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Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., Anterior Insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity. Twenty-nine early psychosis individuals (11 at-risk mental state and 18 first-episode psychosis) completed the Montreal Imaging Stress Task in conjunction with functional MRI. The study was part of a large-scale randomized controlled trial on the efficacy of an acceptance and commitment therapy-based ecological momentary intervention for early psychosis. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas. Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress ratings. These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity.

Exposure to Stressful Life Events (SLEs) has been linked to psychosis. However, the combined effect of SLEs and familial risk on subclinical psychotic symptoms over time remains unknown. The objective of the present study was to investigate the effect of SLEs on the level of subclinical psychotic symptoms in individuals with and without familial vulnerability for psychosis. Data were collected from siblings of individuals diagnosed with psychotic disorder and healthy controls at baseline (N = 293) and three years later at follow-up (N = 928). We assessed self-reported and observer-rated subclinical positive, negative, and depressive psychotic symptoms. Participants reported the number of SLEs in the preceding 6 months. A multilevel multivariate regression analysis revealed a positive association between the retrospectively assessed number of SLEs and symptom levels, regardless of vulnerability status (p

Introduction/Objective: This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU. Methods: Individuals aged 15–65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. Results: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ2(3) = 9.05; p = 0.033), and negative symptoms (χ2(3) = 19.91; p2(3) = 21.56; p < 0.001). Conclusions: INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.

AIM: The aim of this qualitative study is to explore patients' perspectives on Acceptance and Commitment Therapy for early stages of psychosis. Therefore, we interviewed participants of the INTERACT study, that quantitatively investigated Acceptance and Commitment Therapy in Daily Life (ACT-DL) in combination with treatment as usual, for early stages of psychosis, comparing it to treatment as usual. METHODS: Within 6 months after finishing ACT-DL, we conducted semi-structured, individual interviews with 19 participants. All interviews were audio-recorded and transcribed. Thematic analysis was used for coding and analysis. RESULTS: Two overarching themes were formed: 'the meaning of ACT' and 'what to improve'. Considering the first, participants generally understood and connected with the meaning of ACT, noticing more awareness and acceptance of their thoughts and feelings, and living more in line with their personal values. The second theme included comments on the protocol not being personal or psychosis specific enough and some elements of ACT being too difficult to understand when having active psychotic symptoms. CONCLUSIONS: This study suggests that ACT is an acceptable and promising new form of treatment for early stages of psychosis, and it provides relevant information to further develop ACT for this group. ispartof: EARLY INTERVENTION IN PSYCHIATRY ispartof: location:Australia status: Published online

Background: Individuals with chronic psychosis consistently show impairment in emotion regulation (ER). However, little is known about how contextual appraisals shape ER strategy use in individuals in the early stages of psychosis. The present study investigates the extent to which different appraisal dimensions of the most negative and positive events of the day are associated with ER strategy use in individuals with ultra-high risk (UHR) and first-episode psychosis (FEP).Method: Sixty-eight UHR individuals and fifty-five FEP individuals filled out an experience sampling evening questionnaire for six consecutive days, in which their appraisal of intensity, importance and perceived control concerning the most negative or positive event of the day, and the ER strategies they deploy in response to these events were measured.Results: Multilevel mixed effect models showed that intensity appraisal was most closely associated with ER strategy use, as opposed to importance and controllability appraisals. Higher intense negative events were associated with more rumination and social sharing, while less intense negative events were associated with more reappraisal. Higher intense positive events were associated with a greater number of deployed strategies and more efforts in using savoring, expression and social sharing. The UHR and FEP individuals did not significantly differ regarding effects of above-mentioned appraisal dimensions on ER.Conclusions: These results provide evidence supporting ER flexibility in early psychosis, and event intensity emerged as the dimension most strongly associated with ER. Future research should better account for other situational factors (such as social context) that might affect ER use in psychosis.

