Acceptance and Commitment Therapy and Mindfulness for Psychosis

Description: Emerging from cognitive behavioural traditions, mindfulness and acceptance-based therapies hold promise as new evidence-based approaches for helping people distressed by the symptoms of psychosis. These therapies emphasise changing the relationship with unusual and troublesome experiences through cultivating experiential openness, awareness, and engagement in actions based on personal values. In this volume, leading international researchers and clinicians describe the major treatment models and research background of Acceptance and Commitment Therapy (ACT) and Person-Based Cognitive Therapy (PBCT), as well as the use of mindfulness, in individual and group therapeutic contexts. The book contains discrete chapters on developing experiential interventions for voices and paranoia, conducting assessment and case formulation, and a discussion of ways to work with spirituality from a metacognitive standpoint. Further chapters provide details of how clients view their experiences of ACT and PBCT, as well as offering clear protocols based on clinical practice. This practical and informative book will be of use to clinicians and researchers interested in understanding and implementing ACT and mindfulness interventions for people with psychosis. Eric M. J. Morris is a chartered consultant clinical psychologist and the psychology lead for early intervention for psychosis at the South London and Maudsley NHS Foundation Trust, UK. Eric has been practising Acceptance and Commitment Therapy (ACT) for more than ten years, and researches mindfulness and acceptance interventions for psychosis at the Institute of Psychiatry, King's College London. Eric is a highly experienced trainer and supervisor in contextual cognitive behavioural therapies. Louise C. Johns is a chartered consultant clinical psychologist and coordinator of a specialist clinical service at the Maudsley Hospital, London, UK, offering psychological interventions for outpatients with psychosis. She is also an honorary lecturer at the Institute of Psychiatry, King's College London. Since qualifying as a clinical psychologist in 1998, she has worked in a clinical and research capacity in the field of psychosis. She has published over 50 articles on psychosis, covering development and psychopathology of symptoms, and cognitive behavioural treatments. She has led on the first UK funded studies to evaluate ACT for psychosis in group settings. Joseph E. Oliver is a clinical psychologist currently working in an early intervention programme for psychosis in South London, UK. He is also co-director of Contextual Consulting, an ACT based consultancy, offering contextual-CBT training, supervision and therapy. In addition to teaching and research supervision at King's College London's Institute of Psychiatry, he has active research interests in the use of ACT for psychosis, in group contexts and in its potential to enhance workplace well-being. About the Editors xiv List of Contributors xvi Acknowledgements xix Foreword: Acceptance, Mindfulness and Psychotic Disorders: Creating a New Place to Begin xx 1 Introduction to Mindfulness and Acceptance-based Therapies for Psychosis 1 Joseph E. Oliver, Candice Joseph, Majella Byrne, Louise C. Johns and Eric M. J. Morris 1.1 Introduction to Psychosis 1 1.2 Interventions 2 1.3 Conclusion 8 2 Theory on Voices 12 Fran Shawyer, Neil Thomas, Eric M. J. Morris and John Farhall 2.1 Phenomenology 12 2.2 Mechanisms and Origins of Hearing Voices 13 2.3 Meaning Given to Voice Experience 14 2.4 Responses to Voices 15 2.5 Implications for the Role of Acceptance and Mindfulness in Voices 18 3 Emotional Processing and Metacognitive Awareness for Persecutory Delusions 33 Claire Hepworth, Helen Startup and Daniel Freeman 3.1 Introduction 33 3.2 Persecutory Delusions 33 3.3 Improving Treatments for Persecutory Delusions 34 3.4 Development of the Intervention 35 3.5 The EPMA Intervention 38 3.6 The EPMA Pilot Study 40 3.7 Case Study 41 3.8 Conclusion 42 4 Clinical Assessment and Assessment Measures 47 John Farhall, Fran Shawyer, Neil Thomas and Eric M. J. Morris 4.1 Introduction 47 4.2 Clinical Assessment 47 4.3 Assessment Measures 54 4.4 Conclusion 60 5 Acceptance and Commitment Therapy Case Formulation 64 Patty Bach 5.1 Introduction 64 5.2 Case Study 64 5.3 Case Formulation using