Abstract
Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants with a history of depression, currently in remission (N = 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N = 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse.
Highlights
Because a large portion of those diagnosed with major depressive disorder (MDD) relapse after initially having recovered (Solomon et al, 2000), secondary prevention is critical in long-term management of the disorder (National Institute for Health and Clinical Excellence, 2009)
To evaluate satisfaction and acceptability of the ACT group treatment, participants completed a brief survey about their experience upon its completion. They responded to the following four statements according to a seven-point Likert scale: (a) “I’m satisfied with the ACT group treatment.” (b) “ACT group therapy has had a positive effect on my daily life.” (c) “I handle depressive symptoms better after having completed ACT group therapy,” and (d) “I would recommend ACT group treatment for a friend or family-member struggling with depression.”
There were no significant differences between the attention bias modification (ABM) and control groups in gender, age, educational level, antidepressant medication status, comorbidity, and depressive symptoms at baseline
Summary
Evidence of an attentional bias toward negative stimuli has been reported in both previously (Joormann and Gotlib, 2007) and currently depressed individuals (Gotlib et al, 2004), and in never-depressed individuals at high risk because of familial history (Joormann et al, 2007). This suggests that attentional bias may constitute an important vulnerability factor for depression and therapeutic target, rather than a simple marker of lowered mood. The most direct strategy for reducing such bias would be through approaches that focus on cognitive processing such as attention bias modification (ABM) (Koster et al, 2011)
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