Acceptance and commitment therapy for psychosis: current status, lingering questions and future directions

Purpose Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well-being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. Methods We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness-informed interventions for psychosis. Results Acceptance and commitment therapy for psychosis is promising as a pragmatic, process-driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology-assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. Conclusions Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence-based interventions for psychosis

Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients

Behavioural and Cognitive Psychotherapy, 34(4): pp. 497-502.The aim of the current study was to examine how belief in the validity of hallucinations relates to the association between hallucination frequency and associated distress. In a sample of inpatients with psychotic symptoms, results demonstrated that hallucination believability predicted later distress after controlling for symptom frequency. In addition, results were consistent with the hypothesis that hallucination believability mediated the frequencydistress link. Recent randomized controlled trials have supported the efficacy of cognitive behavior therapy for schizophrenia and related psychotic disorders. Further evidence suggests that cognitive behavioral approaches that incorporate mindfulness and acceptance-based strategies may be effective in reducing the believability of positive symptoms. Future trials incorporating longitudinal designs and more detailed assessments of these variables are needed

Self-efficacy for social situations in adolescents with generalized social anxiety disorder

Behavioural and Cognitive Psychotherapy, 35(2): pp. 209-223.Self-efficacy is a potentially useful concept when applied to Social Anxiety Disorder (SAD). The aims of the current study were to examine the psychometric properties of the Self- Efficacy for Social Situations Scale (SESS; Gaudiano and Herbert, 2003) and to investigate the relationship between self-efficacy and anxiety in an adolescent sample with generalized SAD. Results replicated those found in a previous adult SAD sample. The SESS showed high internal consistency and good construct and criterion-related validity. The SESS also predicted subjective anxiety and perceived performance in social role play tests after controlling for social anxiety severity. Furthermore, self-efficacy more clearly predicted self-ratings in contrast to observer ratings of performance in social role play tests. Finally, changes in social selfefficacy were strongly associated with changes in social anxiety symptoms following treatment, even after controlling for changes in fear of negative evaluation. Treatment implications for adolescent SAD are discussed

Integrating Storytelling into the Theory and Practice of Contextual Behavioral Science

The practice of generating and interpreting stories can be examined through a behavioral lens and has many potential implications for clinical practice. However, storytelling has for the most part yet to be integrated into the field of contextual behavioral science (CBS). A bedrock of human culture, storytelling has influenced both individual behavior and intergroup cooperation for millennia. Basic principles of relational frame theory, such as those pertaining to coherence, perspective-taking, and the transformation of stimulus function, may help to reveal how stories derive their psychological impact. In turn, understanding storytelling from a CBS perspective can facilitate the broader integration of narrative methods into clinical interventions, which may help in expanding the reach and impact of individual, group, and self-help interventions. Suggestions for integrating storytelling into practice are provided as are future directions for studying the behavioral mechanisms of storytelling

Measuring Paranoid Beliefs in Adolescents:A Comparison of the Revised-Green et al.’s Paranoid Thoughts Scale (R-GPTS) and the Bird Checklist of Adolescent Paranoia (B-CAP)

Research on paranoid beliefs in adolescents is in its infancy. Valid and reliable assessments are essential to advancing the field, yet there is no current consensus as to which are optimal to use in this population. This study compared the psychometric properties of two measures of paranoia in a general population adolescent sample. A cross-sectional study with quota sampling (gender and age) recruited adolescents (14-17 years) from the UK (n=262) and USA (n=200), who completed the Revised Green et al. Paranoid Thoughts Scale (R-GPTS) and the Bird Checklist for Adolescent Paranoia (B-CAP). We assessed factor structures, intercorrelations, overlap of participants identified as at-risk for paranoid thoughts via both scales, convergent validity (scales with one another) and discriminant validity (distress, wellbeing, bullying and discrimination). Both scales performed equally well in terms of factorial validity. Intercorrelations between the subscales and with general distress were high for both measures. However, a substantial percentage of participants were identified as having paranoid beliefs according to the R-GPTS but not the B-CAP. Furthermore, the B-CAP showed a very high correlations (0.69≤r≤0.79) with self-reported bullying experiences, which bordered on multicollinearity. Findings highlight the possibility that B-CAP may risk confounding paranoid beliefs with exposure to bullying more so than R-GPTS, and that B-CAP may miss instances of elevated paranoia that are captured by the R-GPTS. Future research needs to further explore this by validating both scales with an external (e.g., interview-based) criterion for paranoia

