Acceptance and Commitment Therapy in Early Psychosis

Recently, with my colleague Joe Oliver, we presented our work (at the ACT Summer Institute IV) on developing acceptance and commitment therapy to help young people recovering from a first episode of psychosis. We titled our presentation “ACT Early”, and described the work we have been doing in developing groups and individual therapy for this population.

Conference Abstract:

The stance of acceptance and committed action may allow for flexibility in response to persisting psychotic experiences, as has been suggested in ACT studies with the seriously mentally ill (Bach & Hayes, 2002; Gaudiano & Herbert, 2006). There is also the exciting potential for researching the impact of ACT in the early phase of psychosis – helping first episode clients to recover from psychosis through the development of a more mindful approach toward unusual experiences and critical appraisals, and committing to values-based actions.

More specifically, the use of ACT may:

[1] foster the development of a psychologically flexible stance toward anomalous experiences,

[2] enable a “values-based” recovery,

[3] reduce the impact of “fear of recurrence” of psychosis through development of mindfulness and self as context,

[4] enable individuals to notice the process of self-stigmatisation, contexts where this operates as a barrier, and commit to valued directions in the face of these appraisals, and

[5] improve relapse prevention plans through the use of mindfulness and committed action.

We describe a group program we have developed, as well as individual work with young people who have experienced a first episode of psychosis. In addition there is discussion about a pilot ACT/mindfulness group for people experiencing at risk mental states, who may be in a prodromal phase of psychosis.

The .pdf of this workshop is here: act-early-morris-oliver-2008 and the audio recording of our presentation is here (.mp3 format, 30MB download)


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“Prozac Nation”? Try Placebo Nation…

Freedom of information opens up the file drawer on Prozac, with The Guardian reporting today that Prozac and similar antidepressants are no more effective than placebo for mild to moderate depression:

“Prozac, the bestselling antidepressant taken by 40 million people worldwide, does not work and nor do similar drugs in the same class, according to a major review released today.

The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.

When all the data was pulled together, it appeared that patients had improved – but those on placebo improved just as much as those on the drugs.

The only exception is in the most severely depressed patients, according to the authors – Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.

“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” says Kirsch. “This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported.” “

The study is published here.

Treating depression is a serious, and lucrative, business (hence the industry-standard practice of consignment to the file drawer for negative results, that this study managed to dig up). The cultural effect of Prozac seemed to fuel the business nicely as well, remember all the triumphalist stuff in the 90s about Prozac being part of a new wave of psychopharmacological tinkering with our very beings?

I’m sure critics of this study will wade in with various statements about the need to correct chemical imbalances in depression, etc. another area where rhetoric (and advertising) is not quite square with the evidence.

As Prof Kirsch has written previously : “listening to Prozac, but hearing placebo”.

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The UK is “an endemic surveillance society”

As a country with the the world’s largest CCTV network and a government keen to propose various intrusions on civilians’ privacy, is it any surprise that Britain achieved the rating “endemic surveillance society” by civil liberties watchdog Privacy International? (along with such privacy luminaries as the United States, Russia, Singapore and China)

I guess that we can be reassured that the UK government knows how to safeguard the personal data of citizens… unless you: receive child benefitreceive a pension, are learning to drive, or have accessed healthcare, of course.

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Street slang or thought disorder? A tough call.

Nice little article in the British Medical Journal last week (written by several clinicians from the OASIS service), about a difficulty that can arise in assessing young people who might have the early signs of psychosis: putting their unconventional speech in context. (The use of unusual words and phrases as part of a pattern of disorganised speech can be evidence of formal thought disorder, a symptom of psychosis).

The authors describe the case of a young man whose use of street slang in the assessment interview made him appear more thought disordered than he actually was. Thankfully the clinician had the foresight to check the and discover that many of the words the man used were “legit”, rather than neologisms (there is a quiz in the article to test yourself on how you would classify the words, as slang or neologism). The authors describe the detailed assessment procedures the team used to further ascertain the presence of an at risk mental state (pdf).

The article made me think about what happens in routine mental health assessments in less specialised settings: how often do clinicians misclassify heavy use of slang as evidence of thought disorder?

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South Pole Scuffle

Also in the news today – a couple of men had “a drunken christmas punch up” at the Amundsen-Scott South Pole station, resulting in one having injuries serious enough to need medical evacuation to a hospital in New Zealand. Just as well it was summer over there, so that the injured fellow could be flown to hospital relatively easily (at great expense, which was the not-so-interesting angle the Australian press took).

I wouldn’t think it was the first time that things got a bit heated at the South Pole, so to speak. Bad puns aside, there are some fascinating articles here about the psychology of wintering at the Antarctic, for you not-so intrepid explorers out there.    

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Planning to build your own Great Pyramid? Check that copyright.


Interesting news today as the Guardian reports that the Egyptian government plans to pass a law to have copyright on the country’s ancient monuments and museum pieces.

How this is going to be enforced is not clear, but one suspects the law is aimed at extracting cash from (amongst so many others) big Hollywood studios. Perhaps that remake of Cleopatra might be put on hold then.

Apparently private individuals will also have to ask for permission to build replicas. I guess I’m gonna rethink my plan to build the Sphinx as a garden ornament…

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The release of David Hicks, a test of Australian values

Another moment to test the compassion of the Australian public, as the news has broken that David Hicks is to be released from prison, albeit under a control order. Although the Federal Police regard Mr Hicks as an ongoing danger it would seem that he currently poses little risk to others, considering his mental state (Sydney Morning Herald, 24/12/07):

DAVID HICKS’S mental condition is so fragile that – only five days before his scheduled release from jail – he suffers from agoraphobia and retreats to the kind of solitary confinement he endured for five years in Guantanamo Bay.The former Muslim extremist has suffered panic attacks and has ventured into the sunshine, in the prison yard, only once since his return to Australia in May this year to serve the balance of his nine-month sentence at Yatala Labour Prison in Adelaide. He could not cope and preferred the enclosed prison and artificial lighting, where he felt more safe.

Is it any surprise to read that Mr Hicks experiences panic attacks and agoraphobia, after his incarceration at Guantanamo Bay?   Imprisoned without trial for 5 years, kept in solitary and tortured with impunity, his case was a convenient political football for the Howard Government’s war on terror (until suddenly it wasn’t). His treatment is a sobering example of what any Australian citizen could experience if they are caught ideologically on the wrong side. Regardless of the legality of Mr Hick’s actions, Australia’s government was willing to trade away the country’s humanitarian values for political reasons.

I hope that Mr Hicks can be supported to lead a productive and peaceful life on his release, after all, isn’t this what Australia really stands for – a fair go?  

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