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

100 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will compare two psychological treatments for major depressive disorder (MDD): cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Both treatments are well-studied and supported by evidence as effective options for people experiencing depression. These treatments will be delivered in an online group format via Zoom. The study will enroll up to 100 participants with depression. Half of the participants will receive online group CBT and half will receive online group ACT. There will be up to 10 members in each group. For both conditions, treatment will be provided over 8 weeks, with a 6-month follow-up period. Enrollment will be ongoing and groups will occur simultaneously. Potential participants are asked to complete an initial screening and an intake evaluation to determine eligibility. They will then receive 8-weeks of treatment. Participants will complete self-report questionnaires throughout their time in the study.

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.

What data supports the effectiveness of Acceptance and Commitment Therapy (ACT) for treating depression?

Research shows that Acceptance and Commitment Therapy (ACT) is effective for treating depression, with studies indicating it can be as effective as Cognitive Behavioral Therapy (CBT). ACT focuses on increasing psychological flexibility, which helps people manage their depression by accepting their thoughts and feelings and committing to actions that align with their values. ^{1 2 3 4 5}

Is Acceptance and Commitment Therapy (ACT) safe for treating depression?

The research does not specifically mention safety concerns for Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT) for depression, suggesting they are generally considered safe for use in humans. ^{1 2 3 6 7}

How does Acceptance and Commitment Therapy (ACT) differ from Cognitive Behavioral Therapy (CBT) for treating depression?

Acceptance and Commitment Therapy (ACT) is unique because it focuses on increasing psychological flexibility through mindfulness and acceptance, helping individuals commit to actions aligned with their values, whereas Cognitive Behavioral Therapy (CBT) primarily targets changing negative thought patterns. ACT can be delivered in various formats, including individual, group, or self-help, and emphasizes processes like cognitive defusion, which are distinct from traditional CBT approaches. ^{1 2 3 4 8}

Research Team

Iony D Ezawa, PhD

Principal Investigator

University of Southern California

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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) 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) 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]

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]

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]

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]

References

1. United States 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. [2018]

2. Switzerland 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. [2019]

3. United States 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. [2021]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy and behavioral activation for the treatment of depression: description and comparison. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy: a meta-analytic review. [2018]

6. Australia pubmed.ncbi.nlm.nih.gov

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

7. Netherlands pubmed.ncbi.nlm.nih.gov

Outcomes of Acceptance and Commitment Therapy for depression and predictors of treatment response in Veterans Health Administration patients. [2023]

8. United States 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. [2019]