Table 1.
Characteristics of the Included Studies
| Reference | Patients | Co-interventions | Intervention groups (program length, frequency, duration) | |
|---|---|---|---|---|
| Treatment | Control | |||
| Bach & Hayes (2002) Bach et al (2012) |
80 hospitalized patients experiencing positive psychotic symptoms (auditory hallucinations, delusions) Diagnoses: Schizophrenia, schizoaffective disorder, mood disorder with psychotic feature, delusional disorder, psychosis NOS Mean age: 39.2 y (ACT), 39.5 y (TAU) |
TAU |
ACT 4 × 45-50 minutes every 2 to 3 days + TAU |
TAU Medication, minimum of 3 sessions psychoeducation group, Minimum of 1 session of individual psychotherapy After discharge: case management, 1 monthly visit to the psychiatrist, medication |
| Chadwick et al (2009) | 22 outpatients with psychotic disorders with auditory hallucinations Diagnosis: schizophrenia according to DSM-IV Mean age: 22.6±8.1 y |
Antipsychotic medication | Mindfulness training Meditation, group discussion, training of awareness in breathing and body Weeks 1-5: 2 × weekly + home practice with CD, Weeks 6-10: home practice |
Waiting list control No specific therapy |
| Chien & Lee (2013) | 96 outpatient patients with schizophrenia Diagnosis of schizophrenia according to DSM-IV Mean age: 25.8±8.5 y |
TAU |
MBPP 12 biweekly × 120 min + TAU |
TAU Routine psychiatric outpatient services; advice on medication and community services; brief education sessions |
| Chien & Thompson (2014) | 107 outpatient patients with schizophrenia Diagnosis of schizophrenia according to DSM-IV Mean age: 25.6±7.7 y |
TAU |
MBPP 12 × 120 minutes over 24 wk |
CPEP + TAU: 12 × 120 min over 24 wk TAU: Routine psychiatric outpatient services; advice on medication and community services; brief education sessions |
| Gaudiano & Herbert (2006) | 40 hospitalized patients with current or recent psychotic symptoms Diagnoses: - Psychotic disorder according to DSM-IV - Affective disorder with psychotic symptoms Mean age: 40.0±10.0 y |
TAU |
ACT 4 × 60 minutes + Enhanced TAU |
Enhanced TAU Psychopharmacology, case management, psychotherapy Group therapy and activities 2x daily Individual therapy as needed After discharge: community service referral Enhancement: daily support by the ACT therapist |
| Langer et al (2012) | 23 psychotic outpatients Diagnoses: schizophrenia, schizoaffective disorder, delusional disorder All according to DSM-IV Mean age: 34.7±8.2 y, 33.9±10.7 y WLC |
Antipsychotic medication |
MBCT Bodyscan, Breathing meditation, sitting meditation Weeks 1-8: once weekly 60 min + home practise |
Waiting list control No specific therapy |
| Shawyer et al (2012) | 44 psychotic patients with command hallucinations Diagnosis of schizophrenia or related condition according to DSM-IV Mean age: 39.0±10.0 y |
Antipsychotic medication |
TORCH Acceptance-Based Cognitive Therapy 3 engagement and assessment sessions Weeks 1-12: once weekly + home exercise |
Befriending A series of conversations with a friendly social acquaintance Avoidance of symptom and problem discussions Weeks 1-12: once weekly Waiting list control No specific therapy |
| White et al (2011) | 27 psychotic outpatients Psychotic disorder according to ICD-10 Age: −33.6±8.6 y ACT −34.6±11.0 y TAU |
TAU |
ACT 10 individual sessions × 60 minutes + TAU |
TAU Psychopharmacology, case management, psychotherapy |
| Longest follow-up | Outcome measures | Results | |
|---|---|---|---|
| 1) Psychotic symptoms 2) Hospitalization rate 3) Affect 4) Acceptance 5) Mindfulness 6) Safety |
Short-term | Long-term | |
| 4 mo 12 mo | 1) Number of patients experiencing symptoms; frequency of symptoms (Likert scale) 2) Hospitalization rate |
