Acceptance and Commitment Therapy for Depression in Spinal Cord Injury

Overseen By Areum Han, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Alabama at Birmingham

Disqualifiers: Cognitive deficits, Language barriers, Suicidal attempts, others

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

Compensation: Varies

Number of Visits: 8

Duration: 8 weeks

34 Participants Needed

Trial Summary

What is the purpose of this trial?

This randomized controlled trial aims to assess effects of videoconferencing acceptance and commitment therapy (ACT) on mental health outcomes in individuals living with spinal cord injuries (SCI). A total of 34 individuals living with SCI sustained within 5 years and experiencing depressive symptoms will be recruited and randomly assigned to either the ACT group or the wait-list control group. The ACT group will receive 8 weekly individual ACT sessions guided by a coach through videoconferencing. The wait-list group will receive ACT sessions after the study period ends. We will provide psychoeducation materials related to SCI as supplemental resources to both groups. Mental health outcomes using self-reported questionnaires will be collected at pretest, posttest, and 2-month follow-up. Exploratory hypotheses are that the group undergoing the ACT intervention supplemented with psychoeducation will show improvements in mental health outcomes (e.g., depression) and ACT processes (e.g., psychological flexibility) at posttest and 2-month follow-up, compared to the wait-list control group provided with psychoeducation materials alone. Interviews will be conducted at posttest to explore the participants' experiences in ACT.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue them, but please confirm with the study coordinators.

What data supports the idea that Acceptance and Commitment Therapy for Depression in Spinal Cord Injury is an effective treatment?

The available research shows that Acceptance and Commitment Therapy (ACT) can help reduce depressive symptoms in people with spinal cord injuries. One study found that ACT processes are linked to fewer depressive symptoms and less pain interference in these individuals. Another study demonstrated that ACT is effective in treating depression in people with physical disabilities, which includes those with spinal cord injuries. Additionally, a study using videoconferencing ACT with psychoeducation showed positive effects on distressed individuals with spinal cord injuries. These findings suggest that ACT can be a helpful treatment for depression in this group. ^{1 2 3 4 5}

What safety data exists for Acceptance and Commitment Therapy (ACT) for depression in spinal cord injury?

The provided research does not explicitly mention safety data for Acceptance and Commitment Therapy (ACT) in the context of depression in spinal cord injury. The studies focus on the effectiveness and core processes of ACT, its impact on depressive symptoms, anxiety, stress, and PTSD in individuals with spinal cord injury. However, none of the abstracts specifically address safety concerns or adverse effects related to ACT. ^{1 2 3 6 7}

Is Acceptance and Commitment Therapy a promising treatment for depression in people with spinal cord injury?

Yes, Acceptance and Commitment Therapy (ACT) is a promising treatment for depression in people with spinal cord injury. Research shows that ACT can help reduce depressive symptoms by focusing on mindfulness, acceptance, and taking committed actions towards personal values. ^{1 2 3 5 8}

Research Team

Areum Han, PhD

Principal Investigator

University of Alabama at Birmingham

Eligibility Criteria

This trial is for adults over 18 who have had a spinal cord injury in the last 5 years and are experiencing mild depression. Participants need to have internet access, a computer or smartphone at home. It's not for those with cognitive deficits, language barriers that could affect participation, recent suicidal attempts, or previous ACT therapy experience.

Inclusion Criteria

Having at least mild depression measured by the Patient Health Questionnaire-9

I am an adult who had a spinal cord injury within the last 5 years and live at home.

Having a computer or a smartphone and internet access at home

Exclusion Criteria

Having cognitive deficits or language barriers that might impede study participation

Having suicidal attempts within 6 months

I have previously undergone acceptance and commitment therapy.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 8 weekly individual ACT sessions guided by a coach through videoconferencing

8 weeks

8 visits (virtual)

Follow-up

Participants are monitored for mental health outcomes using self-reported questionnaires at posttest and 2-month follow-up

2 months

Treatment Details

Interventions

• Acceptance and Commitment Therapy
• Wait-list Control Group with Psychoeducation Materials Provided

Trial Overview The study tests if acceptance and commitment therapy (ACT) via videoconferencing can improve mental health in people with spinal cord injuries when compared to a wait-list group given psychoeducation materials only. The ACT group will get weekly sessions for two months, followed by evaluations.

Participant Groups

Group I: Wait-list control group with psychoeducation materials provided Experimental Treatment 1 Intervention

Care as usual with psychoeducation materials provided during the study period and ACT sessions provided after the study period ends

Group II: Acceptance and commitment therapy (ACT) group Experimental Treatment 1 Intervention

8 weekly ACT sessions individually guided by a trained coach through Zoom videoconferencing with psychoeducation materials provided

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Paralyzed Veterans of America

Collaborator

Trials

5

Recruited

160+

Findings from Research

In a study of 159 individuals with spinal cord injury, Acceptance and Commitment Therapy (ACT) processes significantly predicted levels of depressive symptoms and pain interference, accounting for 29-56% of the variance in these outcomes.

Specifically, the core ACT processes of Pursuit of Values and Emotional Acceptance were strongly linked to lower depressive symptoms, while Self-as-Context and Emotional Acceptance were associated with reduced pain interference, suggesting these processes could be effective targets for therapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between Acceptance and Commitment Therapy (ACT) processes and depressive symptoms and pain interference in persons with spinal cord injury (SCI). Waldron-Perrine, B., Kisser, J., Robinett, E., et al.[2022]

Acceptance and Commitment Therapy (ACT) significantly reduced depressive symptoms in physically disabled individuals, with a notable decrease of -10.39 points on the Beck Depression Inventory-II after eight weeks compared to the control group.

Participants receiving ACT also showed significant improvements in psychological flexibility, adaptive emotion regulation, and overall psychological well-being, indicating that ACT not only helps with depression but also enhances emotional and psychological resilience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial. Zemestani, M., Mozaffari, S.[2022]

In a study of 159 individuals with spinal cord injury, key components of Acceptance and Commitment Therapy (ACT) such as acceptance, values pursuit, and defusion were found to significantly reduce anxiety levels.

The overall ACT processes also contributed to lower perceived stress, suggesting that tailored ACT-based interventions could be effective in managing anxiety and stress for individuals with spinal cord injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study. Dorenkamp, MA., Waldron-Perrine, B., Hanks, R.[2023]

The study found that coach-guided videoconferencing acceptance and commitment therapy (ACT) significantly reduced depression, anxiety, stress, and grief in 10 individuals with spinal cord injury (SCI) after 8 sessions, indicating its potential as an effective psychological intervention.

Participants reported improved coping skills, self-compassion, and engagement in meaningful activities, suggesting that ACT can help individuals with SCI develop better mental health strategies, although it did not significantly change quality of life or resilience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study. Han, A., Wilroy, JD., Jenkins, J., et al.[2023]

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]

Acceptance and Commitment Therapy (ACT) effectively enhances psychological flexibility and has shown efficacy in treating a variety of psychiatric disorders, including depression, anxiety, and PTSD, with a meta-analysis revealing an average effect size of 0.66 at post-treatment across 704 participants.

ACT not only improves mental health outcomes but also benefits other medical areas such as chronic pain management and smoking cessation, demonstrating its versatility and positive impact on quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Acceptance and commitment therapy]. Ducasse, D., Fond, G.[2019]

In a study of 60 patients with spinal cord injury and PTSD, combining rehabilitation therapy with acceptance commitment therapy (ACT) significantly reduced PTSD symptoms and improved functional independence compared to rehabilitation alone.

Patients receiving the combined treatment showed greater improvements in their functional independence measure (FIM) scores at 2 and 3 months post-treatment, indicating that ACT enhances the effectiveness of rehabilitation for better self-care and overall recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of acceptance and commitment therapy on rehabilitation patients with spinal cord injury. Huang, G., Lin, BL., Hu, JH., et al.[2021]

The study emphasizes the need for clearer definitions and distinctions between diagnosable depression and other emotional responses like anxiety and distress in individuals with spinal cord injuries, which can improve understanding and treatment.

It reviews the correlates of depressive behaviors in this population and provides guidelines for more effective research and clinical practices in addressing depression among those with spinal cord injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Depression following spinal cord injury. Elliott, TR., Frank, RG.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Association between Acceptance and Commitment Therapy (ACT) processes and depressive symptoms and pain interference in persons with spinal cord injury (SCI). [2022]

2. England pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study. [2023]

5. 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]

6. France pubmed.ncbi.nlm.nih.gov

[Acceptance and commitment therapy]. [2019]

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

Effect of acceptance and commitment therapy on rehabilitation patients with spinal cord injury. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Depression following spinal cord injury. [2022]