the Inflexahex Model 70 5.4 Conclusion 73 6 Engaging People with Psychosis in Acceptance and Commitment Therapy and Mindfulness 76 Brandon A. Gaudiano and Andrew M. Busch 6.1 Introduction 76 6.2 Acceptance and Commitment Therapy 77 6.3 Functional Analytic Psychotherapy 78 6.4 Acceptance-based Methods and Techniques for Improving Engagement 79 6.5 Special Contexts and Issues 85 6.6 Case Study 88 6.7 Conclusion 90 7 Acceptance and Commitment Therapy for Voices 95 Neil Thomas, Eric M. J. Morris, Fran Shawyer and John Farhall 7.1 Introduction 95 7.2 Formulating how Voices are a Problem 95 7.3 Overall Considerations in Conducting ACT with Voices 96 7.4 Case Study 104 8 Acceptance and Commitment Therapy for Delusions 112 José Manuel García Montes, Marino Pérez Álvarez and Salvador Perona Garcelán 8.1 Introduction 112 8.2 Delusions as Ways of Making Contact with Experience 112 8.3 Intervention with ACT 115 8.4 Conclusion 125 9 Acceptance and Commitment Therapy for Emotional Dysfunction following Psychosis 129 Ross White 9.1 Introduction 129 9.2 Understanding Emotional Dysfunction following Psychosis 129 9.3 Emotional Dysfunction and Experiential Avoidance 130 9.4 An ACT Conceptualisation of Emotional Dysfunction following Psychosis 131 9.5 Treating Emotional Dysfunction following Psychosis 132 9.6 Conclusion 142 10 Person-based Cognitive Therapy for Distressing Psychosis 146 Lyn Ellett 10.1 Introduction 146 10.2 Zone of Proximal Development 146 10.3 Case Formulation in PBCT 150 10.4 Experiential Methods of Change 153 10.5 Conclusion 159 11 Spirituality: A New Way into Understanding Psychosis 160 Isabel Clarke 11.1 Introduction 160 11.2 Repositioning Psychosis and Spirituality: Recognition of the Two Ways of Knowing 161 11.3 Research Basis 162 11.4 Spirituality and Mental Health 162 11.5 Clinical Approach: The Therapeutic Alliance 164 11.6 Psychosis as a Spiritual Crisis 168 12 The Service User Experience of Acceptance and Commitment Therapy and Person-based Cognitive Therapy 172 Joseph E. Oliver, Mark Hayward, Helena B. McGuiness and Clara Strauss 12.1 Introduction 172 12.2 An Overview of Service User Involvement 172 12.3 The Importance of a Service User Perspective in Informing ACT and PBCT for Psychosis 174 12.4 A Service User Perspective on the Experience of ACT for Psychosis 175 12.5 Summary of Qualitative Findings from PBCT Groups on Participant Experiences of Mindfulness Practice and What was Learned from these Studies 180 12.6 Conclusion 188 13 Acceptance and Commitment Therapy for First-episode Psychosis 190 Joseph E. Oliver and Eric M. J. Morris 13.1 Introduction 190 13.2 Recovery from a First Episode of Psychosis 191 13.3 Using ACT to Enhance Recovery from a First Episode of Psychosis 192 13.4 ACT in Different Modalities 198 13.5 Case Study 200 13.6 Conclusion 203 14 Acceptance and Commitment Therapy for Psychosis in Acute Psychiatric Admission Settings 206 Gordon Mitchell and Amy McArthur 14.1 Introduction 206 14.2 Acute Psychosis and ACT Interventions 206 14.3 ACT in the Acute Psychiatric Admission Ward 209 14.4 Case Study 209 14.5 Convergence of Mindfulness/Metacognitive-based Cognitive Therapy Approaches 214 14.6 Reflections on Developing Systemic Applications of ACT 215 14.7 Conclusion 216 15 Developing Acceptance and Commitment Therapy for Psychosis as a Group-based Intervention 219 Amy McArthur, Gordon Mitchell and Louise C. Johns 15.1 Introduction 219 15.2 A Six-session ACT-for-Psychosis Group Protocol 221 15.3 Case Study 231 15.4 Reflections on the Experience of Developing and Delivering the Groups 233 15.5 Other Protocols 234 15.6 Conclusion 237 16 Group Person-based Cognitive Therapy for Distressing Psychosis 240 Clara Strauss and Mark Hayward 16.1 Introduction 240 16.2 Person-based Cognitive Therapy 240 16.3 The Importance of the Group Process in PBCT 242 16.4 Facilitating a PBCT Group 243 16.5 PBCT: An Integrated Model 252 16.6 Group PBCT: The Evidence 253 16.7 Conclusion 254 Appendix A Chessboard Metaphor 256 Appendix B Leaves-on-the-Stream Metaphor 257 Appendix C Passengers-on-the-Bus Metaphor 259 Appendix D Person-in-the-Hole Metaphor 261 Appendix E Polygraph Metaphor 262 Appendix F See the Wood for the Trees (And Other Helpful Advice for Living Life) 263 Appendix G Skiing Metaphor 270 Appendix H Tug-of-War-with-the-Monster Metaphor 271 Index 272

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