skip to main content

The Application of Acceptance Commitment Therapy (ACT) and Family Psychoeducation (FPE) to Clients with Scizophrenia and Aggressive Behavior

*Andi Buanasari  -  Nursing Department, Faculty of Medicine, Sam Ratulangi University, Indonesia
Budi Anna Keliat scopus  -  Faculty of Nursing, Universitas Indonesia, Indonesia
Herni Susanti scopus  -  Faculty of Nursing, Universitas Indonesia, Indonesia
Open Access Copyright (c) 2020 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Aggressive behavior frequently occurs in clients with schizophrenia and causes injuries to the clients themselves, others, and the environment. It becomes one of the most common factors causing rehospitalization in schizophrenic clients. Aggressive behavior can be managed by the intervention administered by nurses in the usual way (treatment as usual; TAU) as well as psychotherapy (acceptance and commitment therapy; ACT and family psychoeducation; FPE).

Purpose: This study aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) and family psychoeducation (FPE) on schizophrenic clients with aggressive behavior.

Methods: This study used a case series method to report four selected cases of schizophrenic clients with aggressive behavior. Acceptance and commitment therapy (ACT), family psychoeducation (FPE), and treatment as usual (TAU) were delivered to four clients with aggressive behavior for six weeks using the Stuart Stress-Adaptation Model.

Results: The finding showed decreased symptoms of aggressive behavior in cognitive, affective, physiological, behavioral, and social aspects and increased ability to control anger, to accept their problems, and to commit to the therapy after ACT, FPE, and TAU interventions.

Conclusion: This report showed that TAU, ACT, and FPE effectively decreased the symptoms of aggressive behavior and increased the clients’ ability to control anger.

Fulltext View|Download
Keywords: Acceptance and commitment therapy; family psychoeducation; aggressive behavior; case series; schizophrenia
Funding: Sam Ratulangi Universit; Universitas Indonesia; Marzoeki Mahdi Mental Hospital

Article Metrics:

