A randomised controlled trial of acceptance and commitment therapy (ACT) for psychosis: study protocol
Open accessAbstract
BACKGROUND: Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis. It is, however, a challenging therapy to deliver and, in the context of increasingly rigorous trials, recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes. Acceptance and commitment therapy shows promise as a briefer, more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis. The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms. METHODS/DESIGN: This is a single (rater)-blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition, Befriending. Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication. Following baseline assessment, participants are randomly allocated to treatment condition with blinded, post-treatment assessments conducted at the end of treatment and at 6 months follow-up. The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale. Secondary outcomes include preoccupation, conviction, distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales, as well as social functioning and service utilisation. The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required. The model of change underpinning ACT will be tested using mediation analyses. DISCUSSION: This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis with an active comparison condition. The rigor of the design will provide an important test of its action and efficacy in this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12608000210370. Date registered: 18 April 2008.
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Thomas et al. (2014) state that ACT helps individuals with schizophrenia experience less drug-resistant psychotic symptoms, like delusions.
“Thomas et al. (2014) state that ACT helps individuals with schizophrenia experience less drug-resistant psychotic symptoms, like delusions (30).”
From Effect of applying nursing-based cognitive defusion techniques on mindful awareness, cognitive fusion, and believability of delusions among clients with schizophrenia: a randomized control trial (2024) · cites this paper as [30]
The Background (‘Aim, hypothesised outcomes and mechanisms of change’; page not given) identifies patients with chronic medication-resistant psychotic symptoms and hypothesises that ACT will reduce preoccupation, conviction and distress associated with delusions. But this is a study protocol, not a finding that ACT helps these patients; the same section says ACT is unlikely to reduce how often symptoms are experienced. (LLM, conf=0.90)
Experimental — accuracy not yet measuredWhen a negative self-referential phrase such as "I am persecuted" is repeated quickly and out loud, its literal meaning starts to fade, transforming it into a mere sequence of sounds.
“For example, the phrase “I am persecuted”. When this phrase is repeated quickly and out loud, the context that initially imbued it with its literal meaning begins to shift. As the repetition continues, the phrase’s literal meaning starts to fade, transforming it into a mere sequence of sounds (30).”
From Effect of applying nursing-based cognitive defusion techniques on mindful awareness, cognitive fusion, and believability of delusions among clients with schizophrenia: a randomized control trial (2024) · cites this paper as [30]
The Background section on mechanisms of change describes ACT defusion as helping people observe experiences with detachment rather than react to their literal content. It does not describe rapidly repeating a phrase aloud, the example “I am persecuted,” or a phrase becoming a sequence of sounds. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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- Authors
- Thomas, N., Shawyer, F., Castle, D. J., Copolov, D., Hayes, S. C., & Farhall, J.
- Affiliations
- Monash Alfred Psychiatry Research centre (AU)
- La Trobe University (AU)
- The University of Melbourne (AU)
- University of Nevada, Reno (US)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Farhall, John
- Venue
- BMC Psychiatry
- Published
- 2014-07-11
- Volume
- 14
- Issue
- 1
- Pages
- 198-198
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4104726
- OpenAlex
- W2032760876
- Cited by
- 35
- References
- 85
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 1
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (public-domain)
- Funders
- La Trobe University
- 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, delusions, cognitive behavioral therapy, positive and negative symptoms, social functioning, service utilization, mediation analysis
- MeSH terms
- Australia, Delusions, Female, Hallucinations, Humans, Male, New Zealand, Psychotic Disorders, Antipsychotic Agents, Treatment Outcome, Sample Size, Patient Selection, Acceptance and Commitment Therapy
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