Effects of Online Acceptance and Commitment Therapy for Family Members of Individuals With Early Psychosis on Self-Stigma, Coping Strategies and Resilience: A Randomized Controlled Trial

Abstract

Introduction: Early psychosis represents a critical period that may profoundly affect not only individuals but also their family members, often leading to increased psychological distress, stigma and caregiving burden. Aim: This study aimed to evaluate the effects of online Acceptance and Commitment Therapy (ACT) on self-stigma, stress coping strategies and resilience levels among family members of individuals with early psychosis. Methods: This study was designed as an exploratory randomized controlled trial. The study population consisted of 41 caregivers of individuals diagnosed with schizophrenia and other psychotic disorders according to DSM-5 criteria, who had received their diagnosis within the past three years and applied to a psychiatry outpatient clinic at a training and research hospital between August and October 2024. Eligible participants were randomly allocated to the intervention group (n = 20) or the control group (n = 21). The intervention group participated in an eight-session online group-based Acceptance and Commitment Therapy program, while the control group did not receive any structured intervention. Data were collected using the Self-Stigma Inventory for Family Members, the Stress Coping Strategies Inventory and the Brief Resilience Scale. Evaluations were conducted at pre-test, post-test and three-month follow-up. Results: No significant differences were observed between groups at baseline (p > 0.05). Post-intervention and follow-up assessments showed significantly lower self-stigma scores in the intervention group compared to controls (p < 0.05). Additionally, coping strategies and resilience scores were significantly higher in the intervention group at post-test and follow-up (p < 0.05). Conclusion: The findings suggest that online ACT may be effective in reducing self-stigma and improving coping strategies and resilience among family members of individuals with early psychosis. Implications for Practice: ACT-based interventions may represent a promising approach to supporting family members during early psychosis. Psychiatric nurses may play a central role in integrating ACT-informed approaches into routine mental health services, thereby supporting family-centered care. Online delivery may serve as a complementary method to facilitate and support the delivery of nursing care by enhancing accessibility and continuity of psychosocial support. Relevance Statement: This study is relevant to psychiatric mental health nursing as it addresses the role of family-centered care during early psychosis. The findings demonstrate that ACT-informed psychosocial approaches may reduce self-stigma and enhance coping and resilience among family members. Psychiatric nurses are well-positioned to identify family needs, deliver psychoeducation and support adaptive coping within routine care. Integrating such approaches into practice may strengthen holistic care and improve outcomes for both individuals with early psychosis and their families. Trial Registration: ClinicalTrials.gov ID: NCT06655688.