  1. Amaresha, A. C., & Venkatasubramanian, G. (2012). Expressed emotion in schizophrenia: an overview. Indian Journal of Psychological Medicine, 4(1), 12-20. doi: 10.4103/0253-7176.96149
  2. Bach P., Gaudiano B. A., Hayes S. C., Herbert J. D. (2013). Reduced believability of positive symptoms mediates improved hospitalization outcomes of Acceptance and Commitment Therapy for psychosis. Psychosocial Psychological Social Integration Approaches, 5, 166–174
  3. Bach, P., Hasyes, S. C., & Gallop, R. (2012). Long-term effects of brief acceptance and commitment therapy for psychosis. Behaviour Modification, 36(2), 165-581. doi: 10.1177/0145445511427193
  4. Bogojevic, G., Ziravac, L., & Zigmund, D. (2015). Impact of expressed emotion on the course of schizophrenia. European Psychiatry, 30(1), 390. doi: 10.1016/S0924-9338(15)30309-6
  5. Buanasari, A., Daulima, N. H. C., & Wardani, I. Y. The experience of adolescents having mentally ill parents with pasung. Enfermeria Clinica, 28(1), 83-87. doi: 10.1016/S1130-8621(18)30043-3
  6. Bucci, S., Birchwood, M., Twist, L., Tarrier, N., Emsley, R., & Haddock, G. (2013). Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices' power and intent. Schizophrenia Research, 147(1), 163-168. doi: 10.1016/j.schres.2013.02.037
  7. Butler, L., Johns, L. C., Byrne, M., Joseph, C., O’Donoghue, E., Jolley, S., … & Oliver, J. E. (2016). Running acceptance and commitment therapy groups for psychosis in community settings. Journal of Contextual Behavioral Science, 5(1), 33-38. doi: 10.1016/j.jcbs.2015.12.001
  8. Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatric disease and treatment, 11, 145–151. doi: 10.2147/NDT.S51331
  9. Fleischman, A., Werbeloff, N., Yoffe, R., Davidson, M., & Weiser, M. (2014). Schizophrenia and violent crime: a population-based study. Psychological Medicine, 44(14), 3051-3057. doi: 10.1017/S0033291714000695
  10. Gearing, R. E. (2008). Evidence-based family psychoeducational interventions for children and adolescents with psychotic disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 17(1), 2-11
  11. Ghouchani, S., Molavi, N., Massah, O., Sadeghi, M., Mousavi, S. H., Noroozi, M., … Farhoudian, A. (2018). Effectiveness of Acceptance and Commitment Therapy (ACT) on aggression of patients with psychosis due to methamphetamine use: A pilot study. Journal of Substance Use, 23(4), 402-407. doi: 10.1080/14659891.2018.1436602
  12. Goulet, M., & Larue, C. (2016). Post-seclusion and/or restraint review in psychiatry: A scoping review. Archives of Psychiatric Nursing, 30(1), 120-128. doi: 10.1016/j.apnu.2015.09.001
  13. Green, A. I., Noordsy, D. L., Brunette, M. F., & O’Keefe, C. (2008). Substance abuse and schizophrenia: Pharmacotherapeutic intervention. Journal of Substance Abuse Treamentt, 34(1). 61-67. doi: 10.1016/j.jsat.2007.01.008
  14. Haddock, G., Eisner, E., Davies, G., Coupe, N., & Barrowclough, C. (2013). Psychotic symptoms, self-harm and violence in individuals with schizophrenia and substance misuse problem. Schizophrenia Research, 151(1-3), 215-220, doi: 10.1016/j.schres.2013.10.031
  15. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behaviour Therapy, 35(4), 639-665. doi: 10.1016/S0005-7894(04)80013-3
  16. Hayward, M., Strauss, C., & McCarthy-Jones, S. (2014). Psychological Approaches to Understanding and Treating Auditory Hallucinations: From Theory to Therapy (Explorations in Mental Health). New York: Taylor and Francis Group
  17. Jansen, J. E., & Morris, E. M. J. (2017). Acceptance and commitment therapy for posttraumatic stress disorder in early psychosis: A case series. Cognitive and Behavioral Practice, 24(2), 187-199. doi: 10.1016/j.cbpra.2016.04.003
  18. Keliat, B. A., Azwar, A., Bachtiar, A., & Hamid, A. Y. S. (2009). Influence of the abilities in controlling violence behaviour to the length of stay of schizophrenic clients in Bogor mental hospital, Indonesia. Medical Journal Indonesia, 18(1), 31-35. doi: 10.13181/mji.v18i1.336
  19. Knezevic, V., Mitrovic, D., Drezgic-Vukic, S., Knezevic, J., Ivezic, A., Siladji-Mladenovic, D., & Golubovic, B. (2016). Prevalence and correlates of aggression and hostility in hospitalized schizophrenic patients. Journal of Interpersonal Violence, 32(2), 151-163. doi: 10.1177/0886260515585537
  20. Lasebikan, V., & Ayinde, O. (2013). Family burden in caregivers of schizophrenia patients: Prevalence and socio-demographic correlates. Indian Journal of Psychological Medicine, 35(1), 60-66. doi: 10.4103/0253-7176.112205
