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Cited by 97Mindfulness and Compassion InterventionsSchizophrenia research and treatmentPsychotherapy Techniques and Applications

The feasibility and acceptability of a brief Acceptance and Commitment Therapy (ACT) group intervention for people with psychosis: The ‘ACT for Life’ study

Open access
Johns, Louise C., Oliver, Joseph E., Khondoker, Mizanur, Byrne, Majella, Jolley, Suzanne, Wykes, Til, Joseph, Candice, Butler, Lucy +2 more·2016·Journal of Behavior Therapy and Experimental Psychiatry
DOI 10.1016/j.jbtep.2015.10.001
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Abstract

BACKGROUND AND OBJECTIVES 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). METHODS 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. RESULTS 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. LIMITATIONS 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). CONCLUSIONS 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.

AI snapshot

Written from the paper’s full text.

TL;DR

A brief manualised group Acceptance and Commitment Therapy intervention for people with psychosis was feasible and acceptable in routine community services. Uncontrolled pre-post analyses showed small-to-medium improvements in functioning and mood, with commensurate changes in ACT processes, but the authors conclude an RCT is needed before implementation.

Key findings

  • Feasibility/acceptability: 89 people consented, 83 completed pre-measures, 69 started the four-week G-ACTp intervention, and 65 completed post-measures. Satisfaction was high (mean 27.4, SD=3.6, range 16–32, n=58).
  • Functioning improved from baseline to 20-week follow-up (Coeff.=-2.4, z=-2.9, p=0.004; 95% CI -4.0 to -0.8; within-subject ES d=0.4), though the T8 post-treatment change was not significant (Coeff.=-1.4, p=0.08).
  • Mood improved at post-treatment (Coeff.=-1.9, z=-2.9, p=0.004; 95% CI -3.1 to -0.6) and follow-up (Coeff.=-2.3, z=-3.5, p=0.001; 95% CI -3.5 to -1.0; d=0.4).
  • ACT processes changed in the expected direction: reduced experiential avoidance (T8 Coeff.=-3.6, p<0.001; T20 Coeff.=-3.0, p=0.001), reduced cognitive fusion (T8 Coeff.=-2.4, p=0.003; T20 Coeff.=-2.6, p=0.002), and increased mindfulness (T8 Coeff.=6.4, p<0.001; T20 Coeff.=6.8, p<0.001).

Methods

  • Within-participant pre-post design in community psychosis teams in South London and Maudsley NHS Foundation Trust; inclusion criteria were age 18–65, sufficient English, and persisting distress and/or difficulty reaching a life goal.
  • The intervention comprised four two-hour weekly group ACT workshops, delivered in 13 closed groups of 4–8 participants, with a taster meeting, telephone booster at 10 weeks, and follow-up at 20 weeks. Measures included Sheehan Disability Scales (functioning), HADS (mood), AAQ-II, CFQ, SMQ, and a modified CSQ-8 satisfaction measure, completed with an independent assessor.
  • Outcomes were analysed using three-level linear mixed models across T0, T4, T8, and T20, with baseline averaged across T0 and T4, random effects for group and individual, and Pearson correlations for associations between change in clinical outcomes and ACT processes.

Limitations

  • Stated: the uncontrolled pre-post design precluded blinded assessments and may have inflated effect sizes; participants may have improved because of other factors, and receipt of other interventions was unrestricted.
  • Stated: the preliminary process findings are consistent with mediation but cannot demonstrate mediation without a comparison control condition.
  • Evident from the text: attendance at individual assessments and workshops was variable, the sample was modest, and the authors note that between-group effects in a future RCT may be substantially smaller than the pre-post effects reported here.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jbtep.2015.10.001

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § 3.4 Change in ACT processes · p. 17

    Compared with baseline, participants showed increased mindfulness immediately after the group, maintained at post-treatment follow-up.

    “Compared with baseline, participants showed reduced experiential avoidance/greater acceptance; reduced cognitive fusion; and increased mindfulness immediately after the group, all of which were maintained at post-treatment follow-up.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 3.3 Clinical outcomes · p. 17

    Mood improved significantly from baseline to follow-up (Coeff.=-2.3, z=-3.5, p=0.001, 95% CI -3.5 to -1.0).

