Article Review: Bach, P., & Hayes, S. C. (2002). The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of consulting and clinical psychology, 70, 1129-1138. Harris, R. (2009). ACT made simple.

If you work at an acute inpatient psychiatric hospital, you will see familiar faces as patients are readmitted.   It’s an evitable occurrence.  When this happens you can do one of two things, either continue with the same treatment approach or go back to the drawing boards and find new evidence based treatment techniques.


One new up and coming therapeutic approach that can be used in an inpatient psychiatric hospital is Acceptance and Commitment Therapy (ACT).  ACT is a part of the third wave behavioral movement that focuses on allowing the client to take action in his or her own life (Harris, 2009).   In ACT, rather than focusing on solely reducing symptoms of the psychopathology the client will work to increase his or her positive psychological skills using techniques of defusion, mindfulness, and acceptance.  ACT therapy frequently uses metaphors to describe new skills such as placing all thoughts of a leave floating down a stream when discussing the topic of defusion.


Bach and Hayes (2002) sought out to determine if a brief version of ACT could reduce the number of hospitalizations of psychotic patients along with reducing the believability of the symptoms as reported by the patients.  The researchers conducted a randomized control study with 80 patients who were readmitted to a state psychiatric hospital.  All patients either reported experiencing delusions or hallucinations.  Individuals were excluded from the study if they had a diagnosis of a substance-induced psychosis, severe intellectual disability, or neurocognitive disorder (Bach & Hayes, 2002).  The study collected several different data items including the number of readmissions a patient had for a four month period following discharge, the frequency of symptoms, distress related to those positive symptoms, and self-reported reliability of symptoms.


Study participants were divided into two groups: treatment as usual (TAU) or treatment as usual with brief ACT therapy (TAU+ ACT).   Those in the TAU group received medication, attended at least three group therapy sessions a week, and had the chance to receive individual therapy once a week (Bach & Hayes, 2002).  In the TAU+ACT group, patients received four ACT therapy sessions with a psychology intern (see psychology interns can do a lot while on internship).  Each of the ACT therapy sessions lasted approximately 45 minutes.  During the first therapy session, patients were provided with an overview of ACT, how the patient had managed positive symptoms in the past, and learning to defuse from thought (Bach & Hayes, 2002).  Each additional session took place approximately 72 hours after the previous session.  The second session focused on accepting the positive symptoms by discussing how past attempts to control these symptoms lead to additional distress.  In the third session, the patient began exploring his or her own personal values and goals for life.  When looking at their values, the patient had the opportunity to see how past attempts to manage positive symptoms hindered reaching those goals. The final session was a review session to discuss how the patient could use the skills when discharged.


The study found that just four individual ACT therapy session was enough to reduce the rate of rehospitalization by 50% for a group of patients who were considered to be severely mentally ill (Bach and Hayes, 2002).  Additionally, the study found that those who received ACT therapy were more likely to report their symptoms to others, which aided in the patients being able to stay out of the hospital.  Furthermore, both study groups reported similar levels of frequency and distress associated with positive symptoms; however, the TAU+ACT group reported lower levels of believability in those symptoms than the TAU group.  This shows that even if the symptoms were still present that patients were able to understand that the symptom content was not reality-based.  By understanding that the positive symptoms were not reality-based, the patients were then able to turn their focus to more effective coping skills.


So before you become frustrated the next time you see that familiar face being readmitted take the time to look at different therapeutic approaches because you never know what will work until you try it.


Bach, P., & Hayes, S. C. (2002). The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of consulting and clinical psychology70, 1129-1138.


Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc.



Anissa Pugh, MA LPA
WKPIC Doctoral Intern




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