An intervention that blends in-person therapy with a smartphone app is effective in treating symptoms of early psychosis, particularly in individuals who have extroverted personality traits and who are highly educated, according to a study issued this week in Translational Psychiatry.
Acceptance and Commitment Therapy in Daily Life (ACT-DL) has shown promise for treating early psychosis, wrote Rafaël A. Bonnier, M.S., of the Center for Contextual Psychiatry at KU Leuven University in Belgium, and colleagues. ACT-DL combines face-to-face therapy sessions aimed at improving individuals’ psychological flexibility with an app that assesses their current psychological state and provides exercises related to their most recent therapy session.
To determine who may benefit most from the intervention, Bonnier and colleagues conducted a secondary analysis of data from the INTERACT study; this randomized controlled trial assessed the efficacy of eight weeks of ACT-DL in 71 individuals (59% female) who either had first-episode psychosis or were at an ultra-high risk for psychosis.
The researchers assessed participants’ distress associated with psychotic symptoms, global and social functioning, and negative symptoms (avolition, blunted affect, anhedonia, alogia, and asociality) at baseline, immediately after the intervention, and during six- and 12-month follow-ups. Additionally, they assessed participants’ education levels, personality traits (how extroverted they were and their negative affectivity, or their tendency to experience negative emotions), and frequency and severity of childhood abuse and neglect.
Overall, ACT-DL was generally effective in improving clinical outcomes, but certain sociodemographic characteristics and personality traits predicted clinical outcomes:
- Participants with a higher educational background showed more significant improvement in global functioning at both the six- and 12-month follow-ups compared with those with a lower educational background.
- Female participants showed greater improvements in psychotic distress compared with males at the 12-month follow-up.
- Participants with lower levels of extroversion showed greater improvement in negative symptoms compared with more extroverted participants at the 12-month follow-up.
- Extroverted participants, however, showed significantly greater improvement in global functioning immediately post-intervention and at the six-month follow-up compared with those with lower extroversion. This finding was not evident at the 12-month follow-up.
- Those with higher negative affectivity showed more improvement in negative symptoms and higher psychological flexibility at the 12-month follow-up compared with those with lower negative affectivity.
“Our findings suggest that while ACT-DL improves clinical outcomes in individuals with early psychosis, the improvement rate is dissimilar for individuals and predictable by baseline characteristics,” the authors wrote. “If replicated, these findings enable precision medicine approaches in allocating ACT-DL for early psychosis.”
For related information, see the Psychiatric News article “Special Report: Precise, Personalized, and Preventive Psychiatry”
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