    “Both showed significant improvement over time from baseline to follow-up (Functioning: Coeff.=-2.4, z=-2.9, p=0.004 (95% CI: -4.0 to -0.8); Mood: Coeff.=-2.3, z=-3.5, p=0.001 (95% CI: -3.5 to -1.0)).”
    • Also stated in: § 4.2 Conclusions · p. 21 · plain
      “Both functioning and mood improved, with medium effects.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 3.3 Clinical outcomes · p. 17

    Within-subject effect sizes for functioning and mood were small to medium.

    “Within-subject effect sizes (ES) were small to medium (Table 2).”
    • Also stated in: § 4. Discussion · p. 19 · plain
      “Clinical outcomes improved from pre-post, with small to medium within-subject effects.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 3.3 Clinical outcomes · p. 17

    Functioning improved significantly from baseline to follow-up (Coeff.=-2.4, z=-2.9, p=0.004, 95% CI -4.0 to -0.8).

    “Both showed significant improvement over time from baseline to follow-up (Functioning: Coeff.=-2.4, z=-2.9, p=0.004 (95% CI: -4.0 to -0.8); Mood: Coeff.=-2.3, z=-3.5, p=0.001 (95% CI: -3.5 to -1.0)).”
    • Also stated in: § 4.2 Conclusions · p. 21 · plain
      “Both functioning and mood improved, with medium effects.”
    Quote in the paperSubstantial claim
  • Findingown data
    § 3.4 Change in ACT processes · p. 17

    Compared with baseline, participants showed reduced cognitive fusion immediately after the group, maintained at post-treatment follow-up.

    “Compared with baseline, participants showed reduced experiential avoidance/greater acceptance; reduced cognitive fusion; and increased mindfulness immediately after the group, all of which were maintained at post-treatment follow-up.”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Findingown data
    § Abstract (249 words) · p. 5

    Brief group ACT interventions for people with psychosis are feasible and acceptable.

    “This preliminary study showed that brief group ACT interventions for people with psychosis are feasible and acceptable.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.4 Change in ACT processes · p. 17

    There were significant changes in the processes targeted by the intervention, with small to medium pre-post effects.

    “There were significant changes in the processes targeted by the intervention, with small to medium pre-post effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Abstract (249 words) · p. 5

    Independently assessed acceptability and satisfaction were high.

    “Independently assessed acceptability and satisfaction were high.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data
    § Abstract (249 words) · p. 5

    Functioning improved from baseline to follow-up (20 weeks) in participants with psychosis who started the ACT group intervention (Coeff.=-2.4, z=-2.9, p=0.004; 95% CI: -4.0 to -0.8; within subject effect size d=0.4).

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.4 Change in ACT processes · p. 17

    Functioning showed significant change at post-treatment follow-up (T20) but not immediately after the group (T8).

    “Clinical outcomes showed significant changes at the post-treatment follow-up, rather than immediately after the group, for functioning, and at both time points for mood.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Abstract (249 words) · p. 5

    Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures.

    “Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 4. Discussion · p. 18

    The assessment battery could be completed in a single session, usually of 45-60 minutes with a short break.

    “No particular measure was identified as consistently cognitively or emotionally demanding to complete, and the assessment battery could be completed in a single session, usually of 45-60 minutes with a short break.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 19

    The intervention was successfully manualised and could be delivered to a standardised protocol in a routine service setting.

    “We were successful in our manualisation of the intervention, and it was possible to deliver GACTp to a standardised protocol in a routine service setting.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 19

    Mean scores showed small improvements during the anticipatory/engagement phase, which were augmented during treatment and either maintained or built upon at follow-up.

    “Mean scores show small improvements during the anticipatory/engagement phase, which were augmented during treatment and either maintained or built upon at follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.4 Change in ACT processes · p. 17

    Changes in outcomes were not related to age, workshop attendance, service, gender, or ethnicity, except a small association between functioning and service where early psychosis participants showed greater improvement.

    “Changes were not related to age, workshop attendance, service, gender, or ethnicity, with the exception of a small association between functioning and service, such that early psychosis participants showed greater improvement (r=0.3, p=0.02; otherwise, r values all ≤0.2, p values all ≥ 0.1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 4. Discussion · p. 18

    Recruitment proceeded at a rate of 4-5 participants per month.

    “Recruitment proceeded at a rate of 4-5 participants/month.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 19

    Participants noted general group therapy factors, mindfulness and ACT exercises, and between-session committed actions as helpful aspects of the intervention.

