A parallel group randomised open blinded evaluation of Acceptance and Commitment Therapy for depression after psychosis: Pilot trial outcomes (ADAPT)

Background

Depression is one of the major contributors to poorer quality of life amongst individuals with psychosis and schizophrenia. The study was designed as a Pilot Trial to determine the parameters of a larger, definitive pragmatic multi-centre randomised controlled trial of Acceptance and Commitment Therapy for depression after psychosis (ACTdp) for individuals with a diagnosis of schizophrenia who also meet diagnostic criteria for major depression.

Methods

Participants were required to meet criteria for schizophrenia and major depression. Blinded follow-ups were undertaken at 5-months (end of treatment) and at 10-months (5-months posttreatment). Primary outcomes were depression as measured by the Calgary Depression Scale for Schizophrenia (CDSS) and the Beck Depression Inventory (BDI).

Results

A total of 29 participants were randomised to ACTdp + Standard Care (SC) (n = 15) or SC alone (n = 14). We did not observe significant differences between groups on the CDSS total score at 5-months (Coeff = − 1.43, 95%CI − 5.17, 2.32, p = 0.45) or at 10-months (Coeff = 1.8, 95%CI − 2.10, 5.69, p = 0.36). In terms of BDI, we noted a statistically significant effect in favour of ACTdp + SC at 5-months (Coeff = − 8.38, 95%CI − 15.49, − 1.27, p = 0.02) but not at 10-months (Coeff = − 4.85, 95%CI − 12.10, 2.39, p = 0.18). We also observed significant effects on psychological flexibility at 5-months (Coeff = − 8.83, 95%CI − 14.94, − 2.71, p < 0.01) but not 10-months (Coeff = − 4.92, 95%CI − 11.09, 1.25, p = 0.11).

Implications

In this first RCT of a psychological therapy with depression as the primary outcome, ACT is a promising intervention for depression in the context of psychosis. A further large-scale definitive randomised controlled trial is required to determine effectiveness.

Trial registration: ISRCTN: 33306437