Cross-cultural validation of the Revised Green et al., Paranoid Thoughts Scale

Background. With efforts increasing worldwide to understand and treat paranoia, there is a pressing need for culturally valid assessments of paranoid beliefs. The recently developed Revised Green et al. Paranoid Thoughts Scale (R-GPTS) constitutes an easy to administer self-report assessment of mild ideas of reference and more severe persecutory thoughts. Moreover, it comes with clinical cut-offs for increased usability in research and clinical practice. With multiple translations of the R-GPTS already available and in use, a formal test of its measurement invariance is now needed.Methods. Using data from a multinational cross-sectional online survey in the UK, USA, Australia, Germany, and Hong Kong (N=2510), we performed confirmatory factory analyses on the R-GPTS and tested for measurement invariance across sites.Results. We found sufficient fit for the two-factor structure (ideas of reference, persecutory thoughts) of the R-GPTS across cultures. Measurement invariance was found for the persecutory thoughts subscale, indicating that it does measure the same construct across the tested samples in the same way. For ideas of reference, we found no scalar invariance, which was traced back to (mostly higher) item intercepts in the Hong Kong sample.Conclusion. We found sufficient invariance for the persecutory thoughts scale, which is of substantial practical importance, as it is used for the screening of clinical paranoia. A direct comparison of the ideas of reference sum-scores between cultures, however, may lead to an over-estimation of these milder forms of paranoia in some (non-western) cultures

Onset of illness and developmental factors in social anxiety disorder: Preliminary findings from a retrospective interview

Journal of Psychopathology and Behavioral Assessment, 29(2): pp. 101-110.Although many advances have been made in the treatment of Social Anxiety Disorder (SAD), less is known about its onset and factors related to its course and severity. The current study aimed to investigate developmental factors (e.g., onset of illness, behavioral inhibition, socially 12 traumatic experiences) that research has suggested are related to the course and severity of SAD in a sample of adults diagnosed with generalized SAD. Results showed behavioral inhibition to be the only consistent predictor of current severity. Results for age of onset were consistent with previous studies suggesting an early childhood and later adolescent pattern. In addition, an earlier age of onset negatively impacted improvement in cognitive behavior therapy for SAD, but no other developmental factors were related to treatment outcome. Future research using longitudinal designs and multiple informants is needed to confirm findings from retrospective reports

Pandemic Paranoia in the General Population:International Prevalence and Sociodemographic Profile

BACKGROUND: The term ‘pandemic paranoia’ has been coined to refer to heightened levels of mistrust and suspicion towards other people specifically due to the COVID-19 pandemic. In this study, we examine the international prevalence of pandemic paranoia in the general population and its associated sociodemographic profile. METHODS: A representative international sample of general population adults (N = 2510) from five sites (USA N = 535, Germany N = 516, UK N = 512, Australia N = 502 and Hong Kong N = 445) were recruited using stratified quota sampling (for age, sex, educational attainment) and completed the Pandemic Paranoia Scale (PPS). RESULTS: The overall prevalence rate of pandemic paranoia was 19%, and was highest in Australia and lowest in Germany. On the subscales of the PPS, prevalence was 11% for persecutory threat, 29% for paranoid conspiracy and 37% for interpersonal mistrust. Site and general paranoia significantly predicted pandemic paranoia. Sociodemographic variables (lower age, higher population size and income, being male, employed and no migrant status) explained additional variance and significantly improved prediction of pandemic paranoia. CONCLUSIONS: Pandemic paranoia was relatively common in a representative sample of the general population across five international sites. Sociodemographic variables explained a small but significant amount of the variance in pandemic paranoia

The treatment of psychotic major depression: is there a role for adjunctive psychotherapy?

Psychotherapy and Psychosomatics, 76(5): pp. 271-277.Background: Psychotic depression is a relatively prevalent mood disorder associated with greater symptom severity, a poorer course of illness and higher levels of functional impairment compared with nonpsychotic depression. Separate lines of investigation suggest that various forms of cognitive- behavioral therapy are efficacious for treating severe forms of nonpsychotic depression as well as primary psychotic disorders. However, there currently are no empirically supported psychotherapies specifically designed for treating psychotic depression. Method: We review the efficacy of current somatic treatments for the disorder and discuss the limited data to date on potentially useful psychotherapeutic approaches. In particular, we describe the clinical improvement observed in a subgroup of hospitalized patients with psychotic depression treated with Acceptance and Commitment Therapy as part of a larger clinical trial. Results: Pilot results demonstrated that Acceptance and Commitment Therapy was associated with clinically significant reductions in acute symptom severity and impairment compared with treatment as usual. Conclusion: The findings suggest that patients with psychotic depression can benefit from psychotherapy. Clinical and research recommendations in this area are presented