Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T03:15:10.389Z Has data issue: false hasContentIssue false

Acceptance and Commitment Therapy for Psychosis and Trauma: Investigating Links between Trauma Severity, Attachment and Outcome

Published online by Cambridge University Press:  17 July 2018

Alicia Spidel*
Affiliation:
Université de Montréal
Isabelle Daigneault
Affiliation:
Université de Montréal
David Kealy
Affiliation:
University of British Columbia
Tania Lecomte
Affiliation:
Université de Montréal
*
Requests for reprints should be addressed to Alicia Spidel. E-mail: [email protected]

Abstract

Background: Although Acceptance and Commitment Therapy (ACT) may be effective for individuals with psychosis and a history of childhood trauma, little is known about predictors of treatment response among such patients. Aims: The current study examined: (1) whether severity of trauma predicted treatment response, and (2) profiles of patients with regard to their responses to treatment. Method: Fifty participants with psychosis and childhood trauma history were recruited and randomized to take part in either eight sessions of group-based ACT, or to be on a waiting list for the ACT group (i.e. treatment as usual group). The entire sample was used for the first part of the analyses (aim 1), whereas subsequent subsample analyses used only the treatment group (n = 30 for aim 2). Results: It was found that trauma severity did not moderate the effectiveness of ACT on symptom severity, participants’ ability to regulate their emotional reactions, or treatment compliance with regard to help-seeking. In addition, among those receiving ACT, the results revealed three distinct and clinically relevant change profiles. Avoidant attachment style and number of sessions attended were predictive of belonging to the different clusters or profiles. Patients in the profile representing the least amount of clinical change attended an average of two sessions less than those in the other change profiles. Conclusion: ACT offered in a group format appears to be a promising treatment for those with psychosis and history of trauma regardless of trauma severity. Given the brevity of the intervention, patients should be encouraged to attend each session to obtain maximum benefit.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arseneault, L., Cannon, M., Fisher, H. L., Polanczyk, G., Moffitt, T. E. and Caspi, A. (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry, 168, 6572.Google Scholar
Bach, P. and Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129.Google Scholar
Bendall, S., Jackson, H. J. and Hulbert, C. A. (2010). Childhood trauma and psychosis: review of the evidence and directions for psychological interventions. Australian Psychologist, 45, 299306.Google Scholar
Bernstein, D.P., Ahluvalia, T., Pogge, D. and Handelsman, L. (1997). Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 340348.Google Scholar
Bernstein, D. P. and Fink, L. (1998). Childhood Trauma Questionnaire: A Retrospective Self-Report: Manual. Psychological Corporation.Google Scholar
Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K. et al. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry, 151, 1132.Google Scholar
Brennan, K. A., Clark, C. L. and Shaver, P. R. (1998). Self-report measurement of adult attachment: an integrative overview. In Simpson, J. A. and Rholes, W. S. (eds), Attachment Theory and Close Relationships (pp. 4676). New York, NY, USA: Guilford Press.Google Scholar
Chadwick, P., Taylor, K. N. and Abba, N. (2005). Mindfulness groups for people with psychosis. Behavioural and Cognitive Psychotherapy, 33, 351.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Hillsdale, New Jersey: Erlbaum.Google Scholar
Crippa, J. A. S., Sanches, R. F., Hallak, J. E. C., Loureiro, S. R. and Zuardi, A. W. (2001). A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience. Acta Psychiatrica Scandinavica, 103, 465470.Google Scholar
Feeney, J. A., Noller, P. and Hanrahan, M. (1994). Assessing adult attachment. In Sperling, M. B. and Berman, W. H. (eds), Attachment in Adults: Clinical and Developmental Perspectives (pp. 128152). New York, NY, USA: Guilford Press.Google Scholar
Follette, V. M., Polusny, M. A., Bechtle, A. E. and Naugle, A. E. (1996). Cumulative trauma: the impact of child sexual abuse, adult sexual assault, and spouse abuse. Journal of Traumatic Stress, 9, 2535.Google Scholar
Galbraith, J. I., Moustaki, I., Bartholomew, D. J. and Steele, F. (2002). The Analysis and Interpretation of Multivariate Data for Social Scientists. CRC Press.Google Scholar
Garnefski, N., Kraaij, V. and Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30, 13111327.Google Scholar
Garnefski, N. and Kraaij, V. (2006). Cognitive emotion regulationquestionnaire–development of a short 18-item version (CERQshort). Personality and Individual Differences, 41, 10451053.Google Scholar
Garnefski, N. and Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European Journal of Psychological Assessment, 23, 141149.Google Scholar
Gaudiano, B. A. and Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results. Behaviour Research and Therapy, 44, 415437.Google Scholar
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.Google Scholar
