Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms.

Tom Østergaard,Vegard Øksendal Haaland,Robert D Zettle,Tobias Lundgren,Nils Inge Landrø

doi:10.3389/fpsyg.2020.00528

Abstract

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

Highlights

According to the World Health Organization (WHO), major depressive disorder (MDD) represents one of the greatest global health challenges (WHO, 2017)
Depressed persons will often experience depressive symptoms between episodes at different levels of severity (Judd et al, 1998; Möller, 2008; Nil et al, 2016), that are predictive of recurrence of MDD (Judd et al, 1998; Paykel, 2008), suggesting that interventions that target them could be effective in reducing relapse
The results from the self-reported and clinician-rated measures of depressive symptoms for the sample in this study will be reported here insofar as they are relevant in interpreting the correlational and mediational analyses central to the purpose of this project

Summary

Introduction

According to the World Health Organization (WHO), major depressive disorder (MDD) represents one of the greatest global health challenges (WHO, 2017). Depressed persons will often experience depressive symptoms between episodes at different levels of severity (Judd et al, 1998; Möller, 2008; Nil et al, 2016), that are predictive of recurrence of MDD (Judd et al, 1998; Paykel, 2008), suggesting that interventions that target them could be effective in reducing relapse. A large amount of the burden associated with depression could be averted by interventions that prevent relapse or recurrence (Vos et al, 2004). MBCT, in particular, which was designed to be a depression relapse-prevention intervention, has shown promise in doing so (Teasdale et al, 2000; Ma and Teasdale, 2004)

Objectives

Results

Conclusion