Effectiveness of acceptance and commitment therapy for inpatients with psychosis: Implementation feasibility and acceptability from a pilot randomized controlled trial.

OBJECTIVE: Acceptance and Commitment Therapy for Inpatients (ACT-IN) with psychosis has been found to be efficacious in previous trials, but its effectiveness has not been studied when implemented by frontline clinicians in routine settings. METHOD: In this pilot randomized controlled effectiveness trial, inpatients with schizophrenia-spectrum disorders were randomized to ACT-IN plus treatment as usual (TAU) (n = 23) or a time/attention matched (TAM) supportive condition plus TAU (n = 23) delivered by routine hospital staff. Both conditions received individual and group therapy during inpatient care and completed follow-up phone sessions during the first month post-discharge. Patients were assessed through 4 months post-discharge (blinded to condition) to determine feasibility, acceptability, and preliminary effectiveness of ACT-IN. RESULTS: ACT-IN was feasible to deliver with fidelity by frontline staff when integrated into an acute care setting. At post-treatment, patients reported significantly greater treatment satisfaction in ACT-IN relative to TAM. Overall, results showed significant but similar improvements for both conditions through 4-month follow-up in psychiatric symptoms, functioning, and mindfulness. Only ACT-IN improved over time in distress. Furthermore, patients receiving TAM had a 3.76 times greater risk of rehospitalization over 4 months compared with ACT-IN. CONCLUSIONS: ACT-IN is feasible and acceptable for patients with psychosis, can be implemented by hospital staff when integrated into acute treatment, and may result in decreased rehospitalization compared to alternative therapies. A future full-scale randomized-controlled implementation trial is warranted. CLINICALTRIALS: gov Identifer: NCT02336581.

Feasibility and Preliminary Effects of Implementing Acceptance and Commitment Therapy for Inpatients With Psychotic-Spectrum Disorders in a Clinical Psychiatric Intensive Care Setting.

The aim of this study was to adapt Acceptance and Commitment Therapy for Inpatients (ACT-IN) for implementation in a typical hospital setting to prepare for a larger clinical trial. The sample consisted of 26 inpatients diagnosed with psychotic-spectrum disorders. Using an open trial design, patients received individual and group ACT-IN sessions during their stay. We assessed the feasibility/acceptability of ACT-IN and preliminary changes on patient outcomes at baseline, discharge, and 4-month follow-up. We successfully recruited and retained participants as planned. Patients reported satisfaction with treatment, and routine hospital staff showed adoption and fidelity to the intervention. Relative to baseline, patients demonstrated significant improvements in symptoms and functioning across the 4-month follow-up. The current study shows that ACT-IN may be feasible and acceptable for inpatients with psychotic disorders in a psychiatric intensive care setting and should be tested in a future effectiveness-implementation trial.

HYPNOSIS, HYPNOTIC PHENOMENA, AND HYPNOTIC RESPONSIVENESS: Clinical and Research Foundations-A 40-Year Perspective.

The authors summarize research findings, their clinical implications, and directions for future research derived from 40 years of study of hypnosis, hypnotic phenomena, and hypnotic responsiveness at Steven Jay Lynn's Laboratory of Consciousness, Cognition, and Psychopathology and Joseph P. Green's Laboratory of Hypnosis. We discuss (a) the accumulating body of evidence that hypnosis can be used to advantage in psychotherapy; (b) the fact that hypnosis can facilitate a broad array of subjective experiences and suggestions; (c) the failure to find a reliable marker of a trance or radically altered state of consciousness and reservations about conceptualizing hypnosis in such terms; (d) determinants of hypnotic responsiveness, including attitudes and beliefs, personality traits, expectancies, motivation, and rapport; (e) efforts to modify hypnotic suggestibility; and (f) the need to further examine attentional abilities and the role of adopting a readiness response set that the authors argue is key in maximizing hypnotic responsiveness.

Time-lagged predictors of daily medication nonadherence beliefs during the month post-hospital discharge in patients with psychotic-spectrum disorders.

