Washington State Institute for Public Policy
Acceptance and Commitment Therapy for schizophrenia/psychosis
Adult Mental Health: Serious Mental Illness
Benefit-cost estimates updated December 2016.  Literature review updated September 2016.
Acceptance and Commitment Therapy for schizophrenia/psychosis aims to increase client acceptance of psychotic symptoms (such as hallucinations and delusions) and reduce the negative behavioral impact of psychosis. Acceptance and Commitment Therapy relies on six core processes of change: 1) acceptance; 2) learning to view thoughts as hypotheses rather than facts; 3) being present; 4) viewing the self as context for experience; 5) identifying core values; and 6) acting based on those values. These core principles are applied through various exercises and through homework.

Treatment groups received 2 to 16 hours of individual acceptance and commitment therapy. Treatments in this review provided acceptance and commitment therapy as an addition to usual treatment; comparison groups received usual treatment. This review excludes studies of acceptance and commitment therapy for other disorders.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $886 Benefits minus costs $503
Participants $12 Benefit to cost ratio $1.73
Others $199 Chance the program will produce
Indirect $98 benefits greater than the costs 58 %
Total benefits $1,195
Net program cost ($692)
Benefits minus cost $503
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Health care associated with psychiatric hospitalization $886 $12 $199 $443 $1,540
Adjustment for deadweight cost of program $0 $0 $0 ($345) ($345)
Totals $886 $12 $199 $98 $1,195
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $693 2015 Present value of net program costs (in 2015 dollars) ($692)
Comparison costs $0 2015 Cost range (+ or -) 15 %
These therapies took place over 2-12 weekly or bi-weekly sessions; total length of treatment was 6 weeks on average. The per-participant cost of treatment was weighted by the treatment Ns reported in the studies. Cost per session is $122.25/session (2015 dollars). This rate is based on actuarial tables reported in Mercer (2014) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2015.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Global functioning 2 39 0.214 0.231 40 0.158 0.433 41 0.214 0.355
Medication adherence 1 35 -0.245 0.329 40 -0.181 0.522 41 -0.245 0.457
Hospitalization (psychiatric) 3 64 -0.596 0.245 40 0.000 0.118 41 -0.596 0.015
Psychosis symptoms (positive) 3 53 -0.230 0.198 40 -0.170 0.411 41 -0.230 0.247
Psychiatric symptoms 2 39 -0.454 0.233 40 -0.337 0.522 41 -0.454 0.051
Psychosis symptoms (negative) 3 53 -0.433 0.209 40 -0.321 0.500 41 -0.433 0.038
Citations Used in the Meta-Analysis

Bach, P., & Hayes, S.C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial., Journal of Consulting and Clinical Psychology, 70, (5), 1129-39.

Gaudiano, B.A., & Herbert, J.D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research and Therapy, 44, (3), 415-437.

White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49, (12), 901-907.

Shawyer, F., Farhall, J., Mackinnon, A., Trauer, T., Sims, E., Ratcliff, K., Larner, C., ... Copolov, D. (2012). A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behaviour Research and Therapy, 50, (2), 110-121.

Tyrberg, M.J., Carlbring, P., Lundgren, T., Tyrberg, M.J., & Lundgren, T. (2016). Brief acceptance and commitment therapy for psychotic inpatients: A randomized controlled feasibility trial in Sweden. Nordic Psychology, 1-16.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov