOWLAN, K., EPSTEIN-LUBOW, G., & MILLER, I. W. (2015) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000092 · Cited by 37 · see citing works
Self-citationBacon, T., Farhall, J., & Fossey, E. (2014) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000209 · Cited by 36 · see citing works
“Previous ACTp research found “believability” – the extent to which a symptom is considered to be true – negatively mediates associated distress (Bach, Gaudiano, Hayes and Herbert, 2012; Gaudiano et al., 2010).”
BackgroundInfluentialLe modèle de la flexibilité psychologique : une approche nouvelle de la santé mentale
Dionne, F., Ngô, T.-L., & Blais, M.-C. (2014) · Santé mentale au Québec · doi:10.7202/1023992ar · Cited by 36 · see citing works
Castilho, P., Martins, M. J., Pinto, A. M., Viegas, R., Carvalho, S., & Madeira, N. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.11.007 · Cited by 31 · see citing works
Collip, D., Geschwind, N., Peeters, F., Myin-Germeys, I., van Os, J., & Wichers, M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0066747 · Cited by 28 · see citing works
“Two small randomized trials showed that ACT significantly reduces distress related to hallucinations [42,43] as well as re-hospitalization for inpatients with psychosis [18], with effects extending to up to 1 year post-discharge [44].”
BackgroundMak, W. W. S., Chio, F. H. N., Chong, K. S. C., & Law, R. W. (2021) · Mindfulness · doi:10.1007/s12671-020-01568-3 · Cited by 27 · see citing works
Running acceptance and commitment therapy groups for psychosis in community settings
Butler, L., Johns, L., Byrne, M., Joseph, C., O’Donoghue, E., Jolley, S., Morris, E. M. J., & Oliver, J. E. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.12.001 · Cited by 25 · see citing works
El‐Ashry, A. M., Abd-Eldayem, S. M., & Ramadan, F. (2021) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2021.01.003 · Cited by 26 · see citing works
A Case Study of Overselling Psychotherapy: An ACT Intervention for Diabetes Management
O’Donohue, W., Snipes, C., & Soto, C. G. (2015) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-015-9308-1 · Cited by 23 · see citing works
Gaudiano, B., Davis, C., Epstein-Lubow, G., Johnson, J., Mueser, K., & Miller, I. (2017) · Healthcare · doi:10.3390/healthcare5020023 · Cited by 22 · see citing works
“Changes in believability of psychotic symptoms mediated the effects of treatment condition on levels of distress about psychotic symptoms at hospital discharge [47].”
BackgroundSelf-citationCognitive Fusion Mediates the Impact of Attachment Imagery on Paranoia and Anxiety
Sood, M., & Newman‐Taylor, K. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10127-y · Cited by 23 · see citing works
“Similarly, believability (a proxy for fusion) of psychotic experience mediated rehospitalization rates following therapy for inpatients with psychosis (Bach and Hayes 2002), whereas decreased believability (or defusion) mediated reductions in psychosis-related distress (Gaudiano et al. 2010).”
