“My voices are just part of me, they don’t own me”: a qualitative investigation of Acceptance and Commitment Therapy groups for people experiencing psychosis [paper]

Our qualitative study of the experiences of people with psychosis who engaged in Acceptance and Commitment Therapy groups to support their recovery has just been published online in the journal Psychosis

The qualitative study was led by Dr Sally Bloy, who interviewed people participating in ACT for Life groups, meeting them after the group program to hear about their experiences. [the larger ACT for Life group evaluation was published in 2016; Dr Louise Johns was the chief investigator]

The ACT for Life groups were brief, running over 4 weekly sessions, and focused on supporting wellbeing through promoting mindfulness and values-based actions. The groups use a central metaphor of the Passengers on the Bus to illustrate the potential of trying out different ways of responding to experiences (such as feelings, thoughts, memories, urges, voices etc) to go in valued life directions. The groups were run in inner-city locations in the London Borough of Lambeth, in community mental health teams in the South London & Maudsley NHS Foundation Trust. We have previously described the key aspects of these groups in a paper published in the Journal of Contextual Behavioral Science (Butler et al., 2016). There is also a detailed description of the group program here.

We developed a grounded theory of the processes of change as experienced by the participants: themes were identified of Awareness, Relating Differently, Reconnecting with Life, and a general group theme, Leaning on Others. These appear in the diagram below (also in the paper):    

A model of processes of change as articulated by participants (Bloy, Morris et al)

We are grateful to the experts by experience who shared their perspectives on the ACT for Life groups reported in this paper, along with all the participants who took part in the larger evaluation study (Johns et al., 2016). Their engagement helped us to better understand how group ACT is experienced by people with psychosis in community settings and led to further developments, including a preliminary randomised controlled trial of a longer version of the group and the publication of a treatment manual by New Harbinger (ACT for Psychosis Recovery). This group program is being offered in routine care in community mental health services in Australia (see here for a recent evaluation), the United Kingdom, New Zealand, and other countries.  

It seems right to have final words be from a participant:

Talking about those passengers in the bus . . . I never thought in that way, but once I was reassured that they are just part of me, they are not owning me, that really helped me to . . . you know, okay let them be there. I know I can’t get rid of those thoughts but I know they’re there. As long as I know they’re there they can’t take control over me. That’s fine for me.

Participant 6

The pre-print of the paper is here (PDF).

‘My voices are just part of me, they don’t own me’: a qualitative investigation of Acceptance and Commitment Therapy groups for people experiencing psychosis  

Authors: Sally Bloy, Eric Morris, Louise Johns, Anne Cooke & Joseph Oliver

Objectives:  This study aimed to generate a grounded theory of change processes as experienced by people with psychosis who engaged in an Acceptance and Commitment Therapy (ACT) group program. A secondary aim was to identify how participants described changes in their relationship to distress following the groups. 

Design: The study used a qualitative research methodology, grounded theory. This was used to explore emergent themes in the participants’ subjective experiences of group ACT delivered in community mental health services. 

Methods: The experience of the ACT group process was investigated for nine participants. Semi-structured interviews were used to explore how the group experience and the exercises, metaphors and skills promoted by ACT were used by participants in their daily lives. 

Results: There were four main themes emerging from the interviews: awareness, relating differently, reconnection with life, leaning on others. 

Conclusions: The participants all described experiencing subjective benefits from being involved in the ACT groups, along with perspectives on processes of change. These reports of changes were consistent with the model and extend our understanding of the lived experience of engaging in ACT for psychosis groups.   

Keywords: Psychotic Disorders; Acceptance and Commitment Therapy; Cognitive Behavioural Therapy; Community Mental Health Services; Grounded Theory; Recovery  

doi: https://doi.org/10.1080/17522439.2020.1870542

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