Effects of Acceptance Commitment Therapy Based Recovery Enhancement Program on Psychological Flexibility, Recovery Attitude, and Quality of Life for Inpatients with Mental Illness

In Sook Kim; Jae Woon Lee

doi:10.12934/jkpmhn.2019.28.1.79

Journal List > J Korean Acad Psychiatr Ment Health Nurs > v.28(1) > 1119806

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Lee: Effects of Acceptance Commitment Therapy Based Recovery Enhancement Program on Psychological Flexibility, Recovery Attitude, and Quality of Life for Inpatients with Mental Illness

Original Article

J Korean Acad Psychiatr Ment Health Nurs 2019;28(1):79-90.

Published online: 17 March 2019

DOI: https://doi.org/10.12934/jkpmhn.2019.28.1.79

Effects of Acceptance Commitment Therapy Based Recovery Enhancement Program on Psychological Flexibility, Recovery Attitude, and Quality of Life for Inpatients with Mental Illness

In Sook Kim¹, Jae Woon Lee²

¹Assistant Professor, Department of Nursing, Changshin University, Changwon, Korea

²Advanced Practice Nurse, Department of Nursing, Bugok National Hospital, Changnyeong, Korea

Corresponding author: Lee, Jae Woon https://orcid.org/0000-0002-9648-7233 Department of Nursing, Bugok National Hospital, 145 Bugok-ro, Bugok-myeon, Changnyeong 50365, Korea. Tel: +82-55-520-2582, Fax: +82-55-520-2631, E-mail: jungnamguy@hanmail.net

Received 31 January 201911 March 2019 Accepted 16 March 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to (1) develop an acceptance commitment therapy (ACT) based recovery enhancement program for inpatients with mental illness and (2) test the effects of the program on patients’ psychological flexibility, recovery attitude, and quality of life.

Methods

A mixed methods design was used: a combination of a repeated-measure design with a non-equivalent control group and qualitative data collection. The participants were 41 inpatients with mental illness (experimental group: 20, control group: 21). The ACT based recovery enhancement program was conducted over four sessions for a total of two weeks. Data were collected from December 2018 to January 2019.

Results

Study results revealed that the ACT based recovery enhancement program was effective for psychological flexibility (F=150.71, p<.001), recovery attitude (F=60.22, p<.001), and quality of life (F=31.59, p<.001) for inpatients with mental illness.

Conclusion

The results of this study suggest that the ACT based recovery enhancement program can be used as an effective mental health nursing intervention for psychological flexibility, recovery attitude, and quality of life of inpatients with mental illness.

Keywords: Acceptance and commitment therapy, Hospitalization, Mental disorders, Mental health recovery, Quality of life

REFERENCES

1. Kim HJ. Meaning of recovery from mental illness: findings of a qualitative study. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2009; 18(4):379–389.

2. Keum R, Kim S. Perceived functional health patterns and recovery in people with schizophrenia spectrum disorders. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2012; 21(3):238–249. https://doi.org/10.12934/jkpmhn.2012.21.3.238.

3. Bae JK, Son MJ, Lee J. Development of the recovery attitudes scale for persons with psychiatric disabilities. Korean Journal of Clinical Psychology. 2009; 28(2):605–627. https://doi.org/10.15842/kjcp.2009.28.2.016.

4. Choi MO. The process of the perceived attitude for bringing up on the attitude of recovery and self-advocacy of children with mentally ill. Mental Health & Social Work. 2008; 29:257–294.

5. Bae JK, Son MJ, Lee J. The effects of attitude toward recovery on quality of life among persons with psychiatric disabilities: test of mediating effects model. Korean Journal of Clinical Psychology. 2009; 28(3):811–831. https://doi.org/10.15842/kjcp.2009.28.3.009.

6. Lee BK, Park GH, Lee CW. The relationships between recovery attitude and, drug attitude in schizophrenic inpatients focusing on the moderating effect of cognitive insight. Korean Journal of Health Psychology. 2016; 21(1):257–271. https://doi.org/10.17315/kjhp.2016.21.1.013.

7. Seo JU. The effects of a recovery enhancement program on recovery attitude, drug attitude, and quality of life for mentally ill persons in day hospital [master's thesis]. [Daegu]: Daegu Catholic University;2014. p. 58.