BackgroundLee, J., Lim, J., Kang, S., Kim, S., Jung, S. Y., Kim, S., Hong, S., & Park, Y. R. (2024) · JMIR Human Factors · doi:10.2196/52295 · Cited by 20 · see citing works
Paget, A., & Ellett, L. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.12.001 · Cited by 17 · see citing works
Wilson, K. G., Bordieri, M. J., Flynn, M. K., Lucas, N. N., & Slater, R. M. (2011) · doi:10.1002/9781118001851.ch10 · Cited by 18 · see citing works
Fielding-Smith, S. F., Hayward, M., Strauss, C., Fowler, D., Paulik, G., & Thomas, N. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01129 · Cited by 17 · see citing works
“Social and occupational engagement are emphasized by a number of exisiting interventions, for example Social Recovery Focused Cognitive Therapy (Fowler et al., 2009), Acceptance and Commitment Therapy (Gaudiano et al., 2010) and Person Based Cognitive Therapy (Chadwick, 2006), and may be particularly helpful for voice…”
BackgroundMechanisms of change in an Internet-Based ACT study for depression in China
Zhao, C., Ren, Z., Jiang, G., & Zhang, L. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.03.004 · Cited by 14 · see citing works
Schizophrenia: An exploration of an acceptance, mindfulness, and compassion-based group intervention
Martins, M. J., Castilho, P., Santos, V., & Gumley, A. (2017) · Australian Psychologist · doi:10.1111/ap.12210 · Cited by 13 · see citing works
“In a single case series, Mayhew and Gilbert (2008) found that CFT was feasible and acceptable and that participants showed decreases in depression, psychoticism, anxiety, obsessive–compulsive symptoms, paranoia, and interpersonal sensitivity at post-inter- vention. Laithwaite et al. (2009) found improvements associate…”
BackgroundMethodThe Relation between Negative Automatic Thoughts and Psychological Inflexibility in Schizophrenia
Popa, C. O., Rus, A. V., Lee, W. C., Cojocaru, C. M., Schenk, A., Văcăraș, V., Olah, P., Mureşan, S., Szasz, S., & Bredicean, C. A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11030871 · Cited by 13 · see citing works
“Consequently, PI has a negative impact on the well-being and quality of life of individuals with psychotic disorders [25,26].”
BackgroundAcceptance and Commitment Therapy in Group Format for College Students
Christodoulou, V., Flaxman, P. E., & Lloyd, J. (2021) · Journal of College Counseling · doi:10.1002/jocc.12192 · Cited by 12 · see citing works
Monestès, J., Vavasseur-Desperriers, J., Villatte, M., Denizot, L., Loas, G., & Rusinek, S. (2014) · L Encéphale · doi:10.1016/j.encep.2014.01.006 · Cited by 12 · see citing works
Lüdtke, T., Platow-Kohlschein, H., Rüegg, N., Berger, T., Moritz, S., & Westermann, S. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00228 · Cited by 12 · see citing works
“A person who hears voices twice as often does not necessarily suffer twice as much (17).”
BackgroundMartins, M. J. R. V., Castilho, P., Carvalho, C. B., Pereira, A. T., Santos, V., Gumley, A., & de Macedo, A. F. (2017) · European Psychologist · doi:10.1027/1016-9040/a000283 · Cited by 11 · see citing works
“…reporting (reporting bias) Other bias Bach and Hayes (2002)/Bach et al. (2012) Unclear Unclear Unclear Low Low Unclear Low Gaudiano and Herbert (2006)/Gaudiano et al. (2010) Low High High High Low Unclear Low Williams et al. (2008) Unclear Unclear Low Low Unclear Unclear Low Chadwick et al. (2009)…”
BackgroundMindfulness and Acceptance: The Perspective of Acceptance and Commitment Therapy
Levin, M. E., & Hayes, S. C. (2011) · Wiley eBooks · doi:10.1002/9781118001851.ch12 · Cited by 11 · see citing works
Self-citationDavies, B. E., Morgan, S., John-Evans, H., & Deere, E. (2019) · The Journal of Forensic Psychiatry & Psychology · doi:10.1080/14789949.2019.1614650 · Cited by 9 · see citing works
“In an investigation into the mediators of change after ACTp intervention, Gaudiano, Herbert, and Hayes (2010) found that 68% of the variance of the effect of treatment on distress was explained by hallucination believability at post-treatment.”
