Cognitive Behavioral Therapy vs Acceptance and Commitment Therapy for Depression

Overseen By Iony D Ezawa, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Southern California

Disqualifiers: Other diagnosis, Suicide risk, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 16

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two online therapy methods, cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT), to determine which is more effective for treating major depressive disorder (MDD). Researchers will divide participants into two groups: one will receive CBT, and the other ACT, both over an 8-week period. The trial seeks individuals diagnosed with MDD who reside in California and have a stable internet connection for online sessions. Each therapy focuses on different strategies to manage thoughts and feelings, helping participants either change negative patterns or accept them while taking positive action. Participants will complete questionnaires throughout the study to track their progress.

As an unphased trial, this study provides a unique opportunity to enhance understanding of effective online therapies for MDD.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on psychological treatments for depression, so it's best to discuss your medications with the study team.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that both Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are safe and effective for treating depression. Studies have found that ACT reduces symptoms of depression and anxiety, improving mental health without major side effects. For instance, a study involving over 1,300 patients found that ACT significantly improved depression.

Similarly, CBT is known for its safety and effectiveness. It helps people change negative thought patterns, leading to better mental health. Research indicates that CBT is as effective as medication for treating depression and works well over the long term.

Both therapies have been tested in various formats, including online, and are generally well-tolerated, with few reports of negative effects. Participants usually do not experience major problems during treatment. Overall, these therapies are considered safe and helpful for managing depression. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for depression because they offer unique approaches compared to traditional medications and standard talk therapies. CBT focuses on identifying and changing negative thought patterns and behaviors, which can lead to improved mood and outlook. Meanwhile, ACT emphasizes accepting negative thoughts and feelings while committing to actions that align with personal values, promoting a more flexible mindset. These therapies provide non-pharmacological options that empower individuals to actively participate in their mental health journey, potentially leading to long-lasting benefits without medication side effects.

What evidence suggests that this trial's treatments could be effective for depression?

This trial will compare Acceptance and Commitment Therapy (ACT) with Cognitive Behavioral Therapy (CBT) for treating depression. Studies have shown that ACT can significantly reduce depression symptoms by helping individuals accept negative thoughts and focus on actions aligned with their personal values. Research indicates that ACT effectively manages depression, even when delivered online.

CBT is another proven treatment for depression, aiding individuals in recognizing and changing negative thinking patterns. A review of 115 studies demonstrated that CBT effectively treats depression, with benefits lasting up to six months after treatment. Both ACT and CBT are reliable options for reducing depression symptoms, and this trial will evaluate their effectiveness in separate treatment arms. ^{1 2 3 4 6}

Who Is on the Research Team?

Iony D Ezawa, PhD

Principal Investigator

University of Southern California

Are You a Good Fit for This Trial?

This trial is for individuals with major depressive disorder (MDD) who are comfortable receiving psychological treatment in an online group setting. Participants will be screened and evaluated to ensure they meet the study's requirements.

Inclusion Criteria

Lives in California

Access to a private location with a stable internet connection and a working video camera

Able and willing to give informed consent

Exclusion Criteria

I have a mental health condition that is not primarily depression and needs different treatment.

Clear indication of secondary gain (e.g., court ordered treatment)

Current suicide risk or significant intentional self-harm in the last six months sufficient to preclude treatment on an outpatient basis.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (virtual)

Intake Evaluation

Participants complete an intake evaluation to determine eligibility

1 week

1 visit (virtual)

Treatment

Participants receive 8 weeks of online group therapy (CBT or ACT)

8 weeks

8 sessions (virtual)

Follow-up

Participants complete monthly follow-up surveys for 6 months

6 months

6 visits (virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Acceptance and Commitment Therapy
• Cognitive Behavioral Therapy

Trial Overview

The study compares two evidence-supported treatments for depression: Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), both delivered online over 8 weeks, with a follow-up after 6 months.

How Is the Trial Designed?

Group I: Cognitive Behavioral Therapy Active Control 1 Intervention

Over 8 sessions, clients learn techniques to challenge and change maladaptive thought and behavioral patterns

Group II: Acceptance and Commitment Therapy Active Control 1 Intervention

Over 8 sessions, clients learn techniques to accept their negative internal experiences and commit to action in line with their values

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

Published Research Related to This Trial

Acceptance and Commitment Therapy (ACT) is an effective treatment for Major Depressive Disorder (MDD), utilizing mindfulness and acceptance strategies to enhance psychological flexibility, which is crucial for behavior change.