8. Luoma JB, Hayes SC, Walser RD. Learning ACT: an acceptance and commitment therapy skills- training manual for therapists. 1st Korean Ed. Choi YH, You ES, Choi JH, translators. Seoul: Hakjisa;2012. p. 520.

9. Kim KH. A convergence study about metaanalysis on the effects of ACT intervention program. Journal of the Korea Convergence Society. 2016; 7(5):145–153. https://doi.org/10.15207/JKCS.2016.7.5.145.

10. The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Social Science & Medicine. 1995; 41(10):1403–1409. https://doi.org/10.1016/0277-9536(95)00112-K.

11. Park HS, Lee JW. Mediating effect of psychological flexibility on quality of life in inpatients with schizophrenia. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2018; 27(3):284–292. https://doi.org/10.12934/jkpmhn.2018.27.3.284.

12. Park JH, Park HS. Hope enhancement program for increased hope, self-efficacy, and quality of life for mentally ill persons in day hospitals. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2017; 26(3):260–270. https://doi.org/10.12934/jkpmhn.2017.26.3.260.

13. Bach P, Hayes SC. The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting Clinical Psychology. 2002; 70(5):1129–1139. https://doi.org/10.1037/0022-006X.70.5.1129.

14. Bach P, Hayes SC, Gallop R. Longterm effects of brief acceptance and commitment therapy for psychosis. Behavior Modification. 2012; 36(2):165–181. https://doi.org/10.1177/0145445511427193.

15. Lee JW, Ha JH. The effects of an acceptance-commitment therapy based stress management program on hospitalization stress, self-efficacy and psychological well-being of inpatients with schizophrenia. Journal of Korean Academy of Nursing. 2018; 48(4):443–453. https://doi.org/10.4040/jkan.2018.48.4.443.

16. Lee JW, Park HS. Development and effects of an acceptance commitment-based cognitive behavioral program for patients with schizophrenia. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2018; 27(4):342–354. https://doi.org/10.12934/jkpmhn.2018.27.4.342.

17. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psycho metric properties of the acceptance and action questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy. 2011; 42(4):676–688. https://doi.org/10.1016/j.beth.2011.03.007.

18. Heo JH, Choi MS, Jin HJ. Study on the reliability and validity of Korean translated acceptance-action questionnaire-II. The Korean Journal of Counseling and Psychotherapy. 2009; 21(4):861–878.

19. Goldberg DP, Hiller VF. A scaled vesion of the general health questionnaire. Psychological Medicine. 1979; 9(1):139–145.

20. Kook SH, Son CN. A validation of GHQ/QL-12 to assess the quality of life in patients with schizophrenia: using RMSEA, ECVI, and Rasch model. Korean Journal of Clinical Psychology. 2000; 19(3):587–602.

21. Stoddard JA, Afari N. The big book of ACT metaphors: a practitioner's guide to experiential exercise and metaphors in acceptance and commitment therapy. 1st Korean Ed. Son CN, translator. Seoul: Sigma Press;2016. p. 254.

22. Choi DJ, Kim SJ. An integrative review of acceptance and commitment therapy (ACT) for mental health problem. The Korean Journal of Stress Research. 2017; 25(2):75–85. https://doi.org/10.17547/kjsr.2017.25.2.75.

23. Naeem F, Asmer MS, Khoury B, Kingdon D, Farooq S. Acceptance and commitment therapy for schizophrenia and related disorders. Cochrane Database of Systematic Reviews. 2015; 6:1–12. https://doi.org/10.1002/14651858.CD011734.

24. Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62(1):107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x.

25. Byun EK, Jun SS. Factors Influencing quality of life in people with mental disabilities using mental health centers. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2011; 20(2):157–166. https://doi.org/10.12934/jkpmhn.2011.20.2.157.

26. A-Tjak JGL, Davis ML, Moria N, Powers MB, Smits JAJ, Em-melkamp PMG. A metaanalysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy Psychosomatics. 2015; 84(1):30–36. https://doi.org/10.1159/000365764.

27. Montgomery KL, Kim JS, Franklin C. Acceptance and commitment therapy for psychological and physiological illnesses: a systematic review for social workers. Health & Social Work. 2011; 36(3):169–181. https://doi.org/10.1093/hsw/36.3.169.

28. Park BS, Lim SO, Bae SW. A metaanalysis on the variables related with quality of life among persons with severe mental illness. Mental Health & Social Work. 2013; 41(3):63–92.

