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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether acceptance and commitment therapy (ACT) can improve mental health for people with spinal cord injuries who feel depressed. Participants will either receive ACT sessions through video calls or be placed on a waitlist for ACT after the trial. Both groups will receive educational materials related to spinal cord injuries. The trial seeks individuals who have experienced a spinal cord injury in the last five years and are experiencing mild depression. As an unphased trial, this study offers a unique opportunity to contribute to understanding how ACT can benefit mental health in individuals with spinal cord injuries.

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 prior data suggests that this therapy is safe for individuals with spinal cord injuries?

Research shows that Acceptance and Commitment Therapy (ACT) is generally well-received by people with spinal cord injuries (SCI). Studies indicate that ACT can help improve stress and emotion management. Although specific safety data for ACT in SCI-related depression isn't detailed, ACT has reduced depression and improved quality of life in various situations.

This therapy is non-invasive, as it doesn't involve medication or physical procedures, often lowering the risk of side effects. ACT helps people accept their thoughts and feelings and encourages actions that align with their values. Trained coaches deliver this approach through videoconferencing, making it safe, convenient, and accessible for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Acceptance and Commitment Therapy (ACT) for depression in people with spinal cord injuries because it offers a unique approach to managing mental health. Unlike traditional antidepressants or cognitive-behavioral therapy, ACT focuses on helping individuals accept their thoughts and feelings rather than trying to change them, which can be particularly empowering for those dealing with the emotional challenges of a spinal cord injury. This therapy is delivered through Zoom, making it accessible to individuals regardless of their location, and it provides flexibility and continuity in care. By integrating mindfulness and acceptance strategies, ACT has the potential to improve mental well-being without the side effects often associated with medication.

What evidence suggests that Acceptance and Commitment Therapy might be an effective treatment for depression in spinal cord injury?

Studies have shown that Acceptance and Commitment Therapy (ACT), which participants in this trial may receive, can help reduce depression and pain in people with spinal cord injuries (SCI). Research suggests that ACT improves mental health by increasing psychological flexibility, enabling individuals to better handle various situations and emotions. One study found that ACT was especially effective when combined with rehabilitation therapy, reducing PTSD symptoms and improving self-care. ACT delivered through video calls has also shown promise for enhancing mental health in people with SCI. Overall, these findings suggest that ACT could be a helpful treatment for depression in individuals living with SCI. ^{1 2 6 7 8}

Who Is on the Research Team?

Areum Han, PhD

Principal Investigator

University of Alabama at Birmingham

Are You a Good Fit for This Trial?

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 a computer or a smartphone and internet access at home

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

Exclusion Criteria

I have previously undergone acceptance and commitment therapy.

Having cognitive deficits or language barriers that might impede study participation

Having suicidal attempts within 6 months

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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 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]

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) 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 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]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/36048060/

Association between Acceptance and Commitment ... These results demonstrate that ACT core processes account for moderate to large amounts of the variance in indicators of depressive symptoms and pain ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06233656

NCT06233656 | Acceptance and Commitment Therapy for ... This project aims to test the efficacy of an 8-week videoconferencing ACT program for improving mental health in depressed individuals living with SCI. The ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8498220/

Effect of acceptance and commitment therapy on ... The above results demonstrate that ACT combined with rehabilitation therapy was effective in reducing PTSD symptoms and improving body function and self-care ...

4. psycnet.apa.org psycnet.apa.org/record/2022-94759-001

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

5. archives-pmr.org archives-pmr.org/article/S0003-9993(22)01756-7/abstract

Influence of Acceptance and Commitment Therapy Core ... : The results of our study indicate that considerable variance in anxiety and stress in individuals with SCI is accounted for by the core ...

6. withpower.com withpower.com/trial/phase-wounds-and-injuries-2-2023-97904

Acceptance and Commitment Therapy for Depression in ... The provided research does not explicitly mention safety data for Acceptance and Commitment Therapy (ACT) in the context of depression in spinal cord injury.

7. brieflands.com brieflands.com/articles/ijpbs-105378

The Effect of Acceptance and Commitment Therapy on ... According to the findings, ACT can improve psychological flexibility and emotional regulation in patients with spinal cord injuries.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9789494/

Efficacy of Internet-Based Acceptance and Commitment ... A growing body of evidence shows that ACT can reduce depressive symptoms, anxiety, stress, and psychological distress and improve quality of life (QoL) in ...