title: The active therapeutic processes of acceptance and commitment therapy for persistent symptoms of psychosis: clients' perspectives.
abstract: BACKGROUND
  There is limited research on the applicability and effectiveness of Acceptance and Commitment Therapy (ACT) for people experiencing psychotic disorders. Clinical trials suggest ACT may be efficacious in reducing distress and rehospitalization rates in psychosis. Mindfulness and reduced literal believability of thought content have been associated with reduced distress for this population.
  
  
  OBJECTIVE
  To better understand ACT for psychosis, this study investigated clients' perspectives of the hypothesized active therapeutic processes of ACT.
  
  
  METHODS
  Semi‑structured interviews, conducted with nine adults diagnosed with schizophrenia or schizoaffective disorder and persistent positive symptoms, were analysed thematically.
  
  
  RESULTS
  Four themes emerged: Usefulness of therapy; Changes attributed to ACT; Understanding of therapy; and Non-specific therapy factors. All participants found therapy useful and recommended ACT. Mindfulness, defusion, acceptance and values work were described as the most useful therapy components and contributing to positive changes. Self-rated frequency of symptoms did not change; however a reduction in the intensity and distress associated with symptoms was reported. Non-specific therapy factors were deemed useful by participants but not directly related to outcome.
  
  
  CONCLUSIONS
  These findings are consistent with the theoretically defined underlying active processes of ACT and are relevant for this population. The findings also indicate important clinical implications for ACT for this client group: greater attention to the client connecting metaphors and concepts to the intended meaning may be valuable; caution should be used with some mindfulness and defusion techniques for intense experiences; and values work may be particularly useful for this population.
authors.affiliation: La Trobe University,Bundoora,Australia.
authors.forename: Tory
authors.initials: T
authors.lastname: Bacon
authors.affiliation: La Trobe University,Bundoora,Australia.
authors.forename: John
authors.initials: J
authors.lastname: Farhall
authors.affiliation: La Trobe University,Bundoora,Australia.
authors.forename: Ellie
authors.initials: E
authors.lastname: Fossey
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000223:Adaptation, Psychological; D000328:Adult; D003702:Delusions / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D059026:Diagnostic Self Evaluation; D004644:Emotions; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales; D013811:Psychotherapeutic Processes; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D036301:Qualitative Research; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D013850:Thinking