June 1st, 2015

ACT may benefit patients with depression and psychotic features

Treatment for individuals with psychotic disorders such as schizophrenia has typically involved cognitive behavioral therapy and medication. But research is demonstrating that acceptance-based behavioral therapy may offer significant benefits beyond those derived from traditional treatment approaches.

Brandon A. Gaudiano, Ph.D., research psychologist in Butler Hospital’s Psychosocial Research Program, faculty member in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University and author of Incorporating Acceptance and Mindfulness into the Treatment of Psychosis, has been studying the use of Acceptance and Compassion Therapy (ACT) and mindfulness for individuals with psychosis and depression.

The term “acceptance psychotherapy” might lend itself to a preconceived notion of giving in or resignation, but Gaudiano pointed out that the main philosophy is to actively embrace an experience. “Being open to an experience allows us to stay on track,” he said. “Instead of adopting a ‘grin and bear it’ attitude, the individual takes [the experience] and incorporates it into his or her life,” he said. “You might not necessarily love the experience, but you can learn to be more tolerant. It’s all in how the person reacts and chooses to engage.”

For instance, if a patient considers himself “a loser,” he is encouraged to recognize that this thought is “an experience of the moment,” according to Gaudiano. “The thought doesn’t dictate what the patient chooses next. He has to look at his personal goals and values to guide his actions, not his negative thoughts.”

Self-compassion is a key component of ACT. Gaudiano said that a poor self-image challenges a person’s ability to pursue pleasurable activities in life. “We all have negative thoughts. That’s part of life, but we ask patients to treat themselves more gently,” he said. “ACT focuses on the person, developing personal values and concentrating on what makes life important and meaningful.”

Additionally, in his research Gaudiano uses behavioral activation, a strategy complementary to mindfulness. “Research literature shows that when people are more emotionally upset, they tend to withdraw from life. If they stay stuck over months or years, they start cutting off all the important parts of life that make them happy,” he said. “Behavioral activation matches well with mindfulness and acceptance and helps the individual re-engage with life and get back to activities enjoyed before the illness.”

Currently, Gaudiano is conducting a study funded by the National Institute of Mental Health to broaden the reach of ACT for hospitalized patients. “We are training staff working on inpatient units at Butler to deliver ACT to patients with diagnoses across the psychiatric spectrum,” he said. The study is measuring outcomes from ACT delivered by trained bachelor’s and master’s level counselors, occupational therapists, nurses and mental health workers. “The real question is how to transfer the therapy from research to practice to derive the most benefits,” he said.

According to Gaudiano, staff has been very receptive to the treatment, finding that it fits well with the recovery model. Delivering this therapy, as part of the system of care, will help promote recovery upon discharge, he said.

Gaudiano noted that mindfulness, acceptance and compassion-focused strategies are not currently widely used, in spite of research supporting their efficacy as complementary therapies. “We have to get providers involved in doing this evidence-based therapy,” he said. “Mindfulness can help prevent relapse. Patients are learning a different way of coping and get short and long term benefits of staying well.”

By Phyllis Hanlon

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