Journal of Psychiatry

Abstract

Acceptance and Commitment Therapy Compared to Treatment as Usual in Psychosis: A Systematic Review and Meta-Analysis

Silvina B Tonarelli, Rebecca Pasillas, Luis Alvarado, Alok Dwivedi and Andrea Cancellare

Introduction: Schizophrenia and psychotic disorders are chronic conditions. Although antipsychotic medications are the first line of treatment, many patients continued to have symptoms. Acceptance and Commitment Therapy (ACT) is a therapy that applies mindfulness to teach patients accepting the existence of symptoms rather than avoid them. A meta-analysis was conducted to measure the efficacy of ACT in treatment of psychosis.
Methods: A systematic review search was conducted using the following keywords: "acceptance and commitment therapy", "randomized", "clinical trials", "psychosis"," schizophrenia", and "major depressive disorder AND psychosis". All studies were read by two authors and checked for eligibility. Studies were included if randomly allocate to ACT or usual treatment (TAU), and psychosis as diagnosis. Mantel and Haenszel approach was used to determine the heterogeneity in the study. For quantitative outcomes, standardized mean difference between ACT and TAU was used to summarize effect size, while relative risk was used for categorical outcomes along with 95% confidence interval.
Results: 217 studies were identified. 92 studies were selected for review after removing the duplications. A total of 4 studies were included in quantitative-synthesis. The mean age for the participants was 38 years of age. Regarding treatment outcomes, there was a significant difference between the two arms in the degree of change of negative symptoms (p=0.008), but the difference was not significant for positive symptoms. There was a reduction of re-hospitalization rate at 4 months in ACT compared to TAU in participants with psychosis.
Conclusions: ACT is a promising adjunctive therapy for patient with psychosis.