Hostname: page-component-cb9f654ff-mwwwr Total loading time: 0 Render date: 2025-09-01T11:46:43.794Z Has data issue: false hasContentIssue false
  • English
  • Français

Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial

Published online by Cambridge University Press:  11 July 2011

M. Fledderus ,
E. T. Bohlmeijer ,
M. E. Pieterse  and
K. M. G. Schreurs
M. Fledderus*
Affiliation:
University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands
E. T. Bohlmeijer
Affiliation:
University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands
M. E. Pieterse
Affiliation:
University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands
K. M. G. Schreurs
Affiliation:
University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands Roessingh Rehabilitation Centre, Enschede, The Netherlands
*
*Address for correspondence: M. Fledderus, M.Sc., University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, PO Box 217, 7500 AE Enschede, The Netherlands. (Email: m.fledderus@utwente.nl)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In order to reduce the high prevalence of depression, early interventions for people at risk of depression are warranted. This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy (ACT) for reducing depressive symptomatology.

Method

Participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the self-help programme with extensive email support (n=125), the self-help programme with minimal email support (n=125) or to a waiting list control group (n=126). Participants completed measures before and after the intervention to assess depression, anxiety, fatigue, experiential avoidance, positive mental health and mindfulness. Participants in the experimental conditions also completed these measures at a 3-month follow-up.

Results

In the experimental conditions significant reductions in depression, anxiety, fatigue, experiential avoidance and improvements in positive mental health and mindfulness were found, compared with the waiting list condition (effect sizes Cohen's d=0.51–1.00). These effects were sustained at the 3-month follow-up. There were no significant differences between the experimental conditions on the outcome measures.

Conclusions

The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology.

Keywords

Acceptance and Commitment Therapydepressionpositive mental healthrandomized controlled trialself-help