We used ecological momentary assessment (EMA) to examine the period following hospitalization when risk for medication nonadherence is highest among patients with psychotic-spectrum disorders. EMA data were collected daily via smartphones from 23 patients with psychotic-spectrum disorders (totaling 1149 surveys) in the month immediately following discharge. Nonadherence beliefs significantly correlated with percentage of medication doses. Time-lagged increases in irritability, sadness, life dissatisfaction, functional impairment, and previous day missed medication dose predicted subsequent increases in nonadherence beliefs over time. Future research should study mobile interventions that target the factors found to predict nonadherence beliefs to improve post-hospital recovery.

A Randomized Survey of the Public's Expectancies and Willingness to Participate in Clinical Trials of Antidepressants Versus Psychotherapy for Depression.

BACKGROUND: Expectancies and treatment preferences are known to affect the outcomes of patients enrolled in clinical trials for depression, but there is little research on their influence when the public is considering participation in these trials. METHOD: We conducted an online survey (May 2013) in which participants (N = 615) were randomly assigned to read hypothetical descriptions of clinical trials for depression based on 1 of the following study designs: medication versus placebo, medication versus medication, psychotherapy versus placebo, or psychotherapy versus psychotherapy. Afterward, individuals rated willingness to participate in the trial, logic and credibility of the treatments, and expected success and improvement in symptoms. RESULTS: There were no differences in expectancies for ratings of credibility and logic or success and improvement among clinical trial designs. However, self-reported willingness to participate in the study was rated significantly higher in the 2 psychotherapy trial designs (active-comparator and placebo-controlled) compared with the active-comparator medication design (P < .05). Psychiatric treatment history, general treatment preferences, and depression severity were positively correlated with willingness to participate primarily in the active-comparator medication design. CONCLUSIONS: Consistent with the broader treatment preference literature, individuals reported a greater willingness to participate in psychotherapy compared with antidepressant studies. Thus, people's perceptions of different treatments are likely to influence not only the outcomes of clinical trials for depression but also decisions to participate in these trials in the first place.

The Promises and Challenges of Ecological Momentary Assessment in Schizophrenia: Development of an Initial Experimental Protocol.

Severe mental illnesses, including schizophrenia and other psychotic-spectrum disorders, are a major cause of disability worldwide. Although efficacious pharmacological and psychosocial interventions have been developed for treating patients with schizophrenia, relapse rates are high and long-term recovery remains elusive for many individuals. Furthermore, little is still known about the underlying mechanisms of these illnesses. Thus, there is an urgent need to better understand the contextual factors that contribute to psychosis so that they can be better targeted in future interventions. Ecological Momentary Assessment (EMA) is a dynamic procedure that permits the measurement of variables in natural settings in real-time through the use of brief assessments delivered via mobile electronic devices (i.e., smart phones). One advantage of EMA is that it is less subject to retrospective memory biases and highly sensitive to fluctuating environmental factors. In the current article, we describe the research-to-date using EMA to better understand fluctuating symptoms and functioning in patients with schizophrenia and other psychotic disorders and potential applications to treatment. In addition, we describe a novel EMA protocol that we have been employing to study the outcomes of patients with schizophrenia following a hospital discharge. We also report the lessons we have learned thus far using EMA methods in this challenging clinical population.

Reasons for playing casual video games and perceived benefits among adults 18 to 80 years old.

Casual video games (CVGs) are becoming increasingly popular among middle-aged and older adults, yet there are few studies documenting why adults of different ages play these games, what benefits they perceive, and how regularly they play. The present study compared the online survey responses of 10,308 adults ranging from 18 to 80 years of age to questions regarding PopCap's popular free online game, Bejeweled Blitz (BJB). All respondents cited playing against friends as their main reason for playing. However, there were differences by age in the second most frequently cited reason. Middle-aged adults cited stress relief, and older adults reported that they seek the game's challenges. As a result of playing CVGs, younger adults noted that they felt sharper and experienced improved memory; older adults were more likely to feel that their visuospatial skills and response time benefited. Adults aged 60 and older had heavier patterns of game play than did adults under the age of 60 years. A significant number of respondents (14.7%) spontaneously noted that they felt that BJB had addictive qualities. CVG players seem to be drawn into this activity by its social nature and to a certain extent by its reinforcing properties. Once involved, however, they believe that they derive a number of benefits that, for older adults, appear to offset declines in age-sensitive cognitive functions.