    “Participants noted several helpful aspects of the intervention: general group therapy factors; the mindfulness and ACT exercises; and the between-session committed actions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 4. Discussion · p. 18

    Active support from the assessor was required to explain measures, encourage completion, and point out any missed items.

    “However, active support from the assessor was required to explain measures, encourage completion, and point out any missed items.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 3.4 Change in ACT processes · p. 17

    Mood showed significant change at both post-treatment (T8) and follow-up (T20).

    “Clinical outcomes showed significant changes at the post-treatment follow-up, rather than immediately after the group, for functioning, and at both time points for mood.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given
    § 4. Discussion · p. 18

    For attended assessments, completion of individual measures was good, with no missing data.

    “For attended assessments, completion of individual measures was good, with no missing data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 19

    Participants found the short duration of the intervention and its focus on values-based living appealing, and were willing to work towards goals between sessions.

    “The short duration of the intervention and its focus on values-based living appealed to participants, who were very willing to work towards goals between sessions and to notice any difficulties they encountered.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 20

    The individual taster meeting and telephone booster took up to an additional hour of one-to-one therapist contact, totaling just over four hours per participant, increasing to almost six hours if a third facilitator attends the group.

    “The individual 'taster' meeting and telephone booster together took up to an additional hour of one to one therapist contact totaling just over four hours per participant, increasing to almost six hours if a third facilitator attends the group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 4. Discussion · p. 18

    89 participants were recruited over a 20-month period.

    “The 89 participants were recruited over a 20 month period by a single research worker, in an inner-city, borough-based service, catering for a local population of around 280,000 people, and carrying a caseload of around 1,700 individuals with psychosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § 1. Introduction · p. 8

    The ACT model is compatible with conceptualisations of recovery from severe mental illness and well-suited for people with psychosis.

    “The ACT model is compatible with conceptualisations of recovery from severe mental illness (defined as 'living a satisfying, hopeful and contributing life even with limitations caused by the illness', Anthony, 1993; and 'having a sense of purpose and direction', Deegan, 1988), and therefore well-suited for people with psychosis.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Anthony, 1993 source

      Not checked in the free run.

    • cites Deegan, 1988 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § 1. Introduction · p. 8

    Group interventions are a more efficient use of therapist time than individual work and may confer additional benefits of social support, normalising, and access to other perspectives.

    “Group interventions are notionally a more efficient use of therapist time than individual work, and may confer additional benefits of social support from peers, normalising, and access to other perspectives (Walser and Pistorello, 2004; Ruddle et al., 2011).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Walser and Pistorello, 2004

      Not checked in the free run.

    • cites Ruddle et al., 2011 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data
    § 2.5 Analysis · p. 14

    None of time, age, service, gender, or ethnicity predicted missingness.

    “We investigated Time, Age, Service (Early/Established Psychosis), Gender and Ethnicity (BME/non-BME), as potential predictors of missingness, but none was found to predict missingness significantly.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § 2.2.2 Secondary clinical outcome: mood · p. 10

    The Hospital Anxiety and Depression Scale (HADS) had good internal reliability in the current study (Cronbach alpha = 0.8).

    “The scale is well-established and psychometric properties, as reported by the authors, are good. In the current study, internal reliability was good (Cronbach alpha = 0.8).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § 2.2.1 Primary clinical outcome: functioning · p. 10

    The Sheehan Disability Scales had acceptable internal reliability in the current study (Cronbach alpha = 0.7).

    “The scale has good construct validity, internal reliability and sensitivity to change (Sheehan and Sheehan, 2008; Leon et al., 1997); internal reliability in the current study was acceptable (Cronbach alpha = 0.7).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Abstract (249 words) · p. 5

    ACT lends itself to brief group delivery, potentially increasing access to therapy without inflating costs.

    “ACT also lends itself to brief group delivery, potentially increasing access to therapy without inflating costs.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Morris, Johns & Oliver, 2013

      Not checked in the free run.

    • cites Hayes et al., 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § 2.3 Design · p. 11

    Assessments were completed with a trained research assistant who was not involved in the delivery of therapy.

    “Assessments were self-report, completed with a trained research assistant, who was not involved in the delivery of therapy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § 2.4.2 Adherence to the intervention · p. 14

    Adherence to the ACT protocol was high, with mean ACT consistency ratings of 1.7 and inconsistency ratings of 0.15.