BackgroundWe investigated treatment effects of Acceptance and Commitment Therapy in Daily Life (ACT-DL) on psychological flexibility (PF) and the moderating role of the therapeutic working alliance on these effects in patients with early psychosis.MethodsACT-DL is an ecological momentary intervention (EMI) combining face-to-face ACT with a smartphone app. In the multi-center INTERACT randomized controlled trial, n=148 early psychosis individuals were randomized to either treatment as usual (TAU as the control condition, n=77) or to ACT-DL in addition to TAU (ACT-DL + TAU as the experimental condition, n=71). We assessed global PF and the therapeutic alliance with self-report questionnaires. In addition, we used the experience sampling methodology (ESM) to assess PF with a momentary (in-the-moment and since-the-previous-beep openness) and an evening (daily PF) questionnaire. Assessments took place at baseline, post-intervention (POST), six (FU6), and twelve months (FU12) follow-up.ResultsGlobal (B=19.49 to 33.14; all P-valuesConclusionOur results provide partial support for the capability of ACT-DL to improve daily life measures of openness, and emphasize the importance of the therapeutic relationship in supporting processes of change.

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of “Switch,” an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants’ smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants’ activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

BACKGROUND Acceptance and Commitment Therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with a mobile health (mHealth) ecological momentary intervention (EMI) may increase its treatment effects and empower clients to take treatment into their own hands. OBJECTIVE This study aimed to investigate treatment adherence to and acceptability of Acceptance and Commitment Therapy in Daily Life (ACT-DL), a novel Ecological Momentary Intervention for people with Ultra-High-Risk (UHR) state and a First-Episode Psychosis (FEP). METHODS In the multi-center INTERACT randomized controlled trial, UHR and FEP individuals aged 15-65 were randomized to treatment as usual only (TAU) (control) or to ACT-DL+TAU (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone application, delivering ACT skills and techniques in daily life. We collected data on treatment adherence to and acceptability of ACT-DL. Predictors included baseline demographic, clinical and functional outcomes. RESULTS ACT-DL+TAU participants (n=71) completed a mean of 6 (SD=3) sessions, with 59% (n=42) of participants completing all sessions. App adherence data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant to 6 out of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness), and that 91% reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Ethnic minority background predicted lower notification response compliance (b=-4.37; p=.012), yet higher app usefulness (b=1.25; p=.049). Negative (b=-0.26; p=.010) and affective (b=0.14; p=.04) symptom severity predicted lower and higher ACT training usefulness respectively. Being female (b=-1.03; p=.049) predicted lower usefulness of the ACT metaphor images on the app. CONCLUSIONS Our results corroborate good treatment adherence to and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. CLINICALTRIAL The trial was prospectively registered within the Dutch Trial Register (ID: NTR4252). INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-019-3912-4

Background: Treatment in the early stages of psychosis is crucial to prevent poor clinical and social outcomes. The aim of this study was to investigate the efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in reducing psychotic distress in a multi-centre randomised controlled trial of individuals with an Ultra-high Risk for Psychosis (UHR) or a first-episode of psychosis (FEP). Methods: Individuals aged 15-65 years with a clinically established UHR or FEP status were recruited from secondary mental health services in 5 regions and were randomly assigned to treatment as usual (TAU) or ACT-DL+TAU. ACT-DL consisted of 8 ACT sessions augmented with an EMI app. The primary outcome was a reduction in psychotic distress as assessed with CAARMS at post-intervention, 6- and 12-month follow-up. Secondary outcomes were symptom severity, functioning and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. Findings: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomised to ACT-DL+TAU (n=71) or TAU (n=77). 115 (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of a greater reduction in CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3)=2·38; p=0·50). However, momentary psychotic distress (χ2(3)=21·56; p

In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p = .027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p = .011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808. ispartof: BEHAVIOUR RESEARCH AND THERAPY vol:128 ispartof: location:England status: published

BackgroundPsychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a first-episode psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the INTERACT study is to investigate the efficacy of a novel ecological momentary intervention, Acceptance and Commitment Therapy in Daily Life (ACT-DL) in a multi-centre randomised controlled trial of individuals with UHR or FEP.Methods/designIn a multi-centre randomised controlled trial, individuals aged 16–65 years with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only, which will include – for the entire study period – access to routine mental health care and, where applicable, CBT for psychosis (CBTp). Outcomes will be assessed at baseline (i.e. before randomisation), post-intervention (i.e. after the 8-week intervention period), and 6-month and 12-month follow-ups (i.e. 6 and 12 months after completing the intervention period) by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include (momentary) psychotic experiences, social functioning and psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed.DiscussionThe current study is the first to test the efficacy of ACT-DL in individuals with UHR and FEP. If this trial demonstrates the efficacy of ACT-DL, it has the potential to significantly advance the treatment of people with UHR and FEP and, more generally, provides initial support for implementing mHealth interventions in mental health services.Trial registrationNetherlands Trial Register, ID:NTR4252. Registered on 26 September 2013.