Figure 1.

Conceptual framework of this study.

Table 1.

Acceptance-Commitment Therapy based Recovery Enhancement Program

Session	Themes	Purpose	Contents of program	Time (minutes)
1	Paradox of control	Accepting through creative despair	․ ACT program introduction	10
			․ Activities using metaphor	20
			․ Avoiding thinking about the food you want to eat	20
			․ Breathing meditation	10
2	Self acceptance and willing to experience	Accepting and experiencing is my choice	․ Activities using metaphor	20
			․ Choosing coffee and green tea	20
			․ Eating meditation	20
3	The mind hears and believes as we think and speak	Getting away from stereotypes and looking at it objectively	․ Education that breaks away from the fusion of thought and language	15
			․ Watching videos related to stereotypes	10
			․ Watermelon words follow game	15
			․ Looking at the mind train	10
			․ Breathing meditation	10
4	Focus on finding my value	Separating thoughts from the actual and understanding	․ Watching videos of people who have overcome mental illness	20
			․ Having lecture on the difference between value and goal	15
			․ Activities using metaphor	15
			․ Finding values and conducting action table activity
			․ Breathing meditation	10

Table 2.

Homogeneity of General Characteristics between Experimental and Control Groups (N=41)

Characteristics	Categories	Exp. (n=20)	Cont. (n=21)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Men	12 (60.0)	11 (52.4)	0.24	.756
Gender	Women	8 (40.0)	10 (47.6)
Age (year)	＜40	7 (35.0)	8 (38.1)	0.42	＞.999
	≥40	13 (65.0)	13 (61.9)
		42.55±12.91	43.86±12.96	-0.32	.748
Marital status	Married	1 (5.0)	4 (19.0)	1.89	.343^†
Marital status	Single	19 (95.0)	17 (81.0)
Education level	≤High school	13 (65.0)	15 (71.4)	0.20	.744
Education level	≥College	7 (35.0)	6 (28.6)
Religion	Have	15 (75.0)	12 (57.1)	1.45	.326
Religion	Have not	5 (25.0)	9 (42.9)
Diagnosis	Schizophrenia	16 (80.0)	14 (66.7)	0.93	.484
Diagnosis	Bipolar disorder	4 (20.0)	7 (33.3)
Types of admission	Voluntary	13 (65.0)	18 (85.7)	2.38	.159^†
Types of admission	Involuntary	7 (35.0)	3 (14.3)

Exp.=experimental group; Cont.=control group;

^† Fisher's exact test.

Table 3.

Homogeneity of Dependent Variables in Pretest (N=41)

Variables	Exp. (n=20)	Cont. (n=21)	t	p
Variables	M±SD	M±SD	t	p
Psychological flexibility	27.25±4.95	28.29±6.83	-0.55	.583
Recovery attitude	100.55±11.66	94.76±18.11	1.21	.234
Quality of life	16.95±6.38	17.86±5.64	-0.48	.632

Exp.=experimental group; Cont.=control group.

Table 4.

Change of Psychological Flexibility, Recovery Attitude, and Quality of Life between Two Groups (N=41)

Variables	Group	Pretest	Posttest 1	Posttest 2	Sources	F (p)
Variables	Group	M±SD	M±SD	M±SD	Sources	F (p)
Psychological flexibility	Exp. (n=20)	27.25±4.95	41.30±5.20	43.20±5.46	Group	41.46 (＜.001)
	Cont. (n=21)	28.29±6.83	26.24±6.48	24.05±6.41	Time	62.03 (＜.001)
					G×T	150.71 (＜.001)
Recovery attitude	Exp. (n=20) Cont. (n=21)	100.55±11.66 94.76±18.11	127.60±9.75 99.67±18.78	129.50±10.30 101.67±17.72	Group Time	20.90 (＜.001) 143.21 (＜.001)
Recovery attitude					G×T	60.22 (＜.001)
Quality of life	Exp. (n=20)	16.95±6.38	22.50±6.02	24.20±4.84	Group	3.66 (.063)
	Cont. (n=21)	17.86±5.64	18.10±6.66	17.00±7.64	Time	23.20 (＜.001)
					G×T	31.59 (＜.001)

Exp.=experimental group; Cont.=control group; G×T=interaction term between group and time.

TOOLS

Similar articles