Feasibility of a Novel Process-based Treatment for Patients With Psychosis
Condition: Schizophrenia; Schizotypal Disorder; Delusional Disorder; Brief Psychotic Disorder; Shared Psychotic Disorder; Schizoaffective Disorder; Other Psychotic Disorder Not Due to A Substance or Known Physiological Condition; Unspecified Psychosis Not Due to a Substance or Known Physiological Condition; Manic Episode, Severe With Psychotic Symptoms; Bipolar Disorder, Current Episode Manic Severe With Psychotic Features; Bipolar Disorder, Current Episode Depressed, Severe, With Psychotic Features; Major Depressive Disorder, Single Episode, Severe With Psychotic Features; Major Depressive Disorder, Recurrent, Severe With Psychotic Symptoms
MeSH terms: Mania; Disease; Schizophrenia; Depressive Disorder; Depression; Depressive Disorder, Major; Bipolar Disorder; Psychotic Disorders; Mental Disorders; Schizophrenia, Paranoid; Shared Paranoid Disorder
Study type: Interventional

Summary: 
      The purpose of this single-arm feasibility study is to develop and pilot test a novel
      process-based and modular group therapy approach for patients with acute psychotic symptoms
      in an inpatient setting.
    

Detailed description: 
      Due to the enormous economic and social costs of psychotic-spectrum disorders, increasing the
      effectiveness of treatment options has become an important subject for psychiatric research.
      Latest findings in the field of psychotherapy for psychosis show some promising results for
      so-called Process-based Therapies (PBT) such as the Metacognitive Training (MCT) and
      Acceptance and Commitment Therapy (ACT) (Barnicot et al., 2020). Instead of trying to change
      the content of psychotic symptoms such as hallucinations and delusions, PBT directly address
      cognitive processes, which have been found to maintain the disorder's symptomatology (Hayes
      et al., 2020). While MCT focusses on changing patients' cognitive biases by inducing
      metacognition (Moritz & Woodward, 2007), ACT works with psychological processes such as
      mindfulness, willingness and cognitive distancing (Gaudiano & Herbert, 2006). There is a
      growing study base for PBT in a psychotic outpatient setting, research in non-ambulatory
      settings though is rare (Barnicot et al., 2020). Therefore, the aim of the current study is
      to develop and test the feasibility and safety of a new process-based group therapy program
      for acute psychotic patients. The five-week treatment approach will consist of three
      different modules combining interventions from both MCT and ACT (Module I: Psychoeducation,
      Module II: Metacognition, Module III: Cognitive Defusion). First preliminary effectiveness
      and process measures (PANSS, BPRS, WHO-DAS, CGI, BCIS and CFQ) will also be included in order
      to inform the design of future research. Thus, the study will give valuables insights in the
      feasibility and effectiveness of an innovative psychotherapy approach and breaks new ground
      in the field of psychotherapy research for psychosis.
    

Intervention name(s): Metacognitive and Defusion Training
Intervention type(s): Behavioral
Intervention description(s): Module I will give a brief introduction into the rational of the therapy and explain the terms cognitive biases and relational responding and their role in the development of psychological problems (psychosis) in a simple language and with the help of examples and small exercises. The principle of metacognition and cognitive defusion in psychotherapy will be made clear. An outlook on the procedures and the goals of the group therapy will be given. Module II will include interventions adapted from the MCT manual (Moritz et al., 2017) and Module III with consist of defusion strategies taken from the ACT group manual (Dambacher et al., 2020) and existing studies on ACT and psychosis (Bach et al., 2013; Gaudiano & Herbert, 2006).
Intervention model: Single Group Assignment
Intervention model description: Incoming patients from the clinic of Max Planck Institute of Psychiatry are continuously screened for study eligibility and - after they have given informed consent - are assigned to the experimental treatment condition.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Psychosis spectrum disorder; Process-based therapy; Modular psychotherapy; Group Therapy; Acceptance and Commitment Therapy (ACT); Metacognitive Training (MCT)