Background Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral intervention that holds promise for treatment of individuals in the early stages of psychosis. To increase its treatment effects, we have developed an ACT smartphone app that can be used as an add-on to traditional ACT – ACT in Daily-Life (ACT-DL). Augmenting face-to-face ACT with a mobile health ecological momentary intervention (EMI) may empower clients to take treatment into their own hands and bridge the treatment-practice gap. We tested the feasibility and acceptability of ACT-DL as part of a randomized controlled trial in individuals in the early stages of psychosis. Methods Participants at ultra-high risk (UHR) for, or with a first episode of psychosis (FEP) were randomized to ACT-DL (n=71) or to treatment-as-usual (n=77). In ACT-DL, participants followed seven face-to-face individual ACT-sessions. After each session, they took home a smartphone with the ACT-DL app installed on it that reminded individuals of ACT principles with visual cues of metaphors and provided exercises, 8 times a day for three subsequent days. On-demand exercises were always available. We gathered user data on adherence to app notifications, on-demand use of the app, and rated metaphor usefulness after each session. At post-measurement, a debriefing questionnaire assessed user evaluation on the use, usefulness, and burden of (parts of) the ACT-DL intervention. Results ACT-DL participants attended on average 5 out of 7 ACT sessions, with 42 completing all sessions. App user data (n=58) showed that on a weekly basis, participants interacted on average 16 times with the ACT-DL app, responding to 25% of the notifications, and initiating 5 on-demand exercises. Perceived usefulness of ACT-metaphors varied substantially between participants and weeks. Neither clinical status (UHR vs FEP), nor other baseline (or therapy) related variables were related to dropout, while minority status (b=-4.88; p Discussion This study showed that, despite large between-subject variability, early psychosis patients are largely positive about ACT-DL, acknowledging the usefulness of the app to implement ACT in their daily lives, the homework exercises, and the face-to-face sessions. This argues for the use of a blended care approach in early psychosis. However, the relatively low number of completion rates and app compliance, the perceived burden from notifications, and the variability in perceived usefulness of (parts of) the app, corroborates the need for future improvements in intervention design. I will provide suggestions for app optimisation.

OBJECTIVE: Late onset psychosis not only occurs as a prodromal symptom to neurodegeneration, but it can also be associated with a non-progressive mild cognitive deficit. Studying the phenomenology of psychotic symptoms and the neuropsychological profile may serve as sensitive and non-invasive tools for differential diagnosis. METHOD: We compared 57 individuals with very-late-onset schizophrenia-like psychosis (VLOSLP), 49 participants with Dementia with Lewy Bodies (DLB) and 35 patients with Alzheimer's type Dementia and psychosis (AD+P) concerning the phenomenology of psychotic symptoms and the neuropsychological profile using several measures of cognitive function in a cross-sectional study. RESULTS: Participants with DLB exhibited more visual hallucinations, especially those involving animals, and less partition/paranoid delusions than both other groups. VLOSLP showed more partition delusions and auditory hallucinations of human voices than both other groups. Hence, patients with DLB and VLOSLP showed greater dissimilarity in the phenomenology of psychosis, whereas individuals with AD+P held an intermediate position. Processing speed and executive function were comparably impaired among the three groups, as was expected considering a common underlying set of neurobiological abnormalities for psychosis. However, AD+P showed more strongly reduced learning and consolidation skills, whereas DLB was associated with prominent visuoconstructive deficits. CONCLUSIONS: Phenomenology of psychosis may prove especially informative when comparing individuals with DLB to those with VLOSLP. Neuropsychological profiles are able to further aid differential diagnosis of the three groups. ispartof: ARCHIVES OF CLINICAL NEUROPSYCHOLOGY vol:34 issue:2 pages:183-199 ispartof: location:United States status: published