Feasibility and challenges of inpatient psychotherapy for psychosis: Lessons learned from a veterans health administration pilot randomized controlled trial

被引：9
作者：
Boden M.T. [1 ]
Gaudiano B.A. [2 ,3 ]
Walser R.D. [4 ,5 ]
Timko C. [1 ,7 ]
Faustman W. [6 ,7 ]
Yasmin S. [6 ,7 ]
Cronkite R.C. [1 ,8 ,9 ]
Bonn-Miller M.O. [1 ,4 ,10 ]
McCarthy J.F. [11 ,12 ]
机构：
[1] Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, 94025, CA
[2] Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI
[3] Psychosocial Research Program, Butler Hospital, Providence, RI
[4] National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA
[5] University of California, Berkeley, CA
[6] Palo Alto Division, VA Palo Alto Healthcare System, Palo Alto, CA
[7] Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
[8] Department of Sociology, Stanford University, Stanford, CA
[9] Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA
[10] Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VA Medical Center, Philadelphia, PA
[11] Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health Operations, Ann Arbor, MI
[12] Department of Psychiatry, University of Michigan, Ann Arbor, MI
来源：
BMC Research Notes | / 9卷 / 1期
关键词：
Acceptance and commitment therapy; Feasibility; Hybrid type I; Psychosis; Randomized controlled trial;
D O I：
10.1186/s13104-016-2179-z
中图分类号：
学科分类号：
摘要：
Background: In large health care systems, decision regarding broad implementation of psychotherapies for inpatients with psychosis require substantial evidence regarding effectiveness and feasibility for implementation. It is important to recognize challenges in conducting research to inform such decisions, including difficulties in obtaining consent from and engaging inpatients with psychosis in research. We set out to conduct a feasibility and effectiveness Hybrid Type I pilot randomized controlled trial of acceptance and commitment therapy (ACT) and a semi-formative evaluation of barriers and facilitators to implementation. Findings: We developed a training protocol and refined an ACT treatment manual for inpatient treatment of psychosis for use at the Veterans Health Administration. While our findings on feasibility were mixed, we obtained supportive evidence of the acceptability and safety of ACT. Identified strengths of ACT included a focus on achievement of valued goals rather than symptoms. Weaknesses included that symptoms may limit patient's understanding of ACT. Facilitators included building trust and multi-stage informed consent processes. Barriers included restrictive eligibility criteria, rigid use of a manualized protocol, and individual therapy format. Conclusions are limited by our randomization of only 18 patient participants (with nine completing all aspects of the study) out of 80 planned. Conclusions: Future studies should include (1) multi-stage informed consent processes to build trust and alleviate patient fears, (2) relaxation of restrictions associated with obtaining efficacy/effectiveness data, and (3) use of Hybrid Type II and III designs. © 2016 The Author(s).
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共 17 条
[1]  
Diagnostic and Statistical Manual of Mental Disorders, (2000)
[2]  
Attkisson C.C., Zwick R., The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome, Eval Progr Plan, 5, pp. 233-237, (1982)
[3]  
Bach P., Hayes S.C., The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial, J Consult Clin Psychol, 70, pp. 1129-1139, (2002)
[4]  
Bowersox N.W., Visnic S., Valenstein M., McCarthy J.F., Care for VHA Users with Psychosis in the Veterans Health Administration: FY11: 15th Annual National Psychosis Registry Report, (2013)
[5]  
Carpenter W.T., Kirkpatrick B., The heterogeneity of the long-term course of schizophrenia, Schizophr Bull, 14, pp. 645-652, (1988)
[6]  
Curran G.M., Mukherjee S., Allee E., Owen R.R., A process for developing an implementation intervention: QUERI series, Implement Sci., 3, (2008)
[7]  
Dixon L.B., Dickerson F., Bellack A.S., Bennett M., Dickinson D., Goldberg R.W., Peer J., The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements, Schizophr Bull, 36, pp. 48-70, (2010)
[8]  
Forman J., Damschroder L.J., Robinson C.H., Heisler M., Kerr E.A., RE-AIM Plus: Expanding the RE-AIM Framework for Real-time Program Evaluation, (2010)
[9]  
Gaudiano B.A., Herbert J.D., Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy, Behav Res Ther, 44, pp. 415-437, (2006)
[10]  
Glasgow R.E., Vogt T.M., Boles S.M., Evaluating the public health impact of health promotion interventions: The RE-AIM framework, Am J Public Health, 89, pp. 1322-1327, (1999)
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