In the early stages of psychosis, individuals often experience a range of symptoms such as hearing, seeing, smelling, feeling, and believing things that others do not, as well as negative symptoms like lack of motivation, interest in social interactions, and emotional expression. These symptoms, along with cognitive difficulties and co-morbid mental health problems, can significantly impact their functioning and quality of life (Fusar-Poli et al., 2017, 2020). The National Institute for Health and Care Excellence (NICE) guidelines recommend cognitive behavioural therapy (CBT) and family therapy for individuals in the early stages of psychosis, as well as antipsychotic medication for those diagnosed with first-episode psychosis (NICE, 2014). However, with NICE guidelines for adults with psychosis not being updated for almost a decade, there is a growing body of evidence supporting various therapeutic approaches, including Acceptance and Commitment Therapy (ACT) for individuals experiencing psychosis (Jansen et al., 2020; Yildiz, 2020).
ACT is a third-wave cognitive-behavioural intervention that focuses on improving psychological flexibility and decreasing experiential avoidance. Recent advancements in ACT have led to the development of ACT in Daily Life (ACT-DL), which combines ACT sessions with Ecological Momentary Intervention to enhance the therapeutic effects of ACT for individuals with psychosis (Vaessen et al., 2019). A clinical trial demonstrated that ACT-DL, when combined with treatment as usual, significantly improved distress related to psychotic experiences, functioning, and negative symptoms compared to treatment as usual alone (Myin-Germeys et al., 2022; Vereeken, 2022). This finding is particularly valuable as clinicians often struggle with identifying, assessing, and addressing negative symptoms in individuals with psychosis (Correll & Schooler, 2020; Veerman et al., 2017; Vereeken, 2022).
A qualitative study conducted by Bouws et al. (2023) aimed to explore participants’ experiences of ACT-DL for psychosis, their engagement with ACT principles, and what they found helpful or unhelpful. Seventeen participants from The Netherlands and Belgium who were at high risk of developing psychosis or experiencing a first episode of psychosis took part in the study. The ACT intervention consisted of eight sessions, focusing on six ACT core principles: acceptance, cognitive defusion, self-as-context, contact with the present moment, values, and committed action.
Participants’ experiences of ACT in daily life were analyzed using reflexive thematic analysis, resulting in two over-arching themes and nine sub-themes. The first theme focused on how participants understood and implemented ACT principles in their daily lives, while the second theme explored suggestions for improving the tailored approach of ACT-DL for individuals with psychosis.
Overall, the study suggests that ACT-DL helped participants become more aware of their challenging thoughts and emotions, with a reduced urge to change them. Flexibility in the therapist’s approach and incorporating psychosis-specific interventions were highlighted as potential enhancements to ACT-DL for individuals with psychosis. By amplifying the voices of people with psychosis, this study contributes to the growing evidence base supporting the effectiveness of ACT for individuals experiencing psychosis.