Heck, R. H., Thomas, S. L. and Tabata, L. (2010). Multilevel and Longitudinal Analysis using SPSS. New York, NY: Routledge/Taylor & Francis.Google Scholar
Heck, R. H., Thomas, S. L. and Tabata, L. N. (2013). Multilevel and Longitudinal Modeling with IBM SPSS. Routledge.Google Scholar
Hosmer, D. W. Jr, Lemeshow, S. and Sturdivant, R. X. (2013). Applied Logistic Regression. John Wiley and Sons.Google Scholar
Keller, S. M., Zoellner, L. A. and Feeny, N. C. (2010). Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support. Journal of Consulting and Clinical Psychology, 78, 974.Google Scholar
Kerns, K. A., Abraham, M. M., Schlegelmilch, A. and Morgan, T. A. (2007). Mother–child attachment in later middle childhood: assessment approaches and associations with mood and emotion regulation. Attachment and Human Development, 9, 3353.Google Scholar
Khoury, B. and Lecomte, T. (2012). Emotion regulation and schizophrenia. International Journal of Cognitive Therapy, 5, 6776.Google Scholar
Larkin, W. and Read, J. (2008). Childhood trauma and psychosis: evidence, pathways, and implications. Journal of Postgraduate Medicine, 54, 287.Google Scholar
Lau, J., Ioannidis, J. P., Terrin, N., Schmid, C. H. and Olkin, I. (2006). Evidence based medicine: the case of the misleading funnel plot. British Medical Journal, 333, 597.Google Scholar
Lecomte, T., Spidel, A., Leclerc, C., MacEwan, G. W., Greaves, C. and Bentall, R. P. (2008). Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis. Schizophrenia Research, 102, 295302.Google Scholar
Marganska, A., Gallagher, M. and Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83, 131.Google Scholar
Mørkved, N., Endsjø, M., Winje, D., Johnsen, E., Dovran, A., Arefjord, K. et al. (2017). Childhood trauma in schizophrenia spectrum disorder as compared to other mental health disorders. Psychosis, 9, 4856.Google Scholar
Mueser, K. T., Rosenberg, S. D., Goodman, L. A. and Trumbetta, S. L. (2002). Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia Research, 53, 123143.Google Scholar
Neria, Y., Bromet, E. J., Sievers, S., Lavelle, J. and Fochtmann, L. J. (2002). Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. Journal of Consulting and Clinical Psychology, 70, 246.Google Scholar
Norcross, J. C. and Wampold, B. E. (2011). What works for whom: tailoring psychotherapy to the person. Journal of Clinical Psychology, 67, 127132.Google Scholar
Orsillo, S. M., Roemer, L. and Barlow, D. H. (2003). Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: a case study. Cognitive and Behavioral Practice, 10, 222230.Google Scholar
Roemer, L. and Orsillo, S. M. (2003). Mindfulness: a promising intervention strategy in need of further study. Clinical Psychology: Science and Practice, 10, 172178.Google Scholar
Sacks, J. Y., McKendrick, K. and Banks, S. (2008). The impact of early trauma and abuse on residential substance abuse treatment outcomes for women. Journal of Substance Abuse Treatment, 34, 90100.Google Scholar
Schenkel, L. S., Spaulding, W. D., DiLillo, D. and Silverstein, S. M. (2005). Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research, 76, 273286.Google Scholar
Shawyer, F., Farhall, J., Mackinnon, A., Trauer, T., Sims, E., Ratcliff, K. et al. (2012). A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behaviour Research and Rherapy, 50, 110121.Google Scholar
Spidel, A., Daigneault, I., Kealy, D. and Lecomte, T. (2017). Psychosis and trauma: does Acceptance and Commitment Group Therapy improve psychiatric symptoms and treatment compliance in this population? Psychology and Psychotherapy: Theory, Research and Practice, 91, 248261.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 10921097.Google Scholar
Tait, L., Birchwood, M. and Trower, P. (2002). A new scale (SES) to measure engagement with community mental health services. Journal of Mental Health, 11, 191198.Google Scholar
Tarrier, N., Khan, S., Cater, J. and Picken, A. (2007). The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Social Psychiatry and Psychiatric Epidemiology, 42, 2935.Google Scholar
Thomas, A., Donnell, A. J. and Young, T. R. (2004). Factor structure and differential validity of the expanded Brief Psychiatric Rating Scale. Assessment, 11, 177187.Google Scholar
Tyrrell, C. L., Dozier, M., Teague, G. B. and Fallot, R. D. (1999). Effective treatment relationships for persons with serious psychiatric disorders: the importance of attachment states of mind. Journal of Consulting and Clinical Psychology, 67, 725733.Google Scholar
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W. and Bentall, R. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661671.Google Scholar
Ventura, J., Liberman, R. P., Green, M. F., Shaner, A. and Mintz, J. (1998). Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research, 79, 163173.Google Scholar
Ventura, J., Lukoff, D., Nuechterlein, K. H., Liberman, R. P., Green, M. F. and Shaner, A. (1993). Manual for the expanded brief psychiatric rating scale. International Journal of Methods in Psychiatric Research, 3, 227244.Google Scholar
White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S. and Mitchell, G. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49, 901907.Google Scholar
Submit a response

Comments

No Comments have been published for this article.