  21. Nirmala, B. P., Vranda, M. N., & Reddy, S. (2011). Indian Journal of Psychological Medicine, 33(2), 119-122. doi: 10.4103/0253-7176.92052
  22. Rafiyah, I. (2011). Review: Burden on Family Caregivers Caring for Patients with Schizophrenia and Its Related Factors. Nurse Media Journal of Nursing, 1(1), 29-41. doi: 10.14710/nmjn.v1i1.745
  23. Ran, M. S., Chan, C. L., Ng, S. M., Guo, L. T., & Xiang, M. Z. (2015). The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychological Medicine, 45(10), 2197-2204. doi: 10.1017/S0033291715000197
  24. Richmond, J. S., Berlin, J. S., Fishkind, A. B., Holloman, G. H., Zeller, S. L, Wilson, M. P., … & Ng, A. T. (2012). Verbal de-escalation of the agitated patient: Consensus statement of the American Association for Emergency Psychiatry project BETA de-escalation workgroup. Western Journal of Emergency Medicine, 13(1),17–25. doi: 10.5811/westjem.2011.9.6864
  25. Rueve, M. E., & Welton, R. S. (2008). Violence and mental illness. Psychiatry (Edgmont), 5(5), 34–48
  26. Setiawan, H. (2017). Penerapan terapi kognitif perilaku dan terapi asertif terhadap klien risiko perilaku kekerasan di ruang akut rumah sakit jiwa [Application of CBT and Assertive training to clients with risks of aggressive behaviors in acute psychiatric care] (Unpublished thesis). Universitas Indonesia, Depok, Indonesia
  27. Sharif, F., Shaygan, M., & Mani, A. (2012). Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry, 12(48), 1-9. doi: 10.1186/1471-244X-12-48
  28. Shawyer, F., Farhall, J., Thomas, N., Hayes, S. C., Gallop, R., Copolov, D., & Castle, D. J. (2016). Acceptance and commitment therapy for psychosis: randomised controlled trial. The British Journal of Psychiatry, 210(2), 140-148. doi: 10.1192/bjp.bp.116.182865
  29. Shawyer, F., Mackinnon, A., Farhall, J., Taruer, T., & Copolov, D. (2003). Command hallucinations and violence: Implications for detention and treatment. Psychiatry, Psychology and Law, 10(1), 97-107. doi: 10.1375/pplt.2003.10.1.97
  30. Stanley, B., Molcho, A., Stanley, M., Winchel, R., Gameroff, M. J., Parsons, B., & Mann. J. J. (2000). Association of aggressive behavior with altered serotonergic function in patients who are not suicidal. American Journal of Psychiatry, 157(4), 609-614. doi: 10.1176/appi.ajp.157.4.609
  31. Stanley, S., Balakrishnan, & Ilangovan, S. (2016). Psychological distress, perceived burden and quality of life in caregivers of persons with schizophrenia. Journal of Mental Health, 26(2), 134-141. doi: 10.1080/09638237.2016.1276537
  32. Stuart, G. W. (2013). Principles and Practice of Psychiatric Nursing. Missouri: Elsevier Mosby
  33. Sulistiowati, N. M. D., Keliat, B. A., & Wardani, I. Y. (2014). Pengaruh acceptance and commitment therapy terhadap gejala dan kemampuan klien dengan resiko perilaku kekerasan [The effect of Acceptance Commitment Therapy on symptoms and Ability on Clients with aggressive behaviour]. Jurnal Keperawatan Jiwa, 2(1), 51-57
  34. Susanti, H., Lovell, K., & Mairs, H. (2018). What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review. Enfermeria Clinica, 28(1), 102-111. doi: 10.1016/S1130-8621(18)30047-0
  35. Susanti, H., Lovell, K., & Mairs, H. (2019). Emotional reactions and coping strategies of carers of people with serious mental illnesses: A focus group study. Enfermeria Clinica, 29(2), 275-27. doi: 10.1016/j.enfcli.2019.04.033
  36. Torrey, E. F. (2011). Stigma and Violence: Isn’t It Time to Connect the Dots?. Schizophrenia Bulletin, 37(5), 892-896. doi: 10.1093/schbul/sbr057
  37. Volavka, J. (2014). Aggression in psychoses. Advances in Psychiatry, 1-20. doi: 10.1155/2014/196281
  38. Volavka, J., & Citrome, L. (2011). Pathways to aggression in schizophrenia affect results of treatment. Schizophrenia Bulletin, 37(5), 921-929. doi: 10.1093/schbul/sbr04

Last update:

  1. The effect of Qur'anic Healing on reducing the frequency of Auditory Hallucination Rating Scale (AHRS) in schizophrenia

    Muhammad Rosyidul Ibad, Febry Syaren Alfianti, Muhammad Ari Arfianto, Tutu April Ariani, Zahid Fikri. Healthcare in Low-resource Settings, 2024. doi: 10.4081/hls.2024.11909
  2. The Effect of Cognitive Behavioural Therapy–Based Psychoeducation on Medication Adherence and Aggression in Individuals Diagnosed With Schizophrenia: An Experimental Study

    Sevinç Yaşar Can, Funda Kavak Budak. Journal of Psychiatric and Mental Health Nursing, 2024. doi: 10.1111/jpm.13127

Last update: 2024-11-22 10:37:33

No citation recorded.