ACT can be delivered in various formats, including individual, group, or self-help options, and has shown empirical support for its efficacy in improving depression outcomes through its core processes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches. Apolinário-Hagen, J., Drüge, M., Hennemann, S., et al.[2021]

Acceptance and Commitment Therapy (ACT) showed significant improvements in global mental health, depression, cognitive fusion, and values in complex clients treated by both psychologists and non-psychologists in a National Health Service setting.

The positive effects of ACT were partially maintained at a 3-month follow-up, indicating its potential long-term benefits, and outcomes were similar regardless of the therapist's professional background.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and Evaluation of Acceptance and Commitment Therapy Delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: a Preliminary Analysis. Richardson, T., Bell, L., Bolderston, H., et al.[2018]

In a study of 831 Veterans receiving Acceptance and Commitment Therapy for depression (ACT-D), participants showed a significant average reduction in depression symptoms, with a 3.39 point decrease on the PHQ-9 scale, indicating moderate effectiveness.

40% of Veterans achieved subthreshold depression symptoms after treatment, suggesting that ACT-D can be beneficial for many, although adaptations may be necessary for those with comorbid conditions like PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Acceptance and Commitment Therapy for depression and predictors of treatment response in Veterans Health Administration patients. Grau, PP., Sripada, RK., Ganoczy, D., et al.[2023]

In a randomized controlled trial with 82 patients suffering from major depressive disorder, both Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) showed high remission rates of 75% and 80%, respectively, indicating both therapies are effective.

There were no significant differences in effectiveness between ACT and CBT, suggesting that ACT is a viable alternative treatment for depression, warranting further research to explore their effects on different patient groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial in Routine Clinical Practice Comparing Acceptance and Commitment Therapy with Cognitive Behavioral Therapy for the Treatment of Major Depressive Disorder. A-Tjak, JGL., Morina, N., Topper, M., et al.[2019]

Acceptance and Commitment Therapy (ACT) and Behavioral Activation (BA) are two emerging treatments for clinical depression, which is a common issue in outpatient settings.

While ACT and BA may sometimes overlap in their strategies, they also have distinct approaches and conceptualizations, suggesting that the choice between them should be based on specific clinical contexts and patient needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy and behavioral activation for the treatment of depression: description and comparison. Kanter, JW., Baruch, DE., Gaynor, ST.[2022]

Acceptance and Commitment Therapy (ACT) shows a significant advantage over control conditions, with an effect size of 0.42, indicating that ACT-treated participants generally improve more than 66% of those in control groups.

While ACT is more effective than waiting lists and psychological placebos, it does not demonstrate superior efficacy compared to established treatments, suggesting it is a valuable but not necessarily better option for all patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy: a meta-analytic review. Powers, MB., Zum Vorde Sive Vording, MB., Emmelkamp, PM.[2018]

A reanalysis of data from a previous study found that Acceptance and Commitment Therapy (ACT) led to greater reductions in self-reported depression compared to Cognitive Therapy (CT) after 12 weeks, using an intent-to-treat analysis.

The effectiveness of ACT was mediated by cognitive defusion, suggesting that ACT operates through unique mechanisms that differentiate it from traditional CT, which did not show the same mediating effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Zettle, RD., Rains, JC., Hayes, SC.[2019]

Acceptance and Commitment Therapy (ACT) has shown effectiveness in improving outcomes for patients with chronic pain and may also benefit those with mild to moderate depression, making it a valuable tool for general practitioners.

ACT employs mindfulness and acceptance strategies to help patients align their behaviors with their values, and it has shown preliminary benefits in various conditions, including obsessive-compulsive disorder and emotional issues after gastric band surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy - pathways for general practitioners. Smout, M.[2012]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10486021/

Effect of acceptance and commitment therapy for depressive ...

ACT may improve depression by modulating psychological flexibility. Studies have shown that changes in cognitive content alone are not effective ...

2.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0165178125003488

The efficacy of acceptance and commitment therapy (ACT) ...

Acceptance and commitment therapy (ACT) has shown effectiveness to reduce depressive and anxiety symptoms in individuals with depression compared to ...

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5039035/

Effectiveness of Web-Delivered Acceptance and ...

ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high ...

4.

bmcpsychiatry.biomedcentral.com

bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-07067-w

Effects of acceptance and commitment therapy on negative ...

ACT appears to significantly improve depressive symptoms, anxiety, and psychological flexibility in individuals with depression.

5.

frontiersin.org

frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2025.1590489/full

The effect of acceptance and commitment therapy on ...

This study confirmed that ACT significantly alleviated depressive symptoms among parents of children with special needs (SMD = −0.36, p < 0.0001). However, its ...

6.

sciencedirect.com

sciencedirect.com/science/article/pii/S2212144720301940

The empirical status of acceptance and commitment therapy

Results showed that ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain, and transdiagnostic groups.