    “Mean ACT consistency and inconsistency ratings were 1.7 (range 1.1 to 2) and 0.15 (range 0 to 0.8), respectively, indicating high adherence.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationown data
    § 4. Discussion · p. 18

    The choice of primary outcome was fitting.

    “Participants highlighted the general focus on activity as a positive aspect of the study, suggesting that the choice of primary outcome was fitting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § 4.2 Conclusions · p. 21

    The study was preliminary and uncontrolled.

    “However, the study was preliminary and uncontrolled, and further treatment development work may be necessary if effects are not replicated in a subsequent randomized controlled evaluation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § 4. Discussion · p. 18

    Randomisation employing a control condition can impact adversely upon recruitment and retention rates, with losses to follow-up of 20% of participants not uncommon.

    “Randomisation employing a control condition can impact adversely upon recruitment and retention rates: losses to follow-up of 20% of participants are not uncommon (e.g. Garety et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Garety et al., 2008 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § 4.1 Limitations · p. 21

    Participants may have improved without any intervention.

    “Participants may therefore have improved without any intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Study design and conductnone given
    § Acknowledgements · p. 22

    ACT therapy adherence was independently rated.

    “We are very grateful to Amy McArthur and Gordon Mitchell, who provided the initial training for the therapists and who rated the ACT therapy adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § 4.2 Conclusions · p. 21

    The ACT group intervention has the potential to be a helpful and easily accessible psychological treatment for people with psychosis.

    “Results suggest that the ACT group intervention has the potential to be a helpful and easily accessible psychological treatment for this stigmatised client group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § 4. Discussion · p. 18

    The study did not specifically collect feedback on assessments.

    “However, we did not specifically collect feedback on assessments, and consultation to ensure that these capture the outcomes of most relevance to service users should be a key component of future studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § 4.1 Limitations · p. 21

    Receipt of other interventions was unrestricted.

    “Receipt of other interventions was unrestricted, and clinical improvement may be attributable to these, although the changes in ACT-specific processes suggests that at least some change can be attributed to the groups.”
    Quote in the paperSubstantial claim
34 of 34

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = -2.9reported p = .004 · recomputed p = .004

    “z=-2.9, p = .004”

  • Consistentz = -3.5reported p = .001 · recomputed p < .001

    “z=-3.5, p = .001”

  • Consistentz = -0.3reported p = .8 · recomputed p = .764

    “z=-0.3, p = .8”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Mood follow-up confidence interval differs between the text and Table 3

    Minor

    The abstract and Results report the lower bound of the mood follow-up 95% confidence interval as −3.5, while Table 3 reports −3.6 for the same coefficient and time point.

  • Claimed functioning-ACT process associations do not meet the stated corrected threshold

    Minor

    Table 4 states a Bonferroni-corrected significance threshold of 0.0014, but its three functioning-ACT process associations have p-values of 0.02, 0.05, and 0.05. None meets the table's stated threshold, contrary to the unqualified claim that functioning changes were associated with each ACT process.

2 of 2

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Authors
Johns, L. C., Oliver, J. E., Khondoker, M., Byrne, M., Jolley, S., Wykes, T., Joseph, C., Butler, L., Craig, T., & Morris, E. M. J.
Affiliations
King's College London (GB)
Corresponding author
Johns, Louise C.
ORCID
Venue
Journal of Behavior Therapy and Experimental Psychiatry
Publisher
Elsevier BV
Published
2016-03
Volume
50
Pages
257-263
ISSN
0005-7916 (ISSN-L)
DOI
10.1016/j.jbtep.2015.10.001
OpenAlex
W2180534176
Semantic Scholar
e1795bb1e892b2c1b806c9c3fbe82135de807bf4
Cited by
97
References
40
Citations by year
2026: 3 · 2025: 4 · 2024: 11 · 2023: 8 · 2022: 9 · 2021: 21 · 2020: 17 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 2 · 2015: 1
FWCI
7.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders
Guy's and St Thomas' Charitable Foundation (G090704)
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, group intervention, brief psychotherapy, feasibility, acceptability, user satisfaction, mood
MeSH terms
Adult, Aged, Feasibility Studies, Female, Humans, Male, Middle Aged, Patient Compliance, Psychotherapy, Brief, Psychotherapy, Group, Psychotic Disorders, Treatment Outcome, Patient Satisfaction, Young Adult, Acceptance and Commitment Therapy

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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