Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Aug 19, 2025; 15(8): 107313
Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.107313
Acceptance and commitment therapy applied to early psychosis: Therapeutic foundations and a narrative systematic review
Josep Pena-Garijo, Tábata Baeza-Mor, José Martinez-Raga
Josep Pena-Garijo, Tábata Baeza-Mor, José Martinez-Raga, Department of Psychiatry and Mental Health, University Hospital Doctor Peset, Valencia 46017, Spain
José Martinez-Raga, Department of Medicine, University of Valencia, Valencia 46010, Spain
Author contributions: Pena-Garijo J, Baeza-Mor T, and Martínez-Raga J contributed equally to this work; Pena-Garijo J conceptualized and designed the study and drafted the original manuscript; Pena-Garijo J, Baeza-Mor T, and Martínez-Raga J conducted the literature review and data analysis. All the authors prepared the manuscript and approved its final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Josep Pena-Garijo, PhD, PsyD, Department of Psychiatry and Mental Health, University Hospital Doctor Peset, 90 Gaspar Aguilar Ave, Valencia 46017, Spain. jpena@uji.es
Received: March 20, 2025
Revised: April 26, 2025
Accepted: June 12, 2025
Published online: August 19, 2025
Processing time: 141 Days and 13.2 Hours
Abstract
BACKGROUND

Acceptance and commitment therapy (ACT) is a third-generation therapy that appears to be a promising psychological intervention for psychotic disorders. While several systematic reviews and meta-analyses that address the efficacy of ACT for psychosis have been conducted, no systematic review has specifically focused on the application of ACT to the early stages of psychosis.

AIM

To review the state of the art regarding the feasibility and efficacy of treating early psychosis (EP) with ACT-based interventions.

METHODS

First, we describe the foundations of the ACT model to provide the background required to contextualize the main objective of this review. Second, we searched the PubMed and PsycINFO databases for studies published up to January 2025 and identified eight studies that met our selection criteria. The systematic review was conducted in accordance with the PRISMA guidelines and the critical appraisal checklist provided by the Joanna Briggs Institute for randomized controlled trials (RCTs).

RESULTS

All studies were published after 2019. Among the reviewed studies, five were RCTs with a total combined sample of 399 nonoverlapping participants. The methodological quality was moderate for RCTs. The results showed that ACT-based treatments are feasible and improve psychotic symptoms, medication adherence, and global functioning in patients with EP. Furthermore, preliminary evidence exists for the benefits of group-based and online-delivered programs and those that combine face-to-face therapy with novel real-time digital interventions, such as “ecological momentary intervention”, to apply therapeutic concepts to real life.

CONCLUSION

ACT-based treatments in the early stages of psychosis are feasible and improve symptoms, treatment adherence, and self-care skills. Although promising, these results are inconclusive. Further research is required.

Keywords: Acceptance and commitment therapy; Acceptance-based therapy; Early psychosis; First-episode psychosis; Schizophrenia; Ecological momentary intervention; Digital intervention; Systematic review

Core Tip: Acceptance and commitment therapy (ACT) is a promising intervention for the treatment of psychotic disorders, but research on its application to the early stages of the disease is still limited. This study reviews the current understanding of ACT-based interventions for the early phases of psychosis. ACT applied to early psychosis is feasible and improves psychotic symptoms, treatment adherence, and functioning. Furthermore, preliminary evidence indicates the benefits of group-based, online-delivered, and hybrid interventions that combine face-to-face treatment with innovative real-time digital interventions. Although promising, further research should confirm these preliminary findings.