1) Significantly more patients in the ACT reported symptoms; no significant group differences in frequency 2) Significantly lower hospitalization rate in the ACT group |
2) Significant increase in hazard rate in TAU compared to ACT |
| 10 wk | 1) Severity and intensity of auditory hallucinations and delusions (PSYRATS) 5) Mindfulness (SMQ), mindful responses to voices (SMQ, SMVQ) |
1) No significant group difference 5) No significant group differences |
|
| 18 mo | 1) Psychotic symptom severity (BPRS) 2) Rehospitalization (number and duration) |
1) Significantly higher symptom severity in the TAU group 2) Significantly higher number and longer duration of rehospitalization in the TAU group |
1) Significantly higher symptom severity in the TAU group 2) Significantly higher number and longer duration of rehospitalization in the TAU group |
| 24 mo | 1) Psychotic symptom severity (BPRS) 2) Rehospitalization (number and duration) |
1) Significantly higher symptom severity in the TAU group 2) Significantly longer duration of rehospitalization in the TAU group |
1) Significantly higher symptom severity in the TAU group 2) Significantly longer duration of rehospitalization in the TAU group |
| 4 mo | 1) Psychotic symptoms (BPRS, CGI), frequency of symptoms (Likert scale) 2) Hospitalization rate (Odds Ratio) 3) Affect (BPRS); Distress (Likert scale) 6) Adverse events |
1) No significant group differences 2) No significant group differences 3) Affect: Significant group difference favoring ACT Distress: Significant group difference favoring ACT 6) No adverse events |
|
| 8 wk | 1) Psychotic symptoms (CGI) 4) Acceptance (AAQ II) 5) Mindfulness (SMQ) |
1) No significant group difference 4) No significant group difference 5) Significant group difference favoring MBCT |
|
| 3 mo 6 mo | 1) Psychotic symptoms (PANSS) 4) Acceptance of auditory and command hallucinations (VAAS) |
1) Positive symptoms: significant reduction within TORCH; Negative symptoms: significant increase within waiting list 4) Acceptance: no significant group difference |
1) Positive symptoms: no significant group difference; Negative symptoms: significant reduction within TORCH PANSS total: significant reduction within TORCH 4) Acceptance of auditory hallucinations: significant increase within TORCH; Acceptance of command hallucinations: significant increase within BEF |
| 3 mo | 1) Psychotic symptoms (PANSS) 3) Anxiety and Depression (HADS) 4) Acceptance (AAQ-II) 5) Mindfulness (KIMS) 6) Adverse events |
1) Positive symptoms: no significant group difference; Negative symptoms: significant larger decrease in ACT than TAU 3) No significant group difference 4) No significant group difference 5) Significantly larger increase in ACT than TAU 6) No serious adverse events |
|
Abbreviations: AAQ-II, Acceptance & Action Questionnaire; ACT, Acceptance and Commitment Therapy; BPRS, The Brief Psychiatric Rating Scale; 0CGI, The Clinical Global Impression, CPEP, Conventional Psychoeducation Program; DSM-IV, Diagnostic Statistical Manual; HADS, Hospital Anxiety and Depression Scale; ICD-10, International Classification of Diseases; KIMS, Kentucky Inventory of Mindfulness Skills; MBCT, Mindfulness Based Cognitive Therapy; MBPP, Mindfulness-Based Psychoeducation Program; NOS, not otherwise specified; PANSS, Positive and Negative Syndrome Scale; PSYRATS, The Psychotic Symptom Rating Scales; SMQ, Southampton Mindfulness Questionnaire; SMVQ, Southampton Mindfulness Voices Questionnaire; TAU, treatment as usual; TORCH, Treatment of Resistant Command Hallucinations; VAAS, The Voices Acceptance and Action Scale..