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 485 - 495
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Andersson, G, Estling, F, Jakobsson, E, Cuijpers, P, Carlbring, P (2011). Can the patient decide which modules to endorse? An open trial of tailored Internet treatment of anxiety disorders. Cognitive Behaviour Therapy 40, 57–64.CrossRefGoogle ScholarPubMed
Andrews, G, Issakidis, C, Sanderson, K, Corry, L, Lapsley, H (2004). Utilizing survey data to inform public policy, comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 84, 526–533.CrossRefGoogle Scholar
Attkisson, CC, Zwick, R (1982). The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning 5, 233–237.CrossRefGoogle ScholarPubMed
Baer, RA, Smith, GT, Hopkins, J, Krietemeyer, J, Toney, L (2006). Using self-report assessment methods to explore facts of mindfulness. Assessment 13, 27–45.CrossRefGoogle Scholar
Beekman, AT, Deeg, DJ, Van Limbeek, J, Braam, AW, De Vries, MZ, Van Tilburg, W (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CESD), results from a community-based sample of older subjects in the Netherlands. Psychological Medicine 27, 231–235.CrossRefGoogle Scholar
Biglan, A, Hayes, SC, Pistorello, J (2008). Acceptance and commitment, implications for prevention science. Prevention Science 9, 139–152.CrossRefGoogle ScholarPubMed
Bohlmeijer, ET, Fledderus, M, Rokx, TAJJ, Pieterse, ME (2011 a). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: evaluation in a randomized controlled trial. Behaviour Research and Therapy 9, 62–67.CrossRefGoogle Scholar
Bohlmeijer, ET, Hulsbergen, M (2008). Voluit leven. Mindfulness of de kunst van het aanvaarden, nu als praktisch hulpboek [Living to the Full. Mindfulness or the Art of Acceptance, now as a Practical Help Book]. Boom: Amsterdam.Google Scholar
Bohlmeijer, ET, Ten Klooster, PM, Fledderus, M, Veehof, MM, Baer, R (2011 b). Psychometric properties of the Five Facet Mindfulness Questionnaire in depressed adults and development of a short form. Assessment. Published online 17 May 2011. doi:10.1177/1073191111408231.CrossRefGoogle ScholarPubMed
Bond, FW, Hayes, SC, Baer, RA, Carpenter, KC, Guenole, N, Orcutt, HK, Waltz, T, Zettle, RD (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: a revised measure of psychological flexibility and acceptance. Behavior Therapy. doi:10.1016/j.beth.2011.03.00.CrossRefGoogle Scholar
Bouma, J, Ranchor, AV, Sanderman, R, Van Sonderen, E (1995). Het meten van symptomen van depressie met de CES-D, een handleiding [Measuring Symptoms of Depression with the CES-D, A Guide]. Noordelijk Centrum voor Gezondheidsvraagstukken: Groningen.Google Scholar
Carlbring, P, Gunnarsdottir, M, Hedensjö, L, Andersson, G, Ekselius, L, Furmark, T (2007). Treatment of social phobia, randomized trial of Internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry 90, 123–128.CrossRefGoogle Scholar
Cook, RJ, Sackett, DL (1995). The number needed to treat, a clinically useful measure of treatment effect. British Medical Journal 310, 452–454.CrossRefGoogle Scholar
Cuijpers, P, Donker, T, Van Straten, A, Li, J, Andersson, G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 1943–1957.CrossRefGoogle ScholarPubMed
Cuijpers, P, Smit, F (2004). Subthreshold depression as a risk indicator for major depressive disorder, a systematic review of prospective studies. Acta Psychiatrica Scandinavica 109, 325–331.CrossRefGoogle ScholarPubMed
Cuijpers, P, Smit, F, Van Straten, A (2007). Psychological treatments of subthreshold depression, a meta-analytic review. Acta Psychiatrica Scandinavica 115, 434–441.CrossRefGoogle ScholarPubMed
Cuijpers, P, Van Straten, A, Smit, F, Mihalopoulos, C, Beekman, A (2008). Preventing the onset of depressive disorders, a meta-analytic review of psychological interventions. American Journal of Psychiatry 65, 1272–1280.CrossRefGoogle Scholar
Cuijpers, P, Van Straten, A, Warmerdam, L, Van Rooy, MJ (2010). Recruiting participants for interventions to prevent the onset of depressive disorders. Possible ways to increase participation rates. BMC Health Services Research 10, 181.CrossRefGoogle ScholarPubMed
De Brey, HA (1983). Cross-national validation of the client satisfaction questionnaire, the Dutch experience. Evaluation and Program Planning 6, 395–400.CrossRefGoogle ScholarPubMed
Dempster, AP, Laird, NM, Rubin, DB (1977). Maximum likelihood from incomplete data via the EM algorithm. Journal of the Royal Statistical Society Series B Methodological 39, 1–38.Google Scholar
Donker, T, Van Straten, A, Marks, I, Cuijpers, P (2009). A brief web-based screening questionnaire for common mental disorders, development and validation. Journal of Medical Internet Research 11, 19.CrossRefGoogle ScholarPubMed
Fava, GA, Rafanelli, C, Ottolini, F, Ruini, C, Cazzaro, M, Grandi, S (2001). Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia. Professional Psychology, Research and Practice 31, 899–905.Google Scholar