BackgroundDuff, H., Larsson, A., & McHugh, L. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.11.003 · Cited by 10 · see citing works
Mindfulness and Acceptance Techniques
Herbert, J. D., & Forman, E. M. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt07 · Cited by 10 · see citing works
Self-citationWaldeck, D., Pancani, L., Morris, E. M. J., Adie, J. W., Holliman, A. J., & Tyndall, I. T. (2022) · Current Psychology · doi:10.1007/s12144-022-04008-8 · Cited by 9 · see citing works
Garrosa, E., Blanco‐Donoso, L. M., Jiménez, B. M., González, A., Fraca, M., & Meniz, M. J. (2014) · Anales de Psicología · doi:10.6018/analesps.30.2.148701 · Cited by 9 · see citing works
Clen, S. L., Mennin, D. S., & Fresco, D. M. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt05 · Cited by 10 · see citing works
Understanding and Enhancing Psychological Acceptance
Herbert, J. D., & Brandsma, L. L. (2015) · Sage eBooks · doi:10.4135/9781483385822.n5 · Cited by 8 · see citing works
Self-citationAcceptance and commitment therapy for psychosis in community-based mental health center
Burhan, H. Ş., & Karadere, M. E. (2020) · Anatolian Journal of Psychiatry · doi:10.5455/apd.93130 · Cited by 8 · see citing works
Radical psychotic doubt and epistemology
Jeppsson, S. M. I. (2022) · Philosophical Psychology · doi:10.1080/09515089.2022.2147815 · Cited by 7 · see citing works
“Acceptance and commitment therapy for psychosis patients urges them not to fight their symptoms, and is overall more focused on easing distress, but acquiring the correct and sane beliefs about one’s experiences is still considered an important goal (e.g., Gaudiano et al., 2010).”
BackgroundDoes the Cognitive Fusion Questionnaire measure more than frequency of negative thoughts?
Krafft, J., & Levin, M. E. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.002 · Cited by 6 · see citing works
Raugh, I. M., & Strauss, G. P. (2024) · Behavior Therapy · doi:10.1016/j.beth.2023.05.004 · Cited by 6 · see citing works
Langlois, T., Sanchez-Rodriguez, R., Klein, R., Lamy, P., Callahan, S., & Lecomte, T. (2020) · L Encéphale · doi:10.1016/j.encep.2020.01.009 · Cited by 6 · see citing works
Shawyer, F., Thomas, N., Morris, E. M. J., & Farhall, J. (2013) · doi:10.1002/9781118499184.ch2 · Cited by 6 · see citing works
Mediation Using Covariance Based-Structural Equation Modeling (CB-SEM): The Why and How?
Rahman, M. M., Adedeji, S. B., Bashir, M. A., Islam, J., Reaz, M., & Khan, A. M. (2018) · Asian Journal of Empirical Research · doi:10.18488/journal.1007/2018.8.12/1007.12.434.442 · Cited by 5 · see citing works
“Cognitive (e.g., Debeer et al., 2009), clinical (Costa and Pinto-Gouveia, 2011; Gaudiano et al., 2010), health (e.g., Leonard and Rasmussen, 2011; Ruby et al., 2011), political (e.g., Duncan and Stewart, 2007; Wohl and Branscombe, 2009).”
BackgroundGonzález-Deleito, C. M., McCracken, L. M., & Tyrberg, M. J. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2300369 · Cited by 4 · see citing works
“Following previous research (Bach & Hayes, 2002; Gaudiano et al., 2010; Peters et al., 2004; Zettle & Hayes, 1986) symptom believability for delusions was measured with the item “how true do you believe [specific delusion] to be?” and a numerical rating scale from 1= “don’t believe it’s true” to 5=…”
BackgroundMethodYousefi, M., Younesi, S. J., Farhoudian, A., & Safi, M. H. (2020) · فصلنامه علمی پژوهشی توانبخشی · doi:10.32598/rj.21.3.3028.1 · Cited by 4 · see citing works
Gaudiano, B. A., Primack, J. M., & Miller, I. W. (2016) · Journal of Psychiatric Intensive Care · doi:10.20299/jpi.2016.015 · Cited by 4 · see citing works
“Research on ACT for inpatients with psychosis has demonstrated that the treatment has significant effects on distress and believability associated with hallucinations compared with treatment as usual (Gaudiano et al., 2010).”
Self-citationAcceptance and Commitment Therapy for Patients with a First Psychotic Episode
Владимирович, Ч. Н., Moiseeva, T., Belyakova, M. A., Polyakova, M. D., & Sozinova, M. V. (2021) · Consortium Psychiatricum · doi:10.17816/cp97 · Cited by 3 · see citing works
Narrative changes about “voices” following a contextual group therapy for people with psychosis
Langlois, T., Bourcier, A., Lamy, P., Lhermine, M., Callahan, S., & Lecomte, T. (2020) · Psychosis · doi:10.1080/17522439.2020.1801817 · Cited by 3 · see citing works
“The main active process is the capacity to accommodate the voice experience (Louise et al., 2018), to defuse (i.e. to step back from distressful thoughts) (Gaudiano & Herbert, 2006; Morris et al., 2013), and to reduce experiential avoidance strategies implemented (Gaudiano et al., 2010).”
BackgroundKhakbaz, H., Khanjani, M. S., Younesi, J., Ardakani, M. R. K., Safi, M. H., & Hosseinzadeh, S. (2022) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-127419 · Cited by 3 · see citing works
“Considering the relationship between anxiety reduction and cognitive defusion (51), it seems that ACT, by using failure strategies, such as conscious observation of psychiatric experiences, reduces the stress caused by the symptoms and then diminishes psychotic symptoms and improves emotion regulation.”
BackgroundClinical Assessment and Assessment Measures
Farhall, J., Shawyer, F., Thomas, N., & Morris, E. M. J. (2013) · Wiley eBooks · doi:10.1002/9781118499184.ch4 · Cited by 3 · see citing works
Engaging People with Psychosis in Acceptance and Commitment Therapy and Mindfulness
Gaudiano, B. A., & Busch, A. M. (2013) · Wiley eBooks · doi:10.1002/9781118499184.ch6 · Cited by 3 · see citing works
Self-citationGuilt, dysfunctional thought processes and depression in caregivers of people with dementia
Roach, L. (2013) · ERA · Cited by 3 · see citing works
Gussmann, E., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf-Beck, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160075 · Cited by 2 · see citing works
“It has also been found to mediate symptom distress in psychosis via reduced believability of thought and voice content (131), and changes in metacognitive beliefs and coping skills (18).”
BackgroundACT for the Treatment of Psychosis and Schizophrenia-Spectrum Disorders
Gaudiano, B. A., & Ellenberg, S. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.24 · Cited by 2 · see citing works
Self-citationGussmann, E., Lindner, C., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf‐Beck, J. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01690-y · Cited by 2 · see citing works
“Literature moreover discusses the mediating role of cognitive defusion in increasing psychological flexibility and thus fostering effective coping necessary for reducing symptom believability, subjective symptom severity, and psychosis-related distress in acute inpatients [111–113].”
BackgroundGaudiano, B. A. (2012) · doi:10.1002/9781118330029.ch10 · Cited by 2 · see citing works
Self-citationDepression in psychosis : associations with psychological flexibility and emotion regulation
Frost, R. N. (2012) · Enlighten: Theses (The University of Glasgow) · Cited by 2 · see citing works
Michielse, S., Bakker, J., Lange, I., Batink, T., Goossens, L., Wichers, M., Lieverse, R., Myin-Germeys, I., Schruers, K., van Amelsvoort, T., et al. (2023) · Neuroimage: Reports · doi:10.1016/j.ynirp.2023.100190 · Cited by 1 · see citing works
“…and duration of hospitalization (Cramer et al., 2016), while other studies showed that ACT reduced distress related to hallucinations in psychotic disorder (Gaudiano et al., 2010) and improved emotional functioning reducing the number of crisis contacts after treatment (White et al., 2011).”
Thapar, S., Quesada, D., & Knaüper, B. (2025) · JMIR Formative Research · doi:10.2196/69532 · Cited by 2 · see citing works
“For instance, the therapists raised concerns about the inclusion of a distress rating scale, arguing that it risked reinforcing symptom reduction as a primary goal, contrary to ACT’s emphasis on psychological flexibility [118].”
Pena-Garijo, J., Mor, T. B., & Martı́nez-Raga, J. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i8.107313 · Cited by 2 · see citing works
Persistierendes Stimmenhören bei schizophrenen Psychosen
Schnell, T. G. (2016) · Springer eBooks · doi:10.1007/978-3-662-50315-7_8 · Cited by 1 · see citing works
Langlois, T., Sanchez-Rodriguez, R., Bourcier, A., Lamy, P., Véry, E., Callahan, S., & Lecomte, T. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114860 · Cited by 1 · see citing works
Mindfulness as a Key Construct in Modern Psychotherapy
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Self-citationTerapia de Aceptación y Compromiso aplicada a la esquizofrenia. Estado actual y direcciones futuras
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Cognitive processing associated with hallucinations for At Risk Mental State
Leicester, S. (2013) · Minerva Access (University of Melbourne) · Cited by 1 · see citing works
Psychotherapy for Schizophrenia‐Spectrum Disorders
Ellenberg, S., Lynn, S. J., & Strauss, G. P. (2017) · Wiley eBooks · doi:10.1002/9781119462996.ch14 · Cited by 1 · see citing works
Woodrich, L. (2011) · CommonKnowledge Research Repository (Pacific University Oregon)
Ziaei, F., & Nickname, M. (2017) · Razavi International Journal of Medicine · doi:10.5812/rijm.62159
“These substitutes include active and conscious acceptance of personal experiences; which are related to people’s lives as well as lack of efforts to reduce or change events (15).”
BackgroundMartins, M. J., Castilho, P., Macedo, A., Pereira, A. T., Vagos, P., Carvalho, D., Bajouco, M., Madeira, N. G. G. F., Nogueira, V., & Carvalho, C. B. (2018) · Psychosis · doi:10.1080/17522439.2018.1502340
Schizophrenia Spectrum and Other Psychotic Disorders: Third Wave Case Conceptualization
Ellenberg, S., & Gaudiano, B. A. (2022) · Springer eBooks · doi:10.1007/978-3-031-11677-3_22
Self-citationThe Efficacy of an Online Act Intervention for Anxiety: An Outcome Randomized Control TrialPreprint
Tulbure, B. T., Tirica, Ș., Dolot, L. I., Marian, Ș., Sălăgean, N., & Rusu, A. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4651512
Acceptance and Commitment Therapy (Act) in Psychotic Patient
Khairunnisa, K., & Yitnamurti, S. (2024) · Jurnal Psikiatri Surabaya · doi:10.20473/jps.v13i1.33317
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The Hitchhiker’s guide to hallucination research
Abalo‐Rodríguez, I., & Pinheiro, A. P. (2025) · Consciousness and Cognition · doi:10.1016/j.concog.2025.103941
- Authors
- Gaudiano, B. A., Herbert, J. D., & Hayes, S. C.
- Affiliations
- Brown University (US)
- Drexel University (US)
- University of Nevada, Reno (US)
- Corresponding author
- Gaudiano, Brandon A.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 41
- Issue
- 4
- Pages
- 543-554
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC3673289
- OpenAlex
- W2045103741
- Cited by
- 91
- References
- 59
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 5 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 9 · 2014: 5 · 2013: 12 · 2012: 6
- FWCI
- 8.81
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH076937)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- acceptance and commitment therapy, psychosis, hallucinations, mediators of change, mechanism of action, hospitalized patients, brief psychological intervention, usual care
- MeSH terms
- Adult, Behavior Therapy, Female, Hallucinations, Humans, Male, Psychotic Disorders, Randomized Controlled Trials as Topic
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