Acceptance and commitment therapy for psychosis: intent to treat, hospitalization outcome and mediation by believability

Cognitive behavior therapy (CBT) has been shown to be efficacious when used as an adjunct to pharmacotherapy for psychotic disorders. Acceptance and Commitment Therapy (ACT) is a contextual form of CBT that attempts to alter one's relationship to symptoms of psychosis rather than attempting to reduce or control them. Two previously published randomized trials of ACT for symptoms of psychosis have found evidence for decreased believability of symptoms and decreased hospitalization, among other outcomes. Using the combined dataset from these trials, the impact of ACT on intent to treat analyses of hospitalization outcomes and the mediating role of symptom believability on hospitalization outcomes were examined. Results showed reduction of rehospitalization at the 4-month follow-up, mediated by symptom believability but not symptom-related distress. The current study provides incremental support for the impact and putative processes of ACT for psychosis.