Acceptance and Commitment Therapy for Delusions
Condition: Schizophrenia; Delusional Disorder
MeSH terms: Schizophrenia; Delusions; Schizophrenia, Paranoid
Study type: Interventional

Summary: 
      Symptoms of schizophrenia have historically been treatment resistant despite advances in
      psychopharmacology. Acceptance and Commitment Therapy (ACT) has been shown through some
      preliminary research to be effective with psychotic symptoms (Bach & Hayes, 2002). ACT is
      considered part of the "third wave of CBT" along with Dialectical Behavior Therapy (DBT;
      Linehan, 1993) and Mindfulness-based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale,
      2001). The target of change in ACT is acceptance of symptoms as experiences that a person can
      have without experiencing distress, and while living a life in accordance with one's values.

      The current study assessed the effectiveness of ACT (8 sessions) for delusions. Participants
      received treatment as usual throughout the study. The intervention followed the protocol of
      ACT described in Hayes, Strosahl and Wilson (1999) in which treatment will consist of
      building acceptance, willingness, and commitment to change, clarifying values, defusion of
      thoughts and feelings, as well as defusion of self. These therapeutic aims attempted to be
      achieved by the practice of various exercises in and out of session as well as the discussion
      of various metaphors within session. It was hypothesized that participants will exhibit
      decreased distress due to delusions, decreased delusional conviction and a reduction of
      overall anxiety levels from participants' baselines.
    

Detailed description: 
      Four patients were recruited from New York Presbyterian Hospital, Weill Medical College,
      Payne Whitney Clinic (Manhattan Campus), outpatient psychiatric program. Patients were
      randomly assigned to a length of baseline before beginning the 8-week ACT treatment. There
      was be a five-week baseline period for all patients after which two patients will be
      introduced to ACT treatment in weekly increments. All patients received treatment as usual
      throughout baseline and ACT treatment. During baseline, patients were assessed by an
      independent rater every week and during ACT treatment, patients were assessed every other
      week and at a one-month follow-up. Each participant's assessment results were compared over
      time, so that there will be an established baseline level of functioning which will be
      compared to his or her level of functioning during treatment, at the end of treatment, and
      finally at the one-month follow-up. Hypotheses: It was hypothesized that patients' distress,
      anxiety and tension due to delusional thinking would decrease over time when comparing
      baseline to treatment, treatment to outcome, and then outcome to follow-up. Additionally, the
      number of delusional thoughts and the rate of re-hospitalization was hypothesized to decrease
      over time.
    

Intervention name(s): Acceptance and Commitment Therapy
Intervention type(s): Behavioral
Intervention description(s): Considered part of the "third wave of CBT" along with Dialectical Behavior Therapy (DBT; Linehan, 1993) and Mindfulness-based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2001), ACT is built upon the strong, research-based foundation of CBT. However, while CBT for psychosis focuses on reducing symptoms, ACT focuses on changing the way in which the person experiences his or her symptoms so that the person can still live his or her life in accordance with his or her life values. Specifically, CBT attempts to reduce delusions by disputing the evidence for the delusion and ACT attempts to increase the person's ability to live his or her life while still experiencing delusions (Hayes, Strosahl & Wilson, 1999).
Other intervention name(s): ACT
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Acceptance and Commitment Therapy; Delusions