Fava, GA, Ruini, C, Rafanelli, C, Finos, L, Salmaso, L, Mangelli, L, Sirigatti, S (2005). Well-being therapy of generalized anxiety disorder. Psychotherapy Psychosomatic 74, 26–30.CrossRefGoogle ScholarPubMed
Fledderus, M, Bohlmeijer, ET, Smit, F, Westerhof, GJ (2010). Mental health promotion as a new goal in public mental health care. A randomized controlled trial of an intervention enhancing psychological flexibility. American Journal of Public Health 100, 2372–2378.CrossRefGoogle ScholarPubMed
Forman, EM, Herbert, JD, Moitra, E, Yeomans, PD, Geller, PA (2007). Randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification 31, 772–799.CrossRefGoogle ScholarPubMed
Gellathy, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 1217–1228.CrossRefGoogle Scholar
Gregory, R, Canning, S, Lee, T, Wise, J (2004). Cognitive bibliotherapy for depression, a meta-analysis. Professional Psychology, Research and Practice 35, 275–280.CrossRefGoogle Scholar
Haringsma, R, Engels, GI, Beekman, ATF, Spinhoven, P (2004). The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology. International Journal of Geriatric Psychiatry 19, 558–563.CrossRefGoogle Scholar
Hayes, SC, Luoma, JB, Bond, FW, Masuda, A, Lillis, J (2006). Acceptance and commitment therapy. Model, processes and outcomes. Behaviour Research and Therapy 44, 1–25.CrossRefGoogle ScholarPubMed
Jacobs, N, Kleen, M, De Groot, F, A-Tjak, J (2008). Het meten van experiëntiële vermijding. De Nederlandstalige versie van de Acceptance and Action Questionnaire-II (AAQ-II ) [Measuring experiential avoidance. Dutch translation of the Acceptance and Action questionnaire-II (AAQ-II)]. Gedragstherapie 41, 349–361.Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance, a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J (1990). Full Catastrophe Living, Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Delacorte: New York.Google Scholar
Kabat-Zinn, J (1994). Wherever You Go, There You Are, Mindfulness Meditation in Everyday Life. Hyperion: New York.Google Scholar
Keyes, CLM (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology 73, 539–548.CrossRefGoogle ScholarPubMed
Keyes, CLM, Dhingra, SS, Simoes, EJ (2010). Change in level of positive mental health as a predictor of future risk of mental illness. American Journal of Public Health 100, 2366–2371.CrossRefGoogle ScholarPubMed
Lamers, SMA, Westerhof, GJ, Bohlmeijer, ET, Ten Klooster, PM, Keyes, CLM (2010). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology 67, 99–110.CrossRefGoogle Scholar
Lappalainen, R, Lehtonen, T, Skarp, E, Taubert, E, Ojanen, M, Hayes, SC (2007). Preliminary controlled effectiveness trial: the impact of CBT and ACT models using psychology trainee. Behavior Modification 31, 488–511.CrossRefGoogle ScholarPubMed
Lipsey, MW, Wilson, DB (1993). The efficacy of psychological, educational and behavioral treatment. Confirmation from meta-analysis. American Psychologist 48, 1181–1209.CrossRefGoogle ScholarPubMed
Lorant, V, Croux, C, Weich, S, Deliège, D, Mackenbach, J, Ansseau, M (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. British Journal of Psychiatry 190, 293–298.CrossRefGoogle ScholarPubMed
Nordin, S, Carlbring, P, Cuijpers, P, Andersson, G (2010). Expanding the limits of bibliotherapy for panic disorder: randomized trial of self-help without support but with a clear deadline. Behavior Therapy 41, 267–276.CrossRefGoogle ScholarPubMed
Olssøn, I, Mykletun, A, Dahl, AA (2005). The Hospital Anxiety and Depression rating scale, a cross-sectional study of psychometrics and case findings abilities in general practice. BMC Psychiatry 5, 46.CrossRefGoogle Scholar
Radloff, LS (1977). The CES-D scale, a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Seekles, W, van Straten, A, Beekman, A, van Marwijk, H, Cuijpers, P (2011). Effectiveness of guided self-help for depression and anxiety disorders in primary care: a pragmatic randomized controlled trial. Psychiatry Research 187, 113–120.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janav, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (MINI). The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
Smit, F, Ederveen, A, Cuijpers, P, Deeg, D, Beekman, A (2006). Opportunities for cost-effective prevention of late-life depression. An epidemiological approach. Archives of General Psychiatry 63, 290–296.CrossRefGoogle ScholarPubMed
Spinhoven, PH, Ormel, J, Sloekers, PPA, Kempen, GIJM, Speckens, AEM, Van Hemert, AM (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine 27, 363–370.CrossRefGoogle ScholarPubMed
Vercoulen, JHM.M, Alberts, M, Bleijenberg, G (1999). The Checklist Individual Strength (CIS). Gedragstherapie 32, 131–136.Google Scholar
Wood, AM, Joseph, S (2010). The absence of positive psychological (eudemonic) well-being as a risk factor for depression, a ten year cohort study. Journal of Affective Disorders 122, 213–217.CrossRefGoogle ScholarPubMed
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed