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      Acceptance and Commitment Therapy for Inpatients with Psychosis (the REACH Study): Protocol for Treatment Development and Pilot Testing

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          Abstract

          Patients with schizophrenia-spectrum disorders frequently require treatment at inpatient hospitals during periods of acute illness for crisis management and stabilization. Acceptance and Commitment Therapy (ACT), a “third wave” cognitive-behavioral intervention that employs innovative mindfulness-based strategies, has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in acute-care psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its use of an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACT. The aim of the Researching the Effectiveness of Acceptance-based Coping during Hospitalization (REACH) Study is to adapt a promising acute-care psychosocial treatment for inpatients with psychosis, and to pilot test its effectiveness in a routine inpatient setting. More specifically, we describe our plans to: (a) further develop and refine the treatment and training protocols, (b) conduct an open trial and make further modifications based on the experience gained, and (c) conduct a pilot randomized controlled trial in preparation for a future fully-powered clinical trial testing the effectiveness of ACT.

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          Size of treatment effects and their importance to clinical research and practice.

          Helena Kraemer, David Kupfer (2006)
          In randomized clinical trails (RCTs), effect sizes seen in earlier studies guide both the choice of the effect size that sets the appropriate threshold of clinical significance and the rationale to believe that the true effect size is above that threshold worth pursuing in an RCT. That threshold is used to determine the necessary sample size for the proposed RCT. Once the RCT is done, the data generated are used to estimate the true effect size and its confidence interval. Clinical significance is assessed by comparing the true effect size to the threshold effect size. In subsequent meta-analysis, this effect size is combined with others, ultimately to determine whether treatment (T) is clinically significantly better than control (C). Thus, effect sizes play an important role both in designing RCTs and in interpreting their results; but specifically which effect size? We review the principles of statistical significance, power, and meta-analysis, and commonly used effect sizes. The commonly used effect sizes are limited in conveying clinical significance. We recommend three equivalent effect sizes: number needed to treat, area under the receiver operating characteristic curve comparing T and C responses, and success rate difference, chosen specifically to convey clinical significance.
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            Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies.

            Todd Kashdan, Velma Barrios, John Forsyth … (2006)
            Extending previous work, we conducted two studies concerning the toxic influences of experiential avoidance (EA) as a core mechanism in the development and maintenance of psychological distress, and disruption of pleasant, engaging, and spontaneous activity. Of particular interest was whether EA accounted for relationships between coping and emotion regulation strategies on anxiety-related pathology (Study 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). In Study 1, EA mediated the effects of maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears). In Study 2, EA completely mediated the effects of two emotion regulation strategies (i.e., suppression and reappraisal) on daily negative and positive experiences and was associated with diminished daily positive affective experiences and healthy life appraisals, diminished frequency of positive events and more frequent negative life events, and greater negative affective experiences. The present data show that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA. Further consideration of experiential avoidance as a generalized diathesis and toxic process will be useful in improving our understanding of the etiology, phenomenology, and treatment of anxiety conditions, general human suffering, and disruptions in hedonic capacity.
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              Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy.

              Steven C. Hayes, Michael E Levin, Jennifer Plumb-Vilardaga … (2013)
              A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term "contextual behavioral science." We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy.
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                Author and article information

                Contributors
                Sampath Parthasarathy: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Healthcare (Basel)
                Journal ID (iso-abbrev): Healthcare (Basel)
                Journal ID (publisher-id): healthcare
                Title: Healthcare
                Publisher: MDPI
                ISSN (Electronic): 2227-9032
                Publication date (Electronic): 05 May 2017
                Publication date Collection: June 2017
                Volume: 5
                Issue: 2
                Electronic Location Identifier: 23
                Affiliations
                [1 ]Butler Hospital, Providence, RI 02906, USA; chdavis@ 123456butler.org (C.H.D.); gary_epstein-lubow_MD@ 123456brown.edu (G.E.-L.); ivan_miller@ 123456brown.edu (I.W.M.)
                [2 ]Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
                [3 ]College of Human Medicine, Michigan State University, Flint, MI 48502, USA; jennifer.johnson@ 123456hc.msu.edu
                [4 ]Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, USA; mueser@ 123456bu.edu
                Author notes
                [* ]Correspondence: brandon_gaudiano@ 123456brown.edu ; Tel.: +1-401-455-6457
                Article
                Publisher ID: healthcare-05-00023
                DOI: 10.3390/healthcare5020023
                PMC ID: 5492026
                PubMed ID: 28475123
                SO-VID: 32451554-cec7-4e3a-840b-b6819b56d375
                Copyright © © 2017 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 17 March 2017
                Date accepted : 03 May 2017
                Categories
                Subject: Article

                Keywords: hospitalization,psychotic disorders,psychotherapy,pilot projects
                Data availability:
                Keywords: hospitalization, psychotic disorders, psychotherapy, pilot projects

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